Assyrian people and Marfan syndrome: Difference between pages

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Revision as of 17:41, 25 June 2007

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{{Infobox_Disease

{{POV check}}

| Name = Marfan syndrome

{{reqmap}}

| Image = Marfansyndrome.jpg

:''This article concerns the Assyrian people. For their ancient empire, see [[Assyria]].''

| Caption =

{{Ethnic group|

| DiseasesDB = 7845

|group=Assyrians

| ICD10 = {{ICD10|Q|87|4|q|80}}

|image=[[Image:FlagofAssyria.png|200px]]<br>Flag

| ICD9 = {{ICD9|759.82}}

|poptime=3-4 million (est.)

| ICDO =

|popplace=[[Iraq]], [[Iran]], [[Syria]] and [[Turkey]]:<br> &nbsp;&nbsp; 1.8 million (est.)<br>

| OMIM = 154700

[[United States]] and [[Canada]]:<br> &nbsp;&nbsp; 300,000 (est.)<br>

| MedlinePlus = 000418

[[Armenia]], [[Georgia (country)|Georgia]] and [[Russia]]:<br> &nbsp;&nbsp; 64,000 (est.)<br>

| eMedicineSubj = ped

[[Europe]]:<br> &nbsp;&nbsp; 93,000 (est.)<br>

| eMedicineTopic = 1372

[[Australia]] and [[New Zealand]]:<br> &nbsp;&nbsp; 33,000 (est.)<br>

| eMedicine_mult = {{eMedicine2|orthoped|414}}

Other:<br> &nbsp;&nbsp; 150,000 (est.)<br>

| MeshID = C17.300.500

|langs=[[Assyrian language|Assyrian]]

|rels=[[Christianity]] (various denominations)

|related=

}}

'''Marfan syndrome''' is an [[autosomal dominant]] genetic disorder of the [[connective tissue]] characterized by disproportionately long [[limb]]s, long thin fingers, a relatively tall stature, and a predisposition to cardiovascular abnormalities, specifically those affecting the [[heart valves]] and [[aorta]]. The [[disease]] may also affect numerous other structures and organs &mdash; including the [[lung]]s, [[eye]]s, dural sac surrounding the [[spinal cord]], and [[hard palate]]. It is named after [[Antoine Marfan]], the [[France|French]] [[pediatrician]] who first described it in 1899.

The '''Assyrians''' are a [[Syriac]]-speaking minority inhabiting northern [[Iraq]], northeastern [[Syria]], southeastern [[Turkey]] and northwestern [[Iran]], some of whom are also identified as [[Aramaeans]], [[Syriacs]] and [[Chaldean]]s. They are the heirs and descendants of the formerly extensive [[Assyria]]n Empire, and thus the original inhabitants of much of Iraq and Eastern Syria. Nowadays, the survivors are a persecuted indigenous minority in the [[Middle East]] with their own language and religion. It is likely that a significant proportion of the ethnically [[Arab]] [[citizen]]s of modern-day Iraq and Syria are the descendants of ethnic Assyrians who, voluntarily or by force, [[cultural assimilation|assimilated]] into the [[Arabized]] [[Muslim]] population and thus lost their original [[ethnicity|ethnic identity]].

==Epidemiology==

Assyrians trace their heritage to an ancient race of the same name, one of the few major factions which appeared after the collapse of the [[Akkadian Empire]]; the world's first Semitic empire created under [[Sargon I]]. At its peak, the Assyrian empire encompassed what is now western [[Iran]], all of Mesopotamia ([[Iraq]]) and [[Syria]], [[Israel]], the [[Armenia]]n highlands, and even threatened [[Egypt]] in the [[8th century BC|8th]] and [[7th century BC|7th centuries BC]]. The ancient Assyrians subdued other ancient peoples of the region. They were masters of siege warfare, and were among the first to practice forced deportations, a method soon adopted by their neighbours. For these reasons, the ancient pre-Christian Assyrians were greatly feared by other ancient peoples of the region.

Marfan syndrome affects males and females equally,<ref name="marorg">{{Cite web|url=http://www.marfan.org/nmf/GetSubContentRequestHandler.do?sub_menu_item_content_id=6&menu_item_id=3|title=The role of heredity and family history|accessdate=2007-01-11|publisher=National Marfan Foundation|year=1999}}</ref> and the mutation shows no geographical bias. Estimates indicate that approximately 60 000 (1 in 5000, or 0.02% of the population)<ref name="marorg"/> to 200 000<ref name="mednet">{{Cite web|url=http://www.medicinenet.com/script/main/art.asp?articlekey=63689|title=New, Deadly Relative of Marfan's Syndrome Discovered|accessdate=2007-01-11|publisher=MedicineNet.com|year=2006}}</ref> Americans have Marfan syndrome. Each parent with the condition has a 50% chance of passing it on to a child due to its [[autosomal dominant]] nature. Most individuals with Marfan syndrome have another affected family member, but approximately 15-30% of all cases are due to ''[[de novo mutation|de novo]]'' [[genetic mutation]]s<ref name="robspath">{{cite book | title=Robbins Pathologic Basis of Disease| last=Cotran| coauthors=Kumar, Collins| publisher=W.B Saunders Company| ___location=Philadelphia| id=0-7216-7335-X}}</ref> &mdash; such spontaneous mutations occur in about 1 in 20 000 births. Marfan syndrome is also an example of [[dominant negative mutation]] and [[haploinsufficiency]].<ref name="Judge_et_al_2004">{{cite journal | last = Judge | first = Daniel P. | coauthors = Nancy J. Biery, Douglas R. Keene, Jessica Geubtner, Loretha Myers, David L. Huso, Lynn Y. Sakai, Harry C. Dietz | title = Evidence for a critical contribution of haploinsufficiency in the complex pathogenesis of Marfan syndrome. | journal = The Journal of Clinical Investigation | volume = 114 | issue = 2 | pages = 172-181 | doi = 10.1172/JCI200420641 | id = PMID 15254584 | url = http://www.jci.org/cgi/content/full/114/2/172 | accessdate = 2007-02-15}}</ref><ref name="Judge_et_al_2005">{{cite journal | last = Judge | first = Daniel P. | coauthors = Harry C. Dietz | title = Marfan's syndrome. | journal = Lancet | volume = 366 | issue = 9501 | pages = 1965-76 | year = 2005 | doi = 10.1016/S0140-6736(05)67789-6. | id = PMID 16325700 | url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16325700 | accessdate = 2007-02-15}}</ref> It is associated with [[incomplete penetrance]], therefore not all persons carrying the mutation develop the disease.

