The retina is a membrane that lines the back of the eye. Retinal detachment is characterised by the detachment of this membrane, resulting in immediate partial loss of vision in the area of the detachment. This is a serious condition that must be treated quickly.

1. Definition of retinal detachment

The retina is a film that lines the back of the eye and receives the images perceived by the eye. It is, in a way, the equivalent of the photographic film in old cameras. When the images arrive on the retina, they are instantly sent to the brain. The brain analyses them and allows us to interpret them and act accordingly. The retina is made up of millions of nerve cells that are sensitive to the surrounding light. It is protected by a vitreous body, a kind of transparent gel that fills the entire eyeball. Retinal detachment refers to the separation of the neurosensory retina from the underlying pigment epithelium, the wall of the eye. The most common cause of this is a rupture of the retina. Sometimes it is a simple tear. More rarely, a hole may appear. This is called rhegmatogenous detachment, according to EM Consulte.

The retinal detachment is often preceded by a flash of light. This is the result of a localised tension that appears between the retina and the vitreous. Other patients also speak of "flying flies" in their field of vision. The latter is slight bleeding within the vitreous or is associated with a retinal tear. If the retinal detachment is confirmed, the patient will have a permanent black veil in the affected area of the eye. Gradually, this may worsen until it becomes a surgical emergency. In France, retinal detachment affects approximately one person per 10,000 per year, according to the Sorbonne-Saint-Michel ophthalmological centre. The peak incidence is generally around the age of 30 and 60. People in their thirties are more likely to suffer from retinogenic retinal detachment, while people in their sixties are more likely to suffer from rhegmatogenous retinal detachment.

2. Symptoms of retinal detachment

Retinal detachment is characterised by the appearance of certain symptoms in the field of vision, which was previously non-existent:

• luminous points, more or less fixed and diffuse ;
• the appearance of a single, fixed, slightly bluish flash of light, always located in the same place, and whether the eyes are closed or in darkness;
• the impression of seeing small flying flies or very fine particles in the image being observed;
• the presence of a pronounced shadow or black veil at the edges of the field of vision;
• the vision that is more blurred and/or foggy than usual, suggesting a sudden and rapid loss of vision;
• loss of vision in one eye.

The best way to observe the severity and extent of the symptoms is to compare the vision in both eyes. By closing both eyes successively one after the other, it is possible to better characterise and describe the disorders.

3. Causes of retinal detachment

There are three different types of retinal detachment according to the MSD Manual:

• rhegmatogenous, i.e. related to a retinal tear;
• tractional ;
• serous.

The last two categories are not related to a retinal tear. They are therefore called non-rhegmatogenous detachments. Moreover, they are less frequent. Several risk factors are likely to lead to a retinal detachment

• high myopia ;
• a previous eye trauma;
• retinal degeneration;
• a history of cataract surgery;
• family history of retinal detachment.

Retinal detachment can be caused by vitreoretinal traction. This can occur when a fibrous membrane forms in proliferative diabetic retinopathy or sickle cell disease. Serous detachment occurs when fluid accumulates in the subretinal space. Its causes can be multiple and include severe uveitis (i.e. inflammation of the iris, similar body or choroid of the eye), Vogt-Koyanagi-Harada disease, choroidal haemangiomas, and primary or metastatic choroidal tumours (i.e. cancers of the retina).

4. Retinal detachment: when to consult?

In order for the practitioner to make a more accurate diagnosis, it is strongly recommended to note the times when the first symptoms appeared. It is then important to schedule an emergency consultation with an ophthalmologist. When an individual experiences a decrease in vision in one eye or changes in the field of vision, it may mean that he or she is subject to a retinal detachment. To ensure better visual recovery and for the treatment to be effective, the retinal detachment must be operated on within 24 to 48 hours. Otherwise, it can progress to total detachment, resulting in permanent vision loss. When a person sees light spots or dust in the field of vision, it may be a sign that the fluid between the lens and the retina is being pulled. This may be a tear that precedes detachment. Here again, an ophthalmologist must be consulted. An appointment must be made very quickly. Because retinal detachment can have serious consequences, it should never be taken lightly. In this case, rapid treatment is essential to ensure that the treatment is effective.

5. Examinations and diagnosis of retinal detachment

When a patient presents with signs of retinal detachment, the ophthalmologist will see the patient in an emergency consultation. If this is not possible in the practice, the patient is referred to a hospital or care facility where there is an ophthalmic emergency. During the appointment, the ophthalmologist carries out several checks. He measures visual acuity and eye pressure. Then he performs a fundus examination. This allows him to observe the retina perfectly and reliably diagnose whether a detachment is really present. The fundus is the ideal way to look for any tears or to locate a detached area. Both eyes are systematically examined. In this way, the practitioner can identify any existing retinal tears or lesions predisposing to tears, even in the healthy eye. If the ophthalmologist finds that there is a favourable ground for the development of a retinal detachment, he or she can administer a preventive treatment with laser photocoagulation.

6. Treatments for retinal detachment

In the case of retinal detachment, the only possible treatment is surgery. The operation consists of reinstalling the detached retina. There are a number of techniques available for this. The medical procedure used depends on the location of the detachment, the number of tears, the age of the patient, his or her activities, and the age of the detachment. The practitioner can use several surgical methods:

• by endo-ocular route: this is also called vitrectomy. With this procedure, the surgeon sucks out the excess vitreous gel to release the traction on the retina;
• exo-ocular: the retina is brought closer to the tear by external compression of the eye, using silicone bands or sponges.

Tears that precede retinal detachment can be treated with cold or laser:

• Laser treatment, also known as retinal photocoagulation: laser impacts are applied around the tears. Laser treatment, also known as retinal photocoagulation: laser impacts are applied all around the tears, fusing the different layers of the retina to prevent detachment.
• Cold, or cryotherapy: a probe is placed in the eye at the site of the tear. This cools the eye to an extreme temperature, which also helps to fuse the different layers of the retina.

Gas can also be injected into the eye to hold the retina in place. The gas expands and remains in the eye for several days or up to a few weeks, giving the retina time to heal.

