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Albaladejo A, Lorleac'h A, Allain JS. [The spring of artificial intelligence: AI vs. expert for internal medicine cases]. Rev Med Interne 2024:S0248-8663(24)00032-8. [PMID: 38331591 DOI: 10.1016/j.revmed.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION The "Printemps de la Médecine Interne" are training days for Francophone internists. The clinical cases presented during these days are complex. This study aims to evaluate the diagnostic capabilities of non-specialized artificial intelligence (language models) ChatGPT-4 and Bard by confronting them with the puzzles of the "Printemps de la Médecine Interne". METHOD Clinical cases from the "Printemps de la Médecine Interne" 2021 and 2022 were submitted to two language models: ChatGPT-4 and Bard. In case of a wrong answer, a second attempt was offered. We then compared the responses of human internist experts to those of artificial intelligence. RESULTS Of the 12 clinical cases submitted, human internist experts diagnosed nine, ChatGPT-4 diagnosed three, and Bard diagnosed one. One of the cases solved by ChatGPT-4 was not solved by the internist expert. The artificial intelligence had a response time of a few seconds. CONCLUSIONS Currently, the diagnostic skills of ChatGPT-4 and Bard are inferior to those of human experts in solving complex clinical cases but are very promising. Recently made available to the general public, they already have impressive capabilities, questioning the role of the diagnostic physician. It would be advisable to adapt the rules or subjects of future "Printemps de la Médecine Interne" so that they are not solved by a public language model.
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Affiliation(s)
- A Albaladejo
- Médecine interne et immunologie clinique, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
| | - A Lorleac'h
- Groupement hospitalier Bretagne Sud, 5, avenue Choiseul, 56100 Lorient, France.
| | - J-S Allain
- Groupement hospitalier Bretagne Sud, 5, avenue Choiseul, 56100 Lorient, France.
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Besse MC, Perrotin F, Aouba A, Gallou S, Karras A, Pillebout E, Urbanski G, Allain JS, Merlot C, Humbert S, Ramdani Y, Ferreira-Maldent N, Maillot F, Audemard-Verger A. Pregnancy outcome in patients with a medical history of immunoglobulin A vasculitis: a case-control study. Scand J Rheumatol 2024; 53:36-43. [PMID: 37439394 DOI: 10.1080/03009742.2023.2226518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 06/14/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Data on obstetric outcomes in patients with a history of immunoglobulin A vasculitis (IgA-V) are lacking. The aim of this study was to assess maternal, neonatal, and vasculitis outcomes during pregnancy. METHOD We conducted a French retrospective case-control study. Pregnancies of patients with a history of IgA-V (cases) were retrospectively studied and compared to pregnancies in women who developed IgA-V after their pregnancies and to pregnancies in healthy women (controls). RESULTS Twenty-six pregnancies in patients with a history of IgA-V were included and compared to 15 pregnancies in women who later developed IgA-V and 52 pregnancies in healthy women. Both gestational hypertension and pre-eclampsia were more frequent in the case group than in the other groups (23% vs 0% vs 0%, p < 0.01; 12% vs 7% vs 0%, p = 0.04). Hypertensive disorder of pregnancy occurred more frequently in patients with pre-existing kidney disease (78% vs 12%, p < 0.01). Caesarean section was more often performed in the case group than in the other groups (27% vs 0% vs 10%, p = 0.04). No foetal loss or maternal deaths occurred. There were no differences in delivery term or birth weight. No vasculitis flares were observed during pregnancy. CONCLUSION Women with a history of IgA-V appear to be at higher risk for gestational hypertension and pre-eclampsia, especially in cases with renal involvement; however, both mother and newborn outcomes appear to be favourable.
