Protecting your eyes is the best way to preserve your long-term vision. And it can be as simple as putting on an elegant pair of sunglasses.

Less time in front of the screen

Smartphones, laptops, and other devices are an integral part of our life. Although they help us both work, distracting us and shopping and maintaining links with our loved ones, they are a threat to our vision.

Fixing the screen for long periods can cause "computer vision syndrome", which results in eye fatigue, blurred vision, headache, and dry eyes. "Take frequent breaks during the day by following the 20-20-20 rule," recommends Morgan Statt, who takes care of health and safety at Consumersafty.org in New York. "Every 20 minutes, look away for 20 seconds to something else that is at least 20 feet (6 meters) from distance" to give your eyes a break in using your close vision.

Log the air conditioning from your eyes

"Directing your air conditioner directly on your face will relieve you during a hot summer day, but it can also wreak havoc on your eyes," warns Morgan Statt. Dry air evacuates the natural humidity of the surface of the eye. To protect your sight, she says, direct the ventilation mouths away from your face.

Look for shadow

"Choose sunglasses that protect from 100% the Ultraviolet A and B rays of the sun, which can cause all kinds of damage and eye problems," says Vincent Hau, a Californian ophthalmologist. Your sunglasses don't have to cost a fortune either. "Paying more expensive does not necessarily mean better protection," he observes. You can get sunglasses in a pharmacy whose protection is as good, even better than brand sunglasses. ”

Wear them even in cloudy weather

One of the current myths about sunglasses is that you don't need to wear them if it is not sunny. "Even in cloudy weather, ultraviolet rays continue to pass and can damage your eyes," says Dr. Hau. Think of your sunglasses in the same way as you think of your sunscreen, and never go out without protection.

Put on views of the view regularly, even if you do not wear glasses

Wondering how to improve your sight? "Visit your ophthalmologist once a year for an examination of the bottom of the eye," advises Matthew Alpert, an optometrist from Los Angeles. This examination (with or without dilation of the pupil) allows the doctor to examine the bottom of the eyes to detect any sign of deterioration or illness. “Complete sight exams are not limited to the eyes. They can also help detect chronic diseases such as high blood pressure and diabetes, "added the optometrist.

Never sleep with your lenses

As tempting as it may seem after a difficult day, Inna Ozerov, an ophthalmologist who exercises in Florida, insists on the danger of sleeping with your contact glasses - even when the manufacturer says that you can do it. "The surface of the corneal lenses can allow microorganisms to adhere to your eye, which increases the risk of infection," she said.

By removing your lenses before bedtime, you also increase contact with your eyes with oxygen, which decreases the risk of infection.

Stop smoking

In addition to all the health problems associated with smoking, "tobacco is extremely toxic to retina cells, a thin layer of tissue lining the back of the eye, and it considerably increases the risk of developing a degeneration macular degeneration, which can lead to blindness, ”warns the Ozerov Dre. Macular degeneration occurs when the central part of the retina (the macula) deteriorates.

Drink a lot of water before flying

Dehydration aggravates the symptoms of eye dryness, so if you take the plane, drink a lot of water before and during a flight to protect your eyes, explains Dr. Alpert. "There is nothing wrong with taking an alcoholic or caffeinated drink, but you will need to drink more water to compensate for the loss of liquid," he adds. In addition, air conditioning in planes tends to blow dry air directly in your eyes, so close the vents before takeoff.

Keep your distance

"Find a comfortable working distance from your screen," insists Dr. Alpert. This is particularly important for children because the intensity of light increases exponentially as we approach our eyes with light sources. " The blue light emitted by our digital devices can increase our risk of developing macular degeneration and can also cause eye fatigue. Investing in a blue light filter can also help you protect your vision.

Reduce the brightness

"Reduce the brightness level of the screens of your electronic devices to reduce exposure to blue light, especially in the evening," said Dr. Alpert. This will reduce the risk of eye fatigue and other problems associated with exposure to blue light.

Remove yourself before going to bed

The mascara, the line, and the eyeshadow can really embellish your eyes, but they can also obstruct the tiny sebaceous glands located at the base of your eyelashes. "It can irritate their eyes, make them blush and tear them, and make the wearing of corneal lenses uncomfortable," warns Monica Nguyen, an optometrist in New York and New Jersey. Remove your makeup at the end of the day before washing your face, because sleeping with these eye impurities has an increased risk of accumulation of bacteria and infection, "she said.

Then gently pass a damp cotton swab along the upper and lower edges of the eyelids to remove any makeup residue and help open these glands.

Do not share eye makeup

You can also protect your eyes by not sharing your eye makeup with your friends. Never do this because bacteria can easily go from a mascara or a line to your eye.

You should also clean your brushes regularly and invest in new eye makeup every three months, says Dr Nguyen. And always get rid of all your eye makeup after an eye infection.

Maintain your contact glasses

"Follow simple hygiene, such as hand washing and the appropriate cleaning of corneal lenses with a solution intended for this use," says Dr Nguyen. It is important to remove bidimensional and monthly contact lenses at the end of the day, clean them in the palm of your hand, and let them sit in a solution all night. "

It is also important to clean them with the solution before putting them back in the morning. "Single-use contact lenses are excellent because you can throw them every day and take a new pair the next day."

Wear swimming glasses at the pool

It is not enough to close your eyes when you swim underwater to protect them. Chemicals that disinfect pools (physiological chlorine and serum) can damage your eyes, causing tingling, burns, drought, and/or redness. David Evans, managing director of Better Vision Guide, recommends wearing swimming glasses. These same chemicals can also cause irritation and infections of corneal lenses. "If you accidentally wear contact lenses during swimming, remove them and rinse your eyes and lenses immediately after swimming," says David Evans.

Put protective glasses when you play sports

It may not be sexy, but protecting your eyes can save your sight. "Many eye injuries can occur at home or during recreational or sports activities," said DRE Nguyen. Do not take a risk and wear protective glasses, she says. "In the event of an eye injury, even if it seems minor, immediately consult an optometrist or your ophthalmologist to receive an appropriate treatment and prevent a loss of vision and/or blindness."

Apply sunscreen around your eyes

Research from the University of Liverpool reveals that we tend to neglect about 10% of our face when we apply sunscreen, especially on and around the eyelids. This is particularly worrying, because we know that around 10% of skin cancers occur in this thin and sensitive area.

"Apply a sunscreen with an FPS of 30 or more to the entire exposed skin, especially on the face," recommends Michele Green, a dermatologist at the Lenox Hill Hospital in New York.

Eat fish

Omega-3 fatty acids present in salmon, mackerel and other fatty fish help prevent dryer drought and keep the retina health, says Justin Bazan, medical advisor to the Council Vision. The American Heart Association recommends eating fish (especially fatty fish) at least twice a week (two portions).

Consume these foods to preserve your eyes from aging.

Sleep enough

Lack of sleep can contribute to the redness of the eyes, says David Evans. Create an environment conducive to rest by keeping your bedroom cool and dark, and reserving it only for sleep and love antics. If you are constantly having difficulty sleeping well at night and you always wake up, tell your doctor about what can cause your lack of sleep.

