Medicine and Health Sciences Commons^™

Reducing Hypotension In Elective Cesarean Section Patients With Administration Of Ondansetron Prior To Spinal Anesthesia: A Retrospective Chart Analysis, Linsey Erin Phipps

Doctoral Projects

The birth of a child is one of the most memorable moments in a woman’s life, and many women undergo an elective cesarean section, requiring spinal anesthesia. At this time, the patient and the unborn child’s well-being become the anesthetist’s main focus. The ultimate goal of anesthesia providers is to provide the safest care to the patient. Spinal anesthesia has many benefits, but has a common side effect of hypotension, which can also result in nausea. Hypotension, dangerous to mother and child, is often treated with vasopressors, but can also cause nausea, which is treated by the administration of ondansetron. …

Oral Carbohydrate Administration Prior To Colorectal Surgery: Practice Change Outcomes And Economic Analysis, Joshua Kendrick Ezelle

Doctoral Projects

Difference in recovery times has been an interest of mine for many years. I observed that an open heart surgery routinely recovered and discharged on the third post-op day, while a colorectal patient often required a hospital stay of five to ten days. I began researching recovery methods of colorectal patients. I found enhanced recovery techniques like decreased narcotic, use of NSAID’s, early ambulation, and the use of medications that assist with bowel peristalsis are being employed nationally. Other techniques are now starting to be used with positive results. One of these is Carb-loading. Carb-loading is the oral intake of …

Bilateral Moyamoya Disease In A 2-Year-Old Pakistani Male Treated With Bilateral Encephaloduroarteriosynangiosis: A Positive Outcome., Shahvaiz Magsi, Adeel Khoja, Mansoor Ali Merchant Rameez, Ariba Khan, Noman Ishaque

Department of Medicine

Background. We present a rare case of bilateral moyamoya disease presenting as multiple strokes and neurological deficits, treated with the neurosurgical procedure, encephaloduroarteriosynangiosis (EDAS), in a 2-year-old male Pakistani minor. A positive outcome was achieved and the patient recovered fully. Case Summary. Our patient presented with a history of seizures and multiple episodes of hemiparesis (on and off weakness) at the age of 2 years. He had a delayed speech development and could not speak more than a few words. He had a slight slurring of speech too. He was diagnosed with bilateral moyamoya disease on Computed Tomography Angiography (CTA). …

Clinical Manifestations And Outcomes Of Pulmonary Aspergillosis: Experience From Pakistan., Nousheen Iqbal, Muhammad Irfan, Ali Bin Sarwar Zubairi, Kauser Jabeen, Safia Awan, Javaid Khan

Department of Medicine

Introduction: Pulmonary aspergillosis has variable course of illness, severity and outcomes depending on underlying conditions. There is limited data available on the clinical manifestations and outcome of pulmonary aspergillosis from Pakistan.

Methods: To determine the clinical manifestations and outcome of pulmonary aspergillosis in a tertiary care hospital a retrospective study was conducted from 2004 to 2014 in patients admitted with pulmonary aspergillosis at the Aga Khan University Hospital Karachi, Pakistan.

Results: Of the 280 cases with provisional diagnosis of aspergillosis 69 met the inclusion criteria. The mean age was 45±15.7 years, 48 (69.6%) were men and 21 (30.4%) had diabetes …

Quality Of Life After Stroke In Pakistan, Wardah Khalid, Shafquat Rozi, Tazeen S. Ali, Iqbal Azam Syed, Michael Mullen, Saleem Illyas, Qamarunnisa, Nabila Soomro, Ayeesha Kamran Kamal

Department of Medicine

Background: There is very little information about the quality of life (QOL) of stroke survivors in LMIC countries with underdeveloped non communicable health infrastructures, who bear two thirds of the global stroke burden.

Methodology: We used a sequential mix methods approach. First, a quantitative analytical cross-sectional study was conducted on 700 participants, who constituted 350 stroke survivor and their caregiver dyads. QOL of stroke survivor was assessed via Stroke Specific Quality of Life Scale (SSQOLS) whereas QOL of caregivers was assessed through RAND-36. In addition; we assessed complications, psychosocial and functional disability of stroke survivors. Following this quantitative survey, …

Spectrum Of Acute Flaccid Paralysis In Children, Shaila Ali, M. Zia Ur Rehman, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

Acute flaccid paralysis (AFP) is a clinical syndrome characterized by rapid onset of weakness in a child aged less than 15 years due to any cause when polio is suspected(1). Exact cause of AFP with its incidence is needed for proper management.

