Efectividad del entrenamiento muscular pélvico temprano en la fuerza de suelo pélvico, síntomas de incontinencia urinaria, función sexual y calidad de vida en pacientes posprostatectomía radical: revisión sistemática de ensayos clínicos aleatorizados / Effectiveness of early pelvic muscle training on pelvic floor strength, urinary incontinence symptoms, sexual function, and quality of life in post-radical prostatectomy patients: Systematic review of randomized clinical trials

Este estudio tuvo como objetivo evaluar la efectividad del entrenamiento muscular pélvico temprano para reducir los síntomas de incontinencia urinaria, mejorar la calidad de vida, función sexual y aumentar la fuerza de suelo pélvico en pacientes posprostatectomía radical. Se realizó una búsqueda en 8 bases de datos hasta el 26 de octubre de 2022, se evaluó la calidad metodológica y el riesgo de sesgo de 14 estudios incluidos (n=1236), se calculó la evidencia y el metaanálisis. El entrenamiento redujo significativamente los síntomas de incontinencia urinaria en comparación con un grupo control (DME=−2,80; IC 95%=−5,21 a −0,39; p=0,02), con heterogeneidad significativa (I2=83%; p=<0,0001) y evidencia moderada. Además, presentó evidencia moderada para mejorar la calidad de vida, y muy baja para mejorar la función sexual y fuerza de suelo pélvico. Estos resultados deben ser observados con precaución debido a la heterogeneidad significativa de los estudios analizados. (AU)

This study aimed to evaluate the effectiveness of early pelvic muscle training in reducing urinary incontinence symptoms, improving quality of life, sexual function, and increasing pelvic floor strength in post-radical prostatectomy patients. A search was carried out in 8 databases until October 26, 2022, the methodological quality and the risk of bias of 14 included studies (n=1236) were evaluated, moreover, the evidence and the meta-analysis were calculated. The intervention significantly reduced urinary incontinence symptoms compared to a control group (SMD=−2.80, 95% CI=−5.21 to −0.39, P=.02), with significant heterogeneity (I2=83%; P=<.0001) and moderate evidence. In addition, it presented moderate evidence to improve quality of life, and very low evidence to improve sexual function and pelvic floor strength. These results should be viewed with caution due to the significant heterogeneity of the studies analysed. (AU)

Ampliación de variables de la eficacia del entrenamiento del diafragma en pacientes con EPOC. Revisión sistemática / Expansion of variables of the effectiveness of diaphragm training in patients with COPD. Systematic review

Antecedentes: La enfermedad pulmonar obstructiva crónica (EPOC) produce una obstrucción al flujo de aire de los pulmones que genera tos, mucosidad y dificultad respiratoria. Presenta una alta morbimortalidad y tiene una prevalencia del 10,3% en todo el mundo. Recientemente se ha sugerido el uso del entrenamiento diafragmático en estos pacientes. Objetivo: El objetivo fue examinar la evidencia disponible sobre la eficacia del entrenamiento del diafragma sobre el FEV1, la prueba de la marcha de 6 minutos, la saturación de oxígeno, el tiempo inspiratorio, el tiempo espiratorio y la escala de supervivencia de la EPOC (BODE). Material y métodos: Se realizó una revisión sistemática siguiendo la declaración PRISMA. Resultados: Los resultados mostraron que el entrenamiento del diafragma es efectivo en pacientes con EPOC para mejorar el FEV1. Conclusiones: La prueba de la marcha de 6 minutos y la saturación de oxígeno; sin embargo, no es efectivo para las variables tiempo inspiratorio, tiempo espiratorio y escala de supervivencia de la EPOC (BODE). (AU)

Background: Chronic obstructive pulmonary disease (COPD) causes an obstruction to the airflow of the lungs, causing coughing, mucus, and difficulty breathing. It has a high morbidity and mortality with a prevalence of 10.3% worldwide. The use of diaphragmatic training in these patients has recently been suggested. Objective: The objective was to examine the available evidence on the effectiveness of diaphragm training on FEV1, 6-minute walk test, oxygen saturation, inspiratory time, expiratory time and COPD survival scale (BODE). Material and methods: A systematic review was carried out following the PRISMA regulations. Results: The results showed that diaphragm training is effective in patients with chronic obstructive pulmonary disease to improve FEV1. Conclusion: 6-minute walk test and oxygen saturation; however, it is not effective for the variables inspiratory time, expiratory time and the COPD survival scale (BODE). (AU)

[Effectiveness of early pelvic muscle training on pelvic floor strength, urinary incontinence symptoms, sexual function, and quality of life in post-radical prostatectomy patients: Systematic review of randomized clinical trials]. / Efectividad del entrenamiento muscular pélvico temprano en la fuerza de suelo pélvico, síntomas de incontinencia urinaria, función sexual y calidad de vida en pacientes posprostatectomía radical: revisión sistemática de ensayos clínicos aleatorizados.

This study aimed to evaluate the effectiveness of early pelvic muscle training in reducing urinary incontinence symptoms, improving quality of life, sexual function, and increasing pelvic floor strength in post-radical prostatectomy patients. A search was carried out in 8 databases until October 26, 2022, the methodological quality and the risk of bias of 14 included studies (n=1236) were evaluated, moreover, the evidence and the meta-analysis were calculated. The intervention significantly reduced urinary incontinence symptoms compared to a control group (SMD=-2.80, 95% CI=-5.21 to -0.39, P=.02), with significant heterogeneity (I2=83%; P=<.0001) and moderate evidence. In addition, it presented moderate evidence to improve quality of life, and very low evidence to improve sexual function and pelvic floor strength. These results should be viewed with caution due to the significant heterogeneity of the studies analysed.

Diaphragmatic and excursion thickness in newborns using diaphragmatic kinesiology ultrasound: an observational study / Espessura e excursão diafragmática em recém-nascidos usando ultrassonografia cinesiológica do diafragma: um estudo observacional

Abstract Introduction The study of the diaphragm muscle has aroused the interest of physiotherapists who work with kinesiological ultrasonography, but still little explored; however, its findings can contribute to the clinical practice of hospitalized patients in neonatal intensive care units. Objective To measure the excursion and thickening of the diaphragm and describe measurements among neonates, preterm, and full-term. Methods Diaphragmatic kinesiological ultrasonography was performed on hospitalized newborns, in Neonatal Unit Care Unit, placed in supine position in their own bed, on the sixth day of life. Three repeated measurements of the same respiratory cycle were made, both for excursion and for diaphragmatic thickening. Results 37 newborns participated in the study and 25 were premature. The mean weight at the time of collection was 2,307.0 ± 672.76 grams and the gestational age was 35.7 ± 3.3 weeks. Diaphragmatic excursion increased with increasing gestational age (p = 0.01, df = 0.21) in term infants (p = 0.17, df = 0.35). Conclusion There was a positive correlation between diaphragmatic excursion and gestational age. There was no statistically significant difference in the measurements of excursion and inspiratory diaphragm thickening between preterm and term newborns, although pointing to higher measurements in the latter group.

