Medicine and Health Sciences Commons^™

Evaluation Of Diazepam Nasal Spray In Patients With Epilepsy Concomitantly Using Maintenance Benzodiazepines: An Interim Subgroup Analysis From A Phase 3, Long-Term, Open-Label Safety Study., Eric B Segal, Daniel Tarquinio, Ian Miller, James W Wheless, Dennis Dlugos, Victor Biton, Gregory D Cascino, Jay Desai, R Edward Hogan, Kore Liow, Michael R Sperling, Blanca Vazquez, David F Cook, Adrian L Rabinowicz, Enrique Carrazana

Department of Neurology Faculty Papers

OBJECTIVE: Diazepam nasal spray (Valtoco), indicated for acute treatment of frequent seizure activity (seizure clusters) in patients with epilepsy ≥6 years of age, is designed to be a rapid, noninvasive, socially acceptable route of administration. This interim analysis evaluated the safety profile of diazepam nasal spray in patients with and without concomitant use of benzodiazepines, with use of a second dose for a seizure cluster as a proxy for effectiveness.

METHODS: A long-term, phase 3, open-label safety study enrolled patients with epilepsy who had seizures despite a stable antiseizure medication regimen.

RESULTS: Among 175 patients enrolled by October 31, 2019, …

Using Biofeedback To Reduce Spatiotemporal Asymmetry Impairs Dynamic Balance In People Post-Stroke, Sungwoo Park, Chang Liu, Natalia Sánchez, Julie K. Tilson, Sara J. Mulroy, James M. Finley

Physical Therapy Faculty Articles and Research

Background. People poststroke often walk with a spatiotemporally asymmetric gait, due in part to sensorimotor impairments in the paretic lower extremity. Although reducing asymmetry is a common objective of rehabilitation, the effects of improving symmetry on balance are yet to be determined. Objective. We established the concurrent validity of whole-body angular momentum as a measure of balance, and we determined if reducing step length asymmetry would improve balance by decreasing whole-body angular momentum. Methods. We performed clinical balance assessments and measured wholebody angular momentum during walking using a full-body marker set in a sample of 36 people with …

Commencement Program 2021 (School Of Public Health), Loma Linda University

Commencement Programs

CONTENTS

1 | Message from the President

2 | 2021 Events of Commencement

4 | University Administration

5 | Significance of Academic Regalia

6 | University History Highlights

8 | Criteria for Institutional Awards

10 | Loma Linda University Health and Loma Linda University Honorees

23 | The Program, The School Honorees, and The Speaker

25 | Candidates for Degrees

Antibiotic Tolerance And Heteroresistance: Associated Fitness Costs And Potential In Evading Antibiotic Killing, Tina H. Dao

Theses and Dissertations (ETD)

Streptococcus pneumoniae is a prominent human pathogen that causes both invasive and non-invasive diseases, such as otitis media, pneumonia, meningitis, and bacteremia. Although it is frequently an asymptomatic colonizer of the human nasopharynx, S. pneumoniae is a major cause of morbidity and mortality in the immune compromised population, young children, and the elderly. Up until the 1970s, S. pneumoniae was susceptible to almost all antibiotics. Since then, this pathogen has gained resistance to a variety of antibiotic treatments, including beta-lactams, macrolides, and fluoroquinolones.

In the first chapter, we focused on fluoroquinolone resistance in S. pneumoniae. Fluoroquinolones are one of the …

Feasibility And Acceptability Of Using Mobile Health Apps In Underserved Patients With Diabetes, Jieyu Luo

Theses and Dissertations (ETD)

Introduction. Diabetes mellitus is a condition with a growing morbidity and mortality burden. An estimated 30 million adults currently live with diabetes, with each individual spending over $9500 annually on medical care. The successful management of diabetes is a lifelong endeavor. This involves balancing a variety of factors including diet, medications, and glucose monitoring. It has been well established that successful control of diabetes depends largely upon patients’ daily lifestyle habits and activities. Not all patients, however, have the resources necessary for effective diabetes management. Health disparities lead to a higher rate of diabetes development in minority and poor populations. …