7. How can retinal detachment be prevented?

To prevent retinal detachment, it is essential to take care of your eyesight, starting with regular check-ups with your eye doctor. It should also be noted that some people have more risk factors for this condition. They are therefore all the more concerned with preventive consultations. These include people over 50, diabetics, people with high blood pressure or high myopia, anyone with a family history of retinal detachment, or cataract patients. The best way to prevent retinal detachment is to perform regular fundus examinations. This is currently the preferred examination for a closer look at the fragile areas of the eye, and for the detection of potential tears or small detachments. When lesions are observed, laser or cold treatment is an excellent preventive solution. These create an adhesive scar on the retina, which greatly reduces the risk of detachment. This is a preventive treatment carried out under local anaesthetic, using an anaesthetic eye drop. Finally, it should be noted that the eye fundus can also be used to detect other eye diseases such as glaucoma or AMD.

Sources :

EM consulte, Paris Centre COSS Ophtalmologie, Manuel MSD, Revue générale des uvéites Manuel MSD, Centre de prévention et de santé universitaire

 Several dozen cases of this rare disease originating in Africa have been reported in Europe since early May. Spain has issued a health alert, and the United Kingdom fears a community infection.

After the United Kingdom, Portugal and Spain, it is Canada and the United States that have indicated on Wednesday that they have detected people with monkeypox, a rare disease normally confined to the African continent. Characterized by its impressive pustules, this infection is transmitted by close contact or exchange of body fluids.

The United Kingdom has warned that all of the carriers of the disease on its soil are men who have homosexual relations. The World Health Organization (WHO) said on Tuesday that it wanted to shed light on these cases.

- Where does monkeypox come from?

Monkeypox, or simian orthopoxviruses, is a rare viral zoonosis, as indicated by the WHO on its website, that is a virus transmitted to humans by animals. The disease was first detected in humans in 1970, in the Democratic Republic of Congo. Since then, the majority of cases have been reported in rural and rainforest areas in the Congo Basin and West Africa, where the virus is endemic, according to WHO.

Infection from animals to humans results from direct contact with blood, body fluids, or skin or mucous membrane lesions of animals that are carriers of the disease. The WHO lists monkeys, giant Gambian rats and squirrels as species at risk. Consumption of meat infected with the virus may also be at risk.

- How is this disease transmitted?

Human-to-human transmission is the result of close contact with a person who has the disease. Either by coming into contact with their respiratory secretions or by touching infected lesions and biological fluids.

"Transmission occurs primarily through respiratory droplet particles and usually requires prolonged face-to-face contact," adds the WHO.

- What are the symptoms?

Human infection by monkeypox is divided into two periods. The first is called "invasive", with fever, headache, swollen glands and muscle pain.

It is then followed by a period of rash, which starts on the face and spreads to other parts of the body. The face is most affected, followed by the palms of the hands and soles of the feet.

"The skin rash evolves in about ten days from maculo-papules (lesions with a flattened base) to vesicles (small blisters filled with liquid), then pustules and finally crusts. The complete disappearance of the latter can take up to three weeks," says the World Health Organization.

It should be noted that two different versions of the virus exist, the one from the Congo Basin and the one from West Africa. The first version is the most virulent.

• Can monkeypox be cured?

Monkeypox is not a particularly dangerous disease for humans, although it is inconvenient because of the pustules it generates. The WHO, thus ensures that in the vast majority of cases, it heals itself. Symptoms can last from 14 to 21 days.

The disease can still be fatal, but the case fatality rate remains below 10%. It is especially the youngest children who are likely to develop a severe form.

There is currently no vaccine or treatment for the disease, although the smallpox vaccine has shown some effectiveness in preventing its development. However, the latter is no longer produced since the eradication of the disease.

- Where were the last cases reported?

If this relatively rare infection is attracting attention today, it is because, since the beginning of May, many European and North American countries have reported cases of this disease on their soil.

The alert was first issued in the United Kingdom on May 6. A total of nine cases have been detected in the UK. With the exception of the first individual who had recently travelled to Nigeria, all other individuals were infected on British soil, as reported by the UK Health Security Agency (UKHSA).

At the beginning of the week, Spain and Portugal announced that they had detected around 40 suspected cases on their territory, prompting the two countries to issue a health alert.

On the other side of the Atlantic, Canada indicated on Wednesday that it was looking into more than a dozen suspected cases, which are currently being examined in Montreal. As for the United States, a man who had recently visited Canada tested positive for monkeypox in the state of Massachusetts.

Since the detection of this disease in humans in 1970, cases of contamination outside the African continent have been very rare. It was only in 2003 that the disease was detected outside the continent, in the United States. Patients had been in contact with domestic prairie dogs, which had been infected by imported African rodents.

- Is there a risk of community contamination among homosexual men?

The surge in infections in Europe is accompanied by concerns that they may be the result of sex between men. Indeed, London reported that patients identified as carriers of monkeypox had all had sex with other men.

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In Geneva, Ibrahima Socé Fall, WHO assistant director-general for emergency response, said:

"We are seeing transmissions among men who have sex with men," which is "new information that we need to study properly to better understand the dynamics" of transmission."

How can I avoid getting infected?

Monkeypox can be spread when a person is in close contact with an infected person. The virus can enter the body through skin lesions, the respiratory tract, or through the eyes, nose or mouth.

It has not previously been described as a sexually transmitted infection, but it can be transmitted through direct contact during sex.

It can be spread by any of the following:

• contact with clothing worn by an infected person (including bedding or towels)
• direct contact with lesions or scabs on the patient's skin
• coughing or sneezing from an infected person

For this reason, health officials recommend not wearing clothing and not having close contact with people who may be sick.

If you have symptoms, isolate yourself and, once you have recovered, wash your clothes, including towels and sheets.

Also, they suggest using disposable tissues when coughing and sneezing and, if you can, avoiding doing so in the presence of others.

Hygiene and other care

The U.S. Centers for Disease Control and Prevention (CDC) reminds us that handwashing remains a decisive action against this virus.

'Practice good hand hygiene after contact with infected animals or humans. Wash your hands with soap and water or use an alcohol-based hand sanitizer," the CDC recommends.

The Cleveland Clinic recalls that in Africa, the disease has become more common in children, so parents should also apply these precautions to minors.