Resumo Introdução O estudo do músculo diafragma tem des-pertado o interesse dos fisioterapeutas que trabalham com ultrassonografia cinesiológica. Ainda pouco explo-rado, contudo, seus achados podem contribuir para a prática clínica dos pacientes internados em unidades de terapia intensiva neonatal (UTIN). Objetivo Mensurar a excursão e o espessamento diafragmático e descrever as medidas entre recém-nascidos prematuros e a termo. Métodos Realizou-se ultrassonografia cinesiológica diafragmática em recém-nascidos internados em UTIN, posicionados em supino em seu próprio leito, no sexto dia de vida. Foram realizadas três medidas repetidas do mesmo ciclo respiratório, tanto da excursão quanto do espessamento diafragmático. Resultados Participaram do estudo 37 recém-nascidos, dos quais 25 eram pre-maturos. O peso no momento da coleta foi de 2.307,0 ± 672,76 gramas e a idade gestacional foi de 35,7 ± 3,3 semanas. A excursão diafragmática aumentou de acordo com o aumento da idade gestacional (p = 0,01; df = 0,21). A espessura variou entre 0,10 e 0,16 cm durante a inspiração nos prematuros e entre 0,11 e 0,19 cm nos nascidos a termo (p = 0,17; df = 0,35). Conclusão Houve correlação positiva entre a excursão diafragmá-tica e a idade gestacional. Não observou-se diferença estatisticamente significativa das medidas de excursão e de espessamento diafragmático inspiratório entre recém-nascidos prematuros e recém-nascidos a termo, embora apontando para maiores medidas neste último grupo.

Eficacia del entrenamiento del diafragma sobre la disnea en pacientes con enfermedad pulmonar obstructiva crónica: revisión sistemática / Efficacy of diaphragm training on dyspnea in patients with chronic obstructive pulmonary disease: a systematic review

La enfermedad pulmonar obstructiva crónica (EPOC) provoca tos, disnea y falta de energía, y es la tercera causa de muerte en todo el mundo. El entrenamiento del diafragma se muestra como una opción útil y poco agresiva en estos pacientes. El objetivo fue analizar la evidencia existente acerca de los efectos del entrenamiento del diafragma sobre la disnea en pacientes con EPOC. Se realizó una revisión sistemática siguiendo la declaración PRISMA. Se consultaron las bases de datos PubMed, Cinahl, PsycINFO, SPORTDiscus, Academic Search Complete, Lilacs, IBECS, CENTRAL, SciELO y WOS. Se seleccionaron ensayos clínicos controlados aleatorizados centrados en el efecto del entrenamiento del diafragma sobre la disnea en pacientes con EPOC. Se utilizó la herramienta propuesta por Cochrane para la valoración del riesgo de sesgo, y la calidad de la evidencia se valoró con el sistema GRADE. Se seleccionaron tres ensayos clínicos controlados aleatorizados (n = 88; rango-edad: 60-69 años) considerados de bajo riesgo de sesgo. Se concluye que el entrenamiento del diafragma no es una terapia efectiva para mejorar la disnea. (AU)

Chronic obstructive pulmonary disease (COPD) causes cough, dyspnea, and lack of energy, being the third cause of death worldwide. Diaphragm training appears to be a useful and non-aggressive treatment in these patients. The objective was to analyze the existing evidence on the effects of diaphragm training on dyspnea in patients with COPD. A systematic review was carried out following the PRISMA statement. The PubMed, Cinahl, PsycINFO, SPORTDiscus, Academic Search Complete, Lilacs, IBECS, CENTRAL, SciELO, and WOS databases were searched. Randomized controlled clinical trials focusing on the effect of diaphragm training on breathlessness in patients with COPD were selected. The tool proposed by Cochrane was used for the assessment of risk of bias and the quality of evidence was assessed using the GRADE system. Three randomized controlled clinical trials (n = 88; age range: 60–69 years) considered to be of low risk of bias were selected. Diaphragm training is not an effective therapy to treat dyspnea. (AU)

UDC- COVID 19: herramienta digital para predecir el retiro de la ventilación mecánica invasiva de pacientes con COVID-19

En diciembre de 2019 las Autoridades de la República Popular China, comunicaron a la OMS varios casos de neumonía de etiología desconocida en Wuhan, una ciudad situada en la provincia china de Hubei. Una semana más tarde confirmaron que se trataba de un nuevo coronavirus que fue denominado SARS-CoV-2, este virus causa diversas manifestaciones clínicas englobadas bajo el término COVID-19. El presente trabajo presenta un prototipo de aplicación con el nombre UDC-COVID19 que propone una herramienta digital sobre la base de una revisión actualizada de la evaluación ultrasonográfica del diafragma como elemento predictivo para retirar la ventilación mecánica invasiva en pacientes con COVID-19, proporcionando una excelente herramienta digital para la evaluación de la estructura y función dinámica diafragmática, es precisa, reproducible, sin radiación ionizante, fácil de realizar a la cabecera del paciente y costo efectiva en pacientes críticamente enfermos.

In December 2019, the Authorities of the People's Republic of China reported to the WHO several cases of pneumonia of unknown etiology in Wuhan, a city located in the Chinese province of Hubei. A week later, they confirmed that it was a new coronavirus called SARS-CoV-2, which causes various clinical manifestations encompassed under the term COVID-19. The present work presents an application prototype with the name UDC-COVID19 that proposes a digital tool based on an updated review of the ultrasonographic evaluation of the diaphragm as a predictive element to withdraw invasive mechanical ventilation in patients with COVID-19, providing an excellent digital tool for the evaluation of the diaphragmatic structure and dynamic function since it is precise, reproducible, without ionizing radiation, easy to perform at the patient's bedside and cost effective in critically ill patients; mechanical ventilation.

