Haemorrhage of human foetal cortex associated with SARS-CoV-2 infection.

Maternal viral infection and immune response are known to increase the risk of altered development of the foetal brain. Given the ongoing global pandemic of coronavirus disease 2019 (COVID-19), investigating the impact of SARS-CoV-2 on foetal brain health is of critical importance. Here, we report the presence of SARS-CoV-2 in first and second trimester foetal brain tissue in association with cortical haemorrhages. SARS-CoV-2 spike protein was sparsely detected within progenitors and neurons of the cortex itself, but was abundant in the choroid plexus of haemorrhagic samples. SARS-CoV-2 was also sparsely detected in placenta, amnion and umbilical cord tissues. Cortical haemorrhages were linked to a reduction in blood vessel integrity and an increase in immune cell infiltration into the foetal brain. Our findings indicate that SARS-CoV-2 infection may affect the foetal brain during early gestation and highlight the need for further study of its impact on subsequent neurological development.

Individual Cofactors and Multisensory Contributions to the Postural Sway of Adults with Diabetes.

To assess the interactions between individual cofactors and multisensory inputs on the postural sway of adults with type 2 diabetes and healthy subjects, 69 adults accepted to participate in the study (48 with/ 21 without diabetes). Assessments included neuro-otology (sinusoidal-rotation and unilateral-centrifugation), ophthalmology and physiatry evaluations, body mass index (BMI), physical activity, quadriceps strength, the ankle/brachial index and polypharmacy. Postural sway was recorded on hard/soft surface, either with eyes open/closed, or without/with 30° neck extension. The proportional differences from the baseline of each condition were analyzed using Multivariate and Multivariable analyses. Patients with polyneuropathy and no retinopathy showed visual dependence, while those with polyneuropathy and retinopathy showed adaptation. Across sensory challenges, the vestibulo-ocular gain at 1.28 Hz and the BMI were mainly related to changes in sway area, while the dynamic visual vertical was mainly related to changes in sway length. The ankle/brachial index was related to the effect of neck extension, with contributions from quadriceps strength/physical activity, polyneuropathy and polypharmacy. Across conditions, men showed less sway than women did. In conclusion, in adults with diabetes, sensory inputs and individual cofactors differently contribute to postural stability according to context. Rehabilitation programs for adults with diabetes may require an individualized approach.

Barriers and Facilitators in Access to Diabetes, Hypertension, and Dyslipidemia Medicines: A Scoping Review.

Objective: Identify barriers and facilitators in access to medicines for diabetes, hypertension, and dyslipidemia, considering patient, health provider, and health system perspectives. Methods: Scoping review based on Joanna Briggs methodology. The search considered PubMed, Cochrane Library, CINAHL, Academic Search Ultimate, Web of Science, SciELO Citation Index, and grey literature. Two researchers conducted screening and eligibility phases. Data were thematically analyzed. Results: The review included 219 documents. Diabetes was the most studied condition; most of the evidence comes from patients and the United States. Affordability and availability of medicines were the most reported dimension and specific barrier respectively, both cross-cutting concerns. Among high- and middle-income countries, identified barriers were cost of medicines, accompaniment by professionals, long distances to facilities, and cultural aspects; cost of transportation emerges in low-income settings. Facilitators reported were financial accessibility, trained health workers, medicines closer to communities, and patients' education. Conclusion: Barriers and facilitators are determined by socioeconomic and cultural conditions, highlighting the role of health systems in regulatory and policy context (assuring financial coverage and free medicines); providers' role bringing medicines closer; and patients' health education and disease management.

Stimulation of the Semicircular Canals or the Utricles by Clinical Tests Can Modify the Intensity of Phantom Limb Pain.

