Search

Abstract Citizen science data on biodiversity has experienced significant growth, largely driven by advancements in technology that facilitate data sharing. In recent years, mobile applications have provided a substantial boost to both the collection and sharing of this data. While this accessible information is undoubtedly valuable, we must consider the numerous biases present in this data when used for high-quality research. In this study, we analyse citizen science data for the birds of the Iberian Peninsula, comprising over 23 million unique records after filtering for duplicates (i.e., instances where the same observation was uploaded more than once). Using a 10 × 10 km square grid, we present information on well-surveyed cells (completeness) as well as temporal, taxonomic, geographical, and land use coverages. We found that the completeness of information is generally high, with better coverage around densely populated areas such as major cities and coastal regions, as well as popular birding destinations, which are frequently visited. The Mediterranean ecoregion and wetlands exhibit the highest levels of surveying. Furthermore, we observed an increase in temporal coverage since the 1980s and broad taxonomic coverage across all bird orders in the Iberian region. Our results underscore the utility of citizen science for many locations, as expressed in 10 × 10 km cells. However, they also highlight the inadequate data completeness across part of the territory, particularly in forested or sparsely inhabited areas. These findings not only identify cells suitable for bird diversity or conservation studies but also indicate areas where citizen-driven bird recording efforts should be encouraged.

ABSTRACT Objective While weight status and clinical laboratory measures are important in assessing obesity‐related disease severity and chronic disease risk, including a broader range of emotional, psychosocial, and behavioral factors would provide greater context of an individual's overall state of wellness and could be used to better guide treatment decisions. The purpose of this research was to develop a comprehensive Lifestyle Wellness assessment for use in lifestyle‐based wellness interventions and programs. Methods A cross‐sectional exploratory factor analysis (EFA) was conducted using baseline data from N = 138 adults participating in behavioral weight loss trials. An unweighted least squares extraction method with oblique rotation was used. Twenty‐one putative measures spanning constructs related to metabolic health, emotional health/wellbeing, body weight and composition, diet quality, and fitness were analyzed for retention. Results Mean body mass index (BMI) was 38.0 ± 6.6 kg/m2, mean age was 57.3 ± 11.1 years, and 77.5% of participants were female. The EFA produced a five‐factor model with 13 items that explained 80.3% of the variance. The retained factors included: (1) Psychosocial State: mindfulness, resilience, quality of life, and happiness; (2) Blood Pressure State: systolic and diastolic blood pressure; (3) Lipid State: total cholesterol and LDL‐cholesterol; (4) Fitness State: grip strength, jump height, and percent body fat; and (5) Body State: BMI and waist circumference. Conclusions Lifestyle Wellness is a comprehensive assessment that enables innovative wellness‐related research such as metabolically healthy obese phenotypes and weight‐neutral interventions. Future research should include investigations in additional populations with greater age, sex/gender, and body size diversity.

Abstract Brillouin Optical Time-Domain Analysis (BOTDA) is a widely-used distributed optical fiber sensing technology employing pulse-modulated pump waves for local information retrieval of the Brillouin gain or loss spectra. The spatial resolution of BOTDA systems is intrinsically linked to pulse duration, so high-resolution measurements demand high electronic bandwidths inversely proportional to the resolution. This paper introduces Brillouin Expanded Time-Domain Analysis (BETDA) as a modified BOTDA system, simultaneously achieving high spatial resolution and low detection bandwidth. Utilizing two optical frequency combs (OFCs) with different frequency intervals as pump and probe, local Brillouin gain spectra are recorded by their spectral beating traces in an expanded time domain. A 2-cm-long hotspot located in a 230 m single-mode fiber is successfully measured in the time domain with a detection bandwidth of less than 100 kHz using dual OFCs with tailored spectral phase, line spacing, and bandwidth.