Exposure Characterization And Assessment Of Airborne Chemicals And Sars-Cov-2 Transmission In New York City Nail Salons, Amelia P. H. Watkins

Dissertations and Theses

Background: Currently, there are 156,000 people employed as manicurists or pedicurists in the United States. Employment in this sector is expected to grow by 10% over the next decade. Exposure assessments have revealed that salon workers are chronically exposed to a variety of substances that cause respiratory sensitization, developmental problems, contact dermatitis, blood, liver, and kidney issues, as well as nervous system impacts. Most recently, the SARS-Cov-2 pandemic has raised the issue of the vulnerability of nail salon workers to airborne infectious diseases as well. This dissertation aims to characterize and assess the chemical exposures that nail salon workers …

The Association Of Symptoms Of Overactive Bladder With Pelvic Organ Prolapse And Its Improvement After Pelvic Reconstructive Surgery, Saida Abrar, Raheela Mohsin Rizvi, Nida Zahid

Department of Obstetrics & Gynaecology

Objectives: This study asseses the association of overactive bladder symptoms and pelvic organ prolapse severity and evaluates the effect of pelvic reconstructive surgery on overactive bladder (OAB) symptoms in women with pelvic organ prolapse (POP). It also looks into any pre and post-operative factors responsible for persistent postoperative OAB symptoms.
Methods: This was a retrospective cross-sectional study conducted at the Aga Khan University Hospital, Karachi between 1st January 2014 and 31st December 2018. In this study women presenting with POP and concommitent OAB who underwent surgery for site specific defects, measured using Pelvic Organ Prolapse Quantification (POP-Q) staging system. OAB …

Retinal Regeneration In A Genetic Mouse Model Of Glaucoma, Joshua Paris

Masters Theses

Glaucoma is a degenerative retinal disease characterized by progressive loss of retinal ganglion cells (RGCs). Previous studies have shown that application of a specific α7 nicotinic acetylcholine receptor agonist, PNU-282987 (PNU), onto the murine retina induces neurogenesis of numerous retinal cell types, including RGCs. The aim of this study is to characterize the short-term and long-term effects of PNU in a glaucoma model. The effects of PNU were analyzed in a DBA/2J mouse model that auto-induces a glaucoma-like condition in adulthood. These mice manifest an elevated intraocular pressure (IOP) starting at 6 months, followed by loss of RGCs. To assess …

Intraoperative Uses Of Near-Infrared Fluorescence Spectroscopy In Pediatric Surgery: A Systematic Review, Heba Alghoul, Farah Al Farajat, Osaid Alser, Andrea Rogers-Snyr, Carroll Harmon, Nathan Novotny

Conference Presentation Abstracts

No abstract provided.

Esophageal Magnamosis For The Treatment Of Type-B Esophageal Atresia In A Child With Prohibitive Operative Risk: A Novel Device And Indication., Irving J. Zamora, Muhammad Oa Ghani, Lauren L. Evans, Nathan M. Novotny, Lyndy J. Wilcox, Harold N. Lovvorn, Kristina A. Betters, Mohammad Sahlabadi, Matthew R. Lucas, Jeffrey S. Upperman, Oliver J. Muensterer, Michael R. Harrison

Conference Presentation Abstracts

No abstract provided.

Identifying Risk Factors Of Upper Extremity Injuries In Collegiate Baseball Players: A Pilot Study, Robert Slowik, Christopher Morris, Matthew C. Hoch, Timothy L. Uhl

Physical Therapy Faculty Publications

Background
Repetitive pitching places tremendous forces on the shoulder and elbow which can lead to upper extremity (UE) or lower extremity (LE) overuse injuries.

Purpose
The purpose of this study was to evaluate pre-season physical measurements in collegiate baseball players and track in-season baseball throwing volume to determine which factors may predict throwing overuse injuries.

Study Design
Retrospective Cohort study.

