Evidence-based opioid prescribing guidelines after lung resection: a prospective, multicenter analysis.

Background: Opioid prescribing guidelines have significantly decreased overprescribing and post-discharge use after cardiac surgery; however, limited recommendations exist for general thoracic surgery patients, a similarly high-risk population. We examined opioid prescribing and patient-reported use to develop evidence-based, opioid prescribing guidelines after lung cancer resection. Methods: This prospective, statewide, quality improvement study was conducted between January 2020 to March 2021 and included patients undergoing surgical resection of a primary lung cancer across 11 institutions. Patient-reported outcomes at 1-month follow-up were linked with clinical data and Society of Thoracic Surgery (STS) database records to characterize prescribing patterns and post-discharge use. The primary outcome was quantity of opioid used after discharge; secondary outcomes included quantity of opioid prescribed at discharge and patient-reported pain scores. Opioid quantities are reported in number of 5-mg oxycodone tablets (mean ± standard deviation). Results: Of the 602 patients identified, 429 met inclusion criteria. Questionnaire response rate was 65.0%. At discharge, 83.4% of patients were provided a prescription for opioids of mean size 20.5±13.1 pills, while patients reported using 8.2±13.0 pills after discharge (P<0.001), including 43.7% who used none. Those not taking opioids on the calendar day prior to discharge (32.4%) used fewer pills (4.4±8.1 vs. 11.7±14.9, P<0.001). Refill rate was 21.5% for patients provided a prescription at discharge, while 12.5% of patients not prescribed opioids at discharge required a new prescription before follow-up. Pain scores were 2.4±2.5 for incision site and 3.0±2.8 for overall pain (scale 0-10). Conclusions: Patient-reported post-discharge opioid use, surgical approach, and in-hospital opioid use before discharge should be used to inform prescribing recommendations after lung resection.

Repurposing of genistein as anti-sickling agent: elucidation by multi spectroscopic, thermophoresis, and molecular modeling techniques.

Sickle cell disease (SCD) is a major medical problem in which mono-therapeutic interventions have so far shown only limited effectiveness. We studied the repurpose of genistein, which could prevent sickle hemoglobin from polymerizing under hypoxic conditions in this disease. Genistein an important nutraceutical molecule found in soybean. The present study examines the repurposing genistein as an anti- sickling agent. Genistein shows inhibition of Hb S polymerization as well as a sickle reversal. Also, we have explored the interaction of the genistein with sickle hemoglobin (Hb S), using fluorescence, far-UV-CD spectroscopy, MicroScale Thermophoresis (MST), FTIR, combined with molecular modeling computations. The quenching constant decreases with increasing temperature, a characteristic that coincides with the static type of quenching mechanism. Temperature-dependent fluorescence measurements and molecular modeling studies reveal that apart from the hydrogen bonding, electrostatic interactions also play a crucial role in genistein and Hb S complex formation. In silico, distribution prediction of adsorption, digestion, metabolism, excretion, and toxicity (ADME/Tox) based on physical and chemical properties show that genistein is nontoxic and has ideal drug properties. The helicity and thermophoretic mobility of Hb S was a change in the presence of genistein, which leads to the destabilizing the Hb S polymer was examined using CD and MST, respectively. Our results open up the possibility for a promising therapeutic approach for the SCD by repurposed genistein as an anti-sickling agent.Communicated by Ramaswamy H. Sarma.

Liver in the Chest: A Case of a Large Traumatic Diaphragmatic Rupture.

Motor vehicle collisions (MVC) cause more than one million deaths annually and an estimated 20-50 million significant injuries. They can cause blunt and penetrating trauma. Blunt diaphragmatic rupture is generally associated with multiple severe injuries due to the high force needed to cause the injury. Traumatic diaphragmatic rupture (TDR) is normally identified during advance trauma life support (ATLS) secondary survey, after other more serious injuries are identified in the primary survey. We present a case of a patient who was involved in a MVC with multiple injuries, which were treated appropriately, prior to identification and treatment of a severe right-sided diaphragm injury. Imaging showed only a persistent right hemidiaphragm elevation. Intra-operative findings consisted of complete herniation of the liver with a Grade IV, 30 cm, right-sided diaphragmatic rupture. The herniated liver was repositioned and the diaphragm primarily repaired without complication. This case highlights a severe injury from a blunt MVC and rapid successful recovery of the patient once appropriately treated.