Adopt these tips to sleep better at night.

Order a spinach omelet for brunch

Lutein and zeaxanthine found in spinach, corn, broccoli, and eggs can help protect your eyes from diseases. According to the American Optometric Association (AOA), these nutrients are deposited in large quantities in the retina of the eye.

Although it is always preferable to obtain nutrients from whole foods, recent studies show that taking 10 mg per day of a lutein supplement and 2 mg per day of a zeaxanthin supplement has advantages for health.

Exercise

Regular physical activity can improve your general state of health and be beneficial for your eyes. A Swedish study even demonstrated that physical exercise could reduce the risk of cataracts, a crystalline disorder that affects vision.

But that's not all. "Exercise avoids certain diseases and affections that affect vision, such as diabetes and high blood pressure," added Dr. Hau. Here's how to improve your view: Give yourself the goal of being 30 minutes a day of aerobic activity almost every day of the week and always talk to your doctor before making changes to your training sessions.

Do you like Bugs Bunny?

Bugs Bunny was right: eating carrots is good for the eyes. "Carrots are one of the many vegetables rich in vitamin A, which is very good for the health of our eyes," said Dr. Hau. Make sure to integrate carrots or other vegetables rich in vitamin A into your diet, such as peppers or squash. "Make them alternate as one of your five daily vegetables, sometimes a week," he adds.

Do not try cosmetic surgery at low prices

A study highlighted a rare, but scary risk of the use of filling products to reduce wrinkles. Blindness. It exhibits the case of nine women in South Korea who have become blind after taking injections. Some areas around the front have risks. "Choosing an injection expert who knows the facial anatomy well as well as all the filling products available and their uses will considerably reduce the already low risk of this fairly terrifying complication," says Mark H. Schwartz, a visual art surgeon in York.

Don't look at the sun

Your mother was right! Attacking the sun, especially during a solar eclipse, can cause blindness. "The sun's rays are very strong and can burn or leave scars on the retina," says Dr. Hau. Never fix the sun directly ”.

Do not exaggerate with the vision

"Medicines like the vision help reduce the redness of the eyes by tightening blood vessels, but they end up getting used to it," said Dr. Lisa Park, an aggregated professor in ophthalmology at Columbia University in New York. If you abuse it, your blood vessels will grow and you will need more and more visors. It's a vicious circle. Rather try artificial tears to soothe your eyes. ”

Protect yourself from allergens

"If your eyes itch, it may be an allergy," said Dre Park. Wash your hands before touching your eyes to avoid contaminating them with allergens like pollen. ” See with an allergist what is behind your symptoms and what treatments can help relieve them.

Avoid smoky places

"Smoke and other vapors can irritate your eyes," says Dr. Park. Avoid smoky parts as much as possible or make sure you ventilate them before spending a while. "

Choose perfume-free cleaning products when possible to reduce the risk of eye irritation caused by vapors.

Choose your places well at the cinema

"If you sit too close or too far from the screen, you may have stunning or a headache," says Dr. Everyone's view is different, so choose your seats accordingly.

Blink

When you blink your eyes, your upper eyelid spreads lacrimal liquid on the front of the eye to keep it moist. "If you do not clig enough, your cornea can dry out and irritate," says Dre Park.

Every 20 minutes, look at a distance of 20 feet (approximately 5-6 m) for 20 seconds and blink.

Take more vitamin D

According to researchers from the University of Buffalo, people who lack vitamin D run approximately 44% more risk of developing macular degeneration linked to aging (DMLA). Vitamin D is said to be sun vitamin because our body manufactures it when it is exposed to its rays. Certain foods such as enriched dairy products, the liver, and eggs are rich in vitamin D. Chat with your doctor about your blood rate of vitamin D to see if you need it.

Get out

The more time you spend, the more likely you are to develop myopia. This is true: children who are often outside and who play sports are less likely to be myopic, according to a new study published in the British Journal of Ophthalmology. "The exposure to fresh air and natural light as long as spending more time looking at distant objects than setting a screen may explain this link," said David Evans.

Never share contact glasses

"You will not see well and it will tire your eyes," says Dr. It is not a common practice, but it sometimes happens that young people exchange recreational lenses that change the color of their eyes, especially when approaching Halloween.

Find out about the eye health of your family

According to the National Eye Institute American, knowing the history of eye health of your family will allow you to better understand your own risk of transmission of certain eye diseases. Talk about it today.

Watch your waist

Lose weight if you are overweight because bringing too many pounds increases your risk of developing diabetes and other systemic diseases, which can cause vision loss, such as diabetic eye diseases or Glaucoma, explains David Evans.

Avoid marijuana

Smoking Marijuana regularly can damage your vision, according to the preliminary results of a French study. Participants, who consumed marijuana at least seven times a week, showed a slight delay in the reaction of retinal lymph node cells (CGR), located on the surface of the retina. These cells receive visual information, and any delay could suggest visual impairment.

Stay Zen

Practicing yoga - or any other daily stress reduction technique - can do more than help you stay calm, rested, and concentrated. It can also save your vision. "We know that stress can put our eyes to the test, and prevent us from making healthy choices that will do good to our vision. Like a healthy diet and regular physical activities, "said David Evans.

Suppress your sweet tooth

Eating too much sugar can make you fat, cause diabetes, and even speed up aging. Research suggests that sugar can make eyes more vulnerable to age-related macular degeneration (AMD). The American Heart Association (AHA) recommends a maximum of approximately 30 g (6 tsp) of sugar added per day for women and nine for men. Good to know: a 350 ml soda can (12 oz) contains about 10 g of added sugar.

Don't forget the lenses in your eyes

Remember to remove your lenses before placing new ones. It seems obvious, but unfortunately, not everyone does. Doctors have recently withdrawn 27 corneal lenses from the eyes of a woman who had been wearing disposable lenses for 35 years. The news was published in the British Medical Journal.

Learn to recognize the signs of a detailed retina

The detachment of the retina is a medical emergency. If you note the sudden or gradual appearance of floating bodies (spots that move before your eyes), flashes, or an obscuring veil in the field of vision, you must see a doctor as soon as possible, warns the National Eye Institute.

Don't rub your eyes

Rating your eyes can provide instant satisfaction with irritated and itching eyes, but it can also worsen the situation. This can increase the risk of infection by propagating more which irritates the eyes. Consult an allergist or an ophthalmologist to stop itching safely.

 Frequent passages to the bathroom could be all that is more normal... But also indicate something serious. Here's how to know it.

Does your bladder make its own?

If you rush to the bathroom twice per hour, or you wake up several times a night to urinate, it's frustrating. Needing to urinate all the time is a real handicap. Sometimes the urgency to urinate is due to an illness that should not be taken lightly. Also, if you worry, talk to your doctor to eliminate possible pathologies. If you are worried, tell your doctor. Let's examine the reasons that may explain the frequency of your urination.