On 5 August 2022, the European Commission adopted the Regulation (EU) 2022/1369 on coordinated demand reduction measures for gas to decrease, on a voluntary basis, 15 % the gas consumption in the European Union (EU) over the period 1 August 2022 – 31 March 2023 compared to the previous five years. In 2023, the prolongation of this regulation was proposed until 31 March 2024 in order to save gas, facilitate the refilling of storages during the summer, and avoid exhaustion at the end of next winter. Thus, there is a need to monitor as closely as possible the natural gas consumption in the EU and keep track of the accumulated demand reduction for natural gas. However, the most up-to-date figures from the statistical office of the EU (Eurostat) are provided with a delay of one to two months and with coarse granularity (monthly). This paper (i) proposes a methodology to estimate the EU natural gas consumption with daily granularity, and (ii) presents two applications for monitoring the gas demand reduction with coarser granularity (weekly and monthly). The methodology, benchmark, and applications exclusively rely on publicly available sources such as Eurostat, the transparency platforms from the European Network of Transmission System Operators for Gas (ENTSOG), Gas Infrastructure Europe (GIE), as well as ENaGaD. ENaGaD is the in-house Joint Research Centre’s database of time series of natural gas consumption of the EU Member States.

Caminar es una tarea extraordinariamente compleja que requiere la intervención de todo el sistema nervioso, viéndose afectada por diversas patologías neurológicas. Los exoesqueletos de rehabilitación de la marcha actuales, aunque potencialmente evidencian una mejora tras la rehabilitación, aún no han mostrado su superioridad terapéutica respecto a la terapia convencional de manera concluyente. Además, los dispositivos robóticos y exoesqueletos de rehabilitación de la marcha actuales no permiten entrenar específicamente la transferencia de peso o requieren de un buen estado funcional para ser utilizados. En este artículo se presenta el modelo conceptual de un sistema robótico ambulatorio acoplado al exoesqueleto Exo-H3 para la rehabilitación de la marcha implementando estrategias de aprendizaje por refuerzo. Se espera que este sistema favorezca la plasticidad neuronal al aportar mayor libertad al usuario para explorar nuevos patrones de movimiento y aumentar su control motor voluntario y su participación activa, mientras el exoesqueleto se adapta y garantiza su equilibrio y estabilidad. Los pasos futuros contemplan el diseño y la fabricación de cada uno de los subsistemas robóticos, validando su funcionamiento individual y en conjunto, con la participación de sujetos sanos y patológicos.

Summary: Granulomatous-lymphocytic interstitial lung disease (GLILD) is a lymphoproliferative and granulomatous pulmonary manifestation of primary immune deficiency diseases, notably common variable immunodeficiency (CVID), and is an important contributor of excess morbidity. As with all forms of ILD, the significance of utilizing a multidisciplinary team discussion to enhance diagnostic and treatment confidence of GLILD cannot be overstated. In this review, key clinical, radiological, and pathological features are integrated into a diagnostic algorithm to facilitate a consensus diagnosis. As the evidence for diagnosing and managing patients with GLILD is limited, the viewpoints discussed here are not meant to resolve current controversies. Instead, this review aims to provide a practical framework for diagnosing and evaluating suspected cases and emphasizes the importance of a multidisciplinary approach when caring for GLILD patients.

Abstract Background Mammals are subject to circadian rhythms for the control of various physiological events. One of the parameters known to be subject to variations throughout the day is body temperature, which is also subject to influences such as environmental temperature. However, there are not many studies on these rhythms in breeding sows. The aim of this study was to determine the circadian parameters for body temperature in post-weaning sows during oestrus period, throughout the seasons in a warm climate. Results Differences were observed in inter-daily stability, intra-daily fragmentation and cycle length comparing the summer sows with the other seasons. Differences were also observed in the period that the sows were in oestrus compared to the non-oestrus period for intra-daily fragmentation, with these differences being more important in the warm seasons compared to the cold seasons. The parameters normalised by COSINOR also showed significant differences when comparing seasons, especially in the acrophase of the temperature maximum. Another significant finding was an increase in vaginal temperature during oestrus in sows monitored in summer compared to the other seasons. Correlations between body, vaginal and environmental temperature were observed. Conclusion There is a seasonal influence on the circadian rhythm of temperature and summer is clearly the season with the greatest differences in circadian parameters when compared to the other seasons. The extreme summer conditions seem to definitely influence this rhythm and make the body and vaginal temperature of the sows different from the rest of the year. The increase in period robustness in both body and vaginal temperature during the days when sows are in oestrus could be related to the hormonal events of oestrus and ovulation and seems to be independent of weather since it occurs in all controlled seasons. However, this robustness is significantly higher in summer than in the other seasons both in the oestrus period and on days when sows are not in oestrus.

