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Introduction Individuals with schizotypal personality disorder are characterized by tendencies to magical thinking, unusual perceptions, discomfort in social situations, and restricted affect. It is frecuent that they have social anxiety and have difficulty in understanding the motivations and thoughts of others. Objectives Presentation of a case of a patient who was first diagnosed with adjustment disorder, but on a closer study, was discovered to have a schizotypal personality disorder. Methods We conducted a bibliographic review by searching for articles about schizotypal personality disorder and theory of mind in Pubmed. Results We present the case of a 39-year-old woman, diagnosed with adjustment disorder after a conflict at work with a colleague that caused her anxiety-depressive symptoms. In consultations, the patient shows verbiage without expansiveness or euphoria, with rambling speech. She expresses feelings of indignation and injustice, she is irritable, with contained anger. She refers that she prefers to be distrustful of others because she does not understand their intentions. Her thoughts are very rigid, which leads her to have avoidant and phobic attitudes, having no relationships of friendship throughout her life. A neuropsychological evaluation is carried out, resulting in a surprising WAIS with a TIC of 128. However, the Mayer‐Salovey‐Caruso Emotional Intelligence Test (MSCEIT) shows difficulties in Perception, Comprehension and Emotional Management Considering the patient’s symptomatology as a whole, it is noteworthy: – Sustained social isolation throughout their life history – Superficiality of interpersonal relationships – Distrust and slight self-referentiality. Deficit in inferring the feelings and thoughts of others – Peculiar speech with ideas of magical content, superstitions and rituals… Which together supported a diagnosis of schizotypal personality disorder and generalized anxiety disorder. From this point we started to work on her self-esteem, modification of irrational beliefs and cognitive distortions, interpersonal communication and metacognitive therapy, with good results. Conclusions The type of schizotypal patients who come to consultations most frequently are the actively isolated/timorous profile due to their intense social anxiety and difficulties in understanding and adapting to the social world around them. Initial therapy should be empathic support. The theory of mind is the ability to infer the other’s mental states and therefore predict their behavior, this ability being diminished in the schizotypal patient. Mentalization tasks, metacognitive therapy, cognitive flexibility training, social skills training, and promoting self-worth are useful. On some occasions it may be necessary to start psychopharmacological treatment to control anxiety and unusual perceptions when they cause discomfort. Disclosure of Interest None Declared

Introduction Clozapine is an atypical antipsychotic synthesised in 1958. It was withdrawn from the market in the 1970s due to the appearance of agranulocytosis, but was reintroduced due to strong evidence of its efficacy and superiority over other antipsychotics in treatment-resistant schizophrenia. Objectives To describe the adequate response to clozapine in treatment-refractory psychosis. Methods Review of the scientific literature based on a relevant clinical case. Results A 16-year-old woman was admitted to a psychiatric inpatient unit for psychotic symptoms and behavioural disorders. She lives with her father and older sister; she has not been in contact with her mother, who lives in another country, for several years. She attends secondary school, with poor academic performance. Maternal diagnosis of schizophrenia. She started using cannabis two years ago, with a progressive increase up to 20 grams per week. He reports the onset of a feeling of strangeness a year ago, with progressive isolation in his room, referring to delirious ideation of harm towards classmates and people from his town, self-referentiality and delirious interpretations of religious mystical content (“God speaks to me through a dove”). He comments on the phenomenon of theft and thought-reading. Soliloquies and unmotivated laughter are observed. Conclusions Treatment was started with risperidone, progressively increasing the dose up to optimisation, without achieving a decrease in positive symptoms, but with the appearance of excessive sedation and sialorrhoea. It was combined with aripiprazole up to 20mg, maintained for a couple of weeks, without significant clinical improvement. Given the failure of two lines of therapy, it was decided to change to clozapine up to a dose of 75mg, with adequate tolerance and response, achieving a distancing of the delirious ideation. Regular haematological controls were performed, with no alterations in haemogram or troponins. Disclosure of Interest None Declared

Introduction A 28 year old patient will be presented. This paramilitary man was brought to the Emergency Room due to an autolytic attempt with Benzodiazepines, along with a mouth suture, in the context of a soon to be resolved problematic ankle osteosynthesis procedure. The patient claimed to be suffering pain, furthermore struggling due to the fact he could not be working due to his ankle issue. Language barrier was a problem during the interview. Objectives The objetives of this case is to try to explain the issues that may arise in patients with personality disorders in the context of an autolytic attempt Methods This patient will be presented, along with systematic bibliography review of the topic. Results The following results were extracted upon the attention given to this patient which was admitted to the Psychiatric Unit. First of all, the mouth stitches were removed, along with a petition for toxicological analysis. The results gave positive for cannabis and benzodiazepines. The patient was also brought previously this year with another autolytic attempt, this time on cocaine consumption too. Furthermore, a thorough review was made of the other autolytic attempts, including those which happened in his country of origin. The patient has hundreds of small cuts among his arms, from previews cuts made in the past. Furthermore, subcutaneous wounds were auto inflicted in the ER, with a small blade. Among the whole interview, it was clear he had a personality disorder, with high impulsivity levels and lack of control once the situation overflows. We also tried to understand the outcome of suturing his mouth. The patient referred his acts of impulsiveness due to his overwhelming situation of both having no job at this moment and the pain he was suffering due to his ankle procedure. The patient was admitted to our Unit due to the high risk he could repeat this act. Upon arrival, the same day he was admitted, the patient asked if he had to stay at the unit. When explaining the following already told event, furthermore insisting in the possibility of been evaluated by the Traumatology team, he proceeded to try and hang himself with his medical-hospital clothing. The patient was treated with antipsychotics. Along with Lormetazepam at night. At the end of the hospitalization, and after been evaluated by the Psychiatrist of this Unit, the patient was also treated with Lithium due to its effectiveness in the treatment of autolytic attempts. Conclusions Personality disorders are one of the psychiatric pathologies that prevail with greater frequency in autolytic attempts 1. Additionally, it should be taken into account the possible ongoing consumption of psychoactive drugs that could also derive in psychopathological decompensation. On top of the following, the use of antipsychotic treatment is indicated for the managing of conduction altercations 2, besides Lithium being a great option in managing suicidal temptations 3. Disclosure of Interest None Declared

