Open tendoachilles injuries due to squatting type of toilet seats: Five-year prospective observational study from a tertiary care center in India.

BACKGROUND: Open traumatic tendoachilles injuries due to toilet seats are least reported. The exact mechanism of such injuries is debatable. None of the studies have reported associated neurovascular injuries and the need for microvascular tissue transfer. METHODS: It is a 5-year prospective observational study from Sep 2013 - Aug 2018 at a tertiary care center on 26 patients who had sustained foot injuries due to squatting type toilet seats. All the patients were managed by thorough wound irrigation and debridement followed by repair of cut tendoachilles, other tendons and neurovascular structures. All the complications and secondary procedures required were recorded. Functional outcome was assessed by Boyden clinical outcome score. Follow up ranged from 1 to 5 years. RESULTS: All the 26 patients reported a particular mechanism of injury. Complete transection of tendoachilles was seen in 23 (88.5%) patients and partial transection in three (11.5%) patients. Microvascular repair of cut posterior tibial artery was undertaken in three and posterior tibial nerve in two cases and microvascular parascapular flap in one case for soft tissue reconstruction. Twenty-three (88.5%) patients had good to excellent Boyden score while three patients (11.5%) had fair to poor score at 1 year. Such severe injuries due to toilet seats have never been reported in literature. CONCLUSIONS: Squatting toilet seats can cause devastating foot injuries involving tendons and neurovascular structures and may require microvascular tissue transfer for definitive wound management. The risk of such injuries will continue unless some modifications are undertaken in the design of the seat.

Detection of morphometric differentiation in Sattar snowtrout, Schizothorax curvifrons (Cypriniformes: Cyprinidae) from Kashmir Himalaya using a truss network system

Schizothorax curvifrons is a morphometrically and meristically most variable and economically valuable promising fish food from Kashmir Valley. Since there is a lack of information on stock structure of wild populations on this species, this study was aimed to investigate the intraspecific variation of this important snowtrout. For this, two rivers and one lake in Kashmir Himalaya were sampled from January 2011 to October 2012. Fish body measurements were taken and morphometric characters using the truss network system was constructed. Altogether, 506 fish specimens were collected. Data were subjected to principal component analysis, discriminant function analysis and univariate analysis of variance. The first principal component explained 63.44% of total variation, while second and third components explained 8.34% and 5.31%, respectively. The step-wise discriminant function analysis retained two variables that significantly discriminated the populations. Using these variables 83.4% of the original specimens were classified into their correct groups and 81.1% of the cross-validated (leave one out procedure) specimens were classified into their correct groups. All of the total 31 transformed truss measurements exhibited highly significant (p<0.001) differences between the populations. This represents the first attempt on stock structure of S. curvifrons; therefore, this study will hopefully guide fisheries taxonomists about its current stock structure and would help in its management and conservation programme across Kashmir Himalaya area.

Schizothorax curvifrons es un alimento para peces, morfométricamente y merísticamente más variable y de mayor valor económico del Valle de Kashmir. Dado que existe una falta de información sobre la estructura de las poblaciones silvestres de esta especie, este estudio tuvo como objetivo investigar la variación intraespecífica de esta importante trucha de nieve. Para ello, se tomaron muestras de dos ríos y un lago en Kashmir Himalaya, de enero 2011 a octubre 2012. Con las mediciones de los peces se construyó una red truss. En total, se recolectaron 506 muestras de peces. Los datos se sometieron a análisis de componentes principales, análisis de función discriminante y el análisis univariante de la varianza. El primer componente principal explicó 63.44% de la variación total, mientras que los componentes segundo y tercero explicaron el 8.34% y 5.31%, respectivamente. El análisis discriminante por etapas, retuvo dos variables que discriminaron significativamente las poblaciones. El uso de estas variables de 83.4% de los especímenes originales se clasificaron en sus grupos correctos y 81.1% de la validación cruzada (deja fuera un procedimiento) especímenes fueron clasificados en sus grupos correctos. Todas las mediciones para entramados transformados, del total de 31, mostraron diferencias altamente significativas (p<0.001) entre las poblaciones. Esto representa el primer intento de obtener la estructura de la población de S. curvifrons, por lo tanto, este estudio espera orientar a los taxonomistas de peces acerca de la estructura de la población actual y ayudar en su manejo y poder establecer un programa de conservación en el área de Kashmir Himalaya.