== Pathogenesis ==

Assyrians were one of the first nations to adopt [[Christianity]] as their state religion almost two thousand years ago, and traditionally belong to the [[Assyrian Church of the East]], the [[Chaldean Catholic Church]] or the [[Syriac Orthodox Church]]. They read and write various dialects of [[Aramaic]], a Semitic language, which in the [[Syriac]] form is used in their religious observances. '[[Aram]]' was the ancient [[Talmudic]] and Christian name for Syria.

Marfan syndrome has been linked to a defect in the ''FBN1'' [[gene]] on [[chromosome]] 15,<ref>{{cite journal | author = McKusick V | title = The defect in Marfan syndrome. | journal = Nature | volume = 352 | issue = 6333 | pages = 279-81 | year = 1991 | id = PMID 1852198}}</ref> which [[Genetics|encodes]] a [[glycoprotein]] called [[fibrillin]]-1. Fibrillin is essential for the formation of the [[elastic fiber]]s found in connective tissue, as it provides the scaffolding for [[tropoelastin]].<ref name="robspath">{{cite book | title=Robbins Pathologic Basis of Disease| last=Cotran| coauthors=Kumar, Collins| publisher=W.B Saunders Company| ___location=Philadelphia| id=0-7216-7335-X}}</ref> Elastic fibers are found throughout the body but are particularly abundant in the [[aorta]], [[ligament]]s and the [[Zonule of Zinn|ciliary zonule]]s of the eye, consequently these areas are among the worst affected. Without the structural support provided by fibrillin many connective tissues are weakened, which can have severe consequences for support and stability.

A related disease has been found in [[mouse|mice]], and the study of mouse fibrillin synthesis and secretion, and connective tissue formation, has begun to further our understanding of Marfan syndrome in humans. It has been found that simply reducing the level of normal fibrillin-1 causes a Marfan-related disease in mice.<ref name="micefib">{{cite journal | author=Lygia Pereira, ''et al.''| title=Pathogenetic sequence for aneurysm revealed in mice underexpressing fibrillin-1| journal=Proceedings of the National Academy of Sciences| year=1999| volume=96| issue=7| page=3819-3823| url=http://www.pnas.org/cgi/content/full/96/7/3819}}</ref>

==Language==

{{main|Assyrian language}}

The Assyrian language belongs to the northeastern Aramaic of the Afro-Asiatic family.

[[Transforming growth factor]] beta (TGFβ) plays an important role in Marfan syndrome. Fibrillin-1 binds TGFβ and inactivates it. In Marfan syndrome, reduced levels of fibrillin-1 allow activated TGFβ to damage the lungs and heart. A defect in the gene ''TGFβR2'' on [[chromosome]] 3, a [[receptor protein]] of TGFβ, has also been related to Marfan syndrome.<ref name="tgf2beta">{{Cite web|url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=gene&dopt=full_report&list_uids=7048|title=TGFBR2 transforming growth factor, beta receptor II|accessdate=2007-01-11|publisher=NCBI|year=2007|author=Entrez Gene|format=Entrez gene entry}}</ref> Marfan syndrome can often be confused with [[Loeys-Dietz syndrome]], a similar connective tissue disorder resulting from mutations in the TGFβ receptor genes ''TGFβR1'' and ''TGFβR2''.<ref name="loeysdietz">{{Cite web|url=http://www.marfan.org/nmf/GetContentRequestHandler.do?menu_item_id=84|title=Related Disorders: Loeys-Dietz |accessdate=2007-01-11|publisher=National Marfan Foundation}}</ref>

The identity of the Assyrian language is complicated. There is "classical Aramaic", which unites the Assyrian people and is used in The Assyrian Church of The East, Chaldean Catholic Church, Syriac Catholic Church and the Syriac Orthodox Church. Although two modern Assyrian (also known as modern Aramaic or Syriac) dialects are spoken by the Assyrian people, these modern dialects together are collectively termed "Syriac".

==Symptoms==

The modern dialects are these:

There are no signs or symptoms that are unique to Marfan syndrome. It is usually a single apparent sign or symptom that leads doctors to look for others and eventually to diagnose the syndrome, which affects connective tissue in diverse organs and systems. Even affected individuals in the same family might exhibit various combinations and severities of symptoms.

===Skeletal system===

* Eastern Assyrian but also called "Assyrian Neo-Aramaic", and "Sureth" in its own language

The most readily visible signs may be associated with the skeletal system. Many individuals with Marfan syndrome grow to larger than normal height and have long, slender limbs, fingers, and toes. An individual's arms may be disproportionately long. In addition to affecting height and limb proportions, Marfan syndrome can produce other skeletal signs. Abnormal curvature of the [[Vertebral column|spine]] ([[scoliosis]]) is common, as is abnormal indentation ([[pectus excavatum]]) or protrusion ([[pectus carinatum]]) of the [[sternum]]. Other signs include abnormal joint flexibility, a high [[palate]], [[malocclusions]], flat feet, stooped shoulders, and unexplained [[stretch marks]] on the skin. Some people with Marfans have [[speech disorder|speech impediments]] resulting from symptomatic high palates and small jaws.

