Co-activation of the abdominal and pelvic floor muscles during voluntary exercises

The response of the abdominal muscles to voluntary contraction of the pelvic floor (PF) muscles was investigated in women with no history of symptoms of stress urinary incontinence to determine whether there is co-activation of the muscles surrounding the abdominal cavity during exercises for the PF muscles. Electromyographic (EMG) activity of each of the abdominal muscles was recorded with fine-wire electrodes in seven parous females. Subjects contracted the PF muscles maximally in three lumbar spine positions while lying supine. In all subjects. the EMG activity of the abdominal muscles was increased above the baseline level during contractions of the PF muscles in at least one of the spinal positions. The amplitude of the increase in EMG activity of obliquus externus abdominis was greatest when the spine was positioned in flexion and the increase in activity of transversus abdominis was greater than that of rectus abdominis and obliquus externus abdominis when the spine was positioned in extension. In an additional pilot experiment. EMG recordings were made from the pubococcygeus and the abdominal muscles with fine-wire electrodes in two subjects during the performance of three different sub-maximal isometric abdominal muscle maneuvers. Both subjects showed an increase in EMG activity of the pubococcygeus with each abdominal muscle contraction. The results of these experiments indicate that abdominal muscle activity is a normal response to PF exercise in subjects with no symptoms of PF muscle dysfunction and provide preliminary evidence that specific abdominal exercises activate the PF muscles. Neurourol. Urodynam. 20:31-42, 2001. (C) 2001 Wiley-Liss, Inc.

Protocolo de Treino dos Músculos do Pavimento Pélvico em Mulheres com Incontinência Urinária de Esforço: Revisão Sistemática

Introdução: Os exercícios de fortalecimento dos músculos do pavimento pélvico (EFMPP) são considerados a primeira intervenção no tratamento da incontinência urinária de esforço (IUE), porém os EFMPP são distintos, não existindo evidência sobre os parâmetros de treino. Objetivo: Identificar o protocolo e/ ou os parâmetros de treino dos músculos do pavimento pélvico (MPP) mais eficaz no tratamento da IUE feminina. Método: A pesquisa bibliográfica foi realizada entre janeiro de 1992 a março de 2014 nas bases de dados PubMed, Cochrane Library, PEDro, web of Science e LILACS. Os artigos incluídos eram de língua inglesa, estudos experimentais, no qual comparavam EFMPP com o tratamento placebo, usual ou sem tratamento, com idade compreendida entre os 18 e os 65 anos e diagnóstico de IUE. Os critérios de exclusão abrangeram o diagnóstico de IUE desencadeada por fatores externos ao trato urinário inferior, grávidas, puérperas, prolapso ≥ 2 e outros tipos de IU. A avaliação da qualidade metodológica for realizada através da escala PEDro. Resultados: Sete artigos de elevada qualidade metodológica foram incluídos na presente revisão. A amostra foi constituída por 331 mulheres, com idade média de 44,4 anos, duração média das perdas urinárias de 64 meses e a gravidade da IUE variou entre ligeira a severa. Os programas de EFMPP eram distintos em relação aos parâmetros de treino dos MPP, sendo que alguns estudos incluíram o treino abdominal, supervisão e técnicas adjuvantes. A taxa de curada da quantidade de perda urinária variou entre 28,6 a 80%, enquanto a força dos MPP variou de 15,6% a 161,7%. Conclusão: Na presente revisão sistemática, os EFMPP combinados com palpação digital, biofeedback e cones vaginais parecem ser mais eficazes na redução da quantidade de perda urinária, comparado com os EFMPP isolados ou sem tratamento. Esta revisão permitiu igualmente identificar as 12 semanas de duração da intervenção, 10 repetições por série e diferentes posições, sendo os parâmetros de treino mais consistentes na redução dos sintomas.

