Computational simulation-based comparative analysis of standard 3D printing and conical nozzles for pneumatic and piston-driven bioprinting.

Bioprinting is an application of additive manufacturing that can deliver promising results in regenerative medicine. Hydrogels, as the most used materials in bioprinting, are experimentally analyzed to assure printability and suitability for cell culture. Besides hydrogel features, the inner geometry of the microextrusion head might have an equal impact not only on printability but also on cellular viability. In this regard, standard 3D printing nozzles have been widely studied to reduce inner pressure and get faster printings using highly viscous melted polymers. Computational fluid dynamics is a useful tool capable of simulating and predicting the hydrogel behavior when the extruder inner geometry is modified. Hence, the objective of this work is to comparatively study the performance of a standard 3D printing and conical nozzles in a microextrusion bioprinting process through computational simulation. Three bioprinting parameters, namely pressure, velocity, and shear stress, were calculated using the level-set method, considering a 22G conical tip and a 0.4 mm nozzle. Additionally, two microextrusion models, pneumatic and piston-driven, were simulated using dispensing pressure (15 kPa) and volumetric flow (10 mm3/s) as input, respectively. The results showed that the standard nozzle is suitable for bioprinting procedures. Specifically, the inner geometry of the nozzle increases the flow rate, while reducing the dispensing pressure and maintaining similar shear stress compared to the conical tip commonly used in bioprinting.

Not exodus, but population increase and gene flow restoration in Cantabrian brown bear (Ursus arctos) subpopulations. Comment on Gregório et al. 2020.

In a genetic study on brown bears (Ursus arctos) in the Cantabrian Mountains, Gregório et al. (2020) interpreted the asymmetrical gene flow they found from the eastern subpopulation towards the western one as an exodus of bears forced to flee from the eastern nucleus "with higher human disturbance and poaching", concluding that connectivity may be operating as a means for eastern Cantabrian bears to find more suitable territories. In this reply, we maintain that the explanations of Gregorio et al. contradict the source-sink theory and we also present demographic data not considered by these authors showing that the eastern subpopulation is not declining, but persistently increasing. After reviewing the demographic and genetic studies published during the last 20 years, we conclude that the connectivity between the two subpopulations is operating as a route which allows the regular movement of males and the restoration of the gene flow across the whole Cantabrian population.

Cryptic population structure reveals low dispersal in Iberian wolves.

Highly mobile mammalian carnivores are expected to have the capability to maintain high levels of gene flow across large geographic scales. Nonetheless, surprising levels of genetic structure have been found in many such populations. We combined genetic and spatial behavioural information from wolves (Canis lupus) in the Iberian Peninsula (Western Europe) during the last two decades to present a particular case of low dispersal levels in a large carnivore population persisting in human-dominated landscapes. We found an exceptionally reticulated pattern of cryptic population structure emerging at two hierarchical levels, in which four or eleven meaningful genetic clusters can be recognized, respectively. These clusters were characterized by moderate-high levels of differentiation (average pairwise FST = 0.09-0.19), low levels of admixture and varying degrees of genetic diversity. The number of dispersers identified among the 11 clusters was very low (<4% out of 218 wolves). Spatial information of tracked wolves further confirmed the geographical genetic patterns (only 2 out of 85 collared wolves overlapped with more than one genetic cluster). The high levels of genetic structure in this population may be determined by the recent demographic history of this population, among other factors. The identification of meaningful genetic clusters has implications for the delineation of conservation units and, consequently, on the conservation and management actions for Iberian wolves.

Caracterización epidemiológica, clínica y de laboratorio en pacientes positivos persistentes a COVID-19

Introducción: La COVID-19 es una preocupación mundial, requiere enfoque integral para reducir la transmisión, comenzando por la detección de casos, atención hospitalaria y seguimiento posterior. Objetivo: Caracterizar a pacientes positivos persistentes a COVID-19 en cuanto a epidemiología, clínica y datos de laboratorio. Métodos: Se realizó un estudio descriptivo transversal en 16 pacientes positivos persistentes a SARS-CoV-2 diagnosticados por RCP-TR en hisopado nasofaríngeo, en el Hospital Comandante Manuel Fajardo Rivero de Santa Clara en el período de septiembre 2020 a noviembre 2020. Resultados: Predominó el sexo femenino en un 75 %, el grupo de edad más representativo fue de 40-59 años de edad (68,75 %), el 37,50 % de los casos fueron asintomáticos y el síntoma más frecuente fue la fiebre menor de siete días 31,25 %. Existió linfopenia en el hemograma inicial con media en 27,49, índice neutrófilo leucocitario por encima de tres en cuatro pacientes con una media inicial 3,42. Estadía hospitalaria de 20,75 días de promedio. La mitad no tenía historia de enfermedad conocida, la comorbilidad más frecuente fue la hipertensión arterial 43,75 %. El índice neutrófilo leucocitario por encima de tres en pacientes con comorbilidades, evolutivo para todos menor de tres. Conclusiones: Predominó el sexo femenino, el grupo de edad más representativo fue de 40-59 años, es frecuente que se presenten asintomáticos y la fiebre fue el síntoma más usual. Existió linfopenia en el hemograma inicial. La mitad de los contagiados sin comorbilidades. El índice neutrófilo leucocitario evolutivo fue menor de tres para todos los pacientes.