Methods
Baseline preseason mobility, strength, endurance, and perception of function were measured in 17 collegiate baseball pitchers. Participants were then followed during the course of the season to collect rate of individual exposure, estimated pitch volume, and rating of perceived …

Inequalities In Early Marriage, Childbearing And Sexual Debut Among Adolescents In Sub-Saharan Africa, Dessalegn Y. Melesse, Réka M. Cane, Aveneni Mangombe, Macellina Y. Ijadunola, Adom Manu, Eniola Bamgboye, Abdu Mohiddin, Rornald M. Kananura, Elsie Akwara, Elsabé Du Plessis

Obstetrics and Gynaecology, East Africa

Background: Adolescent sexual and reproductive health (ASRH) is a major public health concern in sub-Saharan Africa (SSA). However, inequalities in ASRH have received less attention than many other public health priority areas, in part due to limited data. In this study, we examine inequalities in key ASRH indicators.

Methods: We analyzed national household surveys from 37 countries in SSA, conducted during 1990–2018, to exam- ine trends and inequalities in adolescent behaviors related to early marriage, childbearing and sexual debut among adolescents using data from respondents 15–24 years. Survival analyses were conducted on each survey to obtain estimates for …

Intimate Partner Violence Against Adolescents And Young Women In Sub-Saharan Africa: Who Is Most Vulnerable?, Yohannes Dibaba Wado, Martin K. Mutua, Abdu Mohiddin, Macellina Y. Ijadunola, Cheikh Faye, Carolina V. N. Coll, Aluisio J. D. Barros, Caroline W. Kabiru

Obstetrics and Gynaecology, East Africa

Background: Intimate partner violence (IPV) is a global public health and human rights issue that affects millions of women and girls. While disaggregated national statistics are crucial to assess inequalities, little evidence exists on inequalities in exposure to violence against adolescents and young women (AYW). The aim of this study was to deter- mine inequalities in physical or sexual IPV against AYW and beliefs about gender based violence (GBV) in sub-Saharan Africa (SSA).

Methods: We used data from the most recent Demographic and Health Surveys (DHS) conducted in 27 countries in SSA. Only data from surveys conducted after …

Patients’ Perceptions And Understanding Of Pre-Operative Informed Consent In Tertiary Care Setting- Dar-Es-Salaam, Steven Michael Esanju

Master of Medicine in General Surgery

Background: Informed consent under the ethical principle of autonomy demonstrates patient’s agreement to have procedure/intervention done to them. Considering its importance in safeguarding human rights and autonomy, it is now mandatory to take informed consent before any surgery/procedure. Many studies have questioned whether informed consent is being taken in tr ue spirit that ensures proper understanding of the disclosed information or it is just adhered to as a medico legal formality. Globally, studies have demonstrated that majority of patients do not fully understand even small matters regarding their health i ncluding diagnosis, treatment modalities and possible associated risks, because of …

Assessing Hiv Risk, Syndemics, Resilience And Engagement In Care In A Large National Cohort Of Gay, Bisexual And Other Men Who Have Sex With Men In The United States, Javier Lopez-Rios

Dissertations and Theses

Background: HIV continues to be a pervasive public health issue in the United States with more than 1.2 million people living with HIV (PLWHIV) across the nation. Gay, bisexual and other men who have sex with men (GBM) account for over two-thirds of all new HIV diagnoses with racial and ethnic minorities shouldering a large proportion of the burden of disease. Although HIV transmission is predominantly driven by sexual behaviors, there are underlying complex individual, behavioral, and structural factors that contribute to high rates of sexual behavior and subsequent HIV acquisition. Moreover, difficulties remain in maximizing linkage to care …

Secondary Hyperparathyroidism And Its Clinical And Biochemical Associated Factors In Patients On Maintenance Hemodialysis In Dar Es Salaam, Doris Samwel

Master of Medicine in Internal Medicine

Background: Chronic kidney disease affects 13.6% of adult people in Tanzania. Secondary hyperparathyroidism is associated with an increase in disability-adjusted life years, cardiovascular mortality, and all-cause mortality worldwide especially in patients on maintenance hemodialysis. Justification: In Tanzania, there is a lack of prevalence data of secondary hyperparathyroidism and the factors associated with it. Knowing the factors associated with it will help in the early screening of our patients and intervene early before its complications arise. Objectives: This study aimed to assess the magnitude of secondary hyperparathyroidism and its association with clinical and biochemical variables and further to measure the association …