Background: After amputation, phantom limb pain may be produced by the multisensory processes underling the experience of an intact body. Clinical evidence has shown that cold caloric vestibular stimulation may modify the perception of phantom limb pain. However, it is yet unknown if this effect can be observed after the mild vestibular stimulation given by the clinical caloric test, or after utricle stimulation by centrifugation. Additionally, there are no studies on the association between the report of altered perceptions or experience of the self or the environment (depersonalization/derealization symptoms) and phantom limb pain. Objective: To assess the influence of unilateral stimulation of the horizontal semicircular canals by clinical caloric test, and the utricles by unilateral centrifugation on the intensity of phantom limb pain, and to explore the association between phantom limb pain and symptoms of depersonalization/ derealization. Methods: 34 patients (56 ±7 years old, 23 men) accepted to participate after 3 to 23 months of unilateral supracondylar amputation, secondary to type 2 diabetes mellitus. After assessment of vestibular function and symptoms of common mental disorders, using a cross-over design, in 2 separate sessions with 1 week in between, vestibular stimulation was delivered by right/left caloric test (30 or 44°C) or right/ left centrifugation (3.85 cm, 300°/s peak). Before and after each vestibular stimulus, the intensity of phantom limb pain and depersonalization/derealization symptoms were assessed, with a daily follow-up of pain intensity during 1 week. Results: Either caloric stimulation or unilateral centrifugation decreased phantom limb pain (p < 0.05), along with decrease of symptoms of depersonalization/derealization (p < 0.05). One third of the patients reporting pain decrease immediately after stimulation also reported no pain at least for 1 day. Limitations: No sham condition was included. Conclusions: Vestibular stimulation by the clinical caloric tests or by unilateral centrifugation may decrease the intensity of phantom limb pain, with decrease of perceptions of unreality. These effects might be related to an update of the immediate experience of the body, given by the sensory mismatch induced by asymmetrical vestibular stimulation.

Derealization symptoms according to the subjective visual vertical during unilateral centrifugation in patients with type 2 diabetes mellitus.

BACKGROUND: A recent study has shown variability on the perception of verticality during unilateral centrifugation among patients with type 2 diabetes mellitus; it is yet unknown if it is related to symptoms of unreality. OBJECTIVE: In patients with type 2 diabetes mellitus compared to age matched healthy volunteers, to assess depersonalization/derealization (DD) symptoms before and after unilateral centrifugation, according to the subjective visual vertical (SVV). METHODS: 47 patients with type 2 diabetes mellitus and 50 age matched healthy volunteers participated in the study. They replied to standardized questionnaires of symptoms related to balance, depression, and anxiety. Then, after neuro-otological evaluation, they completed a DD inventory before and after unilateral centrifugation (300°/s, 3.85 cm) with SVV estimation. RESULTS: Right/left asymmetric SVV during centrifugation was identified in 17 patients (36%) and no SVV change during centrifugation was identified in 6 patients (13%). Before centrifugation, patients with asymmetric SVV already reported some of the DD symptoms, while patients with no SVV change reported almost no DD symptoms. Unilateral centrifugation provoked an increase of DD symptoms in both healthy volunteers and the entire group of patients (repeated measures ANOVA, p < 0.01), except in the 6 patients with no SVV change. Before centrifugation, the DD score showed influence from the SVV subgroup and the evidence of depression (MANCoVA, p < 0.01); after centrifugation, which provoked asymmetry of the right/left utricular input, only the influence from depression persisted. No influence was observed from the characteristics of the subjects, including retinopathy, peripheral neuropathy (assessed by electromyography) or weight loss, or from the total score on the questionnaire of symptoms related to balance. CONCLUSIONS: In patients with type 2 diabetes mellitus and healthy volunteers, utricular stimulation by unilateral centrifugation may provoke DD symptoms, with an influence from depression. The results support that the aphysiological utricular input given by unilateral centrifugation may contribute to create a misleading vestibular frame of reference, giving rise to 'unreal' perceptions.

Influence of the body mass index on the occurrence of falls in patients with type 2 diabetes mellitus.

To assess the influence of the body mass index (BMI) on the occurrence of falls in adults with type 2 diabetes mellitus, receiving primary health care. We collected data from 134 patients (56.7±9.4 y.o.), none of them were seeking medical care due to sensory or balance decline. During the first evaluation, they reported falls, replied to a questionnaire of symptoms related to balance and had a sensory evaluation. After a 6 months follow-up, they reported falls again and, according to the occurrence of falls during the preceding year, patients were classified in 2 groups: no falls (N=92) and falls (N=42). The occurrence of falls was related to BMI, gender and age. Compared to patients with no falls, patients with falls had a greater BMI and comprised a higher proportion of patients with a BMI ≥35; patients with a BMI ≥35 were younger than patients with a BMI <35. A total symptom score ≥4 allowed the classification of 77.7% of the patients with falls and 59.5% with no falls. In adults with type 2 diabetes mellitus, a BMI ≥35 may have an influence on balance and the occurrence of falls, which might be independent from aging. Patients should be aware of this risk and receive counsel on modifiable risk factors.