You have a urinary tract infection

If you need to go to the toilet all the time and it suddenly happens, you may have a urinary tract infection, explains Dr. Partha Nandi, gastroenterologist and doctor in Detroit Michigan, and author of Ask Dr. Nandi. "Frequent urination can be the symptom of many problems ranging from kidney disease to just overlooking too many liquids. But when this frequent urination is accompanied by fever, an urgent need to urinate, and pain in the abdomen, it can be a urinary tract infection. " There is a urinary tract infection when bacteria enter the bladder. This infection is treated with drugs.

You are diabetic

Frequent urination accompanied by abundant urine is often an early symptom of type 1 or type 2 diabetes. The body tries to get rid of glucose not used by urine. "Excess sugar accumulates in the blood and kidneys are forced to filter it and absorb it. If they do not succeed, they excrete it in the urine, explains Dr. Nandi. They take fluids from other tissues, urination increases, and your body can be dehydrated. " Dehydration leads to serious medical problems and sometimes hospitalization.

As diabetes is accompanied by excessive thirst, you dehydrate by urinating too much and too often, explains Dr. Nandi. The advice to properly manage the contribution of liquid is to "drink enough to prevent constipation and overcoat of urine, but to avoid drinking just before bedtime, so as not to get up at night."

You have prostate problems

"A hypertrophied prostate (large) can squeeze against the urethra, this tube which transports urine out of the body, and blocking the expulsion of urine. The bladder mucosa then becomes irritable, ”explains Dr. Nandi. The bladder can start to contract even when it contains small amounts of urine, which can cause more frequent urination.

Even with benign prostate hyperplasia, men need to urinate more frequently, especially at night. This is called nycturia: elimination of urine at night, sometimes eight times or more, he explains. And then, with a large prostate, there is more pressure on the urethra and the bladder, with the inability to hold back, but also the difficulty of urinating easily.

You take diuretics

Diuretics increase excretion (elimination of organic waste): they will often send you to the toilet. But we can sometimes urinate too much when we are prescribed diuretics regularly.

"These drugs used to treat hypertension or the accumulation of fluids have an effect on the kidneys and evacuate excess liquids, which leads to the frequent need to urinate," said Dr. Nandi. Also, explain to your doctor your concerns and describe your symptoms.

To reduce symptoms, just eat the minimum of food and diuretic drinks. Above all, "avoid all the foods that seem to irritate your bladder or have a diuretic effect: caffeine, alcohol, carbonated drinks, tomato products, chocolate, artificial sweeteners, spicy food. Eat foods rich in fiber, because constipation can worsen the symptoms of a hyperactive bladder, "said Dr. Nandi.

You are pregnant

At the start of pregnancy, hormonal changes can increase the frequency of your urination. We generally urine more during the first trimester. "Later during pregnancy, your growing uterus puts pressure on your bladder. But these causes of frequent urination are very common and they are harmful to the mother or for the baby, "says Dr. Nita Landry, obstetrician-gynecologist in Los Angeles and co-host of the American program The Doctors.

“Kegel exercises are useful. Pregnant women should not take too much caffeine; It will relieve the frequency of their urination and notify other problems that a pregnancy can cause, "she adds. Small digression: Kegel exercises are also good for men. Talk to your spouse and do them together.

"The American Obstetrics and Gynecology College (ACOG) recommends that pregnant women limit caffeine to 200 mg per day, which represents 325 ml (11 OZ) of coffee per day," she said. Health Canada makes a similar recommendation.

You have hyperactive bladder syndrome

It's pretty common. People who suffer from it have involuntary contractions of the bladder which leads them to urinate often and to have spontaneous urination. That is to say, you feel the urgent need to urinate while your bladder is empty.

It’s unpleasant and frustrating, comments Dr. Nandi, because it wakes you up at least once a night to go to the bathroom. But we can deal with the problem. Try to hold back, he advises. "For 12 weeks, increase the interval between your passages to the bathroom. This will help your bladder to hold back and lead you to urinate less often. ”

Some people are treated with Botox. Dr. Nandi explains what happens. "Botox injection into the bladder muscle leads it to relax, increases its capacity, and decreases leaks. There are also various surgical interventions. The least invasive is to implant small nervous stimulators just under the skin. The stimulated nerves control the pelvic floor and these implants modify the contractions in the organs and the muscles around. "

You suffer from interstitial cystitis

Among the symptoms of interstitial cystitis (CI) or painful bladder syndrome, there is "pelvic pain relieved by urination, a persistent need to urinate, and frequent urination," said DRE Nita.

Dr. Nandi adds this. “Most people will urinate about seven times a day. Those who make CI can urinate between 35 and 40 times a day; Often, they will only emit a few drops of urine and the urgency of relieving themselves may not disappear afterwards. This symptom occurs throughout the day and also at night, which disturbs the sleep cycle. And then, the person can feel pain, which intensifies as the bladder fills up. "

Unfortunately, the exact cause of interstitial cystitis is not known, but many factors probably play a role. "A failure of the bladder mucosa, for example: a breach in the epithelium lets pass toxic substances in the urine, which will irritate the mucous membrane of the bladder. There may also be a genetic cause or an infectious etiology, ”explains Dr. Landry.

She warns that not all patients respond to treatment. But here is what your doctor could recommend: oral medication, nervous stimulation techniques, expansion of the bladder with water (hydrodisting), drug instillations directly in the bladder, surgery, or acupuncture that can relieve.

You make anxiety

Butterflies in your stomach sometimes lead to a leak or make you run into the bathroom. "Nervousness and anxiety can increase the frequency of urination," said Dr. Landry. Your bladder continues to swell until it is full. It then sends a signal to the brain that it is time to empty it. Usually, we can delete the sensation and wait until a timely time. But when people are anxious, the bladder becomes more active. ”

You can solve this problem by taking measures to manage your anxiety. Consider reducing your stress, meditation, relaxation techniques, yoga, or physiotherapy of the pelvic floor.

You had a stroke

A stroke can damage the nerves of the bladder and increase urination. As the muscles asked to urinate can be affected, which will have an effect on the control of the bladder, it may be necessary to install a probe to limit the frequent urge to urinate, concludes Dr. Nandi. Brain vascular accidents can also affect cognition, which can also cause excessive urination as well as incontinence.

The probe is not the solution to all problems because it can cause urinary tract infections. If the muscles do not heal, these infections become chronic and have pernicious effects on the quality of life, he warns. Discuss with your doctor the options best suited to your situation.

 TB remains a major infectious disease worldwide, with more than 10 million cases, resulting in 1.4 million deaths each year. The synergy with the AIDS epidemic and the emergence of strains of Mycobacterium tuberculosis (Koch's bacillus) multiresistant to antibiotics and chemotherapeutic agents contribute to aggravating the impact of this disease, considered by the World Health Organization (WHO) as a global health emergency. Despite the enormous health and social issues surrounding TB, there is some progress to note. Indeed, the WHO estimates that between 2000 and 2019, 63 million lives were saved thanks to the diagnosis and treatment of this disease, but the future of this promising assessment may be impacted by the COVID-19 pandemic, which causes many disruptions to screening and treatment centers.