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Affiliation(s)
- M-C Besse
- Department of Internal Medicine and Clinical Immunology, CHU de Tours, Tours, France
- Tours University, Tours, France
| | - F Perrotin
- Tours University, Tours, France
- Department of Obstetrics and Gynecology, CHU de Tours, Tours, France
| | - A Aouba
- Department of Internal Medicine and Clinical Immunology, CHU de Caen, Caen, France
| | - S Gallou
- Department of Internal Medicine and Clinical Immunology, CHU de Caen, Caen, France
| | - A Karras
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance publique des Hôpitaux de Paris, Paris, France
| | - E Pillebout
- Department of Nephrology, Hôpital Saint Louis, Assistance publique des Hôpitaux de Paris, Paris, France
| | - G Urbanski
- Department of Internal Medicine, CHU d'Angers, Angers, France
| | - J-S Allain
- Department of Internal Medicine, CH de Saint Malo, Saint Malo, France
| | - C Merlot
- Department of Internal Medicine, CHR Orléans, Orléans, France
| | - S Humbert
- Department of Internal Medicine, CHRU de Besancon, Besancon, France
| | - Y Ramdani
- Department of Internal Medicine and Clinical Immunology, CHU de Tours, Tours, France
- Tours University, Tours, France
| | - N Ferreira-Maldent
- Department of Internal Medicine and Clinical Immunology, CHU de Tours, Tours, France
| | - F Maillot
- Department of Internal Medicine and Clinical Immunology, CHU de Tours, Tours, France
- Tours University, Tours, France
| | - A Audemard-Verger
- Department of Internal Medicine and Clinical Immunology, CHU de Tours, Tours, France
- Tours University, Tours, France
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Allain JS, Henriot B, Guillemot P, Menard S, Cador-Rousseau B, Jego P, Deshaye R, Azoyan L, Riller Q, Renaud A. [Confusion and drowsiness a 16 year-old man]. Rev Med Interne 2022; 43:566-569. [PMID: 35667918 DOI: 10.1016/j.revmed.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
Affiliation(s)
- J-S Allain
- Médecine interne et immunologie clinique, pôle CVM, CH de Saint Malo, 1, rue de la Marne, 35400 Saint Malo, France; Unité d'investigation clinique, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
| | - B Henriot
- Médecine interne et immunologie clinique, CH de René Pleven, 74, rue Châteaubriand, 22100 Dinan, France
| | - P Guillemot
- Service de médecine du sport, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - S Menard
- Médecine du sport, clinique Saint Laurent, 320, avenue du Général Patton, 35700 Rennes, France; Fédération française de judo, jujitsu, kendo et disciplines associées, 21/25, avenue de la Porte Châtillon, 75014 Paris, France
| | - B Cador-Rousseau
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - P Jego
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - R Deshaye
- Service de médecine interne, Hôtel-Dieu, centre hospitalier universitaire, place Alexis Ricordeau, 44093 Nantes, France
| | - L Azoyan
- Service de médecine interne, centre hospitalier universitaire, Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Q Riller
- Service de médecine interne 2, hôpital de la Pitié-Salpêtrière, Sorbonne université, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - A Renaud
- Service de médecine interne, Hôtel-Dieu, centre hospitalier universitaire, place Alexis Ricordeau, 44093 Nantes, France
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Allain JS, Paven E, Henriot B, Belhomme N, Le Bot A, Ballerie A, Jego P. [Libman-Sacks endocarditis under apixaban in a patient with a high-risk profile venous antiphospholipid syndrome]. Rev Med Interne 2020; 42:218-222. [PMID: 33153775 DOI: 10.1016/j.revmed.2020.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/23/2020] [Accepted: 08/03/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Libman-Sacks endocarditis is a rare complication of antiphospholipid syndrome. Anti-vitamin K therapy is the standard treatment, although valvular replacement surgery may be required in some severe cases. In the latest EULAR recommendations, it is advised not to use direct oral anticoagulants in the management of antiphospholipid syndrome, especially of high-risk profile. CASE REPORT We present a case of a mitral Libman-Sacks endocarditis complicated with multiple strokes occurring in the setting of an antiphospholipid syndrome with triple positive antibody profile in a 63-year-old woman with multiple sclerosis. She was previously treated with apixaban for two years. Tinzaparin followed by prolonged warfarine treatment and two months of hydroxychloroquine resulted in valvular improvement. CONCLUSION To our knowledge, this is the first case of Libman-Sacks endocarditis occurring during apixaban therapy in a patient with antiphospholipid syndrome. This severe case highlights the inefficiency of direct oral anticoagulants to prevent thrombotic events in the antiphospholipid syndrome.