The association of subtypes of breast cancer with tumour characteristics and reproductive factors in 1326 Mexican women.

AIM OF THE STUDY: In breast cancer, oestrogen receptor (ER), progesterone receptor (PgR), and HER2 (HER2/Neu) expression status are used to classify neoplasms into subtypes: Luminal A, Luminal B, HER2/Neu type, and Basallike. The aim of the present study was to establish the molecular subtypes of breast cancers and their association with tumour characteristics and reproductive factors in Mexican women. MATERIAL AND METHODS: A total of 1326 biopsies of breast tumour tissues were analysed for ER, PR, and HER2/Neu by immunohistochemistry (IHC). Information regarding age, tumour characteristics, and node involvement profiles were collected. RESULTS: IHC established that the most common subtype of breast cancer was Luminal A (64.93%), followed by Basal-Like (13.88%), Luminal B (12.52%), and HER2/Neu (8.67%). T2-size tumours (> 2 cm but < 5 cm) were present in 47.59% of all patients. Univariate analysis showed that lymph node positivity (p = 0.009), stage (p = 0.013), and placement of the tumour (p = 0.001) were factors associated with breast cancer subtype. CONCLUSIONS: Our data show that IHC is useful for distinguishing different subtypes of breast cancer and that Luminal A is the most common breast cancer subtype in the Mexican population. All subtypes were associated with unfavourable clinicopathological features, suggesting that late diagnosis is an important contributor to high mortality rates in the Mexican population.

Simulación de queratotomía arqueada por medio de un modelo de elementos finitos: aplicación de una plataforma de interacción entre Matlab y COMSOL Multiphysics / Simulation of arcuate keratotomy using the finite elements method: an application of an interaction platform of Matlab and COMSOL Multiphysics

La queratotomía radial es uno de los métodos quirúrgicos empleados para corregir los defectos ópticos de las personas; ésta ha sido ampliamente estudiada, e incluso se han propuesto nomogramas que permiten predecir los resultados de algunas geometrías; a pesar de esto, las experiencias postoperatorias han demostrado que la tasa de éxito de las cirugías es baja, ya que se presenta hipocorrección o hipercorrección de los pacientes, obligándolos a usar ayudas externas o llevándolos a someterse nuevamente a una cirugía. Teniendo en cuenta esto, se desarrolló una plataforma para simular estas cirugías por medio del método de elementos finitos, empleando los programas Matlab y COMSOL Multiphysics. Por medio de la rutina creada es posible obtener un modelo de la córnea preoperatoria que se asemeje tanto en geometría, como en condiciones de esfuerzo, a la córnea real; adicionalmente, es posible adaptar la geometría de la queratotomía radial que desee simularse. Se realizaron simulaciones para una cirugía compuesta de dos arcos y otra de tres arcos; los resultados obtenidos demuestran la capacidad de la simulación numérica para avanzar en el desarrollo de la cirugía refractiva, al ser posible estudiar parámetros, que de forma experimental, son difíciles de tener en cuenta, como la geometría inicial de la córnea y la edad del paciente, lo cual influye en el módulo de elasticidad del material; por otra parte, se encontró que esta aplicación es una potencial herramienta para los oftalmólogos, pues tiene la capacidad de predecir los resultados postoperatorios.

Radial keratotomy is used as a methodology to correct refractive errors. This surgery has been widely studied and also nomograms have been proposed in order to predict postoperative results of some types of keratotomies. Despite these eff orts, surgical evidence has shown a low success rate because of undercorrection or overcorrection, forcing patients to use spectacles or contact lenses, after surgery, or even leads them to a new procedure. A simulation platform was developed in an attempt to study these surgeries, employing the finite element method, using Matlab and COMSOL Multiphysics simultaneously. The routine is capable of simulate the preoperative cornea in terms of geometry and stress configuration. Also, it could be adapted to simulate any kind of radial keratotomy LASIK and PRK surgeries. Simulations for a double arc keratotomy and a triple arc keratotomy were developed. Results provide evidence of the capability of the platform to improve knowledge of refractive surgery taking into account the possibility to analyze the effect produced by corneal geometry and patient age, which aff ects the elastic modulus of the material, parameters difficult to analyze in an in-vivo experiment. Besides, it demonstrates the potential of the program as a tool for the surgeon to plan refractive surgery.

Assessing the effects of adsorptive polymeric resin additions on fungal secondary metabolite chemical diversity.