Protocolo de Treino dos Músculos do Pavimento Pélvico em Mulheres com Incontinência Urinária de Esforço: Revisão Sistemática

Introdução: Os exercícios de fortalecimento dos músculos do pavimento pélvico (EFMPP) são considerados a primeira intervenção no tratamento da incontinência urinária de esforço (IUE), porém os EFMPP são distintos, não existindo evidência sobre os parâmetros de treino. Objetivo: Identificar o protocolo e/ ou os parâmetros de treino dos músculos do pavimento pélvico (MPP) mais eficaz no tratamento da IUE feminina. Método: A pesquisa bibliográfica foi realizada entre janeiro de 1992 a março de 2014 nas bases de dados PubMed, Cochrane Library, PEDro, web of Science e LILACS. Os artigos incluídos eram de língua inglesa, estudos experimentais, no qual comparavam EFMPP com o tratamento placebo, usual ou sem tratamento, com idade compreendida entre os 18 e os 65 anos e diagnóstico de IUE. Os critérios de exclusão abrangeram o diagnóstico de IUE desencadeada por fatores externos ao trato urinário inferior, grávidas, puérperas, prolapso ≥ 2 e outros tipos de IU. A avaliação da qualidade metodológica for realizada através da escala PEDro. Resultados: Sete artigos de elevada qualidade metodológica foram incluídos na presente revisão. A amostra foi constituída por 331 mulheres, com idade média de 44,4 anos, duração média das perdas urinárias de 64 meses e a gravidade da IUE variou entre ligeira a severa. Os programas de EFMPP eram distintos em relação aos parâmetros de treino dos MPP, sendo que alguns estudos incluíram o treino abdominal, supervisão e técnicas adjuvantes. A taxa de curada da quantidade de perda urinária variou entre 28,6 a 80%, enquanto a força dos MPP variou de 15,6% a 161,7%. Conclusão: Na presente revisão sistemática, os EFMPP combinados com palpação digital, biofeedback e cones vaginais parecem ser mais eficazes na redução da quantidade de perda urinária, comparado com os EFMPP isolados ou sem tratamento. Esta revisão permitiu igualmente identificar as 12 semanas de duração da intervenção, 10 repetições por série e diferentes posições, sendo os parâmetros de treino mais consistentes na redução dos sintomas.

Range of motion measurements based on depth camera for clinical rehabilitation

Dissertação para obtenção do Grau de Mestre em Engenharia Biomédica

Biomedical risk assessment as an aid for smoking cessation.

BACKGROUND: A possible strategy for increasing smoking cessation rates could be to provide smokers who have contact with healthcare systems with feedback on the biomedical or potential future effects of smoking, e.g. measurement of exhaled carbon monoxide (CO), lung function, or genetic susceptibility to lung cancer. OBJECTIVES: To determine the efficacy of biomedical risk assessment provided in addition to various levels of counselling, as a contributing aid to smoking cessation. SEARCH STRATEGY: We systematically searched the Cochrane Collaboration Tobacco Addiction Group Specialized Register, Cochrane Central Register of Controlled Trials 2008 Issue 4, MEDLINE (1966 to January 2009), and EMBASE (1980 to January 2009). We combined methodological terms with terms related to smoking cessation counselling and biomedical measurements. SELECTION CRITERIA: Inclusion criteria were: a randomized controlled trial design; subjects participating in smoking cessation interventions; interventions based on a biomedical test to increase motivation to quit; control groups receiving all other components of intervention; an outcome of smoking cessation rate at least six months after the start of the intervention. DATA COLLECTION AND ANALYSIS: Two assessors independently conducted data extraction on each paper, with disagreements resolved by consensus. Results were expressed as a relative risk (RR) for smoking cessation with 95% confidence intervals (CI). Where appropriate a pooled effect was estimated using a Mantel-Haenszel fixed effect method. MAIN RESULTS: We included eleven trials using a variety of biomedical tests. Two pairs of trials had sufficiently similar recruitment, setting and interventions to calculate a pooled effect; there was no evidence that CO measurement in primary care (RR 1.06, 95% CI 0.85 to 1.32) or spirometry in primary care (RR 1.18, 95% CI 0.77 to 1.81) increased cessation rates. We did not pool the other seven trials. One trial in primary care detected a significant benefit of lung age feedback after spirometry (RR 2.12; 95% CI 1.24 to 3.62). One trial that used ultrasonography of carotid and femoral arteries and photographs of plaques detected a benefit (RR 2.77; 95% CI 1.04 to 7.41) but enrolled a population of light smokers. Five trials failed to detect evidence of a significant effect. One of these tested CO feedback alone and CO + genetic susceptibility as two different intervention; none of the three possible comparisons detected significant effects. Three others used a combination of CO and spirometry feedback in different settings, and one tested for a genetic marker. AUTHORS' CONCLUSIONS: There is little evidence about the effects of most types of biomedical tests for risk assessment. Spirometry combined with an interpretation of the results in terms of 'lung age' had a significant effect in a single good quality trial. Mixed quality evidence does not support the hypothesis that other types of biomedical risk assessment increase smoking cessation in comparison to standard treatment. Only two pairs of studies were similar enough in term of recruitment, setting, and intervention to allow meta-analysis.

