Guía de práctica clínica para el manejo de la Enfermedad Renal Crónica estadíos 3b, 4 y 5 en el Seguro Social de Salud del Perú (EsSalud)

Introducción: El presente artículo resume la guía de práctica clínica (GPC) para el manejo de la enfermedad renal crónica estadíos 3b, 4 y 5 en el Seguro Social del Perú (EsSalud). Objetivo: Proveer recomendaciones clínicas basadas en evidencia para el manejo de pacientes con enfermedad renal crónica estadíos 3b, 4 y 5 en EsSalud. Métodos: Se conformó un grupo elaborador de la guía (GEG) que incluyó especialistas y metodólogos. El GEG formuló 9 preguntas clínicas. Se realizó búsquedas sistemáticas de revisiones sistemáticas y estudios primarios en PubMed entre diciembre del 2020 y agosto del 2021. Se seleccionó la evidencia para responder a las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). El GEG usó la metodología GRADE para revisar la evidencia y formular recomendaciones, los puntos de buena práctica clínica (BPC) y los flujogramas de manejo. Finalmente, la GPC fue aprobada con Resolución N° 88-IETSI-ESSALUD-2021. Resultados: La presente GPC abordó 9 preguntas clínicas. En base a dichas preguntas se formularon 17 recomendaciones (7 fuertes y 10 condicionales), 28 BPC, y 4 flujogramas de manejo. Conclusión: El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para el manejo de la Enfermedad Renal Crónica estadíos 3b, 4 y 5 en EsSalud.

Introduction: This article summarizes the clinical practice guideline (CPG) for the management of stage 3b, 4, and 5 chronic kidney disease (CKD) in the Social Security of Peru (EsSalud). Objective: To provide evidence-based clinical recommendations for the management of stage 3b, 4, and 5 CKD in EsSalud. Methods: A guideline development group (GDG) was formed, including specialists and methodologists. The GDG formulated 9 clinical questions. Systematic searches for systematic reviews and primary studies were conducted in PubMed from December 2020 to August 2021. Evidence was selected to answer the clinical questions posed. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The GDG used the GRADE methodology to review the evidence and formulate recommendations, points of good clinical practice (GPC), and management flowcharts. Finally, the CPG was approved with Resolution No. 88-IETSI-ESSALUD-2021. Results: This CPG addressed 9 clinical questions. Based on these questions, 17 recommendations (7 strong and 10 conditional), 28 GPC points, and 4 management flowcharts were formulated. Conclusion: This article summarizes the methodology and evidence-based conclusions of the CPG for the management of stage 3b, 4, and 5 CKD in EsSalud.

Magnetic Resonance Spectroscopy and Bipolar Disorder: How Feasible Is This Pairing?

Bipolar disorder is a psychiatric disorder that affects a significant part of the world's population; however, its diagnosis is difficult, mainly because of the lack of biomarkers and objective tests that aid the clinical evaluation. Proton magnetic resonance spectroscopy (MRS) is a tool that is relatively unused in the medical field. Its application arises from conventional magnetic resonance, and allows non-invasive, in vivo, the study of various metabolites and compounds in the human brain. This method may allow the assessment of neurobiochemical alterations in bipolar patients. One of the main advantages of this study type is the simplicity in its use since it only needs a standard magnetic resonator. All these characteristics make it an attractive diagnostic tool that can be used anywhere, including in low-middle-income countries. In conclusion, MRS has potential as a diagnostic tool for bipolar disorder; nevertheless, using it for this purpose still requires additional steps.

Development of a Smart Leg Splint by Using New Sensor Technologies and New Therapy Possibilities.

Nowadays, after suffering a fracture in an upper or lower limb, a plaster cast is placed on the affected limb. It is a very old and efficient technique for recovery from an injury that has not had significant changes since its origin. This project aims to develop a new low-cost smart 3D printed splint concept by using new sensing techniques. Two rapidly evolving Advanced Manufacturing (AM) technologies will be used: 3D scanning and 3D printing, thus combining engineering, medicine and materials evolution. The splint will include new small and lightweight sensors to detect any problem during the treatment process. Previous studies have already incorporated this kind of sensor for medical purposes. However, in this study it is implemented with a new concept: the possibility of applying treatments during the immobilization process and obtaining information from the sensors to modify the treatment. Due to this, rehabilitation treatments like infrared, ultrasounds or electroshock may be applied during the treatment, and the sensors (as it is showed in the study) will be able to detect changes during the rehabilitation process. Data of the pressure, temperature, humidity and colour of the skin will be collected in real time and sent to a mobile device so that they can be consulted remotely by a specialist. Moreover, it would be possible to include these data into the Internet of Things movement. This way, all the collected data might be compared and studied in order to find the best treatment for each kind of injury. It will be necessary to use a biocompatible material, submersible and suitable for contact with skin. These materials make it necessary to control the conditions in which the splint is produced, to assure that the properties are maintained. This development, makes it possible to design a new methodology that will help to provide faster and easier treatment.

