[Actual adherence to dimethyl fumarate in patients with relapsing-remitting multiple sclerosis]. / Adhesión real al dimetilfumarato en pacientes con esclerosis múltiple remitente-recurrente.

INTRODUCTION: Multiple sclerosis is a chronic neurological disease with numerous disease-modifying treatments available, including dimethyl fumarate (DMF), a first-line therapy for relapsing-remitting multiple sclerosis. Although rates of discontinuation of DMF are generally low in clinical trials, non-adherence to treatment is associated with poorer clinical outcomes. Assessing real-world adherence and predictive factors is critical to be able to improve clinical outcomes for patients. This study evaluated adherence to DMF over 24 months in a cohort of patients treated in a Portuguese healthcare centre. PATIENTS AND METHODS: A prospective, non-interventional, single-centre study with 24 months' follow-up was conducted. The study included adult patients with relapsing-remitting multiple sclerosis treated with DMF in routine clinical practice. Adherence to DMF was calculated and patients were considered to have adhered if the value was above 80%. Clinical and socio-demographic variables were compared between groups. RESULTS: Of the 80 patients included, 74% were women, with a mean age of 39 years and a mean age of 32 years at diagnosis. Twenty-six patients had not received any previous treatment. Adherence varied between 93, 82 and 87.5% at 6, 12 and 24 months, respectively. No differences were found between patients who had not received any prior treatment and those who had been treated. CONCLUSION: This real-world analysis showed significant adherence to DMF treatment by Portuguese patients over a period of two years. However, these results must be interpreted in the light of the substantial changes in outpatient consultations and the various periodic restrictions due to the COVID-19 pandemic, which had an important effect on patient follow-up and data collection.

TITLE: Adhesión real al dimetilfumarato en pacientes con esclerosis múltiple remitente-recurrente.Introducción. La esclerosis múltiple es una enfermedad neurológica crónica con numerosos tratamientos modificadores de la enfermedad disponibles, incluido el dimetilfumarato (DMF), una terapia de primera línea para la esclerosis múltiple remitente-recurrente. Aunque las tasas de discontinuación del DMF suelen ser bajas en los ensayos clínicos, la falta de adhesión al tratamiento se asocia con peores resultados clínicos. Evaluar la adhesión en el mundo real y los factores predictivos es fundamental para mejorar los resultados clínicos de los pacientes. Este estudio evaluó la adhesión al DMF durante 24 meses en una cohorte de pacientes tratados en un centro portugués. Pacientes y métodos. Estudio prospectivo no intervencionista, de un solo centro, con un seguimiento de 24 meses. El estudio incluyó a pacientes adultos con esclerosis múltiple remitente-recurrente tratados con DMF en la práctica clínica habitual. Se calculó la adhesión al DMF y se consideró que los pacientes eran adherentes si el valor estaba por encima del 80%. Se compararon variables clínicas y sociodemográficas entre grupos. Resultados. De los 80 pacientes incluidos, el 74% eran mujeres, con una edad media de 39 años y una edad media en el momento del diagnóstico de 32 años. Veintiséis pacientes no habían recibido tratamiento previo. La adhesión varió entre el 93, el 82 y el 87,5% a los 6, 12 y 24 meses, respectivamente. No se encontraron diferencias entre los pacientes que no habían recibido tratamiento previo y los que sí lo habían recibido. Conclusión. Este análisis en el mundo real mostró una adhesión significativa al tratamiento con DMF durante dos años por parte de los pacientes portugueses. No obstante, estos resultados deben interpretarse considerando los cambios sustanciales en las consultas externas y las diversas restricciones periódicas debidas a la pandemia de COVID-19, que afectaron en gran medida al seguimiento de los pacientes y a la recopilación de datos.

