Biomedical subjects

C A Churgay

Publications and source records attributed to C A Churgay.

7 recordsLinked to original sources

PubMed1996

The diagnosis and management of bacterial pneumonias in infants and children.

The majority of pediatric pneumonias are viral in origin, but a bacterial source always must be considered in the differential diagnosis because antibiotic administration may be crucial to the patient's management. There is no gold standard for differentiating between pediatric bacterial and viral pneumonias, but signs and symptoms from the clinical presentation, laboratory tests, and appearance of the chest radiograph can be used to help make the distinction. The most important factors governing which antibiotics to choose when treating a child with bacterial pneumonia are the child's age and whether any underlying illnesses are present. Surgical intervention may be needed in addition to antibiotic therapy if complications develop.

Anti-Bacterial Agents↗

PubMed1996

A curriculum for teaching family practice residents how to manage skin lesions.

BACKGROUND AND OBJECTIVES: A curriculum was developed to teach family practice residents how to manage skin lesions as part of an outpatient rotation during which family practice residents are taught procedures by family medicine faculty. The curriculum can be used as a template for teaching and assessing competency for any family practice outpatient procedure. METHODS: The curriculum was pilot tested by eight second-year family practice residents and evaluated by experts in curriculum design and the methods for teaching outpatient procedural skills. Procedure checklists were used to evaluate competency. RESULTS: The residents scored higher on their posttests than on their pretests. The residents, implementing faculty, and outside reviewers rated the curriculum design highly. Performance of procedures did not require longer times when accomplished through this educational experience. CONCLUSIONS: This curriculum can be used to teach family practice residents how to manage skin lesions. Residents were deemed competent to perform a procedure if they successfully followed all of the steps on the procedure checklist. A specific minimum number of procedures was not required to establish competency.

Clinical Competence↗

PubMed1993

Spontaneous abortion.

Spontaneous abortion rates vary with maternal age, but the overall incidence is approximately 2% of clinically recognized pregnancies. The incidence of clinically unrecognized loss is approximately 20%. Most early fetal losses are caused by abnormal karyotypes. Other causes include heavy caffeine use, acute alcohol consumption, and smoking. Ultrasonographic examination, which includes yolk sac configuration and crown-rump length determination can help differentiate between normal and abnormal pregnancies. After 8 weeks' gestation, hormonal assays are decreased. Conservative management of spontaneous abortions can be considered if patients have low beta-hCG levels and no residual tissue detected using ultrasonography. Complications of spontaneous abortion include maternal death, bleeding, and infection. Consideration should be given to the psychological health of women and their partners who experience spontaneous abortion, particularly if they exhibit depression, guilt, and grief reactions.

Abortion, Spontaneous↗

PubMed1993

Ectopic pregnancy. An update on technologic advances in diagnosis and treatment.

From 1970 to 1986, the number of ectopic pregnancies in the United States quadrupled. Maternal mortality rates dramatically declined, yet the risk of dying from an ectopic pregnancy is still 10 times that associated with a term delivery and 50 times that associated with a legal elective abortion. Ectopic pregnancy can be a very difficult diagnosis to make, but advances in hCG assays and transvaginal ultrasound scanning allow the diagnosis to be made in 90% of cases before rupture. Conservative surgical and medical management are associated with success rates greater than 95% and resultant pregnancy rates of approximately 60%.

Female↗

PubMed1993

Diagnosis and treatment of pediatric foot deformities.

In children, the lower extremities have extremely wide variations of normal, including calcaneovalgus foot, metatarsus adductus and flatfoot. The first two conditions often resolve or improve spontaneously over time and may be considered abnormal if they persist into adulthood. Serial casting, splints and surgery are rarely necessary. Corrective shoes, orthotic inserts and some forms of splinting have not proved to be effective. The primary care physician must establish an early and correct diagnosis, perform a general screening examination to rule out accompanying musculoskeletal deformities, assess the conditions that may become disabling and require treatment, and reassure parents and family members when observation with close follow-up is the most appropriate course of action.

Child↗

PubMed1992

Diagnosis and treatment of congenital dislocation of the hip.

Up to 10 percent of infants in the United States are born with congenital dislocation of the hip. The disorder is readily diagnosed using the Ortolani and Barlow maneuvers. If congenital hip dislocation is recognized and treated within the first six to 12 months of life, affected joints develop normally in the vast majority of infants. Prolonged dislocation makes it difficult to return the femoral head to the acetabulum and is associated with a higher incidence of osteoarthritis and poor hip function in adulthood. Infants diagnosed with congenital hip dislocation before six months of age may be managed with a simple positioning device or a Pavlik harness. Older children may require traction, casting or surgery. Radiographs, ultrasound scanning, hip arthrography, computed tomography and magnetic resonance imaging can be helpful in making the diagnosis. Avascular necrosis of the femoral head is the most serious complication of treatment. Family physicians can play a major role in reducing the morbidity associated with improper treatment.

Child↗

PubMedDate not supplied

Maternal fever during labor--what does it mean?

BACKGROUND: Several studies have shown maternal fever to be associated with chorioamnionitis and neonatal sepsis if at least two of the following five criteria are also present: maternal tachycardia, purulent or foul-smelling amniotic fluid, fetal tachycardia, uterine tenderness, or maternal leukocytosis. Less is known about the risk of neonatal sepsis when the presence of maternal fever in labor is the only criterion. METHODS: A retrospective medical record review searching for women who had a fever greater than 100.4 degrees F while in the active phase of labor during a 1-year period at the University of Michigan was undertaken to investigate the relation between isolated maternal fever in labor and neonatal sepsis. Eighty-two cases of maternal fever were found. RESULTS: Forty-six women met the clinical criteria for chorioamnionitis, and 6 of the 7 neonates with sepsis diagnosed were born to these mothers. There were no significant differences found in admission or intrapartum factors between women who did and did not meet clinical criteria for chorioamnionitis, and there was no association between these factors and neonatal sepsis. Epidural anesthesia was administered to 91 percent of these women and might be associated with maternal fever during labor. Using maternal clinical criteria for chorioamnionitis and a neonatal band cell-total neutrophil ratio of 0.2 or greater instead of the current system to determine the need for newborn antibiotic administration would improve the positive predictive value (12.5 percent versus 9.3 percent) and specificity (34.6 percent versus 16 percent) without compromising sensitivity (100 percent). All septic and probably septic newborns would be treated, and neonatal antibiotic administration would be reduced by 17 percent. CONCLUSIONS: The addition of the maternal clinical criteria for chorioamnionitis to the criteria already used for diagnosing and treating neonatal sepsis could prove useful in decisions regarding the selective administration of intrapartum antibiotics and prediction of risk of neonatal sepsis.

Adolescent↗