Introduction: COVID-19 is a global concern, it requires a comprehensive approach to reduce transmission, starting with case detection, hospital care and subsequent follow-up. Objective: To characterize persistent COVID-19 positive patients in terms of epidemiology, clinical and laboratory data. Methods: A cross-sectional descriptive study was carried out in 16 persistent SARS-CoV-2 positive patients diagnosed by RT-CPR in nasopharyngeal swab, at Comandante Manuel Fajardo Rivero Hospital of Santa Clara in the period from September 2020 to November 2020. Results: The female sex predominated in 75%, the most representative age group was 40-59 years of age (68.75%), 37.50% of the cases were asymptomatic and the most frequent symptom was fever less than seven days 31.25%. There was lymphopenia in the initial hemogram with an average of 27.49, and a leukocyte neutrophil index above three in 4 patients with an initial average of 3.42. Hospital stay of 20.75 days on average. Half had no history of known disease, the most frequent comorbidity was arterial hypertension 43.75 %. The neutrophil leukocyte index above 3 in patients with comorbidities, evolutionary for all pariente was less than 3. Conclusions: The female sex predominates, the most representative age group is 40-59 years, it is frequent that they present asymptomatic and fever is the most usual symptom. There is lymphopenia on the initial blood count. Half of those infected without comorbidities. The evolutionary leukocyte neutrophil index was less than 3 for all patients.

Pioderma gangrenoso / Pyoderma gangrenosum

RESUMEN El pioderma gangrenoso (PG) es una enfermedad inflamatoria rara de causa desconocida, perteneciente al grupo de las dermatosis neutrofílicas, caracterizada por ulceraciones cutáneas dolorosas y recurrentes, asociada comúnmente con enfermedades autoinmunes o neoplasias, pero también aparece de forma independiente a estos trastornos. Existen varios subtipos: ulceroso o clásico, ampollar, pustuloso y vegetante. Se presenta una paciente femenina de 68 años de edad, con lesión ulcerosa cutánea, con cultivos bacteriológicos y micológicos negativos, biopsia cutánea que informó pioderma gangrenoso y exámenes complementarios para descartar enfermedades asociadas. No se evidenció asociación con enfermedades sistémicas.

ABSTRACT Pyoderma gangrenosum (PG) is a rare inflammatory disease of unknown cause, belonging to the group of neutrophilic dermatoses, characterized by painful and recurrent skin ulcerations and commonly associated with autoimmune diseases or neoplasms, although it can also occur independently of these disorders. Ulcerative or classic, bullous, pustular and vegetating forms are the different subtypes. We present a 68-year-old female patient with an ulcerative skin lesion, negative bacteriological and mycological cultures, a skin biopsy showing pyoderma gangrenosum and complementary examinations to rule out associated diseases. No association with systemic diseases was evidenced.

Recovery of large carnivores in Europe's modern human-dominated landscapes.

The conservation of large carnivores is a formidable challenge for biodiversity conservation. Using a data set on the past and current status of brown bears (Ursus arctos), Eurasian lynx (Lynx lynx), gray wolves (Canis lupus), and wolverines (Gulo gulo) in European countries, we show that roughly one-third of mainland Europe hosts at least one large carnivore species, with stable or increasing abundance in most cases in 21st-century records. The reasons for this overall conservation success include protective legislation, supportive public opinion, and a variety of practices making coexistence between large carnivores and people possible. The European situation reveals that large carnivores and people can share the same landscape.