Inventory of Sources of Stress During Medical Education - Further Validation

Introduction: The Inventory of Academic Sources of Stress in Medical Education (IASSME) evaluates the presence and intensity of the main sources of academic stress for Portuguese Medicine students in five dimensions: Course demands/CD, Human demands/HD, Lifestyle/LS, Academic competition/AC, and Academic adjustment/AA. Objective(s): To further validate the ISSME using Confirmatory Factor Analysis and to analyze[ATP1] the psychometric properties of a new version including additional sources of stress. Method(s): Participants were 666 Portuguese medicine (82.6%) and dentistry (17.4%) students (81.8% girls);they answered an online survey including the ISSME and other validated questionnaires: Maslach Burnout Inventory - Students Survey (MBI-SS) and Depression Anxiety and Stress Scales (DASS). Result(s): Confirmatory Factor Analysis showed that the second order model composed of five factors (the original structure by Loureiro et al. 2008), but excluding item 11 (loading=.371), presented good fit indexes (chi2 /df=3.274;RMSEA=.0581, p<.001;CFI=.917;TLI=.904, GFI=.919). The Cronbach's alfas were alpha=.897 for the total and from alpha=.669 (F2-HD) to alpha=.859 (F1-CD) for the dimensions. The expanded version, including two additional items related to lack of interest in medicine/dentistry (F6, alpha=.543) and two additional COVID-19 stress-related-items (F7, alpha=.744) also showed acceptable fit indexes (chi2 /df=3.513;RMSEA=.061, p<.001;CFI=.88.;TLI=.866, GFI=.892). This new version's alpha was of .896. Pearson correlations between ISSME and the other measures were significant (p<.01) and high: >.55 with DASS and >.50 with MBI-SS. Girls presented significantly higher ISSME scores. F6 score was significantly higher in dentistry students. Conclusion(s): This further validation study underlines that IASSME presents good validity (construct and convergent) and reliability.

COVID-19 Pandemic: Another Source of Stress for Medical Students

Introduction: The COVID-19 pandemic has completely changed the experience of higher education with potentially negative consequences for students' wellbeing. Objective(s): To compare medicine/dentistry students' depression/ anxiety/stress levels before versus during the pandemic and to analyse the role of COVID-19-related stressors in their psychological distress. Method(s): Students from the Faculty of Medicine University of Coimbra answered socio-demographic and personality questionnaires and the Depression, Anxiety and Stress Scale/DASS before (academic years 2016-2017-2018-2019 - SAMPLE1;n=1000) and during (September-December 2020 and January-March 2021 - SAMPLE2;n=650) the COVID-19 pandemic. Mean age (21.12+/-3.75), personality traits scores, and gender proportions (75% girls) did not significantly differ between samples. SAMPLE2 also filled in the Fear of COVID-19 Scale and a new version of the Inventory of Sources of Stress During Medical Education/ISSDME, containing a COVID-19 -related dimension (restrictions on training and on socializing with friends/colleagues). Result(s): SAMPLE2 presented significantly higher mean scores of depression (3.89+/-3.55vs.3.33+/-3.34), anxiety (3.27+/-4.08vs.2.86+/-3.29), stress (7.07+/-5.72vs.6.18+/-4.59) and total DASS (12.28+/-10.55vs.13.65+/-11.13) than SAMPLE1 (all p<.05). Fear of COVID-19 was a significant predictor of DASS score (adjusted R2=2.9%, p<.001). COVID-19-related stressors continued explaining significant increments of DASS variance after controlling for each of the ISSDME dimensions: Course demands (R2 Change=1.8%), Human demands (2.5%), Lifestyle (2.3%), Academic competition (5.5%), and Academic adjustment (5.2%) (all p<.001). Conclusion(s): This study adds to the evidence of the negative impact of COVID-19 on students and emphasizes its pernicious role on medical students' psychological distress, which is already higher due to the individual and academic stressors to which they are more exposed.

Adherence to the Recommendations from the Portuguese General Directorate of Health (GDH) during the COVID-19 pandemic: fear or prosocial behaviour?