Although it has not yet been detected in animals, other outbreaks of monkeypox have appeared in some species transported from Africa.

That's why the Cleveland Clinic generally recommends cooking all foods that contain meat or animal parts thoroughly.

Some public health experts have also recommended that people travelling abroad pay attention to the recommendations of local authorities and follow their instructions and protocols, if they exist, to avoid potential contagion.

If you work with infected people in hospitals, clinics, or health centers, the CDC recommends using personal protective equipment.

Monkeypox can also be spread through contact with infected animals, such as monkeys, rats and squirrels, or through objects contaminated with the virus, such as bedding and clothing.

How common is monkeypox?

Monkeypox is caused by the virus of the same name, a member of the same family of viruses as smallpox, although it is much less severe and experts say the risk of infection is low.

The virus was first identified in a captive monkey and, since 1970, sporadic outbreaks have been reported in ten African countries.

It occurs mainly in remote areas of central and western African countries near tropical rainforests.

In 2003, an outbreak occurred in the United States, the first time the disease has been observed outside of Africa. Patients acquired the disease through close contact with prairie dogs that had been infected by various small mammals imported into the country. A total of 81 cases were reported, but none resulted in death.

In 2017, Nigeria experienced the largest documented outbreak, approximately 40 years after the country experienced its last confirmed cases of monkeypox. There were 172 suspected cases of monkeypox, and 75% of the victims were men between the ages of 21 and 40

There are two main strains of the virus - West African and Central African.

In the West, the luxury of not being vaccinated

Two of the infected patients in the UK were from Nigeria, so it is likely that they are suffering from the West African strain of the virus, which is usually mild, but this has not yet been confirmed.

Another case is that of a health care worker who contracted the virus from one of the patients.

The more recent cases have no known connection to each other, nor any history of travel. They appear to have caught it in the UK by spreading it in the community.

How dangerous is it?

Most cases of the virus are mild, sometimes resembling chickenpox, and go away on their own within a few weeks.

However, monkeypox can sometimes be more severe and has been reported to have caused deaths in West Africa.

What is the treatment?

There is no treatment for monkeypox, but outbreaks can be controlled by preventing infection.

Vaccination against smallpox has been shown to be 85% effective in preventing monkeypox, and it is still sometimes used.

According to reports, Spain is preparing to order thousands of doses of smallpox vaccine to be used against monkeypox.

Experts believe that vaccination after exposure to monkeypox may help prevent the disease or make it less severe.

 Chronic hyperglycemia is most often related to the development of diabetes. The symptoms of hyperglycemia may take time to become apparent. Hyperglycaemia should be managed as soon as possible to avoid the long-term complications of too much glucose in the blood.

1. What is high blood sugar?

Blood glucose is the name given to the concentration of glucose in the blood. Normally, blood glucose is between 0.7 g/l and 1.1 g/l in the fasting state. It should be below 1.4 g/l after a meal. In fact, blood sugar levels rise temporarily after a meal, only to fall rapidly afterwards. This is physiological hyperglycemia. Sometimes this hyperglycemia can become a chronic condition, and thus pathological. There are different causes for a chronic increase in the blood glucose concentration: e.g. Diabetes, taking certain medications. Chronic hyperglycemia must be controlled because, in the long term, excess glucose in the blood can lead to complications and impair the functioning of tissues and organs.

2. What are the symptoms of high blood sugar?

Chronic low blood glucose is asymptomatic, which can be particularly dangerous because many people are unaware that they have chronic high blood glucose. Above a certain level (which varies among individuals), chronic hyperglycemia can cause:

• a strong thirst;
• a very frequent urge to urinate and abundant urination;
• a significant weight loss despite an increased appetite;
• dizziness;
• Significant fatigue.

3. What causes high blood sugar?

The main cause of pathological hyperglycaemia is diabetes. Normally, glucose enters the cells, where it is used to create energy. In diabetes, glucose can no longer enter the cells, or it has difficulty entering the cells. There are generally two types of diabetes, type I diabetes, called insulin-dependent, and type II diabetes, called non-insulin-dependent. In type, I diabetes, the cells of the pancreas that secrete insulin, the only hormone in the body capable of lowering blood sugar, are destroyed. As a result, blood sugar levels rise rapidly to high levels. This type of diabetes is caused by an autoimmune disease that affects young people in particular. In type II diabetes, the cells become less sensitive to insulin, and glucose, instead of entering the cell, ends up accumulating in the blood. Type II diabetes is a multifactorial disease, with many risk factors such as an unbalanced diet, genetic predisposition, tobacco or alcohol abuse, sedentary lifestyle, and overweight. Type II diabetes is the most common type of diabetes since 90% of diabetics are type II diabetics. There is another type of diabetes, which affects pregnant women and is called gestational diabetes. Generally, this type of diabetes is transient and does not last after delivery. Gestational diabetes can sometimes reveal a pre-existing type I or type II diabetes. Other pathologies can also induce chronic hyperglycemia, for example, hemochromatosis, lesions of the pancreas, or pancreatitis (inflammation of the pancreas). Severe stress can also raise blood sugar levels.

Another possible cause of hyperglycaemia is the prolonged use of certain medications such as corticosteroids, pentamidine, thyroid hormones or certain painkillers. Osmolar hypoglycaemia occurs when the blood glucose concentration is very high and is associated with dehydration: this type of hypoglycaemia can develop in a diabetic person who is not taking his or her medication when taking corticosteroids or diuretics.

4. When to consult in case of Hyperglycaemia?

Hyperglycaemia is silent and does not cause any symptoms, so it is important to check your blood sugar regularly. In the case of diabetes, symptoms of hyperglycemia or hypoglycemia should be reported. Diabetes screening should be done regularly in at-risk populations. These are people over 45 years of age with a risk factors such as:

• - cardiovascular disease;
• - a strong sedentary lifestyle
• - obesity or being overweight;
• - a history of diabetes in the family;
• - a drug treatment that can induce Hyperglycaemia.

