Association of HLA-Class II and IgE serum levels in pediatric asthma.

BACKGROUND: Pediatric bronchial asthma is associated with considerable morbidity. The study was carried out to examine the association of Human Leukocyte Antigen (HLA)-Class II with the disease as we found no similar study on Asian Indian population. OBJECTIVE: To define the HLA-Class II antigens in Asian Indian pediatric patients with asthma. METHODS: A total of 103 children with asthma and 152 controls were analysed for HLA Class II (DRB1, DQB1 and DPB1) by PCR-SSP (Sequence Specific Primers) method. Total serum IgE levels were determined by ELISA assay. RESULTS: A positive family history was recorded in 59 patients (57%) and 13 (8.5%) of healthy controls. Serum IgE levels were more than normal range in 72% of the patients and 33% of healthy subjects with mean values of 4877 and 627 IU/ml, respectively. DRB1 04 and DQB1 03 showed significant positive relations while DRB1 15 showed a negative association with asthma. DQB1 02 was more common in healthy individuals but was not statistically significant. CONCLUSIONS: A positive association of the DR4/DQB1 03 and a negative association of DRB1 15 was seen with extrinsic bronchial asthma. However, more studies are required on larger populations to confirm the association of HLA Class II alleles in Indians before a particular allele can be labeled as being protective or causative for asthma.

Clinical profile, common thrombophilia markers and risk factors in 85 young Indian patients with arterial thrombosis.

CONTEXT AND OBJECTIVE: Arterial thrombosis may occur consequent to hereditary thrombophilia and increased lipoprotein(a) [Lp(a)] and fibrinogen. Our aim was to study the prevalence of common thrombophilia markers in 85 consecutive cases of arterial thrombosis. DESIGN AND SETTING: A retrospective study was conducted from 85 consecutive young patients treated as outpatients or admitted due to stroke or myocardial infarction at a tertiary care hospital. METHODS: Eighty-five Indian patients (age < 45 years) presenting ischemic stroke (n = 48) or myocardial infarction (n = 37) and 50 controls were studied for seven thrombophilia markers including antithrombin (AT), factor V, protein C, protein S, activated protein C resistance (APC-R), fibrinogen and Lp(a). Functional assays for protein C, protein S, factor V and APC-R were performed using clotting-based methods. Semi-quantitative estimation of fibrinogen was done using Clauss's method and Lp(a) using immunoturbidimetry. Statistical analysis was done using the Epi Info 6 software. RESULTS: Thirty-three samples (38.8%) tested positive for one or more thrombophilia markers. The three commonest abnormalities were elevated Lp(a) (20%), fibrinogen (17.6%) and low APC-R (14.2%). Low levels of protein C, protein S and AT were present in 4.7, 9.4 and 7% of the patients, respectively. Overall, the risk factor profile was: smoking (33%), positive family history (15.3%), hyperlipidemia (7%), hypertension, diabetes mellitus and obesity (2.3% each). CONCLUSIONS: An association was found between low levels of protein C, protein S and AT and arterial thrombosis, but only elevated fibrinogen levels, smoking, positive family history and hyperlipidemia showed statistical significance.

Significance of panel reactive antibodies in patients requiring kidney transplantation.

Presence of antibodies against human leukocyte antigen (HLA) molecules, which may be may be directed against HLA class I or/and class II antigens, is a known risk factor for acute rejections and graft loss. Pre-transplantation panel reactive antibody (PRA) estimation is done to identify sensitized patients prior to solid organ transplantation and also forms the basis of cadaver organ allocation. The aim of this study is to evaluate the PRA in 52 patients awaiting first renal transplant, identify various factors contributing to high PRA, and observe its influence on graft survival. This was a case control study performed in a tertiary care hospital. Eighty-five samples including 63 from 52 patients with end-stage renal disease (ESRD), 10 from healthy volunteers, and 12 from presumed sensitized individuals were tested for class I and/or II PRA by enzyme-linked immunosorbent assay (ELISA) using Quik ID ® GTI kits. PRA for both class I and II was zero in all healthy controls and 19/46 (37%) patient samples; while individually, PRA class I and II were zero in 32/60 (53%) and 39/45 (86.3%) samples, respectively. PRA exceeded 10% in 16 samples from 12 patients with peak class I and II PRA of 100% and 46%, respectively. Post-transplantation, 27/31 patients are doing well, while four died with a functioning graft. Patient reactivity to antigen stimulation is the most important factor determining the PRA levels, and class I PRA is more relevant for detection of sensitization in first-time recipients and adversely affects the graft outcome.