Adsorptive polymeric resins have been occasionally described to enhance the production of specific secondary metabolites (SMs) of interest. Methods that induce the expression of new chemical entities in fungal fermentations may lead to the discovery of new bioactive molecules and should be addressed as possible tools for the creation of new microbial chemical libraries for drug lead discovery. Herein, we apply both biological activity and chemical evaluations to assess the use of adsorptive resins as tools for the differential expression of SMs in fungal strain sets. Data automation approaches were applied to ultra high performance liquid chromatography analysis of extracts to evaluate the general influence in generating new chemical entities or in changing the production of specific SMs by fungi grown in the presence of resins and different base media.

The influence of peripheral neuropathy, gender, and obesity on the postural stability of patients with type 2 diabetes mellitus.

AIM: To assess the influence of peripheral neuropathy, gender, and obesity on the postural stability of patients with type 2 diabetes mellitus. METHODS: 151 patients with no history of otology, neurology, or orthopaedic or balance disorders accepted to participate in the study. After a clinical interview and neuropathy assessment, postural stability was evaluated by static posturography (eyes open/closed on hard/soft surface) and the "Up & Go" test. RESULTS: During static posturography, on hard surface, the length of sway was related to peripheral neuropathy, gender, age, and obesity; on soft surface, the length of sway was related to peripheral neuropathy, gender, and age, the influence of neuropathy was larger in males than in females, and closing the eyes increased further the difference between genders. The mean time to perform the "Up & Go" test was 11.6 ± 2.2 sec, with influence of peripheral neuropathy, gender, and age. CONCLUSION: In order to preserve the control of static upright posture during conditions with deficient sensory input, male patients with type 2 diabetes mellitus with no history of balance disorders may be more vulnerable than females, and obesity may decrease the static postural control in both males and females.

Chemical and physical modulation of antibiotic activity in emericella species.

The addition of epigenetic modifying agents and ion-exchange resins to culture media and solid-state fermentations have been promoted as ways to stimulate expression of latent biosynthetic gene clusters and to modulate secondary metabolite biosynthesis. We asked how combination of these treatments would affect a population of screening isolates and their patterns of antibiosis relative to fermentation controls. A set of 43 Emericella strains, representing 25 species and varieties, were grown on a nutrient-rich medium comprising glucose, casein hydrolysate, urea, and mineral salts. Each strain was grown in untreated agitated liquid medium, a medium treated with suberoylanilide hydroxamic acid, a histone deacetylase inhibitor, 5-azacytidine, a DNA methylation inhibitor, an Amberlite non-ionic polyacrylate resin, and the same medium incorporated into an inert static vermiculite matrix. Species-inherent metabolic differences more strongly influenced patterns of antibiosis than medium treatments. The antibacterial siderophore, desferritriacetylfusigen, was detected in most species in liquid media, but not in the vermiculite medium. The predominant antifungal component detected was echinocandin B. Some species produced this antifungal regardless of treatment, although higher quantities were often produced in vermiculite. Several species are reported for the first time to produce echinocandin B. A new echinocandin analog, echinocandin E, was identified from E. quadrilineata.

A new approach to drug discovery: high-throughput screening of microbial natural extracts against Aspergillus fumigatus using resazurin.

Natural products are an inexhaustible source for drug discovery. However, the validation and selection of primary screening assays are vital to guarantee a selection of extracts or molecules with relevant pharmacological action and worthy of following up. The assay must be rapid, simple, easy to implement, and produce quick results and preferably at a low cost. In this work, we developed and validated a colorimetric microtiter assay using the resazurin viability dye. The parameters of the resazurin method for high-throughput screening (HTS) using natural extracts against Aspergillus fumigatus were optimized and set up. The extracts plus RPMI-1640 modified medium containing the spores and 0.002% resazurin were added per well. The fluorescence was read after 24 to 30 h of incubation. The resazurin proved to be as suitable as Alamar Blue for determining the minimal inhibitory concentration of different antifungals against A. fumigatus and effective to analyze fungicidal and fungistatic compounds. An HTS of 12 000 microbial extracts was carried out against two A. fumigatus strains, and 2.7% of the extracts displayed antifungal activity. Our group has been the first to use this methodology for screening a collection of natural extracts to identify compounds with antifungal activity against the medically important human pathogen A. fumigatus.

Poly(3-hydroxybutyrate) production by Bacillus cereus SPV using sugarcane molasses as the main carbon source.

