Association of vitamin D metabolite levels with relapse rate and disability in multiple sclerosis

Multiple sclerosis is an inflammatory demyelinating disease of the central system. It estimated to affect more than 2.5 million people worldwide. It is the most common non-traumatic cause of disability in young adults. Although the cause of multiple sclerosis remains undetermined, number of risk factors for MS have been identified and they can loosely be put into one of two categories; genetic or environmental components. Epidemiologic studies have suggested there is an increase in incidence and prevalence of MS with increasing latitude north and south of the equator. Latitude has implicate vitamin D status as a determinant of risk. To study the association of vitamin D level with relapse rate and disability in patients with relapsing remitting multiple sclerosis in Iraq. Thirty patients [6 males and 24 females] with relapsing remission multiple sclerosis [RRMS], their age range from 16 to 45 years, recruited from MS clinic of neurology department of Baghdad teaching hospital in the medical city in Baghdad and twenty five completely healthy controls [6 males and 19 females] from general population and their age range from 20 to 40 years were enrolled in this study in the period from April 2011 to the end January 2012. The present study shows low vitamin D levels for both patient with RRMS and control group. There is significantly lower 25[OH]D level in patients with relapse compared with patients without relapse in the last 6 weeks. Also we found higher expanded disability status scale [EDSS] in patients with relapse compared with patients without relapse in the last 6 weeks. Lastly, we didn't find any correlation between vitamin D level and EDSS in patients group study. We concluded from this study that there is low circulating level of 25[OH]D in RRMS patients, especially during relapses. Also there is no effect of vit D on disability

effect of stent placement on the size of common bile duct stones in cirrhotic patients: a prospective study

Background: Endoscopic retrograde cholangio-pancreato-graphy [ERCP], endoscopic sphincterotomy [ES] and basket extraction are currently used to remove bile duct stones. The technical difficulty of stone extraction increases with size of stone. Apart from surgical removal, biliary stenting is an alternative for treating difficult cases

Aim: To compare the sizes of the stones before and after stenting in cirrhotic patients with irretrievable common bile duct stones

Patients and methods: Twenty five patients with difficult common bile duct stones were treated by endoscopic stenting. They were 15 males, 10 females with mean age of 57.9+/-9.5 years, 7 of them were Child class A, 12 Child B and 6 Child C. Patients were followed-up at 3 months intervals

Results: Twenty patients [80 %] had a reduction of stone size, 3 had no change and in 2 patients it became slightly larger in size but not in number. Before stenting, the -diameter of stones ranged from 2.3 mm to 33 .mm [mean 22.9+/-3.7 mm]. After stenting, the size ranged from 1.3 to 30mm [mean 15.5+/-4.1 mm]. The difference in the stone diameter was statistically significant, P < 0.0001. Stones were successfully extracted in 22 patients [88%] after stenting, following 2. 2+/-0.4 endoscopic procedures [range 2-3]

Conclusion: Biliary stenting is a safe and effective mode of treatment of common bile duct stones in patients where stone extraction has failed after endoscopic papillotomy. These stones became smaller after stenting. As the difficulty of stone extraction increases with stone size, a period of stenting may make subsequent removal easier for patients with large stones