Mutation of Methionine to Asparagine but Not Leucine in Parathyroid Hormone Mimics the Loss of Biological Function upon Oxidation.

Human parathyroid hormone (PTH) is an 84-amino acid peptide that contains two methionine (Met) residues located at positions 8 and 18. It has long been recognized that Met residues in PTH are subject to oxidation to become Met sulfoxide, resulting in a decreased biological function of the peptide. However, the mechanism of the lost biological function of PTH oxidation remains elusive. To characterize whether the shift from the hydrophobic nature of the native Met residue to the hydrophilic nature of Met sulfoxide plays a role in the reduction of biological activity upon PTH oxidation, we conducted in silico and in vitro site-directed mutagenesis of Met-8 and Met-18 to the hydrophilic residue asparagine (Asn) or to the hydrophobic residue leucine (Leu) and compared the behavior of these mutated peptides with that of PTH oxidized at Met-8 and/or Met-18. Our results showed that the biological activity of the Asn-8 and Asn-8/Asn-18 mutants was significantly reduced, similar to Met-8 sulfoxide and Met-8/Met-18 sulfoxide analogues, while the functions of Asn-18, Leu-8, Leu-8/Leu-18 mutants, or Met-18 sulfoxide analogues were similar to wild-type PTH. This is rationalized from molecular modeling and immunoprecipitation assay, demonstrating disruption of hydrophobic interactions between Met-8 and Met-18 of PTH and type-1 PTH receptor (PTHR1) upon mutation or oxidation. Thus, these novel findings support the notion that the loss of biological function of PTH upon oxidation of Met-8 is due, at least in part, to the conversion from a hydrophobic to a hydrophilic residue that disrupts direct hydrophobic interaction between PTH and PTHR1.

Role of Platelet-rich Plasma in the Healing of Impacted Third Molar Socket: A Comparative Study on Central India Population.

AIM: The aim of the study was to compare the healing and osseous regeneration of mandibular third molar extraction sockets with and without platelet-rich plasma (PRP) with the evaluation of clinical objectives such as pain, swelling, trismus, soft tissue healing, pocket depth distal to second molar and radiological evaluation of the bony density in the postextracted third molar socket. MATERIALS AND METHODS: In this prospective study, 100 patients were selected by the random sampling method from the outpatient department of oral and maxillofacial surgery in the year 2016-2017. Patients were equally allocated into intervention (transalveolar extraction followed by PRP placement) and nonintervention (transalveolar extraction without PRP placement) group as group I and group II, respectively, and evaluation parameters were considered accordingly. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 15.0 (IBM, USA) statistical analysis software. RESULTS: The pain score of patients of group I (non-PRP) was found to be higher as compared to group II (with PRP). Mean trismus of patients of group II was found to be higher than that of group I at postoperative day 7, but this difference was not found to be statistically significant. Swelling at T-Sn (Tragus-Subnasale) and T-Pog (Tragus-Pogonion) was higher among patients of group I as compared to group II. Healing in group II was two to three times faster than group I. Healing among patients of group I and group II was found to be statistically significant. The mean pocket depth of patients of group I was found to be significantly higher than that of group II at follow-up of 1 and 2 months. The bone density of patients of group II was found to be significantly higher than that of group I at 3 months and 6 months follow-up. CONCLUSION: The procedure of PRP preparation is simple and cost-effective, and can be prepared at the point of care. It had a significant impact on the postoperative healing of the third molar socket. CLINICAL SIGNIFICANCE: The use of PRP application increases the bone density, healing process, and improvement in the pain and swelling, and there was a definite reduction in trismus and periodontal probing depth after the impacted mandibular wisdom teeth extraction.

Age-related erosion of obstacle avoidance reflexes evoked with electrical stimulation of tibial nerve during walking.

