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Introduction Chemsex refers to the use of drugs, typically stimulants and/or psychoactive substances, in a sexual context, often in the context of casual or group sex encounters. Currently, the practice of chemsex focuses on men who have sex with men (MSM). On the other hand, Pre-exposure prophylaxis (PrEP) is a biomedical method that has proven effective in preventing HIV transmission, particularly among individuals at a heightened risk, including those who engage in chemsex. MSM account for two thirds of new HIV cases in the US. It is estimated that in 70% of cases seroconversion occurs through “condomless anal sex” (CAS). According to the CDC, one in six MSM will be infected with HIV during their lifetime. The consumption of methamphetamine (MA) has been identified as the main driver of the practice of CAS, alteration of rectal immunological function and faster seroconversion. One in three new HIV infections have been associated with MA consumption. (Grov C et al. JAIDS 2020; 85 272-279). Objectives The primary goal of this study is to describe the prevalence of chemsex engagement among PrEP users, delineate user characteristics and requirements, gain deeper insights into this phenomenon within the Barcelona region, and formulate customized strategies accordingly. Methods This study conducts a literature review to explore the current correlation between engaging in chemsex and the utilization of PrEP. We identified research articles published between January 2020 and December 2022, that discussed the utilization of chemsex drugs prior to or during sexual activities. The findings were synthesised using a narrative approach and conceptualised using a behavioural analysis framework. Results According to a recent cross-sectional study performed at Hospital Clínic de Barcelona, SUD among patients who are being followed-up in the outpatient clinic of PrEP was higher (89%) compared with other European regions such as England (38.5%) or Amsterdam (41%). Moreover, according to data collected in the EMIS 2017 survey, Barcelona is the city with the highest prevalence of chemsex in Spain. (De La Mora L et al. AIDS Beh. 2022; 26: 4055-4062). Conclusions The frequency of chemsex practice among individuals using PrEP in Barcelona surpasses what has been observed in other groups. Nearly 25% of the participants express worries and a requirement for assistance regarding the management of drug use, matters associated with their sexuality, and sexually transmitted infections (STIs). MSM who suffers from substance use disorder may experience difficulty achieving effective daily oral PrEP adherence prevention levels that may serve as early indicators of increased risk of disengagement from PrEP care and discontinuation the PrEP. These results highlight the importance of adopting aninterdisciplinary approach that incorporates education about substances and the implementation of risk mitigation strategies within the context of riskier sexual behaviors. Disclosure of Interest None Declared

Introduction The Acute Organic Change of Character (AOCC) is an organic mental disorder subtype in which perception, thought, mood and personality impairment predominate. It consists in a change in the individual’s general behaviour or attitude, which is shown to be closely associated with or caused by an underlying organic process, and which is rapidly resolved when the organic noxious agent is eliminated (Pintor et al. Journal of Psychiatry and Psychiatric Disorders 4 (2020): 354-358). Objectives To describe the importance of taking AOCC diagnosis into consideration and the role of liaison psychiatrists in AOCC management by presenting two AOCC cases admitted to the Hospital Clinic of Barcelona. Methods We retrospectively reviewed two AOCC cases in patients followed by our hospital’s liaison psychiatry unit during the summer of 2023. We also searched for previous case reports of AOCC using a PubMed query. Results Case 1: A 50-year-old male who suffered a polytrauma with diffuse axonal injury (DAI). His relatives and the referring medical team observed a change in his behaviour consisting in irritability, suspicion, hostility and impatience. No cognitive impairment nor fluctuation in the described symptoms were observed. At the time of discharge character changes were still present due to DAI slow and unpredictable clinical course. Symptomatic treatment with risperidone 6mg/day and quetiapine 100mg/day was administered achieving a satisfactory clinical response. Case 2: A 47-year-old woman with type 2 diabetes who suffered an infectious cellulitis that spread causing sepsis. The patient began to appear disruptive with verbose and tangential speech during her admission. No cognitive impairment nor fluctuation in the described symptoms were observed. Symptomatic treatment with risperidone 10mg/day and olanzapine 5mg/day was administered achieving a satisfactory clinical response. At the time of discharge character changes described before were almost resolved. Conclusions The clinical presentation of both cases suggested organic mental disorders in which a change in general behaviour predominates. Liaison psychiatrists play a key role in AOCC management by recognizing the clinical pattern, helping if needed with psychopharmacological treatment and ensuring a good understanding of the disorder both by the referring medical team and the patient’s relatives. To our knowledge, it would be of great importance to achieve a better understanding of this clinical condition which to date we consider to be underdiagnosed. Disclosure of Interest None Declared