* Western Assyrian, although some refer to the western dialect as 'Turoyo' or 'Suryoyo'

===Eyes===

==Neo-Aramaic Koine==

Marfan syndrome can also seriously affect the eyes and vision. [[myopia|Nearsightedness]] and [[astigmatism]] are common, but farsightedness can also result. Periodic eye exams can lead to an [[ophthalmologist]] or [[optometrist]] discovering dislocation, or [[subluxation]], of the crystalline [[lens (anatomy)|lens]] in one or both eyes ([[ectopia lentis]]) by carefully observing these structures using a [[Slit lamp|slit-lamp]] biomicroscope. This can be differentiated from the similar condition [[homocystinuria]], where the dislocation is inferonasal; in Marfan's the dislocation is superotemporal. Sometimes eye problems appear only after the weakening of connective tissue has caused [[retinal detachment|detachment of the retina]].<ref name="mayo-gen">{{Cite web|url=http://www.mayoclinic.com/health/marfan-syndrome/DS00540/DSECTION=2|title=Marfan Syndrome|accessdate=2007-01-12|publisher=Mayo Clinic}}</ref> Early onset [[glaucoma]] can be another complication.

Beside local Aramaic vernacular forms, there is a literary language, based primarily on the dialect used in the [[Urmia]] district of westernmost Iran. It uses the Syriac alphabet in its Nestorian variety, redesigned by European missionaries in the first half of the [[19th century]]. It it in this alphabet and language, Eastern Neo-Aramaic, that the first newspaper in all of Iran was printed (1849&ndash;1918). When American missionaries first arrived in Urmia, among 125,000 Aramaic-speaking inhabitants only 40 men and one woman (sister of the Patriarch) could read and write. By the [[1890s]], the Assyrians had made such progress in education that most of the dozens of villages in the Urmia area had primary schools, and some had secondary schools as well. Although attempts to create a literary form for Eastern Aramaic probably date back to the [[17th century]] (with the priests of the school of [[Alqosh]]), the Americans and their local advisors in Urmia can fairly be credited for laying the foundations of what is now called Neo-Aramaic Koine: the Greek word "[[koine]] (&#954;&#959;&#953;&#957;&#942;) means "common"; it is employed in [[linguistics]] to designate a "common language" used as [[lingua franca]] (or "common tongue") by speakers of different dialects.

===Cardiovascular system===

Aramaic as a spoken and written language is presently endangered due to several forms of assault on its speakers in Iran, Iraq and Turkey. Aside from the toll that [[World War I]] and the attacks by religious fanatics took on the Assyrian Christians, conversion has also been a problem. Conversion, especially of abducted women and girls who then enter into polygamous marriages, particularly in [[Kurd]]ish [[Muslim]] households, both forced and voluntary conversions, have resulted in a loss of identity and a loss of language for the survivors of the Assyrian people. In the second generation, children of such unions are fully identified as "Kurds" or other Muslims who do not speak any form of Aramaic.

The most serious conditions associated with Marfan syndrome involve the cardiovascular system. Undue fatigue, shortness of breath, [[heart palpitations]], [[tachycardia|racing heartbeats]], or [[angina|pain in the left chest, back, shoulder, or arm]], can bring an individual into the doctor's office. A [[heart murmur]] heard on a [[stethoscope]], an abnormal reading on an [[electrocardiogram]], or symptoms of [[angina]] can lead a doctor to order an [[echocardiogram]]. This can reveal signs of leakage or [[prolapse]] of the mitral or aortic [[heart valve|valves]] that control the flow of blood through the heart. However, the major sign that would lead a doctor to consider an underlying condition is a dilated aorta or an [[aortic aneurysm]]. Sometimes, no heart problems are apparent until the weakening of the connective tissue in the [[aorta|ascending aorta]] causes an [[aortic aneurysm]] or even [[aortic dissection]]. During pregnancy, even in the absence of preconceived cardiovascular abnormality, women with Marfan syndrome are at significant risk of acute [[aortic dissection]], which can be lethal if untreated. For this reason, women with Marfan syndrome should recieve a thorough assessment prior to conception, and [[echocardiography]] should be performed every 6-10 weeks during pregnancy, to assess the aortic root diameter. Most women however tolerate pregnancy well and safe vaginal delivery is possible.<ref name="emed">{{Cite web|url=http://www.emedicine.com/ped/fulltopic/topic1372.htm#section~Miscellaneous|title=Marfan Syndrome, special concerns|accessdate=2007-06-25}}</ref>

===Lungs===

==Assyrians and Islam==

Marfan syndrome is a [[risk factor]] for spontaneous [[pneumothorax]]. In spontaneous unilateral pneumothorax, air escapes from a lung and occupies the [[pleural]] space between the chest wall and a [[lung]]. The lung becomes partially compressed or collapsed. This can cause pain, shortness of breath, [[cyanosis]], and, if not treated, death. Marfan syndrome has also been associated with [[sleep apnea]] and [[idiopathic]] obstructive lung disease.

Assyrians are a [[Semitic]] nation related to [[Arabs]] neither ethnically nor culturally. Their own rich history is distinct from that of the surrounding Arabs. Historically, they contributed to the rise of Arabic astronomy, philosophy and medicine during the [[Abbasid]] period, and many scientists and scholars were in fact of Assyrian birth [http://www.aina.org/aol/peter/greek.htm]. Since the early Islamic period, Assyrians, like other non-Muslims, were subjected to the special poll tax on non-Muslims, the ''[[jizya]]'', and eventually to severe restrictions within the legal structure. Considered unclean in more extremist Islamic settings, like the Jews, Zoroastrians, Mandeans and others, they were restricted from certain employment that would place them in situations where they might interact with Muslims in food preparation or service, for example. Even today in Iran, a Christian shopper cannot touch food at markets run by some of the most radical Muslims.

===Central nervous system===

The Abbasid economic and social restrictions on Assyrians, as well as the assaults during the time of [[Tamerlane]] (14th century), drove the Assyrians ever further into the remote mountains for refuge. Consequent decline in culture followed, so that the speakers and writers of the oldest preserved language of the Middle East &mdash; Aramaic &mdash; were heading toward widespread illiteracy between the 15th and 18th centuries.