In this paper, a thermoelastic problem involving a viscous strain gradient beam is considered from the analytical and numerical points of view. The so-called type Ⅱ thermal law is used to model the heat conduction and two possible dissipation mechanisms are introduced in the mechanical part, which is considered for the first time within strain gradient theory. An existence and uniqueness result is proved by using semigroup arguments, and the exponential energy decay is obtained. The lack of differentiability for the semigroup of contractions is also shown. Then, fully discrete approximations are introduced by using the finite element method and the backward time scheme, for which a discrete stability property and a priori error estimates are proved. The linear convergence is derived under suitable additional regularity conditions. Finally, some numerical simulations are presented to demonstrate the accuracy of the approximations and the behavior of the discrete energy decay.

Abstract Background Dyspnea impairs quality of life (QOL) in patients with fibrotic hypersensitivity pneumonitis (FHP). The Living with Pulmonary Fibrosis questionnaire (L-PF) assesses symptoms, their impacts and PF-related QOL in patients with any form of PF. Its scores have not undergone validation analyses in an FHP cohort. Methods We used data from the Pirfenidone in FHP trial to examine reliability, validity and responsiveness of the L-PF-35 Dyspnea domain score (Dyspnea) and to estimate its meaningful within-patient change (MWPC) threshold for worsening. Lack of suitable anchors precluded conducting analyses for other L-PF-35 scores. Results At baseline, Dyspnea’s internal consistency (Cronbach’s coefficient alpha) was 0.85; there were significant correlations with all four anchors (University of California San Diego Shortness of Breath Questionnaire scores r = 0.81, St. George’s Activity domain score r = 0.82, percent predicted forced vital capacity r = 0.37, and percent predicted diffusing capacity of the lung for carbon monoxide r = 0.37). Dyspnea was significantly different between anchor subgroups (e.g., lowest percent predicted forced vital capacity (FVC%) vs. highest, 33.5 ± 18.5 vs. 11.1 ± 9.8, p = 0.01). There were significant correlations between changes in Dyspnea and changes in anchor scores at all trial time points. Longitudinal models further confirmed responsiveness. The MWPC threshold estimate for worsening was 6.6 points (range 5–8). Conclusion The L-PF-35 Dyspnea domain appears to possess acceptable psychometric properties for assessing dyspnea in patients with FHP. Because instrument validation is never accomplished with one study, additional research is needed to build on the foundation these analyses provide. Trial registration The data for the analyses presented in this manuscript were generated in a trial registered on ClinicalTrials.gov; the identifier was NCT02958917.

