RESUMO
Multiple sclerosis [MS] is a chronic inflammatory disorder of the central nervous system, with a complex etiology that includes a strong genetic component. The chromosome 19q13 region surrounding the apolipoprotein E [APOE] gene has shown consistent evidence of involvement in MS. In a cross-sectional study, to show the APOE genotype and allele frequency in the MS population of Iran in comparison with the control group, we genotyped its polymorphisms [sigma 2, sigma 3 and sigma 4 alleles]. The authors investigated 81 patients with clinically definite MS and 93 asymptomatic elderly volunteers. The frequency of the APOE allele in the MS population in comparison with controls was 9.3% vs. 0.5% for sigma 4, 44.4% vs. 51.6% for sigma 3, and 46.3% vs. 47.8% for sigma 2. The highest frequency of APOE genotype was from sigma 2/sigma 3 with 66.7% vs. 94.6% and the lowest, sigma 4/sigma 4 genotype with 2.5% vs. 0%. The authors found significant differences in the distribution of 84 allele between patients with MS and controls [9.3% vs. 0.5%; X[2]=15.2;df=2; p<0.001]. The highest frequency of sigma 4 allele in MS patients was in Pure Turkish [25.0% vs. 5.3%] ethnicity. There was no significant relation between ethnicity and genotype. In the present study sigma 2/sigma 4, sigma 3/sigma 4 and sigma 4/sigma 4 genotypes were more common in bout-onset cases compared to primary progressive cases, and the secondary progressive disease was higher in carriers of sigma 4 allele. Also, the sigma 2 allele was higher in relapsing remitting disease
RESUMO
Previous studies demonstrated the efficacy of carotid endarterectomy [CEA] in reducing the risk of strokes and deaths in selected patients afflicted with carotid artery stenosis. Selection of patients for CEA depends on degree of stenosis, whether patient is symptomatic or asymptomatic and complication rate of CEA; so, it has been recommended that surgical departments publish their complication rates. As there were no data regarding complication rates of CEA in Iran, this study was performed. We performed a retrospective study of all CEAs performed in Taleghani and Iranmehr hospitals till March 2001.In-hospital mortality or strokes were determined by review of patients' files. Telephone interview of patients or their families achieved additional follow-up for complications occurring within 30 days of CEA. The cohort consisted of 246 consecutive cases of CEA. There were 12 [6.4%] strokes and 4[2.1%] deaths in Iranmehr and 2[3.4%] strokes and 3[5.2%] deaths in Taleghani hospitals. Overall complication rate was 8.5%. Risk factors for stroke or death were history of diabetes mellitus and, unexpectedly, history of previous CEA on contra lateral side. According to the results of this study, CEA is appropriate for symptomatic patients with stenosis greater than 70% and not recommended for asymptomatic patients. Determining complication rates of CEA in other centers will help the selection of appropriate patients for CEA
RESUMO
Background: the apolipoprotein E [APOE] polymorphism is known to affect various neurologic disorders with different effects on the immune system and CNS repair. However, previous studies on possible modulation of the clinical course of multiple sclerosis [MS] by APOE polymorphism have been inconsistent
Objective: to clarify the issue for MS patients' management and future research
Methods: the present cross-sectional study investigated 81 patients with clinically proven MS and related their clinical and demographic findings to the allelic polymorphism of the APOE gene. The genotype distribution of patients with MS was compared with a comparison group of 93 asymptomatic elderly volunteers
Results: significant differences were found in the distribution of Epsilon 4 allele between patients with MS and the comparison group [9.3% vs. 0.5%; p>0.001]. An analysis of disease progression in 81 patients with MS indicated that APOE Epsilon 4 carriers are more likely to be affected with severe disease
Conclusion: the results obtained suggested that APOE genotype affected susceptibility to MS and indicated an association of the APOE Epsilon 4 allele with a more severe course of the disease