Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Variants of acan gene associate with severity of lumbar disc degeneration(Sri Lanka Medical Association, 2016) Perera, G.L.R.S.; Wijayaratne, L.S.; Senarath, U.; Dissanayake, P.H.; Karunanayake, A.L.; Dissanayake, V.H.W.INTRODUCTION AND OBJECTIVES: Structural integrity of aggrecan (coded by ACAN gene) plays a major role in lumbar disc degeneration (LDD). Single nucleotide polymorphisms (SNPs) of ACAN gene have been implicated in LDD. The study aimed to determine the associations between SNPs of ACAN gene and the severity of disc space narrowing (DSN) and osteophytes (OS) of lumbar spine in patients with chronic mechanical low back pain (CMLBP). METHOD: A descriptive cross-sectional study was carried out on 120 patients with CMLBP. Lateral lumbar X-rays were assessed for severity of DSN and OS using a semiquantitative scores (grade 0-3). Twenty-seven exonic SNPs of the ACAN gene were genotyped on a Sequenom mass array iPLEX platform. Multiple linear regression analysis was carried out adjusting for age and body mass index. RESULTS: Mean age was 51.46 ± 10.43 years. 82 (68.3%) were females. 30 (25%) were obese. 31 (25.8%) and 47 (39.2%) had grade 1 DSN and AOS respectively, while 42 (35%) and 13 (10.8%) had grade ≥ 2 DSN and AOS, respectively. “A” allele of rs2882676 (regression coefficient (β) = -0.25, p<0.03), “A” allele of rs1042630 (β = -0.28, p<0.01) and “T” allele of rs1042631 (β = -0.28, p<0.02) were negatively associated with the severity of DSN. “T” allele of rs16942341 (β = 0.4, p<0.02) and “G” allele of rs28407189 (β = 0.4, p<0.02) were positively associated with the severity of AOS. CONCLUSION: SNPs of ACAN gene are associated with severity of degenerative changes of the lumbar spine.Item Single nucleotide variants of candidate genes in aggrecan metabolic pathway are associated with lumbar disc degeneration and modic changes(Public Library of Science, 2017) Perera, R.S.; Dissanayake, P.H.; Senarath, U.; Wijayaratne, L.S.; Karunanayake, A.L.; Dissanayake, V.H.W.INTRODUCTION: Lumbar disc degeneration (LDD) is genetically determined and severity of LDD is associated with Modic changes. Aggrecan is a major proteoglycan in the intervertebral disc and end plate. Progressive reduction of aggrecan is a main feature of LDD and Modic changes. OBJECTIVES: The study investigated the associations of single nucleotide variants (SNVs) of candidate genes in the aggrecan metabolic pathway with the severity of LDD and Modic changes. In-silico functional analysis of significant SNVs was also assessed. METHODS: A descriptive cross sectional study was carried out on 106 patients with chronic mechanical low back pain. T1, T2 sagittal lumbar MRI scans were used to assess the severity of LDD and Modic changes. 62 SNVs in ten candidate genes (ACAN, IL1A, IL1B, IL6, MMP3, ADAMTS4, ADAMTS5, TIMP1, TIMP2 and TIMP3) were genotyped on Sequenom MassARRAY iPLEX platform. Multiple linear regression analysis was carried out using PLINK 1.9 in accordance with additive genetic model. In-silico functional analysis was carried out using Provean, SIFT, PolyPhen and Mutation Taster. RESULTS: Mean age was 52.42±9.42 years. 74 (69.8%) were females. The rs2856836, rs1304037, rs17561 and rs1800587 variants of the IL1A gene were associated with the severity of LDD and Modic changes. The rs41270041 variant of the ADAMTS4 gene and the rs226794 variant of the ADAMTS5 gene were associated with severity of LDD while the rs34884997 variant of the ADAMTS4 gene, the rs55933916 variant of the ADAMTS5 gene and the rs9862 variant of the TIMP3 gene were associated with severity of Modic changes. The rs17561 variant of the IL1A gene was predicted as pathogenic by the PolyPhen prediction tool. CONCLUSIONS: SNVs of candidate genes in ACAN metabolic pathway are associated with severity of LDD and Modic changes in patients with chronic mechanical low back pain. Predictions of in-silico functional analysis of significant SNVs are inconsistent.Item Gross anatomical variations of lumbar vasculature among Sri Lankan adults: a cadaveric study(Sri Lanka Medical Association, 2003) Karunanayake, A.L.; Jayasinghe, J.A.P.; Wijayaratne, L.S.; Pathmeswaran, A.BACKGROUND: Lumbar arteries supply intervertebral discs, vertebrae, muscles and ligaments in the lumbar region. Lumbar arteries can get damaged during urological and vascular surgery. According to textbooks of anatomy there are four pairs of lumbar arteries arising as individual stems from abdominal aorta and they travel posterior to crura