The effectiveness of vertical drop jumps (VDJs) to screen for non-contact ACL injuries is unclear. This may be contributed to by discrete point analysis, which does not evaluate patterns of movement. Also, limited research exists on the second landing of VDJs, potential lower limb performance asymmetries and the effect of fatigue. Statistical parametric mapping investigated the main effects of landing, limb dominance and a high intensity, intermittent exercise protocol (HIIP) on VDJ biomechanics. Twenty-two male athletes (21.9 ± 1.1 years, 180.5 ± 5.5 cm, 79.4 ± 7.8 kg) performed VDJs pre- and post-HIIP. Repeated measures ANOVA identified pattern differences during the eccentric phases of the first and second landings bilaterally. The first landing displayed greater (internal) knee flexor (η = 0.165), external rotator (η = 0.113) and valgus (η = 0.126) moments and greater hip (η = 0.062) and knee (η = 0.080) flexion. The dominant limb generated greater knee flexor (η = 0.062), external rotator (η = 0.110) and valgus (η = 0.065) moments. The HIIP only had one effect, increased thoracic flexion relative to the pelvis (η = 0.088). Finally, the dominant limb demonstrated greater knee extensor moments during the second landing (η = 0.100). ACL injury risk factors were present in both landings of VDJs with the dominant limb at potentially greater injury risk. Therefore, VDJ screenings should analyse both landings bilaterally.
In heart failure, fluid overload is a major pathological mechanism leading to vascular congestion, pulmonary congestion and elevated jugular venous pressures. Diuretics play a significant role in the management of patients with congestive heart failure. It is used to relieve the congestive symptoms of heart failure. However, the appropriate use of diuretics remains challenging due to various complications like electrolyte abnormalities, worsening renal function and diuretic resistance. This has prompted towards the search of safer and effective alternatives. This review evaluates the use of diuretics in congestive heart failure and discusses the complications of different types of diuretics, which is essential for successful management of congestion in patients with heart failure and hence to optimise the outcome for the patients.
Aortic arteriovenous malformations (AVMs) are rare vascular anomalies where the aorta communicates with adjacent venous structures, bypassing the capillary system. We report a case of a neonate born at 34 weeks gestation who presented at 3 weeks of life in respiratory distress. Echocardiography demonstrated severe pulmonary hypertension with right ventricular dilatation but an otherwise structurally normal heart. Clinical examination revealed a pulsatile abdominal mass with an audible bruit.
Abdominal ultrasound was performed and it demonstrated a large cystic mass arising from the inferior vena cava (IVC) with both arterial and venous vascular flow within it. Further evaluation with magnetic resonance angiography (MRA) showed a massive arteriovenous malformation from both left and right iliac arteries, and lumbar arteries communicating with the IVC. A decision was made with interventional radiology to attempt coiling of the vascular lesion. Following this procedure his pulmonary hypertension worsened in severity, culminating in acute heart failure and multi-organ dysfunction. A subsequent interventional radiology procedure found that there was no blood flow to his bowel or abdominal viscera. Cardiac arrest followed with an unsuccessful attempt at resuscitation. This case describes a presentation of severe pulmonary hypertension initially considered to be secondary to either congenital heart disease or intrinsic pulmonary disease, but which was found to be as a result of a very rarely occurring massive aortic AVM.
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