La Revue de medecine interne最新文献

First observed in France in 1999, Aedes albopictus (tiger mosquito) is now established in almost all French departments. As a vector of arboviruses, in particular dengue fever, A. albopictus represents a real threat in Europe, where 304 autochthonous cases of dengue fever were reported in 2024, four times more than the total number of cases reported during the entire 2010-2021 period. Although dengue is asymptomatic in the majority of cases, it can cause severe forms of the disease as hemorrhagic fever (less than 5% of cases). In the context of an unprecedented number of imported cases since the beginning of 2024, notably due to an epidemic in Martinique and Guadeloupe, dengue may be evoked as a diagnosis in patients presenting with a febrile, algic syndrome, which may be accompanied by a skin rash and digestive signs. In this context, entomovirological and epidemiological surveillances are essential to improve our understanding and the control possible future dengue epidemics.

Artificial intelligence (AI) is experiencing considerable growth in medicine, driven by the explosion of available biomedical data and the emergence of new algorithmic architectures. Applications are rapidly multiplying, from diagnostic assistance to disease progression prediction, paving the way for more personalized medicine. The recent advent of large language models, such as ChatGPT, has particularly interested the medical community, thanks to their ease of use, but also raised questions about their reliability in medical contexts. This review presents the fundamental concepts of medical AI, specifically distinguishing traditional discriminative approaches from new generative models. We detail the different exploitable data sources and methodological pitfalls to avoid during the development of these tools. Finally, we address the practical and ethical implications of this technological revolution, emphasizing the importance of the medical community's appropriation of these tools.

Introduction: MYH9 related disease is a rare autosomal dominant inherited disorder characterized in its full expression by thrombocytopenia, platelets macrocytosis, deafness, chronic kidney disease and cataract.

Case report: We present an original and didactic observation of refractory immune thrombocytopenia revealing a late diagnosis of MYH9 related disease. A 64-year-old man with longstanding thrombocytopenia less than 30 G/L without any history of bleeding, was treated with corticosteroids, intravenous immune globulin and thrombopoietin receptor agonists for a coronary angioplasty. The presence of platelets macrocytosis, increased mean platelet volume and deafness led to genetic testing of MYH9 related disease.

Conclusion: MYH9 related disease is the most common inherited thrombocytopenia. If no other symptoms are associated, it is an important differential diagnosis for immune thrombocytopenia that should be known.

Objectives: Hospital-acquired infections (HAIs) during community disease outbreaks threaten vulnerable hospitalized patients. This study compares the outcomes of hospitalized patients who had COVID-19 as either a HAI or a community-acquired infection (CAI).

Methods: We conducted a retrospective cohort study involving adult patients hospitalized across 39 greater Paris University hospitals between January 27th, 2020, and April 21st, 2021, who tested positive for SARS-CoV-2 PCR during their stay. Patients were classified as CAI if they tested positive within 72hours of admission and HAI if they tested negative within 72hours but later positive. HAI was subclassified as possible (first positive test between days 4-7), probable (days 8-13), or definite (day 14 onward). Patients with probable or definite HAI were matched 1:3 to CAI patients for age, sex, and comorbidities, to compare intensive care unit (ICU) transfer and in-hospital death between both groups.

Results: Of 10,831 patients, 506 (4.7%) were classified as HAI. They were older and had more comorbidities. After matching, the 333 patients with probable or definite HAI were less likely to be transferred to the ICU (hazard ratio [HR] 0.57, 95% CI 0.38-0.85) compared to their 999 CAI controls and had a higher risk for in-hospital death (HR 1.58, 95% CI 1.16-2.14).

Conclusion: Patients with COVID-19 as a HAI face a higher risk of death compared to patients hospitalized with COVID-19 acquired in the community and are less likely to be admitted to the ICU. Strict infection control measures are needed during community outbreaks to protect hospitalized patients.

