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96-603: In 1799, The Boston Board of Health was established to combat any potential cholera outbreaks. Paul Revere was Boston's first health commissioner. In 1864 the Boston City Hospital opened, managed by the board. The Boston Public Health Act of 1995 caused the organization of the current commission. In 1996, the modern Boston Public Health Commission opened after the Boston City Hospital (founded 1864) and Boston University Hospital (founded 1855) were merged into

192-505: A medical history , a (brief or complete) physical examination and sometimes laboratory tests. Some more advanced tests include ultrasound and mammography. If done for a group of people the routine physical is a form of screening , as the aim of the examination is to detect early signs of diseases to prevent them. Although annual medical examinations are a routine practice in several countries, examinations performed on an asymptomatic patient are poorly supported by scientific evidence in

288-457: A reservoir of infection, and seafood shipped long distances can spread the disease. Physical examination In a physical examination , medical examination , clinical examination , or medical checkup , a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition . It generally consists of a series of questions about the patient's medical history followed by an examination based on

384-496: A stool test , or a rapid dipstick test , although the dipstick test is less accurate. Prevention methods against cholera include improved sanitation and access to clean water . Cholera vaccines that are given by mouth provide reasonable protection for about six months, and confer the added benefit of protecting against another type of diarrhea caused by E. coli . In 2017, the US Food and Drug Administration (FDA) approved

480-436: A temperate bacteriophage called CTXφ . Microbiologists have studied the genetic mechanisms by which the V. cholerae bacteria turn off the production of some proteins and turn on the production of other proteins as they respond to the series of chemical environments they encounter, passing through the stomach, through the mucous layer of the small intestine, and on to the intestinal wall. Of particular interest have been

576-442: A Henry L. Shattuck Public Service Award because Ivey "led the way in helping Boston confront the unprecedented opioid epidemic presenting itself locally." Cholera Cholera ( / ˈ k ɒ l ər ə / ) is an infection of the small intestine by some strains of the bacterium Vibrio cholerae . Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea lasting

672-497: A baseline assessment to identify normal versus abnormal findings. These are reported to the primary care provider. If necessary, the patient may be sent to a medical specialist for further, more detailed examinations. The term is generally not meant to include visits for the purpose of newborn checks, Pap smears for cervical cancer , or regular visits for people with certain chronic medical disorders (for example, diabetes ). The general medical examination generally involves

768-575: A blood pressure or cholesterol, are inconclusive. A recent study found that the examination is associated with increased participation in cancer screening. Some employers require a mandatory health checkup before hiring a candidate, even though it is now well known that some of the components of the prophylactic annual visit may actually cause harm. For example, lab tests and exams that are performed on healthy patients (as opposed to people with symptoms or known illnesses) are statistically more likely to be "false positives"—that is, when test results suggest

864-405: A few days. Vomiting and muscle cramps may also occur. Diarrhea can be so severe that it leads within hours to severe dehydration and electrolyte imbalance . This may result in sunken eyes , cold skin, decreased skin elasticity, and wrinkling of the hands and feet. Dehydration can cause the skin to turn bluish . Symptoms start two hours to five days after exposure. Cholera is caused by

960-439: A fishy odor. An untreated person with cholera may produce 10 to 20 litres (3 to 5 US gal) of diarrhea a day. Severe cholera, without treatment, kills about half of affected individuals. If the severe diarrhea is not treated, it can result in life-threatening dehydration and electrolyte imbalances. Estimates of the ratio of asymptomatic to symptomatic infections have ranged from 3 to 100. Cholera has been nicknamed

1056-422: A followup after screening. The lack of good evidence contrasts with population surveys showing that the general public is fond of these examinations, especially when they are free of charge. Despite guidelines recommending against routine annual examinations, many family physicians perform them. A fee-for-service healthcare system has been suggested to promote this practice. An alternative would be to tailor

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1152-728: A frequency adapted to age and previous examination results ( risk factors ). The specialist American Cancer Society recommends a cancer-related health check-up annually in men and women older than 40, and every three years for those older than 20. A systematic review of studies until September 2006 concluded that the examination does result in better delivery of some other screening interventions (such as Pap smears, cholesterol screening, and faecal occult blood tests ) and less patient worry. Evidence supports several of these individual screening interventions. The effects of annual check-ups on overall costs, patient disability and mortality , disease detection, and intermediate end points such

