Le foyer Watteau est un foyer de postcure dans la ville, situé dans le 13 ème arrondissement de Paris, destiné à des patients psychotiques pour lesquels leur psychiatre traitant pense une réinsertion « hors les murs de l’hôpital psychiatrique » possible. Il a été créé par Philippe Paumelle, fondateur de l’ASM 13 (Association de santé Mentale du 13 ème arrondissement de Paris) en 1958, dont on sait l’activité pionnière tant dans l’initiation des secteurs de psychiatrie que par ses nombreuses innovations qui ont suivi les décennies suivantes. Le foyer a ouvert ses portes au début des années 1960, sous le nom de foyer de la Bièvre, car il occupait un bâtiment au-dessus de la rivière de la Bièvre (qui traverse Paris de façon souterraine), puis a pris le nom de foyer Watteau, du nom de la rue qui le longe. Description.
Histological data on anti-PD1-associated colitis are limited, while the colitis subtypes are still not clearly defined and different terms are being used. The aim of the study was to explore the histopathology of anti-PD1-induced colitis.Colonic biopsies from 9 patients under anti-PD1 agents presenting diarrhea were examined. Histological evaluation revealed colitis of mild to moderate severity in almost all cases. Four distinct dominant histological patterns were identified with nearly the same incidence: Ulcerative colitis (UC)-like (n=2), GVHD-like (n=2), collagenous-like (n=3) and a mixed colitis pattern combining features of microscopic and UC-like colitis (n=2). The latter was additionally characterized by high crypt epithelium apoptosis and cryptitis with mixed inflammatory infiltrate. Thickening of the subepithelial band of collagen, detachment of the surface epithelium and increased apoptosis of the crypt epithelium were commonly encountered features, irrespective of colitis subtype. CD4/CD8 ratio was lower in the "combined" and higher in the GVHD-like subtype.Anti-PD1-induced colitis is expressed by different patterns of injury which share distinct histological hallmarks harboring diagnostic value, while a "combined" colitis subtype is being established. The histological alterations are indicative of mucosa barrier damage after antΙ-PD1 treatment and its participation in the pathogenetic process.
In recent years, blood eosinophils have been evaluated as a surrogate biomarker for eosinophilic airway inflammation and as a prognostic indicator of the outcomes of hospitalized COPD subjects. During an exacerbation of COPD, eosinopenia has been proposed as a prognostic marker of adverse outcomes.The aim of the present post hoc analysis was to elucidate the effectiveness of blood eosinophils for predicting the need of NIV in subjects with COPD exacerbation.Consecutive subjects admitted to a hospital for COPD exacerbation were included in the analysis. The eosinophil count from the first complete blood count was used to designate the eosinophil groups. The relationship between the clinical characteristics and blood eosinophil counts, as dichotomized using 150 cells/μL, was evaluated. Results Subjects with blood eosinophil number < 150 k/μL had a more severe disease on admission compared to subjects with ≥150 k/μL, regarding pH 7.400 (7.36, 7.44) vs. 7.42 (7.38, 7.45), p = 0.008, PO2/FiO2 levels 238.1 (189.8, 278.6) vs. 276.2 (238.2, 305.6), p < 0.001, CRP (mg/L) levels 7.3 (3.1, 19.9) vs. 3.5 (0.7, 7.8), p < 0.001 and required a longer hospital stay (days) 10.0 (8.0, 14.0) vs. 5.0 (3.0, 7.0) p < 0.001 respectively. The number of blood eosinophils correlated with the levels of CRP upon admission (p < 0.001, r = -0.334), with arterial pH upon admission (p < 0.030, r = 0.121), with PO2/FiO2 (p < 0.001, r = -0.248), and with duration of hospital stay (p < 0.001, r = -0.589). In the multinomial logistic regression analysis, blood eosinophil count < 150 k/μL was an independent predictor of the use of NIV during hospital stay.During COPD exacerbation, low blood eosinophil levels upon admission are related to more severe disease and can be used as a predictor of the need of NIV. Further prospective studies are needed to identify the use of blood eosinophil levels as a predictor of unfavorable outcomes.
Abstract Background Four EMA-approved vaccines against SARS-CoV-2 are currently available. Data regarding antibody responses to initial vaccination regimens in patients with inflammatory bowel diseases (IBD) are limited. Methods We conducted a prospective, controlled, multicenter study in tertiary Greek IBD centers. Participating patients had completed the initial vaccination regimens (1 or 2 doses, depending on the type of COVID-19 vaccine) at least 2 weeks before study enrolment. Anti-S1 IgG antibody levels were measured. Demographic and adverse events data were collected. Results We tested 403 patients (Crohn’s disease, 58.9%; male, 53.4%; median age, 45 years) and 124 healthy controls (HCs). Following full vaccination, 98% of patients seroconverted, with mRNA vaccines inducing higher seroconversion rates than viral vector vaccines (P = .021). In total, IBD patients had lower anti-S1 levels than HCs (P < .001). In the multivariate analysis, viral vector vaccines (P < .001), longer time to antibody testing (P < .001), anti-TNFα treatment (P = .013), and age (P = .016) were independently associated with lower anti-S1 titers. Vedolizumab monotherapy was associated with higher antibody levels than anti-TNFα or anti-interleukin-12/IL-23 monotherapy (P = .023 and P = .032). All anti- SARS-CoV-2 vaccines were safe. Conclusions Patients with IBD have impaired antibody responses to anti-SARS-CoV-2 vaccination, particularly those receiving viral vector vaccines and those on anti-TNFα treatment. Older age also hampers antibody production after vaccination. For those low-response groups, administration of accelerated or prioritized booster vaccination may be considered.
L’approche théorico-clinique de l’analyse de groupe développée par Jean Claude Rouchy accorde une place importante à l’articulation du dispositif avec le cadre institutionnel ainsi qu’à la manifestation d’éléments psychiques au moyen de processus primaires. Dans cet écrit nous questionnons la spécificité de la pratique analytique de groupe auprès de patients psychotiques soignés en institution psychiatrique depuis de longues années. Après avoir évoqué brièvement le débat sur la psychothérapie des psychoses, nous nous centrons sur notre expérience de groupe conduit à deux. La séquence clinique présentée illustre l’émergence du registre archaïque dans le soin de la psychose et l’instauration progressive d’un processus de secondarisation qui nécessite l’implication subjective des thérapeutes.
This article addresses the issue of loss from the angle of the support provided to a group of long-term psychotic patients in a psychiatric institution. We observe that these patients exhibit an extreme dependence on the institutional framework. The question arises of how to support the empowerment process. This article presents our work with an analytic psychotherapy group and describes a clinical session, which is used to illustrate our thoughts on the role of psychological motivation in psychotic functioning related to the experience of loss.
