Manganese Associated with Non-Wilsonian Hepatolenticular Degeneration as a Rare Cause of Encephalopathy: Case Report

Aim: To describe the clinical picture, diagnosis, and treatment of a patient with encephalopathy as a manifestation of manganese-induced non-Wilsonian hepatolenticular degeneration (NWHD) in a high-complexity care center in a Latin American country. Case description: A 55-year-old male patient from the United States with a history of liver disease associated with alcohol consumption was admitted to the emergency department due to diarrhea, hematemesis, and psychomotor agitation. During his stay, his state of consciousness deteriorated, requiring orotracheal intubation. In his diagnostic study, cerebrospinal fluid tests were negative for infectious etiologies; the endoscopic examinations showed no marks of portal hypertension bleeding, while ammonium and tests for metabolic causes were normal. However, areas of hyperintensity in the basal ganglia were documented on brain MRI, with normal ceruloplasmin serum and urine copper levels, which ruled out Wilson's disease and determined the diagnosis of manganese-induced NWHD. Conclusion: NWHD is a rare cause of chronic encephalopathy with clinical manifestations of extrapyramidal symptoms secondary to basal ganglia dysfunction due to severe liver disease. Its diagnosis becomes a challenge, given that manganese deposits produce it, and no biomarkers can establish the level of exposure to this metal. Brain MRI is indispensable in reflecting these deposits in the basal ganglia.

Objetivo: Describir la presentación clínica, el diagnóstico y el tratamiento de un paciente con encefalopatía como manifestación de degeneración hepatolenticular no wilsoniana producida por manganeso, en un centro de alta complejidad de un país latinoamericano. Descripción del caso: Paciente masculino de 55 años, procedente de Estados Unidos, con antecedente de enfermedad hepática asociada con consumo de alcohol, quien ingresó al servicio de urgencias por un cuadro de diarrea, hematemesis y agitación psicomotora. Durante la estancia presentó deterioro en el estado de consciencia, por lo que requirió intubación orotraqueal. En su estudio diagnóstico, las pruebas de líquido cefalorraquídeo fueron negativas para etiologías infecciosas, en los estudios endoscópicos no tenía estigmas de sangrado portal hipertensivo y el amonio y los estudios para causas metabólicas fueron normales. Sin embargo, se documentaron áreas de hiperintensidad en los ganglios de la base en la resonancia magnética cerebral, con niveles de ceruloplasmina sérica y cobre urinario normales, lo que descartó enfermedad de Wilson y definió el diagnóstico de degeneración hepatolenticular no wilsoniana por depósitos de manganeso. Conclusión: La degeneración hepatolenticular no wilsoniana es una causa infrecuente de encefalopatía crónica con manifestaciones clínicas de extrapiramidalismo, secundaria a disfunción de los ganglios de la base por enfermedad hepática grave. Su diagnóstico se convierte en un reto, dado que se produce por depósitos de manganeso y no existen biomarcadores que puedan establecer el nivel de exposición a este metal. La resonancia magnética cerebral juega, por tanto, un papel indispensable al reflejar esos depósitos en los ganglios de la base.

The Influence of Sociocultural Beliefs on Adolescents' Moral and Tolerance Evaluations Toward Corruption.

In the present research, we examine how sociocultural beliefs facilitate more positive and tolerant evaluations toward corruption. Ninety-six adolescents from 6th grade (M = 11.9 years), 11th grade (M = 16.6 years), and college (M = 20.5 years), from Colombia-a country with high levels of corruption-evaluated how morally right and acceptable were bribery and nepotism across a baseline condition without sociocultural information, and three experimental conditions including sociocultural beliefs about illegality, institutional illegitimacy, and survival. Results suggest that compared to the baseline, the sociocultural beliefs in the three experimental conditions lead to more positive and tolerant evaluations, and less severity and more acceptability towards corruption in different degrees. Implications for moral reasoning about corruption are discussed.

Hate: Toward understanding its distinctive features across interpersonal and intergroup targets.