The main hindrance in the use of polyhydroxyalkanoates (PHAs) as a replacement for existing petroleum-based plastics is their high production cost. The carbon source accounts for 50% of the cost for PHA production. Thus, increasing the yield and productivity of PHAs on cheap substrates is an important challenge for biotechnologists to support the commercialization and further applications of these polymers. In this study, we have investigated the use of an agricultural raw material, sugarcane molasses, as the main carbon source for poly(3-hydroxybutyrate) (P(3HB)) production by Bacillus cereus SPV. These studies were carried out in both shaken flasks and 2 L bioreactors. Various conditions were evaluated for their effects on biomass and P(3HB) accumulation. A high polymer yield was obtained, 61.07% dry cell weight (DCW) in a 1 L shaken flask study and 51.37% DCW in a 2 L fermenter study. These yields are 50% higher than previously observed with Bacillus cereus SPV. Hence, the results are encouraging and show that sugarcane molasses are a promising carbon source for an economical and commercially viable production of P(3HB).

[Differences of risk factors for peripheral arterial disease in type 2 diabetes patients in urban and suburban populations]. / Enfermedad arterial periférica y factores de riesgo en pacientes diabéticos tipo 2: Diferencias en medio urbano y suburbano.

OBJECTIVES: To determine the prevalence of peripheral arterial disease (PAD) in type 2 diabetes patients and to measure the strength of the association of selected risk factors. METHODOLOGY: A cross-sectional study including two hundred and fifty-two type 2 diabetes patients older than 40 years was conducted in three family medicine clinics, one clinic located within the city and two clinics in the suburb. PAD was diagnosed by Doppler pulsed in the patients with an ankle/arm index < 0.9. CLINICAL VARIABLES: Serum cholesterol and triglycerides levels, body mass index (BMI), waist-hip index (WHI), blood pressure (BP) and fasting blood glucose average of the last six months. To ascertain the differences in the prevalence of PAD, chi(2) test was used; t test was used for quantitative variables; and to estimate the risks the odds ratios were calculated. RESULTS: Among urban population the prevalence of PAD was of 25.6% while for those living in the suburb was 9.8 % (p = 0.002). Serum levels of blood glucose and cholesterol were lower in the latter (p = 0.01 and p = 0.001 respectively). PAD was associated with serum blood glucose levels higher than 140 mg/dL (OR = 3.1; 95% CI: 1-9.7); total cholesterol higher than 200 mg/dL (OR = 2.8; 95% CI: 1.1-7.4); proteinuria (OR = 4.9; 95% CI: 1.7-30.6) and blood pressure higher than 140/90 mm Hg (OR = 2.11; 95% CI: 1.08-4.14). CONCLUSIONS: Prevalence of PAD was higher in type 2 diabetes patients receiving care in urban clinics when compared to those cared for at suburban family medicine clinics and its corresponding risk factors showed significant values.

[The subjective visual vertical in vestibular disease]. / La estimación visual de lo que está vertical en alteraciones vestibulares.

OBJECTIVE: To assess and compare the accuracy to perceive visual verticality, with and without trunk-head tilt in the frontal plane (30 degrees), in patients with peripheral or central vestibular disease. METHODS: Thirty eight patients accepted to participate, 23 with peripheral disease and 15 with central disease. We also evaluated 40 healthy subjects. Subjects were seated facing a screen with an anchored motorized bar (20 cm). They were asked to bring the line to vertical, using a joystick, 10 times while seated upright and 10 times while tilted 30 degrees to each side. An average of the distance from true vertical was calculated to determine the tilt of the visual vertical on each posture. RESULTS: Always, estimations made by healthy subjects were < 2 degrees from true vertical. In patients, in upright posture the largest tilt of the visual vertical was observed in patients with peripheral disease and spontaneous nystagmus. However, in all patients the accuracy to estimate the true vertical decreased when they were evaluated with trunk-head tilt (p < 0.05). In this condition the sensitivity of the test increased from 34 to 85% and the efficacy from 68 to 93% (p < 0.05). CONCLUSION: Trunk-head tilt in the frontal plane decreases the accuracy of patients with vestibular disease to visually perceive verticality. This finding shows that head-trunk tilt can improve the sensibility and efficacy of this test to assess the vestibular function.

