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Introduction A 56-year-old patient diagnosed with bipolar affective disorder type II, who remains stable, with no manifest episodes, thanks to aripiprazole 60mg daily. Objectives The aim is to carry out a brief review of the use of the drug as the only stabiliser in bipolar affective disorder. Methods A 56-year-old patient, who has been suffering from episodes of hypomania since the age of 40, with episodes of depression. After poor tolerance to the use of the usual stabilisers, and the impossibility of using antidepressants due to hypomanic swings, it was decided to start treatment with aripiprazole orally, up to a maximum of 60mg daily. Despite the fact that the patient, with this treatment, had no side effects and remained more stable psychopathologically, the patient did not comply adequately with the correct dosage, due to his rotating work shifts. This fact explained that although he acknowledged an improvement, he continued with episodes of depressive symptoms lasting several days followed by episodes of hypomanic characteristics. Results For this reason, it was decided to change treatment to aripiprazole long-acting injectable, in order to ensure linear blood levels of the drug. Initially, it was decided to prescribe 400mg every 28 days. However, after the first administration, 20 days later, the patient began to show dysphoric mood, with marked emotional lability, living in an egodystonic manner. For this reason, the dose was increased to 600mg on a monthly basis. Since then, after a year and a half with the same treatment, the patient has been stable and in line. There has been no further decompensation of the underlying psychopathology and no side effects. Conclusions Aripiprazole in TAB is superior to placebo in type I patients, mainly affecting manic and mixed episodes, but not so much in depressive episodes. It has also been observed that it not only acts in the acute phases, but also has a stabilising function, preventing manic episodes. One study showed that up to 65% of patients on oral aripiprazole in whom it was replaced by AOM remained clinically stable. In the same study, approximately 50% of those who completed 52 weeks of follow-up were able to maintain clinical stability. Disclosure of Interest None Declared

Introduction There are numerous organic causes that can be related to affective symptoms such as neurological, metabolic, infectious and pharmacological. Neurological conditions associated to affective symptoms include vascular lesions, tumors, infections, seizures and dementia. Within cognitive impairment conditions, depressive symptoms are more frequent in vascular dementia and Alzheimer disease, and behavioral or manic symptoms in frontotemporal dementia although we cannot rule out less common associations. Objectives To review about organic mania due to dementia Methods We carry out a literature review about organic mania accompanied by a clinical description of one patient with manic symptoms and cognitive impairment. Results A 80-year-old male was admitted to the short-term hospitalization unit from the emergency department due to maniform symptoms. He had believed for weeks that he was millionaire and capable to cure all the diseases in the world, reason for which he had given away many of his belongings and had tried to register the patent for his invent. He also had future plans to invest all the money he earned from the patent in the construction of roads in Latin America. He had not previous history of mental illness. Neurological study concluded a diagnosis of Alzheimer disease. It was treated as a manic episode with a mood stabilizer and antipsychotic, with partial resolution of the condition. Conclusions It is common to find depressive symptoms in cognitive disorders. Although manic symptoms are much more frequent in frontotemporal dementia or other organic disorders, we can also find them in patients with Alzheimer disease. Since there is no specific curative treatment for this disease, concomitant psychopharmacological treatment is recommended if manic symptoms appear. Disclosure of Interest None Declared

Introduction We present the case of an elderly patient with a severe depressive episode who, in order to maintain psychopathological stabilisation, receives ECT on an outpatient basis. Objectives The objective is to briefly review the use of ECT as a maintenance treatment for severe depression in the elderly. Methods Patient aged 76 years, multipathological, with a history of hypertension, DM and LBP. Femoral head fracture, myelodysplastic syndrome, severe osteoporosis with vertebral crushing, requiring rescue treatment with tramadol, and renal failure. She came for consultation, reporting depressive symptoms of months’ duration, together with delusions of ruin and nihilism. Despite antidepressant and stabilising treatment with duloxetine at daily doses of 120mg, extended-release quetiapine 600mg, lorazepam 2.5mg and mirtazapine 45mg, the patient began to show negative behaviour towards accepting food, clinophilic behaviour and abandonment, which led to her being admitted to the short-term hospitalisation unit. Results Due to the severity of the depressive symptomatology, it was decided to start ECT, administering a total of 12 sessions, which were effective, and outpatient follow-up was resumed. However, after a week, the patient again began to show marked apathy and abulia, as well as complete anorexia lasting more than 24 hours, which led to a new admission. It was then that it was decided to maintain the ECT treatment, on an outpatient basis, as maintenance treatment, together with pharmacological treatment. Conclusions ECT is indicated in severe depression, with or without psychotic symptoms, with malnutrition and organic pathology. According to studies, it has a beneficial response of more than 60%. However, the rate of receiving depressive symptomatology in a severe episode is high, despite ECT, so studies and clinical practice recommend maintenance ECT. It is usual to start with weekly sessions, and progressively space them out to maintain the minimum that guarantees stability. Disclosure of Interest None Declared

Introduction A 9-year-old girl under pediatric follow-up since the age of 4 years after diagnosis of neurofibromatosis type 1 Objectives To present a case of neurofibromatosis and ADHD comorbidity to raise awareness of the importance of screening for neurodevelopmental disorders. Methods Case report and literature review Results The patient had an adequate control and follow-up of the disorder with periodic check-ups and magnetic resonance imaging during her follow-up. She was referred due to symptoms of inattention with failure to perform exams and impulsivity in interpersonal relationships, affecting her social functioning. In addition, the patient presented simple motor tics of eye contraction and shoulder elevation. The patient was diagnosed with attention deficit hyperactivity disorder together with tic disorder. She was treated with stimulant medication with worsening of tics and marked hyporexia. Therefore, medication with guanfacine was started up to 4 mg per day, adjusted by weight. With this dose there was a control of the tics, with improvement of the symptoms of inattention and impulsivity. In different spheres an improvement in their functionality was observed, with improvement in mood, self-esteem and academic performance. Conclusions Neurofibromatosis type 1 is a rare monogenic disorder with a varied presentation (ophthalmologic, dermatologic and predisposition to tumor development). Patientshave been shown to present with symptoms of inattention and executive function impairment, along with other neurodevelopmental disorders such as autism spectrum disorders, learning disabilities or intellectual disability. The literature shows that up to 60% of them has ADHD criteria. Disclosure No significant relationships.

Introduction We present the case of a patient who after a year of psychotic symptoms is diagnosed with thyroid cancer with hyperthyroidism. Objectives A brief review is made of the psychotic symptoms in a patient with hyperthyroidism secondary to cancer of the gland. Methods We present the case of a 52-year-old patient, a former injecting drug addict, who after a year with psychotic symptoms, is diagnosed with thyroid cancer with hyperthyroidism. The patient reported that a year ago, he suddenly had a painless and indurated lump in his neck, associated with weight loss and confusional symptoms. One month after the appearance of the tumor, the patient began to present visual, kinesthetic and haptic hallucinations, with the sensation that supernatural beings were passing through and possessing him. Likewise, he referred to being able to see and feel the atoms of matter, being able to communicate with a superior being whom he called “creator”. Results The patient is admitted for psychotic symptoms. During it, the necessary complementary tests are carried out, objectifying a clinical situation of hyperthyroidism. The study is extended, observing a hyperfunctioning nodule, which corresponded to thyroid cancer. Conclusions Neuropsychiatric symptoms in hyperthyroidism are relatively common. In most cases, the most frequent are cognitive alterations, attention problems and working memory problems. It can also lead to depressive episodes, and more rarely, psychotic symptoms. Disclosure No significant relationships.

