Detección de nistagmo en respuesta a la prueba de Dix-Hallpike en atención primaria: una comparación entre vértigo posicional paroxístico benigno subjetivo y objetivo

Patients who experience both vertigo and nystagmus in the Dix-Hallpike test (DHT) are diagnosed with objective benign paroxysmal positional vertigo (BPPV). This test provokes only vertigo in between 11% and 48% of patients, who are diagnosed with subjective BPPV. Detection of nystagmus has important diagnostic and prognostic implications. To compare the characteristics of patients diagnosed with objective and subjective BPPV in primary care. Cross-sectional descriptive study. Two urban primary care centers. Adults (≥18 years) diagnosed with objective or subjective BPPV between November 2012 and January 2015. DHT results (vertigo or vertigo plus nystagmus; dependent variable: nistagmus as response to DHT), age, sex, time since onset, previous vertigo episodes, self-reported vertigo severity (Likert scale, 0-10), comorbidities (recent viral infection, traumatic brain injury, headache, anxiety/depression, hypertension, diabetes mellitus, dyslipidemia, cardiovascular disease, altered thyroid function, osteoporosis, cervical spondylosis, neck pain). In total, 134 patients (76.1% women) with a mean age of 52 years were included; 59.71% had subjective BPPV. Objective BPPV was significantly associated with hypertension, antihypertensive therapy, and cervical spondylosis in the bivariate analysis and with cervical spondylosis (OR = 3.94, p = 0.021) and antihypertensive therapy (OR 3.02, p = 0.028) in the multivariate analysis. Patients with subjective BPPV were more likely to be taking benzodiazepines [OR 0.24, p = 0.023]. The prevalence of subjective BPPV was higher than expected. Cervical spondylosis and hypertensive therapy were associated with objective BPPV, while benzodiazepines were associated with subjective BPPV

Double-blind placebo-controlled randomized clinical trial to assess the efficacy of montelukast in mild to moderate respiratory symptoms of patients with long COVID: E-SPERANZA COVID Project study protocol

Background: The coronavirus disease 2019 (COVID-19) pandemic continues to affect the globe. After 18 months of the SARS-CoV-2 emergence, clinicians have clearly defined a subgroup of patients with lasting, disabling symptoms. While big strides have been made in understanding the acute phase of SARS-CoV-2 infection, the pathophysiology of long COVID is still largely unknown, and evidence-based, effective treatments for this condition remain unavailable. Objectives: To evaluate the efficacy of 10 mg oral montelukast every 24 h versus placebo in improving quality of life associated with mild to moderate respiratory symptoms in patients with long COVID as measured with the COPD Assessment Test (CAT) questionnaire. The secondary objectives will evaluate the effect of montelukast versus placebo on improving exercise capacity, COVID-19 symptoms (asthenia, headache, mental confusion or brain fog, ageusia, and anosmia), oxygen desaturation during exertion, functional status, and mortality. Methods and analysis: Phase III, randomized, double-blind clinical trial. We will include 18- to 80-year-old patients with SARS-CoV-2 infection and mild to moderate respiratory symptoms lasting more than 4 weeks. Participants will be randomly allocated in a 1:1 ratio to the intervention (experimental treatment with 10 mg/day montelukast) or the control group (placebo group), during a 28-day treatment. Follow-up will finish 56 days after the start of treatment. The primary outcome will be health-related quality of life associated with respiratory symptoms according to the COPD Assessment Test 4 weeks after starting the treatment. The following are the secondary outcomes: (a) exercise capacity and oxygen saturation (1-min sit-to-stand test); (b) Post-COVID-19 Functional Status Scale; (c) other symptoms: asthenia, headache, mental confusion (brain fog), ageusia, and anosmia (Likert scale); (d) use of healthcare resources; (e) mortality; (f) sick leave duration in days; and (g) side effects of montelukast. Ethics and dissemination: This study has been approved by the Clinical Research Ethics Committee of the IDIAPJGol (reference number 21/091-C). The trial results will be published in open access, peer-reviewed journals and explained in webinars to increase awareness and understanding about long COVID among primary health professionals

Effectiveness of a training intervention to improve the management of vertigo in primary care: a multicentre cluster-randomised trial, VERTAP

