La Revue de médecine interne
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Amatoxin-containing mushroom poisoning occurs after consumption of certain mushroom species, of the genera Amanita, Lepiota and Galerina. Amanita phalloides is the most implicated species, responsible for over more than 90% of mushroom-related deaths. The α-amanitin is responsible for most of the observed effects. ⋯ Prognosis of this severe poisoning has greatly benefited from improved resuscitation techniques. Mortality is currently less than 10%. In the event of a suspected or confirmed case, referral to a Poison Control Center is warranted in order to establish the diagnosis and guide the medical management of patients in an early and appropriate way.
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A20 Haploinsufficiency (HA20) is a monogenic autoinflammatory disease associated with an autosomal dominant mutation in the TNFAIP3 gene. It induces a defect in the inactivation of the pro-inflammatory NF-κB pathway. Less than 200 cases have been described worldwide. ⋯ Although the first signs of the disease often appear in the first years of life, the diagnosis is often made in adulthood and requires the involvement of both paediatric and adult physicians. Treatment for HA20 is not codified and relies on conventional or biological immunomodulators and immunosuppressants adapted to the patient's symptomatology. This review highlights the enormous diagnostic challenges in this autoinflammatory disease.
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Comparative Study
[The spring of artificial intelligence: AI vs. expert for internal medicine cases].
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". ⋯ 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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Systemic sclerosis (SSc) is a chronic orphan autoimmune disease with the highest mortality rate among rheumatic diseases. SSc-related interstitial-lung disease (ILD) remains among the leading causes of SSc-related mortality with still few therapeutic effective strategies. ⋯ A documented past and/or present occupational silica exposure, with extensive exposure and/or silica-related ILD and/or with persistent silica content in the broncho-alveolar lavage fluid are contra-indications to aHSCT in SSc patients, due to the risk of silica-related malignancy or of SSc relapse. This article aims to discuss alternative options in SSc patients with a history of silica exposure, and how innovative cellular therapies (mesenchymal stromal cells, CAR cells) could represent new therapeutic options for these patients.