Efficient Upper Limb Position Estimation Based on Angular Displacement Sensors for Wearable Devices.

Motion tracking techniques have been extensively studied in recent years. However, capturing movements of the upper limbs is a challenging task. This document presents the estimation of arm orientation and elbow and wrist position using wearable flexible sensors (WFSs). A study was developed to obtain the highest range of motion (ROM) of the shoulder with as few sensors as possible, and a method for estimating arm length and a calibration procedure was proposed. Performance was verified by comparing measurement of the shoulder joint angles obtained from commercial two-axis soft angular displacement sensors (sADS) from Bend Labs and from the ground truth system (GTS) OptiTrack. The global root-mean-square error (RMSE) for the shoulder angle is 2.93 degrees and 37.5 mm for the position estimation of the wrist in cyclical movements; this measure of RMSE was improved to 13.6 mm by implementing a gesture classifier.

Guía de práctica clínica para el tamizaje, diagnóstico y manejo de la enfermedad renal crónica en estadios 1 al 3 en el Seguro Social del Perú (EsSalud) / Clinical practice guideline for the screening, diagnosis, and management of chronic kidney disease stages 1-3 for the Peruvian Social Security (EsSalud)

RESUMEN El presente artículo resume la guía de práctica clínica (GPC) para tamizaje, diagnóstico y manejo de los pacientes con enfermedad renal crónica (ERC) en los estadios 1 al 3 en el Seguro Social del Perú (EsSalud). Para el desarrollo de esta GPC, se conformó un grupo elaborador de la guía (GEG) que incluyó especialistas clínicos y metodólogos, el cual formuló ocho preguntas clínicas. Para responder cada pregunta se realizaron búsquedas sistemáticas de revisiones sistemáticas y, cuando fue considerado pertinente, de estudios primarios; y se seleccionó la evidencia pertinente. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones periódicas, el GEG usó la metodología GRADE para revisar la evidencia y emitir las recomendaciones. Se emitieron ocho recomendaciones (cuatro fuertes y cuatro condicionales), 29 puntos de buena práctica clínica, y tres flujogramas.

ABSTRACT This paper summarizes the clinical practice guidelines (CPG) for the screening, diagnosis, and management of patients with chronic kidney disease (CKD) stages 1-3 in the Social Security of Peru (EsSalud). A guideline development group (GDG) was established for develop this CPG, which included clinical and methodology specialists, who formulated 08 clinical questions. Systematic searches of systematic reviews and, when considered necessary, primary studies were conducted to answer each question; and relevant evidence was selected. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GDG used the GRADE methodology for reviewing the evidence and for developing recommendations. At the end, this CPG formulated 08 recommendations (04 strong and 04 conditional), 29 points of good clinical practice, and 03 flowcharts were formulated.

Development of a Smart Splint to Monitor Different Parameters during the Treatment Process.

For certain musculoskeletal complex rupture injuries, the only treatment available is the use of immobilization splints. This type of treatment usually causes discomfort and certain setbacks in patients. In addition, other complications are usually generated at the vascular, muscular, or articular level. Currently, there is a really possible alternative that would solve these problems and even allows a faster and better recovery. This is possible thanks to the application of engineering on additive manufacturing techniques and the use of biocompatible materials available in the market. This study proposes the use of these materials and techniques, including sensor integration inside the splints. The main parameters considered to be studied are pressure, humidity, and temperature. These aspects are combined and analyzed to determine any kind of unexpected evolution of the treatment. This way, it will be possible to monitor some signals that would be studied to detect problems that are associated to the very initial stage of the treatment. The goal of this study is to generate a smart splint by using biomaterials and engineering techniques based on the advanced manufacturing and sensor system, for clinical purposes. The results show that the prototype of the smart splint allows to get data when it is placed over the arm of a patient. Two temperatures are read during the treatment: in contact with the skin and between skin and splint. The humidity variations due to sweat inside the splint are also read by a humidity sensor. A pressure sensor detects slight changes of pressure inside the splint. In addition, an infrared sensor has been included as a presence detector.