Compliance To Imaging Follow Up Recommendations Among Patients With Bi-Rads 3 Breast Lesions, Florence Thuita

Master of Medicine in Imaging and Diagnostic Radiology

Background: The Breast Imaging Reporting and Data System 3 (BI-RADS 3) category is assigned to lesions which are deemed to be probably benign on breast imaging with a low likelihood of malignancy (≤2%). With regular imaging follow-up, this category is intended to reduce the rate of invasive biopsies while enabling early detection of breast cancer. However, imaging follow-up has been reported to be challenging to both radiologists and referring clinicians in terms of its appropriate use on the various imaging modalities and understanding management of the patients in this category. Furthermore, it has been reported to induce patient anxiety and …

The Utility Of An Initial Point-Of-Care Lactate In Predicting In-Hospital Mortality Among Adult Patients With Sepsis And Septic Shock At The Emergency Department Of A Tertiary Hospital In Nairobi, Gicheru B. Nyachira

Master of Medicine in Clinical Pathology

Background: Sepsis is a leading cause of death and now a global health priority. Rapid identification, diagnosis and intervention can result in reduced in-hospital mortality. Elevated lactate has been shown to be a strong predictor of in-hospital mortality. However, the optimal cut-off has not been well defined. Identification of the optimal Point-of-Care (POC) lactate cut off that best predicts in-hospital mortality can therefore be used to rapidly risk stratify patients with suspected sepsis and septic shock presenting to the emergency department allowing for immediate intervention. Objective: To determine the lactate cutoff from an initial Point-of-Care lactate result from a GEM …

Immunophenotypic Expression Profile Of Multiple Myeloma Cases At A Tertiary Hospital In Nairobi, Kenya, Isabella Chelagat Mengich

Master of Medicine in Clinical Pathology

Background; Multiple myeloma (MM) is a heterogeneous disease with variable patient outcomes ranging from indolent to aggressive disease. GLOBOCAN data places Kenya amongst the top five African countries for MM incidence and MM-related mortality. Aberrant expression of CD56, CD117, Cyclin D1 and Ki-67 on neoplastic plasma cells has been demonstrated to be useful in disease prognostication. However, majority of the data on MM comes from western countries. The significance of expression of this markers is uncertain in our population. The aim of this study was to determine the immunophenotypic expression profile of CD56, CD117, Cyclin D1 and Ki-67 in a …

Clinicians’ Perceptions Of Pediatric Assent For Invasive Bedside Procedures At Three Tertiary Referral Hospitals In Nairobi County, Kenya., Grace Petrine Oyito Omondi

Master of Medicine in Paediatrics and Child Health

Background: The medical profession is built on the foundation of morals and ethics guided by principles of beneficence, non- maleficence, autonomy and justice. In order for an individual to be sufficiently autonomous, the value of information is indispensable. The information allows the patient to make an informed decision concerning their healthcare. The patient then gives an informed consent or assent as is applicable to the pediatric population. Majority of the studies surrounding pediatric assent revolves around obtaining it for research. There is a paucity of literature in regards to pediatric assent for clinical treatment more so as regards clinicians’ perceptions …

Knowledge, Attitudes And Practice Of Venous Thromboembolism Risk Assessment Among Surgical Doctors In Tanzania, Biswalo Mugeta Yango

Master of Medicine in General Surgery

Introduction Surgical patients are at increased risk of venous thromboembolism due to the nature of their conditions and treatments. The incidence ranges from 61.3% to 64.9% in developed countries, compared to 43% in Africa. Although venous thromboembolism is fatal, it is potentially preventable. Physician-implemented risk assessment models reduce events by 70%. No country in sub-Sahara Africa has implemented a national venous thromboembolism risk assessment guideline. The subsequent burden is probably a reflection of low awareness and knowledge, negative attitudes, and substandard practice among physicians towards risk assessment. Justification In the current study, we assessed Tanzanian surgical doctors' knowledge, attitudes, and …