Introduction With the rapid changes of attitude, investigation and legislation around cannabis and its subproducts in the Western world, there is a need to profoundly examine the consequences of its use in the general population and, specifically, in people affected by mental disorders. There is a clear relationship between cannabis use and psychosis, but there is also growing evidence of its relationship with manic episodes (Sideli et al, 2019). A systematic review published by the CANMAT Task Force in 2022 examined again the relationship between cannabis use and bipolar disorder (BD), establishing association with worsened course and functioning of BD in frequent users (Tourjman et al., 2023). On the other hand, some recent papers have highlighted the role of the endocannabinoid system (ECS) in BD, suggesting even possible beneficial effects, mainly through the CB2 receptor (Arjmand et al, 2019). Objectives To describe the impact of cannabis in the psychiatric readmission in BD and to approach the differences in course in cannabis users with regards to non-users. Methods We conducted a prospective cohort study including the patients admitted to our acute psychiatric unit with the diagnosis of manic or mixed episode during the period between 2015 and 2019 (including patients with one of both final diagnosis: BD or schizoaffective disorder). We established a follow-up of 3 years from the date of admission in which hospital readmissions are examined. Results The study, which included 309 patients, concluded that cannabis users were admitted and had the first episode at a younger age (p=0.005), a higher percentage of them did not have a previous diagnosis (p=0.026) nor a previous history of mental health issues (p=0.019) and it was more likely to be their first admission (p=0.011) and to suffer psychotic symptoms (p=0.002). As of treatment, the results were statistically significant regarding the fact that a lower proportion of patients had received previous psychiatric treatment (p=0.004) and previous electroconvulsive therapy (p=0.003). There was a higher chance of them being non-adherent with medication (p

Introduction In recent years, interest has grown in understanding the particularities of addiction in women. One of these singularities, with an important impact on public health, is pregnancy. Substance use during pregnancy has increased in recent decades. Given that addiction is mainly a chronic disease of the brain circuits of reward, motivation and memory, an event such as pregnancy does not exempt people who suffer from substance use disorder (SUD) from the difficulties of achieving abstinence. Moreover, as addiction often involves cycles of relapse and remission, pregnant women can also suffer a relapse even if they previously had achieved abstinence. On the other hand, given that addiction is a disease with a significant social component, we can find patients in precarious economic and social situations who suffer unwanted and therefore unplanned pregnancies. Objectives To describe the case of a pregnant woman with SUD for multiple drugs who is admitted to the inpatient ward of the Hospital Clínic of Barcelona for detoxification. Also to reflect, taking in to account gender perspective, on the particularities of substance use in women on childbearing age. Methods We present the case of a 25-year-old woman, six weeks pregnant and homeless, who was admitted to the inpatient ward for presumed psychotic symptoms. Even if the patient had a history of intravenous heroin, cocaine, and methamphetamine use, during the admission she only admitted current alcohol consumption (3 UBE/day). During admission, the patient decided to undergo a legal voluntary abortion. Regarding this case, we did a literature review on the consequences of different substances use to pregnancy (to both the fetus and the mother’s health). Likewise, we reflected on interventions that could be carried out in community mental health facilities to detect cases like the one exposed and provide help. Results Poor obstetric outcomes are six times higher in patients who use substances. Newborns can have withdrawal syndrome, spontaneous abortion, pre-term birth, fetal malformations and fetal growth restriction. More than 50% of women of reproductive age use drugs, mainly alcohol. Routine screening and education of women of reproductive age is the best way to reduce substance use during pregnancy. Conclusions We consider it essential for a better management of these patients to remember that the evidence suggests that the decisions that addicts make are mainly driven by a pathology, not by a moral failure. However, pregnancy can be a moment of greater motivation to stop using drugs, given that it is a high risk situation for the mother and the fetus. Disclosure of Interest None Declared

Introduction In Spain and other European countries, patients coming to the emergency room (ER) are usually classified as “organic” or “psychiatric” on arrival, but this may be complicated when psychiatric history is present as the focus can be misplaced (Leeman. IJPM 1975;6(4):544-40; Alam et al. Psychiatr. Clin. North Am. 2017;40(3):425–33). Objectives To describe three cases seen in the psychiatric emergency room (PER) in which triage errors occurred and to review whether it is widespread for psychiatric patients with organic pathology or in need of medical care to be wrongly triaged. Methods We retrospectively reviewed three cases seen in the PER of Hospital Clínic in July 2023 in which triage errors happened. Triage error was considered when patients triaged directly to the PER presented symptoms that either needed medical treatment or required medical clearance before being considered purely psychiatric. Results Case 1: A 27-year-old woman with history of depressive syndrome was triaged for a speech disturbance that had occurred fifteen minutes after intercourse. After being evaluated, she was referred to neurology where she was diagnosed with an acute ischaemic stroke in left middle cerebral artery territory, requiring thrombectomy and posterior admission to neurology. Case 2: A 50-year-old man with history of alcohol use disorder was brought to the PER after saying that “he was seeing people doing magic” at home. When evaluated, significant distal tremor, tachycardia and hypertension were observed, being compatible with withdrawal symptoms, so he was transferred to the ER. There he was monitored and treated, finally requiring admission to internal medicine due to persistent symptoms. Case 3: A 26-year-old man with history of substance use disorder was triaged for loss of consciousness and “spasms”. After evaluation, he was transferred to the ER, where organic screening was carried out, being oriented as a probable tonic-clonic seizure and discharged with outpatient follow-up. Conclusions The cases presented are instances in which somatic diseases in patients pre-labelled with psychiatric histories were wrongly assumed to be recurrences of their psychiatric disorders. In all cases, they needed to be re-examined by the corresponding medical specialty and required diagnostic tests, in two cases hospital admission was needed. Emergency physicians and emergency psychiatrists often disagree on how to medically clear patients (Alam et al. Psychiatr. Clin. North Am. 2017;40(3):425–33; Janiak et al. JEM. 2012;43(5):866–70), some authors have even proposed protocols for doing this in a more systematic way (Shah et al. JEM. 2012;43(5):871–5). To avoid a delay in diagnosis and treatment and the consequences that may result from it, establishing guidelines for proper triage of patients with psychiatric history should be considered. Disclosure of Interest None Declared