Medición de la fuerza muscular en adultos como predictor de extubación en Unidades de Cuidados Intensivos. Revisión narrativa / Measurement of muscular strength in adults as a predicator of extubation in intensive care units. Narrative review

Resumen: Introducción: uno de los principales efectos de la ventilación mecánica invasiva es la lesión de los músculos respiratorios, específicamente, sobre el diafragma en el que pueden ocurrir alteraciones estructurales y funcionales que modifican parcial o totalmente su función. Durante la ventilación mecánica se produce un proceso de atrofia por desuso de dicho músculo. Por ello la utilidad clínica de la medición de la fuerza muscular diafragmática es importante para conocer si el paciente tiene la capacidad de activar los mecanismos protectores de la vía aérea para lograr la extubación exitosa y el retiro del ventilador mecánico en el menor tiempo posible. Objetivos: describir la medición de la fuerza muscular como predictor de la extubación en las unidades de cuidados intensivos. Material y métodos: se realizó una revisión de la literatura, entre 2011 y 2022. Resultados: los pacientes que son sometidos a ventilación mecánica invasiva prolongada generalmente desarrollan una afección muscular diafragmática, lo que se convierte en una problemática para el proceso de extubación temprana, por lo cual es vital conocer los métodos de medición de fuerza muscular como predictor de extubación.

Abstract: Introduction: one of the main effects of invasive mechanical ventilation is injury to the respiratory muscles, specifically the diaphragm. In which structural and functional alterations can occur that partially or totally modify its function. During mechanical ventilation, a process of disuse atrophy of said muscle occurs. Therefore, the clinical utility of measuring diaphragmatic muscle strength is important to know if the patient has the ability to activate the protective mechanisms of the airway to achieve successful extubation and removal of the mechanical ventilator in the shortest time possible. Objective: describe the measurement of muscle strength as a predictor of extubation in intensive care units. Material and methods: a literature review was carried out, carried out between 2011 and 2022. Results: patients who are subjected to prolonged mechanical ventilation generally develop a diaphragmatic muscle disorder, becoming a problem for the weaning, for it is important know the methods of measuring muscle strength.

[Home therapeutic adherence of pelvic floor muscle exercises in urinary incontinence]. / Adherencia terapéutica domiciliaria de ejercicios musculares del suelo pélvico en incontinencia urinaria.

Background: Urinary incontinence (UI) is a medical and social problem that has a great impact on the quality of life of women. Pelvic floor muscle strengthening exercises have been shown to be a form of conservative treatment. However, there is still high failure in this treatment. Objective: To analyze the factors associated with low home therapeutic adherence to pelvic floor exercises in patients with UI. Material and methods: An analytical cross-sectional prolective study was carried out in women aged 20-85 years, with UI and under conservative treatment with pelvic floor muscle exercises. They were questioned about their demographic data; the Morisky Green therapeutic adherence questionnaire and the Likert-type satisfaction scale were applied on the results of the questionnaire. Results: 235 women with UI and with a prescription for pelvic floor muscle exercises, with a median of 55 (46-64) years, were analyzed. The lack of adherence to pelvic floor exercises was observed in 130 (55.32%), whose causes were their work (37.69%), forgetfulness (23.08%) and lack of interest (12.08%). The risk factors for non-adherence were having 3 or less children (OR 1.81 [95% CI 1.10-3.23], p = 0.02), and not feeling satisfied with the exercises (OR 6.70 [95% CI 3.75-11.97], p < 0.001. Conclusion: The factors associated with low home therapeutic adherence to pelvic floor exercises in patients with urinary incontinence were having 3 or less children and not being satisfied with the results.

Introducción: la incontinencia urinaria (IU) es un problema médico y social que causa gran impacto en la calidad de vida de las mujeres. Se ha evidenciado que los ejercicios de fortalecimiento muscular del suelo pélvico (SP) son una forma de tratamiento conservador; sin embargo, aun hay elevado fracaso en este tratamiento. Objetivo: analizar los factores asociados a la baja adherencia terapéutica domiciliaria de los ejercicios del suelo pélvico en pacientes con IU. Material y métodos: estudio transversal analítico prolectivo en mujeres de 20-85 años de edad, con IU y en tratamiento conservador con ejercicios musculares de SP. Se les interrogó sobre sus datos demograficos; se aplicó el Cuestionario de adherencia terapéutica de Morisky-Green y la escala de satisfacción tipo Likert sobre los resultados del cuestionario. Resultados: se analizaron 235 mujeres con IU y prescripción de ejercicios musculares de SP, con una mediana de 55 años (46-64). Hubo falta de adherencia a los ejercicios del SP en 130 (55.32%), cuyas causas fueron actividades laborales (37.69%), olvido (23.08%) y falta de interés (12.08%). Los factores de riesgo para no adherencia fueron: tener tres hijos o menos (RM 1.81 [IC 95% 1.10-3.23], p = 0.02) y no sentirse satisfecha con los resultados de los ejercicios respecto a los síntomas de IU (RM 6.70 [IC 95% 3.75-11.97], p < 0.001). Conclusión: los factores asociados a la baja adherencia terapéutica domiciliaria de los ejercicios del SP en pacientes con IU fueron tener 3 hijos o menos y no sentirse satisfecha con los resultados sobre la mejoría en los síntomas de IU.

Assessment of diaphragmatic function through surface electromyography in healthy individuais. A cross-section observational study

Introduction: Diaphragmatic surface electromyography is a procedure designed to assess the diaphragm. The physiological values of the electrical activity may have potential use in rehabilitation, sports training, ventilatory support withdrawal in critical care units and follow-up of respiratory disease. Objective: To assess and describe the diaphragmatic function through surface electromyography in a population of individuals during spontaneous and forced breathing. Methods: Observational, exploratory cross-sectional study including subjects with no comorbidities. Diaphragmatic surface EMG was performed measuring the mean quadratic root during tidal volume and vital capacity breathing. The body composition of the participants was also assessed. Results: 28 males and 22 females were included in the study. The mean quadratic root of the tidal volume for two minutes was 13.94 nV for females and 13.31 nV for males. The vital capacity was 23.24 nV for males and 22.4 nV for females. A correlation was identified between the mean quadratic root, weight, and body surface. Conclusions: Mean quadratic root values of tidal volume in two minutes in healthy females and males have been documented. The mean quadratic root values are correlated with the physiological and functional characteristics of the participants.

