Estudio metaanalítico de la eficacia de la maniobra de Epley en el vértigo posicional paroxístico benigno / Meta-analysis on the efficacy of Epley's manoeuvre in benign paroxysmal positional vertigo

RESUMEN

Introducción: El vértigo posicional paroxístico benigno (VPPB) es una de las enfermedades que más habitualmente producen vértigo de fisionomía periférica. Objetivo: Evaluar la efectividad de la maniobra de Epley (ME) en el tratamiento del VPPB mediante una revisión crítica de la literatura médica y el empleo del metaanálisis. Métodos: Se realizaron búsquedas en la base de datos MEDLINE (PubMed), en la colección Cochrane (Cochrane Register of controlled studies), BIREME y LILACS (todas ellas hasta diciembre de 2008). Las entradas empleadas incluyeron canalith repositioning procedure, canalith repositioning maneuver, Epley maneuver, Dix-Hallpike, benign vertigo, benign positional vertigo, benign paroxysmal positional vertigo y BPPV. El metaanálisis se realizó con el programa RevMan 5.0. Resultados: Los pacientes a quienes se realiza la ME tienen 6 veces y media más posibilidades de mejorar su cuadro clínico sintomático en comparación con los grupos de control (odds ratio [OR]=6,52; intervalo de confianza [IC] del 95%, 4,17-10,20). Igualmente, los pacientes a quienes se efectuó la ME tienen 5 veces más oportunidades de tener un resultado negativo en el test de Dix-Hallpike que aquellos sin ME (OR=5,19; IC del 95%, 2,41-11,17). Conclusiones: La ME es efectiva en el control del VPPB (AU)

ABSTRACT

Introduction: Benign paroxysmal positional vertigo (BPPV) is one of the most common conditions that cause the physiognomy of peripheral vertigo.Objective: To evaluate the effectiveness of Epley's manoeuvre (EM) in the treatment of BPPV using a critical review of the medical literature and a meta-analysis. Human cytomegalovirus infection is a major cause of morbidity after lung transplantation. LIR-1 (leucocyte immunoglobulin-like receptor-1) is an inhibitory cell surface receptor that has high affinity for an MHC class I homologue (UL18) encoded by human cytomegalovirus. We aimed to investigate whether reactivation of human cytomegalovirus affects the expression of LIR-1. We measured LIR-1 expression on peripheral blood lymphocytes from 13 lung-transplant recipients and established human cytomegalovirus load using PCR. Eight patients developed cytomegalovirus disease. The percentage of cells expressing LIR-1 increased in the patients who developed cytomegalovirus disease several weeks before viral DNA was detectable by PCR. Measurement of LIR-1 expression might allow early identification of cytomegalovirus disease in lung-transplant patients. Searches were made in the databases of MEDLINE (PubMed), in the Cochrane collection (Cochrane Register of controlled studies), BIREME and LILACS (all of them up to December 2008). The search words used were canalith repositioning procedure, canalith repositioning manoeuvre, Epley manoeuvre, Dix-Hallpike, benign vertigo, benign positional vertigo, benign paroxysmal positional vertigo and BPPV. The meta-analysis was performed using the program RevMan 5.0. Results: The patients on whom an EM was performed had a six and half times more chance of their clinical symptoms improving compared to the control group of patients (OR=6.52; 95% CI, 4.17-10.20) (AU)