Combining loop with thiazide diuretics in patients discharged home after a heart failure decompensation: Association with 30-day outcomes.

Objective: To investigate the association of the addition of thiazide diuretic on top of loop diuretic and standard of care with short-term outcomes of patients discharged after surviving an acute heart failure (AHF) episode.

Methods: This is a secondary analysis of 14,403 patients from three independent cohorts representing the main departments involved in AHF treatment for whom treatment at discharge was recorded and included loop diuretics. Patients were divided according to whether treatment included or not thiazide diuretics.

The objective structured clinical examination (OSCE): Main aspects and the role of imaging.

The objective structured clinical examination (OSCE) is a format of examination that enables students to be evaluated in a uniform, standardized, reliable, and objective way. It is carried out in different clinical stations that simulate real clinical situations and scenarios. Numerous universities in Spain and other countries employ this approach for the final examination for medical school students.

Anterior Cruciate Ligament Reconstruction Using Combined Graft of Hamstring and Fascia Lata With Extra-articular Tenodesis. A Technique in Case of Insufficient Hamstrings.

A technique for augmentation of the anterior cruciate ligament (ACL) with hamstring graft and lateral extra-articular tenodesis is presented. The patient is positioned supine with the knee flexed 90°. First, intra-articular injuries are addressed arthroscopically, and then autologous hamstring tendons are harvested and measured; the present technique is a resource for cases with a very small graft diameter (less than 8 mm), due to thin tendons or to tendon breakage, even after tripling the hamstring graft, which is prepared using a facia lata strip long enough to fit the lengths of the femoral tunnel, the anterior cruciate ligament graft, and the tibial tunnel.

Physeal Sparing Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients Bridging the Tibial Physis With Two Divergent Tunnels.

A technique for anterior cruciate ligament (ACL) reconstruction in patients with open physis is presented. The patient is positioned supine with the knee flexed 90°. After intraarticular injuries are addressed, an autologous hamstring graft is harvested and prepared using a suspension device attached in its expansion device.

Optimisation in the multidisciplinary approach to patients with hepatitis C in the era of direct-acting antivirals.

The advents of current direct-acting antiviral treatments has revolutionised the therapeutic approach to hepatitis C, increasing cure rates to above 90% and substantially simplifying treatment, which translates into benefits for patients, clinicians and the health system. These new drugs allow cure to be achieved, irrespective of the patient's characteristics, with tolerability similar to that of placebo and few drug reactions with concomitant medication. This in turn improves patients' quality of life and wellbeing.

The Finochietto Sign as a Pathognomonic Finding of Ramp Lesion of the Medial Meniscus.

Ramp lesions are considered hidden injuries of the medial meniscus and are very difficult to diagnose. The Finochietto jump sign is a very specific finding that could be considered pathognomonic regarding ramp lesions. This sign consists of a sudden jerk that appears when the free edge of the posterior horn of the medial meniscus is dislocated anteriorly due to the medial condyle interposition when an anterior drawer test is performed on a knee with a ramp lesion, especially when it is associated with an anterior cruciate ligament tear.

Non anatomic reinsertion after amputation of the anterior horn of the lateral meniscus.

Anatomical reinsertion is the optimal treatment for meniscal root injuries. However, in chronic settings, tissue fraying of the meniscal root may impede it. This study describes a salvage technical procedure performed in 3 cases of chronic anterior root avulsion of the lateral meniscus with profuse tissue degeneration in which remnant debridement resulted in amputation of the root.

One-Third of Meniscal Tears Are Repairable: An Epidemiological Study Evaluating Meniscal Tear Patterns in Stable and Unstable Knees.

Purpose: To analyze, in a long series of patients with knee injuries, the meniscal tear patterns in both stable and unstable knees to ascertain the exact proportion of such injuries that could have been repaired.

Methods: A descriptive cross-sectional study was undertaken by reviewing the clinical reports of arthroscopic knee operations carried out in 1 hospital. A total of 2,066 consecutive patients were included in the study.

Associated Anterior Cruciate Ligament and Fibular Collateral Ligament Reconstruction With Single Femoral Tunnel and Asymmetric Hamstring Tendon Graft.