Introduction and aim: Hepatocellular carcinoma (HCC) is the third most frequent cancer of digestive tract tumors in Peru, with a high mortality rate of 17.7 per 100,000 inhabitants. A significant number of HCC cases in Peru do not follow the classic clinical epidemiology of the disease described in other parts of the world. Those patients present with a distinct transcriptome profile and a singular tumor process, suggesting a particular type of hepatocarcinogenesis in a portion of the Peruvian population. Our aim was to understand the clinical and biologic involvement of the epigenetic profile (methylation) and gene expression (transcriptome) of HCC in Peruvian patients. Methods: HCC and liver transcriptome and DNA methylation profiles were evaluated in 74 Peruvian patients. Results: When grouped by age, there was greater DNA methylation in younger patients with HCC but no differences with respect to the transcriptomic profile. A high prevalence of the hepatitis B virus (HBV) (>90%) was also observed in the younger patients with HCC. Enrichment analyses in both molecular profiles pinpointed PRC2 as an important molecular effector of that liver tumor process in Peruvian patients. Conclusion: HCC in Peruvian patients has a unique molecular profile, associated with the presence of HBV, as well as overall DNA hypermethylation related to undifferentiated liver cells or cellular reprogramming. Resumen: Introducción: En Perú, el carcinoma hepatocelular (CHC) ocupa el tercer lugar en incidencia entre los tumores del sistema digestivo, y tiene una alta tasa de mortalidad, 17.7 por 100 000 habitantes. La mayoría de los casos reportados no presentan la epidemiología clínica clásica del CHC observado en otras partes del mundo. Además, se ha identificado que estos pacientes presentan un perfil transcriptómico distinto y un proceso tumoral singular, sugiriendo un proceso particular de hepatocarcinogénesis en una fracción de la población peruana. Objetivo: El presente estudio busca comprender la implicancia clínica y biológica del perfil epigenético (metilación) y de expresión de los genes (transcriptómico) del CHC en los pacientes peruanos. Métodos: Se evaluó el perfil de transcriptómico y de metilación de ADN de hígado y CHC en 74 pacientes peruanos. Resultados: El agrupamiento por edades mostró una mayor metilación del ADN en los pacientes jóvenes con CHC, en contraste no se observaron diferencias en el perfil transcriptómico. Adicionalmente, también se evidenció una alta prevalencia del virus de la hepatitis B (VHB) (>90%) en los pacientes jóvenes con CHC. El análisis de enriquecimiento en ambos perfiles moleculares demostró que PRC2 es posiblemente uno de los principales actores moleculares en este proceso tumoral hepático en pacientes peruanos. Conclusión: El CHC peruano presenta un perfil molecular único, asociado a la presencia del VHB, y con una hipermetilación global del ADN asociado a células hepáticas indiferenciadas o a una reprogramación celular.

Primary Processed Foods are a class of food items that are ready for consumption after minimal processing in the supply chain. These products are ubiquitous in our daily diet, but so far a limited number of studies dealt with the optimization of quality control methods to check their content of contaminants. Among primary processed foods, bee pollen is a nutritionally acclaimed food supplement, whose contamination with pesticides and mycotoxins has been largely proven. For this reason, the present study aimed at optimizing for the first time a comprehensive LC-MS/MS method capable of analyzing 282 pesticides and 8 mycotoxins in bee pollen. To obtain a suitable method, two extraction procedures (QuEChERS and Accelerated Solvent Extraction), as well as different chromatographic gradients and columns, were tested. The optimized methodology, comprehending an extraction based on semi-automated QuEChERS, and an analytical method including inert LC column technology, was validated and applied to a sample set of 34 bee pollens. The analyzed samples collectively showed the presence of 41 pesticides and 1 mycotoxin.

