Background and Purpose. Lymphoedema is a serious complication following limb salvage for extremity soft tissue sarcomas (STSs) for which little is known. We aimed to evaluate its incidence, its, severity and its associated risk factors. Material and Method. Patient and tumor characteristics, treatment modalities and complications and functional outcomes (MSTS 1987, TESS), and lymphoedema severity (Stern) were all collected from prospective databases. Charts were retrospectively abstracted for BMI and comorbidities. Results. There were 289 patients (158 males). Mean age was 53 (16–88). Followup ranged between 12 and 60 months with an average of 35 and a median of 36 months. Mean BMI was 27.4 (15.8–52.1). 72% had lower extremity tumors and 38% upper extremity. Mean tumor size was 8.1 cm (1.0–35.6 cm). 27% had no adjuvant radiation, 62% had 50 Gy, and 11% received 66 Gy. The incidence of lymphoedema was 28.8% (206 none, 58 mild, 22 moderate, 3 severe, and 0 very severe). Mean MSTS score was 32 (11–35) and TESS was 89.4 (32.4–100). Radiation dose was significantly correlated with tumor size > 5 cm (P = 0.0001) and TESS score (P = 0.001), but not MSTS score (P = 0.090). Only tumor size > 5 cm and depth were found to be independent predictors of significant lymphoedema. Conclusion. Nine percent of STS patients in our cohort developed significant (grade ≥ 2) lymphoedema. Tumor size > 5 cm and deep tumors were associated with an increased occurrence of lymphoedema but not radiation dosage.

Objective: To compare the characteristics of patients with rheumatic diseases and COVID-19 reported from Latin American countries with those from the rest of the world. Methods: Patients from the COVID-19 Global Rheumatology Alliance Physician-Reported Registry were included. Details regarding demographics, rheumatic disease features, comorbidities, COVID-19 diagnosis and treatment, and outcomes were examined. Chi-squared and t-tests were used to compare associations between groups (Latin America vs. rest of the world). Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of hospitalization (yes/no) and ventilatory support (not hospitalized or supplementary oxygen only vs. non-invasive, invasive ventilation, or ECMO); Poisson models were used to estimate ORs and 95% CIs of mortality. Results: Seventy-four patients from Latin America and 583 patients from the rest of the world were included. The most frequent rheumatic diseases in both groups were rheumatoid arthritis (35% and 39%, respectively) and systemic lupus erythematosus (22% and 14% respectively). Mortality was similar between groups (12% Latin America vs 11% rest of the world, p=0.88. However, Latin American patients in the registry had a higher odds of requiring non-invasive or invasive ventilation, after adjustment [OR= 2.29, 95%CI (1.29, 4.07), p less than 0.01].. Conclusion: Latin American patients with rheumatic disease and COVID-19 reported to this global registry presented a higher need for ventilatory support, however experienced a similar mortality than patients from the rest of the world.