1248-428: A greatly reduced pathogen count—though it will not necessarily be perfectly safe, it is an improvement for poor people with limited options. In Bangladesh this practice was found to decrease rates of cholera by nearly half. It involves folding a sari four to eight times. Between uses the cloth should be rinsed in clean water and dried in the sun to kill any bacteria on it. A nylon cloth appears to work as well but

1344-413: A higher rate than those who were not. Its authors noted that studies often failed to consider or report possible harmful outcomes (such as unwarranted anxiety or unnecessary follow-up procedures), and concluded that routine health checks were "unlikely to be beneficial" in regards to lowering cardiovascular and cancer morbidity and mortality. Physical examination has been described as a ritual that plays

1440-527: A massive inoculation program in British India . Persons who survive an episode of cholera have long-lasting immunity for at least 3 years (the period tested.) A number of safe and effective oral vaccines for cholera are available. The World Health Organization (WHO) has three prequalified oral cholera vaccines (OCVs): Dukoral, Sanchol, and Euvichol. Dukoral , an orally administered, inactivated whole-cell vaccine , has an overall efficacy of about 52% during

1536-535: A non-toxic B-subunit of cholera toxin and providing protection against V. cholerae O1; and two vaccines developed using the same transfer of technology—ShanChol (Shantha Biotec) and Euvichol (EuBiologics Co.), which have bivalent O1 and O139 oral killed cholera vaccines. Oral cholera vaccination could be deployed in a diverse range of situations from cholera-endemic areas and locations of humanitarian crises, but no clear consensus exists. Developed for use in Bangladesh ,

1632-465: A number of types of Vibrio cholerae , with some types producing more severe disease than others. It is spread mostly by unsafe water and unsafe food that has been contaminated with human feces containing the bacteria. Undercooked shellfish is a common source. Humans are the only known host for the bacteria . Risk factors for the disease include poor sanitation , insufficient clean drinking water , and poverty . Cholera can be diagnosed by

1728-408: A one-million fold increase in numbers of V. cholerae in the environment. The source of the contamination is typically other people with cholera when their untreated diarrheal discharge is allowed to get into waterways, groundwater or drinking water supplies. Drinking any contaminated water and eating any foods washed in the water, as well as shellfish living in the affected waterway , can cause

1824-430: A person to contract an infection. Cholera is rarely spread directly from person to person . V. cholerae also exists outside the human body in natural water sources, either by itself or through interacting with phytoplankton , zooplankton , or biotic and abiotic detritus. Drinking such water can also result in the disease, even without prior contamination through fecal matter. Selective pressures exist however in

1920-439: A physical examination is performed when a patient visits complaining of flu-like symptoms. These diagnostic examinations usually focus on the patient's chief complaint. General health checks, including physical examinations performed when the patient reported no health concerns, often include medical screening for common conditions, such as high blood pressure . A Cochrane review found that general health checks did not reduce

2016-488: A problem that does not exist. Disadvantages cited include the time and money that could be saved by targeted screening ( health economics argument), increased anxiety over health risks ( medicalisation ), overdiagnosis , wrong diagnosis (for example athletic heart syndrome misdiagnosed as hypertrophic cardiomyopathy ) and harm, or even death, resulting from unnecessary testing to detect or confirm, often non-existent, medical problems or while performing routine procedures as

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2112-530: A result of transmission by food, while in developing countries it is more often water. Food transmission can occur when people harvest seafood such as oysters in waters infected with sewage , as Vibrio cholerae accumulates in planktonic crustaceans and the oysters eat the zooplankton . People infected with cholera often have diarrhea, and disease transmission may occur if this highly liquid stool, colloquially referred to as "rice-water", contaminates water used by others. A single diarrheal event can cause

2208-421: A severe case if they become infected. Any individual, even a healthy adult in middle age, can undergo a severe case, and each person's case should be measured by the loss of fluids, preferably in consultation with a professional health care provider . The cystic fibrosis genetic mutation known as delta-F508 in humans has been said to maintain a selective heterozygous advantage : heterozygous carriers of

2304-410: A significant role in the doctor-patient relationship that will provide benefits in other medical encounters. When a physical exam is expected by the patient but is not performed by the provider, patients may express concern for the lack of depth of investigation into their illness, the validity of treatment plans and exclusions, and the doctor-patient relationship. By extension, the term "health check"