Perforated Gastric Body Secondary to Migrated Esophageal Stent.

A 44-year-old male presented to the ER with severe abdominal pain and a reported syncope episode. Focused abdominal sonography in trauma and abdominal exam demonstrated free fluid and peritonitis. CT scan demonstrated a metallic object in the stomach with free air and fluid throughout the abdomen. The following report is a rare case presentation of a perforated stomach secondary to a migrated esophageal stent used for the treatment of a benign esophageal stricture refractory to other treatment modalities.

Uptake and detoxification of diesel oil by a tropical soil Actinomycete Gordonia amicalis HS-11: Cellular responses and degradation perspectives.

A tropical soil Actinomycete, Gordonia amicalis HS-11, has been previously demonstrated to degrade unsaturated and saturated hydrocarbons (squalene and n-hexadecane, respectively) in an effective manner. In present study, G. amicalis HS-11 degraded 92.85 ± 3.42% of the provided diesel oil [1% (v/v)] after 16 days of aerobic incubation. The effect of different culture conditions such as carbon source, nitrogen source, pH, temperature, and aeration on degradation was studied. During degradation, this Actinomycete synthesized surface active compounds (SACs) in an extracellular manner that brought about a reduction in surface tension from 69 ± 2.1 to 30 ± 1.1 mN m-1 after 16 days. The morphology of cells grown on diesel was monitored by using a Field Emission Scanning Electron Microscope. Diesel-grown cells were longer and clumped with smooth surfaces, possibly due to the secretion of SACs. The interaction between the cells and diesel oil was studied by Confocal Laser Scanning Microscope. Some cells were adherent on small diesel droplets and others were present in the non-attached form thus confirming the emulsification ability of this organism. The fatty acid profiles of the organism grown on diesel oil for 48 h were different from those on Luria Bertani Broth. The genotoxicity and cytotoxicity of diesel oil before and after degradation were determined. Cytogenetic parameters such as mitotic index (MI); mitosis distribution and chromosomal aberration (type and frequency) were assessed. Oxidative stress was evaluated by measuring levels of catalase, superoxide dismutase and concentration of malondialdehyde. On the basis of these studies it was deduced that the degradation metabolites were relatively non-toxic.

Potential of isoquercitrin as antisickling agent: a multi-spectroscopic, thermophoresis and molecular modeling approach.

Sickle cell disease is an inherited disease caused by point mutation in hemoglobin (ß-globin gene). Under oxygen saturation, sickle hemoglobin form polymers, leading to rigid erythrocytes. The transition of the blood vessels is altered and initiated by the adhesion of erythrocytes, neutrophils and endothelial cells. Sickle Hemoglobin (HbS) polymerization is a major cause in red blood cells (RBC), promoting sickling and destruction of RBCs. Isoquercitrin, a medicinal bioactive compound found in various medicinal plants, has multiple health benefits. The present study examines the potential of isoquercitrin as an anti-sickle agent, showing a significant decrease in the rate of polymerization as well as sickling of RBCs. Isoquercitrin-induced graded alteration in absorbance and fluorescence of HbS, confirmed their interaction. A negative value of ΔG° strongly suggests that it is a spontaneous exothermic reaction induced by entropy. Negative ΔH° and positive ΔS° predicted that hydrogen and hydrophobic binding forces interfered with a hydrophobic microenvironment of ß6Val leading to polymerization inhibition of HbS. HbS-Isoquercitrin complex exhibits helical structural changes leading to destabilization of the HbS polymer as confirmed by CD spectroscopy. MST and DSC results indicate greater changes in thermophoretic mobility and thermal stability of sickle hemoglobin in the presence of isoquercitrin, respectively. These findings were also supported by molecular simulation studies using DOCK6 and GROMACS. Hence, we can conclude that isoquercitrin interacts with HbS through hydrogen bonding, which leads to polymerization inhibition. Consequently, isoquercitrin could potentially be used as a medication for the treatment of sickle cell disease.Communicated by Ramaswamy H. Sarma.