Is hate fundamentally different from other negative emotions? Despite a fair amount of theorizing about hate, there is little empirical evidence that helps to answer this basic question. The present research examines how people construe interpersonal and intergroup hate and provides an empirical analysis of how hate is conceptually different from dislike, anger, contempt, and disgust. In five preregistered studies, using exploratory (Pilot Study) and confirmatory (Studies 1, and 2a through 2c) within-subjects designs, we asked adult participants in the United States (Ntotal = 1,074) to describe examples of their interpersonal and intergroup targets of hate, dislike, anger, contempt, and disgust. We assessed their subjective experiences of each emotion by measuring the associated intensity, duration, arousal, valence, perceived threats, and action tendencies. Across studies, results revealed that participants feel consistently more emotionally aroused, personally threatened, and inclined toward attack-oriented behaviors when experiencing hate as compared with dislike, anger, contempt and disgust toward interpersonal targets. At the intergroup level, results revealed that participants experience hate as more arousing than the three moral emotions, more intense than dislike, anger and contempt, and feel more inclined toward attack-oriented behaviors than when they feel dislike and contempt. Results are in line with a general pattern of increasing differentiation suggesting that hate is conceptually closer to disgust and contempt than to anger and dislike. We discuss the specific differences and similarities between hate and these emotions across targets and their implications for future research on hate and negative emotions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Detection and analysis of COVID-19 in medical images using deep learning techniques.

The main purpose of this work is to investigate and compare several deep learning enhanced techniques applied to X-ray and CT-scan medical images for the detection of COVID-19. In this paper, we used four powerful pre-trained CNN models, VGG16, DenseNet121, ResNet50,and ResNet152, for the COVID-19 CT-scan binary classification task. The proposed Fast.AI ResNet framework was designed to find out the best architecture, pre-processing, and training parameters for the models largely automatically. The accuracy and F1-score were both above 96% in the diagnosis of COVID-19 using CT-scan images. In addition, we applied transfer learning techniques to overcome the insufficient data and to improve the training time. The binary and multi-class classification of X-ray images tasks were performed by utilizing enhanced VGG16 deep transfer learning architecture. High accuracy of 99% was achieved by enhanced VGG16 in the detection of X-ray images from COVID-19 and pneumonia. The accuracy and validity of the algorithms were assessed on X-ray and CT-scan well-known public datasets. The proposed methods have better results for COVID-19 diagnosis than other related in literature. In our opinion, our work can help virologists and radiologists to make a better and faster diagnosis in the struggle against the outbreak of COVID-19.

Uso da matriz derivada do esmalte (mde) associada ao vidro bioativo no tratamento de defeitos infra-ósseos: uma revisão de literatura / Use of enamel matrix derivate (EMD) associated with bioactive glass in the treatment of intraosseous defects: A Literature Review

A regeneração periodontal tem como objetivo recuperar as estruturas perdidas (osso alveolar, cemento e ligamento periodontal) como sequelas da doença periodontal. O conhecimento da Matriz Derivada do Esmalte (MDE) tem na literatura uma ampla aplicação, porém sua relação direta associada aos vidros bioativos é pouco caracterizada em todas suas vias, nesse contexto este estudo teve como proposta baseada numa revisão literária por meio de bases de dados (Pubmed, Scielo, lilacs), discutir aspectos importantes sobre a avaliação da efetividade clínica do vidro bioativo em combinação com a MDE (Emdogain) principalmente em defeitos infra-ósseos. O Emdogain (EMD) sozinho ou em associação a outros biomaterais de enxertia parece promover ganhos na regeneração tecidual de tecidos perdidos pela periodontite, porém sua associação tem-se poucos resultados significativos que justifiquem sua ampla utilização, sua indicação deve estar baseada em um bom diagnóstico periodontal e da morfologia do defeito infraósseo. Assim, tornam-se necessários mais estudos para elucidar interações e mecanismos celulares envolvidos no complexo de ação para justificar o seu uso.(AU)

Periodontal regeneration aims to recover the lost structures (alveolar bone, cementum and periodontal ligament) as sequelae of periodontal disease. The knowledge derived from the enamel matrix (EMD) is in the literature a wide application, but its direct relationship associated with bioactive glass is poorly characterized in all its way in this context this study was proposed based on a literature review through databases (Pubmed, Scielo, lilacs), discuss important aspects of the evaluation of the clinical effectiveness of bioactive glass in combination with EMD (Emdogain) mainly intraosseous defects.Emdogain (EMD) alone or in association with other biomaterials of grafting appears to promote gains in the tissue regeneration of lost tissues by periodontitis, but its association has few significant results that justify its wide use, its indication must be based on a good periodontal diagnosis and infraosseous defect morphology. Thus, further studies are needed to elucidate interactions and cellular mechanisms involved in the action complex to justify its use.(AU)

Tratamento de recessão gengival com utilização da técnica de tunelização associada ao enxerto conjuntivo subepitelial ­ controle clínico de seis anos / Treatment of gingival recession with the tunneling technique and the subepithelial connective tissue graft ­ a 6-year clinical follow-up

O recobrimento radicular é indicado por razões estéticas, para reduzir a hipersensibilidade de raiz e para criar ou aumentar tecido queratinizado. Várias técnicas cirúrgicas têm sido descritas, com a decisão dependendo de parâmetros clínicos anatômicos e técnicos. A principal meta terapêutica é alcançar uma cobertura completa da raiz com um resultado estético satisfatório. Uma abordagem previsível para o recobrimento radicular é a técnica de tunelização associada ao enxerto de tecido conjuntivo subepitelial, matriz dérmica acelular (MDA) ou outros biomateriais. Neste relato de caso com controle clínico de seis anos foi realizada a recuperação do tecido gengival perdido na região do dente 13, com o uso de uma técnica minimamente invasiva: a técnica de túnel associado ao enxerto de tecido conjuntivo subepitelial. Esta associação resultou em um importante ganho de inserção e, além do recobrimento radicular, foram melhoradas a hipersensibilidade e a estética na região.