2400-742: A single-dose, live, oral cholera vaccine called Vaxchora for adults aged 18–64 who are travelling to an area of active cholera transmission. It offers limited protection to young children. People who survive an episode of cholera have long-lasting immunity for at least three years (the period tested). The primary treatment for affected individuals is oral rehydration salts (ORS), the replacement of fluids and electrolytes by using slightly sweet and salty solutions. Rice-based solutions are preferred. In children, zinc supplementation has also been found to improve outcomes. In severe cases, intravenous fluids , such as Ringer's lactate , may be required, and antibiotics may be beneficial. The choice of antibiotic

2496-428: A specialist will focus on their particular field and the nature of the problem described by the patient. Hence a cardiologist will not in routine practice undertake neurological parts of the examination other than noting that the patient is able to use all four limbs on entering the consultation room and during the consultation become aware of their hearing, eyesight, and speech. Likewise an orthopaedic surgeon will examine

2592-518: A specific Weber test and Rinne test , or it may be more briefly addressed in a cranial nerve exam. To give another example, a neurological related complaint might be evaluated with a specific test, such as the Romberg maneuver . The Old Testament makes provision for persons in the Israelite community with leprosy to be examined by a priest : if the presenting sore was white and appeared to go beyond

2688-442: A year (uncertainty range: 21,000–143,000) as of 2015 . This occurs mainly in the developing world. In the early 1980s, death rates are believed to have still been higher than three million a year. It is difficult to calculate exact numbers of cases, as many go unreported due to concerns that an outbreak may have a negative impact on the tourism of a country. As of 2004, cholera remained both epidemic and endemic in many areas of

2784-596: Is endemic . If people are immunized broadly, herd immunity results, with a decrease in the amount of contamination in the environment. WHO recommends that oral cholera vaccination be considered in areas where the disease is endemic (with seasonal peaks), as part of the response to outbreaks, or in a humanitarian crisis during which the risk of cholera is high. Oral Cholera Vaccine (OCV) has been recognized as an adjunct tool for prevention and control of cholera. The World Health Organization (WHO) has prequalified three bivalent cholera vaccines—Dukoral (SBL Vaccines), containing

2880-645: Is a needle exchange run by the Boston Public Health Commission . AHOPE primarily serves homeless people with physical and mental health conditions. AHOPE's programming initially operated out of an outreach van that distributed sterile syringes to people who use drugs around Boston . It was launched in 1994. In 2013, the program opened a location in the South End and saw a 300% increase in people accessing services. In 2014, AHOPE distributed 150,000 clean needles to intravenous drug users , to prevent

2976-422: Is a common problem. Stool and swab samples collected in the acute stage of the disease, before antibiotics have been administered, are the most useful specimens for laboratory diagnosis. If an epidemic of cholera is suspected, the most common causative agent is V. cholerae O1. If V. cholerae serogroup O1 is not isolated, the laboratory should test for V. cholerae O139. However, if neither of these organisms

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3072-495: Is a physical examination performed on an asymptomatic patient for medical screening purposes. These are normally performed by a pediatrician , family practice physician, a physical therapist , physician assistant , a certified nurse practitioner or other primary care provider . This routine physical exam usually includes the HEENT evaluation . Nursing professionals such as Registered Nurse , Licensed Practical Nurses can develop

3168-698: Is a thorough assessment designed to evaluate an individual's overall health. So, it helps to identify any potential health risks early on. Pre-employment examinations are screening tests which judge the suitability of a worker for hire based on the results of their physical examination. This is also called pre-employment medical clearance . Some employers believe that by only hiring workers whose physical examination results pass certain exclusionary criteria, their employees collectively will have fewer absences due to sickness, fewer workplace injuries, and less occupational disease . A small amount of low-quality evidence in medical research supports this idea. Furthermore,

3264-559: Is aided by antibiotic sensitivity testing . Cholera continues to affect an estimated 3–5 million people worldwide and causes 28,800–130,000 deaths a year. To date, seven cholera pandemics have occurred, with the most recent beginning in 1961, and continuing today. The illness is rare in high-income countries , and affects children most severely. Cholera occurs as both outbreaks and chronically in certain areas . Areas with an ongoing risk of disease include Africa and Southeast Asia . The risk of death among those affected

3360-425: Is also used for routing checks on the working of equipment or business operations or solvency . A physical examination may include checking vital signs , including temperature examination , blood pressure , pulse , and respiratory rate . The healthcare provider uses the senses of sight, hearing, touch, and sometimes smell (e.g., in infection, uremia , diabetic ketoacidosis ). Taste has been made redundant by