5. What tests should be done to diagnose hyperglycemia?

Hyperglycaemia is very easy to detect. Glucose is not usually found in the urine. Therefore, a simple urine test with a dipstick can detect the presence of glucose in the urine, which most often indicates hyperglycaemia. A blood test is used to determine the level of glucose in the fasting blood. If the patient has a fasting blood glucose level between 1.1 g/l and 1.26 g/l, the person is considered pre-diabetic. If the fasting blood glucose level exceeds 1.26 g/L on several occasions, then diabetes is diagnosed. To detect the onset of insulin resistance or to detect gestational diabetes, the physician may order a special test called an oral glucose tolerance test (OGTT). This test involves fasting a quantity of glucose and then studying (by taking blood samples every hour) the glucose level in the blood.

6. What are the possible complications of hyperglycemia?

Uncontrolled, chronic high blood sugar can have serious health consequences. Chronic high blood glucose can damage blood vessels. When large vessels such as blood vessels are affected, it is called macroangiopathy, when small tissue and blood vessels are affected, it is called microangiopathy. People with diabetes are at greater risk for cardiovascular disease. People with diabetes are also more likely to develop retinopathy (damage to the vessels in the retina), nephropathy (kidney disease) and foot damage. The most serious complication of Type I diabetes is ketoacidosis. In type I diabetes, which is called insulin-dependent, glucose cannot enter the cells to produce energy, so the cells produce ketone bodies to compensate for this lack of energy. Ketone bodies are small acidic molecules which, if they accumulate, can acidify the body in a very serious way. Untreated ketoacidosis can lead to coma and even death. Untreated gestational diabetes poses multiple risks to the fetus, including macrosomia, neonatal hypoglycaemia and hyperbilirubinemia.

7. What are the treatments for high blood sugar?

The treatment is different depending on the type of diabetes detected. In the case of type I diabetes, the lack of insulin must be compensated by regular subcutaneous injections of insulin. Two types of injections are used to regulate blood sugar: rapid insulin injection and ultra-slow insulin injection. An insulin pump can also be used. Blood sugar levels must be monitored regularly to avoid hyperglycemia or hypoglycemia. For type II diabetes, the treatment first involves weight loss, a balanced diet, stopping smoking and regular physical activity. Smoking cessation is essential to avoid increasing the risk of cardiovascular complications. Oral anti-diabetic drugs that control blood sugar may be prescribed, such as glucose-lowering sulfonamides or alpha-glucosidase inhibitors. Sometimes insulin therapy (insulin injection) may be prescribed, especially when blood sugar levels cannot be stabilized. The treatment of type I and type II diabetes also requires therapeutic education of the patient. Patients should be able to test themselves regularly, and thus achieve true self-monitoring of their blood sugar. When blood glucose exceeds 2.5 g/l, it is also important to monitor the presence of ketones in the urine (using test strips), and the physician should be consulted in case of a positive presence. If the hyperglycemia is too high, one should not hesitate to seek urgent medical attention. In pregnant women, blood sugar control is achieved through a special diet or insulin treatment.

8. How can hyperglycaemia be prevented?

Type II diabetes is a multifactorial disease. Certain measures can help reduce the risk of developing chronic hyperglycemia. These measures include:

• adopting a balanced diet, without excess fats or carbohydrates: favouring fruits and vegetables, eating three meals a day, consuming adapted portions;
• Regular and adapted physical activity: regular and adapted physical activity reduces the risk of suffering from type II diabetes by 30%;
• Avoid alcohol consumption;
• Stop smoking;
• Fight against chronic stress, and take time to relax.

To prevent complications of diabetes, regular preventive medical examinations should be performed, for example: have a fundus examination every year, consult a pedicurist regularly to quickly take care of possible foot problems, and be followed very regularly by a cardiologist. Similarly, kidney function can be monitored in order to detect a kidney problem as soon as possible.

Source :

Fédération française des diabétiques (glycémie) ; Fédération française des diabétiques (hyperglycémie), Inserm (diabète de type II), Inserm (diabète de type I), HAS ; Diabète Occitanie ; Le Manuel MSD

People with Addison's disease require hormone replacement therapy throughout their lives. This condition can appear at any age. Given the disability caused by the symptoms of this disease, it is important to recognize them as early as possible in order to set up a treatment that will limit the aftereffects.

1. Addison's disease: definition

According to the portal of rare diseases and orphan drugs in its article dedicated to Addison's disease, this pathology affects between 1 and 5 people out of 10 000 in France. It owes its name to the first doctor to describe the symptoms of this disease, Thomas Addison, as indicated by the Adrenal Association, which brings together people suffering from pathologies affecting the glands located above the kidneys.

When a person has Addison's disease, the adrenal glands do not produce enough cortisol and aldosterone. These hormones are necessary for the body's metabolism:

• Cortisol allows the body to have an adequate response to any kind of stress. This stress can be caused by a professional or personal situation. It can also be caused by the announcement of an illness, trauma, or by the anticipation of a surgical operation. Cortisol plays a role in regulating blood pressure, heart and immune system function, and blood sugar levels;
• Aldosterone is a hormone that regulates sodium and potassium levels in the blood. It also controls the amount of fluid excreted by the kidneys in the form of urine, which has an impact on blood volume and blood pressure.

In its article on the disease, the French Society of Endocrinology states that Addison's disease is referred to by physicians as "primary adrenal insufficiency". And that it should not be confused with a related disease, "high adrenal insufficiency": this occurs when the pituitary gland, a gland located at the base of the brain, does not secrete enough adrenocorticotropic hormone (ACTH), which is necessary for the adrenal glands to secrete cortisol. These two conditions do not have the same cause or consequences and therefore do not require the same treatment.

2. The symptoms of Addison's disease

The destruction of the adrenal glands usually occurs slowly. The symptoms of Addison's disease appear over the years. The most common are:

• Abnormal menstrual periods in women;
• a desire to eat salty foods associated with a very low blood sugar level;
• gastroenterological disorders: loss of appetite or anorexia, diarrhea, nausea, vomiting, abdominal pain
• mood disorders: depression, irritability, psychological exhaustion
• asthenia (severe fatigue), accompanied by dizziness or vertigo, muscle weakness
• low blood pressure;
• hyperpigmentation of the skin, especially around scars, skin folds, and joints;
• Unexplained weight loss.