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Affiliation(s)
- J-S Allain
- Department of Internal Medicine and Clinical Immunology, Unité d'Investigation Clinique, Rennes University Hospital, Pontchaillou Hospital, 2, rue Henri-Le-Guilloux, 35 000 Rennes, France; Pole CVM, Paul Broussais General Hospital Center, Saint Malo, France; Clinical Investigation Center of Rennes, National Institute of Health and Scientific Research (CIC-INSERM 1414), Rennes, France.
| | - E Paven
- Department of Cardiology, Rennes University Hospital, Pontchaillou Hospital, Rennes, France
| | - B Henriot
- Pole CVM, Paul Broussais General Hospital Center, Saint Malo, France
| | - N Belhomme
- Department of Internal Medicine and Clinical Immunology, Unité d'Investigation Clinique, Rennes University Hospital, Pontchaillou Hospital, 2, rue Henri-Le-Guilloux, 35 000 Rennes, France
| | - A Le Bot
- Infectious Diseases and Intensive Care Unit, Rennes University Hospital, Pontchaillou Hospital, Rennes, France
| | - A Ballerie
- Department of Internal Medicine and Clinical Immunology, Unité d'Investigation Clinique, Rennes University Hospital, Pontchaillou Hospital, 2, rue Henri-Le-Guilloux, 35 000 Rennes, France; Inserm, EHESP, IRSET (institut de recherche en santé, Environnement et travail)-UMR_S 1085, Rennes 1 University, Rennes, France
| | - P Jego
- Department of Internal Medicine and Clinical Immunology, Unité d'Investigation Clinique, Rennes University Hospital, Pontchaillou Hospital, 2, rue Henri-Le-Guilloux, 35 000 Rennes, France; Inserm, EHESP, IRSET (institut de recherche en santé, Environnement et travail)-UMR_S 1085, Rennes 1 University, Rennes, France
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Allain JS, Belhomme N, Henriot B, Haas M, Le Gall-Godard M, Pastoret C, Jego P. [A microcytic sideroblastic anemia successfully treated with B6 vitamin]. Rev Med Interne 2019; 40:462-465. [PMID: 31133329 DOI: 10.1016/j.revmed.2019.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/12/2019] [Accepted: 05/08/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Sideroblastic anemia is a rare cause of microcytic anemia, which is characterized by ring sideroblasts on bone marrow aspirate. This anemia can be congenital or acquired. CASE REPORT We report the case of an alcoholic 49-year-old man who presented with a severe microcytic sideroblastic anemia related to pyridoxine (B6 vitamin) deficiency. Acid folic deficiency was associated. The blood count normalized within one month after vitamin supplementation. CONCLUSION Pyridoxine deficiency must be sought in sideroblastic anemia in patients at risk.
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Affiliation(s)
- J-S Allain
- Service de médecine interne et immunologie clinique, université de Rennes 1, CHU de Rennes, 35000 Rennes, France; Pôle médecine, cardiovasculaire et métabolisme, centre hospitalier de Saint-Malo, 35400 Saint-Malo, France.