Resumen: Antecedentes y objetivo: No se dispone de datos españoles sobre el coste asociado al linfoma cutáneo de células T (LCCT). Además, la incorporación de nuevos tratamientos hace necesario analizar el coste real de la enfermedad. El estudio MICADOS analizó dos objetivos principales: Por un lado, evaluó el impacto en la calidad de vida en los pacientes con LCCT, y por otro lado, estudió los costes de la enfermedad. En esta publicación se recoge el segundo de los objetivos del estudio. Métodos: El coste de la enfermedad se estudió bajo la perspectiva del Sistema Nacional de Salud (SNS) con un horizonte temporal de un año. Participaron 23 dermatólogos y hematólogos de 15 hospitales públicos españoles. Se incluyeron pacientes adultos con LCCT del tipo micosis fungoide (MF) y síndrome de Sézary (SS). Resultados: Se incluyeron 141 pacientes, el 57,4% masculinos, con una edad media de 63,6 años (IC 95%: 61,4-65,7). Los costes directos anuales medios por pacientes del estudio fueron de 34.214€, siendo de 11.952,47€ en estadio I, 23.506,21€ en estadio II, 38.771,81€ en estadio III y 72.748,84€ en estadio IV. El coste anual directo total estimado de todos los pacientes en España con MF/SS resultó en 78.301.171€, donde el 81% de los costes fueron atribuibles a pacientes en estadio I, el 7% al estadio II, el 6% al estadio III y el 6% al estadio IV. Conclusiones: Este estudio ofrece una evaluación precisa del coste directo del LCCT en pacientes con MF/SS en España, mostrando costes que varían sustancialmente en función del estadio. Los costes soportados por el paciente y los costes indirectos deberán considerarse en futuras investigaciones. Abstract: Background and objective: The cost of treating cutaneous T-cell lymphoma (CTCL) in Spain is unknown. With the advent of new treatments, it is more important than ever to gain an accurate picture of the true costs involved. The MICADOS study had 2 primary objectives: 1) to evaluate the impact of CTCL on patient quality of life, and 2) to evaluate the costs associated with the disease. This article reports the results of the cost analysis. Methods: We estimated the cost of treating CTCL over a period of 1 year from the perspective of the Spanish National Health System. Twenty-three dermatologists and hematologists from 15 public hospitals analyzed data for adult patients with mycosis fungoides (MF) or Sézary syndrome (SS). Results: A total of 141 patients (57.4% male) with a mean age of 63.6 years (95% CI: 61.4-65.7 years) were included. The mean direct annual cost of treating CTCL was €34,214 per patient. The corresponding costs by stage were €11,952.47 for stage I disease, €23,506.21 for stage II disease, €38,771.81 for stage III disease, and €72,748.84 for stage IV disease. The total direct annual cost of treating MF/SS in public hospitals in Spain was estimated at €78,301,171; stage I disease accounted for 81% of all costs, stage II for 7%, and stages III and IV for 6% each. Conclusions: The MICADOS study offers an accurate picture of the direct cost of treating CTCL in patients with MF/SS in Spain and shows that costs vary significantly according to disease stage. Patient-borne and indirect costs should be analyzed in future studies.

Wave–current ripples that develop on seabeds of mixed non-cohesive sand and cohesive clay are commonplace in coastal and estuarine environments. While laboratory research on ripples forming in these types of mixed-bed environments is relatively limited, it has identified deep cleaning, the removal of clay below the ripple troughs, as an important factor controlling ripple development. New large-scale flume experiments seek to address this sparsity in data by considering two wave–current conditions with initial clay content, C0, ranging from 0 % to 18.3 %. The experiments record ripple development and pre- and post-experiment bed clay contents to quantify clay winnowing. The present experiments are combined with previous wave-only, wave–current, and current-only experiments to produce a consistent picture of larger and smaller flatter ripples over a range of wave–current conditions and C0. Specifically, the results reveal a sudden decrease in the ripple steepness for C0 > 10.6 %, likely associated with a decrease in hydraulic conductivity of 3 orders of magnitude. Accompanying the sudden change in steepness is a gradual linear decrease in wavelength with C0 for C0 > 7.4 %. Ultimately, for the highest values of C0, the bed remains flat, but clay winnowing still takes place, albeit at a rate 2 orders of magnitude lower than for rippled beds. For a given flow, the initiation time, when ripples first appear on a flat bed, increases with increasing C0. This, together with the fact that the bed remains flat for the highest values of C0, demonstrates that the threshold of motion increases with C0. The inferred threshold enhancement, and the occurrence of large and small ripples, is used to construct a new three-dimensional phase diagram of bed characteristics involving the wave and current Shields parameters and C0, which has important implications for morphodynamic modelling.

Relearning to walk requires progressive training in real scenarios—overground—along with assistance in basic tasks, such as balancing. In addition, user ability must be maximized through compliant robotic assistance as needed. Despite decades of research, gait rehabilitation robotic devices yield controversial results. This article presents the conceptual design of a novel walking assistance and rehabilitation robot, the NIMBLE robot, aimed at providing ambulatory, bodyweight-supported gait training, assisting the user’s center of mass trajectory to aid weight transfer and dynamic balance during walking. NIMBLE consists of a robotic mobile frame, a partial bodyweight support (PBWS) system, an ambulatory lower-limb exoskeleton (Exo-H3) and a cable-driven pelvis-assisting robot. Designed as a modular structure, it differentiates hierarchical communication levels through a Robot Operating System (ROS) 2 network. We present the mechatronic design and experimental results assessing the impact of the mechatronic coupling between the robotic modules on the walking kinematics and the frame movement control performance. The robotic frame hardly affects the walking kinematics up to 2 degrees in both the sagittal and frontal planes, making it feasible for lateral balance and weight translation training. Moreover, it successfully tracks and follows user trajectories. The NIMBLE robotic frame assessment shows promising results for ambulatory gait rehabilitation.