Brief Report On 16th International Neurology Update And Joint Phs, Pss & Mdsp Conference, Abdul Malik

Pakistan Journal of Neurological Sciences (PJNS)

Keeping up to date with new developments in medicine is a real challenge. But it's a challenge all neurologists must take if they are to do justice to their patients and aim for superior clinical expertise. Although neurology specialty is in growing stage & by the Grace of Almighty in last decade neurology bodies showed remarkable development to strengthen and continuing the training & development for the undergraduates, graduates & postgraduates in Pakistan. This year it was also unique precedence that in Karachi, national neurology body jointly organized four days conference with three sub-specialties national organizations.

Antenatal Renal Pelvic Dilatation And Foetal Outcomes - Review Of Cases From A Tertiary Care Center In Karachi, Pakistan, Ruqiya Afroz, Shafia Shakoor, Muhammad Sohail Salat, Shama Munim

Woman and Child Health

Objective: To determine the incidence of antenatal renal pelvic dilatation to evaluate antenatal resolution/ progression and post-natal outcome.
Methods: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of all women found with renal pelvic dilatation in antenatal scans between January 2011 and December 2013. A cut-off of 5mm was used to diagnose renal pelvic dilatation. Renal pelvic dilatation was categorised into three groups: mild (5-6mm in second trimester and 5-9mm in third trimester), moderate (7-10mm in second trimester and 10-15 in third) and severe (more than 10mm in second trimester and more than …

Farm Work Injuries Among A Cohort Of Children In Kentucky, Usa, Steven R. Browning, Susan C. Westneat, Deborah B. Reed

Epidemiology and Environmental Health Faculty Publications

Children residing on farms with livestock may be at an increased risk for work-related injuries, compared to children who work on other commodity farms. This study characterizes children's work tasks on Kentucky farms and assesses whether children who work on beef cattle farms are at an increased risk for farm work injuries. The results of a cohort study of children aged 5-18 years (N=999 at baseline) working on family farms in Kentucky, followed for two consecutive years after an initial enumeration five years previously, found that 70% of the children were involved in animal-related chores. Across all age groups, children …

Predicting Malignant Nodules From Screening Ct Scans, Samuel Hawkins, Hua Wang, Ying Liu, Alberto Garcia, Olya Stringfield, Henry Krewer, Qiang Li, Dmitry Cherezov, Matthew Schabath, Lawrence O. Hall, Robert J. Gillies

Computer Science and Engineering Faculty Publications

Objectives

The aim of this study was to determine whether quantitative analyses (“radiomics”) of low-dose computed tomography lung cancer screening images at baseline can predict subsequent emergence of cancer.

Methods

Public data from the National Lung Screening Trial (ACRIN 6684) were assembled into two cohorts of 104 and 92 patients with screen-detected lung cancer and then matched with cohorts of 208 and 196 screening subjects with benign pulmonary nodules. Image features were extracted from each nodule and used to predict the subsequent emergence of cancer.

Results

The best models used 23 stable features in a random forests classifier and could …

Creativity And The Golden Years: Biopsychosocial And Cultural Influences For Living A Successful Life, Karen V. Duhamel

Health Sciences Faculty Publications

Living successfully into older adulthood is becoming the new social norm. As one ages, the older adult may experience doubt and insecurity about one’s ongoing purpose in life, leading to feelings of failure and stagnation. The purpose of this paper is to explore the role of creativity as a requisite to living a successful life into older adulthood. By examining creativity from a variety of perspectives, social scientists and healthcare professionals can better understand the importance of empowering older adults to tap into their inner resources to promote creative expression leading to self-transformation and personal satisfaction. This paper will discuss …

Visual Impairment And Factors Associated With Difficulties With Daily Tasks, Anne T. Riddering

Dissertations

In the past 10 years, the number of American adults with visual impairments has increased from 1 million to 4 million and is expected to double to 8 million people by the year 2050 (The Eye Diseases Prevalence Research Group, 2004; National Eye Institute, 2013). Therapies to treat retinal diseases causing visual impairment, such as diabetic retinopathy and age-related macular degeneration (Massof, 2002; Mogk, 2011), have evolved in the past two decades (Gupta et al., 2013; Hooper & Guymer, 2003), but little research has examined recent population and difficulties with performing daily activities. Different types of professionals, including ophthalmologists, optometrists, …