However, symptoms can also appear suddenly: doctors refer to this as acute adrenal insufficiency, when the person is faced with an injury, illness, burn, surgery, or a period of intense stress. In these cases, the most obvious symptoms are:

• Sudden weakness ;
• Severe pain in the abdomen, lumbar region, or legs
• A total loss of consciousness;
• A high fever or, on the contrary, a drastic decrease in body temperature.

If not treated immediately by emergency medical services, the person suffering from acute adrenal insufficiency may die.

3. The causes of Addison's disease

Addison's disease is an autoimmune disease. That is, the person suffering from this adrenal insufficiency has his or her immune system (which is supposed to protect him or her from infections) attacking his or her own organs and tissues: in this case, the outer part of the adrenal glands, where cortisol and aldosterone are produced. According to the French Society of Endocrinology in its article on Addison's disease, the autoimmune cause of this pathology would explain about 8 cases out of 10.

Other causes of Addison's disease are :

• tuberculosis, which is involved in about 20% of cases, according to the French Society of Endocrinology;
• human immunodeficiency virus (HIV) infection, which causes AIDS;
• Adrenoleukodystrophy, an X-linked disease - hence the higher prevalence in women than in men;
• Congenital adrenal hyperplasia, which can be detected in utero;
• iatrogenic causes, i.e. following surgery (removal of both adrenal glands) or medication
• cancer, in particular, lung, kidney, breast, or ENT cancer;
• Lymphoma;
• sarcoidosis, an inflammatory disease that causes clusters of cells to form in the organs;
• amyloidosis, which causes abnormal accumulation of certain proteins in the organs.

4. Addison's disease: when to consult?

It is advisable to consult your doctor if you have symptoms that are common in Addison's disease, such as hyperpigmentation, intense, and chronic fatigue, unexplained weight loss, gastrointestinal problems (nausea, vomiting, and abdominal pain) with no immediate cause, dizziness or lightheadedness, an irrepressible need to eat very salty foods, muscle or joint pain.

In addition, when faced with symptoms of acute adrenal insufficiency, it is necessary to go urgently to your doctor or to the hospital. As a reminder, the clinical signs of acute adrenal insufficiency are:

• very severe asthenia ;
• intense pain in the abdomen, lumbar region, or legs
• malaise;
• High fever or a sudden drop in body temperature.

5. Testing and diagnosis of Addison's disease

To diagnose Addison's disease, your doctor will ask you about the symptoms and then perform a clinical examination. If your doctor sees dark spots on your skin, he or she may suspect Addison's disease and order additional tests, including:

• blood tests: these measure blood sodium, potassium, cortisol, and plasma adrenocorticotropic hormone (ACTH) levels;
• An ACTH stimulation test, to assess the response of the adrenal glands after the injection of synthetic ACTH. If the adrenal glands secrete a low amount of cortisol after this administration, it is a sign that they are dysfunctional;
• a chest x-ray to look for calcium deposits on the adrenal glands;
• Computed tomography (CT scan of the adrenals): with this technique, which combines numerous cross-sectional X-ray images, the doctor can evaluate the adrenal glands and/or pituitary gland.

 This condition, which is very frequent, is linked in the vast majority of cases to lithiasis. It must be treated rapidly in order to relieve pain and avoid complications and recurrences. The reference treatment is a cholecystectomy (removal of the gallbladder).

1. What is cholecystitis and what is the difference between acute and chronic cholecystitis?

Cholecystitis is an inflammation of the gallbladder and its excretory duct, the cystic duct. The term cholecyst comes from the Greek word for gallbladder, and the suffix "it" means inflammation. The gallbladder is a small organ located on the right side of the body, against the liver. The liver makes bile, which is a liquid that is essential for digesting fats. The gallbladder is responsible for storing the bile. During digestion, the gallbladder contracts to eject bile through the cystic duct into the duodenum. The bile solubilizes the fats in the small intestine to better absorb them.

Inflammation of the cystic duct and the gallbladder is linked, in the vast majority of cases, to the presence of biliary lithiasis (gallstone) which obstructs the cystic duct. This is called acute cholecystitis. According to the SNFGE (French National Society of Gastroenterology), 90% of acute cholecystitis is caused by lithiasis, and these lithiases are very frequent since they affect about 15% of the population. The lithiasis blocks the cystic duct, which leads to biliary stasis and inflammation that can cause damage to the organ.

Sometimes cholecystitis is not caused by a stone and is called lithiasis cholecystitis. According to the MSD manual, about 5-10% of cholecystitis are non-lithiasis. When acute cholecystitis recurs or when there is a recurrence of gallstones, the gallbladder is regularly inflamed. The gallbladder eventually becomes fibrous: its walls thicken, the gallbladder hardens, and it has more difficulty in functioning, we speak then of chronic cholecystitis. Cholecystitis is to be distinguished from angiocholitis, which is a rarer condition. Angiocholitis is an infection of the bile ducts most often due to lithiasis blocking the bile duct (the main duct connecting the common hepatic duct that exits the liver to the cystic duct) or to parasitic invasion.

2. What are the symptoms of cholecystitis?

Cholecystitis is an inflammation that is usually painful. The pain is sudden in onset, often occurring after meals and during the night, and may last for several hours. It can also radiate to the back. There are also signs of abdominal defense, i.e., a painful contraction in the right hypochondrium (right side of the abdomen) and epigastrium. Cholecystitis may cause nausea and vomiting, but does not cause jaundice because the main excretory pathway of the liver is not obstructed.

The inflammation may be coupled with a bacterial infection, in which case there are infectious signs, such as a fever of varying severity. Cholecystitis can also cause a respiratory blockage during deep inspiration, this is called Murphy's sign. Untreated cholecystitis can lead to gallbladder perforation with biliary peritonitis, but can also lead to an abscess or erosion of the gallbladder wall.

3. What causes cholecystitis?

In most cases, acute cholecystitis is caused by lithiasis. Cholestasis occurs when there is too much cholesterol in the bile, when the cholesterol-solubilizing factors are not present, or when the gallbladder does not contract enough. When a stone blocks the cystic duct, bile stasis occurs. This stasis causes a release of inflammatory enzymes, including an enzyme called phospholipase A. The mucous membrane of the gallbladder secretes more fluid than the organ can absorb, which eventually distends the gallbladder and increases inflammation. This fragility is a breeding ground for infection, especially bacterial infection.