Synthesis of silver nanoparticles colloids in imidazolium halide ionic liquids and their antibacterial activities for gram-positive and gram-negative bacteria.

Four 1-butyl-3-methylimidazolium halide ionic liquids were synthesized via metathesis and anion exchange reactions. Silver nanoparticles (AgNPs) colloids were synthesized in four ionic liquids in the pressurized reactor by reduction of silver nitrate with hydrogen gas, without adding solvents or stabilizing agents. Antibacterial activities of base ionic liquids and AgNPs colloids in ionic liquids were reviewed by well-diffusion method for gram-positive Bacillus cereus (NCIM-2155) and gram-negative Escherichia coli (NCIM-2931) bacteria. Antibacterial activities of ionic liquids and AgNPs colloids in ionic liquids were observed to be controlled by ionic liquids anions and AgNPs particle size. The 1-butyl-3-methylimidazolium iodide ionic liquid exhibited higher antibacterial activities among the studied ionic liquids. Further, the presence of AgNPs in 1-butyl-3-methylimidazolium iodide, ionic liquid enhanced its antibacterial activity for Bacillus cereus and Escherichia coli bacteria.

Secondary patents: innovator and generic strategies.

The global pharmaceutical industry consists of innovators and generics. Innovators focus on drug discovery, and bring new drugs into the marketplace after filing the new drug applications. In contrast, the generics enter the market by making a bioequivalent product by filing abbreviated new drug applications. In order to maximize their returns on R&D and maintain market share, the innovators introduce a wide range of drug products based on the same 'new molecular entity' and protect them against competition by filing what the industry term as secondary patents. The patents of four innovator viz., AstraZeneca, Takeda, Eisai and Wyeth related to the gastroesophageal reflux disease drugs and how their new molecular entity patents overcame the nonobviousness criteria is analyzed and studied in detail.

Nonobviousness of pharmaceutical inventions: implications for patent prosecution and litigation.

Nonobviousness is the most critical patentability criterion. Patents covering new molecular entities and second-generation molecules in the pharmaceutical industry are often challenged for prima facie obviousness during prosecution and/or litigation. In such situations, the patentee has to either reject or rebut the same by clear and convincing evidence or demonstrate unexpected results, to establish nonobviousness. This paper tries to show how the lead compound requirement is consistent with 35 U.S.C. § 103; the prima facie obviousness challenge can be overcome; the two-prong approach is consistent with the Supreme Court's KSR v. Teleflex, 2007 (KSR) decision. The showing is illustrated with the analysis of new molecular entities in the proton-pump inhibitor family.

Harnessing the catabolic versatility of Gordonia species for detoxifying pollutants.