Introducción: La electromiografía de superficie diafragmática es un procedimiento para la evaluación diafragmática. Los valores fisiológicos de la actividad eléctrica tendrían aplicaciones potenciales en rehabilitación, entrenamiento deportivo, en el retiro ventilatorio en unidades de cuidado crítico y en el seguimiento a patologías respiratorias. Objetivo: Evaluar y describir la función diafragmática a través de electromiografía de superficie diafragmática en una población de sujetos durante la respiración espontánea y la respiración forzada. Métodos: Estudio observacional exploratorio de corte transversal en el que se incluyeron sujetos sin comorbilidades. Se realizó electromiografía de superficie diafragmática midiendo la raíz cuadrática media durante respiraciones de volumen corriente y capacidad vital. Adicionalmente, se valoró la composición corporal de los participantes. Resultados: Se incluyeron 28 hombres y 22 mujeres. La raíz cuadrática media de volumen corriente por dos minutos fue de 13,94 µV para mujeres y 13,31 µV para hombres, mientras que la capacidad vital fue 23,24 µV para hombres y 22,4 µV para mujeres. Se encontró una correlación entre la raíz cuadrática media, el peso y la superficie corporal. Conclusiones: Se han documentado los valores de la raíz cuadrática media de volumen corriente por dos minutos en mujeres y hombres sanos. Los valores de la raíz cuadrática media se correlacionan con características fisiológicas y funcionales de los participantes.

Monitorización avanzada durante la desvinculación de la ventilación mecánica invasiva en el trasplante unipulmonar / Advanced monitoring during weaning of invasive me chanical ventilation in single-lung transplantation

Resumen El trasplante de pulmón bilateral es el tratamiento de las enfermedades pulmonares en su etapa terminal. Sin embargo, a veces se realiza el trasplante de un solo pulmón. La técnica no está exenta de complicaciones como la hiperinsuflación aguda del pulmón nativo y cambios en el diafragma, predisponiendo a atelectasias e insuficiencia respiratoria que pueden derivar en resul tados negativos. Por lo tanto, las pruebas de respiración espontánea pueden fallar y retrasar el proceso de des vinculación de la ventilación mecánica. La combinación de herramientas de monitorización avanzadas, como la tomografía por impedancia eléctrica y la ecografía, para diagnosticar la causa de este fallo, reconociendo y cuantificando la distribución del volumen pulmonar y su comportamiento dinámico, podría ser crucial para mejorar los resultados. Presentamos el caso de un paciente con trasplante unipulmonar y ventilación prolongada que falla en repetidas ocasiones durante la desvinculación de la ventilación mecánica, donde utilizamos herramientas de monitoreo avanzado para detectar la causa de la falla.

Abstract Bilateral lung transplantation is the treatment of end-stage lung diseases. However, sometimes a single lung transplant is performed. The technique is not exempt from complications such as acute hyperinfla tion of the native lung and changes in the diaphragm, predisposing to atelectasis and respiratory failure that can lead to negative results. Therefore, spontaneous breathing trials may fail and delay the weaning process. The combination of advanced monitoring tools, such as electrical impedance tomography and ultrasonography, to diagnose the cause of this failure, recognizing and quantifying the distribution of lung volume and its dynamic behavior could be crucial to improve outcomes. We present the case of a patient with a one-lung transplant and prolonged mechanical ventilation who, after presenting successive failures in the weaning pro cess, underwent advanced monitoring in order to find the causes of the failure.

Dextrocardia y herniación intratorácica del hígado. Una rara entidad / Dextrocardia and Intrathoracic Herniation of the Liver. A Rare Entity

Introducción: la incidencia de dextrocardia como anomalía congénita es menor del 0.01% y la combinación con herniación intratorácica del hígado semejando una neoplasia benigna sin antecedente de trauma toracoabdominal abierto o contuso lo hace aún menos frecuente. Caso clínico: se presenta el caso de paciente femenina de 34 años de edad que consulta por dolor de espalda. Al examen físico, se auscultan ruidos cardíacos en el hemitórax derecho y la radiografía de tórax evidencia dextrocardia e imagen que semeja masa supra diafragmática derecha, la TAC trifásica confirma la presencia de protrusión de un segmento del hígado de forma redondeada a través de un defecto no abierto del hemidiafragma derecho. Su tratamiento ha sido conservador. Conclusión: la combinación de dextrocardia acompañada de herniación de una porción del hígado a través de un defecto del diafragma derecho es una asociación extremadamente rara y los reportes de caso publicados son escasos

Hernia de Morgagni en la edad adulta

Introducción: La hernia de Morgagni es una anomalía congénita rara, responsable del 3% de las hernias diafragmáticas, que provoca opacidades radiológicas paracardíaca y retroesternal que suelen confundirse con otras afecciones. Objetivo: Notificar el caso de un paciente adulto diagnosticado con hernia de Morgagni en el Hospital General Docente "Dr. Antonio Luaces Iraola" de Ciego de Ávila. Caso clínico: Se presenta el caso de un varón de 28 años de edad con antecedentes de contusión torácica severa, que presentó dolor abdominal, dispepsias, dolor recurrente en región baja posterior del hemitórax derecho, falta de aire ligera y tos seca. Con la aplicación de un correcto método clínico se excluyeron otros posibles diagnósticos planteados previamente y se concluyó con estudios imagenológicos como una hernia de Morgagni. Se realizó tratamiento quirúrgico mediante laparotomía convencional. La evolución fue favorable, sin complicaciones posoperatorias y con egreso hospitalario precoz. Conclusiones: Se notificó el caso de un paciente diagnosticado con hernia de Morgagni que constituyó un tipo raro de hernia en adultos, cuyo diagnóstico se debe tener en cuenta en pacientes con manifestaciones clínicas digestivas o respiratorias, que presentan radiopacidad paracardíaca en la radiografía de tórax. Es necesario realizar tratamiento quirúrgico oportuno para prevenir posibles complicaciones.

Introduction: Morgagni's hernia is a rare congenital anomaly, responsible for 3% of diaphragmatic hernias, which causes paracardiac and retrosternal radiological opacities that are often confused with other conditions. Objective: To report the case of an adult patient diagnosed with Morgagni's hernia at "Dr. Antonio Luaces Iraola" General Teaching Hospital from Ciego de Avila. Clinical casereport: We report the case of a 28-year-old man with history of severe chest contusion, who showed abdominal pain, dyspepsia, recurrent pain in the lower posterior region of the right hemithorax, slight shortness of breath, and dry cough. With the use of the correct clinical method, other possible diagnoses were excluded from what was previously raised. Imaging studies concluded to be a Morgagni hernia. Surgical treatment was performed by conventional laparotomy. The evolution was favorable, without postoperative complications and with early hospital discharge. Conclusions: The case of a patient diagnosed with Morgagni's hernia was reported. It constituted a rare type of hernia in adults. Its diagnosis should be taken into account in patients with digestive or respiratory clinical manifestations, showing paracardiac radiopacity on chest X-ray. Timely surgical treatment is necessary to prevent possible complications.

Influence of mild pulmonary congestion on diaphragmatic mobility and activities of daily living in chronic kidney disease: An experimental and clinical study.