Introduction: During a public health crisis, preventive measures are essential. However, to make them effective, all citizens must be engaged. Objective(s): To analyse the differential role of individual and contextual variables in the adherence to public health recommendations. Method(s): 1376 adults (70.5% female;mean age=35.55+/-14.27) completed a survey between September/2020 and May/2021 with: Adherence Scale to the Recommendations during COVID-19 (ASR-COVID19;evaluates three dimensions of adherence), Fear of Covid-19 Scale (FC19S) and Toronto and Coimbra Prosocial Behaviour Questionnaire (ProBeQ;assesses empathy and altruism). Result(s): Adherence did not differ between individuals with or without personal or family history of COVID-19 infection. ASRCOVID19 and all dimensions were positively correlated to ProBeQ's altruism and empathy (from r=.32 to r=.54);FCV19S correlated positively to total adherence score and house sanitation (from r=.18 to r=.26;all p<.01). Linear regressions revealed that altruism and empathy (first model), as well as fear of Covid-19 (second model), were significant predictors of adherence;however, while the first model explained ffi28% of its variance, the second (FCV19S as independent variable) only explained ffi3%. Regression models performed in a subsample of participants with personal or family history of COVID-19 revealed that only empathy, but not altruism, was a significant predictor of adherence;in this subsample, fear was no longer a significant predictor of adherence, except for lockdown and use of teleservices. Conclusion(s): Based on our results, we suggest health care providers and public health campaigns should take into consideration social solidarity and altruism, as well as previous experiences, when appealing to public's engagement in health behaviour.

From Perceived Vulnerability to Disease to Psychological Distress in times of COVID19 pandemic

Introduction: Perceived vulnerability to disease/PVD may influence psychological reactions to COVID-19 pandemic. Objective(s): To analyse the role of PVD in psychological distress/PD during the COVID-19 pandemic, testing whether it is mediated by perceived risk of COVID-19, fear of COVID-19 and repetitive negative thinking/RNT. Method(s): Participants (N=413 adults;69.2% women) were recruited from September until December 2020, via social networks. They completed the following self-report validated questionnaires: Perceived Vulnerability to Disease Questionnaire/ PVDQ;Perceived Risk of COVID-19 Scale, Fear of COVID-19 Scale;Perseverative Thinking Questionnaire and Depression Anxiety and Stress Scale. As women had significantly higher levels of PVD, COVID-19 perceived risk and fear, RNT, and psychological distress/PD, gender was controlled in mediation analysis (using PROCESS macro for SPSS;Hayes 2018). Result(s):All the variables significantly (p<.01), moderately (r>.20) and positively correlated. The serial mediation model 6 with the three sequential mediators resulted in significant total effect (c=.326, se=.0791, p<.001, CI:.1702-.4814), non-significant direct effect (c'=.111, se=.065, p=.087, CI:-.0162 to .2380), significant total indirect effect (.2149, se=.065, CI:.1079-.3278);most indirect effects were significant, including the indirect 7 (.0144, se=.0077, CI=.0017-.0320), that goes through all mediators (PVD->COVID19 perceived risk->COVID19 fear->RNT->PD), meaning full mediation. Conclusion(s): The effect of PVD on psychological distress operates by increasing the perception of risk and the fear of COVID-19, which intensify related worries and ruminations in times of pandemic. People with high perceived threat, aversion and discomfort in situations associated with increased risk of infection should be helped to decrease dysfunctional cognitive contents and processes in times of pandemic.