Background:As of the 25th of January 2021, more than 150 thousand deaths as consequence of COVID-19 have been reported in Mexico [1]. Advanced age, male gender and comorbidities have been described as risk factors for severe disease and mortality in general population [2]. COVID-19 mortality in Mexican patients with rheumatic and musculoskeletal diseases (RMDs) is unknown.Objectives:To describe characteristics of Mexican patients with RMDs and COVID-19, and to analyse factors associated with mortality.Methods:The Global Rheumatology Alliance COVID-19 (GRA) physician reported registry, is an international effort to collect information on COVID19 in adult patients with RMDs. GRA is an observational registry. The first patient from Mexico was registered on April 17, 2020. All Mexican patients registered in GRA until October 30, 2020 were included in this analysis. The association of mortality with demographic and clinical variables was estimated using logistic regression analysis.Results:A total of 323 patients were registered, with a median age of 52 (IQR 41-61) years old, 166 (51.4%) patients lived in Mexico City. The most frequent RMDs were rheumatoid arthritis, 149 (46.1%) and systemic lupus erythematosus, 24 (19.8%). Over a third of patients with RMDs and COVID-19 (119 (36.8%)) were hospitalized, and 43 (13.3%) died. Table 1 shows clinical and demographic characteristics. In the univariable analysis, the absence of comorbidities was a protective factor, OR 0.3 (95% CI 0.1-0.6). Factors associated with mortality at COVID-19 diagnosis were age over 65 years old, having type 2 diabetes, chronic renal insufficiency, treatment at COVID-19 diagnosis with corticosteroids or with CD20 inhibitors. In the multivariable adjusted analysis, these factors remained independently associated with mortality. No associations with other treatments or comorbidities at COVID-19 diagnosis were found.Conclusion:Mexican patients with RMDs and COVID-19 in the GRA physician reported registry had a mortality of 13.3%. Factors associated with mortality were those described in the general population, such as older age and being on corticosteroids and CD20 inhibitors treatment at COVID-19 diagnosis.References:[1]WHO. Coronavirus disease (COVID-19) pandemic. https://www.who.int/emergencies/diseases/novel-coronavirus-2019. (accessed 26 January, 2021).[2]Zhou F, et al. Lancet 2020;395(10229):1054-62.Table 1.Clinical and demographic characteristics of patients with rheumatic diseases and COVID-19 in Mexico and mortality.Characteristics at COVID-19 diagnosisTotalN=323Death43 (13.3)Survivors280 (86.7)UnivariableOR (95% CI)MultivariableOR (95% CI)Women, n(%)268 (82.9)33 (76.7)235 (83.9)0.6 (0.3-1.4)0.5 (0.2-1.3)Age >65 years old, n(%)62 (19.2)18 (41.9)44 (15.7)3.9 (1.9-7.7)3.9 (1.9-8.3)RMDs* n(%)-Rheumatoid arthritis149 (46.1)23 (53.5)126 (45.0)1.6 (0.7-3.7)-Systemic Lupus Erythemathosus64 (19.8)10 (23.3)54 (19.3)1.6 (0.6-4.3)-Spondyloarthritis (axial and others)33 (10.2)2 (4.7)31 (11.1)0.1 (0.1-2.8)-Others77 (23.8)8 (18.6)69 (24.6)1-Moderate/High disease activity1, n(%)57 (18.6)7 (17.9)50 (18.7)1.0 (0.4-2.5)-None comorbidities, n(%)136 (42.1)8 (18.6)128 (45.7)0.3 (0.1-0.6)-Hypertension*, n(%)88 (27.2)12 (27.9)76 (27.1)1.0 (0.5-2.1)-Type 2 Diabetes*, n(%)49 (15.2)13 (30.2)36 (12.9)2.9 (1.4-6.1)2.4 (1.1-5.4)Obesity*, n(%)21 (6.5)3 (6.9)18 (6.4)1.1 (0.3-3.9)-Chronic obstructive pulmonary disease*, n(%)15 (4.6)1 (2.3)14 (5.0)0.5 (0.1-3.5)-Chronic renal insufficiency*, n(%)17 (5.2)6 (13.9)11 (3.9)3.9 (1.4-11.4)3.4 (1.1-10.4)Cardiovascular diseases*, n(%)14 (4.3)2 (4.7)12 (4.3)1.1 (0.2-5.0)-Corticosteroids*, n(%)171 (52.9)30 (69.7)141 (50.3)2.3 (1.1-4.5)3.0 (1.4-6.5)CsDMARD*, n(%)247 (76.5)33 (16.3)214 (76.4)1.0 (0.5- 2.2)-CD20 inhibitor*, n(%)21 (6.5)7 (16.3)14 (5.0)3.7 (1.4-9.9)4.9 (1.7-14.5)*Overlapped, 1 307 patients.Disclosure of Interests:None declared

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Background:COVID-19 outcomes in Mexican patients with rheumatic diseases (RDs) in comparison to general population patients are unknown.Objectives:To compare mortality and hospitalization of COVID-19 patients with RDs and those without.Methods:We included for this study all the Mexican patients with RDs and COVID-19 registered from April 17th to October 30th, 2020 in the COVID-19 Global Rheumatology Alliance registry. We compare clinical and demographic characteristics of patients with RDs and COVID-19 to patients with COVID-19 that were selected randomly from the Mexican Epidemiology database (1:3). A logistic regression analysis was performed to adjust for confusion variables.Results:We included 322 patients with COVID-19 and RDs and 969 controls without RDs. Table 1 shows the demographic characteristics and comorbidities of both groups. Bivariate analysis showed that patients with RDs had higher mortality, were older, and were more frequently hospitalized. Comorbidities, such as diabetes, hypertension, cardiovascular and renal diseases were also more frequent in patients with RDs. In the multivariate analysis, having a RD was no longer associated with mortality (Figure 1).Figure 1.Multivariate analysis of mortalityConclusion:Patients with RDs had higher comorbidities, hospitalizations, and mortality than the general population in the bivariate analysis. However, adjusted multivariate analysis showed that the odds for mortality were not increased because of having a RD. These findings suggest that the increased mortality of Mexican patients with RDs may be explained by the higher frequency of comorbidities in this population.Table 1.Comparison of patients with COVID-19 with and without RDsCOVID-19 patients without RDsCOVID-19 patients with RDsp-valueN969323Age (mean (SD))42.6 (17.4)51.2 (13.9)<0.001Sex = Male (%)455 (47.0)55 (17.0)<0.001Deceased = Yes (%)55 (5.7)43 (13.3)<0.001Hospitalization = Hospitalized (%)164 (16.9)152 (47.1)<0.001Intubation = Yes (%)27 (2.8)32 (11.8)<0.001COPD_Asthma = Yes (%)37 (3.8)15 (4.6)0.522Diabetes = Yes (%)114 (11.8)49 (15.2)0.116Obesity = Yes (%)128 (13.3)21 (6.5)0.001Hypertension = Yes (%)152 (15.8)88 (27.2)<0.001Cardiovascular disease = Yes (%)19 (2.0)14 (4.3)0.02CRF = Yes (%)22 (2.3)17 (5.3)0.007Pregnancy = Yes (%)5 (0.5)2 (0.6)0.827Smoker = Yes (%)86 (8.9)10 (3.1)0.001Abbreviations: RDs, rheumatic diseases; COPD, chronic obstructive pulmonary disease; CRF, chronic renal failure.Disclosure of Interests:None declared