 In the case of lithiasis cholecystitis, the causes are variable, they can be related to :

• sepsis or important burns ;
• very long fasting;
• Following a surgical operation;
• parenteral nutrition, because this type of nutrition favors biliary stasis;
• immunodeficiency syndrome;
• gallbladder motility disorders;
• vasculitis (a rare autoimmune disease)
• Parasitic infection;
• chronic conditions such as diabetes or cardiovascular disease.
• In all cases, there is ischemia of the gallbladder wall.

4. Cholecystitis: when to consult?

Cholecystitis must be treated immediately, on the one hand, to relieve the pain, and on the other hand to avoid recurrence and complications. Some cholecystitis resolves quickly on their own, the lithiasis being evacuated rapidly, but the repetition of cholecystitis exposes to chronic forms. Moreover, some cholecystitis can quickly become a medical emergency, so one should not hesitate to consult at the first signs of acute cholecystitis.

When there is significant pain associated with a high fever and nausea and vomiting, you should consult quickly.

5. What are the tests for cholecystitis and how is the diagnosis made?

First of all, the doctor will perform palpation. An obvious sign of cholecystitis is Murphy's sign: when the patient lies on his back and the doctor palpates the gallbladder, during a deep inspiration, the pain is aggravated and blocks the inspiration. Indeed, the inflamed and painful gallbladder presses directly on the diaphragm and cuts off inspiration.

Ultrasound remains the reference examination for diagnosing cholecystitis. This examination shows a thickening of the gallbladder wall of several millimeters. Murphy's sign may also be present on ultrasound and is particularly characteristic of the condition. Ultrasound can also be used to visualize lithiasis as well as any effusions.

In the case of lithiasis cholecystitis, a CT scan or a cholescintigraphy can be prescribed. Cholescintigraphy makes it possible to follow, via the injection of a radioactive product, the path of the bile, and thus to detect a possible obstacle in the path of the bile. This type of cholecystitis is often difficult to diagnose because it develops in people whose health is very poor.

 The blood test shows an increase in a type of white blood cell called neutrophils. The level of CRP (C-reactive protein) is also increased, which indicates inflammation. Liver function tests are usually normal. The lipase level is increased. When the stone becomes unblocked, transaminases are also increased.

 6. How is cholecystitis treated?

Pain is treated with strong painkillers and, if there is an infection, antibiotics are also prescribed. The standard treatment for symptomatic cholecystitis is cholecystectomy, i.e. removal of the gallbladder. It is the only treatment that allows a definitive cure and avoids relapses. According to the HAS, cholecystectomy is recommended for symptomatic acute lithiasis cholecystitis. In case of visceral failure, this operation should even be scheduled within 72 hours.

 Cholecystectomy is usually performed under laparoscopy. Laparoscopy is called minimally invasive because it requires only a few small incisions: usually, 2 or 3 small openings are made to pass a camera and surgical instruments. According to the French Association for Continuing Medical Education in Hepato-Gastroenterology, the 2006 Cochrane review gives this technique as a surgical reference in the treatment of cholecystitis. Generally, the postoperative course is very light, and the hospital stay lasts only one to two days. When cholecystectomy is performed in an emergency or when there are complications, it may be performed by laparotomy (much larger incision of the abdominal wall), the operative follow-up is then more important. For aliphatic cholecystitis, the reference treatment also remains surgery and management of the associated pathology.

7. How to prevent cholecystitis?

The majority of cholecystitis is related to lithiasis. There are two types of cholelithiasis: cholestatic and pigmentary. Cholestatic lithiasis is the most common type. Certain factors increase the risk of suffering from cholestatic lithiasis, such as:

• multiple pregnancies;
• age: according to Dr. Didier Mennecier (Hepatoweb website), the risk of suffering from lithiasis is 60% after the age of 80;
• being overweight or having significant weight variations;
• long fasts;
• certain medications, especially those that cause biliary stasis;
• certain pathologies such as intestinal diseases (Crohn's disease, corresponding to intestinal malabsorption which leads to a decrease in bile secretions, and an increase in the level of cholesterol in the bile.

Some risk factors can be avoided, so it is advisable to :

• practice regular physical activity adapted to your needs;
• eat fruits and vegetables and foods rich in fiber, and avoid eating foods that are too fatty or too sweet;
• avoid being overweight.
• Pigmentary lithiasis can be caused by drugs (drugs that promote hemolysis of red blood cells), or linked to a disease such as hemolytic disease where red blood cells are destroyed.

Sources :

 In order to determine your caloric needs per day, the calculator below, will allow you to know them with a reasonable caloric reduction goal to lose weight sustainably.

Why is a healthy weight important?

People often reduce excess fat for a stunning look. But that's not enough, achieving and maintaining a healthy weight is paramount to your overall health. In addition, your healthy weight is the basic factor that helps you prevent and control many diseases and conditions. Obese and overweight people are at a higher risk of developing serious health problems, such as heart disease, high blood pressure, type 2 diabetes, gallstones, respiratory problems, and some cancers.

This is the main reason why maintaining a healthy weight is so important to everyone. A healthy weight helps you feel good and increase your energy levels. So use our weight loss goal calculator to achieve your healthy weight goals.

About the Fat Loss Calculator

Maintaining an optimal body weight is essential for a healthy life free of many diseases. The ideal body weight is not the same for every person, because every person's body is different. Therefore, a healthy weight represents the ideal value within the ideal weight range for your height and gender, which you can calculate from our free weight loss calculator. Being an ideal weight person can not only keep you active and fit, but also protect you from various diseases, from diabetes to heart disease. An overweight person is more likely to get a disease at a young age. For example, they may develop high blood pressure at an early age. Obesity can also make you lazy because you are not able to do the physical exercises that are essential to your health and lose weight. In addition to all this, there is a long list of diseases that are more common in obese people.

