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ObjectivesTo evaluate the distinct impact of disease modifying antirheumatic drugs (DMARD) combination and monotherapy in immune response to an inactivated SARS-CoV-2 vaccine in patients with rheumatoid arthritis (RA).MethodsThis phase 4 prospective study analysed seroconversion (SC) of anti-SARS-CoV-2 immunoglobulin G (IgG) and neutralising antibodies (NAb) induced by the inactivated vaccine (CoronaVac) in patients with RA in comparison to controls (CG). Disease activity and treatment were also assessed. Only participants with baseline negative IgG/NAb were included.ResultsPatients with RA (N=260) and CG (N=104) had comparable median ages (59 years (50–65 years) vs 58 years (49.8–64 years), p=0.483). Patients with RA had moderate but lower SC (61.8% vs 94.2%, p0.05). After multivariate analyses, factors independently related to reduced SC were: older age (OR=0.79 (0.70–0.89) for each 5-year interval, p7.5 mg/day (OR=0.38 (0.19–0.74), p=0.004) were negatively related to the presence of NAb. Further comparison of SC/NAb positivity among RA treatment subgroups and CG revealed that methotrexate/tofacitinib/abatacept/tocilizumab use, in monotherapy or in combination, resulted in lower responses (pConclusionsPatients with RA under DMARD have a moderate immunogenicity to CoronaVac. We identified that nearly all DMARD combinations have a deleterious effect in immunogenicity, whereas a more restricted number of drugs (methotrexate/tofacitinib/abatacept/tocilizumab) also hampered this response as monotherapy. These findings reinforce the need of a broader approach, not limited to specific drugs, to improve vaccine response for this population.Trial registration detailsNCT04754698.

Background Vitamin D acts as a mediator in the immune system regulating antiviral mechanisms and inflammatory processes. Vitamin D insufficiency has been suggested as a potential risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, although its impact on the prognosis of hospitalized patients with coronavirus disease 2019 (COVID-19) remains unclear. Objective This multicenter prospective cohort study was designed to investigate whether serum 25-hydroxyvitamin D [25(OH)D] concentration is associated with hospital length of stay and prognosis in hospitalized patients with COVID-19. Methods Patients with moderate to severe COVID-19 (n = 220) were recruited from 2 hospitals in Sao Paulo, Brazil. Serum 25(OH)D concentrations were categorized as follows

Importance The efficacy of vitamin D3supplementation in coronavirus disease 2019 (COVID-19) remains unclear. Objective To investigate the effect of a single high dose of vitamin D3on hospital length of stay in patients with COVID-19. Design, Setting, and Participants This was a multicenter, double-blind, randomized, placebo-controlled trial conducted in 2 sites in Sao Paulo, Brazil. The study included 240 hospitalized patients with COVID-19 who were moderately to severely ill at the time of enrollment from June 2, 2020, to August 27, 2020. The final follow-up was on October 7, 2020. Interventions Patients were randomly assigned to receive a single oral dose of 200 000 IU of vitamin D3(n = 120) or placebo (n = 120). Main Outcomes and Measures The primary outcome was length of stay, defined as the time from the date of randomization to hospital discharge. Prespecified secondary outcomes included mortality during hospitalization; the number of patients admitted to the intensive care unit; the number of patients who required mechanical ventilation and the duration of mechanical ventilation; and serum levels of 25-hydroxyvitamin D, total calcium, creatinine, and C-reactive protein. Results Of 240 randomized patients, 237 were included in the primary analysis (mean [SD] age, 56.2 [14.4] years; 104 [43.9%] women; mean [SD] baseline 25-hydroxyvitamin D level, 20.9 [9.2] ng/mL). Median (interquartile range) length of stay was not significantly different between the vitamin D3(7.0 [4.0-10.0] days) and placebo groups (7.0 [5.0-13.0] days) (log-rankP = .59; unadjusted hazard ratio for hospital discharge, 1.07 [95% CI, 0.82-1.39];P = .62). The difference between the vitamin D3 group and the placebo group was not significant for in-hospital mortality (7.6% vs 5.1%; difference, 2.5% [95% CI, –4.1% to 9.2%];P = .43), admission to the intensive care unit (16.0% vs 21.2%; difference, –5.2% [95% CI, –15.1% to 4.7%];P = .30), or need for mechanical ventilation (7.6% vs 14.4%; difference, –6.8% [95% CI, –15.1% to 1.2%];P = .09). Mean serum levels of 25-hydroxyvitamin D significantly increased after a single dose of vitamin D3vs placebo (44.4 ng/mL vs 19.8 ng/mL; difference, 24.1 ng/mL [95% CI, 19.5-28.7];P Conclusions and Relevance Among hospitalized patients with COVID-19, a single high dose of vitamin D3, compared with placebo, did not significantly reduce hospital length of stay. The findings do not support the use of a high dose of vitamin D3for treatment of moderate to severe COVID-19. Trial Registration ClinicalTrials.gov Identifier:NCT04449718

A notificação dos acidentes de trabalho é de fundamental importância na gestão da saúde pública, tendo grande impacto no atendimento dos serviços de emergência e nos benefícios acidentários da Previdência Social. O objetivo deste estudo foi realizar uma análise descritiva dos dados de doenças ou agravos relacionados ao trabalho notificados em Minas Gerais, Brasil por meio de sistemas de informação do SUS, disponíveis no DATASUS. Tratou-se de estudo ecológico, exploratório descritivo, quantitativo, retrospectivo, apoiado em análise de base de dados secundários, no período de janeiro de 2008 a dezembro de 2012. Os resultados apontaram um aumento de 101,1% na proporção de municípios com casos de doenças ou agravos notificados relacionados ao trabalho e de 39,1% na taxa de acidentes de trabalho em Minas Gerais por 100 mil habitantes, taxa não proporcional ao crescimento populacional do estado no mesmo período. Concluiu-se que havia ainda um grande sub-registro nos sistemas de informação, principalmente no Sistema de Informação de Agravos de Notificação, apesar do crescimento das variáveis analisadas. Palavras-chave: Notificação de acidentes de trabalho. Saúde do trabalhador. Saúde pública.