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.

BackgroundPituitary dysfunction in adults are often associated with tumors of the gland and manifests with mass effects and hypopituitarism. MRI of pituitary region often provides confirmation of the diagnosis and assists in planning neurosurgery.Case presentationA 69 years old female evaluated for chronic headache was found to have a supra-sellar mass lesion that mimicked a pituitary tumor, with biochemical evidence of hypopituitarism. Cerebral angiogram confirmed the diagnosis of an aneurysm of the intracavernous internal carotid artery. She was successfully treated with coil embolization of the aneurysm and achieved resolution of symptoms and return of biochemistries to normal.ConclusionCarotid aneurysm can mimc pituitary tumours clinically and radiologically on MRI scan. This rare possibility should be considered in evaluating supra-sellar masses to avoid catastrophic consequences.

No abstract

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.

Objectives: To evaluate Guillain-Barre syndrome (GBS) subtypes in Sri Lanka. Design setting:The patients satisfying established criteria for diagnosis of GBS were included. The cases were classified into GBS subtypes based on electrodiagnostic findings. Patient intervention: NoneMeasurements: Clinical neurophysiological evaluations were done. The studies were repeated as appropriate. Results:The evaluations were done between 2 and 143 days from onset (median = 7 days). There were 1153 patients (Male: Female = 1.4 :1) with age 1 to 86 years (mean = 43.7). Of them 191 (16.6%) were below 13 years (Male: Female = 1.2:1). GBS subtypes were demyelinating type 577 (50%), axonal forms 475 (41.2%), Miller-Fisher syndrome 5 (0.4%) and unclassifiable 96 (8.3%). Among the children there were 99 (51.8%) with demyelinating type, 82 (42.9%) with axonal forms, 10 (5.2%) with unclassifiable findings and none with MFS. There was some clustering of both demyelinating and axonal cases in the early and late months of the year whereas in children there is excessive occurrence of GBS cases of both types in the first 5 months of the year. There is a second peak of axonal GBS later in the year. Overall tendency of reduction in the number of cases, especially axonal forms, is noticeable over the years. Interpretation:The age and sex distribution of the cases is similar to that of other countries. The occurrence of axonal subtypes is prominent. The proportions of GBS subtypes and case clustering in children may be related to the preceding infection.