The genus Gordonia includes variedly pigmented aerobic, non-motile, non-sporulating Gram positive (sometimes variable) coccoid forms and rods. Different isolates display distinguishing physiological traits and biochemical properties that are significant in remediation applications. Strains inherently prevalent in soils, seawater, sediments and wastewaters can degrade hydrocarbons. Immobilized cells and microbial consortia containing Gordonia species have been used for in situ applications. Hydrocarbon uptake in this Actinomycete is mediated by attachment to large droplets or by pseudosolubilization of substrates. Hydrocarbons so internalized are degraded by relevant enzymes that are innately present in this microorganism. Wild-type and recombinant strains also mediate desulfurization of polyaromatic sulfur heterocyclic compounds. This organism is metabolically capable of bringing about detoxification of phthalate esters. Two species namely, Gordonia polyisoprenivorans and Gordonia westfalica mediate degradation of rubber and the metabolic pathways involved in the process have been well-understood. Some members are able to transform nitriles into commercially valuable products and others degrade the explosive hexahydro-1,3,5-trinitro-1,3,5-triazine. Cholesterol, pyridine derivatives, fuel oxygenates, thiodiglycol, bis-(3-pentafluorophenylpropyl)-sulfide and 6:2 fluorotelomersulfonate are also biotransformed or degraded by Gordonia species. Some members of this genus are significant in the treatment of wastewaters including those that are rich in steroids and lignin. There are also several patents highlighting the commercial relevance of this genus. On account of its diverse catabolic properties, this Actinomycete has become important in bioremediation of polluted environments.

Alizarin interaction with sickle hemoglobin: elucidation of their anti-sickling properties by multi-spectroscopic and molecular modeling techniques.

Polymerization of hemoglobin S is a major cause of morbidity and mortality in sickle cell disease, which leads to sickling and destruction of red blood cell. Alizarin, a bioactive compound from Rubia cordifolia, is reported to be blood purifier. This study investigates the potential of alizarin as an anti-sickling agent, showing a significant decrease in the rate of polymerization, therefore inhibiting the rate of sickling with increasing concentration. Interaction studies indicated that the fluorescence intensity of sickle hemoglobin (Hb S) decreases gradually with increasing alizarin concentration. This suggests the static quenching, where binding constant and the number of binding sites were deduced at different temperatures. The negative values of Gibbs energy change (ΔG0) strongly suggest that it is entropy-driven spontaneous and exothermic reaction. Negative enthalpy (ΔH0) and positive entropy (ΔS0) stipulated that hydrogen and hydrophobic bonding forces were interfering in a hydrophobic micro-environment of ß6Val leading to Hb S polymerization inhibition. In circular dichroism (CD) spectra, Hb S in the presence of alizarin shows helical structural changes leading to destabilization of Hb S polymer. These findings were also supported by molecular docking simulation studies using DOCK6 and GROMACS. So, from these findings, we may conclude that alizarin interacts with Hb S through hydrogen bonding and leading to inhibition of Hb S polymerization. Consequently, alizarin may have potential use as an anti-sickle cell medication for sickle cell disorder. Communicated by Ramaswamy H. Sarma.

A pilot study on machine learning approach to delineate metabolic signatures in intellectual disability.

Intellectual disability (ID) is a neurodevelopmental disorder characterized by cognitive delays. Inborn errors of metabolism constitute an important subgroup of ID for which various treatments options are available. We aimed to identify potential biomarkers of inherited metabolic disorders from the children with ID using tandem mass spectrometry and develop a novel machine learning algorithm to differentiate between the cases and the controls. All of the cases were having IQ score <70, gross motor delay, speech disorder and no recognizable symptoms of the condition. Metabolite profiling of ID individuals exhibited low tyrosine/large neutral amino acids, high citrulline/arginine ratios; elevated proline, alanine, phenylalanine, and ornithine, while a significant decrease in the level of amino acid arginine, and elevated C4 (butyrylcarnitine) and C4OH/C3DC (3-hydroxybutyrylcarnitine/malonylcarnitine). Machine learning algorithm differentiated cases and controls efficiently using specific thresholds of ornithine, arginine and C4OH/C3DC. Furthermore, ID cases were distinguished into mild, moderate, and severe based on specific thresholds of methionine, arginine, and C5OH/C4DC (3-hydroxyisovalerylcarnitine/methylmalonylcarnitine). The machine learning algorithm could successfully identify specific metabolite markers in ID and correlate the same with neurological features.

Secondary patents in the pharmaceutical industry: missing the wood for the trees?

