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Septic Abortion
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
After obtaining a thorough history from the patient to assess her possible risk factors, patients should have an appropriate physical examination, including assessment of vital signs. Pelvic infections that ascend to the uterus can further disseminate, leading to bacteremia and subsequent systemic inflammation that causes sepsis [9]. If left untreated, this can lead to sepsis and ultimately septic shock, a life-threatening condition associated with hypotension (systolic blood pressure <90 mm Hg or a reduction of 40 mm Hg from baseline) despite adequate fluid resuscitation, perfusion abnormalities, and multiorgan dysfunction. These abnormalities can quickly lead to lactic acidosis, oliguria, obtundation, and death [9]. Medical providers caring for these women should pay special attention to the patient's vital signs because, for example, a patient who presents with fever with associated hypotension and tachycardia and a history of a recent induced abortion should alert the medical provider that this patient is likely experiencing a septic abortion and requires immediate attention, both medically and surgically, to quickly remove and treat the underlying source of the infection to prevent further sequelae. Table 10.2 illustrates the pertinent laboratory findings associated with severe forms of septic abortions.
Clinical Record: Oncological Screening
Published in Paloma Tejero, Hernán Pinto, Aesthetic Treatments for the Oncology Patient, 2020
In 2003, the Council of the European Union (EU) established a series of recommendations about breast cancer screening, including the carrying out of screening mammograms in patients from 50 years of age every 2 years, according to the European Guidelines for Quality Assurance in Mammography Screening. In Spain, most autonomous communities perform screenings in women aged between 50 and 69 years, although some communities have reduced the age of onset to 45 years [16] and perform screenings once a year. Furthermore, a monthly physical self-examination has been recommended for women over 50 years, and a physical examination every 3 years for women aged 20–50 years, and once a year for women over 50 years.
Gastrointestinal Aspects of Eating Disorders
Published in Kevin W. Olden, Handbook of Functional Gastrointestinal Disorders, 2020
Bruce D. Waldholtz, Arnold E. Andersen
The physical examination is of great importance in detecting the frequently occurring physical consequences of starvation, vomiting, medication abuse, or overexercise and in searching for coexisting independent disease. In the presence of anxiety, depression, and other comorbid psychiatric problems, it is important to make clear to the patient the contribution to care of a general physical examination and to have a same-gender attendant present to reassure the patient and to protect the physician. Generally vaginal examination will be deferred in non-sexually-active women. Rectal exam is performed as needed, with awareness of psychological reactions to examination.
Autoimmune disorders associated with common variable immunodeficiency: prediction, diagnosis, and treatment
Published in Expert Review of Clinical Immunology, 2022
Niloufar Yazdanpanah, Nima Rezaei
Some Mycoplasma and Ureaplasma species are recognized as the most common cause of septic arthritis in CVID [187]. Anti-nuclear antibody (ANA) could be ordered when a rheumatologic disorder is suspected. Meanwhile, disease-specific autoantibodies could also be ordered; for instance, anti-CCP for RA and anti-dsDNA, anti-Sm, and anti-ribosomal P antibodies for SLE. Nevertheless, in the context of CVID, antibody testing could be misleading; antibody testing in CVID patients could be negative due to intrinsic antibody production defects, while also the laboratory results could be inconclusive in patients who are receiving immunoglobulin replacement therapy. Hence, careful physical examination, imaging evaluations, and biopsy studies (in some cases) could help in differentiating conditions. Precise physical examination by an expert rheumatologist is strongly recommended in patient’s follow-up.
Is the benefit of using adjuvant capecitabine in patients with residual triple-negative breast cancer related to pathological response to neoadjuvant chemotherapy?
Published in Expert Review of Anticancer Therapy, 2022
Özgecan Dülgar, Başak Bala Öven, Muhammed Mustafa Atcı, Rukiye Arıkan, Seval Ay, Murat Ayhan, Oğuzhan Selvi, Deniz Tataroglu Ozyukseler, Ertuğrul Bayram, Erkan Özcan, Ayşe İrem Yasin, Mahmut Gümüş
We collected data from eight cancer centers. Patients with pCR were excluded in 218 patients with TNBC. 160 consecutive patients with treated NAC who had residual tumor were included. All patients had histologically confirmed triple negative breast cancer and residual disease, whose data were collected from medical records retrospectively. Patients who received NAC and achieved pCR were excluded and hormone receptor positive tumors were also excluded. The histopathological characteristics of the patients as patients age, histologic type, menopausal status, clinical stage at diagnosis, nodal stage, Ki 67, histologic grade, surgery type, median residual tumor size, tumor lymphocyte infiltration (TIL), and completion of doses of adjuvant capecitabine were collected from the patients’ file. History and physical examination were performed every 3 months for 2 years, and every 6 months after that until 5 years, then annually for follow-up.
Review of Ebola virus disease in children – how far have we come?
Published in Paediatrics and International Child Health, 2021
Devika Dixit, Kasereka Masumbuko Claude, Lindsey Kjaldgaard, Michael T. Hawkes
The WHO evidence-based guidelines focused on several key principles in the management of EVD patients including paediatric patients. As with any critically ill patient, it is crucial to conduct a systematic assessment and re-assessment of all EVD patients including vital signs and volume status [71]. The key components of physical examination include regular monitoring of vital signs, i.e. respiratory rate, oxygenation saturation, temperature, heart rate and blood pressure. Monitoring gastro-intestinal fluid loss and urine output are also important in assessing the hydration status of children. A prospective cohort demonstrated that assessment of respiration, skin pinch (turgor), presence of tears and mental status were important in the assessment of hypovolaemia [70,72]. In the author's (MH) experience, fluid management of children in the Butembo ETC was particularly challenging. Accurate monitoring of ‘ins and outs’ was not possible and general practitioners often lacked familiarity with weight-based intravenous (IV) fluid requirements for children.