What treatments are safe and effective for mild to moderate hypertension in pregnancy?

There is considerable debate concerning the treatment of mild to moderate essential hypertension during pregnancy. Evidence suggests that because of the potential risk of fetal intrauterine growth restriction, treatment of hypertension should be delayed until maternal blood pressure reaches 150-160 mm Hg systolic or 100-110 mm Hg diastolic, as long as the mother has no preexisting end organ damage. Methyldopa has been the drug of choice for oral treatment, as it is the only medication to have any extended follow-up study. However, a recent meta-analysis raised the possibility of increased fetal mortality (strength of recommendation [SOR]: A, based on systematic review of randomized controlled trials)

Aplicación de la microscopia electrónica en el diagnóstico de las patologías renales

Objetivos: Detectar, en nuestro medio, en qué nefropatías es imprescindible el uso de la microscopia electrónica. Diseño: Analítico no experimental. Institución: Instituto de Patología, Facultad de Medicina, UNMSM. Material biológico: Biopsias renales provenientes del Hospital Cayetano Heredia, cuyo diagnóstico no fue concluyente utilizando las técnicas convencionales hematoxilina eosina, tricrómica de Masson o Mallory, ácido periódico Shiff (PAS), reticulina o inmunofluorescencia. intervenciones: Las biopsias fueron procesadas para su estudio ultraestructural con microscopio electrónico de transmisión de UNI, siguiendo los protocolos para el procesamiento de las muestras biológicas. Principales medidas de resultados: Se observó las características ultraestructurales de los glomérulos, el área mesangial, el endotelio la membrana basal, las células podocitarias, el espacio de Bowman y el epitelio parietal. Resultados: Estos casos fueron diagnosticados de acuerdo a la clasificación de la Organización Mundial de la Salud y clasificados en glomeruloesclerosis focal y segmentaria, glomerulopatía membranosa estadio I, cambios mínimos. Conclusiones: El diagnóstico de la mayor parte de las glomerulopatías puede ser realizado mediante técnicas de microscopia de luz e inmunofluorescencia. La microscopia electrónica de transmisión fue esencial para concluir en el diagnóstico de glomerulopatías membranosas y nefropatías hereditarias, como el Síndrome de Alport

Cultura tributaria y su incidencia en el cumplimiento de las obligaciones tributarias de los comerciantes del mercado central de Piura durante el período 2018

La investigación tuvo como objetivo general determinar de qué manera el nivel de cultura tributaria incide en el cumplimiento de las obligaciones tributaria de los comerciantes del mercado central de la ciudad de Piura durante el periodo 2018. Fue de enfoque cuantitativo, de diseño no experimental y tipo correlacional, de acuerdo al espacio y tiempo fue transversal y su escala de medida fue mixta, las principales técnicas de análisis de datos aplicados fueron; (01) encuesta. La población de estudio estuvo conformada por los comerciantes del Mercado central de Piura, de los cuales se extrajo mediante un muestreo probabilístico aleatorio simple una muestra representativa conformada por 96 comerciantes. Analizados los resultados obtenidos se concluyó que existe una correlación positiva moderada entre la cultura tributaria y el cumplimiento de las obligaciones tributarias (rho=,549; P= ,000); demostrando que la Superintendencia de administración tributaria y aduanas y otras instituciones relacionadas a la formación de una cultura tributaria deben seguir mejorando aquellos factores relacionados con la educación tributaria, conciencia tributaria, difusión y orientación tributaria con el propósito de reducir el nivel de contingencias tributarias, así mismo incrementar el nivel de cumplimiento de las obligaciones tributarias

The development and preliminary validation of a Preference-Based Stroke Index (PBSI)

BACKGROUND: Health-related quality of life (HRQL) is a key issue in disabling conditions like stroke. Unfortunately, HRQL is often difficult to quantify in a comprehensive measure that can be used in cost analyses. Preference-based HRQL measures meet this challenge. To date, there are no existing preference-based HRQL measure for stroke that could be used as an outcome in clinical and economic studies of stroke. The aim of this study was to develop the first stroke-specific health index, the Preference-based Stroke Index (PBSI). METHODS: The PBSI includes 10 items; walking, climbing stairs, physical activities/sports, recreational activities, work, driving, speech, memory, coping and self-esteem. Each item has a 3-point response scale. Items known to be impacted by a stroke were selected. Scaling properties and preference-weights obtained from individuals with stroke and their caregivers were used to develop a cumulative score. RESULTS: Compared to the EQ-5D, the PBSI showed no ceiling effect in a high-functioning stroke population. Moderately high correlations were found between the physical function (r = 0.78), vitality (r = 0.67), social functioning (r = 0.64) scales of the SF-36 and the PBSI. The lowest correlation was with the role emotional scale of the SF-36 (r = 0.32). Our results indicated that the PBSI can differentiate patients by severity of stroke (p < 0.05) and level of functional independence (p < 0.0001). CONCLUSIONS: Content validity and preliminary evidence of construct validity has been demonstrated. Further work is needed to develop a multiattribute utility function to gather information on psychometric properties of the PBSI

Voluem 23, Number 2, June 2003 OLAC Newsletter

Digitized June 2003 issue of the OLAC Newsletter

Impairment, disability and fatigue in multiple sclerosis

Background: Identifying the predictors of pain is important for both health professionals and researchers, because pain has repeatedly been found to be a strong predictor of activity limitations and participation restrictions. The objective of this study was to determine the predictors of pain presence and severity in a large, well-designed sample of community dwelling individuals with multiple sclerosis (MS). Methods: This was a cross-sectional study. A center-stratified random sample including 188 persons with MS were recruited from three major MS clinics in the Greater Montreal, Canada. Main outcomes included pain prevalence and severity. Predictor variables included depression, anxiety, perceived health status, fatigue, sleep problems, and perceived cognitive deficits. Participants completed three questionnaires: the first asked about the socio-demographic and clinical information of the subjects, the second assessed the pain characteristics of the subjects, and the third covered the predictor variables. Results: The prevalence of pain in our sample was 42%. MS- related disability was found to be in the main predictor for both pain presence and intensity. Fatigue also was a main contributor to pain presence. The results of this study also showed that pain was associated with higher levels of depression, anxiety, sleep problems, and perceived cognitive deficits, and diminished perceived health status. Conclusions: The results of this study indicated that pain is a common symptom among people with MS. Pain presence was predicted by MS-related disability and fatigue, while pain intensity was only predicted by MS severity

Volume 23, Number 3, September 2003 OLAC Newsletter

Digitized September 2003 issue of the OLAC Newsletter

Volume 23, Number 1, March 2003 OLAC Newsletter

Digitized March 2003 issue of the OLAC Newsletter