Factors Affecting Community Participation In Young Adults With Intellectual And Developmental Disabilities, Molly Bathje

Dissertations

Young adults with intellectual and developmental disabilities (IDD) participate less frequently in communities than other disabled and non-disabled peers (Verdonschot, de Witte, Reichrath, Buntinx, & Curfs, 2009) even though they express a desire to participate (Kampert & Goreczny, 2007) and federal policy mandates community inclusion (Haertl, 2014). Participation in one’s community is linked to health and quality of life (World Health Organization, 2002). The broad goal of this three paper dissertation is to contribute to a deeper understanding of what facilitates and impedes community participation for young adults with IDD by (1) developing a new conceptual model, (2) evaluating a …

Chikungunya Virus Infection In Balb/C And Icr Mouse Models, Sonthaya Tiawsirisup, Ranida Tuanudom, Nichapat Yurayart

The Thai Journal of Veterinary Medicine

Chikungunya virus (CHIKV) infection is an emerging or re-emerging infectious disease found in several countries. The ecology of this virus involves humans, reservoir animals, and mosquito vectors. Two experiments were conducted in this study. Blood samples were collected and tested for CHIKV infection by using immunocytochemistry (ICC) staining and reverse transcription polymerase chain reaction (RT-PCR). For the first experiment, BALB/c mice were inoculated with 106.3 CID50/mouse. Mean CHIKV titers in the BALB/c mice were 103.3, 101.5, 102.3, and 102.3 CID50/ml of serum on day 1 to day 4 post inoculation (PI), respectively. For the second experiment, there were two groups …

Coexisting Cardiac And Hematologic Disorders., Jordan E. Goldhammer, Benjamin A. Kohl

Department of Anesthesiology Faculty Papers

Patients with concomitant cardiac and hematologic disorders presenting for noncardiac surgery are challenging. Anemic patients with cardiac disease should be approached in a methodical fashion. Transfusion triggers and target should be based on underlying symptomatology. The approach to anticoagulation management in patients with artificial heart valves, cardiac devices, or severe heart failure in the operative setting must encompass a complete understanding of the rationale of a patient's therapy as well as calculate the risk of changing this regimen. This article focuses common disorders and discusses strategies to optimize care in patients with coexisting cardiac and hematologic disease.

Perceptual Variations In Thermoregulation During Exercise In A Hot Environment, William C. Alger

Electronic Theses and Dissertations

ABSTRACT

Professionals are seeking to find ways to prevent exertional heat illness (EHI) in populations working in hot environments as well as populations that are physically active. The purpose of the present study was to evaluate individuals’ ability to accurately perceive core temperature ranges associated with homeothermic and EHI temperatures during exercise. Ten physically active males exercised on a treadmill at a self-selected rate until core temperature reached 39°C. Participants rated perceived core and skin temperature on 100 mm scales each time core temperature increased 0.25˚ C (37.5-39.0˚ C), along with thermal comfort and sweating sensation. During exercise core temperature …

Principles Of Incorporating Spirituality Into Professional Clinical Practice, Thomas G. Plante

Psychology

Incorporating spirituality into contemporary professional clinical practice has become more common in recent years most notably with the popular interest of mindfulness meditation, mindfulness based stress reduction, and yoga in particular. However, many other spiritual and religiously based assessment and treatment approaches have also been successfully utilized with a great deal of evidence-based research to support their use and effectiveness. The purpose of this brief article is to outline several guiding principles for those professionals interested in integrating spiritual and religious wisdom and approaches into their professional clinical practices in the spirit of diversity and multiculturalism sensitivity and respect. Psychology …

Vitamin D Supplementation To Prevent Acute Respiratory Tract Infections: Systematic Review And Meta-Analysis Of Individual Participant Data, Adrian R. Martineau, David A. Jolliffe, Richard L. Hooper, Lauren Greenberg, John F. Aloia, Peter Bergman, Gal Dubnov-Raz, Susanna Esposito, Davaasambuu Ganmaa, Adit A. Ginde, Emma C. Goodall, Cameron C. Grant, Christopher J. Griffiths, Wim Janssens, Ilkka Laaksi, Semira Manaseki-Holland, David Mauger, David R. Murdoch, Rachel Neale, Judy R. Rees

