Response to: myositis after SARS-CoV-2 vaccination occurs more frequently than assumed and is probably causally related.

We thank Finsterer et al. for the attention paid to our publication; we recognize the validity of the points mentioned in their letter to the editor and will try to answer the observations made.

Idiopathic inflammatory myopathies linked to vaccination against SARS-CoV-2: a systematic review.

The COVID-19 pandemic represents a global health problem, which has been mitigated by the opportune introduction of vaccination programs. Although we already know the benefit that vaccines provide, these are not exempt from adverse events which can be mild to deadly, such as idiopathic inflammatory myopathies, in which a temporal association has not been defined. It is for this reason that we carried out a systematic review of all reported cases of vaccination against COVID-19 and myositis. To identify previously reported cases of idiopathic inflammatory myopathies associated with vaccination against SARS-CoV-2 we registered this protocol on the website of PROSPERO with identification number CRD42022355551. Of the 63 publications identified in MEDLINE and 117 in Scopus, 21 studies were included, reporting 31 cases of patients with vaccination-associated myositis. Most of these cases were women (61.3%); mean age was 52.3 years (range 19-76 years) and mean time of symptom onset post-vaccination was 6.8 days. More than half of the cases were associated with Comirnaty, 11 cases (35.5%) were classified as dermatomyositis, and 9 (29%) as amyopathic dermatomyositis. In 6 (19.3%) patients another probable trigger was identified. Case reports of inflammatory myopathies associated with vaccination have heterogeneous presentations without any specific characteristics: as a consequence, it is not possible to ensure a temporal association between vaccination and the development of inflammatory myopathies. Large epidemiological studies are required to determine the existence of a causal association.

The effect of transdermal gender-affirming hormone therapy on markers of inflammation and hemostasis.

BACKGROUND: Cardiovascular risk is increased in transgender persons using gender-affirming hormone therapy. To gain insight into the mechanism by which sex hormones affect cardiovascular risk in transgender persons, we investigated the effect of hormone therapy on markers of inflammation and hemostasis. METHODS: In this exploratory study, 48 trans women using estradiol patches plus cyproterone acetate (CPA) and 47 trans men using testosterone gel were included. They were between 18 and 50 years old and did not have a history of cardiovascular events. Measurements were performed before and after 3 and 12 months of hormone therapy. RESULTS: After 12 months, in trans women, systemic and endothelial inflammatory markers decreased (hs-CRP -66%, (95% CI -76; -53), VCAM-1-12%, (95% CI -16; -8)), while platelet activation markers increased (PF-4 +17%, (95% CI 4; 32), ß-thromboglobulin +13%, (95% CI 2; 24)). The coagulation marker fibrinogen increased transiently, after 3 months (+15%, (95% CI 1; 32)). In trans men, hs-CRP increased (+71%, (95% CI 19; 145)); platelet activation and coagulation markers were not altered. In both trans women and trans men, leptin and adiponectin changed towards reference values of the experienced gender. CONCLUSIONS: Platelet activation and coagulation marker concentrations increased in trans women using transdermal estradiol plus CPA, but not in trans men using testosterone. Also, concentrations of inflammatory markers decreased in trans women, while hs-CRP increased in trans men. Our results indicate that hormone therapy may affect hemostasis in transgender persons, which could be an underlying mechanism explaining the increased cardiovascular risk in this population.

The stabilization of managese(III) by azide ions in aqueous solution.

