Although the health burden of shift work has not been extensively studied, evidence suggests that it may affect the metabolic balance and cause obesity and other metabolic disorders. Sleep deprivation, circadian desynchronization and behavioral changes in diet and physical activity are among the most commonly mentioned factors in studies of the association between night work and metabolic disorders. Individual adaptation to night work depends greatly on personal factors such as family and social life, but occupational interventions may also make a positive contribution to the transition to shift work, such as exposure to bright lights during the night shift, melatonin use, shift regularity and clockwise rotation, and dietary adaptations for the metabolic needs of night workers. The evaluation of the impact of night work on health and of the mechanisms underlying this relationship can serve as a basis for intervention strategies to minimize the health burden of shift work. This review aimed to identify highlights regarding therapeutic implications following the association between night and shift work and metabolic disorders, as well as the mechanisms and pathways responsible for these relationships.

Background: Obesity is associated with increased general mortality and comorbidities, it is multifactorial and some evidence has shown that sleep duration and shift work may be implicated in its pathogenesis. Objectives:The aim of this study was to evaluate the association between shift work, quality of life and obesity among healthcare workers of a Brazilian University Hospital. Methods:A cross-sectional study was performed from April 2013 to December 2014 with 200 workers of a University Hospital. Sociodemographic data were evaluated and BREF WHOQOL was used for quality of life. The physical activity was evaluated using the International Physical Activity Questionnaire (IPAQ), Chronotypes and daily sleep preference were investigated using Munich Chronotype Questionnaire (MCTQ). Venous blood was collected after 12-h of fasting for laboratory tests. Results:In this sample, the night shift workers had higher income and were older compared to day shift workers. Night shift workers sleep less hours, had higher weight, body mass index and abdominal circumference when compared to the day shift workers. Night shift workers had almost 3 times higher association with abdominal obesity independent of age and gender, than day shift workers. MCTQ parameters showed that night shift workers had lower sleep duration during working days and also during free days, associated with a higher level of social jetlag. Social jetlag had an association with obesity. We found no difference for quality of life between shifts. Conclusions:Night work was a risk factor for abdominal obesity, social jetlag was higher in night shift workers and it was associated with presence of obesity.

Bullous SDRIFE and Covid-19Dear Editor, Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) is a drug reaction with well-defined criteria and some clinical and histopathological variability, in addition to simultaneous overlapping features with other pharmacological reactions. 1,2 We report a special case of SDRIFE with bullae formation in a patient with severe COVID-19, a situation that is unmatched in the literature. A 53-year-old obese woman with diabetes mellitus, chronic obstructive pulmonary disease, and a diagnosis of COVID-19 made 21 days earlier was admitted to the intensive care unit (ICU) with respiratory failure, bacterial pneumonia (Pseudomonas aeruginosa), intravascular device-related blood-

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