of the diaphragm. There are no published studies in Sri Lanka either confirming this or describing the variations of lumbar arteries. OBJECTIVE: To describe the anatomy of lumbar arteries with regard to their numbers, origin and pathway. MATERIALS AND METHODS: This descriptive study was done on cadavers in anatomy departments of Kelaniya, Colombo and Sri Jayawardenepura Universities. Lumbar arteries were cleared from the origin of the abdominal aorta up to the point of passing deep to the Psoas major muscle. Their origin, number and pathway were noted. RESULTS: Dissected 109 cadavers. Ages ranged 43 -90 years. Mean age 70 years (SD 13.6). Males constituted 57% of the sample. The number of lumbar arteries varied from 3-5 pairs. In 12% of cadavers lumbar arteries originated as a common stem from the aorta and divided into two. These arteries traveled anterior to crura of the diaphragm in 17% of cadavers. CONCLUSIONS: There were variations with regard to the number, origin from abdominal aorta and pathway of lumbar arteries from what is described in textbooks. These findings will be useful for surgeons performing retroperitoneal surgery.Item Radiological features of chronic low back pain (LBP) in adult Sri Lankans; A case control study(Sri Lanka Medical Association, 2003) Karunanayake, A.L.; Fonseka, M.M.D.; Pathmeswaran, A.; Wijayaratne, L.S.BACKGROUND: Chronic LBP affects 30% of adult Sri Lankans. The presence of vertebral osteophytes, spondylolisthesis and disc space narrowing are thought to be important contributing factors of LBP. No studies have been done in Sri Lanka, investigating the importance of these in LBP. Objective: To determine the association between chronic LBP and vertebral osteophytes, spondylolisthesis and disc space narrowing. MATERIALS AND METHODS: A case control study was done in two hospitals in Ragama. Cases and controls were selected from medical, surgical and orthopaedic wards and clinics. They were matched for age and sex. Subjects who were 18 years and above with chronic LBP (more than three months) were selected as cases. Patients who were 18 years and above without LBP were selected as controls. They had symptoms such as abdominal pain and dysuria requiring radiography. In both groups postero-anterior and lateral radiographic appearances of the lumbar spine were studied. RESULTS: There were 130 cases and 130 controls. Age range was 18 -82 years. Mean age of patients was 49.3 years (SD 15). Mean age of controls was 51.4 years (SD 17). Females constituted 62% of cases and controls. Vertebral osteophytes were present in 72% of cases and 64% of controls (P = 0.184). Spondylolisthesis was present in 8% of cases and 7% of controls (P = 0.959). Disc space narrowing was present in 15% of cases and 2% of controls (OR = 7.8, P =0.0004). CONCLUSIONS: Disc space narrowing was significantly higher in patients with LBP.Item Effect of atherosclerosis on lumbar intervertebral disc cells in a sample of Sri Lankan population: a postmortem study(Sri Lanka Medical Association, 2004) Karunanayake, A.L.; Pathmeswaran, A.; Wijayaratne, L.S.; Fonseka, M.M.D.BACKGROUND: Disc degeneration is an important cause of low backache. The cartilage cells of the disc are important to maintain the structure and function of intervertebral discs. Lumbar arteries provide blood supply to lumbar discs. OBJECTIVE: To describe the association between cell density of fourth lumbar intervertebral disc and atherosclerotic changes of fourth lumbar artery openings. METHODS: Descriptive study was done on 4th lumbar intervertebral disc and 4lh lumbar arteries of postmortem specimens. H&E sections were prepared on the annulus fibrosus of lumbar discs. Atherosclerotic changes of lumbar artery openings were studied. By using a graticule number of cells per 4mm" were counted in each disc specimen in ten low power fields and mean cell density was calculated. Cell density of less than three was categorized as low cell density. Atherosclerotic changes of lumbar arteries were graded into three groups according to severity. Grade 1 was the least severe and grade 3 was the most severe. The chi-square for trend was used to find the association between the atherosclerotic changes of lumbar arteries and the cell density. RESULTS: 31 postmortem specimens. Age range 21 - 96 years. Median age 43 years. There was a significant association (P = 0.005) between atherosclerotic changes of lumbar arteries and low cell density. OR for gradcl, grade 2 and grade 3 was I, 4.5 and 18 respectively. CONCLUSIONS: Atherosclerotic