{"title":"[Atrial fibrillation in 2025: Diagnosis and treatment].","authors":"Jean-Marc Sellal, Néfissa Hammache, Mathieu Echivard","doi":"10.1016/j.revmed.2025.02.010","DOIUrl":"https://doi.org/10.1016/j.revmed.2025.02.010","url":null,"abstract":"<p><p>Atrial fibrillation (AF) is the most common arrhythmia. It increases the risk of hospitalization, heart failure, cognitive decline and mortality. It is the first cause of ischemic stroke. These are largely preventable if AF is diagnosed. It is essential to estimate the patient's embolic risk using the CHA2DS2-VA score, which now replaces the CHADS-Vasc score. Patients who require it must receive adequate anticoagulant treatment. New technologies (in particular, smart-watch) have led to advances in the detection and diagnosis of this arrhythmia. Patients suffering from AF may be treated with a heart rate control strategy (to limit tachycardia) or a rhythm control strategy (to maintain sinus rhythm). Catheter ablation is increasingly being offered to patients as an alternative to antiarrhythmic therapy. Controlling risk factors is essential to prevent the onset of AF, and to try to maintain sinus rhythm over the long term.</p>","PeriodicalId":94122,"journal":{"name":"La Revue de medecine interne","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fanny Urbain, Louise Bicart-See, Clovis Adam, David Adams, Olivier Lambotte, Céline Labeyrie, Nicolas Noel
{"title":"[Neurolymphomatosis].","authors":"Fanny Urbain, Louise Bicart-See, Clovis Adam, David Adams, Olivier Lambotte, Céline Labeyrie, Nicolas Noel","doi":"10.1016/j.revmed.2025.02.003","DOIUrl":"https://doi.org/10.1016/j.revmed.2025.02.003","url":null,"abstract":"<p><p>Neurolymphomatoses (NL) are defined as the direct infiltration of the peripheral nervous system (PNS) by lymphomatous or leukaemic cells. The diagnosis of this rare disease is complex, typically relying on peripheral nerve histology, an invasive examination with a risk of sequelae. This diagnostic entity should be considered in the presence of a painful neuropathy, sometimes severe, whether or not associated with immunohaematological abnormalities, and in cases of resistance to first-line immunomodulatory treatments. NLs are classified into primary, which are limited to or originate from the peripheral nerve, and secondary NLs resulting from systemic involvement. The epineurium, the perineurium and the endoneurium might be affected. Diffuse large B-cell lymphomas are the most frequent histological entity, followed by marginal zone and lymphoplasmacytic lymphomas. The genesis of these infiltrations and their links with primary central nervous system lymphomas are not clearly established. In the future, the contribution of multimodal imaging techniques (whole-body PET, plexus MRI, nerve ultrasound) and sensitive technologies for detecting lymphoid clones (molecular biology, immunophenotyping) as well as therapeutic sequences will need to be clarified by dedicated multicentre studies.</p>","PeriodicalId":94122,"journal":{"name":"La Revue de medecine interne","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Immuno'logical (the scientific updates you wouldn't dare to read anywhere else): X chromosome, Xist, and female autoimmunity].","authors":"Valentin Lacombe","doi":"10.1016/j.revmed.2025.02.009","DOIUrl":"https://doi.org/10.1016/j.revmed.2025.02.009","url":null,"abstract":"<p><p>This first article in the Immuno'logical series explores the role of the X chromosome and the non-coding RNA Xist in the female predisposition to autoimmune diseases, by breaking down three fundamental research studies to make them more digestible for non-experts. Xist is a non-coding RNA that inactivates one of the two X chromosomes in every female cell by wrapping around it. Here, we dive into how Xist is involved in the production of anti-RNP antibodies in lupus, how the TLR7 gene can be a rebel and escape Xist's control, and how a lack of affinity between Xist and its X chromosome can contribute to other autoimmune diseases. Let's be serious without taking ourselves too seriously, and uncover the fascinating world of Xist in autoimmunity!</p>","PeriodicalId":94122,"journal":{"name":"La Revue de medecine interne","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Camille Bonnet, Daouda Niaré, Marion Debin, Thierry Blanchon
{"title":"[Aedes albopictus (tiger mosquito) and arboviroses: What to expect in the coming years?]","authors":"Camille Bonnet, Daouda Niaré, Marion Debin, Thierry Blanchon","doi":"10.1016/j.revmed.2025.02.005","DOIUrl":"https://doi.org/10.1016/j.revmed.2025.02.005","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":94122,"journal":{"name":"La Revue de medecine interne","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Artificial intelligence in healthcare: A survival guide for internists].","authors":"Thomas Barba, Marie Robert, Arnaud Hot","doi":"10.1016/j.revmed.2025.02.002","DOIUrl":"https://doi.org/10.1016/j.revmed.2025.02.002","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":94122,"journal":{"name":"La Revue de medecine interne","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Refractory immune thrombocytopenia revealing MYH9 related disease in a 64-year-old man].","authors":"Quentin Bodard, Guillaume Fredon, Agnès Riche, Xavier Tessier, Johanne Liberatore","doi":"10.1016/j.revmed.2024.12.005","DOIUrl":"https://doi.org/10.1016/j.revmed.2024.12.005","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Case report: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":94122,"journal":{"name":"La Revue de medecine interne","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Vulnerability of hospitalized patients during community disease outbreaks: Lessons from the early COVID-19 pandemic.","authors":"Eliana Wassermann, Claude Bachmeyer, Guillaume Lemaitre, Mélodie Bernaux, Christel Daniel, Judith Leblanc, Olivier Steichen","doi":"10.1016/j.revmed.2025.01.003","DOIUrl":"https://doi.org/10.1016/j.revmed.2025.01.003","url":null,"abstract":"<p><strong>Objectives: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":94122,"journal":{"name":"La Revue de medecine interne","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ugo Boccadifuoco, Geoffrey Cheminet, Benjamin Morino, Jean-Benoît Arlet
{"title":"[Extramedullary hematopoiesis, a rare complication of sickle cell disease: A six-case series and literature review].","authors":"Ugo Boccadifuoco, Geoffrey Cheminet, Benjamin Morino, Jean-Benoît Arlet","doi":"10.1016/j.revmed.2024.12.006","DOIUrl":"https://doi.org/10.1016/j.revmed.2024.12.006","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":94122,"journal":{"name":"La Revue de medecine interne","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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