Safety and risk assessment of psychedelic psychotherapy: A meta-analysis and systematic review.

Psychotherapies assisted by psychedelic substances have shown promising results in the treatment of psychiatric disorders. The aim of this systematic review and meta-analysis was to evaluate safety data in human subjects. We carried out a search on MEDLINE, Embase and PsycINFO databases between 2000 and 2022. Standardized mean differences between different dose ranges and between acute and subacute phases were calculated for cardiovascular data after psychedelic administration. Risk differences were calculated for serious adverse events and common side effects. Thirty studies were included in this meta-analysis. There were only nine serious adverse events for over 1000 administrations of psychedelic substances (one during the acute phase and 8 during the post-acute phase). There were no suicide attempts during the acute phase and 3 participants engaged in self-harm during the post-acute phase. There was an increased risk for elevated heart rate, systolic and diastolic blood pressure for all dose range categories, as well as an increased risk of nausea during the acute phase. Other common side effects included headaches, anxiety, and decreased concentration or appetite. This meta-analysis demonstrates that psychedelics are well-tolerated, with a low risk of emerging serious adverse events in a controlled setting with appropriate inclusion criteria.

Significant Psychedelic Experiences Evaluated for Mystical Characteristics Associated with Cannabis Use Reduction and Psychological Flexibility Improvement: A Naturalistic Cross-Sectional Retrospective Survey.

Treating cannabis use disorder remains a significant challenge in the field of addiction medicine. Some recent studies point to psychedelic-assisted psychotherapy as a potential treatment option for substance use disorders. The objective of this study was therefore to explore the impact of naturalistic psychedelic experiences on cannabis use and psychological flexibility. An online retrospective survey was carried out on 152 cannabis users who also reported a significant experience induced by psychedelics in the past. Following a psychedelic experience, there was a significant and sustained reduction of average CUDIT score (p < .001), frequency of cannabis use (p < .001), and acute duration of daily intoxication (p < .001). Cannabis use reduction during the first month post-experience was significantly associated with the intensity of the mystical experience (p = .01). Participants reported a concomitant increased lasting improvement of psychological flexibility following the experience (p < .001), which was correlated to the intensity of the mystical experience during the first month post-experience (p = .04). This study demonstrates that naturalistic psychedelic experiences may be followed by a decrease in cannabis use. Positive health outcomes appear potentially connected to the intensity of the mystical experience, as well as an improvement in psychological flexibility.

[Prevalence and Risk Factors of Chlamydia Trachomatis Infection Among Women Consulting at the Sexually Transmitted Infection Centre in la Reunion: A Cross-Sectional Study]. / Prévalence et Déterminants de L'infection à Chlamydia Trachomatis chez les Femmes Consultant en Centres de Dépistage à la Réunion: Une Étude Transversale.

Introduction: Chlamydia trachomatis (CT) infection is the commonest bacterial sexually transmitted infection (STI) in the world. Often asymptomatic, it can lead to significant complications in women. In France, since 2003, systematic screening for CT in STI center has been recommended for women aged less than 25 year. The main objective of this study was to determine CT prevalence in patients attending STI centers in Reunion Island. The second objective was to explore the determinants of this infection. Method: A cross-sectional survey using an anonymous questionnaire was conducted among women attending STI center in two hospitals in western and southern Reunion Island during one year. All women who had performed a CT PCR, based on vaginal self-swabs, were included. Results: Among the 620 patients tested, the prevalence of infection was 6.6% (95% CI [4.7-8.6]). By age group, the highest prevalence was between 12 and 17 years with 14.3% positive tests compared to 7.5% and 3.9% respectively in 18-24 and 25-67 year age group (p = 0.003). The risk factors for CT were a young age (p = 0.02), a first sexual intercourse between 11 and 14 years old (p = 0.01), lack of previous STI screening history (p = 0.02), and the following motives for seeking screening: "partner unfaithfulness" (p = 0.01) and "infected partner" (p = 0.02). Conclusion: This study highlights the high prevalence of CT among Reunionese minors. A more systematic screening and a reinforcement of STI awareness among young people in Reunion Island seem to be essential.

Identifying factors associated with treatment delay in leptospirosis: A retrospective study of patients admitted to hospital in Reunion (Indian Ocean) between 2014 and 2015.