3456-442: Is available to determine the presence of V. cholerae . In those samples that test positive, further testing should be done to determine antibiotic resistance. In epidemic situations, a clinical diagnosis may be made by taking a patient history and doing a brief examination. Treatment via hydration and over-the-counter hydration solutions can be started without or before confirmation by laboratory analysis, especially where cholera

3552-446: Is effective for adults aged 18–64 as a single dose. One injectable vaccine was found to be effective for two to three years. The protective efficacy was 28% lower in children less than five years old. However, as of 2010 , it has limited availability. Work is under way to investigate the role of mass vaccination. The WHO recommends immunization of high-risk groups, such as children and people with HIV , in countries where this disease

3648-416: Is increasing within cholera bacteria. In Bangladesh , for example, most cases are resistant to tetracycline , trimethoprim-sulfamethoxazole , and erythromycin . Rapid diagnostic assay methods are available for the identification of multi-drug resistant cases. New generation antimicrobials have been discovered which are effective against cholera bacteria in in vitro studies. A rapid dipstick test

3744-480: Is isolated, it is necessary to send stool specimens to a reference laboratory. Infection with V. cholerae O139 should be reported and handled in the same manner as that caused by V. cholerae O1. The associated diarrheal illness should be referred to as cholera and must be reported in the United States. The World Health Organization (WHO) recommends focusing on prevention, preparedness, and response to combat

3840-460: Is less in those with lowered gastric acidity (for instance those using proton pump inhibitors ). Children are also more susceptible, with two- to four-year-olds having the highest rates of infection. Individuals' susceptibility to cholera is also affected by their blood type , with those with type O blood being the most susceptible. Persons with lowered immunity , such as persons with AIDS or malnourished children, are more likely to develop

3936-754: Is maintained. The WHO only recommends antibiotics in those with severe dehydration. Doxycycline is typically used first line, although some strains of V. cholerae have shown resistance . Testing for resistance during an outbreak can help determine appropriate future choices. Other antibiotics proven to be effective include cotrimoxazole , erythromycin , tetracycline , chloramphenicol , and furazolidone . Fluoroquinolones , such as ciprofloxacin , also may be used, but resistance has been reported. Antibiotics improve outcomes in those who are both severely and not severely dehydrated. Azithromycin and tetracycline may work better than doxycycline or ciprofloxacin . In Bangladesh zinc supplementation reduced

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4032-469: Is not as affordable. Continued eating speeds the recovery of normal intestinal function. The WHO recommends this generally for cases of diarrhea no matter what the underlying cause. A CDC training manual specifically for cholera states: "Continue to breastfeed your baby if the baby has watery diarrhea, even when traveling to get treatment. Adults and older children should continue to eat frequently." The most common error in caring for patients with cholera

4128-442: Is rapid and thready, and urine output decreases with time. Muscle cramping and weakness, altered consciousness, seizures , or even coma due to electrolyte imbalances are common, especially in children. Cholera bacteria have been found in shellfish and plankton . Transmission is usually through the fecal-oral route of contaminated food or water caused by poor sanitation . Most cholera cases in developed countries are

4224-406: Is rare. For example, the last major outbreak of cholera in the United States occurred in 1910–1911. Cholera is mainly a risk in developing countries in those areas where access to WASH (water, sanitation and hygiene) infrastructure is still inadequate. Effective sanitation practices, if instituted and adhered to in time, are usually sufficient to stop an epidemic. There are several points along

4320-575: Is the preferred solution, often with added potassium. Large volumes and continued replacement until diarrhea has subsided may be needed. Ten percent of a person's body weight in fluid may need to be given in the first two to four hours. This method was first tried on a mass scale during the Bangladesh Liberation War , and was found to have much success. Despite widespread beliefs, fruit juices and commercial fizzy drinks like cola are not ideal for rehydration of people with serious infections of

4416-404: Is to underestimate the speed and volume of fluids required. In most cases, cholera can be successfully treated with oral rehydration therapy (ORT), which is highly effective, safe, and simple to administer. Rice-based solutions are preferred to glucose-based ones due to greater efficiency. In severe cases with significant dehydration, intravenous rehydration may be necessary. Ringer's lactate

4512-543: Is usually less than 5%, given improved treatment, but may be as high as 50% without such access to treatment. Descriptions of cholera are found as early as the 5th century BC in Sanskrit . In Europe, cholera was a term initially used to describe any kind of gastroenteritis, and was not used for this disease until the early 19th century. The study of cholera in England by John Snow between 1849 and 1854 led to significant advances in