Relationship between personality, adherence to (mental) health behaviours and psychological distress during the COVID-19 pandemic

Introduction: Public health authorities around the world have been disseminating messages to support mental health and psychosocial well-being during the COVID-19 pandemic. Based on the Portuguese guidelines, we have developed the Adherence Scale to the RecommendationsforMental Health during the COVID-19 Pandemic (ASR-MH-COVID19) to better understand this health behaviour. Objective(s): To analyse the relationship between sociodemographics, personality traits, Adherence (to the Recommendations for Mental Health during the COVID-19 Pandemic) and psychological distress. Method(s): 413 individuals (69.2% female;mean age=31.02+/-14,272) completed an on-line survey, in September-December 2020, including sociodemographic questions, ASR-MH-COVID19, NEO-FFI-20 and Depression Anxiety Stress Scale (DASS-21) and Health Perception Scale. Result(s):Adherence scores did not significantly differ by gender, age and years of education. Women presented higher DASS and Neuroticism scores (p<.01). Adherence were negatively correlated with Neuroticism (r=-.247) and with Depression/Anxiety/Stress (all r.- 200), positively with Openness to Experience (r=.174), Conscientiousness (r=.194) and Perceived Health (Physical, r=.173 and Psychological, r=.215) (all p<.01). Mediation analysis (Hays' Macro Process - Model 4) revealed that Adherence is a partial mediator between Openness and DASS and Conscientiousness and DASS;when considering Neuroticism, only the direct effect was significant. The effect of Perceived Health (both Physical and Psychological) on DASS was also mediated by Adherence. Conclusion(s): The Health Behaviour Model proposes a pathway linking personality and health that applies to these results about adherence and psychological distress during the COVID-19 pandemic. Personality and perceived health (also a trait) influence both adherence to mental health behaviours and psychological distress. Understanding personality is vital for health care providers.

Adherence Scale to the Recommendations for Mental Health during the COVID-19 pandemic from the Portuguese General Directorate of Health (ASR-MHCOVID19) - Development and validation

Introduction: The COVID-19 crisis has generated an increasing stress throughout the population. Objective(s): To develop and validate the Adherence Scale to the Recommendations for Mental Health during the COVID-19 pandemic from the Portuguese General Directorate of Health (GDH) (ASR-MH-COVID19). Method(s): The items content was based on the GDH guides for the prevention of mental health and psychosocial well-being of the general population during the COVID-19 outbreak. After content and facial validity analysis, the preliminary version of the ASR-MHCOVID19 (8 items to be answered on a Likert scale) was completed by 413 individuals (69.2% female;mean age=31.02+/-14,272), in September-December 2020 (Sample1) and then by 967 (70.9% female;mean age=34.02+/-14,272), in February-May 2021 (Sample2). Sample1 was randomly divided in two sub-samples. Sample1A was used for exploratory factor analysis/EFA and Sample1B for confirmatory factor analysis/CFA;CFA was then replicated with Sample2. The online surveys also included the Adherence Scale to the Recommendations of Portuguese GDH to minimize the impact of COVID-19 (ASR-COVID-19;Pereira et al. 2020). Result(s): CFAs were informed by EFA and showed that the unidimensional model presented acceptable-good fit indexes (Sample1B: chi2 /df=2.747;RMSEA=.0980, p<.001;CFI=.973;TLI=.918, GFI=.972;Sample2: chi2 /df=3.327;RMSEA=.0490, p<.001;CFI=.993;TLI=.983, GFI=.990). Cronbach's alfas were alpha<.850. Pearson correlations between ASR-MH-COVID19 and ASR-COVID19 were significant (p<.01) and moderate-high for the total (r=.753) and dimensional scores (Distance and respiratory hygiene, r=.739;House and personal hygiene, r=.584;Use of remote services and isolation r=.425). Conclusion(s): The new ASR-MH-COVID19 has shown validity and reliability, allowing the investigation of this (mental) health behaviour.

