Hôpital de l'Antiquaille

L'ancienne Kerdylion est située en Grèce du Nord sur un haut plateau à l'extrémité Est du mont éponyme, à l'Ouest de l'embouchure du fleuve Strymon. À l’époque archaïque et durant une bonne partie de l’époque classique, l’établissement appartenait au territoire de la cité côtière d'Argilos. Après plusieurs tentatives d'identification non concluantes, c'est l'archéologue Efstratios Pelekidis qui trouva hors de tout doute l'ancienne Kerdylion en 1920. Depuis les fouilles de Pelekidis, les quelques travaux archéologiques se sont concentrés sur la fortification et sur une porte secondaire de l’établissement, à l'Est du site. Les efforts de l’équipe gréco-canadienne de Kerdylion se sont ainsi concentrés en 2021 et 2022 dans ce même secteur, avec pour objectifs la fouille du rempart au Nord de la porte Est et l’étude stratigraphique de ce secteur de l’établissement afin de démystifier les différentes périodes d'occupation du site qui semblent s’étendre de l’époque archaïque jusqu’à l’époque byzantine.

Individuals with bipolar disorder (BD) frequently experience comorbid medical conditions, with migraine being among the most common. While research on migraine prevalence in BD is growing, the associated clinical features, comorbidities, and treatments remain underexplored and sometimes inconsistent. This study aimed to investigate the clinical features and comorbidities associated with migraine in a large cohort of adults with BD. We assessed 4348 outpatients with BD attending FondaMental Advanced Centers of Expertise. Sociodemographic and clinical data were collected using a standardized procedure. Lifetime diagnoses for medical disorders, including migraine, were based on self-reports, clinician assessments, and medical history reviews. Multivariable logistic regression was used to assess associations between migraine and sociodemographic factors, clinical characteristics, comorbidities, and medications. The prevalence of comorbid migraine in BD was 20%, with 29.1% in BD type II and 19.9% in BD type I. Multivariable analysis found that migraine was associated with younger age (OR=0.98, CI 95% 0.97-0.99), females (OR=2.15, CI 95% 1.56-2.95), sleep disturbances (OR=1.06, CI 95% 1.02-1.11), childhood trauma (OR=1.01, CI 95% 1.00-1.02), hypertension (OR=1.88, CI 95% 1.13-3.15), psoriasis (OR=1.61, CI 95% 1.01-2.56), asthma (OR=1.65, CI 95% 1.02-2.67) and lower use of second-generation antipsychotics (OR=0.65, CI 95% 0.48-0.87). Migraine is common in BD, especially in younger individuals, females, and those with sleep disturbances or a history of trauma, who also experience a higher clinical burden. These overlapping factors highlight the need for an integrated treatment approach, addressing mood stabilization, sleep management, and trauma support to reduce migraine burden in BD patients.

A gradually detailed geophysical investigation took place on Ancient Marina territory. In that area was extended Ancient Tritaea, according to responsible Archaeological Services. The first approach had been attempted since 1988 by applied electric mapping based on a twin-probe array. Later, the survey extended to the peripheral zone under the relative request from the 6th Archaeological Antiquity. A new approach was implemented by combining three different geophysical techniques, like electrical mapping, total intensity, and vertical gradient. These were applied on discrete geophysical grids. Electric mapping tried to separate the area into low and high-interest subareas according to soil resistance allocation. That technique detected enough geometrical characteristics, which worked as the main lever for the application of two other geophysical techniques. The other two techniques would be to certify the existence of geometrical characteristics, which divorced them from geological findings. Magnetic methods were characterized as a rapid technique with greater sensitivity in relation to electric mapping. Also, vertical gradient focuses on the horizontal extension of buried remains. Processing of magnetic measurements (total and vertical) certified the results from electric mapping. Also, both of the techniques confirmed the existence of human activity results, which were presented as a cross-section of two perpendicular parts. The new survey results showed that the new findings related to results from the previous approach. Geophysical research in that area is continuing.

The development of paraclinical tools to assist clinical assessment is already widespread in nearly all other medical specialties. In psychiatry, many efforts are being made to improve management strategies using these new techniques. The first episode psychosis (FEP) is a clinical entity whose evolution after onset is difficult to predict in the current state of our practices. Our main objective was to identify from the literature the most promising biological markers for early prediction of thymic or psychotic trajectories following FEP. We performed a systematic literature review on 4 databases: PubMed, Scopus, PsycINFO, and Web of Science following PRISMA guidelines and using search terms related to FEP and biomarkers. Eight studies were included in our final analysis. Several biomarkers showed promising discriminatory capacities for predicting post-FEP evolution: the interleukins IL-6, IL-12p40, IL-1β, and the mRNA expression levels of the DICER-1 and AKT-1 genes. Other studies that opted for broad-spectrum strategies also highlighted new leads for the discovery of additional biomarkers. Overall, our results indicate the value of replicating studies targeting the analysis of the predictive capacities of several biological markers. It also appears important to homogenize methodologies and favor the construction of predictive models on several of these markers to reinforce their statistical significance.