The evidences of spontaneous oxidation of Mn(II) by the dissolved oxygen in azide buffer medium, which is dependent on the N (-)(3)HN (3) concentration, suggested a formation of stable Mn(III) complexes due to marked colour changes. Spectrophotometric studies combined with coulometric generation of Mn(III), in presence of large excess of Mn(II), showed a maximum absorbance peak at 432 nm. The molar absorptivity increases with azide concentration (0.44-3.9 mol 1(-1)) from 3100 to 6300 mol(-1) 1 cm(-1), showing a stepwise complex formation. Potential measurements of the Mn(III) Mn(II) system in several azide aqueous buffers solutions: 1.0 x 10(-2) mol 1(-1) HN(3), (0.50-2.0 mol 1(-1)) N(-)(3) and 5.0 x 10(-2) mol 1(-1) Mn(II) and constant ionic strength 2.0 mol 1(-1), kept with sodium perchlorate, leads to the conditional potential, E(0')x, in several azide concentrations at 25.0 +/- 0.1 degrees C. Considering the overall formation constants of Mn(II) N (-)(3), from former studies, and the potential, E(0')s = 1.063 V versus SCE, for Mn(III) Mn(II) system in non-complexing media, it was possible to calculate the Fronaeus function, F(0)(L), and the following overall formation constants: beta(1) = 1.2 x 10(5) M(-1), beta(2) = 6.0 x 10(8) M(-2), beta(3) = (2.4 +/- 0.7) x 10(11) M(-3), beta(4) = (1.5 +/- 0.5) x 10(11) M(-4) and beta(5) = (9.6 +/- 0.8) x 10(11) M(-5) for the Mn(III) N (-)(3) complexes. These data give important support to understand the importance of Mn(II) and Mn(III) synergistic effect on the analytical method of S(IV) determination based on the Co(II) autoxidation.

Study of complex formation in the manganese(II)/azide system.

The complex formation between Mn(II) cations and N(3)(-) anions was studied in aqueous medium at 25 degrees C and ionic strength 2.0 M (NaClO(4)). Data of average ligand number, n (Bjerrum's function), were obtained from pH measurements on the Mn(II)/N(3)(-)/HN(3) system followed by integration to obtain Leden's function, F(0)(L). Graphical treatment of data and a matrix solution of simultaneous equations have given the following overall formation constants of mononuclear stepwise complexes: beta(1)=4.15+/-0.02 M(-1), beta(2)=6.61+/-0.04 M(-2), beta(3)=3.33+/-0.02 M(-3), beta(4)=0.63+/-0.01 M(-4). A linear plot of log K(n) vs. (n-1) shows no change in the configuration during complex formation. Slow spontaneous oxidation of solutions to Mn(III) occurs when the N(3)(-) concentration is greater than 1.0 M.

Influence of stabilization occlusal splints on sternocleidomastoid and masseter electromyographic activity.

The present work was conducted in order to determine the effect of stabilization occlusal splints on electromyographic (EMG) activity of sternocleidomastoid and masseter muscles, in subjects with tenderness to palpation in these muscles. A full-arch maxillary stabilization occlusal splint was made for each of 14 subjects. Tonic EMG activity, as well as during saliva swallowing and maximal voluntary clenching, was recorded with and without a stabilization occlusal splint inserted. Similar tonic, as well as maximal voluntary clenching EMG activity, with and without the stabilization occlusal splint, was observed. During saliva swallowing, the activity in both muscles was significantly lower with the stabilization occlusal splint. This suggests that daytime use of the stabilization occlusal splint might improve tenderness to palpation in the studied muscles, since the frequency of swallowing function is higher during waking hours.

Influence of variation in jaw posture on sternocleidomastoid and trapezius electromyographic activity.

This study was conducted in order to determine the influence of variation in the occlusal contacts on electromyographic (EMG) cervical activity in 20 patients with myogenic cranio-cervical-mandibular dysfunction. EMG recordings during maximal voluntary clenching were performed by placing surface electrodes on the left sternocleidomastoid and upper trapezius muscles in the following conditions: intercuspal position; edge to edge left laterotrusive contacts (ipsilateral); edge to edge right laterotrusive contacts (contralateral); edge to edge protrusive contacts; and retrusive occlusal contacts. A significant higher EMG activity was recorded in both muscles during maximal voluntary clenching in retrusive occlusal contact position, whereas no significant differences in EMG activity were observed between intercuspal position, ipsilateral, contralateral and protrusive contact positions. The EMG pattern observed suggests that a more frequent intensity and duration of tooth clenching in retrusive occlusal contact position could result in more clinical symptomatology in these cervical muscles in patients with myogenic cranio-cervical-mandibular dysfunction.