Grief during the COVID-19 pandemic: A crosssectional online survey in university students

Introduction: Almost 5 million people worldwide have lost their lives due to SARS-CoV-2 (source: WHO coronavirus (COVID-19) dashboard, data of 1.10.2021;https://covid19.who.int/) and therefore, globally, there is an increase of people in grief due to the death of a significant other. Objective(s): To study psychological correlates of grief during the COVID-19 pandemic. Method(s): 591 university students, with a mean age of 23.84+/-7.95 years (range 18-65 years;76.8% women;91.2% Portuguese) completed an online questionnaire during the second COVID-19 confinement (from 15.02 to 13.03.2021), with sociodemographic questions, the Pandemic Stress Index, the Mental Health Inventory, Insomnia Scale, questions on physical/ psychological health, and social isolation. Result(s): Students bereaving the death of a significant other (n=93, 15.7%;n=25, 26.9% reported cause was SARS-CoV-2;time since death: < 3 months to 1-year), compared to those who did not (n= 498;84.3%), described poorer psychological health, higher psychological distress (depression, anxiety, lack of control) and sleep difficulties, higher levels of stress (higher impact of COVID pandemic in daily life, and higher behavior changes in response to COVID-19) and more social isolation. Conclusion(s): COVID-19 pandemic-related stress is a source of additional stress for bereaved students. Grief is also associated with social isolation, poor mental health (depression, anxiety, lack of control) and sleep difficulties. Screening efforts, guidance, and counseling from professionals of mental health care, primary health care, and universities health care services during and after the COVID-19 pandemic could be extremely beneficial for bereaved students, particularly for those at higher risk of developing prolonged grief disorder.

The Portuguese adapted version of the fear of covid-19 scale for the postpartum period

Introduction: The Portuguese version of the Fear of COVID-19 Scale (FCV-19S;Cabacos et al. 2021), composed of seven items, presented good validity and reliability to be used in general population. To be used within perinatal context, specifically in the postpartum period, we have added an item related to the baby (item 8 - "I'm afraid my baby will be infected with coronavirus-19"). Objective(s): To analyze the psychometric properties of Portuguese adapted version of the Fear of COVID-19 Scale for the postpartum period (FCV-19SP), namely construct validity, internal consistency, and convergent validity. Method(s): 207 women (mean age= 33.51 +/- 5.23 years) recruited in the postpartum period (9,06 +/- 8,52 months after delivery) fill in a set of self-reported validated questionnaires: Perinatal Depression Screening Scale (PDSS), Perinatal Anxiety Screening Scale (PASS) and Coronavirus-19 Fear Scale for the postpartum period (FCV-19SP). Result(s): CFA revealed that the unifactorial model composed of eight items presented good fit indexes (X2 /df=1.508;CFI=.991;GFI=.974;TLI=.983;p[RMSEA<=.01] = .049), better than those of the seven items version (X2 /df=3.963;CFI=.957;GFI=.909;TLI=.905;p[RMSEA<=.01] =.219). Cronbach alpha for the FCV-19SPP was alpha=.880. The total score significantly (p<.01) and moderately correlated with PDSS (r=.262) and PASS (r=.371). Conclusion(s): The FCV-19SP is a valid and reliable questionnaire to assess fear of COVID-19 in women in the postpartum period.

Worries during the COVID-19 pandemic - which were the most prevalent and disturbing?

Introduction: The COVID-19 pandemic has brought additional worries and challenges to people's lives, with potential implications for psychological well-being. Objective(s): To understand which worries and life changes have affected most the Portuguese general population during the COVID-19 pandemic and to analyse which contents are associated with higher levels of repetitive negative thinking/RNT and psychological distress/PD. Method(s): In September-December 2020, 413 Portuguese adults (69.2% female;Mean age= 31.02+/-14.272) were asked one open questions, with reference to the COVID-19 pandemic period: "what was your biggest worry?" the answers were independently categorized by two researchers. Participants also filled the validated Depression Anxiety and Stress Scale and the Perseverative Thinking Questionnaire. Result(s): The most prevalent worries were about: 1) fear of contamination (oneself and others-48.7%;2) physical and mental health and well-being (self and others)-27.2%;3) studies and profession-13.3%;4) uncertainty about the future-7.7%;5) economic-financial issues-6.5%;6) miscellaneous-3.3%;7) no worries-0.7%. Participants who had worries of the theme 4 had the highest RNT and PD mean scores, followed by themes 3 and 5, and then themes 2 and 1. These thematic groups significantly (p<.01) differ between each other (except 3-5) and from the other groups. RNT was a significant predictor of PD (R2 =37.0%, beta=.609, p<.001). Conclusion(s): People who worry about the future uncertainties, occupational activities and finances should be systematically assessed with regard to their levels of anxiety, depression and stress and they can learn to deal with the RNT as a way to reduce their psychological suffering in times of pandemic.