4608-697: The Boston Medical Center . This was the first full merger in the United States of a public hospital with a private academic medical center and its hospital. In 2008, the BPHC banned the sale of " blunt wraps ," tobacco-leaf papers that are used to make marijuana cigarettes , in Boston. In April 2009 a Massachusetts judge upheld the ban. Access, Harm Reduction, Overdose Prevention and Education, commonly referred to as AHOPE Boston or AHOPE Needle Exchange, and formerly called Addicts Health Opportunity Prevention Education,

4704-446: The Gs alpha subunit of the heterotrimeric G protein . This results in constitutive cAMP production, which in turn leads to the secretion of water, sodium, potassium, and bicarbonate into the lumen of the small intestine and rapid dehydration. The gene encoding the cholera toxin was introduced into V. cholerae by horizontal gene transfer . Virulent strains of V. cholerae carry a variant of

4800-406: The human stomach . The few surviving bacteria conserve their energy and stored nutrients during the passage through the stomach by shutting down protein production. When the surviving bacteria exit the stomach and reach the small intestine , they must propel themselves through the thick mucus that lines the small intestine to reach the intestinal walls where they can attach and thrive. Once

4896-750: The obituaries of people who died as a result of drug overdose . An individual interviewed in WBUR story credited AHOPE for saving his life. AHOPE advocates for the government to legalize supervised injection sites in Massachusetts . AHOPE works closely with the Boston Public Health Commission program, Providing Access to Addictions Treatment, Hope and Support (PAATHS), to help people with substance use disorders access treatment . This collaboration gives drug users who distrust medical providers an alternative way to ask for treatment. Access, Harm Reduction, Overdose Prevention and Education assisted Boston Healthcare for

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4992-479: The potassium level may be normal, even though large losses have occurred. As the dehydration is corrected, potassium levels may decrease rapidly, and thus need to be replaced. This is best done by Oral Rehydration Solution (ORS). Antibiotic treatments for one to three days shorten the course of the disease and reduce the severity of the symptoms. Use of antibiotics also reduces fluid requirements. People will recover without them, however, if sufficient hydration

5088-531: The transmission of HIV and hepatitis C . In 2018, according to Boston 25 News , AHOPE "distributed about 18,100 Narcan kits, receiving more than 23,000 reports of overdose reversals as a result." In 2020, despite the risks of transmission at the start of the COVID-19 pandemic , AHOPE continued to provide services to drug users, out of fear that stopping them would cause a major outbreak of HIV. In 2022, according to WGBH , AHOPE "collected nearly three times

5184-515: The "blue death" because a person's skin may turn bluish-gray from extreme loss of fluids. Fever is rare and should raise suspicion for secondary infection. Patients can be lethargic and might have sunken eyes, dry mouth, cold clammy skin, or wrinkled hands and feet. Kussmaul breathing , a deep and labored breathing pattern, can occur because of acidosis from stool bicarbonate losses and lactic acidosis associated with poor perfusion . Blood pressure drops due to dehydration, peripheral pulse

5280-411: The "sari filter" is a simple and cost-effective appropriate technology method for reducing the contamination of drinking water. Used sari cloth is preferable but other types of used cloth can be used with some effect, though the effectiveness will vary significantly. Used cloth is more effective than new cloth, as the repeated washing reduces the space between the fibers. Water collected in this way has

5376-463: The 19th century, the history and physical examination were nearly the only diagnostic tools the physician had, which explains why tactile skill and ingenious appreciation in the exam were so highly valued in the definition of what made for a good physician. Even as late as 1890, the world had no radiography or fluoroscopy , only early and limited forms of electrophysiologic testing, and no molecular biology as we know it today. Ever since this peak of

5472-568: The Homeless Program (BHCHP) in their creation of a medical observation and stabilization space for intoxicated patients. Outreach workers from AHOPE work with doctors from BHCHP on the outreach Care Zone van, funded by the Kraft Center for Community Health at Massachusetts General Hospital , to provide patients with food, wound care , physical examinations , and opioid agonist therapy . The Care Zone van works in areas of Boston that report

5568-401: The affected joint, but may only briefly check the heart sounds and chest to ensure that there is not likely to be any contraindication to surgery raised by the anaesthetist . A primary care physician will also generally examine the male genitals but may leave the examination of the female genitalia to a gynecologist . With the clues obtained during the history and physical examination

5664-476: The amount of syringes" that it distributed over a period of eight months. The program offers informational handouts, support groups , HIV testing, and individual counseling. It uses high tech drug testing services to identify the presence of xylazine , fentanyl , and other substances in street drugs . Every Thanksgiving , AHOPE hosts a dinner "for individuals struggling with homelessness and addiction " around Mass and Cass . AHOPE's offices are decorated with

