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1.
Heliyon ; 9(9): e19586, 2023 Sep.
Article in English | MEDLINE | ID: mdl-37810074

ABSTRACT

Background: Limited supply of resources during the COVID-19 emergency encouraged the local development of the Masi mechanical ventilator (MV). Despite the efforts to promote Masi, adopting this innovation faced multiple obstacles, regardless of its performance. We explored the perceptions among healthcare personnel towards incorporating Masi to provide ventilatory support to COVID-19 patients during the second wave in Peru (January to June 2021). Methods: We conducted twelve in-depth virtual interviews. Topics included experience when handling Masi, the impact of the training received, confidence in the device, barriers perceived, and enablers identified. All participants provided verbal informed consent. Results: Most of the participants were male physicians. Participants belonged to seven hospitals that exhibited a wide range of healthcare capacities. Globally, the adoption of Masi MV was driven by the scarcity of ventilatory devices in the wards and reinforced by appropriate training and prompt technical support. Participants reported that Masi's structural and operational features played both advantages and disadvantages. Hospital infrastructure readiness, availability of commercial MVs, mistrust in its simple appearance, and resistance to change among healthcare personnel were perceived as barriers, while low-cost, prompt technical support and user-friendliness were valuable enablers. The first two enablers were observed in participants regardless of their attitude towards Masi. Despite the small number of participants for this qualitative study, it is important to note that the sample size was sufficient to reach saturation, as the topics discussed with participants became redundant and did not yield new information. Conclusions: The perceptions among healthcare personnel to incorporate Masi as a mechanical ventilator for COVID-19 patients showed that communication, training and experience, and peer encouragement were essential to secure its use and sustainability of the technology. A priori judgments and perceptions unrelated to the performance of the novel device were observed, and its proper management may define its further implementation. Altogether our study suggests that along with strengthening local technological development, strategies to improve their adoption process must be considered as early as possible in medical innovations.

2.
HardwareX ; 13: e00378, 2023 Mar.
Article in English | MEDLINE | ID: mdl-36483326

ABSTRACT

Demineralized bone matrix (DBM) is considered one of the most reliable bone tissue grafts for regular surgical use, as it provides a scaffold that is structurally like native bone, and that enhances bone regeneration. However, commercially available DBM products are not suited for surgical restitutions of large bones. Therefore, each Tissue Bank is urged to implement their own demineralization protocol, which usually does not meet the high demand for bone grafting. In this project, we developed an open source system for medium-scale manufacturing of DBM grafts from human cadaveric donors to automate the demineralization protocol and improve its reproducibility. The device consists in (1) unidirectional flow reaction chamber, where the demineralization protocol takes place; (2) automated syringe pump, which controls the reagent́s inlet and vacuum; and (3) reagent dispenser, for the management of the reagents need for the demineralization protocol. Validation of the device included histological analysis, DNA quantification temperature regulation, electrochemiluminescence and colorimetric protocols, followed by the optimization of physicochemical parameters based on Response Surface Methodology. The results showed values of residual lipids and calcium within standardized ranges, and the maintenance of the structural integrity of the DBM, demonstrating the capacity of the system to support the proposed demineralization protocol.

3.
PLoS One ; 17(3): e0264774, 2022.
Article in English | MEDLINE | ID: mdl-35239740

ABSTRACT

The Covid-19 outbreak challenged health systems around the world to design and implement cost-effective devices produced locally to meet the increased demand of mechanical ventilators worldwide. This study evaluates the physiological responses of healthy swine maintained under volume- or pressure-controlled mechanical ventilation by a mechanical ventilator implemented to bring life-support by automating a resuscitation bag and closely controlling ventilatory parameters. Physiological parameters were monitored in eight sedated animals (t0) prior to inducing deep anaesthesia, and during the next six hours of mechanical ventilation (t1-7). Hemodynamic conditions were monitored periodically using a portable gas analyser machine (i.e. BEecf, carbonate, SaO2, lactate, pH, PaO2, PaCO2) and a capnometer (i.e. ETCO2). Electrocardiogram, echocardiography and lung ultrasonography were performed to detect in vivo alterations in these vital organs and pathological findings from necropsy were reported. The mechanical ventilator properly controlled physiological levels of blood biochemistry such as oxygenation parameters (PaO2, PaCO2, SaO2, ETCO2), acid-base equilibrium (pH, carbonate, BEecf), and perfusion of tissues (lactate levels). In addition, histopathological analysis showed no evidence of acute tissue damage in lung, heart, liver, kidney, or brain. All animals were able to breathe spontaneously after undergoing mechanical ventilation. These preclinical data, supports the biological safety of the medical device to move forward to further evaluation in clinical studies.


