Antiphospholipid antibodies in young myocardial infarction patients.

Myocardial infarction (MI) is a multi-factorial disease which claims many young lives. There are very few Indian studies that have investigated antiphospholipid antibodies (APLs) in MI patients. APLs have been implicated in arterial thrombosis including premature coronary artery and cerebrovascular thrombosis. In the present study, the prevalence of two clinically significant APLs--anticardiolipin antibody (ACA) and lupus anticoagulants (LA) in young MI patients was studied and compared with age- and sex-matched controls. Fifty healthy blood donors and 40 young MI patients (less than 45 yrs) diagnosed according to the American Heart Association guidelines were recruited for the study. The criteria for diagnosis were presence of atleast two of three classical findings including: clinical symptoms, diagnostic ECG, and presence of one or more cardiac biomarkers out of raised CK-MB isoform and T-troponin on serial measurement. LA and ACA were tested by lupus-sensitive activated partial thromboplastin time (aPTT) and ELISA respectively. Elevation of ACA was observed in 9 patients, while 6 were positive for LA. ACA of IgG isotype was detected in 8 patients. One patient had LA and raised ACA of IgG and IgM isotypes. Antiphospholipid antibodies were found to be significantly associated with MI in young patients, when considered together (p < 0.05) and in coronary thrombosis, mild elevation of ACA may be considered significant.

Molecular tissue typing in renal transplantation: Initial experience from a tertiary care Naval Hospital.

Background:During the last five years the proportion of living unrelated kidney transplants has increased and DNA tissue-typing methods have become popular in India. This study was carried out to compare the results of tissue - typing by serology and sequence specific primers (SSP) and study the usefulness of 'episode' allograft biopsies for diagnosis of acute graft dysfunction . Materials and Methods:DNA was extracted from whole blood using Qiagen kit. Samples from 60 individuals including thirty patients and their donors were typed by serology and SSP. Fifteen allograft biopsies were performed for suspected acute rejection (AR) cases. Results: Both alleles of HLA - A, B and DR antigen could be determined in 86, 65 and 90% of samples by SSP respectively. There was a discrepancy of 16-40% between SSP and serology. Acute rejection was confirmed in 8/15 biopsies. Graft survival rates were 83 and 76% at one and two years respectively. Neither the graft survival nor the number of AR episodes showed any correlation with the extent of HLA mismatch. SSP was useful in defining A*68, A*66, A*69 and A*33 alleles at private level and A*36, A*74 and A*03 alleles which were blank on serology. Conclusions: SSP has become popular in India due to its simplicity, superior results especially for class II HLA alleles: and episode allograft biopsy is adequate for follow-up of kidney recipients.