Another condition that can reduce the quality of life for an individual, though not life-threatening, is [[dural ectasia]], the weakening of the connective tissue of the dural sac, the membrane that encases the [[spinal cord]]. Dural ectasia can be present for a long time without producing any noticeable symptoms. Symptoms that can occur are lower [[back pain]], leg pain, [[abdominal pain]], other neurological symptoms in the lower extremities, or [[headaches]]. Such symptoms usually diminish when the individual lies flat on his or her back. These types of symptoms might lead a doctor to order an [[X-ray]] of the [[lumbar|lower spine]]. Dural ectasia is usually not visible on an X-ray in the early phases. A worsening of symptoms and the lack of finding any other cause should eventually lead a doctor to order a upright [[MRI]] of the lower spine. Dural ectasia that has progressed to the point of causing these symptoms would appear in a upright MRI image as a dilated pouch that is wearing away at the [[lumbar vertebrae]].<ref name="mayo-gen" /> Other spinal issues associated with Marfan include degenerative disk disease and spinal cysts.

==Management==

==Ottoman Assyrians==

There is no cure for Marfan syndrome, but life expectancy has increased significantly over the last few decades. The syndrome is treated by addressing each issue as it arises, and, in particular, considering prophylactic medication, even for young children, to slow progression of aortic dilation.

The Ottoman Empire, before it began to decay, had an elaborate system of administering the non-Muslim "[[People of the Book]]." That is, they made allowances for accepted monotheists with a scriptural tradition and distinguished them from people they defined as pagans. (Buddhists and Hindus as well as some African groups were the ones with which they came in contact.) As People of the Book (or ''[[dhimmi]]''), Jews, Christians and Mandaeans (in some cases Zoroastrians) received second-class treatment but were tolerated.

Regular checkups by a [[cardiologist]] are needed to monitor the health of the heart valves and the aorta. The goal of treatment is to slow the progression of aortic dilation and damage to heart valves by eliminating [[Cardiac arrhythmia|arrythmias]], minimizing the [[heart rate]], and minimizing [[blood pressure]]. [[Beta blocker]]s have been used to control [[Cardiac arrhythmia|arrythmias]] and slow the [[heart rate]]. Other medications might be needed to further minimize [[blood pressure]] without slowing the [[heart rate]], such as [[ACE inhibitors]] and [[angiotensin II receptor antagonist]]s, also known as angiontensin receptor blockers (ARBs). If the dilation of the aorta progresses to a significant diameter [[aneurysm]], causes a dissection or a rupture, or leads to failure of the aortic or other valve, then surgery (possibly a composite aortic valve graft [CAVG] or valve-sparing procedure) becomes necessary. Although aortic graft surgery (or any vascular surgery) is a serious undertaking it is generally successful if undertaken on an elective basis. Surgery in the setting of acute aortic dissection or rupture is considerably more problematic. Elective aortic valve/graft surgery is usually considered when aortic root diameter reaches 50 millimetres, but each case needs to be specifically evaluated by a qualified cardiologist. New valve-sparing surgical techniques are becoming more common.<ref name="mayo-heart">{{Cite web|url=http://www.mayoclinic.org/marfan-syndrome/heartsurgery.html|title=Heart Surgery for Marfan Syndrome|accessdate=2007-01-12|publisher=Mayo Clinic}}</ref> As Marfan patients live longer, other vascular repairs are becoming more common, e.g. repairs of descending thoractic aortic aneurysms and aneurysms of vessels other than the aorta.

In the Ottoman Empire, this religious status became systematized as the "millet" administrative pattern. Each religious minority answered to the government through its chief religious representative. This is a system that the Ottomans adopted from previous Muslim empires who in turn had gotten it from the Sassanian Iranians. That is how we get the Hebrew term "Resh Galuta" (the head of Diaspora).

The skeletal and ocular manifestations of Marfan syndrome can also be serious, although not life-threatening. These symptoms are usually treated in the typical manner for the appropriate condition. This can also affect height, arm length, and life span. The [[Nuss procedure]] is now being offered to people with Marfan syndrome to correct 'sunken chest' or ([[pectus excavatum]]).<ref name="chkd">{{Cite web|url=http://www.chkd.org/services/nussprocedure/Overview.aspx|title=Overview of the Nuss Procedure for Pectus Excavatum|accessdate=2007-01-12|publisher=Children's Hospital of The King's Daughters}}</ref> Because Marfan may cause spinal abnormalities that are asymptomatic, any spinal surgery contemplated on a Marfan patient should only follow detailed imaging and careful surgical planning, regardless of the indication for surgery.

The Christians that the Ottomans conquered gradually but definitively with the conquest of Constantinople in 1453 were already divided into many denominations, usually organized into a hierarchy of bishops headed by a patriarch.

Clinical trials have been conducted of the drug [[acetazolamide]] in the treatment of symptoms of [[dural ectasia]]. The treatment has demonstrated significant functional improvements in some sufferers.<ref name="spine">{{Cite web|url=http://www.spineuniverse.com/displayarticle.php/article922.html|title=Dural Ectasia in the Marfan Spine: Symptoms and Treatment|accessdate=2007-01-12|publisher=Scoliosis Research Society}}</ref> Other medical treatments, as well as physical therapy, are also available.

The Assyrians under the Ottomans started out under the Armenian patriarchate but petitioned the [[Sublime Porte]] for separate status, mainly as western contacts allowed them a voice of their own. Thus the Assyrian Apostolic Church of Antioch and all the East (Jacobite, later changed to Syrian) received recognition as a separate communnity "millet" as did the Chaldean Catholic Church, the Syrian Catholic and the Church of th the East. The last was the most remote of the Churches in distance from the Porte (in Istanbul).

