In the context of modern rapid access clinics, symptomatic CRC patients with delay between referral and diagnosis (even if this is several months or occasionally more than a year) have less aggressive tumours and markedly better long-term cure rate than their earlier diagnosed counterparts. Attempts to speed up further the diagnosis would be a waste of time and resources, being unlikely to make an appreciable difference to the overall cure rate.

BackgroundAssociation of Vitamin D receptor (VDR) polymorphisms with lumbar disc herniation (LDH) have been identified in several ethnic groups globally. Despite abundant sunlight, vitamin D deficiency is reported in many tropical countries. As vitamin D is a key modulator for intestinal calcium absorption, low vitamin D could contribute to low serum calcium leading to abnormalities of skeletal homeostasis. Therefore, present study was aimed to study the association of serum 25-hydroxyvitamin D (25(OH)D), serum calcium and VDR polymorphisms in a selected Sri Lankan population.Materials & methodsA case control study was conducted in 119 participants (cases = 51: controls = 68). Serum 25(OH)D levels were measured using ELISA. The VDR polymorphisms (Fok I and Taq I) were detected by polymerase chain reaction followed by restriction fragment length polymorphism.ResultsFindings indicated a significantly low (p = 0.000) 25(OH)D levels in cases (18.7±3.7 ng/mL) compared to controls(25.5±9.8 ng/mL) while 25(OH)D in both groups were below the reference range. Mean serum calcium levels in both groups were within normal reference range and was not significantly different among groups. Statistically significant association was not observed between VDR Fok I polymorphisms among cases and controls. Although Fok I polymorphism genotypes were in Hardy-Weinberg equilibrium (HWE), Taq I genotypes in controls violated HWE.ConclusionPresent study confirms that insufficient serum 25(OH)D levels in cases have major contribution to LDH. VDR Fok I polymorphisms did not have any significant association with LDH in Sri Lankan ethnicity.

Back pain associated with lumbar disc herniation is a common musculoskeletal disorder that leads to absence at work place worldwide. Studies have proven in addition to the traditional factors, microbes play a role in disc herniation causing chronic back pain. A 34-year-old male who has not involved in any traumatic work but has a family history of disc herniation presented with lower back pain and numbness in his right leg. He had previously undergone lumbar discectomy at L4/L5 ten years back. Magnetic Resonance Imaging (MRI) showed L5/S1 right para central disc herniation impinging on the right S1 and S2 nerve roots. Standard protocols for disinfection of instruments, external skin and all transport media were adhered. Skin scrapings, muscle biopsy and excised disc tissue were obtained for anaerobic and aerobic bacterial cultures. Anaerobic microbial cultures of excised disc tissue following lumbar discectomy showed Gram positive growth. Further anaerobic isolation carried out using RapID ANA ID kit confirmed the growth as Gemella morbillorum. In addition, neither of the control samples (muscle nor skin) had any anaerobic growth indicating the absence of contamination. Aerobic bacterial growth was not present in the skin, muscles and disc cultures. The study findings add to the available literature, on the role of microorganisms in lumbar disc herniation and future treatment regimens with antibiotics.

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Background: Although many studies have been conducted on risk factors associated with lumbar disc herniation (LDH), only few studies reported on the association of these factors in comparison to LDH and lumbar disc herniation and degeneration (LDHD). There are no reported studies on a regression model incorporating these factors. As the risk factors are better described in regression models, present study aimed to develop a regression model associated with LDH and LDHD in relation to socio-demographic, behavioural and occupational factors.Methods: A case control study conducted using 104 cases with LDH and controls (n=104) without LDH. Pre-tested questionnaire was administered to all participants to gather information.Results: Among the cases with LDH, 35.6 % presented with LDHD while 64.4 % had only LDH. Among the socio-demographic characteristics, body mass index <25 kgm-2 was a significant protective factor for both LDHD (OR=0.31; 95% CI=0.13-0.72) and LDH (OR=0.39; 95% CI=0.20-0.77). Involvement in daily activities with heavy (OR=5.1; 95 % CI=2.1-11.8) and moderate strain (OR=3.1; 95 % CI=1.5-6.6) to back, sitting more than eight hours per day (OR=5.1; 95 % CI=1.0-25.7), smoking (OR=5.0; 95 % CI=1.5-16.4) and sleeping in supine position (OR=2.09; 95% CI=1.09-4.06) were significant risk factors for LDH. Only daily physical activities with heavy strain act as a significant risk factor (OR=3.1; 95 % CI=1.1-8.5) for the development of LDHD. Types of mattresses used did not have significant difference among cases and controls. Majority of cases (56.7 %) did not know the causative factor that led to LDH. According to the regression model, BMI, smoking and involvement in physical activities with moderate and heavy strain to back were considered as significant risk factors for the development of LDH or LDHD.Conclusion: BMI, smoking and daily physical activities with moderate and heavy strain to back are significant risk factors for development of LDH or LDHD in regression model.