We provide an overview of activities carried out at the TJ-II stellarator for improving our understanding of- and developing plasma physics models for particle density profiles in stellarators. Namely, we report on recent progress in turbulent particle transport simulation, validation of pellet deposition models, density profile shaping for performance control and new experimental techniques for edge turbulence and plasma-neutral interaction.

Introduction Catatonia is a syndrome characterized by physical symptoms ranging from immobility to excessive motor activity. Besides being historically associated mainly with schizophrenia, it is widely known that it can be the expression of different psychiatric, neurological or medical conditions. The treatment of choice is benzodiazepines, indicating electroconvulsive therapy in refractory cases. Amantadine is considered a second-line therapy in setting when electroconvulsive therapy is not available. Objectives To describe the case of a patient with treatment-resistant catatonic schizophrenia. Not having responded to benzodiazepines or electroconvulsive therapy, potentiation with amantadine was subsequently started. Methods Our patient presented at a psychopathological level; psychomotor inhibition, a perplexing attitude, and mute speech. At the motor level; ambitendency, indecision, automatic obedience, motor stereotypes, and facial grimaces. He did not present other alterations at the neurological level. Regarding complementary explorations, we performed neuroimaging and blood tests, which resulted all anodyne. With an alternative diagnosis, we considered that sequelae of a neuroleptic malignant syndrome could have produced the symptoms that he had suffered. Due to the persistence of the symptoms and their typical characteristics, catatonia was our first diagnostical impression. As treatment with benzodiazepines was ineffective, electroconvulsive therapy was started. No clinical improvement was observed. Given the refractoriness of the case, a review of the existing literature was carried out. We found reports of a good response to amantadine in similar cases. Amantadine was introduced up to a dose of 200mg. Results After four weeks of treatment with amantadine at a dose of 200mg, the patient showed meager improvement at both psychopathological and motor level. Conclusions We find the case of a patient with long-term schizophrenia who is nowadays dependent on all daily living activities and requires sustained care. Disclosure of Interest None Declared

Introduction Prader-Willi syndrome (PWS) is a genetic disorder with an estimated prevalence of 1:25,000. PWS results from defective gene expression on the paternal copy of chromosome 15. In 70% of the cases it is a deletion that means that part of the paternal chromosome 15 is missing. Maternal uniparental disomy (mUPD) is present in 25% of cases. Typical clinical features of PWS are dysmorphism, hypotonia, hyperphagia, hypogonadism and developmental delay. In addition, the syndrome is accompanied by various psychiatric symptoms that are often insufficiently known within the psychiatric field. Regarding the relationship between PWS and schizophrenia spectrum disorders (SSDs), individuals with mUPD appear to have a 3 to 4 times higher risk of psychotic symptoms than those with the deletion subtype. Psychotic episodes have an atypical presentation with recurrent episodes of confusion and rapidly fluctuating psychotic and mood symptoms. Objectives To describe an unusual clinical case in order to determine the management regarding clinical approach, and provide an overview of psychotic episodes in patients with PWS for the general practitioner with the most up-to-date information on workup and management. Methods We report a case involving a 13-year-old woman with PWS (mUPD of chromosome 15) and mild intellectual disability (IQs 59), who presented psychotic symptomatology in the form of disorganized behavior, delusional ideation, auditory hallucinations, self-referentiality and suspicion. Parents reported that these symptoms started two days prior the day of consultation. No environmentals stressors were identified and no recent treatment changes were made. Patient’s medication consists in 150 mg sertraline per day due to anxiety control and aid in emotional and behavioral regulation. Results Given the diagnostic approach of a psychotic episode (PE) in a patient with PWS, it was decided to offer 0.5mg risperidone per day, in an increasing pattern until reaching a final dose of 1.25 mg per day, presenting a global remission of the psychotic symptomatology. Recommendations for patients with PWS presenting PE are based upon systematic reviews. Patients with PWS, especially mUPD subjects, are at risk for SSDs and mood disorders. Antipsychotics (APs) are the gold standard in the treatment of SSDs, and some authors have suggested that APs protect patients with previous psychotic symptoms from relapse. It is unknown whether there is a protective effect of APs in mUPD patients who have not previously exhibited psychotic signs. Conclusions PWS represents a good example of a genetic disease with behavioral and psychiatric symptoms that may be challenging to treat with psychotropic medications. For a better understanding of psychiatric problems in adults with PWS, longitudinal studies with careful and standardized follow-up of psychiatric symptoms in PWS are necessary. Disclosure of Interest None Declared