Background: Benign paroxysmal positional vertigo (BPPV) is the most common type of vertigo. While BPPV is best treated with canalicular repositioning manoeuvres, they are not routinely performed in primary care (PC). Methods: To evaluate the effectiveness of blended training (online and face-to-face) on the diagnosis and management of vertigo to improve adherence of family doctors to clinical practice guidelines, we designed a community multicentre cluster-randomised open-label trial with an intervention (IG) and a control (GC) group of 10 primary care teams (PCT) each. Outcome variables will be ICD-10 diagnostic codes (proportion of nonspecific diagnoses such as dizziness and vertigo versus specific diagnoses such as BPPV, vestibular neuritis, and Meniere's disease); number of referrals to ENT or neurology specialists; prescription of antivertigo agents; and duration of sick leave due to vertigo. The baseline comparability of the two study groups will be analysed to ensure homogeneity. A description of all baseline variables will be performed. Student's t-test will be used to evaluate the differences between the groups. Logistic regression multivariate analysis will be performed to study the relationship between baseline variables of professionals and centres with outcome variables. Discussion: With the improvement of the diagnosis and management of vertigo by family doctors after this training, we expect an increase in the proportion of specific diagnoses, a decrease in the prescription of antivertigo agents, a decrease in referrals to ENT or neurology specialists and a reduction in the duration of sick leave due to temporary disability. The blended training will be easily expanded within primary care services, since it is mainly delivered online, with a single face-to-face session to ensure that the manoeuvres have been adequately learned

Effectiveness of the Epley’s maneuver performed in primary care to treat posterior canal benign paroxysmal positional vertigo: study protocol for a randomized controlled trial

BACKGROUND: Vertigo is a common medical condition with a broad spectrum of diagnoses which requires an integrated approach to patients through a structured clinical interview and physical examination. The main cause of vertigo in primary care is benign paroxysmal positional vertigo (BPPV), which should be confirmed by a positive D-H positional test and treated with repositioning maneuvers. The objective of this study is to evaluate the effectiveness of Epley’s maneuver performed by general practitioners (GPs) in the treatment of BPPV. METHODS/DESIGN: This study is a randomized clinical trial conducted in the primary care setting. The study’s scope will include two urban primary care centers which provide care for approximately 49,400 patients. All patients attending these two primary care centers, who are newly diagnosed with benign paroxysmal positional vertigo, will be invited to participate in the study and will be randomly assigned either to the treatment group (Epley’s maneuver) or to the control group (a sham maneuver). Both groups will receive betahistine. Outcome variables will be: response to the D-H test, patients’ report on presence or absence of vertigo during the previous week (dichotomous variable: yes/no), intensity of vertigo symptoms on a Likert-type scale in the previous week, total score on the Dizziness Handicap Inventory (DHI) and quantity of betahistine taken. We will use descriptive statistics of all variables collected. Groups will be compared using the intent-to-treat approach and either parametric or nonparametric tests, depending on the nature and distribution of the variables. Chi-square test or Fisher’s exact test will be conducted to compare categorical measures and Student’s t-test or Mann–Whitney U-test will be used for intergroup comparison variables. DISCUSSION: Positive results from our study will highlight that treatment of benign paroxysmal positional vertigo can be performed by trained general practitioners (GPs) and, therefore, its widespread practice may contribute to improve the quality of life of BPPV patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01969513

Effectiveness of the Epley's maneuver performed in primary care to treat posterior canal benign paroxysmal positional vertigo: study protocol for a randomized controlled trial

Background: Vertigo is a common medical condition with a broad spectrum of diagnoses which requires an integrated approach to patients through a structured clinical interview and physical examination. The main cause of vertigo in primary care is benign paroxysmal positional vertigo (BPPV), which should be confirmed by a positive D-H positional test and treated with repositioning maneuvers. The objective of this study is to evaluate the effectiveness of Epley's maneuver performed by general practitioners (GPs) in the treatment of BPPV. Methods/Design: This study is a randomized clinical trial conducted in the primary care setting. The study's scope will include two urban primary care centers which provide care for approximately 49,400 patients. All patients attending these two primary care centers, who are newly diagnosed with benign paroxysmal positional vertigo, will be invited to participate in the study and will be randomly assigned either to the treatment group (Epley's maneuver) or to the control group (a sham maneuver). Both groups will receive betahistine. Outcome variables will be: response to the D-H test, patients' report on presence or absence of vertigo during the previous week (dichotomous variable: yes/no), intensity of vertigo symptoms on a Likert-type scale in the previous week, total score on the Dizziness Handicap Inventory (DHI) and quantity of betahistine taken. We will use descriptive statistics of all variables collected. Groups will be compared using the intent-to-treat approach and either parametric or nonparametric tests, depending on the nature and distribution of the variables. Chi-square test or Fisher's exact test will be conducted to compare categorical measures and Student's t-test or Mann-Whitney U-test will be used for intergroup comparison variables. Discussion: Positive results from our study will highlight that treatment of benign paroxysmal positional vertigo can be performed by trained general practitioners (GPs) and, therefore, its widespread practice may contribute to improve the quality of life of BPPV patients