Angioedema hereditario y embarazo / Hereditary angioedema and pregnancy

El angioedema hereditario es una enfermedad genética rara que se presenta en uno de cada 50 000 individuos, caracterizada por episodios de edema subcutáneo y submucoso. Las alteraciones hormonales pueden desencadenar una crisis y el embarazo afecta el número de los ataques. Se presentan dos casos clínicos de embarazadas con antecedentes personales de angioedema hereditario que presentaron crisis durante la gestación, el parto y el puerperio; las cuales evolucionaron de forma satisfactoria. Se realizó una revisión del tema(AU)

Hereditary angioedema is a rare genetic disease presenting in one out of every 50 000 individuals. The condition is characterized by episodes of subcutaneous and submucosal edema. Hormonal alterations may trigger a crisis and pregnancy affects the number of seizures. Two clinical cases are presented of pregnant women with a personal history of hereditary angioedema who had crises during pregnancy, delivery and puerperium, followed by satisfactory evolution. A review was conducted about the topic(AU)

Enfermedad de Chagas crónica e insuficiencia cardíaca congestiva en un adulto joven / Chagas chronic disease and congestive heart failure in a young adult

Se describe el caso clínico de una paciente de 41 años de edad, con antecedente de enfermedad de Chagas crónica, quien fue ingresado en el Servicio de Cuidados Intensivos del Hospital "El Torno", en el departamento de Santa Cruz, Bolivia, por presentar disnea intensa, cianosis distal, edemas en miembros inferiores, además de taquicardia y dolor precordial, lo cual se interpretó como una insuficiencia cardíaca congestiva descompensada, atribuible a dicha enfermedad. Permaneció en esa unidad durante 4 días y luego del tratamiento médico y la ventilación artificial mecánica no invasiva evolucionó favorablemente y egresó de la institución.

The case report of a 41 year-old patient is described, with a history of Chagas chronic disease who was admitted in the Intensive Care Service of "El Torno" Hospital, in Santa Cruz's department, Bolivia, for presenting intense dyspnea, distal cyanosis, edemas in inferior extremities, besides tachycardia and precordial pain, what was diagnosed as an congestive decompensated heart failure, attributable to this disease. He remained in this unit during 4 days and after the medical treatment and the non-invasive artificial mechanical ventilation he had a favorable clinical course and he was discharged from the institution.

Tromboembolismo pulmonar y enfermedad cerebrovascular isquémica embólica en un anciano boliviano / Lung thromboembolism and embolic ischemic cerebrovascular disease in a Bolivian aged man

Se describe el caso clínico de un paciente de 71 años de edad, quien en el 2008, luego de un episodio de tromboembolismo pulmonar, fuera ingresado en la Unidad de Cuidados Intensivos del Hospital Integral Comunitario de Chacaltaya en Bolivia, por presentar una enfermedad cerebrovascular isquémica embólica de tipo paradójica, como consecuencia de un agujero oval permeable. Como tratamiento se indicó, primero, heparina de bajo peso molecular y, posteriormente, dicumarínicos, con lo cual el paciente evolucionó satisfactoriamente.

The case report of a 71 year patient is presented who in 2008, after an episode of lung thromboembolism, was admitted in the Intensive Care Unit of the Community Comprehensive Hospital of Chacaltaya, Bolivia, he presented an ischemic embolic cerebrovascular disease in a paradoxical way, as consequence of a permeable oval foramen. Heparin of low molecular weight was indicated first as treatment and later, dicumarinics, with which the patient had a satisfactory clinical course.

Relación entre la nutrición enteral precoz y los hallazgos necrópsicos digestivos agudos en una unidad de cuidados intensivos / Relation between the early enteral nutrition and the necropsic acute digestive findings in an intensive care unit

Se realizó un estudio descriptivo, longitudinal y retrospectivo de 74 pacientes fallecidos en la Unidad de Cuidados Intensivos del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde noviembre del 2010 hasta julio del 2011, con vistas a identificar la relación entre la nutrición enteral precoz y los hallazgos necrópsicos digestivos agudos en los afectados. Se estableció como criterio de nutrición enteral precoz su inicio antes de las 36 horas de admisión al Servicio de Urgencia. En la serie predominaron el sexo masculino, los adultos mayores, la afección quirúrgica como la más frecuentemente asociada, los pacientes con dieta y la nutrición enteral precoz en los fallecidos sin lesiones digestivas agudas.

A descriptive, longitudinal and retrospective study of 74 dead patients was carried out in the Intensive Care Unit of "Dr. Juan Bruno Zayas Alfonso" General Hospital in Santiago de Cuba from November, 2010 to July, 2011, aimed at identifying the relation between the early enteral nutrition and the necropsic acute digestive findings in those affected. The beginning before the 36 hours of admission to the Emergency Service was established as criterium of early enteral nutrition. In the series, the male sex, the aged patients, the surgical treatment as the most frequently associated, the patients with diet and the early enteral nutrition in the dead without acute digestive injuries prevailed.