Introduction The coronavirus infectious disease 2019 (COVID-19) pandemic has had a deleterious impact in many areas. Given this, efforts have focused on developing effective vaccines and vaccination campaigns have been carried out prioritizing population at risk. This should include mental health patients since they are at higher risk of developing complications or ending up in a critical status. Since it may be sometimes difficult for these patients to access vaccination, hospitalization may be a window of opportunity to evaluate and offer vaccination. Objectives This study aims to retrospectively assess vaccination status and offer during admission of psychiatry inpatients at Hospital Clínic of Barcelona during a 6-month period, in order to determine if there are differences regarding vaccination rates compared to general population and between main diagnostic categories. Methods We retrospectively evaluated all admitted patients to the acute psychiatry ward. The main collected variables included age, gender, main psychiatric diagnosis, presence of organic comorbidities, vaccination status at admission and vaccination offer during admission. We used descriptive statistics to extract most of the information. A binary logistic regression was also conducted to evaluate whether the main diagnosis, age and gender had some influence upon vaccination status at admission. Results Between January 1st and June 30th of 2022, 216 patients were admitted to the psychiatry ward. A total of 42% were female, with a mean age for the whole sample of 42.8 years (SD 14.7). More than half were current smokers (55%), and 46% of the patients had at least one significant organic comorbidity. The percentages of main diagnosis were as follows: addiction 21.3%; bipolar disorder 18.5%; schizophrenia 18.1%; non-specified psychosis 14.4%; depression 7.4%; cognitive impairment 0.9%; personality disorders 6.9%. Vaccination status was available for 187 patients (86.6%). Of these, 78 patients were fully vaccinated, 68 had an incomplete vaccination status and 41 patients had not received any dose. No differences on the vaccination status were seen based on the psychiatric diagnosis. Among patients with incomplete or no vaccination, 19 patients (17.4%) were offered a vaccination dose. A total of 11 patients accepted and received it (57.9%). In the logistic regression model, the only significant variable predicting an increase in the likelihood of being fully vaccinated was age, with every year of age increasing the probability of full vaccination by 6%. Conclusions Our data suggest that routine screening of vaccination status during psychiatric admission and improved strategies for vaccination offer and acceptance should become a priority in psychiatric wards. Given the impact of the pandemics, and the likelihood of new waves or even new pandemics, more research on vaccination strategies among mental health patients is warranted. Disclosure of Interest None Declared

Introduction Hyperprolinemia is defined by high proline levels of blood and its primary type consists on a metabolic disorder that is the result of a number of different genetic defects affecting the degradation of proline. The complex relationship between this disease and different psychiatric phenotypes has been an important subject of study in recent years, suggesting a “common psychiatric phenotype” (Namavar et al. Am J Med Genet B Neuropsychiatr Genet 2021; 186(5), 289-317), though its exact characteristics are yet to be determined. A higher prevalence of psychotic disorders (Guo et al. Metab Brain dis 2018; 33 89-97) explained through altered glutamate metabolism, autism spectrum disorders, developmental delay and intellectual disability has been proposed. Objectives To describe the case of a patient, recently diagnosed of hyperprolinemia type I, presenting a conduct disorder alongside with ADHD, oppositional defiant disorder and an unspecified pervasive developmental disorder. Methods We present the case of a 15-year-old male that has received follow-up care by our mental health services. The patient was born preterm (35+5 weeks) and required reanimation, oxygen therapy, antiretroviral therapy (biological mother was HIV positive) and pharmacological therapy with phenobarbital (in order to treat methadone withdrawal syndrome). It was adopted nationally when he was 18-month-old and experimented an adequate development during his first years, only highlighting slight psychomotor restlessness and distinctive facial features. During the next years, he receives diagnosis of ADHD (with little to no registered response to amphetamine derivatives), oppositional defiant disorder, social pragmatic communication disorder and fetal alcohol syndrome. Results During his first hospital admission, a neuropediatrician was contacted to study the patient and recommended for a metabolic screening to be done, where high blood levels of proline were detected (940.1μmol/L). After this, a procedure of massive exome sequencing of genes that were known to be related to alterations in the metabolism of proline was conducted, finding the mutation c.[1357C>T] in the gen PRODH. This translates to an amino acid replacement in the protein proline dehydrogenase (p.[Arg453Cys]; [Arg453Cys]), which has been studied (Bender et al. Am J Hum Genet 2005; 76 409–420) that it reduced its activity in a 70%, making it a very probable cause of the hyperprolinemia. Conclusions There is still scarce evidence of the psychiatric phenotypes presented in patients with hyperprolinemia. Further research is needed in order to accurately define the complex relationship between this metabolic disorder and its effect on the central nervous system. Disclosure of Interest None Declared