BACKGROUND: Pulmonary congestion is a strong predictor of mortality and cardiovascular events in chronic kidney disease (CKD); however, the effects of the mild form on functionality have not yet been investigated. The objective of this study was to assess the influence of mild pulmonary congestion on diaphragmatic mobility (DM) and activities of daily living (ADL) in hemodialysis (HD) subjects, as well as compare ADL behavior on dialysis and non-dialysis days. In parallel, experimentally induce CKD in mice and analyze the resulting pulmonary and functional repercussions. METHODS: Thirty subjects in HD underwent thoracic and abdominal ultrasonography, anthropometric assessment, lung and kidney function, respiratory muscle strength assessment and symptoms analysis. To measure ADL a triaxial accelerometer was used over seven consecutive days. Twenty male mice were randomized in Control and CKD group. Thoracic ultrasonography, TNF-α analysis in kidney and lung tissue, exploratory behavior and functionality assessments were performed. RESULTS: Mild pulmonary congestion caused a 26.1% decline in DM (R2=.261; P=.004) and 20% reduction in walking time (R2=.200; P=.01), indicating decreases of 2.23mm and 1.54min, respectively, for every unit increase in lung comet-tails. Regarding ADL, subjects exhibited statistically significant differences for standing (P=.002), walking (P=.034) and active time (P=.002), and number of steps taken (P=.01) on days with and without HD. In the experimental model, CKD resulted in increased levels of TNF-α on kidneys (P=.037) and lungs (P=.02), attenuation of exploratory behavior (P=.01) and significant decrease in traveled distance (P=.034). Thoracic ultrasonography of CKD mice showed presence of B-lines. CONCLUSION: The mild pulmonary congestion reduced DM and walking time in subjects undergoing HD. Individuals were less active on dialysis days. Furthermore, the experimental model implies that the presence of pulmonary congestion and inflammation may play a decisive role in the low physical and exploratory performance of CKD mice.

Diaphragm ultrasound after manual rib cage stabilization maneuver in premature newborns: clinical trial / Ultrassom diafragmático após manobra de estabilização costal manual em recém-nascidos prematuros: ensaio clínico

Abstract Introduction The manual rib cage stabilization maneu-ver (MRCSM) is a physical therapy intervention that promotes stabilization of the zone of apposition of the diaphragm, facilitating the contraction of this muscle and the work of breathing. Objective To evaluate by diaphragm ultrasound the diaphragmatic excursion in premature newborns before and after MRCSM. Methods Before-after clinical trial assessing by diaphragm ultra-sound the effectiveness of MRCSM in the amplitude of diaphragmatic excursions. Results The study sample consisted of 48 premature newborns born at a mean gestational age of 33.0 ± 2.8 weeks with a mean birth weight of 1,904.1 ± 708.9 grams. The newborns were classified in three groups: without respiratory distress syndrome (RDS; n = 26), with RDS (n = 15) and with apnea (n = 7) as a cause of admission to the neonatal intensive care unit (NICU). The measurements of diaphragmatic excursion and thickening were similar in newborns without or with RDS or apnea and there was a significant increase in the amplitude of diaphragmatic excursions after MRCSM (p < 0.001; effect size > 0.68) and less diaphragmatic thickening at exhalation in all of them. The diaphragm thickening fraction was 0.50 (0.33 - 0.72), and the diaphragm thickening rate was 0.04 (0.03 - 0.07). These measurements showed no significant variation with the presence or absence of RDS or apnea (p > 0.05). No significant variations in heart rate (p = 0.30), respiratory rate (p = 0.79), and peripheral oxygen saturation, consid-ering newborns in ambient air (p = 0.17) compared with baseline. Conclusion The MRCSM was effective, safe, and increased the amplitude of diaphragmatic excursion and thickness in premature newborns at one week of age, regardless of the presence or absence of RDS or apnea as a cause of admission to the NICU.

Resumo Introducão A manobra manual de estabilização da caixa torácica (MRCSM) é uma intervenção fisioterapêutica que promove a estabilização da zona de aposição do diafragma, facilitando a contração deste músculo e o trabalho respiratório. Objetivo Avaliar pela ultrassonografia do diafragma a excur-são diafragmática em recém-nascidos prematuros antes e após MRCSM. Métodos Ensaio clínico antes e depois avaliando por ultrassonografia do diafragma a eficácia do MRCSM na amplitude das excursões diafragmáticas. Resultados A amos-tra do estudo foi composta por 48 recém-nascidos prematuros nascidos com idade gestacional média de 33,0 ± 2,8 semanas e peso médio ao nascer de 1904,1 ± 708,9 gramas. Os recém-nascidos foram classificados em três grupos: sem síndrome do desconforto respiratório (SDR; n = 26), com SDR (n = 15) e com apneia (n = 7) como causa de internação na unidade de terapia intensiva neonatal (UTIN) . As medidas de excursão e espessamento diafragmático foram semelhantes em recém-nascidos sem ou com SDR ou apneia e houve aumento significativo na amplitude das excursões diafragmáticas após MRCSM (p < 0,001; tamanho de efeito > 0,68) e menor espes-samento diafragmático na expiração em todos eles. A fração de espessamento do diafragma foi de 0,50 (0,33 - 0,72) e a taxa de espessamento do diafragma foi de 0,04 (0,03 - 0,07). Essas medidas não apresentaram variação significativa com a presença ou ausência de SDR ou apneia (p > 0,05). Não houve variações significativas na frequência cardíaca (p = 0,30), frequência respiratória (p = 0,79), saturação periférica de oxigênio, considerando os recém-nascidos em ar ambiente (p = 0,17) em comparação com o valor basal. Conclusão O MRCSM foi eficaz, seguro e aumentou a amplitude da excursão e espessura diafragmática em recém-nascidos prematuros com uma semana de idade, independentemente da presença ou ausência de SDR ou apneia como causa de admissão na UTIN.