Psychophysiological activation during preparation, performance, and recovery in high- and low-anxious music students

The present study provides a comprehensive view of (a) the time dynamics of the psychophysiological responding in performing music students (n = 66) before, during, and after a private and a public performance and (b) the moderating effect of music performance anxiety (MPA). Heart rate (HR), minute ventilation (VE), and all affective and somatic self-report variables increased in the public session compared to the private session. Furthermore, the activation of all variables was stronger during the performances than before or after. Differences between phases were larger in the public than in the private session for HR, VE, total breath duration, anxiety, and trembling. Furthermore, while higher MPA scores were associated with higher scores and with larger changes between sessions and phases for self-reports, this association was less coherent for physiological variables. Finally, self-reported intra-individual performance improvements or deteriorations were not associated with MPA. This study makes a novel contribution by showing how the presence of an audience influences low- and high-anxious musicians' psychophysiological responding before, during and after performing. Overall, the findings are more consistent with models of anxiety that emphasize the importance of cognitive rather than physiological factors in MPA.

Biomedical risk assessment as an aid for smoking cessation.

BACKGROUND: A possible strategy for increasing smoking cessation rates could be to provide smokers who have contact with healthcare systems with feedback on the biomedical or potential future effects of smoking, e.g. measurement of exhaled carbon monoxide (CO), lung function, or genetic susceptibility to lung cancer. OBJECTIVES: To determine the efficacy of biomedical risk assessment provided in addition to various levels of counselling, as a contributing aid to smoking cessation. SEARCH METHODS: For the most recent update, we searched the Cochrane Collaboration Tobacco Addiction Group Specialized Register in July 2012 for studies added since the last update in 2009. SELECTION CRITERIA: Inclusion criteria were: a randomized controlled trial design; subjects participating in smoking cessation interventions; interventions based on a biomedical test to increase motivation to quit; control groups receiving all other components of intervention; an outcome of smoking cessation rate at least six months after the start of the intervention. DATA COLLECTION AND ANALYSIS: Two assessors independently conducted data extraction on each paper, with disagreements resolved by consensus. Results were expressed as a relative risk (RR) for smoking cessation with 95% confidence intervals (CI). Where appropriate, a pooled effect was estimated using a Mantel-Haenszel fixed-effect method. MAIN RESULTS: We included 15 trials using a variety of biomedical tests. Two pairs of trials had sufficiently similar recruitment, setting and interventions to calculate a pooled effect; there was no evidence that carbon monoxide (CO) measurement in primary care (RR 1.06, 95% CI 0.85 to 1.32) or spirometry in primary care (RR 1.18, 95% CI 0.77 to 1.81) increased cessation rates. We did not pool the other 11 trials due to the presence of substantial clinical heterogeneity. Of the remaining 11 trials, two trials detected statistically significant benefits: one trial in primary care detected a significant benefit of lung age feedback after spirometry (RR 2.12, 95% CI 1.24 to 3.62) and one trial that used ultrasonography of carotid and femoral arteries and photographs of plaques detected a benefit (RR 2.77, 95% CI 1.04 to 7.41) but enrolled a population of light smokers and was judged to be at unclear risk of bias in two domains. Nine further trials did not detect significant effects. One of these tested CO feedback alone and CO combined with genetic susceptibility as two different interventions; none of the three possible comparisons detected significant effects. One trial used CO measurement, one used ultrasonography of carotid arteries and two tested for genetic markers. The four remaining trials used a combination of CO and spirometry feedback in different settings. AUTHORS' CONCLUSIONS: There is little evidence about the effects of most types of biomedical tests for risk assessment on smoking cessation. Of the fifteen included studies, only two detected a significant effect of the intervention. Spirometry combined with an interpretation of the results in terms of 'lung age' had a significant effect in a single good quality trial but the evidence is not optimal. A trial of carotid plaque screening using ultrasound also detected a significant effect, but a second larger study of a similar feedback mechanism did not detect evidence of an effect. Only two pairs of studies were similar enough in terms of recruitment, setting, and intervention to allow meta-analyses; neither of these found evidence of an effect. Mixed quality evidence does not support the hypothesis that other types of biomedical risk assessment increase smoking cessation in comparison to standard treatment. There is insufficient evidence with which to evaluate the hypothesis that multiple types of assessment are more effective than single forms of assessment.

