RESUMO
Objectives: This study aims to determine the rates of clinically-significant anxiety and depressive symptoms during the immediate postpartum in a sample of women referred to a university maternity department, as well as the associated risk factors and the relations with the level of maternal bonding. Patients and methods: During the third national lockdown for the COVID-19 pandemic (February-April 2021), on days 2-3 after delivery 127 mothers were administrated the Edinburgh postnatal depression scale (EPDS), the state-trait anxiety inventory (STAI-YA), the mother-to-infant bonding scale (MIBS) and questions issued from the coronavirus health impact survey questionnaire (CRISIS). Results: The rate of perinatal clinically-significant symptoms were 17% for depression (EPDS cut-off ≥ 12) and 15% for anxiety (STAI-YA cut-off ≥ 40). In the multivariate analysis, being a single mother, risk of being infected by the SARS-CoV2, risk that a close relative might be infected by the SARS-CoV2 and the length of stay in maternity were associated with an increased EPDS total score, while breastfeeding was associated with a lower EPDS total score. Six variables remained positively associated with the STAI-YA total score in the multivariate model: the maternal level of academic achievement, a hospitalization during the pregnancy, peripartum medical complications, risk of being infected by the SARS-CoV2, risk of a close relative being infected by the SARS-CoV2 and physical fatigue. Low but statistically significant correlations were found between the MIBS total score and the EPDS total score (rs = 0.26) and with the STAI-YA total score (rs = 0.26). Discussion: The observed rates of anxiety and depressive symptoms were in the same range as those reported in observational studies conducted in high-resource countries during the COVID-19 pandemic. Risk of being infected by the SARS-CoV2 was both an independent risk factor for anxiety and depressive symptoms. The relations between the measure of maternal bonding and the severity of maternal emotional symptoms call for a better consideration of the long-term consequences of the pandemic on children's socio-emotional development.
Objectifs: Cette étude a pour objectif de déterminer la fréquence des symptômes dépressifs et anxieux maternels lors de la période du post-partum immédiat dans un groupe de femmes venant d'accoucher sur un service universitaire, ainsi que les facteurs de risques associés et les conséquences sur le lien mère-enfant. Patients et méthodes: Au tout début de la pandémie de COVID-19 (entre les mois de février et avril 2021), 127 femmes venant d'accoucher ont complété dans les 2 à 3 jours qui suivent l'accouchement l'Edinburgh postnatal depression scale (EPDS), le State-trait anxiety inventory (STAI-YA), le Mother-to-infant bonding scale (MIBS) et le Coronavirus health impact survey questionnaire (CRISIS). Résultats: La fréquence des symptômes dépressif cliniquement significatifs était de 17 % et de 15 % pour les symptômes anxieux. Le risque d'infection par le SARS-CoV2 était associé à la sévérité de ces symptômes dans les analyses multivariées. Des corrélations statistiquement significatives ont été mis en évidence entre le score MIBS et le score EPDS (rs = 0.26) et avec le score STAI-YA (rs = 0.26). Discussion: La fréquence des symptômes anxieux et dépressifs du péripartum étaient comparable avec d'autres études conduites dans les pays à haut niveau de ressource au cours de la pandémie de COVID-19. Le risque d'infection par le SARS-CoV2 est associé à des niveaux plus élevés de symptômes anxieux et dépressifs, à côté des autres facteurs connus de symptômes émotionnels du post-partum. Les liens retrouvés entre ces symptômes et le niveau de lien mère-enfant invitent à être attentif aux conséquences à long-terme de la pandémie sur le développement socio-émotionnel du nourrisson. Conclusion: Des études complémentaires sont nécessaires pour confirmer ces résultats et déterminer les conséquences potentiellement délétères sur le développement des interactions mère-enfant et du nourrisson.
RESUMO
Mineral metabolism disorders are well-recognized complications in patients with chronic kidney disease (CKD). Furthermore, hyperphosphatemia and secondary hyperparathyroidism are associated with both renal osteodystrophy and cardiovascular disease. During the last 5 years, new therapeutic options have become available to treat these conditions in CKD. We describe the case of a 70-year-old lady with a dialysis history of 5 years and a number of cardiovascular risk factors (hypertension, hypercholesterolemia and obesity). Unfortunately, the patient was poorly compliant with any pharmaceutical treatment. After 2 years, a pharmacological approach with a low dosage of calcium salts and sevelamer HCl, subsequently changed to lanthanum carbonate, intravenous paricalcitol, and cinacalcet HCl reached the goals suggested by the current guidelines. Every nephrologist should look at the pathogenesis and treatment of hyperphosphatemia and secondary hyperparathyroidism. New options are now available and may help the clinician to obtain satisfactory short- and long-term outcomes in the treatment of this disease.
