ABSTRACT
There is an overall increase in the worldwide prevalence and incidence of multiple sclerosis (MS). Studies from several countries also demonstrated an increase of female/male ratio over time denoting an increase in the incidence of MS particularly in women. In this study we sought to assess the trends in MS incidence and prevalence in males and females over recent decades in Isfahan, Iran, which differs from other regions in terms of environmental and lifestyle changes. We determined female/male ratio by year of birth (YOB) in 1584 patients with MS registered with Isfahan Multiple Sclerosis Society (IMSS) from April 2003 to August 2007. A comparison of sex ratio of MS patients by YOB showed a significant, progressive, gradual increase, with an apparent interruption in the late 1960s. In this study year of birth is a significant predictor for sex ratio (p < 0.001, chi(2) = 17.130, Spearman's rank correlation r = 0.893). Our findings show that there is a significant increase in the incidence of MS among females for the the last decades in the Isfahan province of Iran. This rapid increase may be related to changes in environmental interactions rather than genetic factors, and among them vitamin D insufficiency, enhanced diagnosis, and lifestyle changes appear to be more plausible causative factors.
Subject(s)
Multiple Sclerosis/epidemiology , Adolescent , Adult , Aged , Chi-Square Distribution , Female , Humans , Incidence , Iran/epidemiology , Life Style , Logistic Models , Male , Middle Aged , Multiple Sclerosis/etiology , Population Surveillance , Prevalence , Registries , Risk Assessment , Risk Factors , Sex Distribution , Sex Factors , Sex Ratio , Vitamin D Deficiency/complications , Vitamin D Deficiency/epidemiology , Young AdultABSTRACT
OBJECTIVES: We sought to compare the antigenemia assay and in-house semiquantitative polymerase chain reaction to monitor human cytomegalovirus infection after transplant in hematopoietic cell transplant recipients. MATERIALS AND METHODS: A pp65 antigen test for polymorphonuclear leukocytes and a semiquantitative polymerase chain reaction for whole blood were performed for 201 samples obtained from 26 hematopoietic cell transplant recipients over a 3-month surveillance period. RESULTS: Fourteen episodes of antigenemia positivity were detected in 7 patients in whom human cytomegalovirus DNA loads and pp65-positive cells ranged between < 102 to 2.96 x 104 copies/mL and 0-35/ 5 x 104 polymorphonuclear leukocytes, respectively. A significant correlation was detected between human cytomegalovirus DNA load and the antigenemia test. A receiver operating characteristic analysis determined 5000 copies/mL of human cytomegalovirus as the threshold value for initiation of ganciclovir therapy. CONCLUSIONS: Based on a comparison of the pp65 antigenemia assay, quantification of human cytomegalovirus DNA in whole blood can be used to guide clinical management of hematopoietic cell transplant recipients. This approach may have important advantages including superior sensitivity and efficient monitoring of preemptive therapy, allowing inclusion of kinetic criteria in clinical guidelines. Furthermore, a high human cytomegalovirus load among patients with grade II-IV acute graft-versus-host disease may indicate a high risk of human cytomegalovirus disease among hematopoietic cell transplant patients. Human cytomegalovirus reactivation must be monitored using more-sensitive assays such as real-time polymerase chain reaction.