Treatment of a spontaneous [[pneumothorax]] is dependant on the volume of air in the pleural space and the natural progression of the individual's condition. A small pneumothorax might resolve without active treatment in 1 to 2 weeks. Recurrent pneumothoraxes might require chest surgery. Moderately sized pneumothoraxes might need [[Chest tube|chest drain]] management for several days in hospital. Large pneumothoraxes are likely to be medical emergencies requiring emergency decompression.

The interest of Tsarist Russia and the western powers in the fate of the Christians of the Middle East, especially in the Maronites of Lebanon, gradually brought an elevation in culture during the 19th century, while at the same time causing schisms in denominational affiliation. The economic, educational and professional advancement of the Assyrians aroused the envy of their Muslim neighbors, especially the Kurds. Although not fanatically inclined as some Muslims, the Kurds have used their Islamic status to justify the attack on Assyrians in [[Tur Abdin]], in Iran, in Turkey and in Iraq.

Research in laboratory [[mouse|mice]] has suggested that the [[angiotensin II receptor antagonist]] [[losartan]], which appears to block TGF-beta activity, can slow or halt the formation of aortic aneurysms in Marfan syndrome.<ref name="scimag">{{Cite journal | last = Habashi | first = Jennifer P. | coauthors = Daniel P. Judge, Tammy M. Holm, Ronald D. Cohn, Bart L. Loeys, Timothy K. Cooper, Loretha Myers, Erin C. Klein, Guosheng Liu, Carla Calvi, Megan Podowski, Enid R. Neptune, Marc K. Halushka, Djahida Bedja, Kathleen Gabrielson, Daniel B. Rifkin, Luca Carta, Francesco Ramirez, David L. Huso, and Harry C. Dietz | date = [[April 7]], [[2006]] | title = Losartan, an AT1 Antagonist, Prevents Aortic Aneurysm in a Mouse Model of Marfan Syndrome | volume = 312 | issue = 5770 | pages = 117 - 121 | doi = 10.1126/science.1124287 | url = http://www.sciencemag.org/cgi/content/full/312/5770/117 | abstract = http://www.sciencemag.org/cgi/content/abstract/sci;312/5770/117 | news = http://www.news-medical.net/?id=17249}}</ref> A large [[clinical trial]] sponsored by the [[National Institutes of Health]] comparing the effects of losartan and [[atenolol]] on the aortas of Marfan patients is scheduled to begin in early 2007, coordinated by Johns Hopkins.<ref name="trial">{{Cite web|url=http://www.marfan.org/nmf/GetSubContentRequestHandler.do?sub_menu_item_content_id=147&menu_item_id=91|title=Atenolol vs. Losartan in Individuals with Marfan Syndrome Clinial Trial|accessdate=2007-01-12|publisher=National Marfan Foundation}}</ref>

The Assyrians who had converted to Protestanism did not want to pay an annual tribute to the older churches through local bishops who then passed some of it up to the Patriarch who then passed some of it to the Porte in the form of taxes. They wanted to deal directly with the Porte, across ethnic lines, (even if through a Muslim administrator) in order to have their own voice and not be subjected to the rule of the Patriarchal system. This general Protestant charter was granted in 1850. (Joseph, ''Muslim-Christian relations and inter-Christian rivalries in the Middle East: the case of the Jacobites in an age of transition'' [1983])

Genetic counseling and specialized clinics are available at many academic medical centers for affected persons and family members.

At the turn of the 20th century, the Assyrians living in Ottoman territory (all of them except those in Persia and those who had left for the Tsarist Caucasus and Transcaucasus) behaved like separate and competing communities organized along religious lines. The beginnings of national secular identity were beginning to emerge among such intellectual leaders as Prof. Ashour Yosep (Harput), Malfono Naim Faik (Diyarbeker), and John Mooshi (Urmia). When World War I decimated the Assyrians in both the Ottoman empire and Iran, the friction among churches was not as strong as the friction between the secular leaders and the patriarchal leadership. (Naby, ''IJMES,'' 1977)

==Well known people==

===Late Ottoman massacres and other issues===

Below is a list of prominent figures known or believed to have had Marfan syndrome:

Turkish nationalists in the [[Young Turks|Young Turk]] (or C.U.P.) movement, in control of the collapsing [[Ottoman Empire]], began their systematic elimination of Christian minorities, beginning with the deportation of Greeks from eastern [[Thrace]] in January [[1914]]. As early as December 1914, the Assyrians were also being forced from their homes. In northwest Iran, Kurdish tribes descended on Assyrian villages on the Urmia and Salmas plains when Istanbul entered the war in July 1914. The pillaging, looting, killings and abductions began the series of attacks and counterattacks that culminated in the final Ottoman military subjugation of northwest Iran in 1918. (Werda, ''Flickering Light of Asia'' reprinted 1990)

* [[Euell Gibbons]], outdoorsman & health food proponent.

* [[Flo Hyman]], silver medal in Women's Volleyball (1984 Olympics)<ref name="flo">{{Cite web|url=http://www.volleyhall.org/hyman.html|title=Flo Hyman|accessdate=2007-01-11|publisher=Volleyball Hall of Fame}}</ref>

* [[Jonathan Larson]], Tony Award-winning playwright ([[Rent (musical)|Rent]]); he died in 1996 of [[aortic dissection]] on the eve of his musical's premiere<ref name="larson">{{Cite web|url=http://www.wnbc.com/drmaxgomez/5421112/detail.html|title=Marfan's Syndrome Is Deadly, Elusive|accessdate=2007-01-11|publisher=WNBC.com}}</ref>

* [[Robert Johnson (musician)|Robert Johnson]], blues singer and guitarist<ref name="robertj">{{Cite journal | last = Connel | first = David | date = [[September 2]], [[2006]] | title=Retrospective blues: Robert Johnson—an open letter to Eric Clapton | journal = British Medical Journal | volume = 333 | issue = 7566 | pages = 489 | url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1557967|accessdate=2007-01-11}}</ref>

