a b s t r a c tContext: The aim of study was to determine the difference in presentation, risk factors, complications, management and outcome of elderly and young patients with acute myocardial infarction (AMI). Settings and design: Tertiary care center; prospective observational study. Materials and method: The study included 200 consecutive patients with AMI admitted in the ICCU, in a tertiary care center in West India. The group I consisted of 107 patients aged equal to or above 65 years and the group II consisted of 93 patients aged below 65 years. Statistical analysis: Two tailed student's t test and Chi-square statistics (Fisher's test) for P value. Results: The male female ratio was 1.27:1 and 3.43:1 in group I and group II respectively. Atypical presentations were more likely in the elderly, with shortness of breath as the most common presentation (40.18% versus 15.05%; P < 0.05. Risk factors like hypertension, dyslipidemia and diabetes were equally present in both groups but obesity, smoking and family history of coronary artery disease was more prevalent in younger age group (P < 0.05). The elderly were significantly less frequently revascularized (P < 0.05). Time from symptom onset to hospital admission was significantly longer in the case of elderly patients (P < 0.05). The elderly were more likely to have complications of cardiac failure (P < 0.05) and arrhythmias especially atrio-ventricular (AV) blocks. The elderly were also less likely to receive betablockers (P < 0.05). In-hospital mortality was higher in the elderly (P < 0.001). Conclusion: We conclude that the manifestations of AMI are more subtle in the elderly, with different risk factors.

Background. Transplantation of hepatitis C viremic (HCV+) deceased donor kidney transplants (DDKT) into aviremic (HCV-) recipients is a strategy to increase organ utilization. However, there are concerns around inferior recipient outcomes due to delayed initiation of direct-acting antiviral (DAA) therapy and sustained HCV replication when implemented outside of a research setting. Methods. This was a retrospective single-center matched cohort study of DDKT recipients of HCV+ donors (cases) who were matched 1:1 to recipients of HCV-donors (comparators) by age, gender, race, presence of diabetes, kidney donor profile index, and calculated panel-reactive antibody. Data were analyzed using summary statistics, t-tests, and chi-square tests for between-group comparisons, and linear mixed-effects models for longitudinal data. Results. Each group consisted of 50 recipients with no significant differences in baseline characteristics. The 6-mo longitudinal trajectory of serum creatinine and estimated glomerular filtration rate did not differ between groups. All recipients had similar rates of acute rejection and readmissions (all P > 0.05). One case lost the allograft 151 d posttransplant because of acute rejection, and 1 comparator died on postoperative day 7 from cardiac arrest. HCV+ recipients initiated DAA on average 29 ± 11 d posttransplant. Ninety-eight percent achieved sustained virologic response at 4 and 12 wks with the first course of therapy; 1 patient had persistent HCV infection and was cured with a second course of DAA. Conclusions. Aviremic recipients of HCV+ DDKT with delayed DAA initiation posttransplant had similar short-term outcomes compared with matched recipient comparators of HCV-donors.

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Purpose: Pneumocystis jirovecii Pneumonia (PJP) is a life-threatening infection in solid organ transplant recipients. Trimethoprim-sulfamethoxazole (TMP-SMX) is the first line regimen. For people who are intolerant to TMP-SMX, Dapsone is a commonly used alternative. G6PD deficiency should be ruled out before initiation of Dapsone to avoid hemolytic anemia. However, Dapsone associated hemolytic anemia with normal G6PD activity has been reported in HIV patients as well as solid organ transplant recipients. We present a case series of 6 transplant recipients who developed hemolytic anemia after initiation of Dapsone despite normal G6PD activity. Methods: We identified 6 organ transplant recipients with normal G6PD activity who developed anemia after initiation of Dapsone for PJP prophylaxis. Anemia workup include iron studies, vitamin B12, folate, reticulocyte count, haptoglobin, LDH, gastrointestinal, and other anatomic blood loss. Results: All 6 patients had elevated reticulocyte count consistent with hemolytic anemia. Two patients had persistently low haptoglobin but no other signs of microangiopathic hemolytic anemia. There was no substrate deficiency or blood loss. After discontinuation of Dapsone, hemoglobin improved back to baseline without blood transfusion. For summary of cases, see Table . Conclusions: Dapsone associated hemolytic anemia can occur in solid organ transplant recipient with normal G6PD activity. It is important to monitor hemoglobin within the first 3 months of Dapsone initiation. Blood transfusion is usually not required. The pathophysiology of Dapsone associated hemolytic anemia requires further studies.