Obesity is not a good thing at all. You should try to maintain your ideal weight by exercising daily, walking or playing physical games. Today's young generation is very lazy in this regard; they do not like to play outdoor games. Instead, they prefer to sit or lie down and use tablets, cell phones and game consoles. This is also one of the causes of the growing obesity among young people. If you are overweight and considering losing weight, you should first know the ideal weight range for your height and gender. Knowing your ideal weight will give you an idea of the percentage of body fat you need to lose from your body.

Your weight is the measure of two things which are:

- The calories or energy you take in (food, drinks).

- The calories you use or burn (physical activity)

How do you lose weight? You need to burn more calories than your caloric intake, which means you need to do more physical activity. Fat loss is not an easy thing. It requires a determined effort and continuous motivation. Weight loss can be achieved by using medical procedures or by adopting a non-medical method. Medical procedures include bariatric surgery, which is recommended for severe obesity, and appetite suppressing drugs or supplements. There are many non-medical ways to lose weight, including many physical activities and changes in calorie intake, diet, and changes in diet. Weight loss can only be achieved by one thing. If you think you will lose weight by eating less food, you are wrong. Eating less may cause weight loss, but it will hurt you in the long run because it will weaken you and your body. All your internal organs that need energy from food metabolism are not getting enough energy and are unable to function properly. So, eating less will make it harder for you than losing weight, you will get tired easily, you will not be able to concentrate on your studies or work. So take all three things side by side in your weight loss plan. Eat healthy, including raw fruits and vegetables, get more physical activity and watch your caloric intake and the amount of calories you burn daily. This way you stay healthy and lose weight.

Using a Weight Loss Planner

To know the exact calorie intake and the amount of fat to lose, we have designed a unique calorie calculator for people who want to lose weight. It is a weight loss planner that will give you a detailed plan of the total time needed to lose the specific amount of weight without disastrous health effects. You can also calculate your body mass index, which will tell you how many pounds you need to lose from your body. Then, you can use our weight loss calculator to get an idea of your daily calorie intake. You need to combine physical activity and dietary restriction. Losing weight with both is more effective than trying one weight loss method alone. Exercise helps reverse the progression of the disease you already have and also prevents you from getting the disease. For example, exercise helps reduce susceptibility to various diseases such as high blood pressure, high cholesterol, etc. Exercise can help you lose weight and maintain a healthy weight. Exercise increases your body's metabolism, thus consuming calories, so if you take in more each day; you can have more exercise to burn extra calories.

Weight loss for overweight people is important in that being in an optimal weight range is essential to an individual's physical, mental and emotional well-being. You may wonder how to know the healthy weight range for yourself; we will give you that answer. To calculate your body mass index using our BMI calculator, you will get a value that will tell you how much you weigh. Then, use our fat loss calculator to calculate the calories you need to take in daily and the level of physical activity you need to do daily to reach your ideal weight. The weight loss calculator is easy to use and anyone can use it at any time to lose weight.

It is important to keep once you lose weight because it has many health benefits. It can save you from some diseases that will shorten your life and have many adverse effects that can hinder your daily tasks. Keeping your health by maintaining your weight and body fat should be your priority. This practice can make you more active and allow you to do difficult jobs easily. It will also extend your life, as you can see in the past when the means of transportation are not ordinary, but the average age of death is higher than today. Weight loss is not a quick process, it is a process that takes time, and you will need to be very determined to lose weight. It is not a process of a few days but a process of several months. Sometimes you won't notice a small difference in a month, or it may take 2 to 3 months. So, use our free weight loss calculator that will tell you how long it will take to reach your desired weight.

How Many Calories To Lose Weight?

Calorie intake is important for everyone, but many people think that calories are only essential for dieters. Simply put, a calorie is the unit of energy that measures the amount of energy in the food and drink you consume.

To lose weight healthily, you need to consume fewer calories or burn more calories by exercising or exercising to lose weight. According to the WHO, to lose weight, you must burn more calories than you consume.

Any weight loss plan you adopt to reduce excess fat often sticks to calorie intake to lose weight. Well, come to the point that you can on every calorie you need to lose weight with the help of the calories per day calculator.

Term Of "500 Calories Per Day"

People who want to lose a pound; they need to burn an additional 3,500 calories. There are 7 days in a week; if you want to lose a pound in a week, a daily deficit of 500 calories is needed. So use our accurate calorie weight loss calculator to find out your calorie deficit status.

How Much Weight Can You Lose In A Week?

Weight loss in a week depends on different variables regarding diet and physical activity. For healthy weight loss, losing 1 to 3 pounds per week is an excellent approach and is highly recommended for safe and sustainable weight loss.

How Many Calories Should I Eat To Lose Weight?

This is the most typical question that is frequently asked by those who are really trying to lose weight. Well, never give up in the battle of weight loss! Here we are going to tell you about the calories needed to lose weight that might be right for you! Just use our effective daily weight loss calorie calculator to control your daily calorie intake and stick to the points below:

• - You need to consume 1,300 (extra 100) calories per day and add a short evening walk to your daily workout routine; it helps you burn the extra 700 calories per week (use our advanced weight loss tracker for calorie intake suggestions).
• - It is necessary to consume 1,400 (200 calories) more per day and lose weight instantly, you need to add the HIIT workout to your "twice a week" exercise program and "three 30-minute walks in a week". burn the extra 1,400 calories per week.
• - You need to consume 1,500 (300 extra) calories per day. In addition, you should stick to 45 minutes of moderate to vigorous exercise for your daily workout routine. As a result, your body will burn the extra 2,100 calories per week. .
• The above represents calorie consumption for weight loss - before you start consuming these calories, get your weight loss plan and consult your doctor, you should also monitor your calorie counter with a simple weight calculator.

Weight Loss And Fiber

According to the World Health Organization (WHO), fiber plays an essential role in weight loss. This means that you need to consume a sufficient amount of fiber to eliminate excess fat. Whole grains are fully packed with natural fiber. When you bring products from the market, you need to check the nutrition label and the amount of fiber that each product contains. Optimistic studies suggest that you need to consume 20 to 35 grams of fiber per day to have a healthy weight.