In young healthy adults, characteristic obstacle avoidance reflexes have been demonstrated in response to electrical stimulation of cutaneous afferents of the foot during walking. It is unknown whether there is an age-related erosion of this obstacle avoidance reflex evoked with stimulation to the tibial nerve innervating the sole of the foot. The purpose of this study was to identify age-dependent differences in obstacle avoidance reflexes evoked with electrical stimulation of the tibial nerve at the ankle during walking in healthy young and older (70 yr and older) adults with no history of falls. Toe clearance, ankle and knee joint displacement and angular velocity, and electromyograms (EMG) of the tibialis anterior, medial gastrocnemius, biceps femoris, and vastus lateralis were measured. A significant erosion of kinematic and EMG obstacle avoidance reflexes was seen in the older adults compared with the young. Specifically, during swing phase, there was reduced toe clearance, ankle dorsiflexion, and knee flexion angular displacement in older adults compared with the young as well as changes in muscle activation. These degraded reflexes were superimposed on altered kinematics seen during unperturbed walking in the older adults including reduced toe clearance and knee flexion and increased ankle dorsiflexion compared with the young. Notably, during mid-swing the toe clearance was reduced in the older adults compared with the young by 2 cm overall, resulting from a combination of 1-cm reduced reflex response in the older adults superimposed on 1-cm less toe clearance during unperturbed walking. Together, these age-related differences could represent the prodromal phase of fall risk. NEW & NOTEWORTHY This study demonstrated age-dependent erosion of obstacle avoidance reflexes evoked with electrical stimulation of the tibial nerve at the ankle during walking. There was significant reduction in toe clearance, ankle dorsiflexion, and knee flexion reflexes as well as changes in muscle activation during swing phase in older adults with no history of falls compared with the young. These degraded reflexes, superimposed on altered kinematics seen during unperturbed walking, likely represent the prodromal phase of fall risk.

Characterization of EccA3, a CbbX family ATPase from the ESX-3 secretion pathway of M. tuberculosis.

EccA family proteins are conserved components of ESX secretion pathways in M. tuberculosis H37Rv. Here, we report the characterization of EccA3 (Rv0282), a CbbX family AAA (ATPases Associated with diverse cellular Activities) protein from the ESX-3 pathway that is required for in vitro growth of mycobacteria, secretion of virulence factors, and acquisition of iron and zinc. EccA3 is a thermostable ATPase with a molecular weight of ~68kDa. It exists as a dodecamer in the apo form and associates as a hexamer in the presence of ATP. Its C-terminal region consists of a CbbX-like AAA-domain while the N-terminal region contains a tetratricopeptide repeat (TPR) domain with lower homology to other EccA-type proteins. Further, the C-terminal domain functions as the oligomerization domain and also exhibits ATPase activity. Mutational analysis, steady state kinetics and molecular docking studies identify R573 as the important 'sensor arginine' and R505 as an 'arginine finger' in EccA3. Dynamic fluorescence quenching experiments suggest that the N-terminal domain moves closer to the C-terminal domain upon ATP-binding. The ATP-dependent 'open-close' relative movements of the two domains might help EccA3 interaction and secretion of essential virulence factors.

Hydrogen peroxide test for intraoperative bile leak detection.

BACKGROUND: Bile leakage (BL) is a common complication following liver surgery, ranging from 3 to 27% in different series. To reduce the incidence of post-operative BL various BL tests have been applied since ages, but no method is foolproof and every method has their own limitations. In this study we used a relatively simpler technique to detect the BL intra-operatively. Topical application of 1.5% diluted hydrogen peroxide (H2O2) was used to detect the BL from cut surface of liver and we compared this with conventional saline method to know the efficacy. METHODS: A total of 31 patients included all patients who underwent liver resection and donor hepatectomies as part of Living Donor Liver Transplantation. After complete liver resection, the conventional saline test followed by topical diluted 1.5% H2O2 test was performed on all. RESULTS: A BL was demonstrated in 11 patients (35.48%) by the conventional saline method and in 19 patients (61.29%) by H2O2 method. Statistically compared by Wilcoxon signed-rank test showed significant difference (P = 0.014) for minor liver resections group and (P = 0.002) for major liver resections group. CONCLUSION: The topical application of H2O2 is a simple and effective method of detection of BL from cut surface of liver. It is an easy, non-invasive, cheap, less time consuming, reproducible, and sensitive technique with no obvious disadvantages.