Diagnosis of disc degeneration and herniation largely depends on Magnetic Resonance Imaging (MRI)and X-rays which fails to detect early disc degeneration. This study was conducted to compare the degenerative changes seen in histological assessment with T2-weighted MRI findings. The study recruited 104 patients with lumbar disc herniation undergoing lumbar discectomy. Excised lumbar disc fragments were taken for histology and T2-weighted MRI was conducted prior to the surgery. Excised disc fragments were subjected to routine histology procedure and van Gieson stain for collagen was performed on each specimen. Disc degeneration was assessed by histological parameters and T2weighted MRI findings. The majority of subjects (94.2%) showed degenerative changes of the excised portion of the lumbar discs in histological assessment of the disc. However, T2-weighted MRI findings of degenerative changes of the discs were comparatively less (35.6%). According to the histological assessment, higher percentage (61.5 %) of discs were moderately degenerated while 7.7 % had severely degenerated discs. All patients who were confirmed for disc degeneration with T2-weighted MRI (n=37) had confirmed degenerative changes in the histological assessment as well. Histological degenerative alterations were observed in the majority of patients when compared to detectable degenerative changes in T2-weighted MRI suggesting the importance of histological assessment of degeneration in the excised intervertebral disc fragments. As early degenerative changes are not detected by the standard T2weighted MRI technique, if neglected, can progress to severe stages resulting in more discomfort and pain to the patients.

Objective: Present study was aimed to develop a regression model for selected sociodemographic, behavioural and occupational factors with lumbar disc herniation (LDH) and lumbar disc hearniation and degeneration (LDHD) in a selected population in comparison to healthy individuals.Materials & Methods: The study was conducted using 104 cases with disc herniation and controls (n=104) without LDH. Analysis was conducted in sub groups of patients with LDH (n=67) and LDHD (n=37) in comparison to control subjects. Pre-tested questionnaire was administered to all participants to gather information.Results & Discussion: Among the cases 35.6 % presented with LDHD while 64.4 % had only LDH. Among the socio-demographic characters, body mass index <25 kgm-2 was a significant protective factor for both LDHD (OR=0.31; 95% CI=0.13-0.72) and LDH (OR=0.39; 95% CI=0.20-0.77). Involvement in daily activities with heavy (OR=5.1; 95 % CI=2.1-11.8) and moderate strain (OR=3.1; 95 % CI=1.5-6.6) to back, sitting more than eight hours per day (OR=5.1; 95 % CI=1.0-25.7), smoking (OR=5.0; 95 % CI=1.5-16.4) and sleeping in supine position (OR=2.09; 95% CI=1.09-4.06) were significant risk factors for LDH. Only daily physical activities with heavy strain act as a significant risk factor (OR=3.1; 95 % CI=1.1-8.5) for the development of LDHD. Types of mattresses used did not have a significant difference among cases and controls. Majority of cases (56.7 %) did not know the causative factor that led to LDH. According to the regression model, BMI, smoking and involvement in physical activities with moderate and heavy strain to back were considered as significant risk factors for the development of LDH or LDHD.Conclusion: In regression model BMI, smoking and daily physical activities with moderate and heavy strain to back were found to be the significant risk factors for development of LDH or LDHD.International Journal of Human and Health Sciences Vol. 05 No. 04 October’21 Page: 424-434

BackgroundSerum gamma glutamyltransferase (GGT) have shown a strong association with diabetes mellitus (DM) in many reported studies. Studies have proven the association of elevated body mass index (BMI) and deposition of fat causing insulin resistance leading to increased serum GGT levels. Evidence is less supportive in the Sri Lankan context.