*[[Mike Dunleavy]], professional basketball player for the [[Portland Trailblazers]]

* [[Vincent Schiavelli]], actor<ref name="schiavelli">{{Cite web|url=http://www.marfan.org/nmf/PreviewPressReleaseInfoRequestHandler.do?press_release_id=24|title=NMF Mourns the Loss of its Honorary Co-Chair, Vincent Schiavelli|accessdate=2007-01-11|publisher=National Marfan Foundation}}</ref>

* [[Sir John Tavener]],<ref name="bbc">Richard Morrison, ''99 Names for God: John Tavener turns his back on Orthodoxy'', BBC Music, November 2004, page 30</ref> contemporary British composer

* Bradford Cox, frontman of the punk rock band [[Deerhunter]]<ref name="deerhunter">{{Cite web|url=http://www.pitchforkmedia.com/article/feature/43085-interview-deerhunter|title=Pitchfork Feature: Interview: Deerhunter}}</ref>

* [[Joey Ramone]], of the punk rock band [[The Ramones]].

===Spurious or conjectural claims===

In [[1915]] Assyrians, like Armenians, were massacred by the Turks in the cities of Turkey, the [[Hakkari]] region in southeastern [[Anatolia]] and the [[Urmia]] region in northwestern Iran. To justify its massacres Turkey wrongly accused the Assyrian Christians of having thrown themselves under the protection of the [[United Kingdom|British]], who had forces in the field in Iraq and Syria. Such propaganda, publicized in Istanbul newspapers as confirmation of Christian treachery, contributed to the butchery. Thousands fled into exile. By the middle of 1915 the deportations and killings were in full swing. About 500,000 to 750,000 Assyrians, or about three-fourths of the entire Assyrian population, were killed during the "Year of the Sword" (''Shato d´sayfo''), bitterly recalled by minorities today.

There are a number of historical persons believed to have suffered from Marfan's syndrome, but as proper Marfan diagnosis was not available before well into the 20th century most such claims can only be considered as speculation based on sparse medical records and pictures.

* [[Akhenaten]], Egyptian Pharaoh, who was the father of King [[Tutankhamun]] (spurious claim based on early Amarna art style. Tutankhamun, who didn't have syndrome, was also portrayed this way)<ref name="pharaoh">{{Cite web|url=http://www.marfan.ca/pharaoh.html|title=Did Akhenaten Suffer from Marfan's Syndrome?|accessdate=2007-01-11|publisher=Canadian Marfan Association}}</ref>

* For a balanced account of these events, see Wilhelm Baum and Dietmar W. Winkler, ''The Church of the East, a Concise History'', (London and New York: Routledge-Curzon, 2003), pp.135-39.

* [[Osama bin Laden]] may suffer from Marfan Syndrome (speculation based on tall size, use of cane and rumoured heart-disease; almost certainly in error)<ref>http://archive.salon.com/people/feature/2001/11/09/marfan/index.html</ref>

==Assyria Diaspora==

* [[Charles de Gaulle]] (conjectural)<ref>http://archive.salon.com/people/feature/2001/11/09/marfan/index.html</ref>

At the turn of the century the Christian population in Ottoman regions had numbered about 5,000,000. When the massacres finally ended in [[1923]], about 20,000 [[Greeks]], 10,000 [[Armenians]] and 30,000 Assyrians remained. The Assyrian diaspora includes a community in [[Chicago]] numbering as many as 80,000, more than in any other [[United States|American]] city. Since World War I, the Assyrian diaspora has steadily increased so that there are now more Assyrians living in western countries (including Australia) than in the Middle East. [[Södertälje]] in [[Sweden]] is often seen as the unofficial Assyrian capital of Europe due to the city's high percentage of Assyrians and the [[Sweden|Swedish]] professional [[Football (soccer)|football (soccer)]] team [[Assyriska]], which played in the the top football league ([[Allsvenskan]]) in [[2005]], is often viewed as a substitute national team by the diaspora and has fans worldwide. The international [[Suroyo TV]] which broadcast in the Assyrian/[[Syriac]] language is also based here.

* [[Nicollo Paganini]] (Conjectural) <ref>[http://tafkac.org/celebrities/paganini_stories_myths.html], main reference being an article in the AMA journal by Dr. Myron R. Shoenfeld dated 2 January, 1978.</ref>

In [[1918]], Britain resettled 20,000 Assyrians in Iraqi refugee camps in [[Baquba]] and [[Mandan]] after Turkey violently quelled a British-inspired Assyrian rebellion. From there, due to their higher level of education, many gravitated toward Kirkuk and Habbaniya, where they were indispensable in the administration of the oil and military projects. As a result, approximately three-fourths of the Assyrians who had sided with the British during [[World War I]] found themselves living in [[Kurd]]ish areas of Iraq. Thousands of Assyrian men had seen service in the ''Iraqi Levies'', a force under British officers separate from the regular Iraqi army. Pro-British, they had been apprehensive of Iraqi independence. Most of those thus resettled by the British have gone into exile, although by the end of the 20th century, almost all of those who remain were born in Iraq. Assyrians living in northern Iraq today are those whose ancestry lies in the north originally. Many of these, however, in places like Berwari, have been displaced by Kurds since World War I. This process has continued throughout the 20th century: as Kurds have expanded in population, Assyrians have come under attack as in 1933, and as a result have fled from Iraq. (Stafford, ''Tragedy of the Assyrians'', 1935)

* It was once believed that [[Abraham Lincoln]] suffered from Marfan Sydrome, although recent research has argued that he probably didn't.

Unlike the [[Kurds]], the Assyrians scarcely expected a nation-state of their own after World War I, but they did demand reparations from Turkey for the material and population losses they had suffered, especially in northwest Iran, a neutral party in WWI invaded by Turkish forces. Their pressure for some temporal authority in the north of Iraq under the Assyrian patriarch, the [[Mar Eshai Shimun XXIII]], was flatly refused by British and Iraqis alike. In Iran, the once thriving Assyrian community of around 200,000 is diminished at the close of the 20th century to a mere 5,000 while the total population in all of Iran hovers at around 15,000 to 20,000. (The Iran article estimates 68,017,860.)