ObjectivesElectroconvulsive therapy (ECT) is one of the most effective treatments in mood disorders, mainly in major depressive episode (MDE) in the context of either unipolar (MDD) or bipolar disorder (BD). However, ECT remains a neglected and underused treatment. Older people are at high risk patients for the development of adverse drug reactions. In this context, we sought to determine the duration of MDEs and the number of lines of treatment before the initiation of ECT in patients aged 65 years or over according to the presence or absence of first-line indications for using ECT from international guidelines.MethodsIn this multicenter, retrospective study including patients aged 65 years or over with MDEs in MDD or BD who have been treated with ECT for MDEs, data on the duration of MDEs and the number of lines of treatment received before ECT were collected. The reasons for using ECT, specifically first-line indications (suicidality, urgency, presence of catatonic and psychotic features, previous ECT response, patient preference) were recorded. Statistical comparisons between groups used standard statistical tests.ResultsWe identified 335 patients. The mean duration of MDEs before ECT was about 9 months. It was significantly shorter in BD than in MDD- about 7 and 10 months, respectively. The co-occurrence of chronic medical disease increased the duration before ECT in the MDD group. The presence of first-line indications for using ECT from guidelines did not reduce the duration of MDEs before ECT, except where there was a previous response to ECT. The first-line indications reduced the number of lines of treatment before starting ECT.ConclusionEven if ECT seems to be a key treatment in the elderly population due to its efficacity and safety for MDEs, the delay before this treatment is still too long.

BackgroundHuman metapneumovirus (hMPV) is one of the leading respiratory viruses. This prospective observational study aimed to describe the clinical features and the outcomes of hMPV-associated lower respiratory tract infections in adult inpatients. MethodsConsecutive adult patients admitted to one of the 31 participating centers with an acute lower respiratory tract infection and a respiratory multiplex PCR positive for hMPV were included. A primary composite end point of complicated course (hospital death and/or the need for invasive mechanical ventilation) was used. ResultsBetween March 2018 and May 2019, 208 patients were included. The median age was 74 [62–84] years. Ninety-seven (47 %) patients were men, 187 (90 %) had at least one coexisting illness, and 67 (31 %) were immunocompromised. Median time between first symptoms and hospital admission was 3 [2–7] days. The two most frequent symptoms were dyspnea (86 %) and cough (85 %). The three most frequent clinical diagnoses were pneumonia (42 %), acute bronchitis (20 %) and acute exacerbation of chronic obstructive pulmonary disease (16 %). Among the 52 (25 %) patients who had a lung CT-scan, the most frequent abnormality was ground glass opacity (41 %). While over four-fifths of patients (81 %) received empirical antibiotic therapy, a bacterial coinfection was diagnosed in 61 (29 %) patients. Mixed flora (16 %) and enterobacteria (5 %) were the predominant documentations. The composite criterion of complicated course was assessable in 202 (97 %) patients, and present in 37 (18 %) of them. In the subpopulation of pneumonia patients (42 %), we observed a more complicated course in those with a bacterial coinfection (8/24, 33 %) as compared to those without (5/60, 8 %) (p = 0.02). Sixty (29 %) patients were admitted to the intensive care unit. Among them, 23 (38 %) patients required invasive mechanical ventilation. In multivariable analysis, tachycardia and alteration of consciousness were identified as risk factors for complicated course. ConclusionhMPV-associated lower respiratory tract infections in adult inpatients mostly involved elderly people with pre-existing conditions. Bacterial coinfection was present in nearly 30 % of the patients. The need for mechanical ventilation and/or the hospital death were observed in almost 20 % of the patients.

The early stages of psychotic disorders correspond to the early phases of the disease and include the prodromal phase and first-episode psychosis; they constitute a period at high risk of suicidal behaviour. A long duration of untreated psychosis (DUP) is among the risk factors of suicidal behaviour identified in this early period. Many studies have shown the effectiveness of early interventions on the overall prognosis of psychotic disorders in the early stages, and early intervention strategies have been developed and tested worldwide. Several authors reported an improvement in suicidal behaviours; however, all these data have not been systematically analysed yet. The main objective of this systematic review was to collect evidence on the effect on suicidal behaviour of early interventions for patients in the early stages of psychotic disorders. We will carry out a systematic review of the literature according to the PRISMA criteria by searching articles in five databases (PubMed, Cochrane, PsycINFO, Scopus, EMBASE), without restriction on the publication date. The selection criteria are: articles (any type; e.g. prospective, retrospective, controlled or uncontrolled, and literature reviews) on early interventions for psychotic disorders in the early stages with data on suicide attempts, death by suicide, suicidal ideation; articles written in English or French. Exclusion criteria are: articles on suicidal behaviours in patients with psychotic disorders in the early stages, but without early intervention, and articles on early-stage psychotic disorders without data on suicidal behaviours. If this review confirms the effectiveness on suicidal behaviours of early interventions for young patients with psychotic disorders, the development/implementation of such intervention programmes should be better promoted. https://www.crd.york.ac.uk/prospero/, identifier CRD42021237833.

Physical pain is a common issue in people with bipolar disorder (BD). It worsens mental health and quality of life, negatively impacts treatment response, and increases the risk of suicide. Lithium, which is prescribed in BD as a mood stabilizer, has shown promising effects on pain. This naturalistic study included 760 subjects with BD ( FACE-BD cohort) divided in two groups: with and without self-reported pain (evaluated with the EQ-5D-5L questionnaire). In this sample, 176 subjects were treated with lithium salts. The objectives of the study were to determine whether patients receiving lithium reported less pain, and whether this effect was associated with the recommended mood-stabilizing blood concentration of lithium. Subjects with lithium intake were less likely to report pain (odds ratio [OR]=0.59, 95% confidence interval [CI], 0.35-0.95; p=0.036) after controlling for sociodemographic variables, BD type, lifetime history of psychiatric disorders, suicide attempt, personality traits, current depression and anxiety levels, sleep quality, and psychomotor activity. Subjects taking lithium were even less likely to report pain when lithium concentration in blood was ≥0.5mmol/l (OR=0.45, 95% CI, 0.24-0.79; p=0.008). This is the first naturalistic study to show lithium's promising effect on pain in subjects suffering from BD after controlling for many confounding variables. This analgesic effect seems independent of BD severity and comorbid conditions. Randomized controlled trials are needed to confirm the analgesic effect of lithium salts and to determine whether lithium decreases pain in other vulnerable populations.