Increase of the vertical occlusal dimension by means of a removable orthodontic appliance and its effect on craniocervical relationships and position of the cervical spine in children.

The aim of this study was to determine the effect of the increase in the occlusal vertical dimension by means of an orthodontic appliance on craniocervical relationships and position of the cervical spine. Thirty children presenting malocclusion were divided into two groups of 15 (a study and a control group). Those in the study group wore an orthodontic appliance to correct cross-bite. The children in the control group had no treatment during the experimental period. Two lateral craniocervical radiographs were taken for each child. The first one was taken in the intercuspal position in both groups. The second radiograph was taken of the study group after four months of wearing the appliance and also of the control group after four months. Cephalometric analysis in the study group showed a significant forward cervical spine position. There were no significant changes in the control group. The changes found in the study group suggest that when there are signs and symptoms of cervical dysfunction in children undergoing long-term orthodontic treatment, it is necessary to make an evaluation of the cervical column position after the insertion of any orthodontic appliance which increases the occlusal vertical dimension.

Influence of stabilization occlusal splint on craniocervical relationships. Part II: Electromyographic analysis.

The aim of this study was to determine the effect of stabilization occlusal splints on electromyographic (EMG) activity of sternocleidomastoid and trapezius muscles in subjects with spasm in the mentioned muscles. A full-arch maxillary stabilization occlusal splint was made for each of the 15 subjects. In the sternocleidomastoid muscle, tonic and saliva swallowing EMG activity decreased significantly with the splint, whereas maximal clenching activity did not change. In the trapezius muscle, no significant changes were observed with the occlusal splint. The different pattern in both muscles during tonic and swallowing EMG activity with the splint is attributed to differences in the synaptic inputs to the respective motoneuron pools, suggesting that a differential modulation of the motor neuron pools may exist of both muscles, of peripheral and/or central origin.

Influence of stabilization occlusal splint on craniocervical relationships. Part I: Cephalometric analysis.

This study was conducted in order to determine the effect of an occlusal splint on craniocervical relationships, in subjects with muscle spasms in the sternocleidomastoid and trapezius muscles. A full-arch maxillary stabilization occlusal splint was made for each of the 15 subjects. Two lateral craniocervical radiographs were taken for each subject, with and without an occlusal splint. Cephalometric analysis showed that the splint caused a significant extension of the head on the cervical spine. There was also a significant decrease in the cervical spine lordosis in the first, second and third cervical segment. These cervical changes could be a compensation mechanism caused by the extension of the cranium on the upper cervical spine. The change in the curvature implies that it is necessary to periodically evaluate the changes occurring in the craniocervical relationships after the occlusal splint has been inserted.

Body position effects on EMG activity of sternocleidomastoid and masseter muscles in patients with myogenic cranio-cervical-mandibular dysfunction.

This study was conducted in order to determine the effects of body position on integrated electromyographic (IEMG) activity of sternocleidomastoid and masseter muscles in 17 patients with myogenic cranio-cervical-mandibular dysfunction. EMG recordings at rest and during swallowing of saliva and maximal voluntary clenching were performed by placing surface electrodes on the sternocleidomastoid and masseter muscles (contralateral to the habitual side of sleeping of each patient), in the following body positions: standing, seated, supine, and lateral decubitus position. Significant higher EMG activities were recorded in the sternocleidomastoid muscle in the lateral decubitus position and in the supine position (except during swallowing), whereas a significant higher EMG activity was recorded in the masseter muscle during maximal voluntary clenching in standing and seated positions. The EMG pattern observed suggests that the presence of parafunctional habits and body position could be closely correlated with the clinical symptomatology in the sternocleidomastoid and masseter muscles at wakening and during waking hours, respectively, in patients with myogenic cranio-cervical-mandibular dysfunction.