Maize, a globally significant cereal, is increasingly cultivated under challenging environmental conditions, necessitating innovations in sustainable agriculture. This study evaluates the synergistic effects of a novel technique combining a Bacillus velezensis A6 strain with a plant extract from the Lamiales order on maize growth and stress resilience. Employing a pilot field trial, this study was conducted on the “La Añoreta” experimental farm of the ECONATUR group, where various biostimulant treatments, including bacterial and plant extract applications, were tested against a control group. The treatments were applied during key vegetative growth stages (V10-Tenth-Leaf, VT-Tassel, R1-Silking) and monitored for effects on plant height, biomass, and fumonisin content. The results suggest that the combined treatment of Bacillus velezensis A6 and the plant extract increases maize height (32.87%) and yield (62.93%) and also reduces fumonisin concentrations, improving its resistance to stress, compared to the control and other treatments. This study highlights the potential of microbial and botanical biostimulants and its novel combination for improving crop productivity and sustainability, suggesting that such synergistic combinations could play a crucial role in enhancing agricultural resilience to environmental stresses.

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

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

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

Introduction The evolution of depression and dementia has been shown to differ in some studies. For example, a history of recent depression has been found to be associated with an increased risk of Alzheimer’s disease in women (Kim et al., 2021). Objectives We will use data collected from several dementia studies to analyze whether the presence of depression at diagnosis is more frequent in women. Methods We conducted a systematic search for articles analyzing the presence of depression in patients with a diagnosis of dementia. We analyzed by Student’s t test the presence of depression according to sex, considering the alternative hypothesis that there is more depression in female than male patients. Results The mean age of the sample was 71 years. We obtained a statistically significant Student’s t test (p=0.02). Conclusions The approach and approach to depression in the elderly as a risk factor could be different according to sex. For example, some studies have proposed the use of hormone replacement therapy (HRT) after menopause as a possible protective factor for the subsequent development of dementia (Kim et al., 2022). Further studies are recommended in this regard. Disclosure of Interest None Declared

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

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

Introduction Dementia is a syndrome of high prevalence and health impact. The Montreal Cognitive Assessment (MoCA) questionnaire is a screening tool whose use has increased in recent years, especially in cases of mild cognitive impairment. Some studies suggest that its ability to detect cognitive impairment, especially in early or mild stages, seems to be greater than gold-standard instruments (Ciesielska et al., 2016). Objectives We have performed a meta-analysis of reliability generalization to see if different adaptations and use in different contexts show consistent results. Methods We performed a literature search in PyscINFO and Medline with the terms “Cognitive impairment” AND “internal consistency” AND “Cronbach”, using the following inclusion criteria: 1. Be a study in which the MoCA scale was applied to a population sample. 2. Studies published in the last 10 years. 3. Studies that provide the reliability coefficient or sufficient data to calculate them. 4. Be written in English or Spanish. We have limited our study to the last 10 years and the English language has given us a total of 19 results in Medline and 132 results in PsycINFO. Subsequently, we completed this search by snowball sampling. A random effects model was assumed for the statistical calculations and the transformation of our values using the Hakstian and Whalen (1976) proposal. Statistical analysis was performed with the MAJOR package of the Janovi program, based on the R environment. Results We obtained a mean reliability for the transformed test scores of 0.42 (95% CI: 0.38 - 0.45), as well as high heterogeneity measured by Cochran’s Q statistic and the I2 index, which is attributed after analysis of moderating variables to the geographical adaptation of the questionnaire and the type of patient on whom it is applied. Our Funnel Plot graph indicates that we do not appear to have committed a publication bias. Conclusions Our meta-analysis shows high heterogeneity, mainly explained by the population of origin, both geographically (continent) and clinically (presence of primary cognitive impairment or not), with special incidence in those with impairment secondary to other pathologies, mainly neurological. However, we should consider the high probability that we have not included important variables in our analysis that could increase the explanatory power of our model. Disclosure of Interest None Declared