Introduction Premenstrual dysphoric disorder (PMDD) is included for the first time in the last edition of DSM within affective disorders. It is necessary that 5 of a list of 11 symptoms (lability, irritability, depressed mood, anxiety, lethargy, being out of control or physical symptoms among others) appear in the majority of menstrual cycles but must be only present during the week before menstruation improving after its onset. It has a prevalence of 1,8-5,8% and it is associated to significant functional impairment. SSRIs are indicated as first-line treatment in severe symptoms. Objectives To review about premenstrual dysphoric disorder and its psychopharmacological treatment. Methods We carry out a literature review about premenstrual dysphoric disorder, accompanied by a clinical description of one patient treated with sertraline. Results 44 years old female referred to our outpatient mental health service due to anxious and depressive symptoms. She had presented abdominal pain, anxiety, obsessive thoughts, sadness, emotional lability, apahty, anergy, uncontrolled impulse, irritability and vociferous attitude with verbal agressiveness only the week before menstruation during several years. These symptoms interfered negatively in her relationships. We started sertraline treatment with ad integrum clinical recovery after two menstrual cycles. 6 months later we indicated to take sertraline only the week before menstruation, maintaining stability. Conclusions 1) It is important to consider premenstrual dysphoric disorder as a possible diagnosis in women with premenstrual discomfort symptoms. 2) It might be consider as a depressive disorder. 3) Antidepressant treatment should be considered in women with disabling symptoms. Disclosure No significant relationships.

Introduction 15-year-old female referred to outpatient unit after COVID lockdown for binge eating and purging with depressive symptoms and anxiety. Objectives To show the importance of a correct diagnosis in an impulsive patient with eating disorder Methods case report and literature review Results The patient presents emotional instability with interpersonal difficulties with high fear of rejection. She suffered from fear of gaining weight and desires to lose weight with rejection of her body image. Fluoxetine and lorazepam are started together with low doses of olanzapine. During the follow up she presented a worsening of mood, onset of self-injuries and an episode of suicidal attempt. A biographical examination was performed, expressing a feeling of academic failure with difficulty concentrating and performing simple tasks. As a child she is described as impulsive, with frequent arguments with classmates. CPT III was performed with a high probability of ADHD. Treatment was started with lisdexamfetamine up to 50 mg with good tolerance. From the beginning of the treatment the patient expressed a feeling of improvement in the control of emotions as well as in the management of her impulsivity. There was an improvement in her academic performance with a decrease in self-injury episodes. The patient was able to express improvement in the sense of incapacity she felt. Conclusions This case shows how marked emotional dysregulation and impulsive symptoms improves after diagnosis and subsequent treatment of ADHD, also improving eating symptoms. ADHD is present in eating disorders, especially in those with impulse dyscontrol such as binge eating disorder or bulimia nervosa. Disclosure No significant relationships.

Introduction 16-year-old female who starts psychiatric follow-up due to episodes of anxiety crises with dizziness and tremors. Objectives To expose a case in which it is essential to rule out organic pathology in cases where there is anxiety and physical symptoms. Methods Case report and literature review Results The patient explains that she was in a situation of conflict with her ex-partner, commenting that he did not accept the breakup. Sertraline was prescribed in ascending doses up to 100 mg per day with complete remission of anxiety. 8 months later, she went to the emergency room for loss of consciousness and tremor of the lower limbs. She was diagnosed with conversive disorder and was prescribed lorazepam up to 3 mg per day. Since then, there has been a worsening in the frequency of syncope occurring up to 10 times a day, limiting her academic and social life. She was evaluated by a cardiologist who diagnosed Pots Syndrome (postural orthostatic tachycardia syndrome) and started treatment with ivabradine and mineralocorticoids. With this treatment, the episodes were drastically reduced and spaced out to 1-2 per week. The dose of lorazepam is decreased until its withdrawal without worsening of the anxious symptomatology. Conclusions This disorder consists of an involvement of the autonomic nervous system in which there is a sudden drop in blood pressure together with an abrupt increase in heart rate. Its treatment is based on increasing blood volume with drugs such as corticosteroids as well as postural measures with adequate water intake. Disclosure No significant relationships.

Electroencephalography (EEG) signals to detect motor imagery have been used to help patients with low mobility. However, the regular brain computer interfaces (BCI) capturing the EEG signals usually require intrusive devices and cables linked to machines. Recently, some commercial low-intrusive BCI headbands have appeared, but with less electrodes than the regular BCIs. Some works have proved the ability of the headbands to detect basic motor imagery. However, all of these works have focused on the accuracy of the detection, using session sizes larger than 10 s, in order to improve the accuracy. These session sizes prevent actuators using the headbands to interact with the user within an adequate response time. In this work, we explore the reduction of time-response in a low-intrusive device with only 4 electrodes using deep learning to detect right/left hand motion imagery. The obtained model is able to lower the detection time while maintaining an acceptable accuracy in the detection. Our findings report an accuracy above 83.8% for response time of 2 s overcoming the related works with both low- and high-intrusive devices. Hence, our low-intrusive and low-cost solution could be used in an interactive system with a reduced response time of 2 s.

The population in developed countries is aging and this fact results in high elderly health costs, as well as a decrease in the number of active working members to support these costs. This could lead to a collapse of the current systems. One of the first insights of the decline in elderly people is frailty, which could be decelerated if it is detected at an early stage. Nowadays, health professionals measure frailty manually through questionnaires and tests of strength or gait focused on the physical dimension. Sensors are increasingly used to measure and monitor different e-health indicators while the user is performing Basic Activities of Daily Life (BADL). In this paper, we present a system based on microservices architecture, which collects sensory data while the older adults perform Instrumental ADLs (IADLs) in combination with BADLs. IADLs involve physical dimension, but also cognitive and social dimensions. With the sensory data we built a machine learning model to assess frailty status which outperforms the previous works that only used BADLs. Our model is accurate, ecological, non-intrusive, flexible and can help health professionals to automatically detect frailty.

Alcohol consumption in adolescents causes negative effects on familiar, social, academic life, as well as neurocognitive alterations. The binge drinking (BD) pattern of alcohol is characterized by the alternation of episodes of heavy drinking in a short interval of time, and periods of abstinence, a practice that can result in important brain alterations; even more than regular alcohol consumption. The prefrontal cortex, which acts as neural support for the executive processes, is particularly affected by alcohol; however, not all studies are in agreement about how BD alcohol consumption affects executive functioning. Some research has found that alcohol consumption in adolescence does not significantly affect executive functioning while others found it does. It is possible that these discrepancies could be due to the history of alcohol consumption, that is, at what age the subjects started drinking. The aim of our study is to assess the performance on executive functioning tasks of 13–19-year-old adolescents according to their pattern of alcohol consumption. We hypothesize that BD adolescents will perform worse than non-BD subjects in tasks that evaluate executive functions, and these differences will increase depending on how long they have been consuming alcohol. Three hundred and twenty-two students (48.14% females; age range 13–22 years; mean aged 16.7 ± 2.59) participated in the study; all of them had begun drinking at the age of 13 years. Participant were divided into three groups, according to their age range (13–15, 16–18, and 19–22 years) and divided according to their pattern of alcohol consumption (BD and control groups). Then, the subjects were evaluated with neuropsychological tasks that assess executive functions like working memory, inhibition, cognitive flexibility, or self-control among others. The entire sample showed a normal improvement in their executive performance, but this improvement was more stable and robust in the control group. Regarding the executive performance among age groups, control subjects only obtained better results than BDs in the 19–22-year-old range, whereas the performance was quite similar at younger ages. Considering that all the BD subjects started drinking at the same age (13 years old), it is possible that a kind of compensation mechanism exists in the adolescent brain which allows them to reach a normal performance in executive tasks. This theoretical mechanism would depend upon neuronal labor, which could lose efficacy over time with further alcohol ingestion. This process would account for the differences in neuropsychological performance, which were only observed in older students with a longer history of alcohol consumption.

