Volume-assured pressure support mode plus pirfenidone as resuscitation therapy in patients with exacerbation of idiopathic pulmonary fibrosis

Introduction: Treatment among advanced stage idiopathic pulmonary fibrosis is quite challenging, especially considering that no major evidence has been released about it. This case report demonstrates and discusses the benefit of non-invasive mechanical ventilation in volume-assured pressure support (AVAPS) mode plus pirfenidone based on the relief of a patient’s symptoms in combination with high-resolution computed tomography (HRCT) evidence.Material and methods: An 83-year-old female patient with multiple hospital admissions within a  six-month period initially presented with cardiac symptoms which were later attributed to a possible exacerbation of her primary diagnosis, idiopathic pulmonary fibrosis.Conclusion: The addition of non-invasive mechanical ventilation in AVAPS mode plus pirfenidone can improve the survival rates even in patients with current exacerbations of acute respiratory failure due to idiopathic pulmonary fibrosis

Technical and economic feasibility of a vehicle inspection center in the canton of Quevedo

El presente proyecto de investigación se basa en un estudio de factibilidad técnico económico de un Centro de Revisión Técnico Vehicular para la futura implementación para controlar el estado mecánico, sistemas de seguridad, ruido excesivo, emisión de gases, que origina los vehículos generando excesiva contaminación al medio ambiente, además de reducir los accidentes de tránsito provocados por desperfectos en los sistemas que conforman un automotor ya que la Revisión Vehicular actual se la realiza de forma visual, sin estar regido a normas técnicas para la correcta funcionalidad vehicular. Con la utilización del software FlexSim permite simular procesos de una forma ideal, para optimizar los tiempos de trabajo y ocupación de los operarios y equipos que conforman cada uno de los procesos que se llevan a cabo. Se calcula el tamaño de la muestra con el fin de conocer la cantidad de talleres mecánicos a ser encuestados (68 talleres). Mediante el estudio de la factibilidad económica se determina los costos, ingresos que generara el CRTV con una proyección de 5 años de funcionamiento. La inversión estimada para la construcción en la primera fase y adecuación será de 350.000 dólares con una recaudación en el primer año de funcionamiento de 583.769,92 dólares.This research project is based on a technical-economic feasibility study of a Vehicle Technical Inspection Center for the future implementation to control the mechanical condition, safety systems, excessive noise, gas emissions, which originate vehicles generating excessive pollution to the environment, in addition to reducing traffic accidents caused by malfunctions in the systems that make up a vehicle since the current Vehicle Inspection is done visually, without being governed by technical standards for proper vehicle functionality. With the use of FlexSim software, it is possible to simulate processes in an ideal way, to optimize work times and occupation of operators and equipment that make up each of the processes that are carried out. The sample size is calculated in order to know the number of mechanical workshops to be surveyed (68 workshops). The economic feasibility study determines the costs and income that the CRTV will generate with a projection of 5 years of operation. The estimated investment for construction in the first phase and adequacy will be US$350,000 with a revenue in the first year of operation of US$583,769.92

Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010:a systematic analysis for the Global Burden of Disease Study 2010

BACKGROUND: Non-fatal health outcomes from diseases and injuries are a crucial consideration in the promotion and monitoring of individual and population health. The Global Burden of Disease (GBD) studies done in 1990 and 2000 have been the only studies to quantify non-fatal health outcomes across an exhaustive set of disorders at the global and regional level. Neither effort quantified uncertainty in prevalence or years lived with disability (YLDs).METHODS: Of the 291 diseases and injuries in the GBD cause list, 289 cause disability. For 1160 sequelae of the 289 diseases and injuries, we undertook a systematic analysis of prevalence, incidence, remission, duration, and excess mortality. Sources included published studies, case notification, population-based cancer registries, other disease registries, antenatal clinic serosurveillance, hospital discharge data, ambulatory care data, household surveys, other surveys, and cohort studies. For most sequelae, we used a Bayesian meta-regression method, DisMod-MR, designed to address key limitations in descriptive epidemiological data, including missing data, inconsistency, and large methodological variation between data sources. For some disorders, we used natural history models, geospatial models, back-calculation models (models calculating incidence from population mortality rates and case fatality), or registration completeness models (models adjusting for incomplete registration with health-system access and other covariates). Disability weights for 220 unique health states were used to capture the severity of health loss. YLDs by cause at age, sex, country, and year levels were adjusted for comorbidity with simulation methods. We included uncertainty estimates at all stages of the analysis.FINDINGS: Global prevalence for all ages combined in 2010 across the 1160 sequelae ranged from fewer than one case per 1 million people to 350,000 cases per 1 million people. Prevalence and severity of health loss were weakly correlated (correlation coefficient -0·37). In 2010, there were 777 million YLDs from all causes, up from 583 million in 1990. The main contributors to global YLDs were mental and behavioural disorders, musculoskeletal disorders, and diabetes or endocrine diseases. The leading specific causes of YLDs were much the same in 2010 as they were in 1990: low back pain, major depressive disorder, iron-deficiency anaemia, neck pain, chronic obstructive pulmonary disease, anxiety disorders, migraine, diabetes, and falls. Age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010. Regional patterns of the leading causes of YLDs were more similar compared with years of life lost due to premature mortality. Neglected tropical diseases, HIV/AIDS, tuberculosis, malaria, and anaemia were important causes of YLDs in sub-Saharan Africa.INTERPRETATION: Rates of YLDs per 100,000 people have remained largely constant over time but rise steadily with age. Population growth and ageing have increased YLD numbers and crude rates over the past two decades. Prevalences of the most common causes of YLDs, such as mental and behavioural disorders and musculoskeletal disorders, have not decreased. Health systems will need to address the needs of the rising numbers of individuals with a range of disorders that largely cause disability but not mortality. Quantification of the burden of non-fatal health outcomes will be crucial to understand how well health systems are responding to these challenges. Effective and affordable strategies to deal with this rising burden are an urgent priority for health systems in most parts of the world.FUNDING: Bill &amp; Melinda Gates Foundation.</p