Clinical profile, common thrombophilia markers and risk factors in 85 young Indian patients with arterial thrombosis / Perfil clinico, marcadores comuns de trombofilia e fatores de risco em 85 pacientes indianos jovens com trombose arterial

CONTEXT AND OBJECTIVE: Arterial thrombosis may occur consequent to hereditary thrombophilia and increased lipoprotein(a) [Lp(a)] and fibrinogen. Our aim was to study the prevalence of common thrombophilia markers in 85 consecutive cases of arterial thrombosis. DESIGN AND SETTING: A retrospective study was conducted from 85 consecutive young patients treated as outpatients or admitted due to stroke or myocardial infarction at a tertiary care hospital. METHODS: Eighty-five Indian patients (age < 45 years) presenting ischemic stroke (n = 48) or myocardial infarction (n = 37) and 50 controls were studied for seven thrombophilia markers including antithrombin (AT), factor V, protein C, protein S, activated protein C resistance (APC-R), fibrinogen and Lp(a). Functional assays for protein C, protein S, factor V and APC-R were performed using clotting-based methods. Semi-quantitative estimation of fibrinogen was done using Clauss's method and Lp(a) using immunoturbidimetry. Statistical analysis was done using the Epi Info 6 software. RESULTS: Thirty-three samples (38.8%) tested positive for one or more thrombophilia markers. The three commonest abnormalities were elevated Lp(a) (20%), fibrinogen (17.6%) and low APC-R (14.2%). Low levels of protein C, protein S and AT were present in 4.7, 9.4 and 7% of the patients, respectively. Overall, the risk factor profile was: smoking (33%), positive family history (15.3%), hyperlipidemia (7%), hypertension, diabetes mellitus and obesity (2.3% each). CONCLUSIONS: An association was found between low levels of protein C, protein S and AT and arterial thrombosis, but only elevated fibrinogen levels, smoking, positive family history and hyperlipidemia showed statistical significance. .

CONTEXTO E OBJETIVO: Trombose arterial pode ocorrer em consequência de trombofilias hereditárias e de lipoproteína (a) [Lp (a)] e fibrinogênio aumentados. Nosso objetivo foi estudar a predominância de marcadores comuns da trombofilia em 85 casos consecutivos de trombose arterial. TIPO DE ESTUDO E LOCAL: Um estudo retrospectivo foi realizado sobre 85 pacientes jovens tratados consecutivamente no ambulatório ou admitidos por infarto do miocárdio ou acidente vascular cerebral (AVC) num hospital de cuidado terciário. MÉTODOS: Oitenta e cinco pacientes indianos (idade < 45 anos) que se apresentaram com AVC isquêmico (n = 48) ou infarto do miocárdio (n = 37) e 50 controles foram estudados para sete marcadores de trombofilia que incluíram antitrombina (AT), fator V, proteína C, proteína S, resistência ativada da proteína C (APC-R), fibrinogênio e Lp (a). Os ensaios funcionais da proteína C, proteína S, fator V e APC-R foram executados por métodos baseados em coagulação. A avaliação semiquantitativa do fibrinogênio foi feita pelo método de Clauss e a Lp(a) por imunoturbimetria. A análise estatística foi feita pelo software Epi Info 6. RESULTADOS: Trinta e três amostras (38.8%) foram positivas para um ou vários marcadores do trombofilia. As anomalias mais comuns foram Lp (a) (20%), fibrinogênio (17.6%) e APC-R (14.2%) elevados. Baixos níveis da proteína C, proteína S e AT foram detectados em 4.7%, 9.4% e 7% dos pacientes, respectivamente. Globalmente, os perfis dos fatores de risco foram: fumo (33%), antecedentes familiares positivos (15.3%), hiperlipidemia (7%), hipertensão, diabetes mellitus e obesidade (2.3% cada). CONCLUSÕES: Uma associação foi encontrada entre baixos níveis de proteína C, proteína S, AT e trombose arterial, ...

Prevalence of common thrombophilia markers and risk factors in Indian patients with primary venous thrombosis.