Introduction An increase in suicidal behavior among the adolescent population is reflected in the literature and in clinical practice. According to a study of suicidal behavior and mental health by the Spanish ANAR Foundation, the number of cases with suicidal behavior has experienced an accentuated growth in the period 2012-2022 (1,921.3%), highlighting the increase produced in the post-COVID-19 period, between 2020 and 2022 (128%) Objectives To analyze the reasons for admission to the short hospitalization unit. To describe the sociodemographic characteristics of hospitalized adolescents. Methods Descriptive observational study of the sample of adolescents admitted to the inpatient psychiatric unit of the Hospital Universitario Puerta de Hierro between January 1, 2023 and June 30, 2023. It is carried out through the information obtained in the clinical history of the patients. Results During this period of time 113 adolescents were admitted, 80.2% were female. The mean age was 15.16 years. The main reason for admission was autolytic ideation, occurring in 33.3% of the patients. The second most frequent reason for admission was suicide attempt (29.7%) and behavioral disturbance (17.1%) was the third most frequent. Of the methods used in suicide attempts, drug overeating stands out among the methods used in suicide attempts. (75.8%), followed by attempted hanging (12.1%) or cutting (12.1%). Image: Conclusions The results corroborate what is reported in the scientific literature, where self-harm and self-injury attempts have increased and are the most frequent reasons for admission. This shows that suicide is a public health problem of the first order, where prevention and early intervention programs are necessary. Disclosure of Interest None Declared

Introduction A 21-year-old male presented to the emergency room due to strange behavior Objectives Show how emotionally intense events can be a stress factor leading to dissociative or psychotic symptoms. Methods Case report and literature review Results The patient is in Spain after having attended the meeting with the Pope at the World Youth Day in Portugal. He is an engineering student who, in the week prior to the trip, had high levels of stress related to exam time. He also explained that he had recently had conflicts with his partner. In the psychocopathological examination of the patient, a global insomnia of 3 days of duration stands out. In addition, a disorganized and disjointed speech focused on high concern that something bad could happen to his family and partner. In the interview he appears restless, nervous, with a perplexed contact. The patient’s companion says that he has been very worried and obsessed about his relationship with his partner, with constant doubts about asking her to marry him. It is decided to start olanzapine, receiving up to 15 mg per day. In the following interviews he shows better contact and a more organized speech. Conclusions It is known that emotionally intense situations can be a trigger for the development of psychotic symptoms. There are different manifestations of these stressful situations such as physical symptoms like fainting or but mental symptoms are also described such as dissociative amnesias, or less frequent as in this case psychotic symptoms. They are usually of sudden onset and early remission with good response to anxiolytics or antipsychotics. Disclosure of Interest None Declared

Introduction A 7-year-old male diagnosed with autism spectrum syndrome and moebius syndrome was admitted to the psychiatric inpatient unit for a 3-week history of food restriction Objectives To show the importance of exploring symptoms of autism in patients diagnosed with moebius syndrome in order to optimize the intervention of the difficulties that may arise. Methods Case report and literature review Results This is a patient with a history of Moebius Syndrome, who required trauma surgery for a clubfoot in April 2019. In early childhood he needs early psychomotor care. He has an IQ of 91. A diagnosis of autism was made in 2018 highlighting high difficulty for social interaction and communication, with repetitive patterns of behavior and marked restricted interests. The patient came to the emergency room after 3 weeks of food restriction. His parents explain that about a month ago the patient witnessed one of his classmates having an episode of vomiting. Since then he has been afraid that he might vomit. They explain that he constantly asks about food expirations, needing to ask before each meal if it will sit well in his stomach. He has noticeably decreased the amount of food he eats and is becoming more selective with food. In the last week he has lost 2 kilograms. During the hospitalization we worked with the patient on his fears about intakes, achieving a weight recovery and normalizing his eating habits. Conclusions This case points out the association between Moebius syndrome and autism spectrum disorder. In addition, it reflects the importance of early diagnosis, since in this case it was essential to know the patient’s tendency to literalism and rigid thinking in order to receive effective treatment to achieve renutrition. Moebius syndrome is a rare congenital disorder with a prevalence of less than 0.05%, characterized by congenital facial paralysis associated with absence of abduction of the eyes due to alterations of the VI and VII cranial nerves. It presents multiple craniocephalic, musculoskeletal, neurological or ophthalmological manifestations. Different studies have found an association between autism spectrum disorder and Moebius syndrome, with comorbidity between 25-40%, varying according to the studies. Disclosure of Interest None Declared

Introduction The patient was a 34-year-old male admitted to the psychiatric inpatient unit for high anxiety and suicide ideation due to severe toothache. Objectives To show how the antipsychotic pimozide can be an effective option for the treatment of anxiety and obsessive symptoms around physical complaints within the spectrum of somatoform disorders Methods Case report and literature review Results The patient comes to the emergency room with high anxiety and active self-harming ideation. He reports that for months he has been experiencing mouth pain that is becoming more and more intense. He has seen multiple professionals without finding a cause that justifies the pain. In the past she has a history of multiple ailments (knee, abdominal pain…). He is being treated with sertraline 150, clonazepam 3 mg per day and olanzapine 5 mg at night. During admission, treatment with pimozide up to 4 mg per day was started. The patient is progressively less distressed and with more distance from the ideas about pain, being able to carry out more activities during the day. There is remission of suicidal ideation Conclusions There is evidence in the literature that the use of pimozide was effective in different psychotic disorders. It has been seen to reduce the intensity of symptoms in cases of delusional disorders with delirum of somatic type or those such as delusions by parasitization. The use of pimozide has also been effective in the treatment of complex tic disorder. In this case it is effective and could be explained by the close relationship of osbsesive symptoms with psychotic symptoms. Disclosure of Interest None Declared

Introduction Dementia can present with psychiatric symptoms even before the cognitive impairment, which makes difficult to establish an adequate diagnosis. There have described symptoms of this type in vascular dementia, frontotemporal dementia, Alzheimer disease and Lewy bodies dementia. Frontotemporal dementia has a prevalence of 9-20% and it`s the third in frequency among degenerative dementia. It appears before the age of 65 years old and is more common in men. Two variants have been described, linguistic and behavioral. The behavioral one has usually an initial psychiatric presentation, with behavioral disorders, disinhibition and personality changes. Therefore it`s important to make an adequate differential diagnosis with late onset bipolar disorder. Objectives To review about frontotemporal dementia and its differential diagnosis with late onset bipolar disorder. Methods We carry out a literature review about frontotemporal dementia and its differential diagnosis with late onset bipolar disorder, accompanied by a clinical description of one patient with behavioral disturbance and language disorder. Results A 59-year-old female was admitted to the short-term hospitalization unit from the emergency department due to behavior disorder. She had no relevant personal or familiar psychiatric history up to two years before when she received diagnosis of bipolar disorder. She presented behavioral disorganization, psychomotor restlessness, verbal aggressiveness, verbiage, insomnia and decreased intake. Psychopathological examination became difficult due to her language disorder since she presented an incoherent speech with paraphasias and loss of the common thread. Neurological study guided diagnosis to frontotemporal dementia even though they left the psychopharmacological treatment to our discretion. Olanzapine 5 mg twice a day was initiated, and behavioral improvement was observed. However, the patient maintained a significant functional impairment. Conclusions Psychiatric presentation is frequent in dementia, even before cognitive failures which makes essential an exhaustive differential diagnosis. It`s important to consider the diagnosis of frontotemporal dementia in those patients who debut with behavioral disturbance in the 50s. Psychopharmacological treatment is only symptomatic so functional recovery should not be expected. Disclosure of Interest None Declared

Introduction Suicide is the most frequent psychiatric emergency. About 1% of all deaths are due to suicide so around 700,000 people commit suicide each year. Suicide attempt is more frequent in women (3:1) while completed suicide is more frequent in men (4:1). Most suicides occur in the 35-64 age range. The severity of a suicide attempt is assessed in terms of method, potential lethality, rescuability and impulsivity. A previous suicide attempt is the main risk factor for suicide behavior. The majority (more than 90%) of suicide behavior are related to an underlying psychopathology, mainly depression and substance abuse, especially alcohol. However, there are also numerous cases of impulsive attempts in the context of life stressors. Objectives To analyze sociodemographic and clinical characteristics of adult patients with suicidal behavior attended in the emergency department during a one-year period. To study the stability of the data obtained in the following annual period Methods A retrospective review of the population over 18 years attended in the emergency department during 2022 because of suicidal behavior, was carried out. Data collection for the year 2023 is in progress in order to be able to carry out a comparative study between both annual periods. Results 562 patients over 18 years were attended in the emergency department of our hospital due to suicide behavior during 2022. 383 of these patients were women (68.1%) and 179 men (31.9%). with an average age of 38.6 and 42.2 years respectively. The age range between 18 and 25 years accounted for 28.5% of the total cases. The most frequent suicidal behavior was medication overdose with a total of 307 (54.6%), being more frequent in women than in men (2.6:1). The second most frequent reason for attention was suicidal ideation without suicide attempt, with a total of 212 patients (37.7%). 371 patients were discharged home from the emergency department (66%) and 191 required a longer observation in hospital environment. We are awaiting to complete data collection for 2023 to establish a comparison with those described above. Conclusions According to our study, suicidal behavior in adult population is more frequent in women than in men. The most frequent age range in both genders was between 18 and 25 years old. The method most frequently used was medication overdose and suicidal ideation without a suicide attempt was the second most frequent reason of attention. Our patients mostly presented diagnoses of personality disorder, depression and substance use disorder. Disclosure of Interest None Declared