5760-474: The aquatic environment that may reduce the virulence of V. cholerae . Specifically, animal models indicate that the transcriptional profile of the pathogen changes as it prepares to enter an aquatic environment. This transcriptional change results in a loss of ability of V. cholerae to be cultured on standard media, a phenotype referred to as ' viable but non-culturable ' (VBNC) or more conservatively ' active but non-culturable ' (ABNC). One study indicates that

5856-479: The availability of modern lab tests. Four actions are taught as the basis of physical examination: inspection , palpation (feel), percussion (tap to determine resonance characteristics), and auscultation (listen). Although providers have varying approaches as to the sequence of body parts, a systematic examination generally starts at the head and finishes at the extremities and includes evaluation of general patient appearance and specific organ systems. After

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5952-422: The cholera bacteria reach the intestinal wall, they no longer need the flagella to move. The bacteria stop producing the protein flagellin to conserve energy and nutrients by changing the mix of proteins that they express in response to the changed chemical surroundings. On reaching the intestinal wall, V. cholerae start producing the toxic proteins that give the infected person a watery diarrhea. This carries

6048-612: The cholera transmission path at which its spread may be halted: Handwashing with soap or ash after using a toilet and before handling food or eating is also recommended for cholera prevention by WHO Africa. Surveillance and prompt reporting allow for containing cholera epidemics rapidly. Cholera exists as a seasonal disease in many endemic countries, occurring annually mostly during rainy seasons . Surveillance systems can provide early alerts to outbreaks, therefore leading to coordinated response and assist in preparation of preparedness plans. Efficient surveillance systems can also improve

6144-478: The cost of staff health insurance will be lower. However, certain exams or tests that are requested by employers, such as a baseline low back x-ray, should not be performed, according to the American College of Occupational and Environmental Medicine. Reasons for this include the legality and medical necessity of the test as well as the inability of such testing to predict future problems, the radiation exposure to

6240-424: The culturability of V. cholerae drops 90% within 24 hours of entering the water, and furthermore that this loss in culturability is associated with a loss in virulence. Both toxic and non-toxic strains exist. Non-toxic strains can acquire toxicity through a temperate bacteriophage . About 100   million bacteria must typically be ingested to cause cholera in a normal healthy adult. This dose, however,

6336-448: The depth of the skin, it was to be treated as a ritually defiling condition. A further examination was to take place seven days later. The medical history and physical examination were supremely important to diagnosis before advanced health technology was developed, and even today, despite advances in medical imaging and molecular medical tests , the history and physical remain indispensable steps in evaluating any patient. Before

6432-433: The duration and severity of diarrhea in children with cholera when given with antibiotics and rehydration therapy as needed. It reduced the length of disease by eight hours and the amount of diarrhea stool by 10%. Supplementation appears to be also effective in both treating and preventing infectious diarrhea due to other causes among children in the developing world. If people with cholera are treated quickly and properly,

6528-604: The examination, whereas this practice has been subject to controversy in the age of evidence-based medicine . Several studies have been performed before current evidence-based recommendation for screening were formulated, limiting the applicability of these studies to current-day practice. Comprehensive physical exams , also known as executive physicals , typically include laboratory tests, chest x-rays, pulmonary function testing, audiograms, full body CAT scanning , EKGs , heart stress tests, vascular age tests, urinalysis, and mammograms or prostate exams depending on gender. It

6624-443: The field of epidemiology because of his insights about transmission via contaminated water, and a map of the same was the first recorded incidence of epidemiological tracking. The primary symptoms of cholera are profuse diarrhea and vomiting of clear fluid. These symptoms usually start suddenly, half a day to five days after ingestion of the bacteria. The diarrhea is frequently described as "rice water" in nature and may have

6720-485: The first to immunize humans against a bacterial disease. His vaccine and inoculation was rather controversial and was rejected by his peers and several investigation commissions but it ended up demonstrating its effectiveness and being recognized for it: out of the 30 thousand people he vaccinated only 54 died. Russian-Jewish bacteriologist Waldemar Haffkine also developed a human cholera vaccine in July 1892. He conducted

6816-475: The first year after being given and 62% in the second year, with minimal side effects. It is available in over 60 countries. However, it is not currently recommended by the Centers for Disease Control and Prevention (CDC) for most people traveling from the United States to endemic countries. The vaccine that the US Food and Drug Administration (FDA) recommends, Vaxchora , is an oral attenuated live vaccine , that