Introduction Pramipexole is a dopaminergic agonist used in the treatment of Parkinson’s disease and restless leg syndrome. Although there is a lack of pharmacological options to treat drug-induced parkinsonism, not many studies have been made on the use of pramipexole in its management. There is also evidence on pramipexole effectiveness on major depressive episodes, particularly for bipolar and treatment-resistant depression. Objectives To describe a case of drug-induced parkinsonism treated with pramipexole in a complex patient with bipolar disorder type I and obsessive-compulsive disorder, long-term treated with antipsychotics and valproate. Methods We present the case of a 51-year-old woman admitted in our psychiatric inpatient unit mainly to treat a bipolar depression. She also presented a parkinsonian syndrome, and a neurological study was conducted. As a negative DaTSCAN concluded its cause to be pharmacological, we decided to stop lurasidone and initiated pramipexole. Results Guidelines suggest that drug-induced parkinsonism should be managed by discontinuing causative drugs or switching to another agent. However, we decided to use pramipexole with the aim of not only treating the parkinsonian syndrome but helping manage the depressive episode. We observed a remission of the depressive symptoms and an improvement in the parkinsonian symptoms. Conclusions Although the best way to treat drug-induced parkinsonism is to avoid its causative agents, in clinical practice it is not always possible as some patients have resistant and complex psychiatric syndromes. We suggest considering pramipexole in its management, especially when dealing with a patient with a comorbid unipolar or bipolar depression. Further research is necessary to clarify its utility. Disclosure No significant relationships.

Introduction Neuroleptic malignant syndrome (NMS) may be a life-threatening neurologic crisis primarily emerging as an idiosyncratic reaction to antipsychotic agent use, and characterized by a particular clinical syndrome of mental status alter, rigidity, fever and dysautonomia. Mortality results straightforwardly from the dysautonomic manifestations of the disease and from systemic complications. Objectives To describe an unusual clinical case in order to determine the management regarding medication and electroconvulsive therapy (ECT), and provide an overview of NMS for the general practitioner with the most up-to-date information on etiology, workup, and management. Methods We report a case involving a 55-year-old man with paranoid schizophrenia disorder who presented with hyperthermia, hemodynamic instability, miosis, muscular rigidity, urinary incontinence, catatonic signs and mutism after combining several antipsychotics at the same time: long-acting injectable form of paliperidone, aripiprazol and haloperidol. Results Guidelines for specific medical treatments in NMS are based upon case reports and clinical experience. Generally used agents are dantrolene, bromocriptine, and amantadine. A conceivable approach is to start with benzodiazepines along with dantrolene in moderate or severe cases, followed by the addition of bromocriptine or amantadine. ECT is generally reserved for patients not responding to other treatments. Conclusions NMS is an uncommon adverse drug reaction, with a multifactor pathophysiology and manifestation. Early diagnosis and interruption of antipsychotic therapy is the first-line treatment, followed by supportive care and pharmacotherapy. ECT is an effective treatment when supportive treatment together with pharmacotherapy fails. It could be considered first line in severe life-threatening situations. It is advisable to consider maintenance ECT due to the high risk of relapse. Disclosure No significant relationships.

Introduction Bipolar disorder (BD) is considered a risk factor for developing Parkinson’s Disease (PD) because of an altered dopamine activity in both entities. Comorbidity may delay diagnosis and difficult therapeutic management. Objectives To describe the case of a patient with both BD and PD and to determine the appropriate diagnostic and therapeutic approach for patients presenting both entities. Methods We present the case of a 58-year-old woman attended in our neurology unit due to the initial presence of visual hallucinations as a core symptom. Results Psychotic symptoms as hallucinations and off-times, frequently observed in PD, may be misdiagnosed with a worsening of depressive polarity of BD. Thus, overlap between symptoms may lead to a challenging differential diagnosis. Moreover, there is no consensus about the therapeutic management of the comorbidity, due to the bidirectional worsening of symptoms when treatment is adjusted. In our case, a diagnosis of dopaminergic psychosis was made so antipsychotic treatment with quetiapine 50 mg/d was initiated. A worsening of symptoms was observed, presenting the patient a stuporous status, mutism and generalized rigidity. Neuroimaging and lumbar puncture were performed showing no alterations; electroencephalogram showed diffuse slowing. Final diagnosis was an off-episode of PD and a multifactorial encephalopathy resulting in visual hallucinations. Conclusions Coexistence of PD and BD may lead to a diagnostic and therapeutic delay and therefore a worse prognosis. Although these diseases are well-known, it is still challenging to manage patients presenting both entities. Further research is needed to clarify the proper diagnostic and therapeutic approach for these patients. Disclosure No significant relationships.

Introduction Stress is part of the daily life of many people, especially in Western countries. Recent studies have shown that cortisol has been listed as the primary hormone linked to stress. Currently, to measure cortisol values there are only tests that quantify it at a determined time point, without taking into account its variability and its changing pattern over time, depends on the circadian rhythm and other stress-related factors. Objectives This randomized clinical trial of the Hospital Clínic de Barcelona proposes to study the utility of accumulated hair cortisol concentration (HCC) as a measure to correlate the levels of this hormone over time with the stress suffered by the patient. Methods Patients are classified into two groups: a control group and an intervention group. In the second group, the participants will follow a mindfulness-based cognitive therapy (MBCT) with the aim of reducing stress and, consequently, cortisol levels. Results The purpose of this study is to validate the utility of HCC in order to, retrospectively, obtain cortisol secretion curves as a measure of the level of stress of each individual and personalize the treatments. Simultaneously, we intend to present new perspectives for treatment in psychiatric disorders where stress predominates, such as generalized anxiety disorder (GAD) or major depression (MD), which are becoming increasingly important in our society. Conclusions HCC contributes to the practice of personalized medicine as it allows us to detect cortisol exposure in the months prior to obtaining the capillary sample, and thus to draw the trend of this hormone over time. Disclosure No significant relationships.