Effects of COVID-19 on diaphragm thickness and physical performance of athletes / Efeitos da COVID-19 na espessura diafragmática e desempenho físico de atletas

Abstract Introduction Studies suggest that diaphragm thickness (DT) is associated with inspiratory muscle strength and consequently, better ventilatory and mechanical efficiency. On the other hand, infectious diseases such as COVID-19 may impact the structure and function of the respiratory system. Objective Assess the association between DT and the physical performance (PP) of athletes and the effects of COVID-19 infection on these parameters. Methods This is a cross-sectional study of 63 athletes of both sexes from different sport modalities (women: 16.67 ± 5.03 years, 52.09 ± 14.01 kg, 155.90 ± 13.86 cm; men: 23.44 ± 9.65 years, 72.24 ± 14.18 kg, 174.84 ± 6.84 cm), submitted to DT assessment using ultrasound, followed by the PP(Yo-Yo) test) to determine maximum oxygen intake (VO2max). Pearson's correlation was used to determine the association between VO2max and DT, and the Student's t-test for differences between athletes with a positive and negative diagnosis for COVID-19. The significance level was set at 5%. Results There was no association between DT and PP (r = 0.30 and p = 0.22) or between athletes unaffected and affected by COVID-19 in relation to DT (57.00 ± 0.26 vs 52.00 ± 0.25%; p = 0.91) and PP (43.88 ± 2.29 vs 38.34 ± 13.61 ml/kg/min; p = 0.69). Conclusion DT was not associated with maximum oxygen intake in athletes. In addition, athletes infected by COVID-19 exhibited no differences in VO2max or DT when compared to nonaffected individuals.

Resumo Introdução Estudos sugerem que a espessura diafrag-mática (ED) está associada à força muscular inspiratória e, consequentemente, à melhor eficiência ventilatória e mecânica. Por outro lado, doenças infecciosas como a COVID-19 podem impactar a estrutura e função do apa-relho respiratório. Objetivo Avaliar a associação entre a ED e o desempenho físico (DF) de atletas e os efeitos da infecção por COVID-19 sobre esses parâmetros. Métodos Trata-se de um estudo transversal envolvendo 63 atletas de diferentes modalidades esportivas, de ambos os sexos (feminino: 16,67 ± 5,03 anos, 52,09 ± 14,01 kg, 155,90 ± 13,86 cm; masculino 23,44 ± 9,65 anos, 72,24 ± 14,18 kg, 174,84 ± 6,84 cm), que foram submetidos à avaliação da ED por meio de ultrassom e, em seguida, ao teste de DF (Yo-Yo test) para determinar o consumo máximo de oxigênio (VO2max). Utilizou-se a correlação de Pearson para verificar a associação entre VO2max e ED, e o teste t de Student para diferenças entre atletas com diagnóstico positivo e negativo para COVID-19. O nível de significância foi ajustado em 5%. Resultados Não houve associação entre ED e DF (r = 0,30 e p = 0,22) e não houve diferença entre os atletas não infectados e infectados por COVID-19 em relação à ED (57,00 ± 0,26 vs 52,00 ± 0,25%; p = 0,91) e DF (43,88 ± 2,29 vs 38,34 ± 13,61 ml/kg/min; p = 0,69). Conclusão A ED não foi associada ao consumo máximo de oxigênio em atletas. Além disso, atletas infectados por COVID-19 não exibiram diferenças no VO2max e ED em relação aos não infectados.

Associação entre área de secção transversa do reto femoral e excursão diafragmática com o desmame de pacientes com traqueostomia na unidade de terapia intensiva / Association between rectus femoris cross-sectional area and diaphragmatic excursion with weaning of tracheostomized patients in the intensive care unit

RESUMO Objetivo: Verificar a relação entre área de secção transversa do reto femoral e excursão diafragmática com sucesso no desmame da ventilação mecânica em pacientes críticos crônicos com traqueostomia. Métodos: Este foi um estudo de coorte observacional prospectivo. Incluímos pacientes críticos crônicos (aqueles submetidos à colocação de traqueostomia após 10 dias de ventilação mecânica). A área de secção transversa do reto femoral e a excursão diafragmática foram obtidas por ultrassonografia realizada dentro das primeiras 48 horas após a traqueostomia. Medimos a área de secção transversa do reto femoral e a excursão diafragmática para avaliar sua associação com o desmame da ventilação mecânica, incluindo sua capacidade de prever o sucesso no desmame e a sobrevida durante toda a internação na unidade de terapia intensiva. Resultados: Foram incluídos 81 pacientes. Quarenta e cinco pacientes (55%) foram desmamados da ventilação mecânica. A mortalidade foi de 42% e 61,7% na unidade de terapia intensiva e hospitalar, respectivamente. O grupo que falhou em relação ao grupo que obteve sucesso no desmame apresentou menor área transversa do reto femoral (1,4 [0,8] versus 1,84 [0,76]cm2, p = 0,014) e menor excursão diafragmática (1,29 ± 0,62 versus 1,62 ± 0,51cm, p = 0,019). Quando a área de secção transversa do reto femoral ≥ 1,80cm2 e a excursão diafragmática ≥ 1,25cm era uma condição combinada, apresentava forte associação com sucesso no desmame (RC ajustada de 20,81; IC95% 2,38 - 182,28; p = 0,006), mas não com sobrevida na unidade de terapia intensiva (RC ajustada de 0,19; IC95% 0,03 - 1,08; p = 0,061). Conclusão: O sucesso no desmame da ventilação mecânica em pacientes críticos crônicos foi associado a medidas maiores de área de secção transversa do reto femoral e da excursão diafragmática.

ABSTRACT Objective: To verify the relationship between the rectus femoris cross-sectional area and diaphragmatic excursion with successful weaning from mechanical ventilation in chronic critically tracheostomized patients. Methods: This was a prospective observational cohort study. We included chronic critically ill patients (those who underwent tracheostomy placement after 10 days under mechanical ventilation). The rectus femoris cross-sectional area and diaphragmatic excursion were obtained by ultrasonography performed within the first 48 hours after tracheostomy. We measured rectus femoris cross-sectional area and diaphragmatic excursion to assess their association with weaning from mechanical ventilation, including their potential to predict successful weaning and survival throughout the intensive care unit stay. Results: Eighty-one patients were included. Forty-five patients (55%) were weaned from mechanical ventilation. The mortality rates were 42% and 61.7% in the intensive care unit and hospital, respectively. The fail group in relation to the success group at weaning presented a lower rectus femoris cross-sectional area (1.4 [0.8] versus 1.84 [0.76]cm2, p = 0.014) and lower diaphragmatic excursion (1.29 ± 0.62 versus 1.62 ± 0.51cm, p = 0.019). When rectus femoris cross-sectional area ≥ 1.80cm2 and diaphragmatic excursion ≥ 1.25cm was a combined condition, it had a strong association with successful weaning (adjusted OR = 20.81, 95%CI 2.38 - 182.28; p = 0.006) but not with intensive care unit survival (adjusted OR = 0.19, 95%CI 0.03 - 1.08; p = 0.061). Conclusion: Successful weaning from mechanical ventilation in chronic critically ill patients was associated with higher measurements of rectus femoris cross-sectional area and diaphragmatic excursion.