| | - N Belhomme
- Service de médecine interne et immunologie clinique, université de Rennes 1, CHU de Rennes, 35000 Rennes, France
| | - B Henriot
- Service de médecine interne et immunologie clinique, université de Rennes 1, CHU de Rennes, 35000 Rennes, France; Service de médecine interne et immunologie clinique, centre hospitalier René-Pleven, CHU de Rennes, 22100 Dinan, France
| | - M Haas
- Laboratoire d'hématologie, université de Rennes 1, CHU de Rennes, 35000 Rennes, France
| | - M Le Gall-Godard
- Laboratoire d'hématologie, université de Rennes 1, CHU de Rennes, 35000 Rennes, France
| | - C Pastoret
- Laboratoire d'hématologie, Inserm, UMR U1236, université de Rennes 1, CHU de Rennes, 35000 Rennes, France
| | - P Jego
- Service de médecine interne et immunologie clinique, université de Rennes 1, CHU de Rennes, 35000 Rennes, France
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Allain N, Leven C, Falissard B, Allain JS, Batail JM, Polard E, Montastruc F, Drapier D, Naudet F. Manic switches induced by antidepressants: an umbrella review comparing randomized controlled trials and observational studies. Acta Psychiatr Scand 2017; 135:106-116. [PMID: 27878807 DOI: 10.1111/acps.12672] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We aimed to explore whether the prevalence of manic switch was underestimated in randomized controlled trials (RCTs) compared to observational studies (OSs). METHOD Meta-analyses and simple and systematic reviews were identified by two reviewers in a blinded, standardized manner. All relevant references were extracted to include RCTs and OSs that provided data about manic switch prevalence after antidepressant treatment for a major depressive episode. The primary outcome was manic switch prevalence in the different arms of each study. A meta-regression was conducted to quantify the impact of certain variables on manic switch prevalence. RESULTS A total of 57 papers (35 RCTs and 22 OSs) were included in the main analysis. RCTs underestimated the rate of manic switch [0.53 (0.32-0.87)]. Overestimated prevalence was related to imipraminics [1.85 (1.22-2.79)]; to serotonin-norepinephrine reuptake inhibitors [1.74 (1.06-2.86)]; and to other classes of drugs [1.58 (1.08-2.31)], compared to placebo treatment. The prevalence of manic switch was lower among adults than among children [0.2 (0.07-0.59)]; and higher [20.58 (8.41-50.31)] in case of bipolar disorder. CONCLUSION Our results highlight an underestimation of the rates of manic switch under antidepressants in RCTs compared to the rates observed in observational studies.
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Affiliation(s)
- N Allain
- Academic Psychiatry Department, Centre Hospitalier Guillaume Régnier, Rennes, France.,EA 4712 Behavior and Basal Ganglia, CHU Rennes, Rennes 1 University, Rennes, France
| | - C Leven
- Laboratory of Experimental and Clinical Pharmacology, Faculty of Medicine, Rennes 1 University, Rennes, France.,INSERM CIC-P 1414, Clinical Investigation Center, CHU Rennes, Rennes 1 University, Rennes, France
| | - B Falissard
- CESP, University of Paris-Sud, Université Paris-Saclay, UVSQ, INSERM U1178, Maison de Solenn, Paris Cedex, France
| | - J-S Allain
- Department of Internal Medicine, Rennes University Hospital, Rennes, France
| | - J-M Batail
- Academic Psychiatry Department, Centre Hospitalier Guillaume Régnier, Rennes, France.,EA 4712 Behavior and Basal Ganglia, CHU Rennes, Rennes 1 University, Rennes, France
| | - E Polard
- Department of Pharmacology, Pharmacovigilance, Pharmacoepidemiology and Drug Information Center, Rennes University Hospital, Rennes, France.,Pharmacoepidemiology Team (CTAD-PEPI), Rennes University Hospital, Rennes, France
| | - F Montastruc
- Department of Medical and Clinical Pharmacology, Midi-Pyrénées Centre for Pharmacovigilance, Pharmacoepidemiology and Drug Information, INSERM U 1027 Pharmacoepidemiology Research Unit, Toulouse, France
| | - D Drapier
- Academic Psychiatry Department, Centre Hospitalier Guillaume Régnier, Rennes, France.,EA 4712 Behavior and Basal Ganglia, CHU Rennes, Rennes 1 University, Rennes, France
| | - F Naudet
- INSERM CIC-P 1414, Clinical Investigation Center, CHU Rennes, Rennes 1 University, Rennes, France.,Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Palo Alto, CA, USA
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