Rv3868 (EccA1), an essential component of the Mycobacterium tuberculosis ESX-1 secretion system, is thermostable.

Rv3868 (EccA1) is an essential CbxX/CfqX-family ATPase of the Mycobacterium tuberculosis ESX-1 secretion system. Previously, we demonstrated that Rv3868 is composed of two domains; a regulatory N-terminal domain (NT-Rv3868) and an ATP binding C-terminal domain (CT-Rv3868). In the present report, chemical denaturation studies show that electrostatic interactions stabilize the Rv3868. Interestingly, Rv3868 has notable heat stability and retains about 50% of ATPase activity even at 60°C. The C-terminal domain was found to be important for the heat stability as demonstrated by both enzymatic activity assays and thermal denaturation experiments. Furthermore a structure-sequence analysis based on the content of charged and aliphatic amino acids rationalizes the higher propensity of Rv3868 for thermophilic characteristics.

Donor outcome in live-related liver transplantation.

BACKGROUND: Live donor liver transplant has become an accepted, effective and lifesaving alternative to deceased donor transplant. The effect on donor and his safety remains a cause of concern. The donors are all in productive age and in our setting may have to go back to active service. This study is aimed at knowing the results of donor hepatectomies at our centre. METHODS: Data of all donor hepatectomies done at our centre from Apr 2007 to Jun 2013 reviewed. This included the preoperative workup, operative details and postoperative follow-up. RESULTS: 35 Donors of age between 20 and 50 years were taken up for procedure of which one was abandoned due to haemodynamic instability after intubation. In the 34 procedures done the percentage of the residual liver was at least 30%. No donor required blood transfusion. The overall complication rate was 26.5% which was stratified according to the modified Clavien classification of postoperative complications. There was transient rise of bilirubin and liver enzymes in all which returned back to normal with time. Infections were the most common cause of complication. All the donors had gone back to their work after a mean of 42 days after surgery. All donors were willing to donate again if needed. CONCLUSION: Living donor liver transplant a widely practiced modality for end-stage liver disease. It is a safe procedure with good recovery and results. Our study shows that meticulous selection criteria and strict adherence to protocols leads to good outcome.

Oral fibrolipoma: A rare clinicopathological entity.

Fibrolipoma, a subtype of lipoma, is a painless, well-circumscribed, slow-growing, submucosal benign adipocyte tumour. It is uncommon in the oral cavity and oropharyngeal region. It accounts for 1.6% of all facial lipomas. Fibrolipomas mostly affect the buccal mucosa and buccal vestibule and cause functional and cosmetic disabilities. The diagnosis and differentiation of fibrolipoma with clinically similar lesions such as fibroma and pleomorphic adenoma are very essential for a correct treatment plan and complete follow-up. Here, we present fibrolipoma, a very rare subtype of lipoma involving the buccal mucosa of the left premolar region in a 44-year-old male patient.

Assessment of soft- and hard-tissue changes following combined anterior segmental bi-jaw orthognathic surgery.