Ciencia Odontológica 2.0

Libro que muestra avances de la Investigación Odontológica en MéxicoEs para los integrantes de la Red de Investigación en Estomatología (RIE) una enorme alegría presentar el segundo de una serie de 6 libros sobre casos clínicos, revisiones de la literatura e investigaciones. La RIE está integrada por cuerpos académicos de la UAEH, UAEM, UAC y UdeG

A single Epley manoeuvre can improve self-perceptions of disability (quality of life) in patients with pc-BPPV: A randomised controlled trial in primary care

Posterior canal benign paroxysmal positional vertigo (pc-BPPV) causes physical, functional, and emotional impairment. The treatment is the Epley manoeuvre (EM). Objective: The purpose of the study was to compare the impact of the EM and a sham manoeuvre in primary care on self-perceived disability. Design: Randomised, double-blind, sham-controlled clinical trial conducted in primary care with a follow-up of 1 year. Participants: Patients aged ≥18 years old diagnosed with pc-BPPV according to the Dix–Hallpike test (DHT) were randomised to: Interventions: Intervention (EM) group or a control (sham manoeuvre) group. Main measurements: The main study covariates were age, sex, history of depression and anxiety, presence of nystagmus in the DHT, patient-perceived disability assessed with the Dizziness Handicap Inventory – screening version (DHI-S). Data were analyzed using bivariate and multivariate mixed Tobit analyses. Results: Overall, 134 patients were studied: 66 in the intervention group and 68 in the control group. Median age was 52 years (interquartile range [IQR], 38.25–68.00 years. standard deviation, 16.98) and 76.12% of the patients were women. The DHT triggered nystagmus in 40.30% of patients. The median total DHI-S score for the overall sample at baseline was 16 (IQR, 8.00–22.00); 16 [IQR, 10.5–24.0] vs 10 [6.0–14.0] for women vs men (P < .001). Patients treated with the EM experienced a mean reduction of 2.03 points in DHI-S score over the follow-up period compared with patients in the sham group. Conclusions: Pc-BPPV affects the quality of life of primary care patients. A single EM can improve self-perceptions of disability by around 2 points on the DHI-S scale. Resumen: El vértigo posicional paroxístico benigno del canal posterior (pc-BPPV) causa deterioro físico, funcional y emocional. El tratamiento es la maniobra de Epley (ME). Objetivo: El propósito del estudio fue comparar el impacto de la ME y una maniobra simulada en Atención Primaria sobre la discapacidad autopercibida. Diseño: Ensayo clínico aleatorizado, doble ciego y controlado realizado en Atención Primaria con un seguimiento de un año. Participantes: Los pacientes ≥18 años diagnosticados de pc-BPPV según la prueba de Dix-Hallpike (DHT) fueron aleatorizados para: Intervenciones: Grupo de intervención (EM) o un grupo de control (maniobra simulada). Variables principales: Las principales variables del estudio fueron la edad, el sexo, los antecedentes de depresión y ansiedad, la presencia de nistagmo en la DHT, la discapacidad percibida por el paciente, evaluada con la versión de cribado del Inventario de discapacidad del vértigo (DHI-S). Los datos se analizaron mediante análisis Tobit mixtos bivariados y multivariados. Resultados: Se estudió a 134 pacientes: 66 en el grupo de intervención y 68 en el grupo de control. La mediana de edad fue de 52 años (rango intercuartílico [IQR], 38,25-68,00 años; desviación estandar 16,98) y el 76,12% de los pacientes eran mujeres. La DHT desencadenó nistagmo en el 40,30% de los pacientes. La media del DHI-S para la muestra general al inicio del estudio fue de 16 (IQR 8,00-22,00); 16 (RIQ, 10,5-24,0) frente a 10 (6,0-14,0) para mujeres frente a hombres (p < 0,001). Los pacientes tratados con ME experimentaron una reducción media de 2,03 puntos en la puntuación DHI-S durante el período de seguimiento en comparación con los pacientes del grupo simulado. Conclusiones: El Pc-BPPV afecta a la calidad de vida de los pacientes de Atención Primaria. Una sola ME puede mejorar la autopercepción de la discapacidad en alrededor de 2 puntos en la escala DHI-S