Variables associated with bleeding and thrombotic outcomes among patients admitted to the hospital with COVID-19 and elevated D-dimer: insights from the ACTION randomised clinical trial

Background: In the ACTION trial, therapeutic anticoagulation did not show benefit on mortality, days of hospitalization and oxygens therapy at 30 days among patients with COVID19. However, this strategy was associated with higher rate of bleeding and a potential reduction in the rate of clinical thrombotic events. The current analysis evaluated which variables were independently associated with both outcomes in order to help the identification of the risk for thrombotic and hemorrhagic events among patients with COVID19. Methods: A total of 615 patients hospitalized with COVID-19 and elevated D-dimer levels were randomly assigned to prophylactic anticoagulation (mainly in-hospital heparin) or a therapeutic strategy that used in-hospital rivaroxaban 20 mg daily for stable patients, or enoxaparin 1 mg/kg twice daily for unstable patients, followed by rivaroxaban through 30 days. One patient withdrew consent and was not included in the analysis. The current analysis tested baseline clinical characteristics and laboratorial exams one by one with independent logistic regressions for the composite of bleeding (major bleeding and clinically relevant nonmajor bleeding) and thrombotic events (venous thromboembolism, myocardial infarction, stroke, systemic embolism, and major adverse limb events). Significant variables (p<0.05) were selected to adjust several multiple logistic models. Final models were chosen based on Akaike information criterion and therapeutic anticoagulation was included in the final model based on the primary results of the trial. Results: The model for bleeding events showed an accuracy of area under the curve (AUC) of 0.635 (table 1) while the model for thrombotic events had an AUC of 0.725 (table 2). Level of respiratory support (especially invasive ventilation) was associated with both outcomes in the multivariable analysis (tables 1 and 2). Beyond respiratory support, level of creatinine and history of coronary disease were also independently associated to the risk of thrombotic events. When the utilization of therapeutic anticoagulation (mainly with rivaroxaban) was included in the multivariable analysis, this variable was strongly associated with higher risk of bleeding (model AUC of 0.718) but was not associated with lower rate of thrombotic events (Tables 1 and 2). Conclusion: Since the variables associated with higher risk of thrombotic events are similar to the variables associated to bleeding complications, the selection of patients with better balance of risk vs. benefit to use therapeutic anticoagulation in COVID-19 still a challenging decision. Coronary disease and creatine may help to identify patients at higher risk of thrombotic complications while the use of therapeutic dose of direct oral anticoagulant increased the risk of bleeding in almost 4 times among patients hospitalized due to COVID19. Funding Acknowledgement: Type of funding sources: Private company. Main funding source(s): Investigator initiated research with financial support of Bayer