Introduction It is widely described in the scientific literature that patients who suffer from some type of congenital syndrome such as Di George Syndrome are more likely to present some type of psychopathological alteration during their development that may require intervention and treatment by infant and juvenile mental health teams in coordination with neuropediatrics (1). On this occasion, we will present the clinical case of a patient who regularly attends psychiatry consultations for management of anxious symptoms with impulse control deficits associated with intellectual disability, diagnosed since childhood with tetralogy of Fallot and later with Di George syndrome. In this type of case, treatment is usually considered taking into account possible comorbidities at the organic level (since there may be cardiological involvement, which can be an added difficulty when taking into account the adverse effects of some psychotropic drugs) (2). Objectives This is followed by the presentation of the clinical case, which can serve to exemplify this type of case and clarify any doubts that may arise regarding treatment. Methods Presentation of the clinical case and review of updated scientific literature on the subject. Results Patient who first came to the infantile-junior consultations at the age of 8 years due to delay in the acquisition of verbal language and impulsivity. The patient had a history of pediatric follow-up since birth for different physical symptoms that finally led to the diagnosis of Di George syndrome. Given the difficulties he presented both at home and at school, different psychometric tests were performed and it was determined that it could be beneficial to initiate treatment with extended-release methylphenidate. Prior to treatment, psychomotor restlessness (without aggressiveness) and difficulty in concentration prevailed, which improved significantly after upward adjustment of the dose to a guideline corresponding to his age and weight. It was not necessary in this case to administer other treatments (the possibility of starting Aripiprazole in case of episodes of agitation was considered, but it was not necessary). The patient has continued to be monitored by cardiology to assess the possible side effects of the treatment (since it can increase heart rate and blood pressure (3), but so far no complications have been detected). Thanks to psychotherapeutic and educational intervention, language acquisition was achieved, although to date he still requires support due to the difficulties he still presents. Conclusions It is important to take into account the possible side effects of psychopharmacological treatment in patients with an associated congenital syndrome. Intensive and comprehensive follow-up by psychiatry and pediatrics (and later by their primary care physician) should be performed. Disclosure of Interest None Declared

Introduction Lithium was the first mood stabilizer and today continues to be a first-line treatment in the treatment of bipolar disorder despite its adverse effects, which make it important to monitor blood levels and control kidney function. Objectives Presentation of a case of litium withdrawal and relapse in bipolar disorder. Literature review relating to the risk of relapse when lithium treatment is interrupted. Methods We present a clinical case of a patient who suffers a deterioration in renal function that requires the withdrawal of lithium and who consequently suffers a relapse. We conducted a bibliographic research of articles in Pubmed on this topic. Results A 49-year-old male, with a history of multiple admissions to UHB since the age of 18 with a diagnosis of bipolar disorder and treatment with lithium. Decompensations towards the manic pole have always been related to interruptions in lithium treatment. On several occasions when the patient was feeling well emotionally, he believed himself to be “cured” and abandoned the treatment, triggering a manic episode, showing verbal aggression, increased self-esteem and delusional ideation of harm. Remission was usually achieved with the reintroduction of lithium and the addition of high-dose quetiapine. Between episodes, constant overvalued ideas of economic scarcity seemed to persist, which were accentuated in the form of delusional ideas of ruin in depressive decompensations. After 7 years of stability, control analysis showed blood litemia of 2.2 mEq/L with deterioration of kidney function and generalized tremor was observed, without improvement after serum therapy. He was admitted for dialysis and lithium was suspended. Treatment with valproate was started and a consultation scheduled in a week to adjust the dose. The patient did not attend that consultation and was admitted three days later to Psychiatry Hospitalization showing a challenging attitude, evident dysphoric mood, accelerated speech, with derailments and echolalia. Delusional ideation of harm with auditory hallucinations. Insomnia and hyporexia. Chronic renal failure persisted. Conclusions Lithium is a very effective drug but with a narrow therapeutic range that requires adequate monitoring due to the possible consequences of its use at different organs and systems of the body. when lithium is found in the blood at toxic levels with deterioration of kidney function and glomerular filtration fails to recover, lithium treatment should be suspended. Sudden withdrawal of lithium significantly increases the risk of relapse due to rebound effect. More than 50% of patients experience a recurrence within 10 weeks of withdrawal. Disclosure of Interest None Declared

Introduction Conversive disorder is characterised by the presence of one or more involuntary neurological symptoms that are not due to a clear medical pathology. On the other hand, consciously simulated illnesses fall into two diagnostic categories: factitious disorders and malingering, which are differentiated by both the motivation for the behaviour and the awareness of that motivation. Factitious disorder behaviours are motivated by an unconscious need to assume the sick role, whereas malingering behaviours are consciously driven to achieve external secondary gains. Objectives Study of the differences between conversion disorder and factitious disorder and their repercussions from a case of difficult diagnosis. Methods Bibliographic review of scientific literature based on a relevant clinical case. Results We present the case of a 14-year-old male patient. Adoptive parents. Studying in high school. Social difficulties since childhood. He comes to the emergency department on several occasions referring stereotyped movements and motor tics in the four extremities with left cervical lateralization. Increase of these symptoms in the last month, so it was decided to admit him to the pediatric hospital. After observation and study of the patient’s movements with normal complementary tests he should return home. The following day he returned to the emergency department after an episode of dizziness, mutism and emotional block. It was decided to admit him to Psychiatry for behavioral observation and differential diagnosis. Conclusions In the assessment of patients it is essential to make an appropriate diagnosis taking into account the patient’s symptomatology and the patient’s background and life context. Conversion disorder is the unintentional production of neurological symptom, whereas malingering and factitious disorder represent the voluntary production of symptoms with internal or external incentives. They have a close history and this has been frequently confounded. Practitioners are often confronted to medically unexplained symptoms; they represent almost 30% of neurologist’s consultation. The first challenge is to detect them, and recent studies have confirmed the importance of “positive” clinical bedside signs based on incoherence and discordance. Multidisciplinary therapy is recommended with behavioral cognitive therapy, antidepressant to treat frequent comorbid anxiety or depression, and physiotherapy. Factitious disorder and malingering should be clearly delineated from conversion disorder. Factitious disorder should be considered as a mental illness and more research on its physiopathology and treatment is needed, when malingering is a non-medical condition encountered in medico-legal cases. Disclosure of Interest None Declared

