Prevalence of Multiple Sclerosis in a Turkish City Bordering an Iron and Steel Factory

BACKGROUND AND PURPOSE: Multiple sclerosis (MS) is an autoimmune disease characterized by inflammatory demyelination. Recent studies have shown that long-term exposure to air pollutants (including PM10 particulates) is potentially an environmental risk factor for MS. We aimed to determine the prevalence rates of MS in two cities with different levels of air pollution. METHODS: This door-to-door population-based study was conducted between April 2014 and June 2015. Two cities were screened for the prevalence rates of MS: 1) Karabük, which borders an iron-and-steel factory, and 2) Akçakoca, which is a coastal city located in the same region. A validated survey form was used for screening MS. The 2010 McDonald Criteria were used for diagnosing MS. The patients were examined twice, first by a neurology assistant in the field and then by a senior neurologist in public health centers in the cities. RESULTS: The prevalence of MS was 95.9/100,000 in Karabük and 46.1/100,000 in Akçakoca. In total, 33 patients were diagnosed with clinically definite MS. The female/male ratio was 1.5, and 21 patients were diagnosed with relapsing-remitting MS, 9 with secondary progressive MS, and 3 with primary progressive MS. CONCLUSIONS: We found that the prevalence of MS was more than two fold higher in Karabük than in Akçakoca, which supports a link between air pollution and the pathogenesis of MS. However, larger etiological and epidemiological studies are needed to confirm this hypothesis.

A hospital-based study on long-term mortality and predictive factors after spontaneous intracerebral hemorrhage from Turkey

Background: There is no previous study on long-term mortality following spontaneous intracerebral hemorrhage in Turkey. The aim of this study is to investigate long-term mortality following spontaneous intracerebral hemorrhage and the predictive factors for mortality in hospitalized patients in a medical centre in Turkey. Methods: We retrospectively reviewed the hospital records of patients aged 18 and above, hospitalized with spontaneous intracerebral hemorrhage between January 2004 and March 2005, in the Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul. Demographic data, vascular risk factors, Glasgow Coma Scale score and neuroimaging findings were abstracted. Anamnestic findings consisted of the history of hypertension, diabetes mellitus, acetyl salicylic acid-warfarin use and family history of stroke. The anatomic localization, volume, and intraventricular extension of hematoma were determined on CT images. The patients or their family members were called up to determine 30-day and one-year mortality rates. Results: Thirty-day mortality was 38.3% and one-year mortality was 49.6%. The predictive factors for mortality Glasgow Coma Scale score on admission, blood glucose, hematoma volume and intraventricular extension of hematoma. Thirty-day mortality and one-year mortality did not differ with sex (p>0.05). All patients who have hematoma volume of over 60 cm3 died within 30 days. There were correlation between hematoma volume and both 30-day and one-year mortality rates (p<0.001). The patients who had hematoma with extension to ventricles had significantly higher 30-day and one-year mortality rates (p<0.001). Conclusions: Mortality rate after spontaneous intracerebral hemorrhage was high as in other studies from elsewhere. Low level of consciousness on admission and high volume of hematoma were predictive of poor prognosis.