Epidemiology

On average, 10 million people develop an active form of the disease each year (10 million in 2019, according to the World Health Organization - WHO). And TB is one of the top 10 causes of death worldwide. In 2019, 1.4 million people died, 208,000 of whom were also infected with HIV. More than 95% of TB deaths occur in developing countries, but TB remains a major public health problem in many industrialized countries, especially when it comes to multidrug-resistant forms, which are particularly difficult and long (2 years) to treat.

Globally, a quarter of the world's population is infected with Mycobacterium tuberculosis, and 30 countries alone account for 87% of global cases. Globally, there were an estimated 206,030 cases of multidrug-resistant TB in 2019, 10% more than in 2018.

Transmission

Tuberculosis is a contagious disease, caused by the Koch's bacillus (strains of the Mycobacterium tuberculosis complex). This infectious agent is transmitted by air, via droplets containing bacteria, and expectorated by the cough of patients. Inhaling a small number of contaminated droplets is enough to infect an individual. An untreated TB person can infect an average of 5 to 15 people each year. Precarious health and social conditions are often associated with the spread of the disease.

The disease

The active development of the disease among people infected with Koch's bacillus depends on many factors (genetic, immunological, nutritional, and social). It is estimated that 5-15% of infected people will develop TB with symptoms during their lifetime. The bacillus can remain in the body in a 'dormant' state for years. Immunocompromised people have a higher risk of developing active TB. The HIV virus and Koch's bacillus form a dangerous combination, as system deficiencies caused by HIV infection help TB progression. If left untreated, TB is fatal in almost all people with AIDS.

Treatment

In the 40s, there were no drugs to cure tuberculosis. Today, a combination of antibiotics and chemotherapy is used to treat tuberculosis patients, but treatment must be followed for at least 6 months (and up to two years in the case of multidrug-resistant strains). Incomplete or poorly followed treatment is often responsible for the development of antibiotic-resistant TB, which is then transmitted in the community. When treatable, these cases of drug-resistant TB are 100 times more expensive to treat than TB cases that can be treated with standard regimens.

Vaccine

B.C.G. (Bacille de Calmette et Guérin) is the only vaccine currently licensed to vaccinate against tuberculosis. Nevertheless, this vaccine, which celebrates its 100th anniversary in 2021, is a partially effective vaccine: although it is very useful for preventing severe forms of the disease in young children (almost 90% effective in the case of tuberculous meningitis), it provides little protection against cases of pulmonary tuberculosis in adolescents and adults. It, therefore, does not prevent the transmission of the disease and stop the global epidemic.

At the Institut Pasteur

Several teams of microbiologists, immunologists, and geneticists are developing research programs to understand the host-bacillus interaction (including genomic tools), study the genetic evolution of the bacillus, improve the diagnosis of the disease, and find new anti-tuberculosis drugs and improved vaccines.

Faithful to its teaching mission, the Institut Pasteur offers a course "Tuberculosis – biology of microorganisms", and a MOOC, based on international experts. This course is intended for physicians, veterinarians, directors of clinical mycobacteriology laboratories, pharmacists, and researchers who wish to acquire current knowledge about tuberculosis and the practice of molecular methods of diagnosis and medical susceptibility testing, new drugs and treatment regimens as well as molecular and traditional epidemiology. Created in Shanghai in 2008, it has since been taught in Paris, Tunis, and Yaoundé. The next session of the course will take place in 2023.

Latest WHO Reports

TANZANIA, Tanzania (AP) — Senior United Nations officials, health industry leaders, and activists on Monday called for the world to invest more in developing new vaccines and fighting a resurgence of tuberculosis, fuelled by the impact of COVID-19 and armed conflict, including in Ukraine and Sudan.

Monday's event aims to set the stage for the annual meeting of the UN General Assembly in September, which will hold a meeting on tuberculosis.

The latter is the most common deadly infectious disease today, killing approximately 4400 people every day worldwide, including 700 children," said Dr. Lucica Ditiu, Executive Director of the Stop TB Partnership.

UN Under-Secretary-General Amina Mohammed said international efforts to combat the disease have saved 74 million lives since 2000. However, more than 10.5 million people contracted the disease and about 6.1 million died in 2021, and it is now the leading cause of death among people living with HIV.

The TB epidemic is fuelled by a multitude of factors, including poverty, malnutrition, and HIV, and disproportionately affects the most vulnerable in all countries, she said.

According to her, $22 billion is needed to provide all people diagnosed with TB with access to quality treatment by 2027, as well as access to health and social benefits so that they do not suffer financial hardship. It also says an additional $5 billion a year is needed for research.

"We can develop safe and effective vaccines and one-stop shops for quality testing and care," she said.

The Director-General of the United Nations World Health Organization (WHO), Tedros Adhanom Ghebreyesus, said in a video address to the meeting that COVID-19 "has turned our world upside down" for three years and that in addition to the millions of deaths attributed to it, it has deprived millions of people of essential health services.

"Conflicts in Europe, Africa, and the Middle East have made these essential services even more difficult for people living with TB to access," he said. These challenges were a setback in the fight against TB, wiping out some of the important gains we had made over the past 20 years in expanding access to prevention, testing, and treatment. »

Ukraine has the highest estimated number of people with TB in the European Region, at 34 000. It is also home to a high number of people with drug-resistant TB, Dr. Ditiu said.

Ghebreyesus argued that the September meeting must be a turning point in reviving the fight against the disease. This is why WHO "has proposed to establish a TB Vaccine Acceleration Council to facilitate the development, licensing, and use of new vaccines."

 Connected to digestive function, the solar plexus, or celiac, can be the seat of tension, or even localized pain. Where is the solar plexus? How to take care of it on a daily basis? The point with Youri Bertucchi, an osteopath in Toulouse.

The plexus: definition

Made up of a grouping of nerve fibers, plexuses, which in Latin mean 'interlacing' are, by definition, networks of nerves found in both the peripheral and autonomic nervous systems. "In anatomy, different plexuses participate in the formation of the nervous network that runs through the body from head to toe," says Youri Bertucchi, an osteopath in Toulouse. The sacral plexus forms the sciatic nerve for the legs. A little higher in the body, the lumbar plexus starts from the lower back to the thighs and knees. The celiac (or solar) plexus corresponds to the area between the navel and the sternum in the abdomen, it is in the center of the body. In the upper limbs, the brachial plexus corresponds to the meeting of the anterior branches of the last four cervical nerves and the first thoracic nerve, which corresponds to the shoulders, arms, forearms, and hands. Finally, the cervical plexus is connected to the shoulders, head, and neck.

The solar plexus, a network of nerves

The solar plexus is made up of several ganglia, nerves from the brain that pass mainly through the spine and are the starting point for the organs of the belly: the diaphragm (the muscle of respiration), the stomach, the liver, the small intestine. They then travel through the kidneys and even the gonads (ovaries and testicles). Each nerve includes interoceptors whose role is to transmit information, such as the feeling of satiety or bloating for example, to the viscera. The solar plexus includes several pairs of ganglia: celiac ganglia, sometimes called semi-lunar because of their shape suggestive of a crescent moon, and superior mesenteric and aortic renal ganglia. "This plexus is part of the autonomic nervous system, in its sympathetic subdivision. It intervenes in the function of digestion by sending information to all digestive organs, "adds the osteopath.