Introduction Schizotypal personality is a condition suffered by 4% of the population. It is defined by presenting interpersonal, behavioral and perceptual features similar to the clinical features of psychotic disorders, such as schizophrenia, in less intensity and dysfunctionality, but at risk of reaching psychosis. Objectives Presentation of a clinical case about a patient with premorbid schizotypal personality traits presenting with an acute psychotic episode. Methods Literature review on association between schizotypal personality and psychosis. Results A 57-year-old woman with a history of adaptive disorder due to work problems 13 years ago, currently without psychopharmacological treatment, goes to the emergency room brought by the emergency services due to behavioral alteration. She reports that “her husband and son wanted to sexually abuse her”, so she had to run away from home and has been running through the streets of the town without clothes and barefoot. Her husband relates attitude alterations and extravagant behaviors of years of evolution, such as going on diets of eating only bread for 40 days or talking about exoteric and religious subjects, as believing that the devil got inside her husband through a dental implant. He reports that these behaviors have been accentuated during the last month. She has also created a tarot website, and has even had discussions with several users. She is increasingly suspicious of him, has stopped talking to him and stays in his room all day long, with unmotivated laughter and soliloquies. It was decided to admit him to Psychiatry and risperidone 4 mg was started. At the beginning, she was suspicious and reticent in the interview. As the days went by, communication improved, she showed a relaxed gesture and distanced herself from the delirious ideation, criticizing the episode. Conclusions In recent years, there has been increasing interest in understanding the association between schizotypy and serious mental disorder. Several theories understand schizotypy as a natural continuum of personality that reveals genetic vulnerability and that can lead to psychotic disorder when added to precipitating factors. Other theories define schizotypy as a “latent schizophrenia” where symptoms are contained and expressed in less intensity. Around 20% evolves to paranoid schizophrenia or other serious mental disorders. It is complex to distinguish between those individuals in whom schizotypy is a prodrome and those in whom it is a stable personality trait. To date, studies applying early psychotherapeutic or pharmacological interventions have had insufficient and contradictory results, and the follow-up and treatment of these individuals could be a stress factor and a stigma. Some studies are looking for reliable markers of evolution to schizophrenia in order to establish adequate protocols for detention, follow-up and treatment. Disclosure of Interest None Declared

Introduction Pregnancy and puerperium are two critical stages for women’s mental health due to the biological stress of pregnancy itself, as well as the emotional stress that surrounds this vital moment. (1) Debut and aggravation of psychiatric symptoms may occur, as well as relapse in women previously diagnosed with Severe Mental Disorder (SMD). Symptoms of the anxious spectrum are the most frequent within the perinatal mental pathology, being impulse phobias an entity that appears in about 25% of women previously diagnosed with OCD and up to 10-15% of women without previous psychopathology (2) Objectives Exposing the importance of Perinatal Mental Health from the presentation of a clinical case. Methods Review of the literature available in PubMed. Presentation of the pathobiography and evolution of the patient. Results Our case is about a 37-year-old woman, 30 weeks pregnant with her first child and history of having required admission to Psychiatry with subsequent follow-up in Mental Health for anxious-depressive symptoms with the presence of self-injurious ideas who, after two weeks with multiple life stressors, came to the Emergency Department for the presence of impulse phobias focused on pregnancy with significant internal anguish and ideas of death as a resolution to it, which is why it was decided to hospitalize her. During admission, and taking into account the patient’s gestational state, treatment was started with diluted Mirtazapine and Aripiprazole solution at minimal doses, which in this case were sufficient for symptom control. The latest guidelines addressing psychopharmacology during pregnancy and lactation point to sertraline among the antidepressants and Lorazepam among the benzodiazepines as the safest drugs during pregnancy (3). Conclusions - The exacerbation of anxious symptomatology and the presence of gestation-focused impulse phobias are frequent during pregnancy and their intensity increases as the time of delivery approaches. - Sertraline, Lorazepam, Mirtazapine and Aripiprazole are safe drugs during pregnancy. - In these women, a close and multidisciplinary follow-up by Psychiatry and Gynecology is advisable. Disclosure of Interest None Declared

Introduction Delusional parasitosis, also known as delusional infestation or Ekbom’s syndrome, is a rare psychotic disorder characterized by the false belief that a parasitic skin infestation exists, despite the absence of any medical evidence to support this claim. These patients often see many physicians, so a multidisciplinary approach among clinicians is important. Many patients refuse any treatment due to their firm belief that they suffer from an infestation, not a psychiatric condition, so it is crucial to gain the trust of these patients. Objectives The comprehensive review of this clinical case aims to investigate Ekbom syndrome, from a historical, clinical and therapeutic perspective. Methods Literature review based on delusional parasitosis. Results A 65-year-old woman comes to the psychiatry consultation referred by her primary care physician concerned about being infested by insects that she perceives through scales on her skin for the last three months. She recognizes important impact on her functionality. She is also convinced that her family is being infected too. As psychiatric history she recognizes alcohol abuse in the past (no current consumption) and an episode of persecutory characteristics with a neighbor, more than ten years ago. On psychopathological examination, she shows delusional ideation of parasitosis, with high behavioral repercussions, cenesthetic and cotariform hallucinations, as well as feelings of helplessness and anger. Treatment with Pimozide was started and the patient was referred to dermatology for evaluation, a plan she accepted. Her primary care physician and dermatology specialist were informed about the case and the treatment plan. In the recent reviews, the patient is calmer, however, despite the corroboration of dermatology and in the absence of organic lesions in cranial CT, she is still unsatisfied with the results, remaining firm in her conviction of infestation. It was decided to start treatment with atypical neuroleptics (Aripiprazole), with progressive recovery of her previous functionality. Conclusions Despite the increase in the number of studies in recent years, there are still few studies on this type of delirium. The female:male ratio varies in the bibiliography (between 2:1 and 3:1). The onset is usually insidious, generally appearing as a patient who comes to his primary care physician convinced of having parasites in different skin locations. It is usual to observe scratching lesions or even wounds in search of the parasite. In the past, the most used and studied treatment was Pimozide. Currently the treatment of choice is atypical neuroleptics due to their lower side effects. The latest reviews on the prognosis of this disorder show data with percentages of complete recovery between 51% and 70%, and partial responses between 16.5% and 20%. Finally, for a good diagnosis and therapeutic management, it is important to achieve a multidisciplinary approach. Disclosure of Interest None Declared