Biomedical risk assessment as an aid for smoking cessation.

BACKGROUND: A possible strategy for increasing smoking cessation rates could be to provide smokers who have contact with healthcare systems with feedback on the biomedical or potential future effects of smoking, e.g. measurement of exhaled carbon monoxide (CO), lung function, or genetic susceptibility to lung cancer. We reviewed systematically data on smoking cessation rates from controlled trials that used biomedical risk assessment and feedback. OBJECTIVES: To determine the efficacy of biomedical risk assessment provided in addition to various levels of counselling, as a contributing aid to smoking cessation. SEARCH STRATEGY: We systematically searched he Cochrane Collaboration Tobacco Addiction Group Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to 2004), and EMBASE (1980 to 2004). We combined methodological terms with terms related to smoking cessation counselling and biomedical measurements. SELECTION CRITERIA: Inclusion criteria were: a randomized controlled trial design; subjects participating in smoking cessation interventions; interventions based on a biomedical test to increase motivation to quit; control groups receiving all other components of intervention; an outcome of smoking cessation rate at least six months after the start of the intervention. DATA COLLECTION AND ANALYSIS: Two assessors independently conducted data extraction on each paper, with disagreements resolved by consensus. MAIN RESULTS: From 4049 retrieved references, we selected 170 for full text assessment. We retained eight trials for data extraction and analysis. One of the eight used CO alone and CO + Genetic Susceptibility as two different intervention groups, giving rise to three possible comparisons. Three of the trials isolated the effect of exhaled CO on smoking cessation rates resulting in the following odds ratios (ORs) and 95% confidence intervals (95% CI): 0.73 (0.38 to 1.39), 0.93 (0.62 to 1.41), and 1.18 (0.84 to 1.64). Combining CO measurement with genetic susceptibility gave an OR of 0.58 (0.29 to 1.19). Exhaled CO measurement and spirometry were used together in three trials, resulting in the following ORs (95% CI): 0.6 (0.25 to 1.46), 2.45 (0.73 to 8.25), and 3.50 (0.88 to 13.92). Spirometry results alone were used in one other trial with an OR of 1.21 (0.60 to 2.42).Two trials used other motivational feedback measures, with an OR of 0.80 (0.39 to 1.65) for genetic susceptibility to lung cancer alone, and 3.15 (1.06 to 9.31) for ultrasonography of carotid and femoral arteries performed in light smokers (average 10 to 12 cigarettes a day). AUTHORS' CONCLUSIONS: Due to the scarcity of evidence of sufficient quality, we can make no definitive statements about the effectiveness of biomedical risk assessment as an aid for smoking cessation. Current evidence of lower quality does not however support the hypothesis that biomedical risk assessment increases smoking cessation in comparison with standard treatment. Only two studies were similar enough in term of recruitment, setting, and intervention to allow pooling of data and meta-analysis.