Introduction Use of Monoamine Oxidase Inhibitors (MAOIs) has experimented an important reduction in recent years, being replaced by other antidepressant drugs (ADs) associated with a better safety profile. Its use has been restricted to instructed professionals treating resistant and atypical depression. Thus, treatment-emergent affective switch (TEAS) induced by MAOIs is a rare event nowadays. Objectives To describe a manic episode associated to a one-year-long treatment with phenelzine, a MAOI agent. Methods We present the case of a 47-year-old man hospitalized in our acute psychiatric unit after presenting compatible clinical symptoms with a manic episode. He showed severe irritability, decreased need for sleep, pressured speech, increased energy and goal-directed activities. The patient had started phenelzine a year ago for the treatment of major depressive episode resistant to previous pharmacological essayed treatments. No previous history of TEAS was reported, although he had already taken other ADs and mood-stabilizer treatments in the past. Results Several studies reported the effectiveness of MAOIs for the treatment of monopolar depressive episodes resistant to other ADs, especially when atypical symptoms were observed. Data on the use of MAOIs for the treatment of drug-resistant bipolar depressive episodes is scarce. Few studies have described a good response without showing and increased risk of TEAS. Conclusions As MAOIs have fallen out of favour with modern psychiatry, there is scarce evidence on the prevalence of TEAS in patients undergoing treatment with these drugs. Further research is needed in order to accurately define these complex relationships. Disclosure No significant relationships.

The health benefits offered by probiotic fermented milks can be increased by adding native fruit pulps. Red fruits contain ellagic acid (EA) and ellagitannins, interesting substances due to their powerful antioxidant properties and other beneficial biological activities, such as cardio protective effects, selective growth inhibition of human pathogenic bacteria, a-amylase inhibition of angiotensin I converting enzyme, and proliferative activities against several different cancer cells. This study aimed to improve the physical properties of symbiotic yoghurts through their supplementation with a mixture of red berry pulps: strawberry, raspberry and “pitanga”. The simplex-centroid design was used for mixture modelling. The design included seven batches/trials: three supplemented with each type of fruit pulp, three corresponding to the binary mixtures and one supplemented with the combination of the three pulps. A control experiment was prepared without addition of fruit pulp. Processed milk bases were fermented at 42 °C until pH 4.7 by using a starter culture blend that consisted of Streptococcus thermophilus (TA040), Lactobacillus bulgaricus (LB340) and Lactobacillus acidophilus (LA140). Subsequently, milk base (80 %) was blended with a pulp preparation (20 %) and other ingredients according to the experimental design. Physico- chemical analyses, enumeration of viable bacteria, colour and rheological characteristics of the yoghurts were evaluated 36 h after preparation and 21 days after cold storage. Three regression models were adjusted to the results (linear, quadratic and cubic special). The results showed that the addition of a mixture of red fruit pulps affected pH and counts of probiotic bacteria, which slightly decrease during storage. Addition of the three red berry pulps simultaneously enhanced the colour and rheological properties of probiotic yoghurts when compared to the control. It was possible to estimate the optimum mixture compositions of the three fruit pulps that increase EA contents in probiotic yoghurts.

Wound healing is important for skin after deep injuries or burns, which can lead to hospitalization, long-term morbidity, and mortality. In this field, tissue-engineered skin substitutes have therapy potential to assist in the treatment of acute and chronic skin wounds, where many requirements are still unmet. Hence, in this study, a novel type of biocompatible ternary polymer hybrid hydrogel scaffold was designed and produced through an entirely eco-friendly aqueous process composed of carboxymethyl cellulose, chitosan, and polyvinyl alcohol and chemically cross-linked by citric acid, forming three-dimensional (3D) matrices, which were biofunctionalized with L-arginine (L-Arg) to enhance cellular adhesion. They were applied as bilayer skin biomimetic substitutes based on human-derived cell cultures of fibroblasts and keratinocytes were seeded and grown into their 3D porous structures, producing cell-based bio-responsive hybrid hydrogel scaffolds to assist the wound healing process. The results demonstrated that hydrophilic hybrid cross-linked networks were formed via esterification reactions with the 3D porous microarchitecture promoted by foam templating and freeze-drying. These hybrids presented chemical stability, physicochemical properties, high moisture adsorption capacity, surface properties, and a highly interconnected 3D porous structure well suited for use as a skin substitute in wound healing. Additionally, the surface biofunctionalization of these 3D hydrogel scaffolds with L-arginine through amide bonds had significantly enhanced cellular attachment and proliferation of fibroblast and keratinocyte cultures. Hence, the in vivo results using Hairless mouse models (an immunocompromised strain) confirmed that these responsive bio-hybrid hydrogel scaffolds possess hemocompatibility, bioadhesion, biocompatibility, adhesiveness, biodegradability, and non-inflammatory behavior and are capable of assisting the skin wound healing process.