Dartmouth Scholarship

OBJECTIVES To assess the overall effect of vitamin D supplementation on risk of acute respiratory tract infection, and to identify factors modifying this effect. DESIGN Systematic review and meta-analysis of individual participant data (IPD) from randomised controlled trials. DATA SOURCES Medline, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, ClinicalTrials.gov, and the International Standard Randomised Controlled Trials Number registry from inception to December 2015. ELIGIBILITY CRITERIA FOR STUDY SELECTION Randomised, double blind, placebo controlled trials of supplementation with vitamin D3 or vitamin D2 of any duration were eligible for inclusion if they had been approved by a …

Labrad : Vol 42, Issue 3 - December 2016, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Provocative Testing for Growth Hormone Disorders
• Serum Procalcitonin for Early Sepsis Diagnosis
• Monoclonal Gammopathy of Undetermined Significance (MGUS)
• Understanding Six Sigma Methodology
• Blood Collection for Culture
• Molecular Analysis of Alpha Thalassaemia by Multiple Ligation Probe Assay
• Prognostification of Acute Myeloid Leukemia with FLT 3 Mutation
• Interferon Gamma Release Assay (IGRA) for Detection of Mycobacterium Tuberculosis Infection in the Host
• An Analysis of Needle Stick Injury in the Department of Radiology

Pharmacy Newsletter : December 2016, Pharmacy Department

Department of Pharmacy Archives

Content:

• Defined Daily Dose (DDD) – A step toward Antibiotic Stewardship Program
• Potential drug-drug interaction of Macrolide and Domperidone | QT prolongation
• 17th December, 1st National Medication Safety Symposium

Fructose Alters Cell Survival And Gene Expression In Microglia And Neuronal Cells Lines, Drew P. Seidel, Susan Denapoli, Thomas S. Maciulewicz, Melinda E. Lull

Pharmacy Faculty/Staff Publications

Purpose: Microglia are macrophages that are found primarily in the CNS and play a crucial role in maintaining a healthy brain by engulfing invading microorganisms, releasing inflammatory mediators, and pruning dead cells. Microglia can become activated in response to certain stimuli which causes them to transition into a pro-inflammatory state, and can sometimes become chronically activated which can result in neuronal damage. Studies have shown a causal relationship between this activation and sugars such as fructose and glucose. We sought to understand the role of sugars in microglial activation and the subsequent effects on neuron health.

Methods: Rat microglia (HAPI) …

Today - November / December 2016, Loma Linda University Health

TODAY

Inside this issue:

-- LLU Children's Hospital to open pediatric specialty clinic in Indio
-- Wil Alexander remembered: A trailblazer in whole person care
-- Surgical Hospital earns prestigious national award for excellence
-- School of Medicine receives top national ranking for graduates entering family medicine residencies
-- Community event focuses on healing
-- ‘San Bernardino Strong’ kicks off third season of ‘Life on the Line’
-- Allied Health students learn true meaning of service-learning
-- Law enforcement visits campus for a good cause
-- A heartfelt return to Loma Linda Former
-- Regional economist says Loma Linda University Health …

The Humoral Theory Of Transplantation: Epitope Analysis And The Pathogenicity Of Hla Antibodies., Edward J Filippone, John Farber

Department of Medicine Faculty Papers

Central to the humoral theory of transplantation is production of antibodies by the recipient against mismatched HLA antigens in the donor organ. Not all mismatches result in antibody production, however, and not all antibodies are pathogenic. Serologic HLA matching has been the standard for solid organ allocation algorithms in current use. Antibodies do not recognize whole HLA molecules but rather polymorphic residues on the surface, called epitopes, which may be shared by multiple serologic HLA antigens. Data are accumulating that epitope analysis may be a better way to determine organ compatibility as well as the potential immunogenicity of given HLA …

Prevalence And Predictors Of E-Cigarette Trial Among Adolescents In Argentina, Paola Morello, Adriana Perez, Lorena Peña, Paula Lozano, Jim Thrasher, James Sargent, Raul Mejia

Faculty Publications

Introduction: Over the last few years, the increasing use of electronic cigarettes has become a new public health problem. Since 2011, Argentina has had a complete ban on marketing and sale of e-cigarettes. However, e-cigarettes are marketed online and can be easily bought in stores. We conducted a longitudinal study to evaluate the determinants of e-cigarette trial among Argentinean early adolescents.