Background: Anterior segmental Bi-jaw orthognathic surgery is indicated primarily for the correction of dentoalveolar protrusion. They are also indicated for correcting apertognathia, closing interproximal spaces between segments and can be incorporated with other osteotomies to obtain better results. Aim: The aim of this study was to analyze and compare the soft- and hard-tissue changes in patients who underwent combined anterior segmental bi-jaw orthognathic surgery. Settings and Design: To compare and evaluate soft- and hard-tissue changes before and after combined anterior segmental bi-jaw orthognathic surgery by assessing (a) parameters in vertical dimension and (b) parameters in horizontal dimension and patient satisfaction was also assessed following surgery at 6 months' time interval. Materials and Methods: It is a prospective, single center and analytical study with sample size of 20 patients. It required routine setup for orthognathic surgery and manual tracing of lateral cephalograms. The surgical outcomes were assessed by hard tissue (Sella Nasion Point A (SNA) angle, Sella Nasion Point B (SNB) angle, Point A Nasion Point B (ANB) angle, NAPg, U1-NF, L1-MP angles; NA, NB, B-Pg, Nasion-Anterior nasal spine (N-ANS) distance, Anterior nasal spine-Gnathion (ANS-Gn) distance, and overjet and overbite) and soft tissue (facial convexity, NL, LM angles; LM fold, UL and LL protrusions, Upper lip length (ULL), Lower lip length (LLL), Sn-A, Si-B, Pg-Pg*, Ls-U1, Li-L1 distances, interlabial gap, and U1 exposure) variables pre and postsurgery. Statistical Analysis: Descriptive statistics involved the mean and standard deviation, and recorded data were subjected to the statistical analysis using IBM SPSS 20 statistical package. The paired t-test, Pearson correlation coefficient were used. The level of significance P < 0.05 was taken as statistically significant and P < 0.01 as very significant. Results: Overall improvement after surgery in both hard- and soft-tissue parameters was observed and significant changes were seen in every variable, except Si-B (P > 0.05). Correlations between soft- and hard-tissue changes were significant in both sagittal and vertical planes. Patients' satisfaction score showed that all patients had the high overall rate of satisfaction. Conclusions: Our study concludes that combined anterior segmental bimaxillary orthognathic surgery is a simple technique with minimal postoperative complications and limited relapse. The changes in facial esthetics and occlusion following orthognathic surgery depend highly on the stability achieved during the postoperative period.

A Prospective Study on Autotransplantation of Mandibular Third Molars With Complete Root Formation.

Study Design: Autotransplantation, if possible, is a viable option for replacing a missing tooth when a donor tooth is available. The most typical tooth transplant is the transfer of a third molar to a first molar site. No immune reaction results from transplants of this nature. It restores the proprioceptive function and normal periodontal healing; thus, the patient can have a natural chewing feeling and natural biological response. Objective: This study aims to evaluate the prognosis of autotransplanted mandibular third molar and also to evaluate the cost effectiveness of the treatment performed when compared to the other treatment modalities for prosthetic rehabilitation. Methods: A prospective study was done in the Department of Oral & Maxillofacial Surgery, Sardar Patel Post Graduate Institute of Dental & Medical Sciences, Lucknow, UP, India, with over 20 patients to evaluate the prognosis of autotransplanted mandibular third molars with complete root formation after atraumatic extraction of first or second mandibular molar, which were randomly selected irrespective of race, sex, caste, and socio-economic status. Regular clinical and radiographical examinations were performed over a period of 1 year and the patients were assessed for pain, swelling, infection, dry socket, periodontal pocket depth, ankylosis, root resorption, tooth mobility, and level of buccal bone in relation to cementoenamel junction (CEJ). Results: Eighteen out of 20 transplants were successful; only 2 mandibular transplants were extracted because of abnormal horizontal and axial mobility and the reason of failure was attributed to fact that the roots of transplant were short and conical and there was lack of alveolar bone height at the recipient site in one patient, while root resorption was the reason for failure of transplant in the other patient. Conclusions: This study assessed the efficacy of autotransplantation of molars and the viability of the procedure to replace unrestorable molar teeth; it also supports the hypothesis that transplantation of a mandibular third molar for replacement of a lost or seriously damaged molar tooth could be a reasonable alternative.