Actualización en los tratamientos alternativos en el síndrome de dolor-disfunción craneomandibular

Realizamos una revisión bibliográfica sobre los diferentes tipos de tratamiento alternativo en aquellos casos en los que fracasa la terapia convencional en el síndrome de dolor-disfunción craneomandibular y en los cuales la cirugía no sea la terapia de elección; haciendo una clasificación actualizada de los mismos, siendo estos: terapia psíquica (terapia de relajación muscular y control y manejo del estrés), terapia física realizada por el propio paciente y asistida por un fisioterapeuta, terapia mecánica (biofeedback electromiográfico, TENS, ionoforesis, ultrasonidos y láser blando) y terapia farmacológica.

The down-regulation of disgust by implementation intentions: experiential and physiological concomitants

Emotion regulation plays a key role in mental health and psychopathology. Therefore, it seems important to develop effective forms of emotion regulation. Implementation intentions are if-then plans that help people attain their self-regulatory goals. Perspective-taking and response-focused implementation intentions have been shown to reduce feelings of unpleasantness and arousal, respectively, in response to briefly presented disgusting pictures. The present study addressed the open research questions whether forming these types of implementation intentions is effective in regulating affect during prolonged presentation of disgusting pictures, and whether it is associated with changes in physiological arousal. Eighty-one participants viewed disgusting, neutral, and pleasant pictures of 6 s duration under four instructions: the goal intention to not get disgusted, this goal intention furnished with a perspective-taking or a response-focused implementation intention, and no emotion regulation instructions. The dependent variables were ratings of disgust, valence, arousal, and electrodermal activity. Only perspective-taking implementation intention participants significantly reduced their disgust and unpleasantness as compared to goal-intention and control participants. Arousal and skin conductance did not significantly differ between conditions. The effectiveness of response-focused but not perspective-taking implementation intentions seems to be substantially reduced during sustained exposure duration.

Qualidade de vida em mulheres após tratamento da incontinência urinária de esforço com fisioterapia

OBJETVO: comparar a qualidade de vida (QV) antes e após tratamento fisioterápico de mulheres com incontinência urinária de esforço (IUE). MÉTODOS: ensaio clínico não controlado com 26 mulheres com queixa clínica predominantemente de IUE. Foram excluídas mulheres na pós-menopausa, com hiperatividade do detrusor, com cistocele grau II ou maior e tratamento cirúrgico/conservador anterior. O tratamento fisioterápico constituiu-se em 12 sessões individuais de cinesioterapia do assoalho pélvico associadas ao biofeedback eletromiográfico, e as mesmas realizavam 200 contrações divididas entre fásicas (rápidas) e tônicas (lentas). Para avaliar a QV, todas responderam ao King's Health Questionnaire (KHQ), antes e após o tratamento. Os dados foram descritos em freqüências, médias e desvios-padrões, medianas, mínimos e máximos. Os escores do KHQ foram comparados pelo teste de Wilcoxon para amostras pareadas, com nível de significância de 0,05. RESULTADOS: houve uma diminuição dos sintomas urinários, particularmente da freqüência urinária, noctúria, urgência miccional e perdas urinárias aos esforços. Observou-se uma melhora significativa nos escores dos domínios do KHQ: percepção da saúde (49,0±24,0 versus 26,9±15,7; p=0,0015), impacto da incontinência (78,2±28,2 versus 32,1±30,5; p=0,001), limitações das atividades diárias (75,0±28,2 versus 13,5±22,6; p<0,001), limitações físicas (72,4±29,4 versus 15,4±24,5; p<0,001), limitações sociais (38,3±28,6 versus 6,4±14,5; p<0,001), emoções (59,0±33,8 versus 14,1±24,7; p=0,0001), sono/energia (34,0±23,8 versus 6,4±16,4; p=0,001) e as medidas de gravidade (66,9±19,6 versus 22,3±24,2; p<0,001), exceto das relações pessoais (60,5±33,9 versus 41,7±16,7; p=0,0679). CONCLUSÕES: a QV de mulheres com IUE tratadas com fisioterapia pode melhorar em diversos aspectos, quando avaliada com um instrumento específico, como o KHQ.