Effectiveness Of Interventions Designed To Prevent Or Respond To Female Genital Mutilation: Evidence Brief, Dennis Matanda, Melanie Croce-Galis, Jill Gay, Karen Hardee

Reproductive Health

Despite intensified efforts to conduct research globally that informs strategies to address female genital mutilation (FGM), there has been limited rigorous high-quality evidence on interventions that are effective in ending the practice. As we begin the final decade of acceleration toward zero new cases of FGM by 2030, increasing the rigor, relevance, and utility of research for programming, policy development, and resource allocation is critical. This brief highlights key findings from an evidence review that synthesized and assessed the quality and strength of existing evidence on FGM interventions from 2008 to 2020. A number of studies have collated evidence on …

Effectiveness Of Interventions Designed To Prevent Or Respond To Female Genital Mutilation: A Review Of Evidence, Dennis Matanda, Melanie Croce-Galis, Jill Gay, Karen Hardee

Reproductive Health

Girls are one-third less likely to be subjected to female genital mutilation (FGM) today than 30 years ago. However, rapid population growth in some of the world’s poorest countries, where FGM persists, threatens to roll back progress. In 2020 alone, an estimated 4.1 million girls were at risk of being subjected to FGM. Without concerted and accelerated actions to end the practice, an estimated 68 million additional girls will have been subjected to FGM by 2030. Despite intensified global research efforts to inform strategies to address FGM, there has been little synergy between evidence generation and the implementation of programs …

Issues For Consideration In The Scale-Up Of The Inclusion Of Family Planning In The National Health Insurance Benefits Package In Ghana, Kamil Fuseini, Augustine Ankomah

Reproductive Health

Ghana is working toward achieving universal health coverage (UHC). This is driven, in part, by the Sustainable Development Goals (SDGs), specifically SDG 3—Good Health and Well-Being, which seeks to ensure healthy lives and promote well-being for all at all ages. Achieving this feat will improve equity of access as people, especially the poor can access quality health services without financial hardships. Ensuring equitable access to family planning (FP) is essential to securing the well-being of women and supporting the health and development of communities. One pathway to ensuring equity is the inclusion of FP in affordable insurance. While the inclusion …

Inclusion Of Family Planning Within The National Health Insurance Benefits Package In Ghana: A Health Facility Assessment, Population Council, Ministry Of Health, Ghana Health Service, National Health Insurance Authority, Marie Stopes International Ghana

Reproductive Health

In Ghana, National Health Insurance Act 852 of 2012 ensures that health-care benefits include family planning (FP) services, however people continue to pay for FP services because the policy is yet to be implemented in practice. Under the leadership of the Ministry of Health, the National Health Insurance Authority in collaboration with the Ghana Health Service, Marie Stopes International-Ghana and the Population Council implemented a pilot project to remove FP service out-of-pocket costs. All modern clinical FP methods were added to national health insurance and expensed by health facilities through the national health insurance claims process. The intervention significantly increased …

Management Of Intimate Partner Violence In Health Care Settings: A Training Manual For Health Care Providers, Division Of Reproductive And Maternal Health

Reproductive Health

Intimate partner violence (IPV) is any behavior by an intimate partner that causes physical, sexual, or psychological harm. In healthcare settings where providers are well trained, caring, and sensitive, most survivors respond positively to being asked about their exposure to violence. Healthcare providers are in a unique position to identify survivors and offer appropriate management and referrals. The World Health organization developed clinical guidelines to provide evidence-based guidance to healthcare providers on the identification and appropriate response to IPV and sexual violence. Based on this guidance, the Ministry of Health developed a comprehensive training manual to empower healthcare providers with …