A Retrospective Cohort Study of 45 Cases Treated With Surgery First Approach in Orthognathic Surgery and a Short Review.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The purpose of this study was to evaluate and share our experience with the surgery first approach (SFA) for correction of skeletal malocclusion. METHODS: After consultation with the department of orthodontics, 45 patients with skeletal malocclusions suitable to undergo SFA were enrolled in this study (14 bimaxillary protrusion and 31 skeletal class III malocclusion). Le Fort I maxillary osteotomy, bilateral sagittal split ramus osteotomy, subapical osteotomy, and genioplasty were performed as required. After a healing period of 2 weeks, postoperative orthodontic treatment was started to achieve the final occlusion. RESULTS: The mean duration of postoperative orthodontic treatment was 15.2 months, which is much shorter than the conventional orthodontic first approach (OFA) where presurgical orthodontic duration alone takes 12-24 months according to an individual. In the bimaxillary protrusion group, it was 18 months, which was significantly longer than for the other group (P < .05). CONCLUSIONS: SFA offers an efficient alternative to conventional OFA with shorter total treatment duration, immediate marked improvement in facial profile, reduced biological costs, and similar operative stability. However, it comes at the cost of heightened challenges regarding case selection, accurate prediction, and surgical precision. With a joint venture between skilled and experienced surgeons and orthodontists, the outcome can be very promising.

Comparative Evaluation of Hypotensive and Normotensive Anesthesia on LeFort I Osteotomies: A Randomized, Double-Blind, Prospective Clinical Study.

INTRODUCTION: Orthognathic surgery can account for a considerable amount of blood loss since the vascularization of maxillofacial region is such that major bleeding can occur. Intra-bony bleed is often involved as a major aspect of blood loss associated with osteotomies, especially LeFort I osteotomy when performed during orthognathic surgery. This study evolved as a result of the increasing concern to attain a clear surgical field and reduce the duration of surgical procedure and the amount of blood loss associated with orthognathic surgery with the use of controlled hypotension. METHOD: Twenty patients planned for undergoing LeFort I osteotomy were randomly allocated into two groups (Group 1-normotensive anesthesia; Group 2-hypotensive anesthesia). The amount of blood loss, mean difference between hemoglobin and hematocrit in the preoperative and postoperative period, and quality of surgical field were evaluated for patients in the two groups. CONCLUSION: Comparative analysis of the various parameters showed a statistically significant improvement in the hypotensive group when compared to normotensive group, although the duration of surgery and postoperative morbidity were not significantly affected when controlled hypotension was used.

Teleassistance and teleconsultation using smartphones and its contribution in clinical progress of oral and maxillofacial surgery.

Smartphones, an advanced mobile device having combined function of a computer and cellular phone, have become an effective communication within and between specialties for management of patients. It provides voice, text, multimedia messages, camera, and E-mail option and helps the surgical team to communicate with each other. The application of computer technology in the field of cranio and maxillofacial surgery opened a new perspective in the preoperative planning and accurate intraoperative realization of treatment concept. A PubMed, EMBASE, and Web of science search of the English literature were done to review the English literature on teleassistance and teleconsultation using smartphones and its contribution in clinical progress of oral and maxillofacial surgery. Fifteen articles were found the relevant data were extracted and tabulated. Conclusion was drawn that teleconsultation using smartphones is a useful tool for specialized consultation, diagnosis, treatment, and follow-up in remote areas. With technological evolution, new methods of delivering better health-care facilities can be possible with the help of smartphones.

Clinical Profile, Yield of Cartridge-based Nucleic Acid Amplification Test (GeneXpert), and Outcome in Children with Tubercular Meningitis.