* [[Johnny Appleseed]], a pioneer nurseryman in America living during the 18th century; he has become an almost mythical popular culture icon in America.

==Assyrians in Iraq==

In [[1933]], the Iraqi government held the Patriarch of the [[Church of the East]], the Mar Shamun, under house arrest. When he left Iraq to appeal to the British with regard to how the Assyrians were being mistreated in Iraq contrary to the agreement at Iraq's independence to refrain from discrimination against minorities, he was stripped of his citizenship and refused reentry.

==Related disorders==

During July 1933, about 800 armed Assyrians headed for the Syrian border, where they were turned back. While [[Faisal I of Iraq|King Faisal]] had briefly left the country for medical reasons, the Minister of Interior, Hikmat Sulayman, adopted a policy aimed at a final solution of the Assyrian "problem". This policy was implemented by a Kurd, General [[Bakr Sidqi]], who, after engaging in several clashes with the Assyrians, permitted his men to kill about 3,000 Assyrians, including women and children, at the Assyrian villages of Simel/Simele ([[Sumayyil]]) district, and later at [[Suryia]].

The following disorders have similar signs and symptoms of Marfan syndrome:

*[[Arachnodactyly|Congenital Contractural Arachnodactyly (CCA) or Beals Syndrome]]

The Assyrian repression marked the entrance into Iraqi politics of the military, a pattern that has periodically re-emerged since 1958, and offered an excuse for enlarging conscription. The hugely popular Assyrian massacre, an indication of the latent anti-Christian atmosphere, also set the stage for the increased prominence of Bakr Sidqi. In October [[1936]] Bakr Sidqi staged the first military coup in the modern Arab world.

*[[Ehlers-Danlos syndrome]]

*[[Homocystinuria]]

*[[Loeys-Dietz syndrome]]

*[[MASS phenotype]]

*[[Stickler syndrome]]

The following conditions that can result from having Marfan syndrome may also occur in people without any known underlying disorder:

This period also marks the intensification of denominational antagonism among Aramaic speakers in Iraq as some church institutions began to distance themselves from the members of the Church of the East who were seen as magnets for Muslim antagonism. It is from this period that, as the new Mosul-born patriarch of the Assyrian Apostolic Church of Antioch and All the East (Jacobite) came into the pinnacle of this church's hierarchy, he began to move the Church away from the term Assyrian and toward the term "Syrian." At the same time, this Church moved its See to [[Damascus]], [[Syria]].

<div style="width:30%; float:left; padding:0 3% 0 0; border:none; overflow:hidden; clear:left;">

In modern times, Assyrians, for whom no reliable census figures exist in Iraq (as they do not for Kurds), have been doubly mistreated; first by their Kurdish neighbors, then by [[Saddam Hussein]]'s [[Ba'ath|Ba'athist]] regime. Assyrians were deprived of their cultural and national rights while at the same time the Baathist regime tried to co-opt their history. In northern Iraq today, a similar pattern is emerging as Kurds attempt to rewrite the history of the region to give it a Kurdish flavor and diminish its historic Assyrian heritage. As in Ba'athist Iraq, there is a strong tendency in Iraq today to recognize only two ethnic groups: Arab or Kurd. However, the [[Kurdistan]] Autonomous Region has claimed that it has been instrumental in the renovation and support of Assyrian churches and schools.

*[[Aortic aneurysm|Aortic aneurysm or dilitation]]

*[[Arachnodactyly]]

*[[Bicuspid aortic valve]]

*[[Cysts]]

*[[Craniosynostosis]]

*[[Cystic medial necrosis]]

*[[Dural ectasia]]

*[[Ectopia lentis]]

</div>

<div style="width:30%; float:left; padding:0 3% 0 0; border:none; overflow:hidden; ">

*[[Flat feet]]

*[[Gigantism]]

*[[Glaucoma]]

*[[Hernias]]

*[[Hyperflex|Hypermobility of the joints]]

*[[Malocclusion]]

*[[Mitral valve prolapse]]

*[[Myopia]]

</div>

<div class="editmode" style="width:30%; float:left; padding:0 3% 0 0; border:none; overflow:hidden; ">

*[[COPD|Obstructive lung disease]]

*[[Osteoarthritis]]

*[[Pectus carinatum]] or [[pectus excavatum|excavatum]]

*[[Pneumothorax]]

*[[Retinal detachment]]

*[[Scoliosis]]

*[[Sleep apnea]]

*[[Stretch marks]]

</div><br clear="left" />

==References==

After Saddam Hussein's fall in [[2003]], the [[Assyrian Democratic Movement]] was one of the smaller political parties that emerged in the social chaos of the occupation. Its officials say that while members of the Assyrian Democratic Movement also took part in the liberation of the key oil cities of [[Kirkuk]] and [[Mosul]] in the north, the Assyrians were not invited to join the steering committee that was charged with defining Iraq's future. The ethnic make-up of the [[Iraq Interim Governing Council]] briefly (September 2003 - June 2004) guiding Iraq after the invasion included a single Assyrian Christian, [[Younadem Kana]], a leader of the Assyrian Democratic Movement and an opponent of Saddam Hussein since [[1979]].

{{reflist|2}}

==Neo-Assyrian revival==

Many Assyrians currently have an [[apocalyptic]] belief in the future of their nation, based on the following passage from the [[Bible]]:

:''At that time there will be a highway from Egypt to Assyria. The Assyrians will visit Egypt, and the Egyptians will visit Assyria. The Egyptians and Assyrians will worship together. At that time Israel will be the third member of the group, along with Egypt and Assyria, and will be a recipient of blessing in the earth. The Lord who leads armies will pronounce a blessing over the earth, saying, "Blessed be my people, Egypt, and the work of my hands, Assyria, and my special possession, Israel!"'' (''[[Book of Isaiah|Isaiah]]'' 19:23-25).