Body position effects on sternocleidomastoid and masseter EMG pattern activity in patients undergoing occlusal splint therapy.

This study was conducted in order to determine the effects of body position on electromyographic (EMG) activity of sternocleidomastoid and masseter muscles, in 15 patients with myogenic cranio-cervical-mandibular dysfunction undergoing occlusal splint therapy. EMG activity was recorded by placing surface electrodes on the sternocleidomastoid and masseter muscles (contralateral to the habitual sleeping side of each patient). EMG activity at rest and during swallowing of saliva and maximal voluntary clenching was recorded in the following body positions: standing, supine and lateral decubitus. In the sternocleidomastoid muscle significant higher EMG activities at rest and during swallowing were recorded in the lateral decubitus position, whereas during maximal voluntary clenching EMG activity did not change. In the masseter muscle significant higher EMG activity during maximal voluntary clenching in a standing position was observed, whereas EMG activity at rest and during swallowing did not change. The opposite pattern of EMG activity supports the idea that there may exist a differential modulation of the motor neuron pools of the sternocleidomastoid and masseter muscles, of peripheral and/or central origin. This suggests that the presence of parafunctional habits and body position could be closely correlated with the clinical symptomatology in these muscles in patients with myogenic craniomandibular dysfunction.

[Multicenter study on the usefulness of the NasOral system for the denitrogenation and apneic oxygenation in anesthesia]. / Estudio multicéntrico sobre la utilidad del sistema NasOral para la desnitrogenación y oxigenación apneica en anestesia.

OBJECTIVES: To study the usefulness of the NasOral system for denitrogenation prior to anesthetic induction for improving pulmonary oxygen storage that maintains SpO2 within the normal range during induced apnea and facilitates apneic oxygenation. MATERIAL AND METHODS: To establish the study population of 125, five hospitals of the Valencian Community (Spain) enrolled patients scheduled for elective procedures under general anesthesia. The patients were preoxygenated using the NasOral system (denitrogenation). For two minutes, the patients inhaled oxygen through the nose (FiO2 1) at a flow rate of 8-10 l/min (never less than the patient's own minute volume) and exhaled orally through a unidirectional valve. We measured time of apnea with SpO2 > or = 96% to assess the usefulness of the device for denitrogenation. We also measured PetCO2 after endotracheal intubation and after maximum time of apnea (< or = 10 minutes) to assess use of the device for apneic oxygenation during laryngoscopy. RESULTS: We found no significant differences with regard to age, sex, ASA or Mallampati classification among patient groups enrolled at the participating hospitals. Cox's regression analysis was used to determine relative risk of SpO2 < 96%. At 10 minutes post-apnea, 88.8% of all patients maintained SpO2 > or = 96%. However, SpO2 > 96% was maintained by 94.1% in the Mallampati I group and by 84.1% in the Mallampati II group. SpO2 fell below the cut-off (< 96%) in 33.3% of obese patients and in 7.5% of non-obese patients. Analysis of the likelihood of SpO2 < 96% associated with the variables of obesity, sex, age, ASA and Mallampati classification was significant only for obesity, for which a risk of 1.95 was calculated relative to non-obesity (95% CI 1.14-3.35). The NasOral system allows performance of direct laryngoscopy for oral tracheal intubation, maintaining oxygen flow through the permeable airway to facilitate apneic oxygenation. CONCLUSIONS: The NasOral system facilitates denitrogenation before induction of anesthesia in all patients with permeable nasal fossae as well as apneic oxygenation during laryngoscopy.

Seronegative spondyloarthropathies and HLA antigens in a Mestizo population.