Inventory of Sources of Stress During Medical Education - Further Validation

Introduction The Inventory of Academic Sources of Stress in Medical Education (IASSME) evaluates the presence and intensity of the main sources of academic stress for Portuguese Medicine students in five dimensions: Course demands/CD, Human demands/HD, Lifestyle/LS, Academic competition/AC, and Academic adjustment/AA. Objectives To further validate the ISSME using Confirmatory Factor Analysis and to analyze the psychometric properties of a new version including additional sources of stress. Methods Participants were 666 Portuguese medicine (82.6%) and dentistry (17.4%) students (81.8% girls);they answered an online survey including the ISSME and other validated questionnaires: Maslach Burnout Inventory – Students Survey (MBI-SS) and Depression Anxiety and Stress Scales (DASS). Results Confirmatory Factor Analysis showed that the second order model composed of five factors (the original structure by Loureiro et al. 2008), but excluding item 11 (loading=.371), presented good fit indexes (χ2/df=3.274;RMSEA=.0581, p<.001;CFI=.917;TLI=.904, GFI=.919). The Cronbach’s alfas were α=.897 for the total and from α=.669 (F2-HD) to α=.859 (F1-CD) for the dimensions. The expanded version, including two additional items related to lack of interest in medicine/dentistry (F6, α=.543) and two additional COVID-19 stress-related-items (F7, α=.744) also showed acceptable fit indexes (χ2/df=3.513;RMSEA=.061, p<.001;CFI=.88.;TLI=.866, GFI=.892). This new version’s α was of .896. Pearson correlations between ISSME and the other measures were significant (p<.01) and high: >.55 with DASS and >.50 with MBI-SS. Girls presented significantly higher ISSME scores. F6 score was significantly higher in dentistry students. Conclusions This further validation study underlines that IASSME presents good validity (construct and convergent) and reliability. Disclosure No significant relationships.

Implementation of the Chemical Waste Management Program in the Laboratories of the Federal University of Paraiba—UFPB/Brazil

Teaching and research activities in specific fields, such as technology and natural sciences, continuously produce chemical waste in their daily activities. Concerning the environmental impact and risk to human health in teaching and research activities, Brazilian universities have gradually started to draw up their Chemical Waste Management Program (PGRQ) in order to cope with potentially hazardous activities. In this context, the Federal University of Paraiba (UFPB), which has 130 graduate courses, 80 master’s/doctoral programs distributed on 5 campuses in the state of Paraiba/Brazil, is going through a process of implementing a chemical management program for such waste. Therefore, the objective of this article is to describe, through a quantitative and qualitative approach, the initiatives and activities adopted to implement the Chemical Waste Management Plan at UFPB. The study was conducted using data on regular collection from university campuses. Initially, proper chemical containers were distributed to collect and store liquid solutions from research activities and practical lab classes. In the first collection alone, 17,595 kg of environmental liabilities were collected. All collected chemical had their proper final treatment in industrial landfills or incinerated by the contracted company. In 2020, 21,132 kg of hazardous waste from classes A, B and E were collected. In comparison with the previous year, where 11,363 kg of waste were collected, there was an increase of 9769 kg of chemical waste. Due to the COVID-19 pandemic during the year 2021, a large part of the laboratories stopped or decreased their activities and there was a reduction in the amount of hazardous waste produced. UFPB currently has 59 registered points for storage of chemical waste and 21 points for voluntary delivery among its 04 campuses, serving more sloth’s 9000 people, including professors, technicians and graduate students. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

A REVIEW AND UPDATING OF THE KNOWLEDGE OF BIOCHEMICAL MECHANISMS OF PERFORMANCE ACTING SOME SPICES & MEDICINAL HERBALS FROM AYURVEDA PROTOCOL VS COVID-19

The publication and worldwide diffusion of the Ayurveda treatment of COVID-19 and the vital role that spices, and medicinal herbals play in this protocol, promoted by the Department of Health and Family Welfare of India (MoHFW), in the context of SARS-CoV2 infection. Encourage us to review updating the knowledge of these herbals' plants' biochemical mechanisms of action. Several biochemical mechanisms of action of spices have been studied and established in the context of COVID-19. It has been described that herbs act as blocking agonists of some cell receptors, such as the ACE2 receptor of the renin-angiotensin system and TRP receptors belonging to the superfamily of sensory neurons, responsible for symptoms the SARS-CoV2 virus. We also find widely recommended medicinal herbs such as Tinospora cordifolia and Withania somnifera in this protocol, which has been described to stimulate the immune system and, at the same time, increase the destructive capacity of macrophages and biochemically block the entry of SARS-CoV-2 to host cells. Other medicinal herbs recommended by the Ayurveda protocol such as Curcuma longa L, Cinnamomum camphora, Eucalyptus globulus, Allium sativum L, Piper nigrum, Glycyrrhiza glabra L, as well as being potent antioxidants and anti-inflammatory are traditionally selected as an adjuvant treatment indicated for "respiratory diseases" as in the current framework of the COVID-19 pandemic. This article explores the Ayurveda protocol and some recently recommended nutraceutical substances and spiced dietary guidelines, as an alternative treatment in concern to SARS-CoV2 infection, for the treatment of long-term side effects of the post-COVID syndrome.