The root coverage is indicated for aesthetic reasons, to reduce root hypersensitivity and to create or to increase keratinized tissue. Several surgical techniques have been described, with the decision depending on anatomical clinical and technical parameters. The main therapeutic goal is to achieve full coverage of the root with a satisfactory cosmetic result. A predictable approach to root coverage is a tunneling technique associated with subpeithelial connective tissue graft, acellular dermal matrix (ADM) or other biomaterials. In this case report with a 6-year clinical follow-up, the gingival tissue lost at the tooth 13 region was recovered using a minimally invasive technique (tunneling + subepithelial connective tissue graft). This association contributed to a signifi cant attachment level recovery and, besides root coverage, hypersensitivity and esthetics were improved in the operated site.

Standardization of Serum Creatinine Levels in Healthy Dogs Related to Body Weight at the South Valley of Aburra, Colombia / Estandarización de los valores séricos de creatinina en perros sanos con relación al peso corporal en el sur del Valle de Aburra / Padronização de creatinina sérica em cães saudáveis em relação ao peso corporal, no sul do Vale do Aburrá

Currently there are no serum creatinine reference values in Colombia for healthy dogs related to body weight; there are only available foreign studies. The objective was to determine serum creatinine values in healthy dogs related to body weight at the South Valley of Aburra. There were sampled 320 healthy dogs and divided into three groups related to the body weight according to the Kennel Club classification as follows: 1-10 kg, 11-25 kg and over 25 kg. In order to determine their health status, their medical records were revised and a complete physical examination was performed. Subsequently, a blood sample was taken to measure the creatinine levels. Statistically significant differences were found (p<0.05) among the three groups. This article presents evidence to classify serum creatinine values related to body weight in dogs, which could allow veterinarians to have a better reference value for assessing kidney function.

Actualmente no se cuenta con valores de referencia de creatinina sérica en Colombia en caninos sanos con relación al peso corporal. Solo se tienen los estudios foráneos. El objetivo central fue determinar los valores séricos de creatinina en perros sanos según el peso corporal en el sur del Valle de Aburrá. Se muestrearon 320 perros clínicamente sanos, los cuales se dividieron en tres grupos según el peso corporal de acuerdo con la clasificación del Kennel Club, 1-10 kg, 11-25 kg y mayores de 25 kg. Se realizó análisis de la historia clínica y un examen físico completo para determinar su estado de salud. Posteriormente, se tomó la muestra de sangre para la medición de creatinina. Se encontraron diferencias estadísticas significativas (p < 0,05) entre los tres grupos. Este artículo presenta evidencia para clasificar los valores de creatinina sérica según el peso corporal, lo que permite a los médicos veterinarios tener un mejor referente para la evaluación de la función renal.

A medição da creatinina sérica é um dos parâmetros atualmente utilizados na prática clínica pra avaliar a função renal em cães, isto é possível já que a creatinina é um componente do metabolismo muscular a qual é filtrada livremente pelos glomérulos, permitindo deste jeito estabelecer de forma geral a taxa de filtração glomerular e assim mesmo a da função renal. Atualmente não há valores de referência pra creatinina sérica na Colômbia em cães saudáveis em relação ao peso corporal, só ha estudos estrangeiros. Objetivo: Determinar os valores séricos de creatinina em cães saudáveis segundo seu peso corporal no Sul do Valle do Aburra. Foram amostrados 320 cães saudáveis, os quais foram divididos em três grupos, segundo o peso corporal de acordo com a classificação do Kennel Club, 1-10 kg, 11-25 kg e mais de 25 kg. Foi realizada a análise da história clínica e um exame físico completo para determinar seu estado de saúde; em seguida, tomou-se a amostra de sangue para a medição da creatinina. Foram encontradas diferenças estatisticamente significativas (p < 0,05) entre os três grupos. Este artigo apresenta evidências para classificar valores de creatinina sérica segundo o peso corporal, o que poderia permitir aos médicos veterinários ter uma melhor referência ao avaliar a função renal.