Subject(s)
Cardiopulmonary Resuscitation/instrumentation , Respiration, Artificial/instrumentation , Ventilators, Mechanical , Animals , Automation , Blood Gas Analysis , COVID-19/complications , COVID-19/pathology , COVID-19/physiopathology , Female , Hemodynamics , Male , Respiration , SARS-CoV-2/physiology , Swine
4.
Rev. Fac. Med. Hum ; 22(2): 427-428, Abril.- Jun. 2022.
Article in English, Spanish | LILACS-Express | LILACS | ID: biblio-1371631

ABSTRACT

Estimado editor, Con respecto al lamentable derrame de petróleo ocurrido el pasado 15 de enero en nuestro mar y costa peruana, me gustaría comentar sobre la necesidad de formular un Plan de Acción proactivo para abordar las preocupaciones de Salud Ambiental a largo plazo y utilizar las mejores prácticas para comunicar los riesgos a las personas cuyos medios de subsistencia están estrechamente entrelazados con las áreas afectadas.


Dear Editor, Regarding the unfortunate oil spill occurred last January 15th on our coast, I would like to call the attention of your readership towards the need to formulate a proactive Plan of Action to address Environmental Health concerns and use the best practices to communicate risks for people whose livelihoods are closely intertwined with the affected areas.

5.
HardwareX ; 9: e00187, 2021 Apr.
Article in English | MEDLINE | ID: mdl-33681539

ABSTRACT

In this article, we introduce a portable and low-cost ventilator that could be rapidly manufactured, to meet the increasing demand of ventilators worldwide produced by COVID-19 pandemic. These ventilators should be rapidly deployable and with functional capabilities to manage COVID-19 patients with severe acute respiratory distress syndrome (ARDS). Our implementation offers robustness, safety and functionality absent in existing solutions to the ventilator shortage (i.e., telemonitoring, easy-to-disinfect, modularity) by maintaining simplicity. The design makes use of a manual resuscitator as the core respiration component activated by a compression mechanism which consist of two electronically controlled paddles. The quality measurements obtained after testing on a calibrated artificial lung demonstrate repeatability and accuracy exceeding human capabilities of manual ventilation. The complete design files are provided in the supplementary materials to facilitate ventilator production even in resource-limited settings. The implementation of this mechanical ventilator could eliminate device rationing or splitting to serve multiple patients on ICUs.

6.
Expert Rev Mol Med ; 23: e3, 2021 03 25.
Article in English | MEDLINE | ID: mdl-33762030

ABSTRACT

Immunotherapy has changed the landscape of cancer treatment and has significantly improved the outcome of several cancer types including breast, lung, colorectal and prostate. Neoantigen recognition and immune checkpoint inhibitors are nowadays the milestones of different immunotherapeutic regimes; however, high cost, primary and acquired resistance and the high variability of responses make their extensive use difficult. The development of better predictive biomarkers that represent tumour diversity shows promise because there is a significant body of clinical data showing a spectrum of immunotherapeutic responses that might be related back to their specific characteristics. This article makes a conceptual and historical review to summarise the main advances in our understanding of the role of the immune system in cancer, while describing the methodological details that have been successfully implemented on cancer treatments and that may hold the key to improved therapeutic approaches.


Subject(s)
Immunotherapy , Neoplasms , Antigens , Humans , Male , Neoplasms/genetics , Neoplasms/therapy
7.
Rev. Fac. Med. Hum ; 21(2): 259-260, Abr.-Jun. 2021.
Article in English, Spanish | LILACS-Express | LILACS | ID: biblio-1179215

ABSTRACT

Actualmente estamos atravesando una segunda ola de casos durante las pandemias de COVID-19 en Perú. Ya nos acostumbramos a ver héroes anónimos que salen de sus casas todos los días ofrecer su trabajo para apoyar a sus familias y comunidades. Después de casi un año del inicio de esta Crisis de Salud Pública, se está exigiendo mucho más a los profesionales de la salud y afines. Importantes esfuerzos encaminados a mejorar la infraestructura y la orientación técnica de las innovaciones médicas se han visto obligados a avanzar y ser implementados en plazos sin precedentes, pero su visibilidad se ve obstaculizada por otra tarea pendiente en el Sistema de Salud Peruano relacionada con la Ética de la Investigación con Seres Humanos.