Introduction This is a 13-year-old female patient admitted to the psychiatric unit active suicidal ideation. Objectives the objective is to show through a clinical case how vortioxetine can be safe in adolescents. Methods Case report and literature review Results She has a history of daily consumption of at least 2 units of cannabis per day. She presents high emotional distress secondary to academic failure, consuming the substance as a coping strategy. Due to prohibition and control by her parents, the patient stopped taking the substance, presenting severe depressive symptoms, self-injury and suicide ideation. For this reason she is admitted to the inpatient psychiatric unit. The electrocardiogram performed on admission shows a corrected QT index of 524. Exploring physical symptoms, she recognized episodes of syncope and palpitations. Coordination was made with cardiology, who performed an echocardiogram with normal results and began follow-up with them without prescribing medication. It was agreed not to use drugs that could prolong the QT index. Evaluating the clinical situation, it was decided to start treatment with Vortioxetine up to 10 mg. With this treatment there was no worsening of the electrocardiogram and the patient’s mood improved, anxiety and ideas of death were remitted Conclusions This work aims to show how vortioxetine has been effective and safe at the cardiological level in the case of moderate-severe depression in an adolescent with prolonged QT index Disclosure of Interest None Declared

Introduction Corticosteroid treatment has been associated with the appearance of psychiatric symptoms such as depression, mania or psychosis. It is believed that manic symptoms appear with lower doses than psychotic ones. Furthermore, manic symptoms are usually associated with brief treatments against depressive ones that often appear with chronic administration of corticosteroids. The symptoms can persist for to 2 months, with an average duration of 3 weeks. The prognosis is favorable with a complete remission of symptoms in more than 90% of patients. Treatment initially consists in reducing or removing corticosteroids. However, sometimes symptomatic treatment with antipsychotics or mood stabilizers is necessary. Objectives To review about corticosteroid-induced mania Methods We carry out a literature review about corticosteroid-induced mania, accompanied by a clinical description of one patient previously diagnosed of bipolar disorder who presents a manic episode after corticosteroids treatment. Results A 25-year-old male was admitted to the short-term hospitalization unit from the emergency department due to manic symptoms. He had a previous diagnosis of attention deficit hyperactivity disorder sin adolescence and also a diagnosis of bipolar disorder established 7 years ago. During the last year he had received treatment with asenapine 10 mg and lamotrigine 200 mg, with good response. Several weeks before his admission he received corticosteroid treatment during several days, due to an respiratory infection. In this context he appeared more nervous, dysphoric, hyperthymic, impulsive, with increased speech pressure, insomnia and tachypsychia. Despite the withdrawal of corticosteroid treatment, manic symptoms persisted. During admission, asenapine´s dose was increased with a complete remission of the manic symptoms. Conclusions Corticosteroids are associated in a high percentage with the appearance of manic symptoms. The prognosis is usually favorable after the withdrawal of corticosteroid treatment. However, sometimes the symptoms do not disappear despite withdrawal - mainly due to individual vulnerability - or this one is not possible. In these cases, treatment with antipsychotics or mood stabilizers is indicated. Disclosure of Interest None Declared

Introduction Adolescents with emotional dysregulation are at risk for self-injury. Antipsychotics are often used to manage these symptoms. Objectives The aim of the present case is to show the use of cariprazine as an effective drug for emotional dysregulation and impulsivity in a 17-year-old adolescent girl Methods Case report Results The patient was a 17-year-old female admitted to in patient psychiatric unit for a self-harm attempt due to sertraline overdose. She was being followed up for self-injury, anxiety and eating disorder symptoms. Her treatment was sertraline 200 mg, diazepam 20 mg per day and olanzapine 15 mg per day. With this medication she had gained up to 7 kgs in 4 months. A progressive change was made with cariprazine up to 3 mg and olanzapine was reduced to 2.5 mg at night. With this adjustment the patient did not present worsening in anxiety levels, with adequate impulse control and being able to perform emotional regulation strategies. Conclusions Although it has no indication in patients under 18 years of age, it shows a case of good tolerance and efficacy for the management of impulsivity by improving emotional regulation. Cariprazine is an atypical antipsychotic that works through partial agonism on dopaminergic receptors, serotonin 5-HT1A receptors and an antagonist at the 5-HT2B receptors, with moderate affinity for adrenergic, histaminergic, and cholinergic receptors reducing the likelihood of side effects Disclosure of Interest None Declared

Introduction We often find it challenging to manage hyperactivity, low frustration tolerance and angry outbursts in patients with ASD and comorbid ADHD. Fewer drugs are approved for these disorders and these patients are more likely to develop adverse effects. Objectives The aim of this case is to show how the combination of lisdexamfetamine together with guanfacine has very positive effects on anger outbursts and boundary heteroaggressiveness in patients with ASD and ADHD. Methods Case report and literature review Results This is a 14-year-old minor admitted to the psychiatric unit after physical aggression against his family due to anger after removal of video games, requiring police intervention. He has been diagnosed since he was 11 years old with ADHD and Autism Spectrum Disorder. He was being treated with methylphenidate 54 mg and aripiprazole 10 mg. Since the beginning of the admission, the following pharmacological adjustment has been made: Methylphenidate is substituted by lisdexamfetamine up to 50 mg per day. Guanfacine has been started up to 4 mg per day and the dose of aripiprazole has been maintained. The patient had no adverse effects with adequate tolerance without sedation, hyporexia or hypotension. With this adjustment, improvement was found in the levels of restlessness and hyperactivity. The patient expressed a subjective improvement in the levels of restlessness and with a notable improvement in attention in the hospital classroom. An improvement in emotional regulation was also observed, with more tolerance to the imposition of limits, without an explosion of anger in the face of any rule during admission Conclusions The management of hyperactivity and episodes of low frustration tolerance in patients with ASD and ADHD is complex. Many studies point out the time-limited use of some antipsychotics such as risperidone or aripiprazole. This work aims to show guanfacine in combination with lisdexamfetamine as an excellent combination for the management of agitation and rage explosion in these patients. In addition, the profile of adverse effects at metabolic level is much better than that of atypical antipsychotics. Reference - Extended-Release Guanfacine for Hyperactivity in Children With Autism Spectrum Disorder. Lawrence Scahill et al. Am J Psychiatry. 2015 Dec. Disclosure of Interest None Declared

Introduction Patients with autism spectrum disorder are characterized by high anxiety when facing social situations and dealing with interpersonal relationships on a daily basis. Although initially because of their rigid personality with the norm, and their tendency to social distancing, we do not have in mind this pathology as the most likely to develop a substance use disorder. However, it is observed in the literature a remarkable percentage of patients who resort to consumption, mainly alcohol, as an anxiolytic to be able to interact in society. Objectives To show the case of a 19-year-old adult with a diagnosis of ASD who resorts to alcohol consumption in her daily life as a strategy to manage anxiety in social situations. Methods Case report and literatura review Results This is a 19-year-old woman with a recent diagnosis of ASD. She is studying biotechnology and lives with her parents and 3 siblings. The patient reports difficulty in social relationships since early childhood, with experiences of school bullying. She expresses desire to relate with others, although she does it in an inadequate way, with difficulty in detecting nonverbal language, irony and anger when she does not understand a joke. The patient confesses that since she was 16 years old she has consumed alcohol to mitigate the anxiety caused by facing a group of people. She says that she feels that it relaxes her and facilitates interaction, making it more fluid and less tense. However, she recognizes that initially she used to drink 1 or 2 beers, but now she needs to drink up to 2 glasses of gin, recognizing this as something problematic. Conclusions The literature shows how patients with ASD can also present substance use disorder. It has been shown that about 10% of these patients have an abusive use of alcohol. Other samples show wider ranges (7-71%) of prevalence of alcohol consumption in patients with autism. In relation to cannabis, it is seen that around 3% of these patients consume it. These patients seek its anxiolytic effect and to reduce mental health symptoms. In addition, the purchase of alcohol does not involve high social interaction to obtain it, since it is a substance that can be purchased legally. It is important to explore alcohol consumption in consultation with patients with ASD to help them develop more functional anxiety management strategies. Reference Prevalence of psychiatric disorders in adults with autism spectrum disorder: A systematic review and meta-analysis. Lugo-Marín.J et al. 2019. Research in Autism Spectrum Disorders Volume 59, March 2019, Pages 22-33 Disclosure of Interest None Declared