changes of lumbar arteries had a significant negative association with the cell density.Item Association between pain and disability in patients with chronic mechanical low back pain(Sri Lanka Medical Association, 2015) Perera, G.L.R.S.; Wijayaratne, L.S.; Senarath, U.; Dissanayake, P.H.; Karunanayake, A.L.; Dissanayake, V.H.W.INTRODUCTION AND OBJECTIVES: Low back pain is the leading cause of years lived with disability in developed countries as well as in South Asian countries. The aim of this study is to evaluate the association between the intensity of pain and disability in patients with chronic mechanical low back pain (CMLBP) who attended the rheumatology clinic, National Hospital of Sri Lanka (NHSL). METHOD: This is a descriptive study on 675 patients with CMLBP who attended the rheumatology clinic, NHSL, from May 2012 to May 2014, recruited according to inclusion and exclusion criteria. Intensity of pain was measured using the 101-point numerical pain rating scale (NRS) and the disability was measured using the modified Oswestry Disability Index (MODI). A multiple linear regression model adjusted for age, gender, level of education, duration and frequency of pain and duration of treatment was used to assess the association between the intensity of pain and disability. RESULTS: Majority (482, 71.4%) were females. Mean age was 49.19 ± 11.75 years. Mean score for NRS was 46.79 ± 20.38 and for MODI was 31.77 ± 14.16, while 84.3% had daily pain. Intensity of pain was positively associated with the disability (p<0.01) and the standardized regression coefficient was +0.627 after adjusting for confounders. Frequency of pain, female gender and aging were positively associated with disability (p<0.05) while level of education, and durations of pain and treatment did not reach significant level. Conclusion: Intensity of pain explains 63% of the disability associated with CMLBP. Frequency of pain, female gender and age were also associated with disability.Item Association between the intima media thickness of lumbar arteries and the cell density of lumbar intervertebral discs: a postmortem study among Sri Lankan adults(Sri Lanka Medical Association, 2005) Karunanayake, A.L.; Pathmeswaran, A.; Fonseka, M.M.D.; Wijayaratne, L.S.BACKGROUND: Disc degeneration is an important cause of low backache. Cartilage cells help to maintain the structure of the disc. The lumbar arteries provide blood supply to the lumbar discs. The tunica media affects the mechanical properties of the vessel wall and thereby control the blood supply to the tissues. OBJECTIVES: To describe the association between the intima media thickness (expressed as a percentage of total thickness) of 4th lumbar artery and the mean cell density of the 4th lumbar disc. METHODS: Descriptive cross sectional study was done on 4th lumbar discs and 4th lumbar arteries of postmortem specimens. H&E sections were prepared on the annulus fibrosus of lumbar discs and lumbar arteries. By using a graticule number of cells per 4mm2 were counted in each disc specimen in ten low power fields and the mean cell density was calculated. With a graticule measurement of intima media thickness (IMT) and total thickness of lumbar arteries were taken on each artery specimen in ten low power fields. Mean of IMT expressed as a percentage of TT was calculated. Correlation coefficient was calculated to find out the association between the IMT and the mean cell density. RESULTS: Postmortem specimens of 31 subjects aged between 21-96 years (mean age 46 years. SD 19 years) were examined. 24 were males. There was a significant association between the IMT and the cell density (r = 0-37, P< 0.05). CONCLUSIONS: IMT of lumbar arteries had a significant positive association with the cell density.Item Anthropometric patterns among patients with chronic mechanical low back pain(Sri Lanka Medical Association, 2014) Perera, G.L.R.S.; Wijayaratne, L.S.; Senarath, U.; Dissanayake, P.H.; Karunonayake, A.L.; Dissanayake, V.H.W.INTRODUCTION AND OBJECTIVES: Anthropometric parameters may have an association with chronic mechanical low back pain (CMLBP). Our aim was to evaluate the anthropometric patterns; body mass index (BMI), waist circumference (WCJ and waist to height ratio (WHtR) among patients with CMLBP. METHODS: A total of 519 patients with CMLBP were recruited from a cohort of patients attending the rheumatology clinic at the National Hospital of Sri Lanka. Anthropometric parameters were measured using recommended techniques. Independent samples t test and one way ANOVA were