Whole Grain Source :

• Whole grain wheat
• Whole grain oats / rolled oats
• Whole grain corn
• Popcorn
• brown rice
• Whole rye
• Whole grain barley
• Wild rice
• Buckwheat
• Triticale
• Bulgur (cracked wheat)
• Millet
• quinoa
• Sorghum

What To Eat To Lose Weight

Best Fruits For Weight Loss

Grapefruit, apples, berries, stone fruit, passion fruit, rhubarb, kiwi, melons and oranges

Best Vegetables For Weight Loss

Spinach and other leafy vegetables, mushrooms, cauliflower and broccoli, peppers, pumpkin, carrots, beans,

Asparagus and cucumbers

Foods To Avoid To Lose Weight :

French fries, sugary drinks, white bread, chocolate bars, artificially flavored juices, pastries, cookies, alcohol (especially beer), ice cream, pizza, high-calorie coffee drinks and foods high in added sugar

 The attending physician may refer an elderly person to a geriatrician when he notices a situation of frailty. Dr. Yves Passadori, geriatrician, reveals everything you need to know about this medical specialty.

Gerontology, definition

Geriatrics is characterised by the study of the sciences related to ageing and the elderly. The geriatrician can take care of people aged 80 years or 60 years affected by polypathologies, in other words, several pathologies present in the same individual, which are at the origin of a situation of physical incapacity or dependence.

A geriatrician or a gerontologist?

"Gerontology is a medical and human science that studies the problems of ageing. It also includes other sciences such as psychology, epidemiology and demography, which are involved in ageing issues. Geriatrics is therefore a branch of gerontology. A large majority of geriatricians are gerontologists because they need this global approach," explains Dr Yves Passadori, a geriatrician and Deputy Treasurer of the French Society of Geriatrics and Gerontology (SFGG).

When should a geriatrician be consulted?

The attending physician generally refers to a geriatrician when he/she observes a situation of frailty in the elderly. This specialist can in particular take charge of a patient affected by sensory disorders such as poor eyesight or deafness, neurological and cognitive disorders such as Alzheimer's disease, Parkinson's disease or dementia. It offers comprehensive care for the patient.

"In some cases, the general practitioner does not identify situations where he or she could call on a geriatrician. It could be interesting to have a real apprenticeship in spotting alerts of frailty in the elderly. Networking would make it possible to postpone institutionalisation by two or three years. For example, two falls per month should be an alert that prompts tests to be carried out," emphasises Dr Yves Passadori.

Geriatrics cannot cure chronic pathologies, whether cardiac, neurological (Parkinson's or Alzheimer's disease), rheumatological or vascular, but this medical speciality can prevent their aggravation or the complications associated with these conditions, particularly when the patient is affected by polypathologies. "We also evaluate the risk-benefit of therapies, because we cannot go too far when the patient is affected by several diseases," says the geriatrician.

The geriatrician carries out secondary prevention, especially after the diagnosis of cardiac pathologies. "The keys to good ageing are physical exercise, social life and nutrition. This helps to prevent loss of autonomy. Fragility in an elderly person can be biomedical, but also social, psychological and financial. It is very difficult to classify it because it is not necessarily noticeable," says the specialist. He adds, "Almost 20% of 80-year-olds still live at home and are not dependent, but they no longer have the same functional reserves. Running after a bus, for example, is more difficult than before.

The cascade phenomenon can be prevented by sport, activities that keep people mentally fit and a healthy diet. This is manifested in falls, malnutrition, infections and lower immunity in the elderly.

Geriatrician: which professionals work with this specialist?

Geriatrics is not an isolated profession, according to Dr. Yves Passadori. The geriatrician works in conjunction with various health professionals depending on the place in which he or she practices. The geriatrician intervenes in particular in re-education, rehabilitation, and dependency support, as well as in palliative, terminal, and end-of-life care.

In the elderly person's home, the geriatrician works in a team with the nurse, psychotherapist, speech therapist, and occupational therapist. This intervention generally takes place following a request from the attending physician for the care of a patient in a fragile situation. In a geriatric centre, this specialist deals with people over 60 years of age who are sedentary and under medical supervision. They may organise exercise sessions to teach them to adopt a healthy lifestyle in coordination with the general practitioner, nurse, and occupational therapist.

In the hospital, the geriatrician can support primary care. "During a day or week hospitalisation, we take stock of the geriatric syndromes. Management must be adaptive to the different diseases that can affect an elderly patient. We can't treat them all at the same time, otherwise, we risk endangering the life of our patient," says Dr Yves Passadori.

In a hospital rehabilitation department, the geriatrician collaborates with a large majority of health and paramedical professionals, including physiotherapists, speech therapists, adapted physical activity professionals, psychologists, occupational therapists, and psychomotor therapists. This multidisciplinary approach makes it possible to prepare for the patient's institutionalisation in a residence for senior citizens or in a long-term care unit.

During a short stay in the hospital, the presence of a physiotherapist and a psychologist is essential, in addition to that of the geriatrician. In the case of a patient with multiple diseases, it is necessary to keep him walking, otherwise, he will never walk again. The psychologist also plays a very important role with regard to attitudes of abandonment.

In which cases should a person be placed in a specialised institution?

First, the geriatrician assesses the situation, measures the incapacities and resources and identifies the resources that the patient can mobilise to cope with the incapacities. This consultation helps to determine whether the patient can be sent home or placed in an institution.

"For example, a patient who has had a cerebrovascular accident (CVA) that affects his mobility can no longer move on his own. A person must therefore change his position regularly to avoid the risk of bedsores, and it is necessary to install an adapted bed. In an institution, the change of position can be programmed every two to three hours, but it is almost impossible to do it at home," says the geriatrician.

Geriatrician: what studies are required to enter this profession?

There are two ways for a student to enter medical school: the specific health access course (PASS) or a licence with a "health access" option (L.A.S). If this first year is validated, he/she can be admitted to the common core of medical studies for five years. The future doctor then prepares for the national competitive examination (ECN) to begin his internship and specialisation. Since 2014, geriatrics is one of the specialities of the internship and lasts three years. Following the internship, the student can decide to continue his or her training for two to four years as a clinician or assistant.

Thanks to Dr. Yves Passadori, geriatrician and Deputy Treasurer of the French Society of Geriatrics and Gerontology (SFGG)