Methods: A school-based longitudinal study was conducted in 2014-15, in 3 large cities in Argentina. Among students who reported never smoking an e-cigarette at baseline, we assessed demographics, media use, sensation seeking, smoking behavior, network member smoking, use of …

Real Talk: Developing A Computer-Delivered Sexual Health Program For Black Men Who Have Sex With Men, Charles H. Klein, Carmela Lomonaco

Anthropology Faculty Publications and Presentations

HIV disproportionately affects Black men who have sex with men (MSM), yet there are few evidence-based programs that respond to the diverse realities of Black MSM communities. This article examines the development of Real Talk, a new harm reduction-based, sexual health intervention for Black MSM. We first analyze the key themes from our formative research: (1) stigma, discrimination, and intersectionalities in the lives of Black MSM, (2) the importance of safe spaces and community provided by health promotion programs, and (3) moving beyond condoms in sexual health messaging. We then describe our agile design product development process and present an …

The Effect Of Frequency Resolution On Intelligibility Sentence And Its Relevance To Cochlear Implant Design, Seth H. Roy

School of Computing: Dissertations, Theses, and Student Research

The purpose of this study is to understand how electrical stimulation (as opposed to acoustical stimulation) of the auditory nerve is used in cochlear implants. Speech is a complex signal that changes rapidly in time and frequency domains. Since phonemes (the smallest unit of speech that distinguishes words) depend on nuanced differences in frequency patterns, it would be expected that a signal with drastically reduced frequency information would be of limited value for conveying speech. Such a frequency-poor signal is the object to be investigated in the present work. It is also the basis of the way speech is represented …

Professional Product Review Vol. 11 No. 3, American Dental Association, Council On Scientific Affairs

Professional Product Review

A user-friendly newsletter from the ADA Council on Scientific Affairs offering scientifically sound, unbiased, and clinically relevant information to member dentists about professional dental products tested by the ADA. This collection is historical and may not reflect current standards. For up-to-date information contact the ADA.

Susceptibility Of Anopheles Gambiae To Insecticides Used For Malaria Vector Control In Rwanda, Emmanuel Hakizimana, Corine Karema, Dunia Munyakanage, Gad Iranzi, John Githure, Jon Eric Tongren, Willem Takken, Agnes Binagwaho, Constantianus J.M. Koenraadt

Dartmouth Scholarship

Background:

The widespread emergence of resistance to pyrethroids is a major threat to the gains made in malaria control. To monitor the presence and possible emergence of resistance against a variety of insecticides used for malaria control in Rwanda, nationwide insecticide resistance surveys were conducted in 2011 and 2013.

Methods:

Larvae of Anopheles gambiae sensu lato mosquitoes were collected in 12 sentinel sites throughout Rwanda. These were reared to adults and analysed for knock-down and mortality using WHO insecticide test papers with standard diagnostic doses of the recommended insecticides. A sub-sample of tested specimens was analysed for the presence of …

The Stethoscoop, December 2016, Mennonite College Of Nursing

The Stethoscoop

The Stethoscoop is the newsletter for Mennonite College of Nursing students.

Volumetry Of Low-Contrast Liver Lesions With Ct: Investigation Of Estimation Uncertainties In A Phantom Study, Qin Li, Yongguang Liang, Qiao Huang, Min Zong, Benjamin Berman, Marios A. Gavrielides, Lawrence H. Schwartz, Binsheng Zhao, Nicholas Petrick

United States Food and Drug Administration: Publications

Purpose: To evaluate the performance of lesion volumetry in hepatic CT as a function of various imaging acquisition parameters.

Methods: An anthropomorphic abdominal phantom with removable liver inserts was designed for this study. Two liver inserts, each containing 19 synthetic lesions with varying diameter (6–40 mm), shape, contrast (10–65 HU), and both homogenous and mixed-density were designed to have background and lesion CT values corresponding to arterial and portal-venous phase imaging, respectively. The two phantoms were scanned using two commercial CT scanners (GE 750 HD and Siemens Biograph mCT) across a set of imaging protocols (four slice thicknesses, …