used to compare the means of anthropometric parameters. The means of BM1, WC of the patients were compared with means of a national representative sample of Sri Lankan adults. Asian anthropometric cut offs were used to define obesity and abdominal obesity. RESULTS: 372 (71.7%) were females and mean age was 49.64 years (50=1.81). The mean BMI was 26.31 kg/m2 ($0=4.77), WC 85.98cm (50=10.65) and WHtR 0.56 (SD=0.08). Females had significantly higher BMI 27.24 kg/m2 ($0=4.68), WC 86.84cm (SD=10.59) and WHtR 0.577 (50=0.072) compared to males' BMI 23.95 kg/m2, SD=4.14), WC 83.79cm, (50=10.51) and WHtR 0.512 ($0=0.661) (p<0.05). Mean BMI, WC and WHtR increased with age (/xQ.OOl). CMLBP patients had high BMI and WC compared to the national representative sample of Sri Lankan adults (p<0.001). Females had more obesity and abdominal obesity compared to males (p<0.001). CONCLUSIONS: High BMI and WC were seen in patients with CMLBP and the values increased with age. Females were obese and had high abdominal obesity, which may have contributed to CMLBP.Item Use of lumbar vertebral body antero-posterior ratio to detect vertebral fractures among Sri Lankan patients with low backache(Sri Lanka Medical Association, 2007) Karunanayake, A.L.; Pathmeswaran, A.; Wijayaratne, L.S.OBJECTIVE: To determine an antero-posterior (A/P) ratio value for lumbar vertebral bodies to detect vertebral fractures among Sri Lankans presenting with low backache. DESIGN, SETTING AND METHODS: A case control study conducted at Teaching Hospital, Ragama and Rehabilitation Hospital, Ragama. In lateral radiographs of lumbar spine, the anterior and posterior vertebral body heights of fourth and fifth lumbar vertebrae were measured in 130 patients with low backache and 133 without low backache. Vertebral body heights were measured using a vernier caliper. After measuring the heights of the vertebrae, the antero- posterior (A/P) ratio was calculated. Reduction in anterior, middle, posterior or total height of the vertebral body was classified as a vertebral fracture. Cases and controls were matched for age and sex. Results were analysed using EPI6 statistical package. RESULTS: The age range of study subjects were 38- 82 years (mean age of cases 49.3 years, SD 15; mean age of controls 51.4 years, SD 17). 81 (62.5%) of the patients and 82 (61.7%) of the controls were females. 67% of cases and 6% of controls had an A/P ratio value of less than 0.9 in at least one of the fourth and fifth lumbar vertebrae. This difference was statistically significant (P <0.00i). CONCLUSION: A/P ratio value of iess than 0.9 can be used to detect vertebral fractures among Sri Lankan patients with low backacheItem Radiological changes of spine in patients with chronic low back ache(Department of Family Medicine, Aga Khan University Pakistan, 2007) Karunanayake, A.L.; Pathmeswaran, A.; Wijayaratne, L.S.OBJECTIVE: To determine the association between causes such as disc space narrowing, vertebral osteophytes and spondylolisthesis with chronic low backache among Sri Lankan adults. METHODOLOGY: A case control study was done at the Teaching hospital Ragama and Rehabilitation hospital Ragama Sri Lanka. Postero- anterior and lateral radiographs of the lumbo- sacral spine of a hundred and thirty cases and a hundred and thirty three controls were studied. The cases and controls were matched for age and sex. All radiographs were read by two radiologists working independently for the presence of verebral osteophytes, spondylolisthesis and disc space narrowing. The results were analysed by applying chi squared test for bivariate associations and logistic regression for multivariate associations. RESULTS: The age range of the study subjects was 18-82 years. Mean (SD) age for cases was 49.3 years (15 years); Mean (SD) age for controls was 51.4 years (17 years). There were 81 (62.3%) females with low backache and 82 (61.7%) females without low backache. Disc space narrowing was present in 15% of cases and 2% of controls. A person with disc space narrowing had a 7 times greater chance of developing low backache compared to a person without disc space narrowing (OR = 6.8, P= 0.008). Vertebral osteophytes were present in 72% of cases and 64% of controls. Spondylolisthesis was present in 8% of cases and 7% of controls. Vertebral osteophytes and spondylolisthesis did not have a significant association with low backache. Conclusion: Among the radiological features of the lumbar spine, disc space narrowing was the only feature with a significant association with low backache.