6912-420: The genetic mechanisms by which cholera bacteria turn on the protein production of the toxins that interact with host cell mechanisms to pump chloride ions into the small intestine, creating an ionic pressure which prevents sodium ions from entering the cell. The chloride and sodium ions create a salt-water environment in the small intestines, which through osmosis can pull up to six liters of water per day through

7008-457: The genetic structure. Two clusters have been identified: Cluster I and Cluster II. For the most part, Cluster I consists of strains from the 1960s and 1970s, while Cluster II largely contains strains from the 1980s and 1990s, based on the change in the clone structure. This grouping of strains is best seen in the strains from the African continent. In many areas of the world, antibiotic resistance

7104-402: The healthcare provider can now formulate a differential diagnosis , a list of potential causes of the symptoms. Specific diagnostic tests (or occasionally empirical therapy ) generally confirm the cause, or shed light on other, previously overlooked, causes. The physical exam is then recorded in the medical record in a standard layout which facilitates billing and other providers later reading

7200-512: The highest amount of overdose. EurekAlert! wrote, "By the end of 2019, the program's 24-foot mobile medical unit had recorded 9,098 contacts with people living with addiction in areas identified as overdose hot spots in and around Boston, distributing 96,600 syringes and 2,956 naloxone kits to rapidly reverse opioid overdose." In 2018, the Boston Municipal Research Bureau honored Leroy Ivey, AHOPE's outreach coordinator, with

7296-435: The importance of the physical examination, reviewers have warned that clinical practice and medical education need to remain vigilant in appreciating the continuing need for physical examination and effectively teaching the skills to perform it; this call is ongoing, as the 21st-century literature shows. People may request modesty in medical settings when the health care provider examines them. In many Western societies,

7392-463: The intestinal cells, creating the massive amounts of diarrhea. The host can become rapidly dehydrated unless treated properly. By inserting separate, successive sections of V. cholerae DNA into the DNA of other bacteria, such as E. coli that would not naturally produce the protein toxins, researchers have investigated the mechanisms by which V. cholerae responds to the changing chemical environments of

7488-400: The intestines, and their excessive sugar content may even harm water uptake. If commercially produced oral rehydration solutions are too expensive or difficult to obtain, solutions can be made. One such recipe calls for 1 liter of boiled water, 1/2 teaspoon of salt, 6 teaspoons of sugar, and added mashed banana for potassium and to improve taste. As there frequently is initially acidosis ,

7584-412: The main organ systems have been investigated by inspection , palpation , percussion , and auscultation , specific tests may follow (such as a neurological investigation, orthopedic examination) or specific tests when a particular disease is suspected (e.g. eliciting Trousseau's sign in hypocalcemia ). While the format of examination as listed below is largely as taught and expected of students,

7680-496: The majority of the population. A Cochrane Collaboration meta-study found that routine annual physicals did not measurably reduce the risk of illness or death, and conversely, could lead to overdiagnosis and over-treatment; however, this article does not conclude that being in regular communication with a doctor is not important, simply that an actual physical examination may not be necessary. Some notable general health organisations recommend against annual examinations, and propose

7776-497: The mortality rate is less than 1%; however, with untreated cholera, the mortality rate rises to 50–60%. For certain genetic strains of cholera, such as the one present during the 2010 epidemic in Haiti and the 2004 outbreak in India, death can occur within two hours of becoming ill. Cholera affects an estimated 2.8 million people worldwide, and causes approximately 95,000 deaths

7872-448: The multiplying new generations of V. cholerae bacteria out into the drinking water of the next host if proper sanitation measures are not in place. The cholera toxin (CTX or CT) is an oligomeric complex made up of six protein subunits : a single copy of the A subunit (part A), and five copies of the B subunit (part B), connected by a disulfide bond . The five B subunits form a five-membered ring that binds to GM1 gangliosides on

7968-400: The mutation (who are not affected by cystic fibrosis) are more resistant to V. cholerae infections. In this model, the genetic deficiency in the cystic fibrosis transmembrane conductance regulator channel proteins interferes with bacteria binding to the intestinal epithelium , thus reducing the effects of an infection. When consumed, most bacteria do not survive the acidic conditions of

8064-493: The notes. While elective physical exams have become more elaborate, in routine use physical exams have become less complete. This has led to editorials in medical journals about the importance of an adequate physical examination. Physicians at Stanford University medical school have introduced a set of 25 key physical examination skills that were felt to be useful. Depending upon the chief complaint , additional sections may be included. For example, hearing may be evaluated with