Resume: Introducción: Las ataxias (AT) y paraparesias espásticas hereditarias (PEH) son síndromes neurodegenerativos raros. Nos proponemos conocer la prevalencia de las AT y PEH en España en 2019. Pacientes y métodos: Estudio transversal, multicéntrico, descriptivo y retrospectivo de los pacientes con AT y PEH, desde marzo de 2018 a diciembre de 2019 en toda España. Resultados: Se obtuvo información de 1933 pacientes procedentes de 11 Comunidades Autónomas, de 47 neurólogos o genetistas. Edad media: 53,64 años ± 20,51 desviación estándar (DE); 938 varones (48,5%), 995 mujeres (51,5%). En 920 pacientes (47,6%) no se conoce el defecto genético. Por patologías, 1.371 pacientes (70,9%) diagnosticados de AT, 562 diagnosticados de PEH (29,1%). La prevalencia estimada de AT es 5,48/100.000 habitantes, y la de PEH es 2,24 casos/100.000 habitantes. La AT dominante más frecuente es la SCA3. La AT recesiva más frecuente es la ataxia de Friedreich (FRDA). La PEH dominante más frecuente es la SPG4, y la PEH recesiva más frecuente es la SPG7. Conclusiones: La prevalencia estimada de AT y PEH en nuestra serie es de 7,73 casos/100.000 habitantes. Estas frecuencias son similares a las del resto del mundo. En el 47,6% no se ha conseguido un diagnóstico genético. A pesar de las limitaciones, este estudio puede contribuir a estimar los recursos, visibilizar estas enfermedades, detectar las mutaciones más frecuentes para hacer los screenings por comunidades, y favorecer los ensayos clínicos. Abstract: Introduction: Ataxia and hereditary spastic paraplegia are rare neurodegenerative syndromes. We aimed to determine the prevalence of these disorders in Spain in 2019. Patients and methods: We conducted a cross-sectional, multicentre, retrospective, descriptive study of patients with ataxia and hereditary spastic paraplegia in Spain between March 2018 and December 2019. Results: We gathered data from a total of 1933 patients from 11 autonomous communities, provided by 47 neurologists or geneticists. Mean (SD) age in our sample was 53.64 (20.51) years; 938 patients were men (48.5%) and 995 were women (51.5%). The genetic defect was unidentified in 920 patients (47.6%). A total of 1371 patients (70.9%) had ataxia and 562 (29.1%) had hereditary spastic paraplegia. Prevalence rates for ataxia and hereditary spastic paraplegia were estimated at 5.48 and 2.24 cases per 100 000 population, respectively. The most frequent type of dominant ataxia in our sample was SCA3, and the most frequent recessive ataxia was Friedreich ataxia. The most frequent type of dominant hereditary spastic paraplegia in our sample was SPG4, and the most frequent recessive type was SPG7. Conclusions: In our sample, the estimated prevalence of ataxia and hereditary spastic paraplegia was 7.73 cases per 100 000 population. This rate is similar to those reported for other countries. Genetic diagnosis was not available in 47.6% of cases. Despite these limitations, our study provides useful data for estimating the necessary healthcare resources for these patients, raising awareness of these diseases, determining the most frequent causal mutations for local screening programmes, and promoting the development of clinical trials.

Introduction: Ataxia and hereditary spastic paraplegia are rare neurodegenerative syndromes. We aimed to determine the prevalence of these disorders in Spain in 2019. Patients and methods: We conducted a cross-sectional, multicentre, retrospective, descriptive study of patients with ataxia and hereditary spastic paraplegia in Spain between March 2018 and December 2019. Results: We gathered data from a total of 1933 patients from 11 autonomous communities, provided by 47 neurologists or geneticists. Mean (SD) age in our sample was 53.64 (20.51) years; 938 patients were men (48.5%) and 995 were women (51.5%). The genetic defect was unidentified in 920 patients (47.6%). A total of 1371 patients (70.9%) had ataxia and 562 (29.1%) had hereditary spastic paraplegia. Prevalence rates for ataxia and hereditary spastic paraplegia were estimated at 5.48 and 2.24 cases per 100 000 population, respectively. The most frequent type of dominant ataxia in our sample was SCA3, and the most frequent recessive ataxia was Friedreich ataxia. The most frequent type of dominant hereditary spastic paraplegia in our sample was SPG4, and the most frequent recessive type was SPG7. Conclusions: In our sample, the estimated prevalence of ataxia and hereditary spastic paraplegia was 7.73 cases per 100 000 population. This rate is similar to those reported for other countries. Genetic diagnosis was not available in 47.6% of cases. Despite these limitations, our study provides useful data for estimating the necessary healthcare resources for these patients, raising awareness of these diseases, determining the most frequent causal mutations for local screening programmes, and promoting the development of clinical trials. Resumen: Introducción: Las ataxias (AT) y paraparesias espásticas hereditarias (PEH) son síndromes neurodegenerativos raros. Nos proponemos conocer la prevalencia de las AT y PEH (APEH) en España en 2019. Pacientes y métodos: Estudio transversal, multicéntrico, descriptivo y retrospectivo de los pacientes con AT y PEH, desde Marzo de 2018 a Diciembre de 2019 en toda España. Resultados: Se obtuvo información de 1.933 pacientes procedentes de 11 Comunidades Autónomas, de 47 neurólogos o genetistas. Edad media: 53,64 años ± 20,51 desviación estándar (DE); 938 varones (48,5%), 995 mujeres (51,1%). En 920 pacientes (47,6%) no se conoce el defecto genético. Por patologías, 1.371 pacientes (70,9%) diagnosticados de AT, 562 diagnosticados de PEH (29,1%). La prevalencia estimada de AT es 5,48/100.000 habitantes, y la de PEH es 2,24 casos/100.000 habitantes. La AT dominante más frecuente es la SCA3. La AT recesiva más frecuente es la ataxia de Friedreich (FRDA). La PEH dominante más frecuente es la SPG4, y la PEH recesiva más frecuente es la SPG7. Conclusiones: La prevalencia estimada de APEH en nuestra serie es de 7,73 casos/100.000 habitantes. Estas frecuencias son similares a las del resto del mundo. En el 47,6% no se ha conseguido un diagnóstico genético. A pesar de las limitaciones, este estudio puede contribuir a estimar los recursos, visibilizar estas enfermedades, detectar las mutaciones más frecuentes para hacer los screenings por comunidades, y favorecer los ensayos clínicos.