Hemoptisis por enfermedad de Rendu-Osler-Weber o telangiectasia hemorrágica hereditaria en un paciente joven / Hemoptysis due to Rendu-Osler-Weber disease or hereditary hemorrhagic telangiectasia in a young patient

Se presenta el caso clínico de un joven de 20 años de edad, con el diagnóstico de hemoptisis moderada, quien fue ingresado en la Unidad de Cuidados Intensivos del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, donde se le realizaron múltiples exámenes, cuyos resultados permitieron llegar al diagnóstico definitivo de enfermedad de Rendu-Osler-Weber o telangiectasia hemorrágica hereditaria. Luego de la aplicación de otros procederes, el paciente evolucionó satisfactoriamente y egresó de la institución.

The case report of a 20 years young patient is presented, with the diagnosis of moderate hemoptysis who was admitted in the Intensive Care Unit from "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba, where multiple tests were carried out whose results allowed to arrive to the definitive diagnosis of Rendu-Osler-Weber disease or hereditary hemorrhagic telangiectasia. After the indication of other procedures, the patient had a satisfactory clinical course and he was discharged from the institution.

Adenocarcinoma en la trompa de Falopio derecha / Adenocarcinoma in the right Fallopian tube

Se presenta el caso clínico de una paciente de 49 años de edad, quien fue ingresada en el Servicio de Obstetricia y Ginecología del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba con el diagnóstico de fibroadenoma uterino. Se realizó histerectomía total abdominal con doble anexectomía y se observó la presencia de un fibroma uterino y un tumor en la trompa de Falopio derecha. Se indicó quimioterapia y seguimiento en el Hospital Oncológico de esta ciudad.

The case report of a 49 year female patient is presented who was admitted in the Obstetrics and Gynecology Service from "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba with the diagnosis of uterine fibroadenoma. An abdominal total hysterectomy with double anexectomy was carried out and the presence of an uterine fibroma and a tumor in the right Fallopian tube was observed. Chemotherapy and follow-up in the Oncological Hospital of this city was indicated.

Cólera en una embarazada de procedencia rural / Cholera in a pregnant woman of rural origin

Se describe el caso clínico de una embarazada de 21 años de edad, con 28 semanas de gestación, de procedencia rural y aparente buen estado de salud, quien fue remitida desde su área de salud (municipio Songo- La Maya) hacia el Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, por presentar vómitos y diarreas, con signos de deshidratación moderada, de manera que se le realizó test rápido de cólera cuyos resultados fueron positivos. La paciente fue ingresada en la Unidad de Cuidados Intensivos bajo tratamiento médico y epidemiológico, con lo cual evolucionó favorablemente y egresó de la institución 5 días después.

The case report of a 21 years pregnant woman, with 28 weeks of pregnancy, of rural origin and apparent good health condition, who was transferred from her health area (Songo - La Maya municipality) to "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba, for presenting vomits and diarrheas, with signs of moderate dehydration is described, so that a quick test of cholera was carried out, with positive results. The patient was admitted in the Intensive Care Unit under medical and epidemiological treatment, with which she had a favorable clinical course and she was discharged from the institution 5 days later.

Caracterización de ancianos hospitalizados en una Unidad de Cuidados Intensivos / Characterization of hospitalized aged patients in an Intensive Care Unit

Se realizó un estudio descriptivo y transversal de 188 gerontes, ingresados en la Sala de Cuidados Intensivos del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, durante el 2012, a fin de caracterizarles según variables de interés. En la casuística primaron el sexo femenino, el grupo etario de 60-74 años y las enfermedades quirúrgicas. Requirieron de ventilaron mecánica invasiva 47 ancianos (35,0 %), de los cuales fallecieron 33 (70,0 %). La corta estadía en la unidad estuvo relacionada con el mayor número de pacientes vivos.

A descriptive and cross sectional study of 188 elderly, admitted in the Intensive Care Room of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba was carried out during the 2012, in order to characterize them according to variables of interest. Female sex, the age group 60-74 and the surgical diseases prevailed in the case material. Forty seven aged patients required invasive mechanical ventilation (35.0%), of which 33 died (70.0%). The short stay in the unit was related to the highest number of alive patients.

Morbilidad y mortalidad por infarto agudo del miocardio / Morbidity and mortality due to acute myocardial infarction

Se realizó un estudio descriptivo y retrospectivo de 134 pacientes con infarto agudo del miocardio, egresados de la Unidad de Cuidados Intensivos del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde el 2005 hasta el 2010, con vistas a determinar la tasa de mortalidad y letalidad por dicha afección, así como relacionar la letalidad con los factores de riesgo. En la serie, la fibrilación ventricular constituyó la principal causa de muerte. El riesgo de fallecer en la Unidad de Cuidados Intensivos se asoció a factores de riesgo tales como edad avanzada, hábito de fumar y profundas alteraciones fisiológicas con sus antecedentes personales.