8160-409: The periodic medical examination are not entirely clear. They have been referenced as early as 1671. They have also been advocated for since the 1920s. Some authors point to pleads from the 19th and early 20th century for the early detection of diseases like tuberculosis , and periodic school health examinations. The advent of medical insurance and related commercial influences seems to have promoted

8256-446: The reported symptoms. Together, the medical history and the physical examination help to determine a diagnosis and devise the treatment plan. These data then become part of the medical record . The routine physical , also known as general medical examination , periodic health evaluation , annual physical , comprehensive medical exam , general health check , preventive health examination , medical check-up , or simply medical ,

8352-399: The risk assessment for potential cholera outbreaks. Understanding the seasonality and location of outbreaks provides guidance for improving cholera control activities for the most vulnerable. For prevention to be effective, it is important that cases be reported to national health authorities. Spanish physician Jaume Ferran i Clua developed the first successful cholera inoculation in 1885,

8448-428: The risk of death from cancer , heart disease , or any other cause, and could not be proved to affect the patient's likelihood of being admitted to the hospital, becoming disabled, missing work, or needing additional office visits. The study found no effect on the risk of illness, but did find evidence suggesting that patients subject to routine physicals were diagnosed with hypertension and other chronic conditions at

8544-422: The screening interval to the age, sex, medical conditions and risk factors of each patient. This means choosing between a wide variety of tests. The routine physical is commonly performed in the United States and Japan, whereas the practice varies among South East Asia and mainland European countries. In Japan it is required by law for regular working employees to have a health check once a year. The roots of

8640-406: The spread of cholera. They also stress the importance of an effective surveillance system. Governments can play a role in all of these areas. Although cholera may be life-threatening, prevention of the disease is normally straightforward if proper sanitation practices are followed. In developed countries , due to their nearly universal advanced water treatment and sanitation practices, cholera

8736-632: The stomach, mucous layers, and intestinal wall. Researchers have discovered a complex cascade of regulatory proteins controls expression of V. cholerae virulence determinants. In responding to the chemical environment at the intestinal wall, the V. cholerae bacteria produce the TcpP/TcpH proteins, which, together with the ToxR/ToxS proteins, activate the expression of the ToxT regulatory protein. ToxT then directly activates expression of virulence genes that produce

8832-607: The surface of the intestinal epithelium cells. The A1 portion of the A subunit is an enzyme that ADP-ribosylates G proteins , while the A2 chain fits into the central pore of the B subunit ring. Upon binding, the complex is taken into the cell via receptor-mediated endocytosis . Once inside the cell, the disulfide bond is reduced, and the A1 subunit is freed to bind with a human partner protein called ADP-ribosylation factor 6 (Arf6). Binding exposes its active site, allowing it to permanently ribosylate

8928-410: The toxins, causing diarrhea in the infected person and allowing the bacteria to colonize the intestine. Current research aims at discovering "the signal that makes the cholera bacteria stop swimming and start to colonize (that is, adhere to the cells of) the small intestine." Amplified fragment length polymorphism fingerprinting of the pandemic isolates of V. cholerae has revealed variation in

9024-463: The worker, and the cost of the exam. A physical examination may be provided under health insurance cover, required of new insurance customers. This is a part of insurance medicine . In the United States, physicals are also marketed to patients as a one-stop health review, avoiding the inconvenience of attending multiple appointments with different healthcare providers. Physical examinations are performed in most healthcare encounters. For example,

9120-451: The world. Recent major outbreaks are the 2010s Haiti cholera outbreak and the 2016–2022 Yemen cholera outbreak . In October 2016, an outbreak of cholera began in war-ravaged Yemen . WHO called it "the worst cholera outbreak in the world". In 2019, 93% of the reported 923,037 cholera cases were from Yemen (with 1911 deaths reported). Between September 2019 and September 2020, a global total of over 450,000 cases and over 900 deaths

9216-629: Was reported; however, the accuracy of these numbers suffer from over-reporting from countries that report suspected cases (and not laboratory confirmed cases), as well as under-reporting from countries that do not report official cases (such as Bangladesh, India and Philippines). Although much is known about the mechanisms behind the spread of cholera, researchers still do not have a full understanding of what makes cholera outbreaks happen in some places and not others. Lack of treatment of human feces and lack of treatment of drinking water greatly facilitate its spread. Bodies of water have been found to serve as

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