RESUMEN
BACKGROUND: Patients with primary systemic vasculitis or polymyalgia rheumatica might be at a high risk for poor COVID-19 outcomes due to the treatments used, the potential organ damage cause by primary systemic vasculitis, and the demographic factors associated with these conditions. We therefore aimed to investigate factors associated with COVID-19 outcomes in patients with primary systemic vasculitis or polymyalgia rheumatica. METHODS: In this retrospective cohort study, adult patients (aged ≥18 years) diagnosed with COVID-19 between March 12, 2020, and April 12, 2021, who had a history of primary systemic vasculitis (antineutrophil cytoplasmic antibody [ANCA]-associated vasculitis, giant cell arteritis, Behçet's syndrome, or other vasculitis) or polymyalgia rheumatica, and were reported to the COVID-19 Global Rheumatology Alliance registry were included. To assess COVID-19 outcomes in patients, we used an ordinal COVID-19 severity scale, defined as: (1) no hospitalisation; (2) hospitalisation without supplemental oxygen; (3) hospitalisation with any supplemental oxygen or ventilation; or (4) death. Multivariable ordinal logistic regression analyses were used to estimate odds ratios (ORs), adjusting for age, sex, time period, number of comorbidities, smoking status, obesity, glucocorticoid use, disease activity, region, and medication category. Analyses were also stratified by type of rheumatic disease. FINDINGS: Of 1202 eligible patients identified in the registry, 733 (61·0%) were women and 469 (39·0%) were men, and their mean age was 63·8 years (SD 17·1). A total of 374 (31·1%) patients had polymyalgia rheumatica, 353 (29·4%) had ANCA-associated vasculitis, 183 (15·2%) had giant cell arteritis, 112 (9·3%) had Behçet's syndrome, and 180 (15·0%) had other vasculitis. Of 1020 (84·9%) patients with outcome data, 512 (50·2%) were not hospitalised, 114 (11·2%) were hospitalised and did not receive supplemental oxygen, 239 (23·4%) were hospitalised and received ventilation or supplemental oxygen, and 155 (15·2%) died. A higher odds of poor COVID-19 outcomes were observed in patients who were older (per each additional decade of life OR 1·44 [95% CI 1·31-1·57]), were male compared with female (1·38 [1·05-1·80]), had more comorbidities (per each additional comorbidity 1·39 [1·23-1·58]), were taking 10 mg/day or more of prednisolone compared with none (2·14 [1·50-3·04]), or had moderate, or high or severe disease activity compared with those who had disease remission or low disease activity (2·12 [1·49-3·02]). Risk factors varied among different disease subtypes. INTERPRETATION: Among patients with primary systemic vasculitis and polymyalgia rheumatica, severe COVID-19 outcomes were associated with variable and largely unmodifiable risk factors, such as age, sex, and number of comorbidities, as well as treatments, including high-dose glucocorticoids. Our results could be used to inform mitigation strategies for patients with these diseases. FUNDING: American College of Rheumatology and the European Alliance of Associations for Rheumatology.
RESUMEN
BACKGROUND: The re-emergence of worldwide concern with arthropod-borne viruses (arboviruses) draws increasing attention to their mosquito vectors, particularly Aedes aegypti, whose control heavily rely on insecticide use. As a consequence, insecticide resistance is frequent, but the general patterns of occurrence, cross-resistance and prevailing mechanisms remain unrecognized in some areas such as the Neotropical region. Thus, we sought here to recognize the general trends and patterns of insecticide resistance in Latin America and the Caribbean. A systematic literature review (2008-2018) aimed the data-gathering for the region and meta-analyses to address the stated knowledge gap. RESULTS: A high incidence of insecticide resistance prevails in the mosquito populations of the region. Dichlorodiphenyltrichloroethane (DDT), temephos and deltamethrin were the main insecticides evaluated and the meta-analyses indicate a high frequency of DDT-resistant populations (86.7 ± 0.1%), followed by temephos (75.7 ± 0.1%) and deltamethrin (33.0 ± 0.1%). No evidence of cross-resistance was detected among these three insecticides, and the V1016I knockdown (KDR) site mutation does not explain the patterns of deltamethrin resistance in the region. CONCLUSION: Resistance to DDT, temephos and deltamethrin is serious and widespread, and there is no cross-resistance among them. Altered target site sensitivity is not the main pyrethroid resistance mechanism, which is likely due to a mix of mechanisms. Therefore, the replacement of deltamethrin and particularly temephos in the region by alternative insecticides is an important resistance management recommendation, but should be done with compounds out of the cross-resistance spectrum for these populations and insecticides. Nonetheless, the non-recognition of the prevalent resistance mechanisms in the region makes this suggestion more difficult to apply and invites more broad-scale studies of resistance mechanisms to fill this knowledge gap and improve the resistance management recommendations. © 2020 Society of Chemical Industry.