A technique for associated anterior cruciate ligament and fibular collateral ligament reconstruction is shown, using a single hamstring tendon graft, which is prepared asymmetrically, leaving one-third of the length with a single diameter and two-thirds with a double diameter. A single femoral tunnel is created, using an interference screw for fixation and isolation of the grafts. A suspension device is used for tibial fixation, allowing for length adjustment according to the graft's length.

"Over the Top" Augmentation for Partial Anterior Cruciate Ligament Tears Using Suspension Device for Tibial Fixation.

A technique for augmentation of the partial anterior cruciate ligament is presented. The patient is positioned supine with the knee flexed 90°. After addressing intra-articular injuries, the autologous semitendinosus tendon is harvested and measured in a doubled manner; after that, the tibial tunnel is performed in the outside-in direction, of the same diameter of the doubled graft.

Associated Reconstruction of Anterior Cruciate and Anterolateral Ligaments With Single Asymmetric Hamstring Tendons Graft.

The anterior cruciate ligament (ACL) rupture is a common disease that accounts for 250,000 cases/year in the United States. The anterolateral ligament (ALL) has been suggested to be an important restraint for rotational instability, and its reconstruction provides a reinforcement to the ACL reconstruction in this aspect, especially in high-demand athletes and in knees with high-grade pivot shift. Different techniques for associated ACL and ALL reconstruction have been described, but the ideal technique remains unclear.

Transosseous Posterior Meniscal Root Reinsertion Using Knotless Anchor for Tibial Fixation.

A technique for posterior meniscal root reinsertion is presented. With the arthroscope in the central transtendinous portal for a better view, a 5-mm transtibial tunnel is created with the aid of an anterior cruciate ligament guide open to 45°. A suture device, which consists of a long needle with an eyelet on its tip, is introduced through the tunnel with a suture thread inserted through the eyelet, while the meniscus is stabilized with a grasper inserted through the anterior portal.

Posterior Cruciate Ligament Reconstruction With Hamstring Tendons Using a Suspensory Device for Tibial Fixation and Interference Screw for Femoral Fixation.

A technique for posterior cruciate ligament reconstruction is presented. Autologous hamstring tendons are selected as a graft. An interference screw is used for femoral fixation.

Frequency of different electrocardiographic abnormalities in a large cohort of Spanish workers.

Aims: Our aim was to describe the electrocardiographic findings of a large sample of Spanish workers from several different employment sectors.

Methods And Results: Between May 2008 and November 2010, 13 495 consecutive 12-lead resting electrocardiograms (ECGs) were obtained during health examinations of working adults aged 16-74 years in 5 cities in different regions of Spain. Of those, 13 179 ECGs suitable for interpretation were included in this study.

Clinical, virological and phylogenetic characterization of a multiresistant HIV-1 strain outbreak in naive patients in southern Spain.

Background: We describe the characteristics of an HIV-1 strain with six viral reverse transcriptase mutations (D67N, T69N/D, V118I, V179D, T215S and K219Q), which we have called the Malaga strain. This strain was detected in treatment-naive patients from southern Spain.

Methods: The study was undertaken at the Virgen de la Victoria Hospital, Malaga, a reference centre for the study of HIV-1 genotype resistance in Andalusia (the 'Costa del Sol'), Spain.

Castleman's disease. A rare cause of isolated retroperitoneal mass.

Objectives: We describe a case of hyaline vascular type Castleman 's disease with unifocal presentation as retroperitoneal mass. We describe the pathological and radiological findings and present a bibliographic review.

Methods: Castleman's disease is a rare benign disease of unknown etiology characterized by a lymphoproliferative disorder.

Peripheral precocious puberty due to inadvertent exposure to testosterone: case report and review of the literature.

Sexual development in children due to exogenous androgen exposure is rare and sparsely reported. In this paper, we present a new case of peripheral precocious puberty of exogenous origin in an 18-month-old boy due to inadvertent exposure to a testosterone gel used by his father as hormonal replacement therapy. We also review other cases in the literature.