From an energetic point of view, the solar plexus is also intertwined, which allows the different flows of energy to flow and radiate throughout the body. In Hinduism, the solar plexus is one of the 7 chakras, located at the level of the sternum. Named simply in English 'solar plexus chakras' (its original name being Manipura), it is the third chakra starting from the Root chakra, and the center of energy and serenity.

Issues related to the solar plexus

The celiac plexus is an area particularly sensitive to stress. It is therefore not uncommon for disorders such as tension, a feeling of oppression, heaviness, or even pain related to stress to lodge in this area. "This is not a problem that will set up overnight. Rather, it reflects a situation of chronic stress, emotional problems that persist and that literally end up weighing on this area," explains Youri Bertucchi.

In addition, long-term use of certain medications (such as anti-inflammatories, for example) can also cause stomach pain in this area. As this plexus is related to digestion, gastric problems can cause various problems at this level, such as pain, burning, or gastroesophageal reflux. "People who drink a lot of coffee, and soft drinks, or those who eat too fast often feel localized pain in the celiac plexus," adds the specialist.

Projected pain, at the level of the shoulder blades, is also possible. More rarely, there is the pain located at the base of the neck, shoulders, or even arms. It is sometimes difficult to relieve and understand the exact origin of these pains since stress often intervenes, thus promoting a vicious circle of pain and fatigue. "The therapeutic solution is then to break this loop by working in a personalized way with each patient according to his symptomatology, his lifestyle, and his personal history to relieve the pain," advises the osteopath.

Personalized care

However, intervening directly in this area, especially if it is tense or painful, is not always advisable. "It is possible to act directly on the plexus, but it is not always the most effective approach to relieve tension. It is sometimes more useful to work first on other areas such as the pelvis, diaphragm, or even the head or neck," explains the therapist. If the area is sensitive, the approach should be gentle and delicate. Indeed, the treatment can temporarily generate excitement in the sympathetic system or, conversely, a vagal reflex that can result in a nauseating state, a feeling of coldness, and fatigue ... This goes against the desired role. In all cases, both the practitioner and the patient must remain attentive to their feelings in order to best guide the therapeutic approach to pain.

Taking care of the solar plexus on a daily basis

Pamper your solar plexus, and goes through a daily routine:

• On a daily basis, taking care of your celiac plexus involves adopting a healthy lifestyle: chewing food slowly, reducing your consumption of stimulants, and acidic but also sweet foods, avoiding snacking, and staying hydrated;
• It is also very important to take the time to walk and ensure that sleep is restorative;
• In case of tension or pain in this area, self-massage can help, provided that the touch is soft and adapted. "It is better to avoid pressing directly on the plexus, with your fingertips," advises Youri Bertucchi;
• Finally, since this plexus is close to the diaphragm, adapted breathing exercises can help relax this area. Do not hesitate to consult a health professional.

 Abulia is a mental disorder that is characterized by an absence or reduction of willpower. This disorder is most often present during a psychiatric illness. His treatment combines psychotherapy and medication.

Aboulie, what is it?

Definition

Abulia is a motivational disorder. The word aboulie means deprived of will. This term refers to a mental disorder: the person who suffers from it wants to do things but cannot take action. In practice, she is unable to make decisions and carry them out. This differentiates this disorder from apathy because an apathetic person no longer has initiative. Abulia is not a disease but a disorder encountered in many psychiatric illnesses: depression, schizophrenia... It is also seen in people with chronic fatigue syndrome or burnout.

Causes

Abulia is a disorder most often associated with psychiatric illnesses: depression, schizophrenia...

Drug addiction can also be a cause of abulia, as well as diseases: chronic fatigue syndrome, burnout, or narcolepsy.

Diagnostic

Abulia is diagnosed by a psychiatrist or psychotherapist. People suffering from psychiatric illnesses such as depression or schizophrenia may be affected by abulia. Motivational disorders represent an important component of behavioral disorders. Abulia is a syndrome favored by psychiatric illnesses. Substance abuse is a risk factor for abulia.

Symptoms of abulia

A decrease in willpower

Abulia is manifested by a decrease in the spontaneity of action and language.

Other signs of abulia

The decrease or absence of willpower can be accompanied by other signs: motor slowing, bradyphrenia (slowing down of mental functions), attention deficit and increased distractibility, apathy, withdrawal...

Intellectual abilities are preserved.

Treatment of abulia

Treatment depends on the diagnosis. If the abulia has an identified cause such as depression, burnout, or drug addiction, it is treated (medication, psychotherapy).

If the abulia is isolated, it is treated by psychotherapy which aims to understand why the person has developed this syndrome.

Prevent abulia

Abulia cannot be prevented like other motivational disorders. On the other hand, it is important that a person who notices changes in his personality (or whose entourage has made this observation) consults a specialist.

 A fortunately rare complication of breastfeeding, breast abscess can result from untreated or poorly treated infectious mastitis. It requires rapid treatment combining antibiotic treatment and drainage of the abscess.

What is a breast abscess?

A breast abscess is a formation of a purulent collection (an accumulation of pus) in the mammary gland or periglandular tissue. The abscess most often results from a Staphylococcus aureus infection. This infection can result from various breastfeeding complications:

most frequently, untreated or poorly treated infectious mastitis (incomplete breast drainage, unsuitable antibiotic, or shortened treatment);

A superinfected crevice, which presents an entry point for pathogenic germs.

Thanks to the good management of mastitis, breast abscess, fortunately, remains a rare pathology, affecting only 0.1% of breastfeeding mothers.

What are the symptoms of a breast abscess?

A breast abscess is manifested by very specific symptoms:

the presence in the breast of a hard, well-defined, warm mass;

intense throbbing pain, increased on palpation;

a swollen, tense breast with a red color on the affected area, sometimes with a paler central area. Shiny at first, the skin can then peel, or even crack, letting the pus flow out;

fever.

Faced with these symptoms, it is important to consult as soon as possible.

How to diagnose breast abscess?

In addition to the clinical examination, an ultrasound is generally performed to confirm the diagnosis of breast abscess, measure the abscess and specify its location. These elements are important for the choice of treatment.

How to treat a breast abscess?

A breast abscess cannot be resorbed alone, nor with a “natural” treatment. It is a medical emergency requiring rapid treatment in order to avoid sepsis, a serious complication. This treatment is multiple:

Anti-inflammatory analgesic treatment

An anti-inflammatory analgesic treatment compatible with breastfeeding, in order to relieve pain.

Antibiotic treatment

Antibiotic treatment (combination of amoxicillin/clavulanic acid, erythromycin, or clindamycin) systemically for a minimum of 14 days in order to eradicate the germ in question. This treatment can be adapted according to the results of the bacterial analysis of the puncture fluid.

A puncture-aspiration of pus

A puncture-aspiration of the pus using a needle to drain the abscess. The procedure takes place under local anesthesia and under ultrasound control. Once the pus has completely drained, irrigation of isotonic solution (a sterile saline solution) is performed to clean the abscess, then a dressing is applied to absorb the pus.