La estimación visual de lo que está vertical en alteraciones vestibulares / The subjective visual vertical in vestibular disease

Objective. To assess and compare the accuracy to perceive visual verticality, with and without trunk-head tilt in the frontal plane (30°), in patients with peripheral or central vestibular disease. Methods. Thirty eight patients accepted to participate, 23 with peripheral disease and 15 with central disease. We also evaluated 40 healthy subjects. Subjects were seated facing a screen with an anchored motorized bar (20 cm). They were asked to bring the line to vertical, using a joystick, 10 times while seated upright and 10 times while tilted 30° to each side. An average of the distance from true vertical was calculated to determine the tilt of the visual vertical on each posture. Results. Always, estimations made by healthy subjects were < 2° from true vertical. In patients, in upright posture the largest tilt of the visual vertical was observed in patients with peripheral disease and spontaneous nystagmus. However, in all patients the accuracy to estimate the true vertical decreased when they were evaluated with trunk-head tilt (p < 0.05). In this condition the sensitivity of the test increased from 34 to 85% and the efficacy from 68 to 93% (p < 0.05). Conclusion. Trunk-head tilt in the frontal plane decreases the accuracy of patients with vestibular disease to visually perceive verticality. This finding shows that head-trunk tilt can improve the sensibility and efficacy of this test to assess the vestibular function.

Objetivo. Identificar y comparar la precisión de la estimación visual de lo que está vertical, con y sin inclinación tronco-cefálica en el plano frontal (30°), en pacientes con enfermedad vestibular periférica o central. Métodos. Participaron 38 pacientes con enfermedad vestibular, periférica en 23 y central en 15, además de 40 sujetos sin enfermedad vestibular. Se les instruyó a colocar en posición vertical una barra motorizada de 20 cm, manipulada por control remoto, mientras se encontraban sentados a 30 cm de una pantalla, sin guías visuales. Después de 10 determinaciones con el tronco y la cabeza erguidos y 10 determinación con inclinación tronco-cefálica de 30° a cada lado, se calculó el promedio del error de las estimaciones efectuadas en cada postura. Resultados. En sujetos sin enfermedad vestibular el error de la estimación en cualquier posición fue siempre menor a 2°. En posición erguida, el mayor error en la estimación se observó en pacientes con enfermedad periférica con nistagmus espontáneo. En todos los pacientes el error aumentó significativamente con inclinación tronco-cefálica (ANOVA, p < 0.05), particularmente en aquellos con afección de sistema nervioso central. Al efectuarse la prueba con inclinación tronco-cefálica la sensibilidad de la prueba para identificar a pacientes con enfermedad vestibular aumentó de 34 a 85% y la eficiencia de 68 a 93% (p < 0.05). Conclusión. La inclinación tronco-cefálica en el plano frontal aumenta la desviación de la percepción de lo que está vertical en pacientes con lesión vestibular periférica o central, lo que mejora la utilidad de la prueba para evaluar la función vestibular.

Las maniobras de Epley y de Semont en el tratamiento del vértigo postural paroxístico benigno / The Epley and semont maneuvers in the treatment of beningn paroxistic postural vertigo

Se realizó un estudio prospectivo para comparar los resultados de las maniobras de 'reposición' de Epley y 'liberadora' de Semont en 100 pacientes con vértigo postural paroxístico benigno (VPPB), del canal semicircular posterior. Los pacientes se incluyeron en dos grupos de estudio, pareados por edad y sexo y con similar número de pacientes con VPPB idiopático en cada grupo. Al grupo I se le aplicó la maniobra de 'reposición' y al grupo II la maniobra 'liberadora'. Durante los siguientes tres meses, a las semanas 1, 4 y 12, se evaluaron la remisión del nistagmus posicional y la mejoría subjetiva de cada paciente. En caso de que el nistagmus estuviera presente, se aplicó la maniobra correspondiente otra vez. Aproximadamente 60 por ciento de los pacientes presentó remisión del nistagmus posicional después de una sola aplicación de cualquiera de las maniobras. En cada grupo de estudio, a los tres meses, la remisión del nistagmus se presentó en más de 90 por ciento de los casos, con una mediana de la mejoría subjetiva de 90 por ciento. No se identificaron diferencias significativas en el porcentaje de remisión de los pacientes con VPPB idiopático vs aquellos con VPPB asociado a otras alteraciones. Se concluye que la aplicación de cualquiera de las dos maniobras es una opción eficaz para el tratamiento del VPPB del canal semicircular posterior.