Behavior under Load of A Human Shoulder: Finite Element Simulation and Analysis.

Most musculoskeletal injuries occur during the work routines in different areas, due to repetitive and sustained movements, they are often located in the shoulder. For workers in the building sector, the repetitive movements and displacements occur under load and unnatural postures of the shoulder joint. For this reason, this study aims to model in 3D the biological components which form the shoulder joint for the later finite element analysis. Three cases with different loads have been considered for this study. Due to a linear and isotropic joint approach it has been possible to evaluate the tensions in the main components of the shoulders: muscles, tendons and ligaments. The methodology used allowed obtaining an improved mesh of the shoulder joint to analyse real situations with finite element method analysis with applications in the field of sports medicine, work, etc. Furthermore, the simplification adopted for modelling the joint muscles, as 1D elements in the finite element model has made it possible to establish different positions of human joint without mesh again each of the studied positions. The results are consistent with the states of applied loads. In fact, the maximum stresses in bones are in the insertion areas of the ligaments. Due to the static positions of the joint under study, the muscles do not support high stresses. According to the stresses distribution, the maximum values are in the zones of tendons. From the result analysis, it is observed how the stresses distribution in the cartilage area maintains coherence with reality since the maximum stresses appear in the lower half of the cartilage. In this area in which the Humerus-scapula contact is greater, the compression tensions are greater.

Experimental Comparison on Dental BioTribological Pairs Zirconia/Zirconia and Zirconia/Natural Tooth by Using a Reciprocating Tribometer.

The application of tribology in dentistry is growing rapidly, intense research has been conducted to develop an understanding of dental tribology for better selection of artificial materials and dental implant design. Dental biotribology, has been one of the most important branches in biotribology in recent years. The aim of this research is to investigate the tribological performances in the tooth-to-tooth contact and material-to-natural tooth contact (zirconia vs. zirconia and natural tooth vs. zirconia). The presented research was carried out by testing the above mentioned tribological pairs with the use of a reciprocating tribometer under lubricated conditions (artificial saliva). The normal force used in the tests was 20 N the time for each test was of 60 min. The stroke length was 2 mm, according to the range of displacement used in scientific literature. The wear mass loss evaluation was evaluated by using a gravimetric method. In order to characterize the wear mechanisms, present in the worn surfaces after each of tribo-tests, a topographic analysis was carried with a 3D non-contact optical profiler. The results show that the minimum value of the COF is obtained in the case of Zirconia vs. Zirconia tribo-couple. The results on the wear mass loss show a very low wear rate when coupling in tribological condition natural tooth with a ceramic restoration (a mean value of 0.5 mg was found). This rate is even lower when the contact is between two artificial zirconia teeth.

Monitoring an Analysis of Perturbations in Fusion Deposition Modelling (FDM) Processes for the Use of Biomaterials.

During an FDM production process, there are different external disturbances to the characteristics of the machine that can affect to the production process. These disturbances will cause the final result differs from the desired one. Moreover, these disturbances, such as temperature or chamber humidity, are extremely important in case of using biocompatible materials. The use of these kind of materials with not controlled environment, can cause them to modify or loss of their properties; what will make the product unusable. Apart from these external disturbances, the conditions of the machine to which the material is subjected must also be considered, such as temperature, vibrations or extrusion speed. The monitoring of all these data will allow to know the conditions to which the product was exposed during the process. In this way, it will be able to verify the validity of the final product. For these reasons, the purpose of this work is to monitor the conditions of production of structures with biocompatible materials by fused deposition modelling (FDM) technique. This monitoring will allow us to obtain a report that guarantee the technical and geometrical characteristics of the model and the biomaterial properties. The parameters chosen to be monitored are: Diameter of filament use, temperature in extrusion nozzle, ambient temperature in closed chamber, ambient humidity in closed chamber. The obtained results, after collected and analysing the data, present variations of up to 3% in the temperature of the nozzle of the extruder with respect to set temperature. In the case of the filament diameter the difference with respect to the value provided from the filament supplier is of 13,7%. In addition, the results show how the ambient humidity in closed chamber has changed by 2 percentage points and the ambient temperature in closed chamber has been increased 6,52 °C with respect to the set values.