It is often necessary to repeat this puncture several times (2 to 3 times on average) in order to achieve total resorption of the abscess. Non-invasive (and therefore less likely to damage the mammary gland), not inducing unsightly scars, and not requiring hospitalization (and therefore no mother-baby separation), ultrasound-guided puncture-aspiration is the treatment of first intent of breast abscess.

Installation of a drain

In the presence of an abscess more than 3 cm in diameter, a percutaneous drain can be placed under ultrasound, in order to perform daily rinsing.

Surgical drainage

In the event of failure of ultrasound-guided puncture-aspiration (very viscous pus, septate abscess, a large number of punctures, very significant pain, etc.), a large or deep abscess, or a recurrent or chronic abscess, drainage surgery is necessary.

After incision of the skin under local or general anesthesia, the surgeon scratches the shell of the abscess with his finger in order to remove the majority of the cells (the micro-abscesses located around). He then irrigates the area with an antiseptic solution before setting up a drainage device (gauze wick or flexible plastic blade) in order to evacuate the various liquids (pus, blood) during the healing process, but also to keep the open abscess.

This is important in order to obtain progressive healing, from the inside out, and to avoid recurrences. Local care will be provided daily, and analgesics prescribed.

Can you continue to breastfeed with a breast abscess?

With the prescribed antibiotics being compatible with breastfeeding, the mother can continue breastfeeding with the unaffected breast. On the affected breast, continued breastfeeding is possible if the abscess is not periareolar, in other words, if the baby's mouth is not too close to the puncture site. Breast milk is generally free of pathogenic germs.

The mother will simply make sure to wash her hands well before and after feeding and to put a sterile compress on the puncture site during the feeding so that the baby does not come into contact with the pus. If feedings are too painful, the mother can use a breast pump while the patient heals in order to avoid engorgement which can promote the persistence of the abscess.

 Also called ovarian dystrophy, polycystic ovary syndrome affects between 5 and 10% of women. The leading cause of infertility in France, PCOS is linked to hormonal dysfunction.

Contrary to what its name might suggest, polycystic ovary syndrome is not characterized by the presence of multiple cysts in the ovaries. To understand this error, we must go back in time, more precisely to 1935, the year in which the syndrome was first described by doctors Irving Freiler Stein and Michael Leventhal. The disease is still sometimes called Stein-Leventhal syndrome. This publication (Stein I, Leventhal M, Amenorrhea associated with bilateral polycystic ovaries, Am J Obstet Gynecology) is the first report describing a series of patients, not isolated cases, with polycystic ovaries, hirsutism, and amenorrhea (absence of menses). It was a landmark in the history of medicine, but Stein and Leventhal had mistaken the numerous follicles present in the ovaries of these patients for cysts. Although the term is incorrect, it is still used.

1. What is PCOS? Definition

Ovarian dystrophy is a chronic syndrome related to hormonal dysfunction of cerebral and/or ovarian origin. This dysfunction leads to the abnormally high secretion of androgens by the ovaries. Secreted by the adrenal glands, androgens are so-called male hormones, since they participate in the development of male physical characteristics. But they are also secreted by the ovaries.

In the case of PCOS, this secretion is excessive, resulting in the production of testosterone. This disrupts the normal functioning of the ovaries and therefore ovulation. The ovaries, on the other hand, are perfectly normal, as are the eggs. In the absence of any other pathology, of course. But this hormonal imbalance complicates their functioning. PCOS can occur as early as adolescence or later in life without any real explanation.

2. Symptoms of Polycystic Ovarian Syndrome

Symptoms of ovarian dystrophy differ markedly from woman to woman. Some patients may be completely asymptomatic, while others have severe and varied symptoms. Ovarian dystrophy can be particularly debilitating for these women whose symptoms are not always limited to the gynecological sphere.

Symptoms related to the menstrual cycle

Women who suffer from PCOS have ovulation problems, which may be rare (called days ovulation) or even absent (anovulation), due to the inability of the follicles to mature. Cycles are irregular, sometimes very long, and often anarchic with amenorrhea that can last several months. Because of this disturbance of the menstrual cycle, SPOK causes infertility in almost half of the women who suffer from it.

The consequences of hyperandrogenism

The excess of male hormones, in particular testosterone, obviously has an impact on women's bodies and can cause numerous symptoms. In particular, excessive hair growth (hirsutism) can be observed both on the body and on the face. This hormonal imbalance can also cause acne on the face, back, and chest. It should be noted that the symptoms related to hyperandrogenism are increased by obesity. But PCOS itself can cause significant weight changes.

Metabolic disorders

Ovarian dystrophy can also be manifested by metabolic disorders. These women are more likely to be overweight and to suffer from hypertension. Polycystic ovary syndrome also predisposes to insulin resistance, for example. Because of their body's difficulty in managing carbohydrates, these women may have pre-diabetes or diabetes.

Skin symptoms

Acne is not the only dermatological symptom of SPOK. The insulin resistance we mentioned can cause a condition called acanthosis nigricans. This dermatosis causes the skin to become thicker and darker in certain areas of the body: the armpits, the back of the neck, and the skin folds. In dark-skinned individuals, the skin may take on a parchment-like appearance. This hyperinsulinemia can also cause acrochordons, which are tiny growths that are most often found in the armpits and neck.

Other symptoms related to ovarian dystrophy

PCOS can also cause many other symptoms. Although it is important to remember that not all of these symptoms are present in all women who are actually diagnosed. For example, some women may experience migraines, insomnia, hair loss, decreased libido, vaginal dryness, sleep apnea, anxiety, depressive symptoms.

3. Causes of PCOS

The causes of ovarian dystrophy are not clearly identified and remain poorly understood. Genetic mutations could be at the origin of the disease; about twenty genes have been identified but they are present in only 10% of PCOS cases. Family history is often found, and it is estimated that between 60 and 70% of daughters born to mothers with PCOS develop symptoms, although the transmission mechanism is unknown.

Environmental causes, including exposure to endocrine disruptors, are also suspected, but no definitive evidence exists today.

4. PCOS: How is the diagnosis made?

The symptoms we have listed can have other causes, so it is important to consult a doctor who can rule them out and confirm or not the diagnosis of PCOS. The diagnosis of PCOS is made in several stages and requires various tests to be carried out.

A blood test

The doctor prescribes a hormonal test which is performed between the 2nd and 5th day of the menstrual cycle. If menstruation is absent, it may be caused by a treatment. This blood test measures several hormones: follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These two hormones play an essential role in the ovarian cycle: FSH stimulates follicular maturation and the production of estrogen, LH causes ovulation. In PCOS, the production of these two hormones is disturbed and does not vary as it should during the cycle. This results in an inversion of the FSH/LH ratio.

In addition to these hormones, this test also measures androgens: the level of circulating testosterone, androstenedione (a steroid hormone), and dehydroepiandrosterone sulfate (DEHS). In ovarian dystrophy, androgens are elevated. The blood test also includes an hCG test (the pregnancy hormone), a carbohydrate and lipid test, and in some cases prolactin, TSH, and a 17-hydroxy progesterone test.