Improved efficacy of low-dose spironolactone and metformin combination than either drug alone in the management of women with polycystic ovary syndrome (PCOS): a six-month, open-label randomized study.

CONTEXT: To improve the treatment outcomes in women with polycystic ovary syndrome (PCOS), various drugs like glitazones, oral contraceptive pills, or antiandrogens have been combined with metformin. OBJECTIVE: The aim of the study was to compare the efficacy of the combination of low-dose spironolactone and metformin with either drug alone in the management of women with PCOS. DESIGN AND SETTING: The present study was an open-label, randomized study conducted at a tertiary care referral center. PATIENTS AND INTERVENTION: Of 204 women who met the 2006 Androgen Excess-PCOS criteria for PCOS, 198 were randomized into 3 equal groups to receive metformin (1000 mg/d), low-dose spironolactone (50 mg/d), or a combination of both drugs for a period of 6 months. A total of 169 subjects (n = 56 metformin, 51 spironolactone, 62 combination) completed the study. MAIN OUTCOME MEASURES: Menstrual cycle pattern, Ferriman-Gallwey score, body mass index (BMI), waist-hip ratio, blood pressure, LH, FSH, total T, glucose and insulin sensitivity indices were measured at baseline (0 mo) and 3 and 6 months after the intervention. Recording of adverse events and drug compliance was assessed at each of the visits. RESULTS: The 3 groups had comparable mean age and BMI at baseline. By 6 months, menstrual cycles/y increased, whereas Ferriman-Gallwey score, serum total T, and area under the curve-glucose and -insulin decreased significantly (P < .05) in the combination group as compared to either drug alone. There was no significant change in body weight, BMI, waist-hip ratio, and blood pressure in any of the 3 groups. The combination group had better compliance than either drug alone, and the adverse event rate was not higher. CONCLUSION: The combination of low-dose spironolactone with metformin seems superior to either drug alone in terms of clinical benefits and compliance in women with PCOS.

Giant cystic Virchow-Robin spaces with adjacent white matter signal alteration.

Perivascular spaces surround the small arteries and veins as they enter into the brain parenchyma from the subarachnoid spaces. Also called as Virchow-Robin spaces, these are prominent in the basal ganglia and high convexity white matter of the elderly. Occasionally VR spaces may get massively enlarged and may mimic a cystic mass lesion. The typical CSF-like signal intensity of the cysts and location on MRI, in the absence of a neurological abnormality help in the diagnosis of the giant VR spaces and thus biopsy is avoided. Typically there is no significant adjacent brain abnormality; however FLAIR images may sometimes reveal perilesional white matter hyperintensity, which may be an indication of gliosis due to the mass effect of the lesion. Such a signal alteration should not deter one from making a diagnosis of giant Virchow-Robin spaces when the rest of the imaging findings are typical. We describe a case of a 50-year-old female with incidental giant Virchow-Robin spaces in the right hemispheric subcortical white matter with adjacent white matter hyperintense signal intensity on T2-weighted and FLAIR images.

Concomitant Rupture of Hydatid Cyst of Liver in Hepatic Duct and Gallbladder: Case Report.

Hydatid cyst liver rupture into the biliary tree may involve the common hepatic duct, lobar biliary branches, the small intrahepatic bile ducts or rarely the gallbladder. Rupture can be occult or frank. A frank intrabiliary rupture of hepatic hydatid cyst is a rare but serious event. The authors are reporting a case of concomitant rupture of hydatid cyst of liver into right hepatic duct and the gallbladder. A 50-year-old female patient who presented with acute cholangitis was confirmed as a case of intrabilary rupture on ultrasonography, endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography. Rupture of hydatid cyst of liver in right hepatic and the gallbladder was confirmed on surgery. Suture repair of cystobiliary fistula, choledochoduodenostomy with cholecystectomy was done.