Background: Basal cell carcinoma (BCC) is the most prevalent cancer. A minority of BCCs have an aggressive behaviour (laBCC) and may require hedgehog pathway inhibitors such as sonidegib as its treatment. Objective: To describe the use of sonidegib in a large number of patients and provide more data on its real-life efficacy and safety profile. Methods: We conducted a retrospective and multicentric study that included patients treated with sonidegib. Epidemiological, effectiveness and safety data were collected. Results: A total of 82 patients with a mean age of 73.9 years were included. Ten patients had Gorlin syndrome. Median treatment duration was 6 months. Median follow-up duration was 34.2 months. Globally, 81.7% of the patients showed clinical improvement (52.4% partial response and 29.3% complete response), 12.2% clinical stability and 6.1% disease progression. There was no statistically significant difference in clinical improvement between the 24 h and 48 h sonidegib posology. After 6 months of treatment, 48.8% of the patients discontinued sonidegib. Prior vismodegib treatment and recurrent primary BCC were associated with a poorer response to sonidegib. At 6 months of treatment, 68.3% of the patients experienced at least one adverse effect. Conclusion: Sonidegib shows good effectiveness and acceptable safety profile in usual clinical practice. Resumen: Antecedentes: El carcinoma de células basales (CBC) es el cáncer más prevalente. Una minoría de CBC tiene un comportamiento agresivo (laBCC) y puede requerir inhibidores de la vía del erizo, como sonidegib como tratamiento. Objetivo: Describir el uso de sonidegib en un gran número de pacientes y aportar más datos sobre su perfil de eficacia y seguridad en la vida real. Métodos: Realizamos un estudio retrospectivo y multicéntrico que incluyó pacientes tratados con sonidegib. Se recogieron datos epidemiológicos, de eficacia y de seguridad. Resultados: Se incluyeron un total de 82 pacientes con una edad media de 73,9 años. Diez pacientes tenían síndrome de Gorlin. La mediana de duración del tratamiento fue de 6 meses. La mediana de duración del seguimiento fue de 34,2 meses. Globalmente, el 81,7% de los pacientes mostró mejoría clínica (52,4% respuesta parcial y 29,3% respuesta completa), el 12,2% estabilidad clínica y el 6,1% progresión de la enfermedad. No hubo diferencias estadísticamente significativas en la mejoría clínica entre la posología de sonidegib de 24 horas y de 48 horas. Después de 6 meses de tratamiento, el 48,8% de los pacientes suspendió sonidegib. El tratamiento previo con vismodegib y el CBC primario recurrente se asociaron con una peor respuesta a sonidegib. A los 6 meses de tratamiento el 68,3% de los pacientes experimentó al menos un efecto adverso. Conclusión: Sonidegib muestra un perfil de eficacia y seguridad mejor de lo esperado en la práctica clínica habitual.

Abstract Background The World Health Organisation (WHO) calls on stakeholders to give Higher Education a key educational importance for the future of Europe. Within the content of the training programmes at university, sexuality emerges as a relevant topic in the nursing degree, to promote integral health from a holistic perspective. However, research on the presence of sexuality at the curricular level in Higher Education suggests that it is incomplete and underdeveloped. Methods This is a protocol for a long-term, multi-centre, exploratory, descriptive, and cross-sectional study with a quantitative and qualitative approach lasting two years. The research will be carried out in the educational community, including, on the one hand, students, and professors and health professionals of nursing programmes from five universities in different parts of the world (Portugal, Spain, Italy, and the United States), and on the other hand, women, young people, and immigrants from these communities. The study will have several target populations. Firstly, the target is nursing students, with whom the aim is to define their perspective on the sexuality content taught at the university, and their level of knowledge. Secondly university professors and health professionals, with whom we will check their perspective on sexuality in the classroom, as well as their level of knowledge in this field. And finally, we will work with the community (women, young people, and immigrants) to whom we will try to bring sexuality from a useful and enjoyable perspective. In order to measure these variables in the protocol, instruments such as questionnaires and semi-structured interviews will be used. During data collection, ethical principles will be guaranteed and informed consent will be requested from the participants. Discussion The results of the research will have a high curricular impact on the educational community, and will last over time, since the tools generated in the project will be included as part of nursing training programmes. In addition, participation in the project will improve health education for health professionals and at the community level on sexuality in both urban and rural populations.