Introduction We present the case of a 41-year-old male patient with multiple psychiatric diagnoses, he was diagnosed with agenesis of the corpus callosum, which explains his clinical presentation. Objectives The objective is to carry out a brief review of the symptoms associated with the agenesis of the corpus callosum. Methods The patient has been diagnosed with ADHD, cyclothymia, depressive anxiety disorder and social phobia. He has been treated with a multitude of drugs such as antidepressants, anxiolytics, stimulants and even low-dose antipsychotics. Despite the pharmacological treatments received, as well as the therapies, the patient’s functionality has progressively worsened, to the point of restricting going out of the home or maintaining a stable job. Biographical data were collected, including psychomotor retardation and inappropriate laughter. He showed mannerisms such as fluttering and low frustration tolerance. He was slow to respond to his name and showed little affective resonance with his sister and parents. Restrictive interests, especially with English culture, for which he later studied English philology. On the other hand, his mother explains that he had no symbolic play and that, from early childhood, he had difficulties in relationships with peers. Due to the aforementioned clinical manifestations, the functional worsening and the examination carried out in the consultation room, it was decided to extend the study with a brain MRI, where an agenesis of the corpus callosum was observed. Results Agenesis of the corpus callosum is a malformation of the central nervous system, which affects one in every 4000 births. It can be partial or complete, and occurs between the 7th-20th week of gestation. Agenesis of the corpus callosum presents with a triad of symptoms: - Reduced interhemispheric communication of sensory-motor information. - Increased information processing time - Difficulty in abstract thinking. This triad causes difficulties not only cognitively, but also socially. There is difficulty in integrating and learning new verbal and visual information. Tendency to literalism, with difficulty in understanding double meanings. They also have difficulty understanding non-verbal language and reading emotions, which makes interaction with peers difficult. All these symptoms can sometimes be confused with symptoms compatible with Autism Spectrum Disorder. Conclusions After the diagnosis and after focusing the patient’s treatment on the most limiting symptoms of his daily life, an integrated approach was initiated, not only at a pharmacological level, with the use of antidepressants and anxiolytics, but also from a psychotherapeutic point of view, working on those areas in which the patient is most dysfunctional. He was accompanied in the disability application process, as well as helped in the search for associations for adults with ASD, finding there the answer to his symptoms and difficulties. Disclosure of Interest None Declared

Introduction The objective of this poster is to show the importance of understanding the situation of the patient’s family in order to know the development and role that eating symptoms are occupying both in the patient and in the different members that make up the family Objectives Highlight the triggering and sustaining factors of a case of anorexia nervosa Methods Case Report Results Patient is a 14-year-old woman who begins to develop excessive concern about her body image initiating eating behaviors in the form of high restriction and counting of calories from food. Also she explains that she began to compulsively perform more than two hours a day of sports in order to lose weight Family genogram: she is an only daughter, whose parents have been separated for 4 years. Parents recognize conflictive relationship. The patient recognizes a very close relationship with her mother. When she talks about her relationship with her father, she explains how she felt very close to her father when she was young but that after the separation her father moved away. She describes that his father rebuilt his life a year ago and that he recently informed her that he is going to be a father again. She recognizes intense feelings of abandonment from her father. She acknowledges that the sense of control starting with anorexia initially helped her to feel confident about herself. Conclusions Understanding the origin of the symptoms and their function is essential for a better management of cases of anorexia Disclosure No significant relationships.

Introduction The presence of psychological impact on relatives of patients admitted for Covid-19 has been described. The effectiveness of psychological first aid in critical situations has also been described. The first psychological aid describes a human response supporting another person who is suffering. This intervention is indicated for those affected by a traumatic event. Objectives To present a theoretical review about psychological first aid and to describe data about it on relatives of patients admitted for Covid-19. Methods Literature review about psychological first aid and data description of telephone intervention carried out by mental health professionals on family members of patients admitted for Covid-19. Results From an initial pool of 77 Covid-19 patients, 50 were selected as telephone contact with relatives was possible. Mean age was 68.9 years, 13 were female and 37 male. 90% were admitted in internal medicine department and 10% in intensive care unit. First telephone intervention in all cases was to introduce the psychiatrist in charge of the follow-up and provide contact number of psychiatry department. In 13 relatives` support, emotional ventilation and active listening was provided and 2 of them also received therapeutic guidelines. Further phone contact was required in 12 relatives. In follow-up phone calls, all relatives received therapeutic guidelines and 3 was referred to our outpatient clinic. Conclusions Family members of patients admitted for covid-19 may present emotional symptoms, many of them normal reactions in context of a crisis situation. A large percentage do not require a structured psychotherapeutic intervention but can benefit from a first psychological help. Disclosure No significant relationships.

Introduction A 15-year-old man who comes to the consultation referred from neurology for a poorly progressive tic disorder that is resistant to treatment. This is a patient with no relevant medical history. He has good academic performance, without symptoms of inattention, hyperactivity or impulsivity. He does not present buccophonatory tics Objectives To Show guanfacine as a efficient treatment fot tics disorder Methods Case report Results He has presented complex motor tics as cervical contractions that have had to receive physiotherapeutic treatment. He also presents simple ocular tics. The patient at our evaluation is on a 4 mg dose of pimozide without response. He was previously on risperidone. It was decided to start treatment with guanfacine up to 5 mg with reduction of pimozide, to 1 mg. The patient with this dose adjustment shows a notable improvement in the frequency and intensity of the tics, both cervical and ocular. The patient also refers to a feeling of being calmer and being able to face stressful situations such as being exposed to social relationships, intervening more in class without increasing their anxiety levels. Conclusions Guanfacine is a selective alpha-2a adrenergic receptor agonist that has an indication for attention deficit hyperactivity disorder. Like its precursor, clonidine, there is more and more literature that proposes this medication and others for ADHD as useful drugs in pathologies such as tic disorder. It has a safe use profile, which with progressive adjustment and hardly any side effects is placed as a treatment to take into account in this pathology. Disclosure No significant relationships.

Introduction Faced with recent onset psychotic symptoms in patients over 60 years of age without a psychiatric history, it is important to carry out an adequate differential diagnosis. Objectives The objective is to carry out a review of Charles Bonnet syndrome through the presentation of a case Methods 75-year-old patient who suddenly began to present auditory hallucinations. The patient had no relevant psychiatric history or medical history. She reported that suddenly, two months ago, she had begun to listen to his neighbor through the walls of his home. She heard him talk about her, threatening and insulting her. Later, as a result of these hallucinations, she began to believe that in the bathroom he was spying on her through a camera, forcing her to shower in the dark. Weeks later, she thought that he was also chasing her down the street through a chip that had implanted her. She was distressed and highly anxious. She had started not sleeping out of fear of this neighbor. Results In addition to the psychiatric evaluation, an MRI was requested to rule out incipient cognitive deterioration, as well as a hearing examination. It was found that he had severe hearing loss in the left ear. Given these findings, he was diagnosed with Charles Bonnet syndrome. Conclusions Charles Bonnet syndrome is normally associated with blindness, however, it is also described in deafness. It occurs with hallucinations of the lost sensory organ. It is a clinical picture that does not respond well to treatments. Disclosure No significant relationships.