Introduction: Extramedullary hematopoiesis (EMH) is very rarely described during sickle cell disease (SCD). Our aim was to describe six cases of EMH occurring in adult SCD patients and to conduct a literature review.

Methods: Retrospective, descriptive, and monocentric study, identifying all cases of EMH recorded in our cohort of adult SCD patients, up to April 2024. A literature review via PubMed included thirty-five articles (44 patients).

Results: Six patients (4 men, 83.3% with SS genotype [n=5], 1 SC), with a median age of 22 (range 12-64) years at the time of EMH diagnosis were included. Four patients (66.7%) had an aseptic osteonecrosis of the hip. The localization of EMH varied: paravertebral (n=3), peri-articular in the hip (n=1), adrenal (n=1), hepatic (n=1), splenic (n=1) and was similar to the localizations reported in the literature. EMH was symptomatic at diagnosis in half of the cases. The diagnosis was established by histology (n=3/3) and/or typic magnetic resonance imaging (MRI) (n=4/4). The median baseline hemoglobin was 9.1 (extremes 5.8-10.9) g/dL. A watch-and-wait approach was primarily observed.

Conclusion: EMH in SCD patients appears to be rare, with varied localizations. Its diagnosis is made with MRI and/or biopsy, and its treatment is not consensual.

Hydroxychloroquine (HCQ), a synthetic antimalarial, is recognized for its immunomodulatory, anti-inflammatory and vascular-protective effects. In 20-30% of cases of primary obstetrical antiphospholipid syndrome (APS), the combination of antiplatelet aggregation and prophylactic anticoagulation fails to prevent obstetrical complications, a situation referred to as refractory obstetrical APS. This is partly due to the pro-inflammatory effects of antiphospholipid antibodies (aPL) binding to decidual and trophoblastic cells, which compromise embryonic implantation and placentation. Experimental studies in vitro and in mouse models have shown that HCQ can inhibit the detrimental effect of aPLs on trophoblastic invasion, findings corroborated by retrospective observational clinical studies. However, no randomized controlled trial has evaluated the addition of HCQ to conventional therapy for refractory obstetric APS. The hypothesis of allo-immune and/or autoimmune mechanisms involved in cases of recurrent pregnancy loss (RPL) with no identified cause and in chronic intervillositis of unknown etiology (CIUE) has led to the empirical use of HCQ in these indications. However, current evidence does not support its use in unexplained RPL. A few clinical studies of low scientific evidence suggest a benefit of HCQ in CIUE, but further data are needed. Finally, pre-eclampsia (PE) is another pregnancy-related condition at risk of recurrence, and its pathogenesis also seems to involve an imbalance in immune responses. HCQ's antioxidant properties could have a positive effect on endothelial dysfunction, a key component of PE.

Sleep medicine and internal medicine share a global and transdisciplinary vision of human physiology and illnesses, with an approach guided by the complaint and semiology. In France, approximately 13 to 18 million individuals suffer from a sleep disorder: these disorders therefore represent a public health problem. Their comorbidities with systemic autoimmune diseases are frequent. As such, this article suggests an approach to screening for sleep disorders in daily clinical practice of internal medicine leading, when appropriate, to request specialized diagnostic and/or therapeutic care in sleep medicine to substantially improve patients' quality of life.

The incidence of systemic autoimmune diseases is constantly rising. They are chronic diseases requiring prolonged treatment, with considerable psychosocial impact. While attention to the promising results obtained with CAR-T cells in refractory patients is justified, it seems important not to overlook the opportunities for prevention based on the identification of a pre-disease state. After clarifying the various stages that make up this pre-disease state, using the prototypical example of systemic lupus erythematosus, we will apply a transdisciplinary and transpathological approach to describe comparatively recent data obtained for other systemic autoimmune diseases (rheumatoid arthritis, Sjögren's syndrome and systemic scleroderma). We will then discuss the practical implications of this new paradigm in the typical consultation of a potentially "pre-sick" individual, and on the prospects opened up by this new paradigm in care and research.