A study of prevalence of peripheral arterial disease in type 2 diabetes mellitus using ankle-brachial index and its correlation with coronary artery disease and its risk factors

Background: Peripheral arterial disease (PAD) is one of the macrovascular complications of type 2 diabetes mellitus (T2DM). There is significant difference in the reported prevalence of PAD and its associated risk factors between Indian and Western studies. The purpose of this study was to examine the PAD complicating T2DM, in particular the influence of PAD on the risk of CAD.Methods: Randomly selected 100 T2DM patients presented to Guru Nanak Dev hospital were included. In addition to a detailed history and physical examination, anthropometric parameters like body mass index was measured. CAD in patients was diagnosed by a history of angina, ECG changes, any past history of CAD or any treatment taken for CAD. Ankle brachial index (ABI) was measured. Data was collected systematically and analyzed according to the standard statistical methods.Results: The prevalence of PAD was 15%. CAD was present in 31%. PAD was found to be significantly correlated with age, duration of diabetes, smoking, systolic blood pressure, diastolic blood pressure, prevalence of BMI >25 kg/m2, HbA1c and serum HDL ≤40 mg%. Old age, high HbA1c level, and dyslipidaemia were found to be significant independent predictors of CAD.Conclusions: Using ABI authors found evidence of PAD in 15% patients of T2DM. The prevalence of CAD was higher in patients with PAD. So, there is definite and strong correlation between PAD and CAD. Thus, the early diagnosis of PAD should alert the clinician to a high probability of underlying CAD

Study of rationality and utilization pattern of antimicrobials in ear, nose, throat outpatient department of Tertiary Care Hospital, Nanded

Background: Antimicrobials are most commonly prescribed drugs worldwide. Around 50% of the prescriptions of antimicrobial drugs are either not needed, inappropriate or in wrong doses. With the widespread use of antimicrobial agents (AMAs), the prevalence of resistance has increased. To evaluate the prescription pattern and utilization of AMA in ear, nose, throat (ENT) outpatient department (OPD) of Tertiary Care Hospital, Nanded.Methods: This prospective study was conducted in ENT OPD of Dr. Shankarrao Chavan Government Medical College, Nanded over a period of 3 months. During this period, approximately 1100 patients visited ENT OPD and 600 prescriptions were evaluated. The excluded patients were of post-operative follow-up and of patients undergoing medical examination for fitness and handicap certificate. Data were collected by using specially designed case report form. Appropriateness of AMA was assessed by Kunin’s modified criteria.Results: Total 600 prescriptions were analyzed out of which (91%) consist of AMA. Most of them reported with upper respiratory tract infections (URTI) (30.4%), chronic suppurative otitis media (21.4%), acute suppurative otitis media (10.4%), tonsillitis (3.3%), sinusitis (2.7%), and others (15%). Amoxicillin (43.9%) was preferred AMA followed by ciprofloxacin (30.6%), cotrimoxazole (5.8%), azithromycin (3.2%), doxycycline (3.2%) cefixime + clavulanate (3.2%), and amoxicillin + clavulanate (1.8%). Single antibiotic was preferred in all prescriptions. In the concomitant medications, antihistaminics were prescribed in 97.22% of patients, non-steroidal anti-inflammatory drugs in 94.96% of patients, and antacids in 87.76% of patients. Fixed-dose combinations were used in 10% of prescriptions. Brand names of AMA were used in 10% of prescriptions. As per the Kunin’s modified criteria, 83% of patients received AMA therapy appropriately, while 17% patients inappropriately.Conclusions: Amoxicillin is the most common AMA prescribed and URTI is the most common diagnosis made. All AMAs should be prescribed only when needed and should be used in proper dose and for proper duration. Institution wise antibiotic policy should be used to contain resistance. Proper training and regular orientation programs of the juniors’ doctors for judicial use of AMAs will foster the habit of rational prescribing of AMA

Biochemical characterization and crystal structure of endoglucanase Cel5A from the hyperthermophilic Thermotoga maritima

Tm_Cel5A, which belongs to family 5 of the glycoside hydrolases, is an extremely stable enzyme among the endo-acting glycosidases present in the hyperthermophilic organism Thermotoga maritima. Members of GH5 family shows a common (β/α) TIM-barrel fold in which the catalytic acid/base and nucleophile are located on strands β-4 and β-7 of the barrel fold. Thermally resistant cellulases are desirable for lignocellulosic biofuels production and the Tm_Cel5A is an excellent candidate for use in the degradation of polysaccharides present on biomass. This paper describes two Tm_Cel5A structures (crystal forms I and II) solved at 2.20 and 1.85Å resolution, respectively. Our analyses of the Tm_Cel5A structure and comparison to a mesophilic GH5 provides a basis for the thermostability associated with Tm_Cel5A. Furthermore, both crystal forms of Tm_Cel5A possess a cadmium (Cd) ion bound between the two catalytic residues. Activity assays of Tm_Cel5A confirmed a strong inhibition effect in the presence of Cd metal ions demonstrating competition with the natural substrate for the active site. Based on the structural information we have obtained for Tm_Cel5A, protein bioengineering can be used to potentially increase the thermostability of mesophilic cellulase enzymes

Improved Activity of a Thermophilic Cellulase, Cel5A, from Thermotoga maritima on Ionic Liquid Pretreated Switchgrass

Ionic liquid pretreatment of biomass has been shown to greatly reduce the recalcitrance of lignocellulosic biomass, resulting in improved sugar yields after enzymatic saccharification. However, even under these improved saccharification conditions the cost of enzymes still represents a significant proportion of the total cost of producing sugars and ultimately fuels from lignocellulosic biomass. Much of the high cost of enzymes is due to the low catalytic efficiency and stability of lignocellulolytic enzymes, especially cellulases, under conditions that include high temperatures and the presence of residual pretreatment chemicals, such as acids, organic solvents, bases, or ionic liquids. Improving the efficiency of the saccharification process on ionic liquid pretreated biomass will facilitate reduced enzyme loading and cost. Thermophilic cellulases have been shown to be stable and active in ionic liquids but their activity is typically at lower levels. Cel5A_Tma, a thermophilic endoglucanase from Thermotoga maritima, is highly active on cellulosic substrates and is stable in ionic liquid environments. Here, our motivation was to engineer mutants of Cel5A_Tma with higher activity on 1-ethyl-3-methylimidazolium acetate ([C(2)mim][OAc]) pretreated biomass. We developed a robotic platform to screen a random mutagenesis library of Cel5A_Tma. Twelve mutants with 25–42% improvement in specific activity on carboxymethyl cellulose and up to 30% improvement on ionic-liquid pretreated switchgrass were successfully isolated and characterized from a library of twenty thousand variants. Interestingly, most of the mutations in the improved variants are located distally to the active site on the protein surface and are not directly involved with substrate binding