Introduction The coronavirus crisis has had an impact on the mental health of children and adolescents Objectives Determine how it has affected this population and what mental pathologies are occurring Methods Literature bibliographic review Results School closures and lockdown have been seen to have produced higher levels of anxiety, anger, and sleep and appetite disruption. On the one hand, the children had more anxiety and regressive behaviors, and the adolescents had more isolation, depressive symptoms and even autolytic ideation. The economic crisis and lockdown have affected the family environment, having reported greater situations of domestic violence and substance use among parents. Studies show a prevalence up to 28-34% of post-traumatic stress symptoms among adolescents. In Spain it has been determined that ¼ children present anxiety and / or depression. Their parents noticed in them greater irritability, less concentration and greater feelings of loneliness There has been an increase in addiction to new technologies. This is partly a method of maintaining social relationships, but prolonged use is associated with higher levels of anxiety and depression. Regarding to patients with mental pathology, they have presented greater tantrums, especially ADHD and ASD, due to the loss of structure and routine. Conclusions Confinement and fear of COVID have affected mental health of children and adolescents, with anxiety and depression occurring more frequently. Is highlighted the presence of feelings of loneliness among adolescents and the increase in the use of screens. Finally close to 80% of patients who had mental health conditions referred that this crisis had worsed their symtponms

Introduction Akiskal proposed the bipolar spectrum concept with the aim of including those patients with atypical depressive presentations and mood temperaments. Also Koukopoulos accepted this proposal in those patients with poor response to antidepressants or highly recurrent course. Concretely bipolar disorder type IV was defined as clinical depression based on a lifelong hyperthymic temperament. Some years after DSM-III several experts in bipolar disorder continued in this work line even though DSM-IV and most recent DSM-V not considered to include this concept as a new diagnostic category. Objectives To present a theoretical and practical review about bipolar spectrum and its relationship with hyperthymic traits. Methods We carry out a literature review about bipolar spectrum, accompanied by the clinical description of one patient with major depressive disorder and hyperthymic traits base. Results 45 years old female referred to our outpatient mental health service after episode of voluntary drug overdose. She presented long evolution depressive symptoms (sadness, apathy, anhedonia, anergy, irritability, anxiety, emotional lability, early awakening, social withdrawal, self-care neglect, hopelessness, cognitive failures, guilt feelings and death ideas) with onset in postpartum. She reported a previous depressive episode 9 years ago with good response to fluoxetine. Hyperthimic traits were described but no history of manic symptoms. An erratic evolution was observed with various antidepressant treatment and finally improved adding mood stabilizer. Conclusions We must propose to consider the diagnosis of bipolar spectrum in order to treat effectively patients with major depression dissorder and hyperthymic temperament in absence of manic symptoms. Disclosure No significant relationships.

Abstract  The evaluation of individual rate constants involved in any reaction mechanism of an enzymatic systems first requires experimental monitoring of the time course of the concentration or product rate creation or of any enzyme species. The experimental progress curves obtained must then be fitted to the corresponding theoretical symbolic equation. Nevertheless, in some cases, e.g. when the equation involves two or more exponential terms, this fit is not easy and sometimes impossible. Simplification of the equation is usually required by assuming, for example, that the system has reached the steady-state, assuming an initial steady-state of a segment in the scheme of the reaction mechanism or assuming rapid equilibrium in one or more of the reversible steps, if there are any. But, obviously, simplified equations produce either fewer individual rate constants or global constants consisting of algebraic associations of individual rate constants or individual rate constants or global constants that might considerably differ from the real ones due to the approaches made. In this contribution, we suggest an alternative procedure for evaluating the rate constants of enzyme reactions corresponding to enzyme systems where one or more of the species involved is unstable or where one or more of the enzyme species is irreversibly inhibited, or both. The procedure is based on the numerical determination of statistical moments from experimental time progress curves. The fitting of these experimentally obtained moments to the corresponding theoretical expressions allows us, in most cases, to evaluate of all of the rate constants involved, with only a small error. To verify the goodness of the suggested procedure, it was applied to an unstable enzyme system which had previously been analysed with other methods. Finally, it is indicated how this procedure could also be extrapolated for application to any stable or unstable enzyme system. [ABSTRACT FROM AUTHOR]

Abstract  This work presents an alternative analysis of the integrated rate equations corresponding to the simple Michaelis-Menten mechanism without product inhibition. The suggested new results are reached under a minimal set of assumptions and include, as a particular case, the classical integrated Michaelis–Menten equation. Experimental designs and a kinetic data analysis are suggested to the estimation of the maximum steady-state rate, V max, the Michaelis–Menten constant, K m, the initial enzyme concentration, [E]0, and the catalytic constant, k 2. The goodness of the analysis is tested with simulated time progress curves obtained by numerical integration. [ABSTRACT FROM AUTHOR]

Abstract Background Older adults face unique health challenges as they age, including physical and mental health issues and mood disorders. Negative emotions and social isolation significantly impact mental and physical health. To support older adults and address these challenges, healthcare professionals can use Information and Communication Technologies (ICTs) such as health monitoring systems with multiple sensors. These systems include digital biomarkers and data analytics that can streamline the diagnosis process and help older adults to maintain their independence and quality of life. Method A design research methodology is followed to define a conceptual model as the main artifact and basis for the systematic design of successful systems centered on older adults monitoring within the health domain. Results The results include a conceptual model focused on older adults' Activities of Daily Living (ADLs) and Health Status, considering various health dimensions, including social, emotional, physical, and cognitive dimensions. We also provide a detailed instantiation of the model in real use cases to validate the usefulness and feasibility of the proposal. In particular, the model has been used to develop two health systems intended to measure the degree of the elders' frailty and dependence with biomarkers and machine learning. Conclusions The defined conceptual model can be the basis to develop health monitoring systems with multiple sensors and intelligence based on data analytics. This model offers a holistic approach to caring for and supporting older adults as they age, considering ADLs and various health dimensions. We have performed an experimental and qualitative validation of the proposal in the field of study. The conceptual model has been instantiated in two specific case uses, showing the provided abstraction level and the feasibility of the proposal to build reusable, extensible and adaptable health systems. The proposal can evolve by exploiting other scenarios and contexts.

The increasing interest in digital preservation of cultural heritage has led to ARTDET, a machine learning software for automated detection of deterioration in easel paintings. This web application uses a pre-trained Mask R-CNN model to detect Lacune (areas of missing paint, resulting in visible support panel) from the loss of the Painting Layer (LPL) and stucco repairs. ARTDET leverages high-resolution images annotated by expert restorers. The software achieved 80.4 % recall for LPL and stucco, with a 99 % confidence score in detected damages. Available as open access resource, ARTDET aids conservators and researchers in preserving invaluable artworks.

Introduction: Sepsis is a clinical condition that seriously threatens the body’s balance and is still a significant cause of death. Therefore, clinical management is aimed at a timely classification and implementation of emergency measures based on systems of scales for detection that helps reduce complications in patients. That is the importance of using SOFA (Sequential Organ Failure Assessment) and qSOFA (quick SOFA) in the different services for hospitalized patients. Objective: To evaluate the usefulness of SOFA and qSOFA scale as a predictor of mortality in patients with sepsis hospitalized in the intensive care unit (ICU) of the Good Hope Clinic from January to December 2015. Materials and methods: Retrospective study of adult patients hospitalized in ICU/NICU with sepsis diagnoses. Epidemiological, clinical, and laboratory data were collected to apply the SOFA and qSOFA scales. We performed a description of the variables studied, an analysis of the variables, and the scoring systems compared in the ROC curve. Results: The main infectious focus was respiratory (41.5%). The patients died was 28.3%. The variables serum creatinine and lactate were statistically significant with OR = 11.67 (95% CI 2.58-52.85, p