We are currently cruising through a second wave of cases during the pandemics of COVID-19 in Peru. Anonymous heroes leave their houses every day and keep offering their work to support their families and communities. After almost a year of the beginning of this Public Health Crisis, much more is being demanded from health and allied professionals. Important efforts leading to improvements on infrastructure and technical guidance for medical innovations have been forced to move forward and be implemented in unprecedented timelines, but their visibility is hindered by another pending task in the Peruvian Health System related to the Ethics of Human Research.

8.
Rev. Fac. Med. Hum ; 20(4): 657-661, Oct-Dic. 2020. tab, graf
Article in English, Spanish | LILACS-Express | LILACS | ID: biblio-1141316

ABSTRACT

Objetivo: Analizar el potencial de innovación en apósitos para tratar heridas crónicas en la Ciudad de Lima. Métodos: Se realizó un estudio cualitativo mediante una encuesta y análisis de las entrevistas realizadas a expertos médicos y gestores de compras en insumos para el tratamiento de heridas de difícil resolución en 8 instituciones representativas de salud pública con categorías 1 ­ 4 dentro de las 54 existentes solo en Lima Metropolitana, Perú - 2018. Resultados: Se determinó que en las instituciones de salud pública son atendidos un promedio 17 pacientes mensualmente (60% provenientes de hospitalización y 40% de consultorio externo). Equivale decir que 11,016 pacientes presentan heridas crónicas de difícil resolución al año, los cuales requerirán de tratamiento especializado y una demanda anual promedio de 110,160 apósitos en stock. Los apósitos con mayor demanda corresponden a los Hidrogeles e Hidrocoloides, respectivamente que son utilizados por los resultados positivos que ofrecen en la curación de las heridas, aunque en ocasiones la limitante es el aspecto económico. En el mercado, el precio unitario oscila entre los 20 y 90 soles, esto representa una inversión económica de 1500 soles en promedio por paciente, produciendo en algunos casos complicaciones o abandono del tratamiento cuando los recursos son escasos. Conclusiones: La demanda de pacientes con heridas crónicas de difícil resolución en las instituciones de salud públicas de Lima metropolitana es alta. Es importante promover e incentivar la investigación de nuevas alternativas terapéuticas y/o dispositivos biomédicos que favorezcan su curación.


Objective: To analyze the potential for innovation in dressings to treat chronic wounds in the City of Lima. Methods: A qualitative study was carried out by means of interviews to medical experts and purchasing managers of medical supplies for the treatment of difficult-to-resolve wounds in 8 representative public health institutions with categories 1-4 within the only 54 of Lima, Peru - 2018. Results: It was determined that an average of 17 patients is treated in public health institutions on a monthly basis (60% from hospitalization and 40% from an outpatient office). It is equivalent to say that 11,016 patients present chronic wounds of difficult resolution each year, which will require specialized treatment and an average annual demand of 110,160 dressings in stock. The dressings with the highest demand correspond to the Hydrogels and Hydrocolloids, respectively; used because of the positive results they offer in wound healing, despite economic limitations. The market price per unit ranges between 20 and 90 soles (S/.), representing an economic investment of 1500 soles on average per patient, in some cases causing complications or abandonment of treatment when resources are scarce. Conclusions: There is a high demand for patients with chronic wounds of difficult resolution in the public health institutions of Lima. It is important to promote and incentivize the investigation of new therapeutic alternatives and / or biomedical devices that favor its treatment.

9.
Stem Cells Int ; 2016: 4389802, 2016.
Article in English | MEDLINE | ID: mdl-27563312

ABSTRACT

While sensing the cell environment, the aryl hydrocarbon receptor (AHR) interacts with different pathways involved in cellular homeostasis. This review summarizes evidence suggesting that cellular regeneration in the context of aging and diseases can be modulated by AHR signaling on stem cells. New insights connect orphaned observations into AHR interactions with critical signaling pathways such as WNT to propose a role of this ligand-activated transcription factor in the modulation of cellular regeneration by altering pathways that nurture cellular expansion such as changes in the metabolic efficiency rather than by directly altering cell cycling, proliferation, or cell death. Targeting the AHR to promote regeneration might prove to be a useful strategy to avoid unbalanced disruptions of homeostasis that may promote disease and also provide biological rationale for potential regenerative medicine approaches.

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