Conservative Treatment of Stress Urinary Incontinence: A Systematic Review with Meta-analysis of Randomized Controlled Trials

We performed a systematic review and meta-analysis of randomized controlled trials that studied the conservative management of stress urinary incontinence (SUI). There were 1058 results after the initial searches, from which 37 studies were eligible according to previously determined inclusion criteria. For the primary outcomes, pelvic floor muscle training (PFMT) was more efficacious than no treatment in improving incontinence-specific quality of life (QoL) scales (SMD = [1]1.24SDs; CI 95% = [1]1.77 to [1]0.71SDs). However, its effect on pad tests was imprecise. Combining biofeedback with PFMT had an uncertain effect on QoL (MD = [1]4.4 points; CI 95% = [1]16.69 to 7.89 points), but better results on the pad test, although with elevated heterogeneity (MD = 0.9g; 95%CI = 0.71 to 1,10g); group PFMT was not less efficacious than individual treatment, and home PFMT was not consistently worse than supervised PFMT. Both intravaginal and superficial electrical stimulation (IES and SES) were better than no treatment for QoL and pad test. Vaginal cones had mixed results. The association of IES with PFMT may improve the efficacy of the latter for QoL and pad test, but the results of individual studies were not consistent. Thus, there is evidence of the use of PFMT on the treatment of SUI, with and without biofeedback.

Impacto de uma abordagem interdisciplinar em crianças e adolescentes com disfunção do trato urinário inferior (DTUI)

Introdução: A disfunção do trato urinário inferior (DTUI) corresponde a alterações no enchimento ou esvaziamento de urina de causas neurogênicas, anatômicas e funcionais. Objetivo: Avaliar o impacto do tratamento em crianças e adolescentes com DTUI. Métodos: Coorte histórica de 15 anos de seguimento com participação de 192 pacientes (123F, 69M) com idade inicial de 0,1 a 16,8 anos, analisados à admissão (T0) e ao final do seguimento (T1). A maioria dos pacientes era do grupo neurológico (60,4%). O tratamento instituído foi a uroterapia com intervenção comportamental e cognitiva, micção de hora marcada, hidratação oral, dieta laxativa, biofeedback, eletroestimulação sacral, cateterismo vesical intermitente limpo (CIL), terapia anticolinérgica, enema retal, tratamento da infecção do trato urinário (ITU) e, nos casos refratários, procedimentos cirúrgicos, tais como a derivação urinária continente e incontinente (vesicostomia), ampliação vesical e conduto para a realização do enema anterógrado cólico. Resultados: Os principais sintomas foram incontinência urinária diurna (82,3%), enurese noturna não monossintomática (78,6%), incontinência fecal (54,2%) e constipação intestinal (47,9%). Detectou-se redução significativa da infecção do trato urinário (p = 0,0027), da incontinência urinária diurna (p < 0,001), da enurese noturna (p < 0,001), da incontinência fecal (p = 0,010) e do refluxo vesicoureteral (p = 0,01). Houve aumento significativo no uso do CIL (p = 0,021), da terapia com anticolinérgico (p < 0,001) e diminuição da quimioprofilaxia (p < 0,001). Conclusão: Este estudo mostrou que o tratamento da DTUI na criança deve ser individualizado, além de requerer uma monitorização constante dos parâmetros clínicos, laboratoriais e de imagem, para minimizar o risco de lesão renal.