Introduction Brain tumors can be associated with psychiatric symptoms in up to 50% of cases. The most frequent primary is meningioma and the clinic will depend on its location. Since surgical treatment does not always guarantee complete resolution of the condition, concomitant psychopharmacological treatment is usually recommended. Objectives To review about organic mania and its differential diagnosis. Methods We carry out a literature review about organic affective disorder accompanied by a clinical description of one patient with organic mania. Results A 50-year-old woman admitted due to psychotic symptoms. She had a diagnosis of frontal and parietal meningioma treated with surgical treatment 10 years ago. In this context she had a diagnosis of Organic Affective Disorder and 3 previous psychiatric admissions due to affective or psychotic symptoms. Current episode consisted in dysphoria, magalomanic ideation, delusional ideation of harm and mystical-religious content, high speech pressure and insomnia with little awareness of the disease. Cranial magnetic resonance showed postoperative right frontal changes and stability in parietal meningioma, with no significant differences compared to the previous study. Diagnosis of Organic Affective Disorder is maintained and reintroduced treatment with aripiprazole withdrawaled by the patient weeks before. Because of adverse effects and persistence of the symptoms described, it was changed to olanzapine with good response and tolerability. The behavior was progressively adapted with improvement of the dysphoria and without psychotic symptoms at discharge. Conclusions Affective symptons due to organic disorders such as brain tumors can be treated surgically and with psychopharmacological treatment. Disclosure of Interest None Declared

Introduction: Magnetic resonance imaging (MRI) provides high-resolution fetal anatomy that is recommended as a complementary examination when fetal ultrasound (US) identifies cerebral abnormalities. The aim of this study was to describe fetal MRI findings for diagnosing fetal intracranial hemorrhage (ICH) when nonspecific or inconclusive fetal cerebral US abnormalities are detected. Material and Methods: This case series included pregnant women referred to our center due to cerebral abnormalities detected by fetal US who were subsequently diagnosed with fetal ICH on MRI. Fetal ICH was identified based on signal intensity on T1- weighted image (WI) and T2-W1. Imaging age pattern of hemorrhagic lesions was described. Results: Among the 12 cases diagnosed with fetal ICH by fetal MRI, only three (25.0%) cases were detected by fetal US, while nine (75.0%) had nonspecific or inconclusive ultrasonographic findings. Ventriculomegaly was the most common finding on fetal US. Specific MRI T2 and T1-WI for the diagnosis of fetal ICH were identified in all 12 (100%) cases. Seven (58.4%) cases were classified as early subacute ICH with low-signal on T2-WI and high-signal on T1-WI. Four (33.3%) cases were classified as late subacute ICH, with hyperintense signal on both T2- and T1-WI. Only one case (8.3%) with acute fetal ICH showed a low-signal on T2- and isointense signal T1-WI. Conclusion: Fetal MRI is an accurate complementary tool for the diagnosis of fetal ICH when nonspecific or inconclusive abnormalities are detected by fetal US. This study is the first in Mexico to report fetal MRI findings for the prenatal diagnosis of fetal ICH.

Chronic staphylococcal osteomyelitis can persist for long time periods causing bone destruction. The ability of Staphylococcus aureus to develop chronic infections is linked to its capacity to invade and replicate within osteoblasts and osteocytes and to switch to a dormant phenotype called small colony variants. Recently, osteocytes were described as a main reservoir for this pathogen in bone tissue. However, the mechanisms involved in the persistence of S. aureus within these cells are still unknown. Here, we investigated the interaction between S. aureus and osteoblasts or osteocytes during infection. While osteoblasts are able to induce a strong antimicrobial response and eliminate intracellular S. aureus , osteocytes trigger signals to recruit immune cells and enhance inflammation but fail an efficient antimicrobial activity to clear the bacterial infection. Moreover, we found that extracellular signals from osteocytes enhance intracellular bacterial clearance by osteoblasts. Even though both cell types express Toll-like receptor (TLR) 2, the main TLR responsible for S. aureus detection, only osteoblasts were able to increase TLR2 expression after infection. Additionally, proteomic analysis indicates that reduced intracellular bacterial killing activity in osteocytes is related to low antimicrobial peptide expression. Nevertheless, high levels of lipid mediators and cytokines were secreted by osteocytes, suggesting that they can contribute to inflammation. Taken together, our results demonstrate that osteocytes contribute to severe inflammation observed in osteomyelitis and represent the main niche for S. aureus persistence due to their poor capacity for intracellular antimicrobial response., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Garcia-Moreno, Jordan, Günther, Dau, Fritzsch, Vermes, Schoppa, Ignatius, Wildemann, Werz, Löffler and Tuchscherr.)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19). SARS-CoV-2 relies on cellular RNA-binding proteins (RBPs) to replicate and spread, although which RBPs control its life cycle remains largely unknown. Here, we employ a multi-omic approach to identify systematically and comprehensively the cellular and viral RBPs that are involved in SARS-CoV-2 infection. We reveal that SARS-CoV-2 infection profoundly remodels the cellular RNA-bound proteome, which includes wide-ranging effects on RNA metabolic pathways, non-canonical RBPs, and antiviral factors. Moreover, we apply a new method to identify the proteins that directly interact with viral RNA, uncovering dozens of cellular RBPs and six viral proteins. Among them are several components of the tRNA ligase complex, which we show regulate SARS-CoV-2 infection. Furthermore, we discover that available drugs targeting host RBPs that interact with SARS-CoV-2 RNA inhibit infection. Collectively, our results uncover a new universe of host-virus interactions with potential for new antiviral therapies against COVID-19., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Large clinical trials testing hydrocortisone therapy in septic shock have produced conflicting results. Subgroups may benefit of hydrocortisone treatment depending on their individual immune response. We performed an exploratory analysis of the database from the international randomized controlled clinical trial Corticosteroid Therapy of Septic Shock (CORTICUS) employing machine learning to a panel of 137 variables collected from the Berlin subcohort comprising 83 patients including demographic and clinical measures, organ failure scores, leukocyte counts and levels of circulating cytokines. The identified theranostic marker was validated against data from a cohort of the Hellenic Sepsis Study Group (HSSG) ( n = 246), patients enrolled in the clinical trial of Sodium Selenite and Procalcitonin Guided Antimicrobial Therapy in Severe Sepsis (SISPCT, n = 118), and another, smaller clinical trial (Crossover study, n = 20). In addition, in vitro blood culture experiments and in vivo experiments in mouse models were performed to assess biological plausibility. A low serum IFNγ/IL10 ratio predicted increased survival in the hydrocortisone group whereas a high ratio predicted better survival in the placebo group. Using this marker for a decision rule, we applied it to three validation sets and observed the same trend. Experimental studies in vitro revealed that IFNγ/IL10 was negatively associated with the load of (heat inactivated) pathogens in spiked human blood and in septic mouse models. Accordingly, an in silico analysis of published IFNγ and IL10 values in bacteremic and non-bacteremic patients with the Systemic Inflammatory Response Syndrome supported this association between the ratio and pathogen burden. We propose IFNγ/IL10 as a molecular marker supporting the decision to administer hydrocortisone to patients in septic shock. Prospective clinical studies are necessary and standard operating procedures need to be implemented, particularly to define a generic threshold. If confirmed, IFNγ/IL10 may become a suitable theranostic marker for an urging clinical need., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 König, Kolte, Ahlers, Oswald, Krauss, Roell, Sommerfeld, Dimopoulos, Tsangaris, Antoniadou, Jaishankar, Bogatsch, Löffler, Rödel, Garcia-Moreno, Tuchscherr, Sprung, Singer, Brunkhorst, Oppert, Gerlach, Claus, Coldewey, Briegel, Giamarellos-Bourboulis, Keh and Bauer.)

RNA is a central molecule in RNA virus biology due to its dual function as messenger and genome. However, the small number of proteins encoded by viral genomes is insufficient to enable virus infection. Hence, viruses hijack cellular RNA-binding proteins (RBPs) to aid replication and spread. In this review we discuss the 'knowns' and 'unknowns' regarding the contribution of host RBPs to the formation of viral particles and the initial steps of infection in the newly infected cell. Through comparison of the virion proteomes of ten different human RNA viruses, we confirm that a pool of cellular RBPs are typically incorporated into viral particles. We describe here illustrative examples supporting the important functions of these RBPs in viral particle formation and infectivity and we propose that the role of host RBPs in these steps can be broader than previously anticipated. Understanding how cellular RBPs regulate virus infection can lead to the discovery of novel therapeutic targets against viruses., (Copyright © 2020. Published by Elsevier Ltd.)