INTRODUCTION: The critics of the Innovator pharmaceutical industry allege that secondary patents are trivial modifications over the primary patent, which extend its term and delay the entry of the generics in the market place. The protagonists regard secondary patents a result of continuous research and development (R&D), which help them introduce and protect new, differentiated products. AREAS COVERED: The areas covered are Product life cycle management (PLCM), Drug approval process, Orange book (OB) listed patents, US patent data. EXPERT OPINION: Our analysis of the patents and products of four innovators viz., AstraZeneca, Takeda, Eisai and Wyeth in the field of proton pump inhibitors (PPI's) and Merck and Pfizer in the field of Statins shows that secondary patents help innovators sustain competition against other innovators in the specific product segment. The number of secondary patents listed in OB per NCE depends on the innovators interest in exploiting the NCE, the success of R & D effort and product lifecycle management strategy in the wake of market competition. Market entry decisions of innovators are strategic rather than a mere fallout of the secondary patents granted. Entry of another innovator is more unpredictable and hurts the first entrant more vis a vis the entry of generics who can enter the market when the patents protecting a product are no more enforceable, and hence more predictable. Generic entry in the field of PPI's shows that the term of the primary patent is not extended by the secondary patents.

A novel inhibition based biosensor using urease nanoconjugate entrapped biocomposite membrane for potentiometric glyphosate detection.

A potentiometric biosensor based on agarose-guar gum (A-G) entrapped bio-nanoconjugate of urease with gold nanoparticles (AUNps), has been reported for the first time for glyphosate detection. The biosensor is based on inhibition of urease activity by glyphosate, which was measured by direct potentiometry using ammonium ion selective electrode covered with A-G-urease nanoconjugate membrane. TEM and FTIR analysis revealed nanoconjugate formation and its immobilization in A-G matrix respectively. The composite biopolymer employed for immobilization yields thin, transparent, flexible membrane having superior mechanical strength and stability. It retains the maximum activity (92%) of urease with negligible leaching. The conjugation of urease with AUNps allows improvement in response characteristics for potentiometric measurement. The biosensor shows a linear response in the glyphosate concentration range from 0.5ppm-50ppm, with limit of detection at 0.5ppm, which covers maximum residual limit set by WHO for drinking water. The inhibition of catalytic activity of urease nanoconjugate by gyphosate was confirmed by FTIR analysis. The response of fabricated biosensor is selective towards glyphosate as against various other pesticides. The biosensor exhibits good performance in terms of reproducibility and prolonged storage stability of 180days. Thus, the present biosensor provides an alternative method for simple, selective and cost effective detection of glyphosate based on urease inhibition.

An insight into the ecology, diversity and adaptations of Gordonia species.

The bacterial genus Gordonia encompasses a variety of versatile species that have been isolated from a multitude of environments. Gordonia was described as a genus about 20 years ago, and to date, 39 different species have been identified. Gordonia is recognized for symbiotic associations with multiple hosts, including aquatic (marine and fresh water) biological forms and terrestrial invertebrates. Some Gordonia species isolated from clinical specimens are known to be opportunistic human pathogens causing secondary infections in immunocompromised and immunosuppressive individuals. They are also predominant in mangrove ecosystems and terrestrial sites. Members of the genus Gordonia are ecologically adaptable and show marked variations in their properties and products. They generate diverse bioactive compounds and produce a variety of extracellular enzymes. In addition, production of surface active compounds and carotenoid pigments allows this group of microorganisms to grow under different conditions. Several isolates from water and soil have been implicated in bioremediation of different environments and plant associated species have been explored for agricultural applications. This review highlights the prevalence of the members of this versatile genus in diverse environments, details its associations with living forms, summarizes the biotechnologically relevant products that can be obtained and discusses the salient genomic features that allow this Actinomycete to survive in different ecological niches.

HPLC, NMR based chemical profiling and biological characterisation of Indian propolis.

