Sirtuin3 in Neurological Disorders.

Sirtuins are NAD+ dependent enzymes that have a predominant role in neurodegenerative disorders and also regulate the inflammatory process, protein aggregation, etc. The relationships between sirtuins with that of the nervous system and neurodegeneration, are widely studied. Sirtuins have a strong role in metabolic syndrome in mitochondria also. The activities of sirtuins can be altered by using small molecules that would be developed into drugs and it is proven that the manipulation of SIRT1 activity influences neurodegenerative disease models. They are interesting since using small molecules, which would be developed into a drug, it is feasible to alter the activities of sirtuins. Different functions of sirtuins depend upon their subcellular localization. In this review paper, we discuss different sirtuins, differential expression of sirtuins, and expression of sirtuin in the brain and briefly explains Sirtuin3 (SIRT3).

Lactate levels and risk of lactic acidosis with metformin in diabetic kidney disease patients.

Metformin as an oral antidiabetic drug (OAD) is not recommended in renal failure due to the presumed risk of lactic acidosis though it has advantages in cardiovascular protection with a low risk of hypoglycemia. Few studies have measured lactic acid blood levels in patients with diabetic kidney disease on metformin and demonstrated lactic acidosis. The aim of our study is to see if patients with diabetic kidney disease are at risk of elevated lactate blood levels and lactic acidosis. Lactate levels and blood pH were estimated in patients with type 2 diabetes mellitus receiving metformin in different stages of chronic kidney disease (CKD) and were compared with a similar group not receiving metformin. Patients with diabetic kidney disease, with estimated glomerular filtration rate <60 mL/min who were previously receiving metformin started in centers elsewhere and referred here were studied and compared with a similar group taking other OADs or insulin. Independent sample t-test or ANOVA were used to compare quantitative variables between groups. Pearson correlation was used to analyze association between quantitative variables and linear regression analysis and was employed to note the relationship between quantitative variables. Of 57 patients who received a mean dose of 1.134 grams of metformin, 33 (55.9%) were in stage 3, 16 (28.1%) in stage 4, and 8 (14%) in stage 5 CKD. Mean serum pH (P = 0.572), bicarbonate (P = 0.978), and plasma lactate (P = 0.449) levels in those taking and not taking metformin were comparable. There was no difference in the plasma lactate levels in different stages of CKD in the metformin group (P = 0.498) although there was significant correlation with metformin dose (P <0.05). Blood lactate levels were not elevated in patients with diabetic kidney disease at a daily dose of metformin <1 g.

Trend in the incidence of smear-positive tuberculosis in a district in South India after DOTS implementation.

SETTING: One baseline and three repeat surveys of the prevalence of tuberculosis (TB) disease were conducted in 1999-2008 in rural South India, where the DOTS strategy was implemented in 1999. The impact of DOTS on prevalence was documented, but not its impact on incidence. OBJECTIVE: To ascertain epidemiological trends in the incidence of smear-positive TB. DESIGN: All persons aged ⩾15 years (range 83 000-92 000) were examined using chest radiography (CXR); chest symptoms and history of anti-tuberculosis chemotherapy were noted in all four surveys. Sputum was collected from eligible participants and tested using direct smear and culture, and for drug susceptibility. As follow-up surveys were not frequent, survey cases and cases directly notified under DOTS were combined to estimate the incidence of smear-positive TB. RESULTS: Coverage was consistently high in all the repeat surveys, at ⩾80% for CXR and symptom recording, and at ⩾95% for sputum examination. The annual incidence of smear-positive TB was respectively 112, 80 and 76 per 100 000 population in 2001-2003, 2004-2006 and 2006-2008. The overall decline observed was 7.5% per annum. CONCLUSION: A well-implemented DOTS strategy can lead to a reduction in the TB burden in the community.

High intensity exercise training programme following cardiac transplant.

A 26-year-old male patient who presented with symptoms of end stage cardiac failure as a result of dilated cardiomyopathy, had an orthotopic cardiac transplantation. A comprehensive cardiac rehabilitation programme was provided to him and he was introduced to a sport (tennis). The exercise training programme progressed from low intensity training to high intensity programme over a period of 15 months. A cardio-pulmonary exercise test done 22 months after surgery suggested that he was able to achieve the aerobic capacity comparable to that of a normal South Indian subject. He participated successfully in the World Transplant Games in Sydney and returned safely. This suggests that after a proper cardiac rehabilitation programme, patients undergoing heart transplantation can achieve normal physiological responses to lead a normal active life.

Emphysematous pyelonephritis.

Emphysematous pyelonephritis is a severe form of acute pyelonephritis, characterised by fever, abdominal pain, nausea and vomiting, associated with intraparenchymal and perirenal gas production. It is often diagnosed radiologically, by plain films of abdomen, ultrasonogram and/or CT scan and often needs surgical drainage. We report a case which could be diagnosed clinically because of extensive surgical emphysema in a diabetic patient which was successfully managed by a combined medical and surgical approach.