Pelvic ultrasound

Abdominal and pelvic ultrasound is also performed to diagnose PCOS, although it is not sufficient to make the diagnosis. However, the examination does reveal one of the characteristic features of ovarian dystrophy: the presence of numerous immature follicles in the ovaries. Normally, each ovary contains 5 to 10 follicles of about 5 mm at the beginning of each cycle. One of them will evolve and become a fertilizable oocyte. Either it is fertilized by a spermatozoon, which is the beginning of pregnancy, or it is not fertilized and is evacuated, which is the period. In the case of PCOS, the overproduction of androgens blocks follicular maturation: the follicles (at least 20 less than 9 mm in diameter) accumulate. Ultrasound can also show an enlarged ovary.

5. Polycystic ovary syndrome: how can it be treated?

Although there is no cure for polycystic ovary syndrome, the symptoms can be treated. For women who do not wish to become pregnant, this treatment begins with the use of an estrogen-progestin pill with an anti-androgenic action in order to act on acne, hirsutism, or hair loss. Hygienic and dietary measures must also be observed, including dietary management in case of overweight and regular physical activity. However, weight loss has no impact on the symptoms in women with a BMI within the limits. It is also important to regularly monitor cholesterol and blood sugar levels and to start diabetes treatment if necessary.

6. PCOS and pregnancy: the leading cause of infertility

Some women with PCOS get pregnant easily, but for those with symptoms, the path is usually more difficult. Ovulation must first be induced and regulated with medication (clomiphene citrate) or injections (exogenous gonadotropins). In case of failure and after several months of trying to achieve a pregnancy naturally, it is often necessary to resort to MAP (medically assisted reproduction).

This joint, which joins the thigh to the pelvic bone, is essential for walking and the good stability of the pelvis. What are the main pathologies that affect the hip? What tests can be used to diagnose them? How do treat them? The answers of Dr. Henri Lellouche, rheumatologist.

Between the femoral head and the acetabulum, there are:

• - On the one hand, fibrocartilage called acetabular bulge,
• - On the other hand, a fibrous sleeve called the joint capsule.

"There is a frequent confusion with the so-called "seamstress hip", which is much higher than the so-called surgeon's hip", says the rheumatologist. The tailor's hip is actually the crest of the iliac bone.

The roles of the hip

The hip is the central joint of the body, which allows the good stability of the pelvis on the lower limbs. This joint can move on 3 different planes, allowing a very large amplitude and variety of movements of the lower limbs:

• - The extension/flexion: which allows to bring the leg towards the chest or, on the contrary towards the back,
• - The adduction/abduction: which allows spreading or to tighten the legs,
• - External or internal rotation: which allows the rotation of the hip towards the median or lateral line of the body.

Hip pathologies

There are a large number of hip pathologies, grouped under the name of coxopathies, when the precise diagnosis has not yet been made.

- Cartilage pathologies

The main pathologies of the hip are cartilage wear pathologies, namely osteoarthritis of the hip also called coxarthrosis. It results in pain in the groin, which can radiate to the knee. It is a chronic disease that can seriously affect the daily life of the person suffering from it.

- Tendon pathologies

Hip tendonitis is an inflammation of one of the tendons that attach to the femur, namely the gluteus minimus, the gluteus medius, or the lateral blade of the gluteus medius. It is often caused by excessive walking or frequent climbing of stairs, and very often affects people living in multi-story houses. Hip tendonitis is manifested by pain of varying intensity on the lateral aspect of the upper thigh. The pain wakes up when walking and can be difficult to bear when climbing stairs.

- Pathologies of the acetabular rim

These are all meniscal lesions or tears of the hip meniscus, which can be observed after a sports trauma in young patients.

- Synovial pathology

The most frequent is synovial osteochondromatosis. This part of the joint starts to produce small cartilaginous formations, which are found in the joint and can cause blockages, pain, and stiffness of the hip.

- Pathologies of the bone

The most common is osteonecrosis of the hip, which is the death of bone cells in the joint caused by a lack of blood. Also called infarction, this disease can be caused by trauma (fracture or dislocation of the hip), prolonged use of corticosteroids or alcoholism.

- Inflammatory pathologies

Arthritis corresponds to the inflammation of the hip, which can be caused by a viral, bacterial, or fungal infection, a metabolic disorder, or by rheumatism.

- Congenital malformations

Hip dysplasia is a deformity of the hip joint, resulting from a problem in the development of the hip of the fetus during its growth. Hip dysplasia favors the development of coxarthrosis, which often progresses rapidly.

The symptoms

"Hip pathologies usually result in lameness, often accompanied by pain in the groin, thigh, buttock, and even the knee," describes Dr. Lellouche.

Sometimes the patient also doesn't feel pain but has discomfort or limited movement. "They may have difficulty climbing stairs, getting up from a chair, or having sex," adds the rheumatologist.

Diagnostic tests

- Clinical examination

When a patient consults for hip pain, the first examination is clinical of the entire lower extremity.

"It is essential not to limit the clinical examination to the hip because it often happens that hip pathologies cause pain in the knee: this is called projected pain," describes Dr. Lellouche.

The specialist begins by having the patient walk around to make sure that his or her two feet are in line with each other. Then, he invites the patient to lie down in order to mobilize his hip and check the movements in the 3 axes: flexion/extension, adduction/abduction, and internal or external rotation. "We are looking for any snap, pop, or lack of stability in the movement," says the specialist. Any pain or resistance will help guide the diagnosis.

The doctor also checks for the presence of any muscle atrophy that may be the result of osteoarthritis of the hip.

He also looks for signs of sciatica or curalgia, which can cause the same symptoms as hip pathologies.

- Standard X-ray

It is performed in case of suspicion of osteoarthritis. "It allows checking the architecture of the hip and the balance of the pelvis. It is also useful to check the possible presence of calcification deposits around the joint" explains the rheumatologist.

- MRI

It can be proposed in the second intention, to check the quality of the cartilage and the bone.

- CT scan

It can be proposed according to the clinical examination, or as a third option after X-ray and MRI.

"It is particularly interesting when it is associated with an injection of contrast medium, then it is called arthroscanner. It allows seeing all the pathologies inside the joint, such as synovial pathologies, those of the cartilage or of the padding", details Dr. Lellouche.

Treatments

Treatments for coxopathy vary according to the precise diagnosis of the pathology.

- Coxarthrosis

Symptomatic treatment is based on painkillers, and to a lesser extent on anti-inflammatory drugs - which are best avoided as far as possible.

Infiltrations can also be proposed in certain cases, as well as hyaluronic acid or platelet injections.

"But the ultimate treatment for hip osteoarthritis is hip replacement, which has revolutionized the management of osteoarthritis," insists the rheumatologist. More than 160,000 hip replacements are performed each year in France. "They have made it possible to change the way people suffering from osteoarthritis of the hip are viewed: they no longer need a cane to walk, they can resume a normal life and even play sports again," explains Dr. Lellouche.

