Correlation between vitamin D deficiency and benign paroxysmal positional vertigo

Background: Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of peripheral vertigo. Vitamin D3 is an indispensable part of bone mineralization and calcium homeostasis. Vitamin D3 also plays a role in BPPV and therefore may offer a therapeutic option. Aim and Objective: This study aims to evaluate the relationship of BPPV with Vitamin D deficiency. Materials and Methods: This observational case–control study was done on 80 subjects out of which 40 were confirmed cases of BPPV patients and 40 were controls. Ear, throat, and nose were examined in all patients. Measurement of Vitamin D3 was done in all subjects. Assessment of quality of life was done using Dizziness Handicap Inventory score (DHI) and Visual Vertigo Analog Scale (VVAS). Results: In our study among cases, 14 patients (35%) had normal Vitamin D levels, Vitamin D deficiency was seen in 15 cases (37.5%) and 11 patients (27.5%) had Vitamin D insufficiency. In control group, 22 patients (55%) had normal Vitamin D levels and 9 patients (22.5%) each had Vitamin D insufficiency and deficiency. Mean of Vitamin D concentration in the case group was 23.78 ± 10.43 and in the control group had 35.99 ± 15.99. The relationship between the two groups was significant (P = 0.001). The mean of body mass index in case and control group was 22.46 ± 2.48 and 23.43 ± 2.38, respectively, with P-value of 0.032 indicating significant relationship statistically. Furthermore, VVAS and DHI scores were higher in cases with deficiency and insufficiency of Vitamin D. Conclusion: The present study shows a significant relationship of reduced concentration of Vitamin D with idiopathic BPPV.

Hepatic veins in northwest Indian subjects.

Formation, position, course and areas of drainage by hepatic veins were studied in 153 adult autopsy specimens. There were three major hepatic veins; left, middle and right. The middle hepatic vein (MHV) joined the left hepatic vein (LHV) in 88.2% specimens before the latter opened into inferior vena cava (IVC). Each major hepatic vein was joined by a superior vein. An intersegmental vein was present in the septum between the medial and lateral segments; it either joined the LHV or MHV. Formation and course of posterior hepatic veins (small veins) have been described and a nomenclature has been suggested. The right suprarenal vein either opened directly into IVC or joined the superior or inferior posterior hepatic veins.

Gross anatomy of the pancreatic ducts in north Indians.

Gross anatomy of the pancreatic ducts was studied in dissections and by preparing corrosion casts of pancreases, obtained from 218 male and 57 female adult cadavers. In addition 72 normal pancreatograms were also examined. The main pancreatic duct (MPD) started as two or more tributaries in the tail of the pancreas and crossed the body of the 12th dorsal or the first lumbar vertebra or in between in 72.5% males and 62.5% females. In 96% specimens MPD followed the usual course and opened at the major duodenal papilla. Twenty to thirty five lobular ducts opened on either side of the MPD while a few opened on the anterior or posterior walls. There was no 'herringbone' arrangement. The distance between the two ductules varied from 1 to 10 mm. Mode of formation of the accessory pancreatic duct (APD), its course and termination were also studied. In dissected specimens the embryonic type of pancreatic duct (pancreas divisum) was seen in 9 (4.5%) male and 3 (6%) female specimens. In 15.1% male and 26.3% female (p < 0.05) subjects APD will not act as a safety valve if an obstruction occurs in the distal part of MPD.

Incidence of myocardial bridges in northwest Indians.

Dissection of hearts obtained at autopsy from 150 adults (110 males, 40 females) and 15 children (10 males, 5 females) showed an incidence of myocardial bridges over the coronary arteries to be 34.5% in the male and 32.5% in female adults (p = NS); in children the incidence was 40% in either sex. A similar incidence was found in the neonates. Such bridges were also present in the fetuses. A bridge over the anterior interventricular artery could be identified as early as 60mm C.R. stage. An examination of serial sections of 3 early embryos indicated that the coronary arteries develop epimyocardially. The myocardial bridges seem to develop concurrently with the development of myocardium. In 63% instances a bridge was present on the anterior interventricular artery, other arteries were involved less frequently.

Size of the valves and thicknesses of anterior walls of the ventricles of the adult Indian hearts.

The heart weight, sizes of the aortic, pulmonary, tricuspid and mitral valves and thicknesses of the anterior walls of the two ventricles were measured in normal hearts obtained from 350 male and 150 female medicolegal autopsy subjects belonging to Chandigarh zone of Northwest India and varying in age from 18 to 70 years. All the measurements were found to be smaller than those recorded in the Western population. They were also smaller in the females than in the males. The measurements increased with advancing age.

Blood supply of the human interventricular septum in north-west Indians.

The blood supply of the human interventricular septum was studied in hearts obtained from 500 (300 males and 200 females) medicolegal autopsy subjects aged 18 to 75 years. In 350 specimens the coronary arteries were injected with 20 per cent solution of cellulose acetate butyrate and branches supplying the septum were displayed by dissection while in the remaining hearts the arteries were injected with a solution of barium sulphate and X-rays taken. The anterior two-thirds of the septum is supplied by 4 to 10 perforators and one or two long septal arteries (in 94 per cent instances) which arise from the anterior interventricular artery; the latter turns round the inferior border of the heart and extends for a variable distance in the caudal part of the interventricular sulcus and supplies perforators to the posterior one-third of the septum. The cephalic part of the posterior one-third of the septum gets its blood supply from the posterior interventricular artery; some variations in this arrangement have been encountered. In about 85 per cent instances the right coronary artery or its conus branch gives an interventricular septal branch which pierces the anterior wall of the right ventricle and runs subendocardially on the supraventricular crest to reach the interventricular septum where it anastomoses with the anterior perforators; about 15 per cent subjects who do not have this septal branch are likely to sustain a larger infarction in case the anterior interventricular artery gets blocked.

Origin and size of the coronary arteries in the north-west Indians.

The origin of the coronary arteries and sizes of their ostia were studied in 500 adult hearts (385 male and 115 female), obtained from medico-legal autopsies performed by one of the authors on subjects varying in age from 18 to 75 years and residents of Chandigarh zone. Third coronary artery was present in 34.8% male and 27.8% female hearts (p greater than 0.05). Whereas the incidence of the origin of right coronary artery above the supravalvular ridge was 3.4% in the males and 1.7% in females (p greater than 0.05), that of the left coronary artery was 7% in both sexes. The mean diameter of the origin of the right coronary artery in the males was 3.2 +/- 0.5 mm, and that of the females was 2.8 +/- 0.4 mm (p less than .001). The mean diameter of the left coronary artery in the males was 3.7 +/- .7 mm, and in famels 3.2 +/- .6 mm (p less than .001). The size of the left coronary artery in unsexed hearts of north-west Indian population was calculated as 3.6 mm while that of the right as 3.1 mm. The former is definitely smaller than that given in Western literature, while the size of the right artery is only marginally so. The sizes of both coronary arteries had significant correlationship with body weight, body weight, body surface area, heart weight and age. This investigation showed that the size of the coronary arteries increased with an increase in age.