The Saudi Critical Care Society Extracorporeal Life Support Chapter Guidance On Utilization Of Veno-Venous Extracorporeal Membrane Oxygenation In Adults With Acute Respiratory Distress Syndrome And Special Considerations In The Era Of Coronavirus Disease 2019, Hani N. Mufti, Ahmed A. Rabie, Alyaa M. Elhazmi, Husam A. Bahaudden, Mostafa A. Rajab, Ayed Y. Assiri, Khalid A. Maghrabi, Abdullah M. Abudayah, Adel A. Tash, Awad A. Al-Omari, Mohamed H. Azzam

Saudi Medical Journal

Extracorporeal membrane oxygenation (ECMO) is considered as a supportive treatment that provides circulatory and ventilatory support and can be thought off as a bridge to organ recovery. Since 2009, it has been applied as a rescue treatment for patients with severe adult respiratory distress syndrome (ARDS) mainly due to viral causes. In December 2019, several patients presented with a constellation of symptoms of viral pneumonia in China. A new strain of the corona virus family, called COVID-19, has been discovered to be the cause of this severe mysterious illness that was named severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2). This …

Next-Generation Sequencing In The Diagnosis Of Rare Pediatric Sinonasal Tumors., Atif A. Ahmed, Divya Vundamati, Midhat Farooqi, Elena Repnikova, Timothy Zinkus, Maxine Hetherington, Lorien Paulson

Manuscripts, Articles, Book Chapters and Other Papers

The diagnosis of desmoid fibromatosis or other spindle cell tumors in the sinonasal region is very rare in children and needs to be thoroughly confirmed with immunohistochemical and/or molecular tests. We report 2 patients with such rare tumors and describe the use of next-generation sequencing in their evaluation. A 3-year-old female had a 4.4-cm midline nasal cavity mass involving the bony septum and extending into the base of the skull bilaterally. The moderate cellular fibroblastic proliferation revealed areas of thick keloid-like collagen bands and other areas with myxoid edematous stroma. Deep targeted sequencing identified a novel G34V mutation in the

Evaluation Of Serum Magnesium Differences In Hypertensive Crises And Control Patients: A Randomly Matched Case-Control Study, Ifeanyi Chukwu O. Onor, Emily K. Johnston, Nicole G. Little, Lashira M. Hill, Oluwabunmi E. Lawal, Casey J. Payne, Mallory R. Coleman, Carolkim H. Huynh, Sarah E. Bilbe, Ahlam A. Ayyad, Kabrea J. Jones, Jasmine D. Kinnard, Rosanna Dastoori, Devinn K. Rolland, Amanda S. Miller, Robbie A. Beyl, Christopher J. Gillard, John I. Okogbaa, Daniel F. Sarpong, Rim M. Hadgu, Amne Borghol, Samuel C. Okpechi, Mihran V. Naljayan, Shane E. Sanne, Shane G. Guillory

School of Medicine Faculty Publications

Although the role of magnesium in blood pressure has been well studied among hypertensive patients, no study has explored the role of magnesium in hypertensive crises. The primary objective of this study is to evaluate the differences in serum magnesium levels between hypertensive crises patients and matched controls (age-, sex-, race-, and diabetes-matched) in a 1:1 random match. This study is a single-center, retrospective, chart review, case-control study of patients with hypertensive crises (case group) and patients without hypertensive crises (control group). Patients were included in the case group if they were 18 years of age or older with hypertensive …

Covid-19 In Children-Not Just Little Adults., Jennifer E. Schuster, Annabelle De St Maurice

Manuscripts, Articles, Book Chapters and Other Papers

Comment on

• Underlying Medical Conditions Associated With Severe COVID-19 Illness Among Children. Kompaniyets L, Agathis NT, Nelson JM, Preston LE, Ko JY, Belay B, Pennington AF, Danielson ML, DeSisto CL, Chevinsky JR, Schieber LZ, Yusuf H, Baggs J, Mac Kenzie WR, Wong KK, Boehmer TK, Gundlapalli AV, Goodman AB.JAMA Netw Open. 2021 Jun 1;4(6):e2111182. doi: 10.1001/jamanetworkopen.2021.11182.PMID: 34097050 Free PMC article.