RESUMEN
La depresión posparto es una patología frecuente, estigmatizada, con implicaciones socio-familiares. El objetivo es revisar si existe relación entre el parto mediante cesárea comparado con la vía vaginal de parto, en el riesgo de padecer depresión posparto. En la revisión se realiza una búsqueda en PubMed; se incluyeron estudios donde se comparaba el parto vaginal vs. cesárea en relación con la depresión posparto. Tras aplicar los criterios de elegibilidad, se obtuvieron 11 artículos de interés. La literatura revisada mostró resultados heterogéneos y no concluyentes respecto a la relación directa entre la vía de parto y la depresión posparto. La asociación de la vía de parto con el riesgo de padecer este trastorno sigue siendo controversial.(AU)
Postpartum depression is a very frequent, yet stigmatized illness, and it may carry serious family and social implications. The main aim of this review is to review whether there is a link between caesarean section and the risk of postpartum depression, compared with vaginal delivery. The main search was performed on PubMed. Articles that compared vaginal delivery with caesarean section in relation to postpartum depression were included. After applying eligibility criteria, 11 relevant articles were obtained. The reviewed literature showed heterogeneous and inconclusive results regarding the direct link between delivery mode and postpartum depression. Conclusions. The relationship between mode of delivery and risk of postpartum depression remains controversial.(AU)
Asunto(s)
Humanos , Femenino , Depresión Posparto , Periodo Posparto , Cesárea , Parto Vaginal Después de Cesárea , Parto , GinecologíaRESUMEN
BACKGROUND: Atazanavir (ATV) boosted with ritonavir (ATV/r) is a potent, well-tolerated, once-daily protease inhibitor (PI). Few data are available on this agent as a treatment simplification option for patients taking other PIs. OBJECTIVE: The aim of the study was to determine the effectiveness and safety of ATV-containing regimens in patients who have simplified their antiretroviral treatment. METHODS: SIMPATAZ was a multicentre, prospective, noninterventional study in patients who had undetectable HIV RNA on their current PI-containing therapy and who were switched to an ATV/r-based regimen. Patients underwent a routine physical examination, and data were collected on HIV RNA levels, CD4 cell counts, liver function, lipid parameters, adverse reactions, adherence to treatment and patient satisfaction. RESULTS: A total of 183 patients were enrolled in the study and included in the analysis (80% were male, 29% had AIDS, and 52% were coinfected with HIV and hepatitis B virus or hepatitis C virus). The median baseline CD4 count was 514 cells/µL. Median exposure to previous HIV therapy was 8 years, and 32% of patients had a history of PI failures. Lopinavir boosted with ritonavir was the most frequent PI replaced (62%) and tenofovir+lamivudine /emtricitabine the backbone most used during the study (29%). The study drug was discontinued early by 25 patients (14%), two of whom discontinued as a result of adverse events (Hodgkin lymphoma and vomiting). Two patients died (lung cancer and myocardial infarction). At month 12, 93% of the study population had an undetectable HIV RNA viral load. Hyperbilirubinaemia >3 mg/dL and increased alanine aminotransferase levels>200 IU/L were observed in 38.5% and 4.4% of patients, respectively. Median changes from baseline to month 12 in total cholesterol, triglycerides and low-density lipoprotein cholesterol were -13 mg/dL (-7%; P<0.0001), -19 mg/dL (-13%; P<0.0001) and -7 mg/dL (-6%; P=0.021), respectively. CONCLUSIONS: In a real-world setting, switching from other PIs to ATV/r is a well-tolerated and safe option for improving the lipid profile and for retaining virological response in controlled pretreated patients.