BACKGROUND: Leptospirosis is a life-threatening zoonotic disease for which delayed treatment onset has been associated to poor prognosis. The purpose of the study was to identify the determinants of therapeutic delay in hospitalized leptospirosis cases. PATIENTS AND METHODS: We carried out a retrospective multicenter study in the 4 public hospitals of Reunion Island, South Western Indian Ocean. Medical records of confirmed leptospirosis cases occurring in 2014-2015 were reviewed for socio-economic, demographic, geographic and medical data. The primary outcome measure was the therapeutic delay, defined as the time elapsed between the onset of symptoms and initiation of antibiotics. RESULTS: Of the 117 patients included, 107 were men, with an average age of 44.9±15years. The median therapeutic delay was 4 days (interquartile: 2-5 days) and this delay was not found to be associated with severity. The following were found to be at increased risk of having a longer therapeutic delay: cases occurring outside the epidemic period, or rainy season (OR 2.8 [1.08-7.3], P=0.04) and cases with first medical evaluation in primary health care (OR 4.63 [1.43-14.93]; P=0.01) instead of emergency unit. No socio-economic or geographic characteristics were found to be linked to a longer therapeutic delay. CONCLUSION: Although delayed treatment was not associated to disease severity, our results indicate that leptospirosis awareness is needed all year in the subtropical area of Reunion Island and particularly in primary care.

[Evaluation of the smoking cessation at the patients of Saint-Denis (Reunion island), over the year 2014]. / Évaluation du sevrage tabagique chez les patients de Saint-Denis de la Réunion sur l'année 2014.

INTRODUCTION: The fight against smoking is a major challenge for public health in Reunion Island. This French overseas department knows considerable social inequalities and so there is a possibility of free access to nicotine substitution among disadvantaged patients. The objective was to describe the social characteristics, the level of addiction to smoking and the actual level of smoking cessation at 18 months of tobacco-smoking patients from Reunion who consulted in 2014. METHODS: It was an observational, retrospective, monocentric study carried out in the addictology service in the teaching hospital in Saint-Denis, Reunion Island. Inclusion of patients over the year 2014 who were mono-dependent on tobacco and who were consulting for the first time in order to give up smoking. RESULTS: 122 patients were included, 51 % of women, of an average age of 47.5 years. The rate of smoking cessation at a year and a half was 23 %. There was no significant difference concerning smoking cessation according to the patient's level of addiction, the educational level, the profession or the level of confidence when stopping. DISCUSSION: The proportion of patients who had given up at a year and a half in our study was comparable to the data found in international literature. The impact of free access to nicotine substitution on smoking cessation could not be estimated.

Patient satisfaction regarding outpatient mastectomy in Saint-Nazaire hospital center.

OBJECTIVES: To assess patient satisfaction with outpatient mastectomy and their postoperative quality of life. MATERIALS AND METHODS: A retrospective descriptive study was conducted of patients who had a mastectomy as outpatients at the hospital of Saint-Nazaire between January 2013 and May 2015. Patients were contacted by phone to answer a survey assessing their satisfaction. RESULTS: Out of 16 eligible patients for an outpatient mastectomy, 11 patients were included in our study (4 [25%] had to remain hospitalized after their intervention and one patient could not be contacted). One patient (9%) presented a seroma requiring aspiration. No patients were readmitted. All patients, except one, were satisfied with the overall care. CONCLUSION: The management of outpatient mastectomies seems to be a good option, provided that patients are motivated, properly selected and well-informed prior to surgery.

[Total laparoscopic hysterectomy and same-day discharge: Satisfaction evaluation and feasibility study]. / Prise en charge ambulatoire de l'hystérectomie laparoscopique : évaluation de la faisabilité et de la satisfaction des patientes.

OBJECTIVE: To evaluate the safety and patients' satisfaction after outpatient laparoscopic hysterectomy (LH). METHODS: A retrospective case series of 47 patients discharged home the same day after total LH. Outcomes include the same-day discharge rate, complication and readmission rates, patients' short-term satisfaction and an evaluation of patients' opinion several months later. RESULTS: Among the 47 patients, 42 (89%) were discharged the same day. Five patients remained hospitalized due to postoperative complications (4 patients) and the patient's decision (1 patient). No patient required emergency consultation, readmission or reoperation in the first 72hours after discharge. Six patients (13%) had postoperative complications within the first 3 months after the surgery. Four patients (8%) were readmitted, three of them (6%) had to undergo a second surgery. In the short-term assessment, patients were satisfied with the management in 93% of cases and would recommend it to others, with a median satisfaction rate of 3.8 out of 4. CONCLUSION: Ambulatory laparoscopic hysterectomy is feasible in a well-selected population, with a high level of patients' satisfaction. This management could be an alternative to traditional long hospital stays proposed in France.

The cavaportal shunt in interruptions of the suprarenal inferior vena cava.

Abrupt interruption of the suprarenal inferior vena cava can have dramatic consequences and can be difficult to repair successfully. In the case reported, an excellent result was obtained by a cavaportal anastomosis, with minimal consequences on renal and hepatic functions.

[Inflammatory aneurysm of the aorta. Value of x-ray computed tomography and ultrasonography in the diagnosis of a case and review of the literature]. / Anévrisme inflammatoire de l'aorte. Utilité de la tomodensitométrie et de l'échographie dans le diagnostic d'un cas et revue de la littérature.