A descriptive and retrospective study of 134 patients with acute myocardial infarction discharged from the Intensive Care Unit of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba was carried out from 2005 to 2010, with the objective of determining the death rate and lethality for this disorder, as well as to relate the lethality due to risk factors. In the series, the ventricular fibrillation constituted the main cause of death. The risk of dying in the Intensive Care Unit was associated with risk factors such as advanced age, smoking habit and deep physiologic changes with their personal histories.

Resultados de la atención a gestantes con preeclampsia grave en villa clara (2009-2010) / Results of expectant women´s care with severe preeclampsy in Villa Clara (2009-2010)

Introducción: la preeclampsia representa un riesgo para la madre y el producto de la concepción. Objetivos: Describir los resultados de la atención a la gestante con preeclampsia grave en Villa Clara durante los años 2009 y 2010. Métodos: estudio descriptivo de corte transversal en 238 gestantes que ingresaron en la sala de Cuidados Especiales Perinatales del Hospital Universitario Ginecoobstétrico “Mariana Grajales” con diagnóstico de preeclampsia grave en el período de enero del 2009 a diciembre del 2010. Resultados: entre los 20 y 35 años, se diagnosticaron con preeclampsia grave 109 mujeres (71,0 %). La media de edad fue de 27,3 años y predominó la nuliparidad (60,51 %). El 47,90 % de las gestantes tuvieron su parto antes de las 37 semanas de embarazo, y el 43,27 % tuvieron recién nacidos con peso inferior a los 2 500 g; de ellos, 15 pesaron menos de 1 000 gramos (6,30 %). Predominó la ausencia de complicaciones maternas y perinatales. Las principales complicaciones maternas resultaron la hipertensión persistente en el puerperio (13,02 %) y el hematoma retroplacentario (9,24 %); entre las complicaciones neonatales, se describen el bajo peso al nacer en el 43,27 %, las hipocalcemias en el 17,64 % y la sepsis en el 8,40 %. En el período de estudio, no se informaron muertes maternas en la provincia. Conclusiones: la atención a la preeclampsia grave resultó en un mínimo de complicaciones maternas y perinatales y fue un factor decisivo para preservar la vida de las madres con este padecimiento.

Introduction: preeclampsia represents a risk for the mother and for the product of the conception. Objectives: To describe the results of the expectant women´s care with severe preeclampsia in Villa Clara during 2009 and 2010 years. Methods: a descriptive study of transversal type was carried out in 238 expectant women admitted at the special perinatal care´s ward of the Gynecological and Obstetric University Hospital “Mariana Grajales”, who were diagnosed with severe preeclampsia between January, 2009 and December, 2010. Results: a number of 109 women (71,0 %), between 20 and 35 years old were diagnosed with severe preeclampsia. The average age was of 27, 3 years and nulliparity predominated (60,51 %). The 47,90 % of expectant women gave birth before the 37 weeks of pregnancy and the 43,27 % had newly born with a weight inferior to 2500 g; 15 of them weight less than 1000 grams (6,30 %).The were no considerable maternal and perinatal complications. The main maternal complications were persistent hypertension during puerperium (13,02 %) and retroplacental hematoma (9,24 %); as well as, main neonatal complications were low birth weight in 43,27 %, hypocalcaemia in 17,64 % and sepsis in 8,40 %. During this period there were not reported maternal deaths in the province. Conclusions: severe preeclampsia care resulted in a minimum of maternal and perinatal complications and it was an important factor for the preservation of mother´s life with this suffering.

Evaluación preoperatoria modificada del anciano con fractura de cadera / Modified preoperative evaluation of the elderly with hip fracture

Se realizó un estudio descriptivo, longitudinal y prospectivo para evaluar preoperatoriamente a 99 ancianos con cadera fracturada, atendidos en el Hospital Clinicoquirúrgico Docente Saturnino Lora de Santiago de Cuba desde marzo del 2001 hasta abril del 2002. La evaluación modificada se aplicó al ingreso, con el sistema de puntuación correspondiente, y cuantas veces fue necesaria hasta eliminar las causas de descompensación orgánica y lograr las condiciones ideales para la operación. Dicha estrategia de trabajo disminuyó el riesgo de morir, independientemente de la edad, los antecedentes patológicos personales, la localización de la fractura y el tipo de lesión, de manera que las complicaciones quirúrgicas y reintervenciones resultaron irrelevantes