Rapid cryopreservation of biological specimens is the gold standard for visualizing cellular structures in their true structural context. However, current commercial cryo-fluorescence microscopes are limited to low resolutions. To fill this gap, we have developed cryoSIM, a microscope for 3D super-resolution fluorescence cryo-imaging for correlation with cryo-electron microscopy or cryo-soft X-ray tomography. We provide the full instructions for replicating the instrument mostly from off-the-shelf components and accessible, user-friendly, open-source Python control software. Therefore, cryoSIM democratizes the ability to detect molecules using super-resolution fluorescence imaging of cryopreserved specimens for correlation with their cellular ultrastructure., Competing Interests: The authors declare no conflicts of interest., (Published by The Optical Society under the terms of the Creative Commons Attribution 4.0 License. Further distribution of this work must maintain attribution to the author(s) and the published article’s title, journal citation, and DOI.)

Staphylococcus aureus is a facultative pathogenic bacterium that colonizes the nasopharyngeal area of healthy individuals, but can also induce severe infection, such as pneumonia. Pneumonia caused by mono- or superinfected S. aureus leads to high mortality rates. To establish an infection, S. aureus disposes of a wide variety of virulence factors, which can vary between clinical isolates. Our study aimed to characterize pneumonia isolates for their virulent capacity. For this, we analyzed isolates from colonization, pneumonia due to S. aureus , and pneumonia due to S. aureus /influenza virus co-infection. A total of 70 strains were analyzed for their virulence genes and the host-pathogen interaction was analyzed through functional assays in cell culture systems. Strains from pneumonia due to S. aureus mono-infection showed enhanced invasion and cytotoxicity against professional phagocytes than colonizing and co-infecting strains. This corresponded to the high presence of cytotoxic components in pneumonia strains. By contrast, strains obtained from co-infection did not exhibit these virulence characteristics and resembled strains from colonization, although they caused the highest mortality rate in patients. Taken together, our results underline the requirement of invasion and toxins to cause pneumonia due to S. aureus mono-infection, whereas in co-infection even low-virulent strains can severely aggravate pneumonia.

The compendium of RNA-binding proteins (RBPs) has been greatly expanded by the development of RNA-interactome capture (RIC). However, it remained unknown if the complement of RBPs changes in response to environmental perturbations and whether these rearrangements are important. To answer these questions, we developed "comparative RIC" and applied it to cells challenged with an RNA virus called sindbis (SINV). Over 200 RBPs display differential interaction with RNA upon SINV infection. These alterations are mainly driven by the loss of cellular mRNAs and the emergence of viral RNA. RBPs stimulated by the infection redistribute to viral replication factories and regulate the capacity of the virus to infect. For example, ablation of XRN1 causes cells to be refractory to SINV, while GEMIN5 moonlights as a regulator of SINV gene expression. In summary, RNA availability controls RBP localization and function in SINV-infected cells., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

The crucial participation of cellular RNA-binding proteins (RBPs) in virtually all steps of virus infection has been known for decades. However, most of the studies characterizing this phenomenon have focused on well-established RBPs harboring classical RNA-binding domains (RBDs). Recent proteome-wide approaches have greatly expanded the census of RBPs, discovering hundreds of proteins that interact with RNA through unconventional RBDs. These domains include protein-protein interaction platforms, enzymatic cores, and intrinsically disordered regions. Here, we compared the experimentally determined census of RBPs to gene ontology terms and literature, finding that 472 proteins have previous links with viruses. We discuss what these proteins are and what their roles in infection might be. We also review some of the pioneering examples of unorthodox RBPs whose RNA-binding activity has been shown to be critical for virus infection. Finally, we highlight the potential of these proteins for host-based therapies against viruses. This article is categorized under: RNA Interactions with Proteins and Other Molecules > Protein-RNA Interactions: Functional Implications RNA in Disease and Development > RNA in Disease RNA Interactions with Proteins and Other Molecules > RNA-Protein Complexes., (© 2018 Wiley Periodicals, Inc.)

Sindbis virus (SINV) mRNAs contain several motifs that participate in the regulation of their translation. We have discovered a motif at the 3' untranslated region (UTR) of viral mRNAs, constituted by three repeated sequences, which is involved in the translation of both SINV genomic and subgenomic mRNAs in insect, but not in mammalian cells. These data illustrate for the first time that an element present at the 3'-UTR confers translatability to mRNAs from an animal virus in a cell-specific manner. Sequences located at the beginning of the 5'-UTR may also regulate SINV subgenomic mRNA translation in both cell lines in a context of infection. Moreover, a replicon derived from Sleeping disease virus, an alphavirus that have no known arthropod vector for transmission, is much more efficient in insect cells when the repeated sequences from SINV are inserted at its 3'-UTR, due to the enhanced translatability of its mRNAs. Thus, these findings provide a clue to understand, at the molecular level, the evolution of alphaviruses and their host range.

Microbial growth on medical and technical devices is a big health issue, particularly when microorganisms aggregate to form biofilms. Moreover, the occurrence of antibiotic-resistant bacteria in the clinical environment is dramatically growing, making treatment of bacterial infections very challenging. In search of an alternative, we studied a novel antimicrobial surface coating based on micro galvanic elements formed by silver and ruthenium with surface catalytic properties. The antimicrobial coating efficiently inhibited the growth of the nosocomial pathogens Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis and Enterococcus faecium as demonstrated by the growth inhibition on agar surface and in biofilms of antibiotic resistant clinical E. faecalis, E. faecium, and S. aureus isolates. It also strongly reduced the growth of Legionella in a drinking water pipeline and of Escherichia coli in urine. We postulate a mode of action of the antimicrobial material, which is independent of the release of silver ions. Thus, the novel antimicrobial coating could represent an alternative to combat microbial growth avoiding the toxic side effects of high levels of silver ions on eukaryotic cells., (Copyright © 2015. Published by Elsevier B.V.)

Translation initiation of alphavirus subgenomic mRNA (sgmRNA) can occur in the absence of several initiation factors (eIFs) in infected cells; however, the precise translation mechanism is still poorly understood. In this study, we have examined the mechanism of initiation and AUG selection in Sindbis virus (SINV) sgmRNA. Our present findings suggest that sgmRNA is translated via a scanning mechanism, since the presence of a hairpin structure before the initiation codon hampers protein synthesis directed by this mRNA. In addition, translation is partially recovered when an in-frame AUG codon is placed upstream of this hairpin. This scanning process takes place without the participation of eIF4A and active eIF2. These results, combined with our findings through modifying the SINV sgmRNA leader sequence, do not support the possibility of a direct initiation from the start codon without previous scanning, or a shunting mechanism. Moreover, studies carried out with sgmRNAs containing two alternative AUG codons within a good context for translation reveal differences in AUG selection which are dependent on the cellular context and the phosphorylation state of eIF2α. Thus, initiation at the additional AUG is strictly dependent on active eIF2, whereas the genuine AUG codon can start translation following eIF2α inactivation. Collectively, our results suggest that SINV sgmRNA is translated by a scanning mechanism without the potential participation of crucial eIFs. A model is presented that explains the mechanism of initiation of mRNAs bearing two alternative initiation codons., (© 2014 Garcia-Moreno et al.; Published by Cold Spring Harbor Laboratory Press for the RNA Society.)

We have examined the requirements for the initiation factors (eIFs) eIF4A and eIF2 to translate Sindbis virus (SV) subgenomic mRNA (sgmRNA) in the natural hosts of SV: vertebrate and arthropod cells. Notably, this viral mRNA does not utilize eIF4A in SV-infected mammalian cells. However, eIF4A is required to translate this mRNA in transfected cells. Therefore, SV sgmRNA exhibits a dual mechanism for translation with respect to the use of eIF4A. Interestingly, SV genomic mRNA requires eIF4A for translation during the early phase of infection. In sharp contrast to what is observed in mammalian cells, active eIF2 is necessary to translate SV sgmRNA in mosquito cells. However, eIF4A is not necessary for SV sgmRNA translation in this cell line. In the SV sgmRNA coding region, proximal to the initiation codon is a hairpin structure that confers eIF2 independence only in mammalian cells infected by SV. Strikingly, this structure does not provide independence for eIF4A neither in mammalian nor in mosquito cells. These findings provide the first evidence of different eIF requirements for translation of SV sgmRNA in vertebrate and invertebrate cells. These observations can help to understand the interaction of SV with its host cells., (© 2012 Blackwell Publishing Ltd.)