ABSTRACTBinary sulfides were deposited by sequential thermal evaporation with the stacking order glass/CuS/SnS/ZnS and subsequently subjected to a sulfurization-crystallization process, considering two thermal treatment time intervals, 5 and 20 min. The objective of implementing different annealing durations was to identify the best conditions to form CZTS films in the pure kesterite phase. After being subjected to the annealing, the films show structural characteristics of the kesterite phase. However, XRD data showed that prolonged annealing causes degradation of the kesterite phase, leading to the formation of traces of CuS and Cu5Sn2S7. The films annealed for shorter duration, in this case 5 min, present a denser and more uniform surface morphology, better degree of preferential orientation, small Urbach energy of 0.302 eV, and higher photosensitivity. The band gap of the films was 1.46 eV and 1.53 eV for annealing durations 5 and 20 min, respectively.

Introduction Previous studies suggest that adults with mental disorders (MD) or Autism Spectrum Disorder (ASD) are more likely to be unemployed than those without MD. However, it is unclear whether working adults with MD or ASD perceive the same effort-reward balance as their counterparts without MD or ASD. Objectives To analyze labor conditions and to identify factors associated with effort-reward imbalance among young adults with ASD, MD and those from the general population (GP). Methods A qualitative and quantitative study design is being conducted to analyze the rates of employment among young adults with ASD, and to identify factors associated with employment rates (Fondecyt ID11201028.). As part of this study, we conducted a quantitative analysis in young adults 16 to 30 years of age in two regions of Chile between August and October, 2022. Young adults with MD and ASD were compared with adults of similar age recruited from the GP. We applied a questionnaire to collect data on participant’s sociodemographic information, autonomy level and employment status. We applied the short Spanish version of the effort–reward imbalance (ERI) and overcommitment (OC) questionnaire, which has been widely used in Latin American countries. Chi-square test was used and the Kruskal Wallis H Test was applied to compare among groups. The statistical significance was set at P

In this theoretical–experimental study is presented a hybridization strategy based on the application of an inverse artificial neural network model (ANNi) coupled with metaheuristic optimization algorithms to optimize the drying velocity (vd) of an active indirect solar dryer for plantain and taro (Colocasia antiquorum). In the experimental stage, both fruits were evaluated in periods from 9:00 a.m. to 5:00 p.m. under a humid tropical climate region, varying the voltage of the air extractor fan (at 6 V, 9 V, and 12 V) to control the fan velocity. The experimental results showed that the maximum drying velocities were reached at 9 V, achieving a drying velocity of 1.5, 0.9, and 0.55 g/min, with a total drying time of 465 min for the taro, and 1.46, 1.46, and 0.36 g/min, with a total drying time of 495 min, for the plantain. As a result of the drying curves, it was observed that the drying velocity is higher in taro than in plantain. Subsequently, an artificial neural network (ANN) architecture was trained using the database generated from the solar dryer’s experimental stage. Six environmental variables and one operational variable were considered as the model’s inputs, feeding the ANN to estimate the drying velocity (vd), obtaining a linear regression coefficient R = 0.9822 between the experimental and simulated data. A sensitivity analysis was performed to determine the impact of all the input variables. A hybrid strategy based on ANNi was developed and evaluated with three metaheuristic optimization algorithms; the best result was obtained by genetic algorithms (ANNi-GA) with an error percentage of 0.83% and an average computational time of 4.3 s. The scope of this optimization strategy was to obtain a theoretical result that allows predicting the behavior of the dryer and improving its performance for its practical application in future work through the implementation in development boards. Lastly, the optimization strategy presented is not limited to indirect solar dryers and opens a research window for evaluating other solar drying technologies.

ABSTRACT Blastocystis is the most prevalent protist of the human intestine, colonizing approximately 20% of the North American population and up to 100% in some nonindustrialized settings. Blastocystis is associated with gastrointestinal and systemic disease but can also be an asymptomatic colonizer in large populations. While recent findings in humans have shown bacterial microbiota changes associated with this protist, it is unknown whether these occur due to the presence of Blastocystis or as a result of inflammation. To explore this, we evaluated the fecal bacterial and eukaryotic microbiota in 156 asymptomatic adult subjects from a rural population in Xoxocotla, Mexico. Colonization with Blastocystis was strongly associated with an increase in bacterial alpha diversity and broad changes in beta diversity and with more discrete changes to the microbial eukaryome. More than 230 operational taxonomic units (OTUs), including those of dominant species Prevotella copri and Ruminococcus bromii, were differentially abundant in Blastocystis-colonized individuals. Large functional changes accompanied these observations, with differential abundances of 202 (out of 266) predicted metabolic pathways (PICRUSt), as well as lower fecal concentrations of acetate, butyrate, and propionate in colonized individuals. Fecal calprotectin was markedly decreased in association with Blastocystis colonization, suggesting that this ecological shift induces subclinical immune consequences to the asymptomatic host. This work is the first to show a direct association between the presence of Blastocystis and shifts in the gut bacterial and eukaryotic microbiome in the absence of gastrointestinal disease or inflammation. These results prompt further investigation of the role Blastocystis and other eukaryotes play within the human microbiome. IMPORTANCE Given the results of our study and other reports of the effects of the most common human gut protist on the diversity and composition of the bacterial microbiome, Blastocystis and, possibly, other gut protists should be studied as ecosystem engineers that drive community diversity and composition.