Confiabilidad interevaluador de la medición de la excursión diafragmática y fracción de engrosamiento diafragmático mediante ultrasonografía en voluntarios sanos / Inter-rater reliability of the measurement of diaphragmatic excursion and fraction of diaphragmatic thickening by ultrasonography in healthy volunteers

Antecedentes y objetivo: Determinar la confiabilidad interevaluador en la medición ultrasonográfica (US) de la excursión diafragmática (ED) y la fracción de engrosamiento diafragmático (FED) realizada por profesionales de salud no médicos en voluntarios sanos. Participantes y métodos: Estudio observacional prospectivo en un hospital de tercer nivel en Cali, Colombia. Se realizaron mediciones a 30 voluntarios sanos escogidos mediante muestreo a conveniencia, sin antecedentes de enfermedades pulmonares, con edades entre los 18-60 años. Previamente se realizó una prueba piloto con 8 voluntarios sanos. Las mediciones US de ED y FED se basaron en protocolos publicados anteriormente. Cada evaluador observaba independientemente varios ciclos de respiración tranquila normal durante 3minutos para establecer una línea de base. Para evaluar la confiabilidad interevaluador en las mediciones de ED y FED se utilizó el índice de correlación intraclase (ICC), con intervalos de confianza del 95% y un p<0,05. Resultados: Se identificó concordancia sustancial en la medición de la ED en las ventanas esplénica y hepática debido a que el ICC fue mayor a 0,6 (p<0,05). La medición de la FED en la ventana hepática mostró concordancia leve tanto en el modo 2D como en el modo M (p>0,05). En la ventana esplénica la medición de la FED en el modo 2D se identificó concordancia regular y para el modo M se encontró una concordancia leve (p>0,05). Conclusiones: La US diafragmática constituye un método reproducible con aceptable confiabilidad interevaluador para la medición del grosor inspiratorio/espiratorio y con confiabilidad pobre para la medición de FED.(AU)

Background and objective: To determine the inter-rater reliability in the ultrasonographic (US) measurement of the diaphragmatic excursion (DE) and the diaphragm thickness fraction (DTF) performed by non-medical health professionals in healthy people. Participants and methods: Prospective observational study in a third level hospital in Cali, Colombia. Measurements were made to 30 healthy volunteers chosen by convenience sampling, without a history of lung diseases, with ages between 18-60 years. A pilot test was previously carried out with 8 healthy volunteers. US measurements of DE, and DTF were based on previously published protocols. Each assessor independently observed several cycles of normal quiet breathing for 3minutes to establish a baseline. The Intraclass Correlation Index (ICC) was used to evaluate the inter-rater reliability in the measurements of DE and DTF, with 95% confidence intervals and a P<.05. Results: Substantial agreement was identified in the measurement of DE in the splenic and hepatic windows because the ICC was greater than 0.6 (P<.05). The measurement of the DTF in the hepatic window showed slight agreement in both 2D and M modes (P>.05). In the splenic window, the measurement of the DTF in the 2D mode was found to be moderate agreement and for the M mode a slight agreement was found (P>.05).Conclusions: The diaphragmatic US constitutes a reproducible method with acceptable inter-rater reliability for the measurement of inspiratory/expiratory thickness, and with little reliability for the measurement of DTF.(AU)

Inter-rater reliability of the measurement of diaphragmatic excursion and fraction of diaphragmatic thickening by ultrasonography in healthy volunteers.

BACKGROUND AND OBJECTIVE: To determine the inter-rater reliability in the ultrasonographic (US) measurement of the diaphragmatic excursion (DE) and the diaphragm thickness fraction (DTF) performed by non-medical health professionals in healthy people. PARTICIPANTS AND METHODS: Prospective observational study in a third level hospital in Cali, Colombia. Measurements were made to 30 healthy volunteers chosen by convenience sampling, without a history of lung diseases, with ages between 18-60 years. A pilot test was previously carried out with 8 healthy volunteers. US measurements of DE, and DTF were based on previously published protocols. Each assessor independently observed several cycles of normal quiet breathing for 3min to establish a baseline. The Intraclass Correlation Index (ICC) was used to evaluate the inter-rater reliability in the measurements of DE and DTF, with 95% confidence intervals and a p<0.05. RESULTS: Substantial agreement was identified in the measurement of DE in the splenic and hepatic windows because the ICC was greater than 0.6 (p<0.05). The measurement of the DTF in the hepatic window showed slight agreement in both 2D and M modes (p>0.05). In the splenic window, the measurement of the DTF in the 2D mode was found to be moderate agreement and for the M mode a slight agreement was found (p>0.05). CONCLUSIONS: The diaphragmatic US constitutes a reproducible method with acceptable inter-rater reliability for the measurement of inspiratory/expiratory thickness, and with little reliability for the measurement of DTF.

Evisceración intestinal transvaginal incarcerada con perforación intestinal después de una colporrafia con malla. Reporte de un caso / Incarcerated transvaginal bowel evisceration with intestinal perforation after a mesh colporraphy. A case report

Introducción. La evisceración intestinal transvaginal es consecuencia, en la gran mayoría de casos, de dehiscencia del muñón vaginal posterior a histerectomía en pacientes postmenopáusicas. A través de la dehiscencia vaginal se produce la salida del contenido abdominopélvico, que puede presentarse como una evisceración simple, incarceración, obstrucción, estrangulamiento y perforación de un asa intestinal. Caso clínico. Mujer de 78 años, con antecedente inmediato de colpocleisis y colporrafia con malla de polipropileno por prolapso vaginal, que presentó dehiscencia del muñón vaginal debido a rechazo de la malla, que condicionó la solución de continuidad de la pared vaginal, con prolapso, incarceración, obstrucción y perforación de íleon. Con el diagnóstico de evisceración intestinal transvaginal incarcerada con perforación intestinal se llevó a tratamiento quirúrgico, con abordaje inicial por vía vaginal para liberar el asa intestinal, luego por laparotomía se realizó resección y anastomosis de íleon, sacrocolpopexia con malla y plastia de Douglas. Presentó buena evolución postoperatoria.Conclusión. La evisceración intestinal transvaginal con perforación intestinal es una entidad de muy rara presentación. El órgano más frecuentemente comprometido es el intestino delgado, especialmente el íleon. Puede complicarse con incarceración, obstrucción intestinal, isquemia y perforación. El manejo quirúrgico involucra resección intestinal, cuando hay signos de necrosis, con reparación y fijación del muñón vaginal.

