Effect of a single high-dose vitamin d3 on the length of hospital stay of severely 25-hydroxyvitamin d-deficient patients with COVID-19

OBJECTIVES: In this ancillary analysis of a multicenter, double-blinded, randomized, placebo-controlled trial, we investigated the effect of a single high dose of vitamin D3 on the length of hospital stay of patients with severe 25-hydroxyvitamin D deficiency and COVID-19. METHODS: The primary outcome was length of hospital stay, defined as the total number of days that patients remained hospitalized from the date of randomization until the date of hospital discharge. Secondary outcomes included serum levels of 25-hydroxyvitamin D, mortality during hospitalization, number of patients admitted to the intensive care unit, and number of patients who required mechanical ventilation. ClinicalTrials.gov: NCT04449718. RESULTS: Thirty-two patients were included in the study. The mean (SD) age was 58.5 (15.6) years, body mass index was 30.8 (8.6) kg/m2, and 25-hydroxyvitamin D level was 7.8 (1.6) ng/mL. No significant difference was observed in the median interquartile range of length of hospital stay between the vitamin D3 group (6.0 [4.0-18.0] days) versus placebo (9.5 [6.3-15.5] days) (log-rank p=0.74; hazard ratio, 1.13 [95% confidence interval (CI), 0.53-2.40]; p=0.76). Vitamin D3 significantly increased serum 25-hydroxyvitamin D levels in the vitamin D3 group compared with that in the placebo group (between-group difference, 23.9 ng/mL [95% CI, 17.7-30.1]; p<0.001). CONCLUSIONS: A dose of 200.000 IU of vitamin D3 did not significantly reduce the length of hospital stay of patients with severe 25-hydroxyvitamin D deficiency and COVID-19.

Organizações policiais frente à pandemia: sensemaking, liderança e discricionariedade / Police institutions in the face of the pandemic: sensemaking, leadership, and discretion / Organizaciones policiales frente a la pandemia: sensemaking, liderazgo y discrecionalidad

Resumo O enfrentamento da pandemia da COVID-19 desponta como um dos maiores desafios recentes impostos à humanidade. Dentre as instituições públicas especialmente acionadas, as polícias estão posicionadas na linha de frente. A partir de suas características organizacionais e profissionais, discute-se estratégias de enfrentamento à pandemia por meio do desenvolvimento de novas habilidades organizacionais que propiciem alterar suas lógicas de funcionamento de "guerra contra o crime" para ações humanitárias. Assim, aponta-se a necessidade de coordenação sistêmica dos órgãos policiais, tanto entre em si, como no conjunto das demais medidas de enfrentamento. Nesses termos, a partir da análise de experiências diversas, propõe-se a formação de uma articulação interorganizacional fundamentada na criação de elementos linguísticos e materiais, com o compartilhamento de mapas estratégicos e planos informacionais. Para tanto, conclui-se que a revisão de protocolos de atuação das polícias em emergências de saúde pública, a incluir o Plano de Resposta em Emergências em Saúde Pública, do Ministério da Saúde, tem a capacidade de prover avanços nessa questão.

Abstract Coping with the COVID-19 pandemic is emerging as one of the greatest recent challenges facing humanity. The police forces are at the front line, among the public institutions specially activated in this emergency. Based on police forces' organizational and professional characteristics, this study discusses strategies to deal with the pandemic through the development of new organizational skills that allow them to change their operating logic from "war against crime" to humanitarian actions. The research points out the need for systemic coordination of police bodies, both among themselves and in the set of other coping measures. In these terms, from the analysis of different experiences, it is proposed to form inter-organizational coordination based on the creation of linguistic and material elements, with the sharing of strategic maps and informational plans. In conclusion, the review of police performance protocols in public health emergencies, including the Public Health Emergency Response Plan of the Ministry of Health, has the capacity to improve its response in the face of the COVID-19 pandemic.

Resumen Hacer frente a la pandemia de COVID-19 se está convirtiendo en uno de los mayores desafíos recientes que enfrenta la humanidad. Entre las instituciones públicas especialmente activadas, la policía está posicionada en primera línea. En función de sus características organizativas y profesionales, las estrategias para hacer frente a la pandemia se discuten mediante el desarrollo de nuevas habilidades organizativas que les permitan cambiar su lógica operativa de "guerra contra el crimen" a acciones humanitarias. Por lo tanto, señala la necesidad de una coordinación sistémica de los cuerpos policiales, tanto entre ellos como en el conjunto de otras medidas de afrontamiento. En estos términos, a partir del análisis de diferentes experiencias, se propone formar una articulación interorganizacional basada en la creación de elementos lingüísticos y materiales, con el intercambio de mapas estratégicos y planes informativos. Por lo tanto, se concluye que la revisión de los protocolos de desempeño policial en emergencias de salud pública, incluido el Plan de Respuesta a Emergencias de Salud Pública, del Ministerio de Salud, tiene la capacidad de proporcionar avances en este tema.

Chronic mucocutaneous candidiasis: a case with exuberant cutaneous horns in nipples

Chronic mucocutaneous candidiasis is a rare disorder characterized by persistent and recurrent infections by Candida due to changes in cellular immunity and may be associated with autoimmune endocrine disorders. It is refractory to the usual antifungal treatments, which merely control it with imidazole derivatives. This reports the case of a 50-year-old female patient who referred vaginal discharge associated with vulvar ulcerated lesions and whitish plaques on oral and genital mucous membranes of onset in adolescence besides cutaneous horns in nipples. The clinical picture, family history, culture and anatomopathological studies were consistent with chronic infection by candida. Treatment with systemic antifungals obtained partial response of lesions characterizing a clinical picture of Chronic Mucocutaneous Candidiasis.