Prevalence of COVID-19 in the population of the State of Rio Grande do Norte in 2020: aspects related to age group and comorbidities

The aim of this study was to investigate the experience of the COVID-19 pandemic in the city of Natal, RN, considering the age group of patients affected by the disease and their possible comorbidities, through epidemiological indicators. Therefore, we took a retrospective approach of the numbers, highlighting the prevalence of COVID-19, from the confirmed cases in the year 2020 until the date of January 26, 2021. This is a study with a transversal methodology, of a qualitative and quantitative nature. Patient documents were sought in the Epidemiological Bulletin of the Public Health Secretariat (SESAP/RN), Central Laboratory (LACEN/RN), Kaggle - Coronavirus Brazil, Ministry of Health (MH) Department of Primary Care (DPC), National Registry of Health Facilities (NRHF), SUS Virtual Learning Environment at the Federal University of Rio Grande do Norte (AVASUS/UFRN), Google COVID-19 Community Mobility Reports, Inter-American Development Bank (IDB) in the Coronavirus Impact Panel. In Brazil there are already more than 9,834,513 confirmed cases and almost 239,245 thousand deaths (data collected until February 15, 2021) and in the state of Rio Grande do Norte (RN) there are 147,631 confirmed new cases and 3,381 deaths (data from February 15, 2021). The current scenario requires preventive actions of self-care and collective protection, so that, in this way, there is a reduction in the risks of the virus infecting people from the most vulnerable groups, but this requires the involvement of the mass population.

POSC102 High-Flow Nasal Cannula in Patients with COVID-19: Is a Cost-Effective Alternative?

Objectives: To determine whether the high-flow nasal cannula (HFNC) is a more cost-effective alternative when compared to conventional oxygen therapy (COT) for decreasing invasive ventilation rates in the treatment of acute hypoxemic respiratory failure (HRF) in patients with Covid- 19 from the perspective of private health. Methods: The cost-effectiveness analysis (ACE) was developed through the “decision tree” model. The cost factor was calculated by the average daily ICU value for both procedures, with the unit value of the HFNC being added. The effectiveness factor, due to the absence of real-life data, was obtained by conducting a systematic review with meta-analysis, limited to HRF. Results: After calculating costs inherent to the procedures, we have: HFNC = US$664.75 and COT = US$465.71;corresponding to an increase of US$199.04 for HFNC. As for effectiveness, the systematic review and meta-analysis developed included 1859 patients (HFNC: 781 and COT: 1078). The event rate, that is, of patients who progressed to invasive ventilation, was 35% (272) for the HFNC group and 39% (421) for the COT group - with no statistically significant difference (Risk Difference [RD] -0.03, 95% CI -0.08 to 0.01;p = 0.62 - NNT = ns). In possession of the cost and effectiveness factors, ACE demonstrates that COT is more cost-effective: US$1,019.98 vs. US$764.12;showing an increase of US$255.86 per daily ICU with HFNC. Conclusions: Considering that the medical literature does not show a statistically significant difference in the rates of patients who progress to invasive ventilation, the development of ACE is fundamental to support decision making. When considering an average of 10 days in the ICU, the savings sustained by the adoption of COT alone is US$2,558.60 per patient.