The present study aimed to investigate chemical profile, antioxidant and antimicrobial activities of Indian Melifera propolis (IMP) samples collected from 13 different states. Chemical characterisation of ethanolic extracts of IMP (EEMP) samples was carried out by using HPLC and 1HNMR spectroscopy. The antioxidant activity of EEMP samples was measured by DPPH, ABTS, and FRAP assay. Moreover, the antimicrobial activity of each EEMP sample tested against bacteria and yeast using a 96 well plate microdilution method. All EEMP samples had remarkable antioxidant and antimicrobial activities. The antioxidant potential of EEMP samples found to have a moderate positive correlation with their total phenolics and flavonoids content. Majority of EEMP samples had a minimum inhibitory concentration (MIC) ≤1mg/mL against Staphylococcus aureus. Chemometric analysis of 1HNMR data indicated that brown, green, green-brown, red and red-brown coloured IMP samples were chemically distinct from each other, and showed two separate clusters for northern and southern states propolis samples. HPLC analysis confirmed phenethyl caffeate was most common and abundant compound in IMP samples among studied compounds. In conclusion, this study may be helpful for defining the quality of IMP as a raw material, and also in finished food and health care products.

Robot Assisted Repair of Acquired Abdominal Intercostal Hernias (AIH).

Abdominal intercostal hernia (AIH) is a rare clinical entity in which intra-abdominal visceral contents protrude through a defect between adjacent ribs. Most AIH are repaired via (an open or a laparoscopic) transabdominal approach or a thoracotomy. In this paper, the authors present two cases of AIH. Both cases of AIH developed in male patients after severe coughing episodes and demonstrated on computed tomography (CT) to include multiple abdominal viscera. In both cases, a robot-assisted laparoscopic hernia repair was performed utilizing Sepramesh and V-Lock suturing. To our knowledge, these are the first case reports of a robotic approach to repair of AIH. Both cases demonstrate the safety of this approach and expand on novel robotic approaches to ventral hernia repairs. Studies of longer term outcomes from this surgical approach are limited in the literature due to small number of cases and even fewer associated case reports.

Carotenoid stabilized gold and silver nanoparticles derived from the Actinomycete Gordonia amicalis HS-11 as effective free radical scavengers.

The Actinomycete Gordonia amicalis HS-11 produced orange pigments when cultivated on n-hexadecane as the sole carbon source. When cells of this pigmented bacterium were incubated with 1mM chloroauric acid (HAuCl4) or silver nitrate (AgNO3), pH 9.0, at 25°C, gold and silver nanoparticles, respectively, were obtained in a cell associated manner. It was hypothesized that the pigments present in the cells may be mediating metal reduction reactions. After solvent extraction and High Performance Liquid Chromatography, two major pigments displaying UV-vis spectra characteristic of carotenoids were isolated. These were identified on the basis of Atmospheric Pressure Chemical Ionization Mass Spectrometry (APCI-MS) in the positive mode as 1'-OH-4-keto-γ-carotene (Carotenoid K) and 1'-OH-γ-carotene (Carotenoid B). The hydroxyl groups present in the carotenoids were eliminated under alkaline conditions and provided the reducing equivalents necessary for synthesizing nanoparticles. Cell associated and carotenoid stabilized nanoparticles were characterized by different analytical techniques. In vitro free radical scavenging activities of cells (control, gold and silver nanoparticle loaded), purified carotenoids and carotenoid stabilized gold and silver nanoparticles were evaluated. Silver nanoparticle loaded cells and carotenoid stabilized silver nanoparticles exhibited improved nitric oxide (NO) and 1,1-diphenyl-2-picrylhydrazyl (DPPH) scavenging activities compared to their control and gold counterparts. This paper thus reports cell associated nanoparticle synthesis by G. amicalis, describes for the first time the role of carotenoid pigments in metal reduction processes and demonstrates enhanced free radical scavenging activities of the carotenoid stabilized nanoparticles.

Correlation of first-trimester serum levels of pregnancy-associated plasma protein A with small-for-gestational-age neonates and preterm births.

