Medicine and AI: what does the future hold for internists? (Preprint)

UNSTRUCTURED The exponential development of AI is due to the improvement of processor computing power, deep learning technology, and the free sharing of Big Data. AI can learn independently, without human intervention, and gains ground in medicine: image processing, diagnosis and treatment of cancer through genome study, vaccine development, histological analyses, predictive analyses, etc. Nevertheless, the medical literature considered that AI cannot replace the physician who is essential for social interaction and clinical examination. What will happen in the 2020s? Many improvements are reported in the development of AI: the increase of computing power, the use of new algorithm technologies based on neuroscience, etc. We imagine 4 possible hypotheses for the future: 1) the physician and AI are complementary; the physician examines and interacts with the patient, and AI helps for diagnosis and treatment, 2) AI becomes a “strong” AI, mimics empathy and feelings, and replaces the physician, 3) AI does not progress. The practice of medicine changes very little. AI only interprets imaging studies or acts as a prognostic aid, 4) AI allows transhumanism to flourish. Humans are grafted with neural implants that increase their cognitive functions, allowing them to remain competitive against AI. </sec

Early short-course corticosteroids and furosemide combination to treat non-critically ill COVID-19 patients: An observational cohort study

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Lupus anticoagulant-hypoprothrombinemia syndrome and catastrophic antiphospholipid syndrome in a patient with antidomain I antibodies

International audienceLupus anticoagulant-hypoprothrombinemia syndrome is a rare condition characterized by the association of acquired factor II deficiency and lupus anticoagulant. Contrary to classical antiphospholipid syndrome, it may cause severe life-threatening bleeding (89% of published cases). We report a patient, positive for antidomain I antibodies, with initially primary lupus anticoagulant-hypoprothrombinemia syndrome without previous clinical manifestation or underlying systemic disease. Five years later, he experienced the first systemic lupus erythematous flare. Within a few days, catastrophic antiphospholipid syndrome was diagnosed with heart, liver and kidney involvement. The patient recovered under pulse steroids, intravenous heparin and intravenous immunoglobulins

Exploratory study: use of OSCEs in teleconsultation to evaluate diagnostic hypotheses provided by a symptom checker

Abstract Backround: The overloading of health care systems is an international problem. In this context, new tools such as symptom checker (SC) are emerging to improve patient orientation and triage. Similarly, the COVID-19 pandemic saw the emergence of teleconsultations. The OSCEs could be adapted in this sense for evaluation and training purposes.Objective: The main objective of this study was to explore the performance of a symptom checker against emergency physicians using OSCEs as an assessment method.Methods: We explored a method to evaluate a SC and physician with simulation. A panel of medical experts wrote 220 simulated patients. Each situation was played twice by an actor trained to the role, once in front of the SC, once in front of a physician. Like a telephone consultation, only the patient's voice was accessible. We performed a prospective diagnostic non-inferiority study. If primary analysis failed to detect non-inferiority, we have planned a superiority analysisResults: We cannot conclude if the SC is non-inferior. However, the emergency physician was superior compared to the SC in terms of principal diagnosis (81% versus 30%) and association of principal and secondary diagnosis (92% versus 52%). In terms of patient triage (vital emergency or not), there is still a medical superiority (96% versus 71%). There is also a non-inferiority of the SC compared to the physician in terms of interviewing time.Conclusions and relevance: This type of evaluation should be extended to other types of software in order to provide scientific evidence of the application of tools used in pedagogy to a more clinical research, but also to deepen the evaluation for educational purposes in the face of the advent of physician 2.0.</jats:p

“ Helicobacter pylori in familial mediterranean fever: A series of 120 patients from literature and from france”

International audienceIntroduction: Familial Mediterranean Fever (FMF), the most common monogenic auto-inflammatory disease, is characterized by recurrent febrile abdominal pain. Helicobacter pylori infection (HPI), one of the most frequent infections worldwide, can mimic an FMF attack.Objectives: Identify FMF patients with HPI in a cohort of French FMF patients and the literature and identify features allowing to distinguish HPI from an FMF attack.Methods: A retrospective study of all HPI cases was performed on the cohort of FMF patients fulfilling the Livneh criteria from the French Reference Center for rare Auto-Inflammatory Diseases and Amyloidosis (CEREMAIA). A systematic literature review of HPI in FMF patients was conducted according to the PRISMA guidelines.Results: Eight French patients developed HPI, whose symptoms of epigastralgia, diarrhea, anorexia/weight loss, and nausea/vomiting differed from their typical abdominal FMF attacks. A total of 112 FMF patients with HPI have been described in the literature, including 61 adults. Diagnosis of HPI was made by gastroscopy (n = 43), labelled urea test (n = 55) or IgG serology by ELISA (n = 12). When performed, C-reactive protein was always elevated. Ten cases of interaction between colchicine and antibiotic therapy for HPI (clarithromycin (n = 9) and azithromycin (n = 1)) were reported.Conclusion: We described a total of 120 patients with typical FMF and HPI. When FMF patients develop atypical abdominal symptoms, upper gastrointestinal endoscopy with biopsies is essential to eliminate underlying HPI. Untreated HPI can lead to misdiagnosis of colchicine resistance with inappropriate prescription of an interleukin-1 inhibitor at a non-negligible cost

Exploratory study: Evaluation of a symptom checker effectiveness for providing a diagnosis and evaluating the situation emergency compared to emergency physicians using simulated and standardized patients

International audienceBackgroundThe overloading of health care systems is an international problem. In this context, new tools such as symptom checker (SC) are emerging to improve patient orientation and triage. This SC should be rigorously evaluated and we can take a cue from the way we evaluate medical students, using objective structured clinical examinations (OSCE) with simulated patients. ObjectiveThe main objective of this study was to evaluate the efficiency of a symptom checker versus emergency physicians using OSCEs as an assessment method. MethodsWe explored a method to evaluate the ability to set a diagnosis and evaluate the emergency of a situation with simulation. A panel of medical experts wrote 220 simulated patients cases. Each situation was played twice by an actor trained to the role: once for the SC, then for an emergency physician. Like a teleconsultation, only the patient's voice was accessible. We performed a prospective non-inferiority study. If primary analysis had failed to detect non-inferiority, we have planned a superiority analysis. ResultsThe SC established only 30% of the main diagnosis as the emergency physician found 81% of these. The emergency physician was also superior compared to the SC in the suggestion of secondary diagnosis (92% versus 52%). In the matter of patient triage (vital emergency or not), there is still a medical superiority (96% versus 71%). We prove a non-inferiority of the SC compared to the physician in terms of interviewing time. Conclusions and relevanceWe should use simulated patients instead of clinical cases in order to evaluate the effectiveness of SCs