BACKGROUND: GeneXpert MTB/RIF is a test for early, rapid diagnosis of tubercular meningitis (TBM). AIM: The aim of this article was to study the clinical profile, radiological features, yield of GeneXpert, neurosurgical interventions, and outcome of TBM in children. SETTINGS AND DESIGN: This was a retrospective and prospective observational study. MATERIALS AND METHODS: Diagnosis was based on the uniform research definition criteria and was staged according to the British Medical Research Council. Mantoux test, analysis of cerebrospinal fluid (CSF), CSF GeneXpert, and radiological investigations were performed. RESULTS: Of 36 patients, 50% were aged 1-5 years. Fever (100%), headache (82%), altered sensorium (80%), and vomiting (66%) were common features. Twelve (33%) had contact with active case of tuberculosis; 32 received Bacille Calmette Guarin vaccination. Neurological features included severe deterioration in sensorium (Glasgow Coma Scale < 8) (38%), mild and moderate deficit in sensorium (31%), hemiparesis (41%), and involvement of sixth (25%) and seventh (22%) cranial nerves. Cerebral vision impairment (25%), papilledema (25%), and dystonia (22%) were other findings. CSF GeneXpert was positive in 37% (12/33) patients. Hydrocephalus and basal exudates (75%) were noted on neuro-imaging. Surgical intervention was performed in children with hydrocephalus (13/27). Omayya reservoir was placed in seven children, of which five needed conversion to ventriculoperitoneal (VP) shunt; direct VP shunt was carried out in six (6/13). Good outcome was noted in 78% at discharge. Stage III TBM (P = 0.0001), cerebral infarcts (P = 0.0006), and motor deficits (P = 0.03) were associated with poor outcome. Sequelae included learning difficulties with poor scholastic performance (31.5%). CONCLUSION: GeneXpert has high diagnostic specificity, but negative results do not rule out TBM. CSF GeneXpert provided quick results. Placement of Ommaya reservoir in TBM stage II and III with hydrocephalus was not successful. Hydrocephalus was managed conservatively with success (53%).

Lip synechiae: A rare complication of azithromycin-associated Stevens-Johnson syndrome.

Stevens-Johnson syndrome (SJS) is a severe form of erythema multiforme, is a self-limiting acute inflammatory disease of multifactorial origin, but can also present as a chronic recurrent lesion. It causes a whole plethora of lesions, mostly mucocutaneous. It is a dermatologic emergency that occurs with a spectrum of severity and can result in severe morbidity and mortality. Lip adhesion is an unusual complication of healing in the lesions of SJS, for which only a few cases have been reported till date which not only causes esthetic morbidity but also impairs the proper functioning of the patient. The importance of this lesion also lies in its multifactorial and varied origin, this being the first case to report azithromycin as a causative drug, leading to SJS associated with lip adhesion. In this paper, we present a case report of SJS with lip adhesion, azithromycin being the causative drug, which was treated surgically with chalinoplasty. Along with it, the clinical features, its pathogenesis, the preventive measures, and the treatment modalities for the same including conservative as well as surgical have also been extensively discussed with a review of the existing English literature to date.

Comparative Evaluation between Single Noncompression Miniplate and Two Noncompression Miniplates in the Treatment of Mandibular Angle Fractures.

This study was conducted to compare the outcome of single noncompression miniplate versus two noncompression miniplates in the treatment of mandibular angle fracture. A total of 40 patients were divided into two groups: Group I ( n = 20), patients were treated by single miniplate at superior border of mandible by intraoral approach; Group II ( n = 20), patients were treated by one miniplate at superior border of mandible, intraorally, and another at the lateral aspect of angle, transbuccally by trocar and cannula. Comparative evaluation was done at 1, 2, 4, 6, and 12 weeks and 6 months. The findings of this study suggest that there was no significant difference in postoperative complications (malocclusion, pain, swelling, infection, facial nerve injury, wound dehiscence, plate exposure) and bite force between the two groups.

Collagen Membrane Over Buccal Fat Pad Versus Buccal Fat Pad in Management of Oral Submucous Fibrosis: A Comparative Prospective Study.