OBJECTIVE: To analyze the relationship between first-trimester levels of pregnancy-associated plasma protein A (PAPP-A) and small-for-gestational-age (SGA) neonates and preterm births, and to assess predictive utility for these events. METHODS: A prospective study was conducted among women undergoing first-trimester screening between January 1, 2012, and December 31, 2013, at two centers in Pune, India. Serum PAPP-A levels, pregnancy course, and outcome were assessed. RESULTS: Overall, 1474 women were included. An association was found between the lowest quintile of PAPP-A levels (<0.4 multiples of median) for both SGA (<10th centile; 20.9% of cases in this PAPP-A quintile) and preterm birth (<37weeks; 15.8%). Women in the lowest quintile of PAPP-A concentration had a significantly increased risk of SGA (<10th centile) than did those with higher concentrations (adjusted odds ratio 2.92, 95% confidence interval 2.00-4.27). Their risk of preterm birth (<37weeks) was also increased (adjusted odds ratio 1.84, 95% confidence interval 1.25-2.72). The predictive sensitivities of the lowest quintile of PAPP-A were 35.85% for SGA (<10th centile) and 27.92% for preterm birth (<37weeks). CONCLUSION: Low levels of PAPP-A were associated with SGA and preterm births; however, poor predictive sensitivity could restrict clinical utility of this marker when used alone.

Association of metabolic syndrome with severity of coronary artery disease.

BACKGROUND: South Asians are more prone to develop metabolic syndrome (MetS). The additive predictive value of components of MetS for cardiovascular diseases is still debated. We undertook this study to evaluate the association of MetS and its components with severity of coronary artery disease (CAD). MATERIALS AND METHODS: Three hundred patients with known coronary disease above the age of 25 years were included in this study. Blood samples were collected for biochemical markers. Patients were stratified into subjects with and without MetS (International Diabetes Federation, IDF, criteria) and severity of CAD (number of vessel involved). RESULTS: Mean age of the patient in the study was 60.9 ± 12.4 years (male, M: 72%; female, F: 28%). MetS was present in 64% patients. Patients with MetS had more severe CAD compared to those without MetS. Triple vessel disease (TVD) was present in 62.5% of patients with MetS compared to 34.3% among without MetS (P < 0.0001). The percent number of patients with TVD showed increasing trend with increasing number of components of MetS (0-0%; 1-20%; 2-27.5%; 3-47.8%; 4-72.6%; 5-78.3%; Chi square for trend < 0.0001). Inflammatory markers [interleukin (IL) 6: 77.67 ± 79.48 vs. 41.21 ± 60.72 pg/ml, P < 0.0001; tumor nuclear factor (TNF)-α: 28.0 ± 47.49 vs 20.43 ± 24.5 pg/ml, P < 0.0001; high sensitive C-reactive protein (hsCRP): 14.30 ± 9.91 vs. 7.02 ± 7.18 mg/L, P < 0.0001], insulin resistance [homeostatic model analysis insulin resistance (HOMA-IR): 22.33 ± 23.37 vs. 10.86 ± 13.90, P < 0.0001] were higher and insulin sensitivity [quantitative insulin check index (QUICKI): 0.26 ± 0.03 vs. 0.30 ± 0.04, P < 0.0001] was significantly lower in subjects with MetS compared to subjects without MetS. Among lipids, total cholesterol were comparable but triglyceride (175 ± 42 vs. 179 ± 48 vs. 180 ± 47 mg/dl, P < 0.0001) was high and high-density lipoprotein (HDL; 44.72 ± 7.63 vs. 39.96 ± 8.70 vs. 36.05 ± 8.84, P < 0.0001) was low in subjects with TVD compared to others. Similarly, percentage of patients with diabetes (7.5% vs. 26.3% vs. 63.7%, P < 0.0001) and hypertension (34.3% vs. 56.6% vs. 77.7%, P < 0.0001) were higher in subjects with TVD compared to others. CONCLUSIONS: There is a strong correlation of MetS and its components with severity of CAD.