Introduction. Transvaginal intestinal evisceration is a consequence, in the vast majority of cases, of dehiscence of the vaginal stump after hysterectomy in postmenopausal patients. Through vaginal dehiscence, the exit of the abdominopelvic content occurs, which can present as a simple evisceration, incarceration, obstruction, strangulation and perforation of an intestinal loop. Clinical case. A 78-year-old woman with an immediate history of colpocleisis and polypropylene mesh colporrhaphy due to vaginal prolapse, presents dehiscence of the vaginal stump caused by rejection of the mesh that conditioned the solution of continuity of the vaginal wall, prolapse, incarceration, obstruction and perforation of the ileum. Surgical treatment was performed with the diagnosis of incarcerated transvaginal intestinal evisceration with intestinal perforation. The initial approach was to free the intestinal loop vaginally, followed by laparotomy, ileal resection and anastomosis, mesh sacrocolpopexy, and Douglas plasty were performed. He presented good postoperative evolution.Conclussion. Transvaginal intestinal evisceration with intestinal perforation is a very rare entity. The most common organ involved is the small intestine, especially the ileum. It can be complicated by incarceration, intestinal obstruction, ischemia, and perforation. Surgical management involves intestinal resection, when there are signs of necrosis, with repair and fixation of the vaginal stump.

Two devices to facilitate the perception of pelvic floor muscle contraction in the sitting position in women with urinary incontinence: comparative analysis / Dois dispositivos facilitadores de percepção da contração do assoalho pélvico na posição sentada em mulheres com incontinência urinária: análise comparativa / Dos herramientas que facilitan la percepción de la contracción del suelo pélvico en posición sentada de mujeres con incontinencia urinaria: un análisis comparativo

ABSTRACT The use of support devices may facilitate the perception of pelvic floor muscle (PFM) contraction, which is difficult to be performed. Therefore, this study aimed to compare the perception of PFM contraction in the sitting position during the use of two different support devices on women with PFM dysfunction. This is a cross-sectional study performed with 37 women with stress or mixed urinary incontinence (UI). All women performed three free PFM contractions sitting on a chair, followed by three contractions using each support device (sand pads and a cylindrical foam, which provide sciatic and perineal support, respectively). Women scored the perception of PFM contraction from 1 to 5, as well as the perception of facilitation of contraction (higher grades show better results) and discomfort (higher grades show more discomfort) when compared with free contraction. The cylindrical foam presented similar results to sand pads for the perception of PFM contraction (2.84±1.61 vs. 3.19±1.43; p=0.34) and facilitation of contraction (3.38±1.34 vs. 3.19±1.54; p=0.61), as well as for their discomfort (1.83±1.23 vs. 1.5±1.16; p=0.20). Of all women, 57% preferred sand pads. Thus, both sand pads (sciatic support) and the cylindrical foam (perineal support) improved the perception of PFM contraction and facilitation of contraction in the sitting position of women with PFM dysfunction when compared with sitting with no device. The two devices presented no difference between them.

RESUMO O uso de dispositivos de suporte pode auxiliar na percepção da contração dos músculos do assoalho pélvico (AP). O objetivo deste estudo foi, comparar na posição sentada, a percepção da contração dos músculos do AP durante o uso de dois tipos diferentes de dispositivos, em mulheres com disfunção dos músculos do AP. Para tanto, foi realizado um estudo transversal com 37 mulheres com incontinência urinária (IU) de esforço ou mista. Primeiro as participantes faziam três contrações livres dos músculos do AP sem o uso de dispositivos, sentadas em uma cadeira. Em seguida, faziam três contrações utilizando cada um dos dois dispositivos: almofadas de areia e uma espuma cilíndrica, que forneciam apoio isquiático e perineal, respectivamente. As pacientes atribuíram nota de 1 a 5 para a percepção que tiveram da contração dos músculos do AP, da facilitação da contração (quanto maior a nota, melhor o resultado) e do desconforto com o dispositivo (quanto maior a nota, maior o desconforto) em comparação às contrações livres. Como resultados principais, verificou-se que o uso da almofada cilíndrica foi similar ao das almofadas de areia para a percepção da contração dos músculos do AP (2,84±1,61 vs. 3,19±1,43; p=0,34), e da facilitação da contração (3,38±1,34 vs. 3,19±1,54; p=0,61), assim como do desconforto (1,83±1,23 vs. 1,5±1,16; p=0,20). Entre as participantes, 57% relataram preferir as almofadas de areia. Concluiu-se que em mulheres com incontinência urinária, tanto as almofadas de areia (apoio isquiático) quanto a espuma cilíndrica (apoio perineal) melhoraram a percepção da contração e facilitaram a contração dos músculos do assoalho pélvico na posição sentada, não havendo, no entanto, diferença entre os dispositivos.

RESUMEN Las herramientas de apoyo pueden ayudar en la percepción de la contracción de los músculos del suelo pélvico (SP), que no siempre es fácil de obtener su medición. El objetivo de este estudio fue comparar si dos tipos diferentes de herramientas ayudan a las mujeres con disfunción muscular del SP a contraer estos músculos en posición sentada. Para ello, se realizó un estudio transversal con 37 mujeres con incontinencia urinaria (IU) de esfuerzo o mixta. Primero, las participantes realizaron tres contracciones libres de los músculos del SP sentadas en una silla, sin el uso de herramientas de apoyo. Luego, realizaron tres contracciones utilizando cada uno de los dos dispositivos de apoyo: almohadillas de arena y espuma cilíndrica, que brindan apoyo isquiático y perineal, respectivamente. Las participantes deberían asignar una puntuación de 1 a 5 cuanto a su percepción de la contracción muscular del SP, de la facilitación de la contracción (cuanto mayor sea la puntuación, mejor será el resultado) y la incomodidad con la herramienta (cuanto mayor sea la puntuación, mayor será la incomodidad) en comparación con las contracciones libres. Los principales resultados encontrados apuntan que el uso de la almohadilla cilíndrica fue similar al de las almohadillas de arena en cuanto a su percepción de la contracción de los músculos del SP (2,84±1,61 vs. 3,19±1,43; p=0,34), y la facilitación de la contracción (3,38±1,34 vs. 3,19±1,54; p=0,61), así como la incomodidad (1,83±1,23 vs. 1,5±1,16; p=0,20). El 57% de las participantes informó preferir las almohadillas de arena. Se concluyó que tanto las almohadillas de arena (apoyo isquiático) como la espuma cilíndrica (apoyo perineal) mejoraron la percepción y la facilitación de la contracción muscular del SP en posición sentada de mujeres con disfunción muscular del SP en comparación con la ausencia de la herramienta, sin embargo, hay no hubo diferencia entre las herramientas.