Until recently inflammatory aneurysm of the aorta was discovered only at the time of surgery and confirmed by the pathologist. New imaging modalities, such as ultrasound and CT-scan now enable the radiologist to diagnose this entity before surgery, thus leading to a better surgical planning and reducing the operative morbidity. The authors report a case of inflammatory aneurysm of the aorta and review the literature on this entity.

[Spontaneous rupture of an aneuysm of the abdominal aorta into the inferior vena cava]. / Rupture spontanée d'un anévrysme de l'aorte abdominale dans la veine cave inférieure

Rupture of an aortic aneurysm into the inferior vena cava is a rare complication; it represents 3 p. 100 of all ruptured aneurysms. The authors report a case with a typical clinical history and 3 main symptoms : lumbar pain, a pulsatile expansile mass, a continuous abdominal murmur giving rise to a thrill. The diagnosis was confirmed before operation by angiography which showed a fistula. A technical detail is emphasised: clamping of the inferior vena cava opening the aneurysm to reduce the risk of embolism into the right side of the heart during operation.

[Idiopathic intracranial hypertension and pregnancy. A report of two cases]. / Hypertension intracrânienne bénigne et grossesse. A propos de deux cas.

The authors describe two cases of idiopathic intracranial hypertension (IIH) during pregnancy. The first case was discovered in a 21-year-old primigravida at 15 weeks gestation and thereafter six evacuation lumbar punctures were necessary, and a treatment by acetazolamide, 1000mg/day, was prescribed until parturition. Labor was induced at 37 weeks for intrauterine growth retardation associated with oligohydramnios. The second patient, a 38-year-old tertigravida primipara presented clinical signs of IIH at 28 weeks gestation in the context of preterm labour after a suicide attempt by massive ingestion of venlafaxine. She was given an evacuation lumbar puncture and went into labour at 29 weeks, after tocolysis failure. The diagnosis of IIH is to be done only by exclusion, in front of a normal biological composition of the spinal fluid at lumbar puncture with increased opening pressure, and after a brain imaging excluding any expansive intracranial process or hydrocephaly. Obstetrical prognosis is usually favourable. The main complication of this pathology resides in the ocular impact. Outside pregnancy the risk factors of IIH which have been evoked are polycystic ovary syndromes and blood coagulation anomalies as thrombophilia or hypofibrinolysis. Treatment of this pathology should be medical in the first instance and surgical only in the case of resistance or for severe ocular involvement.

A case of post-traumatic false aneurysm of the superior gluteal artery with compression of the sciatic nerve.

A false aneurysm of the superior gluteal artery with compression of the sciatic nerve is reported in an 18-year-old man who was recovering from multiple injuries sustained in a bicycle accident. Rapidly increasing pain and swelling in the leg, with a rapid fall in the hemoglobin level and weakness of dorsiflexion and inversion of the foot were not compatible with the initial diagnosis of abscess. A selective iliac arteriogram revealed the true diagnosis. The gluteal artery was ligated and the false aneurysm oversewn through a posterior, extrapelvic approach. An abdominal, retroperitoneal approach would have been better but was precluded by injuries to the intrapelvic viscera and left-sided colostomy. False aneurysm of the gluteal artery is a life-threatening condition and must be diagnosed early and treated promptly to ensure a successful outcome.

Infection with fatal outcome after endovascular metallic stent placement.

The authors describe a case in which infection developed in a patient after placement of a metallic endoprosthesis in the iliac artery. The patient died of respiratory failure secondary to sepsis. Imaging studies did not reveal an abscess, aneurysm, or stent occlusion. Stent cultures and hemocultures grew Staphylococcus aureus. As with any foreign body, infectious complications may occur after insertion of metallic stents and should be recognized as soon as possible to initiate appropriate therapy.

Comparison of streptokinase and urokinase in local thrombolysis of peripheral arterial occlusions for lower limb salvage.

PURPOSE: To compare the efficacy and safety of streptokinase (SK) and urokinase (UK) in the treatment of local thrombolysis. PATIENTS AND METHODS: Over a 24-month period, 40 patients with 45 lower limb arterial occlusions of less than 45 days duration underwent intraarterial fibrinolysis. Twenty occlusions were treated with recombinant UK and tissue culture-derived UK, and 25 occlusions were treated with SK. The study was retrospective, but the two groups were very homogeneous in terms of vascular surgical history, medical risk factors, and occlusion characteristics. RESULTS: Complete lysis (95% or more) was achieved in 84% of SK infusions and 89% of UK infusions. Endoluminal and surgical interventions as well as clinical outcomes of SK and UK treatment were comparable. However, infusion time was significantly longer for SK treatment: 28.5 hours versus 19.1 hours for UK treatment (P = .035). Complication rates were not statistically significantly different. Average length of stay in the intensive care unit was identical (2.2 days) for both groups, and the difference in hospital stay was not statistically significant (7.7 days for SK vs 8.7 days for UK). CONCLUSION: At the concentrations and doses used, the efficacy and safety of SK and UK were comparable, despite longer SK infusion time.