OBJECTIVE: The objective of this study was to assess the effectiveness of collagen membrane as biological dressing over buccal fat pad (BFP) during crucial postoperative healing phase in the surgical management of oral submucous fibrosis (OSMF). STUDY DESIGN: The study comprised of 40 patients of OSMF of group IVa (Khanna and Andrade). Patients were randomly divided in two groups (20 patients in each group). Group I patients were treated using buccal fat pad only, whereas collagen membrane was used as a covering over harvested BFP in group II patients. Postoperative follow-up was done at 1 week, 3 weeks, 6 months and 1 year. RESULT: Mean postoperative mouth opening achieved in both the groups was comparable at every follow-up visit. Infection was evident in four patients of group I at 1-week follow-up, whereas none of the group II patients developed infection. Pain score was lesser in group II patients as compared to group I. Relapse was seen in two patients in group I and one patient in group II. Time taken for epithelialization was 2-3 weeks in both the groups. CONCLUSION: Although intraoperative time was increased in group II application of collagen membrane reduced infection when compared with group I. Also, the chances of damage to BFP are reduced during the hygiene maintenance at surgical site and jaw-opening exercise. Reduction in pain scores during postoperative period in group II patients was an additional advantage.

Role of sclerotherapy in management of vascular malformation in the maxillofacial region: Our experience.

The management of vascular anomalies is an extremely challenging area and is as divergent as the nature of lesions. Traditionally, embolization with the resection of the lesion has been used. The purpose of this report is to present cases treated successfully using sclerosing solution injections alone. Management of the vascular malformation using intralesional injections of sodium tetradecyl sulfate to the lesion is discussed. The procedure was performed two times at 2 weeks interval. Complete resolution of the lesion was found following sclerotherapy. Conservative interventional management using intralesional injection of sclerosing solution was successful in treating vascular anomaly.

The effect of laparoscopic sleeve gastrectomy (LSG) on glycemic control in morbidly obese patients.

INTRODUCTION: Bariatric procedures have become popular in treating not only the morbid obesity but also the metabolic derangements. Sleeve Gastrectomy has recently become popular as a standalone procedure and its usefulness as a metabolic procedure especially glycemic control is still under investigation. One of the most commonly used measure of insulin resistance is statistically derived 'Homeostatic model assessment of insulin resistance (HOMA-IR). AIM: The effect of Laparoscopic Sleeve Gastrectomy (LSG) on clinical and measurable change in glycemic control as seen by reduction of insulin resistance ie HOMA-IR levels in morbidly obese patients. MATERIAL AND METHODS: All the patients with BMI ≥35 kg/m(2) with co morbidities and BMI ≥40 kg/m(2) even without co morbidities were included in the study. The period of the study was from Feb 2013 to Sep 2014. Fasting (FBS), post prandial blood sugar (PPBS) and Insulin levels were checked before the surgery, 1month and 3 month after the surgery. We also recorded BMI and diabetic status. HOMA-IR was calculated and trends were recorded. STATISTICAL ANALYSIS: Statistical analysis was carried out using SPSS 16.0. RESULTS: Out of 28 patients 8 were males and 20 were females. The mean age was 43 yrs. 11 (39%) patients were diabetic and mean BMI was 44 kg/m(2) and a range of (35-61.3) kg/m(2). 11 patients had BMI > 45 kg/m(2). The HOMA-IR values decreased significantly after the surgery both in diabetics and non diabetics. CONCLUSION: LSG results in improvement in glycemic control in both diabetics and non diabetics.

Droplets on posterior surface of intraocular lens in silicone oil filled eye.

Silicone oil adherence to silicone IOLs after silicone oil removal is a known complication in pseudophakic patients. Droplet removal is difficult and may require IOL exchange. We describe two cases in which silicone oil droplets were observed early in the postoperative period in PMMA pseudophakic eyes and disappeared during silicone oil-fluid exchange--a phenomenon that has not been reported earlier in human PMMA pseudophakic eyes.