CONTEXT AND OBJECTIVE: venous thrombosis occurs as a result of interaction of genetic and acquired factors including activated protein C resistance (APC-R), fibrinogen levels, antithrombin, protein C, protein S, lupus anticoagulants and anticardiolipin antibodies. This study was aimed at determining the prevalence of these common thrombophilia markers in Asian Indians with primary venous thrombosis. DESIGN AND SETTING: this was a cross-sectional study carried out in Mumbai. METHODS: samples from 78 patients with a confirmed diagnosis of venous thrombosis and 50 controls were tested. Semi-quantitative estimation (functional assays) of protein C, protein S and antithrombin was performed. Quantitative estimation of fibrinogen was done using the Clauss method. Lupus anticoagulants were screened using lupus-sensitive activated partial thromboplastin time and ß2-glycoprotein-I dependent anticardiolipin antibodies were estimated by ELISA. APC-R was measured using a clotting-based method with factor V deficient plasma and Crotalus viridis venom. Statistical analysis was performed using Epi-info (version 6). RESULTS: the popliteal vein was the most commonly involved site. Forty-four samples (56%) gave abnormal results. The commonest were elevated fibrinogen and APC-R (17.9% each), followed by low protein S (16.6%). CONCLUSIONS: this study confirms the literature findings that fibrinogen level estimation and screening for APC-R are important for the work-up on venous thrombosis patients since these, singly or in combination, may lead to a primary thrombotic episode. The frequency of the other thrombophilia markers was higher among the patients than among the controls, but without statistically significant difference.

Prevalence of common thrombophilia markers and risk factors in Indian patients with primary venous thrombosis / Prevalência de marcadores comuns de trombofilia e fatores de risco em pacientes indianos com trombose venosa primária

CONTEXT AND OBJECTIVE: Venous thrombosis occurs as a result of interaction of genetic and acquired factors including activated protein C resistance (APC-R), fibrinogen levels, antithrombin, protein C, protein S, lupus anticoagulants and anticardiolipin antibodies. This study was aimed at determining the prevalence of these common thrombophilia markers in Asian Indians with primary venous thrombosis. DESIGN AND SETTING: This was a cross-sectional study carried out in Mumbai. METHODS: Samples from 78 patients with a confirmed diagnosis of venous thrombosis and 50 controls were tested. Semi-quantitative estimation (functional assays) of protein C, protein S and antithrombin was performed. Quantitative estimation of fibrinogen was done using the Clauss method. Lupus anticoagulants were screened using lupus-sensitive activated partial thromboplastin time and β2-glycoprotein-I dependent anticardiolipin antibodies were estimated by ELISA. APC-R was measured using a clotting-based method with factor V deficient plasma and Crotalus viridis venom. Statistical analysis was performed using Epi-info (version 6). RESULTS: The popliteal vein was the most commonly involved site. Forty-four samples (56 percent) gave abnormal results. The commonest were elevated fibrinogen and APC-R (17.9 percent each), followed by low protein S (16.6 percent). CONCLUSIONS: This study confirms the literature findings that fibrinogen level estimation and screening for APC-R are important for the work-up on venous thrombosis patients since these, singly or in combination, may lead to a primary thrombotic episode. The frequency of the other thrombophilia markers was higher among the patients than among the controls, but without statistically significant difference.

CONTEXTO E OBJETIVO: A trombose venosa ocorre como resultado da interação de fatores genéticos e adquiridos, incluindo resistência à proteína C ativada (APC-R), os níveis de fibrinogênio, antitrombina, proteína C, proteína S, anticoagulante lúpico e anticorpos anticardiolipina. Este estudo teve como objetivo verificar a prevalência de fatores trombofílicos frequentes em indianos com trombose venosa primária. TIPO DE ESTUDO E LOCAL: Estudo transversal analítico realizado em Mumbai. MÉTODOS: Foram testadas amostras de 78 pacientes com diagnóstico confirmado de trombose venosa e 50 controles. Foi realizada a dosagem sérica semiquantitativa (funcional) de proteína C, proteína S e antitrombina e a dosagem quantitativa de fibrinogênio (método de Clauss). Anticoagulantes lúpicos foram identificados por meio do tempo de tromboplastina parcial ativada sensível ao lúpus, e anticorpos anticardiolipina dependentes de β2-glycoproteína-I por ELISA. APC-R foi medida por método baseado em coagulação com plasma deficiente em fator V e veneno de Crotalus viridis. A análise estatística utilizou Epi-info (versão 6). RESULTADOS: A veia poplítea foi o local mais frequentemente afetado; 44 amostras (56 por cento) tiveram resultados anormais. Os achados mais frequentes foram elevação do fibrinogênio e APC-R (17,9 por cento cada), e baixa proteína S (16,6 por cento). CONCLUSÕES: Corroborando com a literatura, este estudo mostrou que a elevação do nível de fibrinogênio e a triagem para APC-R são importantes na avaliação de pacientes com trombose venosa, pois, individualmente ou em combinação, podem ter levado ao episódio trombótico primário. A frequência dos outros marcadores de trombofilia foi mais alta entre os doentes quando comparados aos controles, porém sem diferença estatisticamente significante.