Female mammals employ reproductive strategies (e.g., internal gestation) that result in power asymmetries specific to intersexual dyads. Because the number of eggs available for fertilization at any given time for most mammals is quite limited, having a fertilizable egg is potentially an important source of economic power for females. Control over mating opportunities is a source of intersexual leverage for female Verreaux’s sifaka (Propithecus verreauxi). We examined economic factors thought to influence the value of mating opportunities, and, thus, the extent of female leverage: kinship and market effects. Using a longitudinal dataset of agonistic interactions collected during focal animal sampling of all adult individuals in 10 social groups from 2008 to 2019, we tested the effects of relatedness, female parity, reproductive season, and adult sex ratio (population and group) on (1) the direction of submissive signaling and (2) which sex won a contested resource. While 96% of the acts of submission were directed from males toward females, females only won a third of their conflicts with males. Thus, our study has implications for evolutionary explanations of female-biased power. If female power evolved due to their greater need for food and other resources, then intersexual conflicts would be expected to result in males more consistently relinquishing control of resources. As expected, males were more likely to chatter submissively toward successful mothers, during the mating season, and when the sex ratio was male-biased. Although females generally had less power to win a conflict when their fertilizable egg was less valuable (when they were nulliparous or unsuccessful mothers or when interacting with male kin) and with an increasing female-bias in the sex ratio, this ability to win additionally was influenced by which sex initiated the conflict. Our study demonstrates that female leverage can be influenced by the supply and demand for mating opportunities, but evoking submission does not translate into winning a resource. Indeed, intersexual power is dynamic, contextual, and dependent on the individuals in the dyad.

Introduction: There are four objectives to this paper: (1) To determine whether undergraduates enrolled in Health-Sciences studies agree with the use of human stem cells for medical research, treatment and genetic uses. (2) Whether they would consider the use of pre-implantation-embryos for medical research. (3) Whether attitudes toward the previous two issues are linked to gender, field of study, transcendental/spiritual convictions and political biases. (4) A panel of discussion will modify their opinion. Results: The present study shows that, before attending a discussion panel session, media was the main source of information that the students had on the surveyed topics. A discussion panel was useful for clarifying respondents’ opinions on the explored items. Significantly, the discussion panel had an influence on those respondents who did not have a formed opinion on the explored items. Conclusions: A discussion panel is a convenient, but limited tool, in the shaping of undergraduate opinions on ethically controversial scientific matters. Resumen: Introducción: Los objetivos de este artículo son conocer si: 1) los estudiantes de pregrado matriculados en titulaciones de grado de ciencias de la salud están de acuerdo con la utilización de las células madre humanas para la investigación médica de los embriones preimplantatorios, la cura de enfermedades y los usos génicos; 2) consideran el uso de los embriones preimplantatorios humanos para la investigación; 3) las actitudes hacia los 2 temas anteriores están relacionadas con el género, el grado universitario en curso, la afiliación política y las convicciones trascendentales o espirituales, y 4) conocer si un panel de discusión, con expertos, modifica esas opiniones. Resultados: Los resultados del presente estudio mostraron que antes del panel de discusión, los medios de comunicación eran la principal fuente de información de los encuestados sobre los temas estudiados. El panel de discusión fue útil para aclarar las opiniones de los encuestados, aprobar o desaprobar los ítems explorados. Significativamente, el panel de discusión influyó en los encuestados que dijeron que no tenían una opinión formada sobre los ítems explorados antes del panel de discusión. Conclusiones: El panel de discusión es una herramienta conveniente pero limitada en la formación de las opiniones de los estudiantes de pregrado en titulaciones de ciencias de la salud sobre cuestiones científicas éticamente controvertidas.

Grain storage has as its central objective to stock the grain, giving the producer the advantage of distributing it at the best time, thus creating a favorable and profitable market logistics. The state of Mato Grosso is the country's leader in grain production, however its competitiveness vis-à-vis the rest of the country is historically affected by the many logistical bottlenecks still present, including storage, which for years has been one of the main competitive disadvantages. Given this, data were collected based on research on grain production in the state of Mato Grosso in the IBGE and CONAB databases, with the objective of making an analysis on the current static storage capacity of grain in the state of Mato Grosso. In the year 2019, the static storage capacity is 37.808.087 tons showing a deficit of 29.565.71 tons of grains, so that the mesoregions of North and Southeast Mato Grosso lead with the largest static capacity, but still unable to meet demand.

A variety of animals have been shown to make confidence judgments about their own knowledge or performance, but the mechanism for these metacognitive decisions is still debated. Much of the work on animal metacognitive abilities has been to rule out alternative, non-introspective mechanisms such as associative learning, behavioral cue association, or environmental cue association. However, the human metacognition literature has shown that even humans often do not use true introspection or directly access their own memory to make metacognitive judgments–they sometimes use heuristic strategies based on perceptual salience. Often these heuristic strategies are inaccurate and cause metacognitive errors. Here we offer a new route to testing animal metacognitive abilities by comparing the fragility of human and animal metacognition. We show that monkeys’ confidence judgments, like those of humans, are at least partly based on salient perceptual features of the stimuli and susceptible to faulty heuristics.