Novel Technique Based on Fused Filament Fabrication (FFF) and Robocasting to Create Composite Medical Parts.

The purpose for this study is to obtain a new composite manufacturing system based on Additive Manufacturing techniques that allows the creation of parts for the medical industry. These pieces will be resistant, lightweight and may have geometries more complex than those created with traditional systems of composite material. The new system is based on the union of two heads on a 3D Rep-Rap printer. One of the heads is an extruder head of thermoplastic Fused Filament Fabrication (FFF) and the other is a dosing head, based on the Robocasting technique, designed to be assembled on the 3D printer. Thermoplastics material and epoxy resin will be used. The alternate printing of both materials generates a piece of composite material. This new technique will allow to increase the structural properties of the piece in the XY plane. The new additive manufacturing system allows to obtain mechanical improvements both in the modulus of elasticity and in the tensile strength. Increase the modulus of elasticity of a value between 50 and 80% depending on the thermoplastic filament used. In the same way the tensile strength has increased between 50 and 60%. The improvement in the strength / weight ratio allows to this new additive manufacturing system to create medical pieces in which the lightness and resistance are its main characteristic, such as orthopedic prostheses.The results show that the use of FFF together with Robocasting, as a manufacturing process for end-use parts, generates an additional advantage that had not been considered until now. The combination of a thermoplastic and an epoxy resin opens a new path in the additive manufacturing since it allows creating pieces with new qualities without being conditioned by the design.

Filament Advance Detection Sensor for Fused Deposition Modelling 3D Printers.

The main purpose of this paper is to present a system to detect extrusion failures in fused deposition modelling (FDM) 3D printers by sensing that the filament is moving forward properly. After several years using these kind of machines, authors detected that there is not any system to detect the main problem in FDM machines. Authors thought in different sensors and used the weighted objectives method, one of the most common evaluation methods, for comparing design concepts based on an overall value per design concept. Taking into account the obtained scores of each specification, the best choice for this work is the optical encoder. Once the sensor is chosen, it is necessary to design de part where it will be installed without interfering with the normal function of the machine. To do it, photogrammetry scanning methodology was employed. The developed device perfectly detects the advance of the filament without affecting the normal operation of the machine. Also, it is achieved the primary objective of the system, avoiding loss of material, energy, and mechanical wear, keeping the premise of making a low-cost product that does not significantly increase the cost of the machine. This development has made it possible to use the printer with remains of coil filaments, which were not spent because they were not sufficient to complete an impression. Also, printing models in two colours with only one extruder has been enabled by this development.

Rapid prototyping prosthetic hand acting by a low-cost shape-memory-alloy actuator.

The purpose of this article is to develop a new concept of modular and operative prosthetic hand based on rapid prototyping and a novel shape-memory-alloy (SMA) actuator, thus minimizing the manufacturing costs. An underactuated mechanism was needed for the design of the prosthesis to use only one input source. Taking into account the state of the art, an underactuated mechanism prosthetic hand was chosen so as to implement the modifications required for including the external SMA actuator. A modular design of a new prosthesis was developed which incorporated a novel SMA actuator for the index finger movement. The primary objective of the prosthesis is achieved, obtaining a modular and functional low-cost prosthesis based on additive manufacturing executed by a novel SMA actuator. The external SMA actuator provides a modular system which allows implementing it in different systems. This paper combines rapid prototyping and a novel SMA actuator to develop a new concept of modular and operative low-cost prosthetic hand.

3D Digitization and Prototyping of the Skull for Practical Use in the Teaching of Human Anatomy.

The creation of new rapid prototyping techniques, low cost 3D printers as well as the creation of new software for these techniques have allowed the creation of 3D models of bones making their application possible in the field of teaching anatomy in the faculties of Health Sciences. The 3D model of cranium created in the present work, at full scale, present accurate reliefs and anatomical details that are easily identifiable by undergraduate students in their use for the study of human anatomy. In this article, the process of scanning the skull and the subsequent treatment of these images with specific software until the generation of 3D model using 3D printer has been reported.