The aim of this paper is to consider one of the most traffic-loaded regions of Astana city(Kazakhstan) and to determine the concentration of carbon-monoxide (CO) in the airduring the peak hours. CFD analysis based on the SolidWorks-EFD platform was used tosimulate the dispersion of contaminants given the estimated emission rates and weatherconditions at the crossroad of Bogenbay Batyr and Zhenis Avenues in Astana.Turbulence prediction was based on k-ε model with wall functions. The governingequations were discretized using the finite volume method and a 2nd order spatialscheme. The mesh verification was based on 1% convergence criterion for a 50% ofmesh density increment; air pressure near the wall of a selected building was chosen asthe parameter to control the convergence. Numerical results are presented for prevailingconditions during all 4 seasons of the year, demonstrating that the highest levels of COare recorded in summer and reach the values up to 11.2 ppm which are still lower thanthe maximum level admitted for humans. Nevertheless, obtained results show thatAstana is gradually becoming a city that is likely to reach the critical levels of pollutantsin the nearest future if control measures are not taken with enough anticipation. As for afuture work, it is proposed to perform in-situ validation of specific scenarios to checkand support the results obtained with CFD and to develop then specific policies fortackling the problem before it becomes evident.

This paper aims to develop appropriate boundary conditions to be used in the numerical analysis (CFD) of smoke transport within a semi-enclosed space resembling a typical road tunnel. The study considers the following stages: (a) Model set up: the geometry of an existing tunnel, with available experimental data to validate numerical results, is recreated in 3D CAD model with physical properties and known boundary conditions; (b) Mesh verification: different aspects and techniques of mesh generation, such as local and global refinement and first/second-order discretization schemes were considered for the mesh sensitivity analysis. The aim of this stage is to demonstrate that numerical results are mesh-independent, i.e. use as large as possible element sizes to reduce the computational cost, yet refine grid in crucial locations to record important features of transport and thermal phenomena; (c) Model validation: This stage considers the inaccuracies associated to turbulence models, intensity of turbulence at inlet boundaries, buoyancy, turbulent diffusion and convection on the numerical results of the study. Different combinations of numerical aspects of the study were tested. Results of these combinations were compared with experimental data and the most accurate combination of variables was taken as benchmark. Obtained numerical model serves as a guideline tool capable of reproducing propagation of smoke in semi-enclosed spaces within minimal uncertainty than can be used in further studies as a predicting tool for engineering purposes.

The effect of a surfactant on wettability alteration and emulsion inversion is studied using Dissipative Particle Dynamics (DPD) modeling. The DPD model contains 1200 oil molecules, 4800 water molecules, 400 oil soluble (indigenous to the oil) surfactants with a head-tail configuration and 400 water soluble molecules to mimic a surface active chemical/ion in the water. Results show that surfactant migrates to the fluid-fluid interface in general, where its potential energy is minimal. However, thermal kinetic energy can lead to a “tunneling” through the interface and into the other phase with a small probability. The same effect lead to migration of the oil soluble surfactant from the oil phase onto the water wet surface, and caused wetting alternation from a water-wet to a surfactant coated effectively oil-wetting surface. The water soluble surface active molecule suppressed this effect when added. Additional emulsion inversion studies confirmed the “Bancroft rule”: oil-in-water emulsions were induced by water soluble surfactant, and water-in-oil emulsions were induced for oil soluble surfactant. The explored cases were characterized by high interfacial curvature. For cases in which the surfactant is just as soluble in water as in oil, the interface had a minimal curvature; i.e., a flat interface or a more geometrically complex gyroid interface with a minimal average curvature. Results demonstrate that DPD represents a suitable numerical laboratory to investigate the macroscopic behavior (topology and morphology) of an oil/water/surface system as function of the molecular parameters such as solubility.

This paper presents a study of the motion of a deformable droplet modeled using Shan-Chen (SC) Multiphase Lattice Boltzmann Model (LBM). Firstly, a 2D static droplet in a periodic domain is modeled such that its surface tension is numerically determined and successfully validated against Young-Laplace equation. Next, simulation of a 2D droplet transported by a gas stream along a periodic microchannel is carried out. Initially, the droplet is placed close to the top wall and surrounded by a gas stream which is originally flowing in fully developed condition, as described by the classical plane Poiseuille flow. Both the droplet and the carrier fluid have same kinematic viscosities but different densities. The simulation is extended until pseudo-steady state, determined by a constant vertical position and normalized velocity, is reached. The results of this study are successfully validated using available data from previous highly-accurate numerical work. The LBM demonstrated a number of major advantages such as easiness to set up, ability to track the phase interface automatically and its inherent parallel capacity which helped reducing the computational time. However, numerical results obtained with the SC-LBM, which is presented in this study, demonstrate that the LBM also has limitations in handling large density and viscosity ratios between the phases.

Liquid-solid flows, in both heterogeneous and saltation regimes, are critical in the transport of suspended solid particles in pipelines prone to particles settling and accumulating on the bottom of the pipe, eventually blocking the flow and risking flow assurance. Numerical simulation of a statistically developed and steady two- phase liquid-solid flow in a horizontal pipe is performed by solving Reynolds-Averaged Navier-Stokes (RANS) equations within an Eulerian-Eulerian framework to predict the complex interaction among particles and between particles and their transporting fluid and surrounding walls. Particles are treated as a secondary fluid phase with viscosity determined using the Granular Kinetic Theory (GKT), including its three potential contributions, i.e., frictional, collisional and kinetic interactions. A case study for a horizontal pipe flow with mono-disperse and bi-disperse liquid-particle mixtures, at different flow velocities and particle-bulk concentration, is presented. Particles concentration for statistically steady heterogeneous and saltation regimes without a fixed bed are presented. Governing equations for each phase are solved numerically using ANSYS-Fluent platform which is based on the finite volume method to integrate the equations about each control volume and turning the problem into a system of algebraic equations. A second-order spatial discretization is implemented across the model. Bulk concentrations of solid particles in water were considered in percentage of 10% and 20%. Solid particles of 0.125mm and 0.440mm in diameter were used in the study, while bulk velocities of 1m/s, 2m/s and 3m/s were prescribed.