Plasmodium vivax malaria incidence has increased in Latin America and Asia and is responsible for nearly 74.1% of malaria cases in Latin America. Immune responses to P. vivax are less well characterized than those to P. falciparum, partly because P. vivax is more difficult to cultivate in the laboratory. While antibodies are known to play an important role in P. vivax disease control, few studies have evaluated responses to P. vivax sexual stage antigens. We collected sera or plasma samples from P. vivax-infected subjects from Brazil (n = 70) and Cambodia (n = 79) to assess antibody responses to domain 1 of the gametocyte/gamete stage protein Pvs230 (Pvs230D1M). We found that 27.1% (19/70) and 26.6% (21/79) of subjects from Brazil and Cambodia, respectively, presented with detectable antibody responses to Pvs230D1M antigen. The most frequent subclasses elicited in response to Pvs230D1M were IgG1 and IgG3. Although age did not correlate significantly with Pvs230D1M antibody levels overall, we observed significant differences between age strata. Hemoglobin concentration inversely correlated with Pvs230D1M antibody levels in Brazil, but not in Cambodia. Additionally, we analyzed the antibody response against Pfs230D1M, the P. falciparum ortholog of Pvs230D1M. We detected antibodies to Pfs230D1M in 7.2 and 16.5% of Brazilian and Cambodian P. vivax-infected subjects. Depletion of Pvs230D1M IgG did not impair the response to Pfs230D1M, suggesting pre-exposure to P. falciparum, or co-infection. We also analyzed IgG responses to sporozoite protein PvCSP (11.4 and 41.8% in Brazil and Cambodia, respectively) and to merozoite protein PvDBP-RII (67.1 and 48.1% in Brazil and Cambodia, respectively), whose titers also inversely correlated with hemoglobin concentration only in Brazil. These data establish patterns of seroreactivity to sexual stage Pvs230D1M and show similar antibody responses among P. vivax-infected subjects from regions of differing transmission intensity in Brazil and Cambodia.

The evolutionary processes underlying the high diversity and endemism in the Cerrado, the most extensive Neotropical savanna, remain unclear, including the factors promoting the presence and evolution of savanna enclaves in the Amazon forest. In this study, we investigated the effects of past climate changes on genetic diversity, dynamics of species range and the historical connections between the savanna enclaves and Cerrado core for Qualea grandiflora, a tree species widely distributed in the biome. Totally, 40 populations distributed in the Cerrado core and Amazon savannas were analyzed using chloroplast and nuclear DNA sequences. We used phylogeographic, coalescent and ecological niche modeling approaches. Genetic data revealed a phylogeographic structure shaped by Pleistocene climatic oscillations. An eastern-western split in the Cerrado core was observed. The central portion of the Cerrado core harbored most of the sampled diversity for cpDNA. Ecological niche models predicted the presence of a large historical refuge in this region and multiple small refuges in peripheral areas. Relaxed Random Walk (RRW) models indicated the ancestral population in the north-western border of the central portion of the Cerrado core and cyclical dynamics of colonization related to Pleistocene climatic oscillations. Central and western ancient connections between Cerrado core and Amazonian savannas were observed. No evidence of connections among the Amazonian savannas was detected. Our study highlights the importance of Pleistocene climatic oscillations for structuring the genetic diversity of Q. grandiflora and complex evolutionary history of ecotonal areas in the Cerrado. Our results do not support the recent replacement of a large area in the Amazon forest by savanna vegetation. The Amazonian savannas appear to be fragmented and isolated from each other, evolving independently a long ago.

While the immunogenic potential of the vaccination against infectious diseases was extensively shown, data on the safety assessment of recombinant proteins in vaccine formulations administered during pregnancy are still scarce. In the current study, the antigenicity of a vaccine against leishmaniasis (based on Leishmania braziliensis recombinant protein peroxidoxin) during pregnancy and possible maternal reproductive outcomes and fetal anomalies after immunization with a leishmanial vaccine or adjuvant alone (Bordetella pertussis derived MPLA adjuvant) were assessed. Rats were mated and allocated in three groups: Control-rats received saline; Adjuvant-rats received the adjuvant MPLA, and Vaccine-rats received the combination of MPLA and peroxidoxin. The administration was subcutaneously at the dorsal region, three times (days 0, 7, 14 of pregnancy). On day 21 of pregnancy, all rats were bled for biochemical and immunological measurements. The gravid uterus was weighed with its contents, and the fetuses were analyzed. The immunization with peroxidoxin induced a significant production of circulating IgG levels compared to other groups but caused a significant in post-implantation loss (14.7%) when compared to Control (5.0%) and Adjuvant (4.4%) groups. Furthermore, a significantly high rate of fetal visceral anomalies, such as hydronephrosis and convoluted ureter, was also observed in animals that received vaccine when compared to Control or Adjuvant groups. These data indicate the importance of safety evaluation of vaccines during pregnancy and the limited use of peroxidoxin administration during pregnancy. More importantly, the safety monitoring of immunization with MPLA derived from Bordetella pertussis demonstrated no reproductive outcomes associated with adjuvant administration, suggesting its safe use during pregnancy.