HLA-A and -B antigens incidence were investigated in 100 cases of Seronegative Spondyloarthropathies and in 303 control individuals of a Venezuelan Mestizo population. Significative increased incidence of B27 was found among 69% of patients with ankylosing spondylitis and 68% with Reiter syndrome being the incidence in the control group of 2.9%. The B27 negative patients showed 40.4% positivity for Bw35, with spondylitic lesion in 12 out of 17 cases. Our results question the applicability of B27 as diagnostic criteria in the Mestizo patients bearers of a Seronegative Spondyloarthropathy and suggest the need to investigate further the role of antigens of the B locus in the pathophysiology of these clinical entities.

Osteosarcoma de humero. Amputacion interescapulotoracica. / Osteosarcoma of the humerus. Forequarter amputation

Se presenta el caso de un paciente de 12 anos de edad tratado por un osteosarcoma osteogenico de humero izquierdo con amputacion de extremidad superior del tipo interescapulotoracica segun la tecnica de Litlewood y quimioterapia durante 2 anos, con una sobrevida de 5 anos y medio. Se analiza las ventajas y las indicaciones de esta tecnica quirurgica

Estudio multicéntrico sobre la utilidad del sistema Nasoral® para la desnitrogenación y oxigenación apneica en anestesia / Multicenter study of the usefulness of the NasOral® system for denitrogenation and apneic oxygenation in anesthesia

OBJETIVOS. Estudiar la utilidad del sistema NasOral® para la desnitrogenación previa a la inducción de la anestesia, para conseguir el mejor almacenamiento pulmonar de oxígeno, que mantenga la SpO2 en límites normales durante la fase de apnea inducida y facilite la oxigenación apneica. MATERIAL Y MÉTODOS. La población de estudio incluye a 125 pacientes de cinco hospitales de la Comunidad Valenciana, seleccionados para anestesia general electiva, a quienes se realiza preoxigenación (desnitrogenación) con el sistema NasOral®, mediante la inspiración nasal de un flujo de O2 (FiO2, 1) a 8-10 l/min (no inferior al volumen minuto del paciente), y espiración oral a través de válvula unidireccional, durante 2 min. Medimos el tiempo de apnea con SpO2 96 por ciento para valorar la utilidad del dispositivo en la desnitrogenación, y PetCO2 tras la intubación endotraqueal al final del tiempo máximo de apnea ( 10 min), para evaluar la indicación del dispositivo para oxigenación apneica durante la laringoscopia. RESULTADOS. No encontramos diferencias significativas con respecto a la edad, sexo, ASA y Mallampati de la muestra entre los hospitales participantes. Para analizar el riesgo relativo de descender a SpO2 < 96 por ciento se utilizó la regresión de Cox. Del total de casos, el 88,8 por ciento mantuvo SpO2 96 por ciento a los 10 min postapnea. En el grupo de Mallampati I este porcentaje alcanza el 94,1 por ciento, mientras en el de Mallampati II es de 84,1 por ciento. Con respecto a la obesidad, el 33,3 por ciento de pacientes obesos desciende a SpO2 límite (< 96 por ciento), mientras que en los no obesos la tasa disminuye al 7,5 por ciento. La probabilidad de riesgo de descender a SpO2 límite entre las variables obesidad, sexo, edad, ASA y Mallampati, sólo se hace significativa entre los obesos con un riesgo relativo de 1,95 frente a los no obesos (intervalo de confianza [IC] 95 por ciento: 1,14-3,35).El mecanismo del sistema NasOral® permite practicar la laringoscopia directa para la intubación orotraqueal, manteniendo un flujo de O2 a través de la vía aérea permeable que facilita la oxigenación a neica. CONCLUSIONES. El sistema NasOral® permite la desnitrogenación previa a la inducción de la anestesia en todos los pacientes con fosas nasales permeables, y facilita la oxigenación apneica durante la laringoscopia (AU)