Hip prostheses can be made in 3D to measure, and the success rate of the operation is close to 98%.

- Tendonitis

"The treatment of hip tendonitis is difficult because it is a tendonitis that tends to be rebellious" explains the rheumatologist. Physiotherapy sessions, physiotherapy - by the shock wave and ultrasound - as well as muscle maintenance are proposed to the patient.

Infiltrations can be performed under ultrasound, known as echo-guided.

"We also recommend drinking a lot of water because dehydration weakens the tendons," says the expert.

- The joint bulge and the synovium

Today, it is no longer necessary to operate openly to treat the pathologies of the joint bulge and the synovium. A minimally invasive surgical technique - called hip arthroscopy - can be used to treat a wide range of balloon and synovial pathologies. "It involves a small camera placed in the hip, which can also be used for diagnostic purposes," says the rheumatologist.

- Osteonecrosis

Osteonecrosis is usually treated surgically.

Several experimental treatments are also underway. Hip replacement is indicated for the most advanced cases.

- Fracture of the neck of the femur

A fracture of the neck of the femur is a very common fracture and is directly related to osteoporosis. It affects nearly 50,000 people each year, with a death rate of 16% within 5 months of the fracture.

"Today, it is the prevention of osteoporosis that is most important, to reduce the risk of fracture" insists Dr. Lellouche. The prosthesis is only rarely offered to elderly people because it is far too expensive, and surgical treatment is done with nails and plates, with a much more difficult recovery.

Sources :

Ameli - Arthrose de la hanche, symptôme et diagnostic

Ameli - Arthrose de la hanche : définition et facteurs favorisants

 Small bowel cancer is rare, representing less than 5% of digestive cancers. Its incidence is estimated at less than 23 cases per million individuals. 

Adenocarcinoma is the most common form of small bowel cancer. This type of cancer forms from the glandular cells of the mucosa of the small intestine. The main symptom of the disease is blood in the stool, sometimes associated with abdominal cramps and vomiting. Diagnosis is based on imaging studies. Surgical removal is the best treatment option.

Definition and symptoms

About the small intestine

The digestive system is composed of several organs whose purpose is to transform ingested food into small molecules that can be assimilated by the body. Thus, the first step is to bring the food to the mouth in order to shred it through chewing and with the help of the teeth. The salivary glands are in charge of producing saliva that will mix with the ingested food and start digestion. It also helps the food to progress towards the esophagus and then the stomach.

Once in the stomach, the food is kneaded and degraded thanks to the gastric juices in order to form a mush: the chyme. Once this is formed, it begins its journey through the intestines.

Diagram showing the anatomy of the upper body - small intestine cancer

First, there is the small intestine, also called the "small intestine", a long, tubular organ that connects the stomach to the large intestine, and in which most digestion takes place. The small intestine makes up three-quarters of the digestive system and is the longest part of the digestive tract. Many of the nutrients that are essential for the body to function properly will enter the bloodstream at this point.

The small intestine is composed of three parts: the duodenum, the jejunum, and the ileum. Food that is partially digested in the stomach enters the duodenum with digestive juices and bile. The food then progresses into the jejunum where further decomposition takes place. The digested food finally passes into the ileum where absorption of nutrients continues.

The remaining contents continue to progress to the large intestine or colon. The remaining fluid and nutrients are absorbed, while the remaining solids are stored in the rectum awaiting expulsion via the anus.

What is small bowel cancer?

Small bowel cancer is a malignant tumor. In fact, the cells of the small intestine can sometimes undergo changes that make their growth and behavior abnormal. This is called a precancerous state. For the small intestine, the most frequent precancerous state is the adenomatous polyp. At this stage, the cells are not yet cancerous, but the risk of them becoming cancerous is significant.

Sometimes the modified cells in the small intestine become cancerous. Cancer in the glandular cells (cells that make up the lining of the small intestine) develops. This is called adenocarcinoma of the small intestine. It is the most common cancer of the small intestine.

However, other cancers can occur in the organ:

• Neuroendocrine tumors that arise in the neuroendocrine cells of the small intestine;
• Lymphoma is when cancer starts in the lymphatic tissue of the small intestine;
• A sarcoma is cancer that starts in the wall of the small intestine.

Small bowel cancer affects men more often than women. Generally, patients are over 50 years old at the time of diagnosis. Nearly 45% of them are 70 years or older.

Several risk factors are mentioned, including certain digestive tract diseases such as Crohn's disease or celiac disease, or hereditary digestive diseases (e.g. familial adenomatous polyposis or FAP). The risk of developing cancer also increases with age.

What are the symptoms?

Small bowel cancer usually develops without symptoms. When symptoms do exist, they are not very specific and another cause is first suspected:

• Pain in the abdomen;
• Nausea;
• Vomiting;
• Weight loss;
• Constipation or diarrhea;
• Bowel bleeding;
• Blood in the stool or black stool;
• Fatigue and feeling weak.

Namely! The presence of these symptoms should lead to medical consultation.

In some cases, small intestine cancer can lead to serious complications such as bowel obstruction or intestinal perforation.

Diagnosis and treatment

How is small bowel cancer diagnosed?

Diagnosis of small bowel cancer: a medical device that goes into the intestine to check the diagnosis of small bowel cancer is based on a variety of medical imaging tests: ultrasound, radiology, and gastroscopy. A gastroscopy is an upper GI endoscopy.

Ultrasound

An ultrasound is a medical examination based on the use of ultrasound emitted by the probe of a device called an ultrasound scanner. Ultrasound is a beam of inaudible sound waves sent by the probe that reflect off the walls of the organs to be analyzed and produce an echo. The images are obtained thanks to the return of this echo. The reflected waves are then converted by a computer into several shades of gray to form the image.

An ultrasound takes an average of 10 to 30 minutes. The examination is painless and harmless (since it does not use X-rays). There is no need for the patient to be hospitalized and no need for anesthesia.

Radiography

An x-ray is a medical imaging test that allows you to see part or all of an area of the body.  This examination requires the use of X-rays because of their ability to penetrate tissues to a greater or lesser extent depending on their density.

The examination itself lasts between 10 and 15 minutes under the supervision of the medical team.

Gastroscopy

A gastroscopy or endoscopy is an examination performed under local or general anesthesia using an endoscope (flexible tube equipped with a camera and a lamp). This instrument can also be used to take a sample (biopsy), remove a tumor or a foreign body or coagulate blood vessels (treatment to stop bleeding).

Please note! Endoscopy is sometimes performed by video capsule. A wireless, battery-powered capsule is swallowed by the patient and allows tumors in the small intestine to be visualized.

What is the treatment?

The first choice of treatment for small bowel cancer is the surgical removal of the tumors. However, the treatment is chosen according to the size and location of the tumor, the age and health of the patient, and the presence of any metastases. It may therefore also include radiotherapy and/or chemotherapy.

In the case of extensive cancer, radiation therapy is often combined with chemotherapy. Chemotherapy is also sometimes used before or after surgery. It should be noted that chemotherapy can be a palliative treatment when the cancer is too advanced.

Charline D., Doctor of Pharmacy