The present study aimed to determine whether certain correction factors used in the in-place prediction of compressive strength with concrete cores are directly applicable to self-consolidating concretes (SCCs). The parameters considered were core diameter, casting direction, core moisture, a number of variables intrinsic to cores, and concrete strength. Factors were also established for converting SCC 15 3 15-cm cubic specimen strength into 30 315-cm cylindrical specimen strength. The findings show that the correction factors recommended in EHE-08 and ACI 214.4R-10 overestimate the in-place compressive strength of the SCC analysed. The factors found for converting cubic into cylindrical specimen strength, in turn, were observed to differ from the values set out in the 2010 Model Code, but to be similar to the EHE-08 code proposals.

We evaluated the effect of cadmium (Cd) on the structure and function of the head kidney in the freshwater fish Colossoma macropomum (C. macropomum). Juveniles were exposed to 0.1 mg/L CdCl2 for 31 days. Blood samples were examined using hematological tests and head kidney histology was determined by light microscopy. The concentration of Cd in the head and trunk kidneys was measured using an atomic absorption spectrophotometer. Cd produced histopathological changes in the head kidney, the most evident of these being: the thickening of the vein wall, an increase in the number of basophils/mast cells close to blood vessels and a severe depletion of hematopoietic precursors especially the granulopoietic series. In the blood, a decrease in the total leucocytes and hemoglobin concentration was observed. Cd-exposed fish showed higher Cd concentrations in the trunk kidney than the head kidney. In conclusion, exposure to Cd affected precursor hematopoietic cells in C. macropomum.

Abdominal aortic aneurysm (AAA) is a dilation of the abdominal aorta (above 50 % of its original diameter), which can cause death upon rupturing. It usually grows asymptomatically leading to late clinical intervention. The medical criteria to indicate surgery are based on measuring the diameter and growth rate, but in many cases aneurysms fail at uncharacterized critical values. In search of a more efficient technique in predicting AAA failure, there is consensus on the importance of studying its geometric characteristics and estimation of the wall stress, but no fully successful correlation has been found between the two yet. This work examines the relationship between a parameterized geometry (18 input variables and 10 dependent indices) and 1 output variable: the maximum wall stress. Design of Experiments (DOE) techniques are used to generate 183 geometric configurations, for which Finite Element Analyses are performed using ANSYSTM state-of-the-artsolver with a hyperelastic, isotropic and homogeneous arterial model for the wall, considering systolic internal pressure (steady state) and the restriction of longitudinal movement at the blood vessel end-sections. Due to the large number of independent parameters to consider, a preliminary Parameters Correlation analysis was performed to determine if a correlation between all input parameters and the maximum stress existed. The correlations between input parameters and the output variable were determined using the Spearman Rank correlation. Correlations with the maximum wall stress for: maximum diameter (??= 0.46), wall thickness (??= - 0.35), dc parameter (? = 0.21) and tortuosity (? = 0.55) were found. The response surface function between geometry and maximum wall stress was estimated by three models: Universal Kriging geostatistical regression (18 parameters), multiple linear regression (4 parameters) and multiple exponential regression (4 parameters). The models accounted for the stress variance by 99 %, 61 % and 66 %, respectively, with average percentage errors of 0.12 %, 16 % and 17 %, respectively. The solution spaces obtained from this study might provide physicians with a better estimation of the AAA rupture potential and thus, facilitate safer and anticipated treatments of the condition.

Nowadays, a Ventricular Assist Device (VAD) is a hope of clinic solution to patients with heart failure. This study presents the design of the “trumpet mouth” ventricular cannula (TMVC) connected to a pediatric VAD, optimized to reduce the conditions that generate blood damage. The flow through the TMVC is analysed using Computational Fluid Dynamics (CFD) techniques. The optimization of the TMVC considered the turbulent and byphasic nature of the flow at the systolic and diastolic phases of the cardiac cycle. To assess the hemodynamic performance of the cannula, three geometric parameters were chosen as input or independent variables in the optimization: the cannula tip curvature angle (?) and the inner and outer curvature radii (R1 and R2). The output parameters or objective functions were the Modified Index of Hemolysis (MIH), the Modified Index of Platelet Lysis (MILpl) and the fluid pressure drop (?P). The mathematical optimization passed through an enhanced sampling process of combined scenarios of input parameters and thereafter, the response surface was generated using the Kriging algorithm. The selection of the geometric parameters that minimized MIH, MILpl and ?P were obtained after the application of a Multi-Objective Genetic Algorithm (MOGA) and the generation of Pareto fronts to obtain the points that met the established conditions of reduction of blood damage. The optimal geometric parameters for the ventricular cannula obtained through the optimization process are: ??(27.29 degrees), R1 (0.83 mm) and R2 (0.20 mm). The final results showed a reduction in MIH for both cardiac phase configurations in the zone of the cannula tip and an overall reduction of 25% and 60% in the MIH and MILpl, respectively, compared to the damage for the cannula with nominal input parameters.