A brain-computer interface for navigation in virtual reality

L'interface cerveau-ordinateur (ICO) décode les signaux électriques du cerveau requise par l’électroencéphalographie et transforme ces signaux en commande pour contrôler un appareil ou un logiciel. Un nombre limité de tâches mentales ont été détectés et classifier par différents groupes de recherche. D’autres types de contrôle, par exemple l’exécution d'un mouvement du pied, réel ou imaginaire, peut modifier les ondes cérébrales du cortex moteur. Nous avons utilisé un ICO pour déterminer si nous pouvions faire une classification entre la navigation de type marche avant et arrière, en temps réel et en temps différé, en utilisant différentes méthodes. Dix personnes en bonne santé ont participé à l’expérience sur les ICO dans un tunnel virtuel. L’expérience fut a était divisé en deux séances (48 min chaque). Chaque séance comprenait 320 essais. On a demandé au sujets d’imaginer un déplacement avant ou arrière dans le tunnel virtuel de façon aléatoire d’après une commande écrite sur l'écran. Les essais ont été menés avec feedback. Trois électrodes ont été montées sur le scalp, vis-à-vis du cortex moteur. Durant la 1re séance, la classification des deux taches (navigation avant et arrière) a été réalisée par les méthodes de puissance de bande, de représentation temporel-fréquence, des modèles autorégressifs et des rapports d’asymétrie du rythme β avec classificateurs d’analyse discriminante linéaire et SVM. Les seuils ont été calculés en temps différé pour former des signaux de contrôle qui ont été utilisés en temps réel durant la 2e séance afin d’initier, par les ondes cérébrales de l'utilisateur, le déplacement du tunnel virtuel dans le sens demandé. Après 96 min d'entrainement, la méthode « online biofeedback » de la puissance de bande a atteint une précision de classification moyenne de 76 %, et la classification en temps différé avec les rapports d’asymétrie et puissance de bande, a atteint une précision de classification d’environ 80 %.

Efecto del flujo del dializado sobre la ganancia interdialítica en hemodiálisis crónica (Estudio FLUGAIN)

Objetivos: Determinar si existe diferencia en la ganancia interdialítica entre los pacientes al ser tratados con flujo de dializado (Qd) de 400 mL/min y 500 mL/min. Diseño: Se realizó un estudio de intervención, cruzado, aleatorizado, doble ciego en pacientes con enfermedad renal crónica en hemodiálisis para determinar diferencias en la ganancia de peso interdialítica entre los pacientes tratados con flujo de dializado (Qd) de 400 ml/min y 500 ml/min. Pacientes: Se analizaron datos de 46 pacientes en hemodiálisis crónica con Qd de 400 ml/min y 45 con Qd de 500 ml/min. Análisis: La prueba de hipótesis para evaluar diferencias en la ganancia interdialítica y las otras variables entre los grupos se realizó mediante la prueba T para muestras pareadas. Para el análisis de correlación se calculó el coeficiente de Pearson. Resultados: No hubo diferencia significativa en ganancia interdialítica usando Qd de 400 ml/min vs 500 ml/min (2.37 ± 0.7 vs 2.41 ± 0.6, p=0.41) ni en Kt/V (1.57 ± 0.25 vs 1.59 ± 0.23, p = 0.45), potasio (4.9 ± 1.1 vs 5.1 ± 1.0, p=0.45), fosforo (4.5 ± 1.2 vs 4.4 ± 1.2, p=0.56) o hemoglobina (11.3 ± 1.8 vs 11.3 ± 1.6, p=0.96). Conclusiones: En pacientes con peso ≤ 65 Kg el uso de Qd de 400 ml/min no se asocia con menor ganancia interdialítica de peso. No hay diferencia en la eficiencia de diálisis lo que sugiere que es una intervención segura a corto plazo.