At the same time, recognizing the dire prospects for the survival of any [[Aramaic]]-speaking, Christian Syriac-based community in Iraq, a slow process of ecumenicism on the one hand, to bring together the various church groups, and a political awakening is taking place. Both in the large diaspora and in the Middle East, enhanced communication, especially through the Internet and by e-mail is breaking down the barriers that 20th century nationalism in Iraq, Syria and Turkey in particular, had fostered. While there are still many quarrels, the multi-lingualism of Assyrians and the rise in communications in English, is breaking down some of the antagonisms. To some extent, the quarrels are fed inadvertently by Western scholarship combined with a lack of cultural and historical knowledge among Assyrians themselves. Many continue to link language use with ethnic name: since all Assyrians speak one of two living forms of Aramaic (eastern and western), the assumption is often made that this must also become the ethnic name of the group. Others who want to revive classical Syriac, the revered liturgical language of the community, insist on some term having to do with the word "Syriac" and call themselves [[Syriacs]]. Because the indigenous word in both dialects for the people themselves and for the language is "Suryoyo" or "Suryaye," some take the facile route of equating these terms with Syriac or Syrian without realizing that the terms Assyrian and Syrian are the same in origin.

Similar disagreements over language and unity exist among many minorities in the Middle East that have had no state structure. Assyrians have managed to preserve Aramaic for more than two thousand years without any state backing. The rich traditions and history of this people have provided sustenance in times of persecution before. The cultural heritage and the language will help to preserve the community again.

==See also==

* [[Assyria]]

* [[Flag of Assyria]]

* [[Assyrian Genocide]]

* [[Assyrian Identity]]

* [[Assyrian language]]

* [[List of Assyrians]]

* [[Assyrian Captivity of Israel]]

==Assyrian denominations==

* [[Assyrian Church of the East]]

* [[Chaldean Catholic Church]]

* [[Syriac Orthodox Church]]

* [[Syriac Catholic Church]]

==External links==

* [http://www.zowaamarfanworld.org/ International Federation of AssyrianMarfan DemocraticSyndrome MovementOrganisations]

* [http://www.furkonomarfan.comorg/ AssyriaNational Marfan LiberationFoundation Party(USA)]

* [http://www.ainamarfan.org.za/diagnosis.html Assyrian InternationalMarfan Newsdiagnosis Agencycriteria]

*[http://www.ncbi.nlm.nih.gov/disease/Marfan.html National Institute for Health Marfan syndrome page (USA)]

* [http://www.aina.org/martyr.htm Genocides Against the Assyrian Nation]

*[http://www.medicinenet.com/marfan_syndrome/index.htm Marfan Syndrome Center at medicinenet.com]

* [http://www.assyrianaid.org Assyrian Aid Society]

*[http://marfansyndrome.researchtoday.net/ Marfan Syndrome Research] - recent literature on Marfan Syndrome

* [http://reference.allrefer.com/country-guide-study/iraq/iraq16.html Iraq &mdash; Country Study & Guide]

* [http://www.aina.org/articles/assyrianidentitysupportmarfan.pdfcom AssyrianMarfan Identitysupport]

*[http://www.marfan.ca/ Canadian Marfan Association]

* [http://www.aina.org/articles/gdaicc.htm Genetic Differentiation In Iranian Christian Communities]

*[http://www.marfan.org.uk/ Marfan Association UK]

* [http://www.shuraya.com/pressreleases/ASSYRIAN%20MASSACRES.htm Assyrian massacres from the perspective of the Assyria Liberation Party, a manifesto]: folk tradition still attributes the massacres to the Sultan.

* [http://www.ainamarfan.org.mx/releases/2000/sptranscript.htm SwedishMarfan Parliamentde transcriptMexico]

* [http://www.bethsuryoyomarfan.comno/ Beth SuryoyoNorwegian AssyrianMarfan (Othuroyo)Organization]

*[http://www.marfanlife.net Marfan Life blog] - mostly links to news articles about Marfan Syndrome

* [http://www.shuraya.com/ SHURAYA]

*[http://www.marfanlife.net/lists/ Marfan-List] - email discussion list for people and families with Marfan Syndrome

* [http://www.beepworld.de/members41/assyrismus// Assyrismus]

*[http://www.marfan.org.za/ South African Marfan Syndrome Organisation] - support group for Africa

* [http://www.assyrianvoice.net/ Assyrian Voice]

*[http://www.medstudents.com.br/original/revisao/marfan/marfan.htm Eye Findings in Marfan's syndrome]

* [http://christiansofiraq.com/behind.html The last Assyrians in Urmia]

* [http://christiansofiraq.com News and historical articles about Assyrians]

[[Category:Ethnic groups in IraqCardiology]]

[[Category:TurkishDiseases societyinvolving the fasciae]]

[[Category:SyrianGenetic societydisorders]]

[[Category:Ethnic groups in IranSyndromes]]

[[Category:Ethnic groups of the Middle East]]

[[ar:متلازمة مارفان]]

[[fr:Peuple assyrien]]

[[hede:אשור (עם)Marfan-Syndrom]]

[[es:Síndrome de Marfan]]

[[sl:Asirci]]

[[fr:Syndrome de Marfan]]

[[pl:Asyryjczycy (wspó&#322;cze&#347;ni)]]

[[ko:마르팡 증후군]]

[[sv:Assyrier]]

[[it:Sindrome di Marfan]]

[[he:תסמונת מרפן]]

[[nl:Syndroom van Marfan]]

[[ja:マルファン症候群]]

[[nn:Marfans syndrom]]

[[pl:Zespół Marfana]]

[[pt:Síndrome de Marfan]]

[[ru:Синдром Марфана]]

[[sr:Марфанов синдром]]

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[[uk:Синдром Марфана]]