Introducción: El procedimiento de peritonectomía radical seguida por quimioterapia intraperitoneal hipertérmica (HIPEC, Hyperthermic Intraperitoneal Chemotherapy), se considera el estándar de tratamiento para neoplasias del peritoneo. Objetivo: Evaluar varios desenlaces en una cohorte de pacientes con neoplasias del peritoneo tratados con HIPEC. Métodos: Se incluyeron 24 pacientes tratados en forma consecutiva con peritonectomía radical más HIPEC, entre noviembre de 2007 y julio de 2010. Quince (62%) tenían tumores de origen apendicular, 4 (16,7%) tumores primarios del peritoneo y el resto fueron 2 carcinomas de ovario, uno de colon, un carcinosarcoma y un hemangioendotelioma. La edad promedio fue 53 años (rango 26-68) y mediana de seguimiento 14,2 (1-32) meses. Se valoraron datos demográficos, histología, índice de carcinomatosis peritoneal (PCI), características de los procedimientos quirúrgicos y varios desenlaces como supervivencia libre de recaída (SLR) y global (SG). También se determinó la morbilidad y mortalidad a corto plazo. Resultados: En 18 (75%) se logró citorreducción completa. El PCI promedio fue 15 (< 10: 41% y > 10: 58%) y la mediana (rango) para el tiempo quirúrgico, estancia en UCI, duración del soporte nutricional y tiempo de estancia hospitalaria fueron de 12,5 (7-20) horas, 11,4 (2-74) días, 13,8 (12-65) días y 29,1 (10-90) días, respectivamente. Un paciente (4%) falleció, 6 meses después del procedimiento por múltiples complicaciones asociadas. Se observó morbilidad considerable en el 52% de los casos, incluyendo eventos tromboembólicos (41%), bacteremia relacionada con catéter (29%), fístulas (29%) y nefrotoxicidad (25%). Seis pacientes (25%) tuvieron recaída con una SLR de 21 meses. Conclusiones: La cirugía citorreductiva más HIPEC en pacientes bien seleccionados con neoplasias las cuales afectan el peritoneo, resulta un procedimiento que se puede realizar en Colombia con un adecuado perfil de seguridad y eficacia. La mortalidad fue similar a lo reportado en la literatura mundial.

Se realizó una simulación mediante Elementos Finitos y CFD de un prototipo de gasificador experimental a partir de unageometría propuesta. Se abordan aspectos termomecánicos, al calcularse las deformaciones originadas en el equipo,producto de su peso, en las condiciones de emplazamiento y la carga térmica a la que se somete. También se considera elflujo multifásico gas-sólido presente en el lecho fluidizado, se determina el rango de presiones y velocidades de trabajo deldispositivo, y se estudia la evolución del flujo. Para ello se utiliza el modelo de fuerza de arrastre y presión de sólido deGidaspow, así como los criterios de velocidad mínima de fluidización de Wen & Yu y Kunii & Levenspiel.Palabras claves: Gasificación, lecho fluidizado, CFD, FEM, flujo multifásico.______________________________________________________________________________Abstract.A Finite Element and CFD simulations were conducted to a prototype of experimental gasifier, starting from a proposedgeometry. Thermomechanic aspects are briefed, calculating the reactor deformation, due to its weight and the thermic load.The gas-solid multiphase flow, present on the fluidized bed was also considered, the working range for the pressure andvelocity fields were determined and the flow evolution was studied. The drag force and solid pressure models byGidaspow, and the minimum fluidization velocity criteria, by Wen & Yu and Kunii & Levenspiel were used.Key words: gasification, fluidized bed, CFD, Finite Element, Multiphase Flow.

Development of Computational Fluid Dynamics (CFD) computer codes for complex turbomachinery affords a complete three-dimensional (3-D) flow field description. While significant improvements in CFD have been made due to improvements in computers, numerical algorithms, and physical modeling, a limited experimental database for pump CFD code validation exists.

This paper presents results obtained by a multi-variable method combined with CFD to study the performance of an air curtain in a fire scenario inside a tunnel. An air curtain is a plane stream of air blown across an opening to create a singularity that hampers the free air movement through this opening. An air curtain is used to produce a barrier effect while permitting traffic of people, vehicles, materials or objects between the areas the air curtain separates. They are widely used at building entrances to ensure a constant inside-outside temperature difference. Air curtains are also often mounted in the front of refrigerated food counters and open-shelves for customers to easily see products without having to open a door. In many circumstances, an air curtain can be seen as an impinging plane jet. The main flow is then composed of three or four basic regions depending on the jet height H to width e ratio: a free jet (just downstream of the discharge nozzle exit), a development region (absent if H/e is small), an impingement region including a stagnation zone, and a wall-jet region. The air curtain investigated in this study is part of an emergency ventilation system designed to stop smoke propagation during fire in a tunnel. The whole system is made of 2 air curtains forming a confinement cell within which smoke should be retained. A traditional CFD study would take a lot of time and computational resources. Therefore, CFD was combined with Response Surface Methodology (RSM), a useful tool to produce results that take into consideration many variables and ranges in an optimal way. The virtual set-up investigated in this study describes a 2D tunnel of length 100 m with one confinement cell and a fire source designed from real fire simulations for testing ventilation systems. The Reynolds number based on the flow velocity and width at the discharge duct of the air curtain was varied from 4·105 to 1·106. The height-to-width (H/e) ratio was varied from 2 to 30. The efficiency of the air curtain was assessed through the temperature and smoke concentration difference between the tunnel exit and the confined section. The RSM method proved to be an efficient way to study multiple ventilation conditions for a given fire scenario from a reduced number of traditional CFD simulations. Air curtains are shown to be effective barriers able to confine heat, reduce the temperature in the tunnel outside of the confinement cell, and thus facilitate evacuation. Smoke leakage occurs through the curtain due to two main reasons: the first one is based on the development condition of the impinging jet, and the second is related to mass conservation within the confinement section. The results show that the best air barriers are those with a high Reynolds number and a small H/e ratio.

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TiO2, TiO2-Cu, TiO2-CNTs y TiO2-CNTs-Cu films were obtained by Dip-coating technique and 500°C for 1h. The Anatase phase of TiO2 was identified and the TiO2-Cu film also presented the Tenorite secondary phase of CuO. The planes (101) and (200) of the Graphite 2H phase were identified in the films with CNTs. The crystal size was obtained between 5 to 16 nm. The morphology is homogeneous without pores and without cracks. The bandgap value for TiO2-CNTs-Cu and TiO2 films were 3.22 and 3.48 eV respectively. For photocatalytic evaluation Visible and UV irradiation were used and TiO2-CNTs showed a degradation of 53%. [ABSTRACT FROM AUTHOR]