Este artículo reseña: Bertot Triana, Harold, Estudios sobre jurisprudencia de la Corte Interamericana de Derechos Humanos. Cavilaciones al hilo de temas actuales del Sistema Interamericano de Derechos Humanos, Editorial Olejnik, Santiago de Chile, 2023, 383 pp.

Background and objective: The cost of treating cutaneous T-cell lymphoma (CTCL) in Spain is unknown. With the advent of new treatments, it is more important than ever to gain an accurate picture of the true costs involved. The MICADOS study had 2 primary objectives: 1) to evaluate the impact of CTCL on patient quality of life, and 2) to evaluate the costs associated with the disease. This article reports the results of the cost analysis. Methods: We estimated the cost of treating CTCL over a period of 1 year from the perspective of the Spanish National Health System. Twenty-three dermatologists and hematologists from 15 public hospitals analyzed data for adult patients with mycosis fungoides (MF) or Sézary syndrome (SS). Results: A total of 141 patients (57.4% male) with a mean age of 63.6 years (95% CI: 61.4-65.7 years) were included. The mean direct annual cost of treating CTCL was €34,214 per patient. The corresponding costs by stage were €11,952.47 for stage I disease, €23,506.21 for stage II disease, €38,771.81 for stage III disease, and €72,748.84 for stage IV disease. The total direct annual cost of treating MF/SS in public hospitals in Spain was estimated at €78,301,171; stage I disease accounted for 81% of all costs, stage II for 7%, and stages III and IV for 6% each. Conclusions: The MICADOS study offers an accurate picture of the direct cost of treating CTCL in patients with MF/SS in Spain and shows that costs vary significantly according to disease stage. Patient-borne and indirect costs should be analyzed in future studies. Resumen: Antecedentes y objetivo: No se dispone de datos españoles sobre el coste asociado al linfoma cutáneo de células T (LCCT). Además, la incorporación de nuevos tratamientos hace necesario analizar el coste real de la enfermedad. El estudio MICADOS analizó dos objetivos principales: Por un lado, evaluó el impacto en la calidad de vida en los pacientes con LCCT, y por otro lado, estudió los costes de la enfermedad. En esta publicación se recoge el segundo de los objetivos del estudio. Métodos: El coste de la enfermedad se estudió bajo la perspectiva del Sistema Nacional de Salud (SNS) con un horizonte temporal de un año. Participaron 23 dermatólogos y hematólogos de 15 hospitales públicos españoles. Se incluyeron pacientes adultos con LCCT del tipo micosis fungoide (MF) y síndrome de Sézary (SS). Resultados: Se incluyeron 141 pacientes, el 57,4% masculinos, con una edad media de 63,6 años (IC 95%: 61,4-65,7). Los costes directos anuales medios por pacientes del estudio fueron de 34.214€, siendo de 11.952,47€ en estadio I, 23.506,21€ en estadio II, 38.771,81€ en estadio III y 72.748,84€ en estadio IV. El coste anual directo total estimado de todos los pacientes en España con MF/SS resultó en 78.301.171€, donde el 81% de los costes fueron atribuibles a pacientes en estadio I, el 7% al estadio II, el 6% al estadio III y el 6% al estadio IV. Conclusiones: Este estudio ofrece una evaluación precisa del coste directo del LCCT en pacientes con MF/SS en España, mostrando costes que varían sustancialmente en función del estadio. Los costes soportados por el paciente y los costes indirectos deberán considerarse en futuras investigaciones.