Sunday, June 19, 2016

Honduras-VCU Global Health 2016: Back in Country, Getting Started

Mosquito control poster- Ministry of Health
The June 2016 VCU Global Health and Health Disparities trip to rural, mountainous La 
Hicaca and environs is about to push off.

Highlights for the upcoming brigade include:
  • Reassessment of chlorine water sanitation project efficacy for sustainable potable water
  • Re-deployment of home water filters for improvement of water sanitation, as summarized here.
  • Ongoing implementation of new indoor cookstoves for improved indoor air quality, as previously summarized here.
  • Ongoing deworming and assessment of mass deworming efficacy, in collaboration with Dr. Ana Sanchez of Brock University, Ontario, Canada.
  • Ongoing installation of latrines to scale, in collaboration with the Pico Bonito Foundation, to minimize open defecation and the transmission of soil transmitted helminths
  • At the request of the local Ministry of Health, as part of the station based clinic process- targeted, formal educational messages will be delivered. This will include messages to prevent diarrheal illnesses, respiratory illnesses and mosquito,vector-borne diseases such as Dengue, Chikungunya and Zika virus.
  • Ongoing cervical pap smear assessments in collaboration with local public health authorities
  • For the first time, in collaboration with our colleagues from Brock University, we will formally assess and de-lice school aged children.

As always, plans are fluid and subject to the unexpected nature of things in Honduras. 

VCU News is with us this year, filming a short documentary.

Stay tuned

Monday, June 13, 2016

Vibrio vulnificus Infections- Two in One Week

It has been a busy several weeks on the VCU Infectious Diseases consult service. 

We have seen two Vibrio infections causing severe skin and soft tissue infections in gentlemen who enjoy crabbing and aquatic activities in the Rappahanock river. 

As novel as it may seem to some, Vibrio is endemic yet rare in this part of Virginia, as reported here by the Virginia Department of Health.

Virtually nothing is risk free and the environment, aquatic or otherwise, is teeming with potential pathogens. Lacerations and heavy alcohol use with associated liver disease, as in one of the recent cases,does not help to minimize risk of infection with Vibrio.

Despite what is written in the lay press, Vibrio is not a 'flesh eating bacteria.'

Off to Honduras this weekend where there will be less Vibrio and more scabies.

Saturday, June 11, 2016

Audiophiles, Check This Out: The Rise and Fall of Tower Records

I am off my medical topic so please forgive me. Those who know me will understand.

Audiophiles, check out this cool documentary, All Things Must Pass: The Rise and Fall of Tower Records. From a radical new record store in California to mega chain worldwide, Tower Records conquered the world but failed to keep up with the times.  

From vinyl to CD to MP3 to Napster to iTunes, the music (r)evolution is covered in the narrative of Tower Records.

Ironically, vinyl is back!

No music, no life. 

Thursday, June 9, 2016

Nullius in Verba!

The Royal Society circa early 1800's. Source: The Times UK
Nullius in verba!  Take nobody's word for it. The motto of the British Royal Society.

I came across this while reading a book on the ancient science of enlightenment titled Siddartha's Brain

Take nobody's word for it. Look for truth by observation and empiricism.

I  wish that we were more rigorous in the practice of medicine, specifically infectious diseases. In this paper, at least 50% of Infectious Diseases Society of America Guidelines are based on expert opinion.

So if I suggest a treatment and justify it by that's just the way we do it, be skeptical, don't take my word on it.

Tuesday, June 7, 2016

Pragmatic studies, and why I like them!

I was just recently asked to review a paper for Infection Control and Hospital Epidemiology. Nothing unusual, of course, but it got me thinking again about methodology.

Of course, the epidemiology gold standard study remains the cluster randomized, prospective trial. But not all clinical questions can be answered this way. Of note, to assess the effectiveness of hand hygiene in the hospital, it would not be ethical do a randomized, prospective trial of hand hygiene versus no hand hygiene across a health system.

There is another limitation to these highly sophisticated clinical and epidemiologic trials: they frequently do not represent real life conditions.

Clinical trials are overseen by a dedicated team, have motivated participants and have structured oversight  to ensure protocol fidelity. I have seen  several prospective, clinical trials fail to "take root" after the conclusion of the protocol, even if the results were beneficial.

Pragmatic studies, although not as methodologically sound,  can test the implementation of an intervention in real life situations. It may not be as robust, but it does give a sense of both feasibility and impact.  This is practical and applicable.  It is also likely reproducible.

If more robust protocols cannot be implemented in the real world, then what is their real value?

Thursday, June 2, 2016

Not Just a Cold. VCU Medicine Grand Rounds- Dr. De La Cruz, Viral Respiratory Pathogens and Transplant Recipients

Congratulations to Dr. Oveimar De La Cruz of the VCU Infectious Diseases Division on an excellent internal medicine grand rounds on respiratory viruses in transplant recipients.

The lecture was informative and entertaining and covered the impact of viral respiratory pathogens (Influenza, RSV, Parainfluenza etc) on inflammatory pathogenesis, bronchiloitis obliterans pneumonia, bacterial and fungal co-infections, graft dysfunction and mortality.

Expect a published, invited review article on the topic in the next 12 months.

Not just a cold.

Monday, May 30, 2016

The Salt of the Earth- Photography, Humanism and Self Reflection

The Salt of the Earth is a deep and provoking documentary on Brazilian Sebastiao Salgado's career as an economist turned professional photographer. 

Salgado travels the world as a witness to life, death, tragedy and the depth of the human condition. His work spans years and space, having visited every continent.

Truth and meaning through photography. Beautiful, sad and resonating. 

Salgado is a humanist with a global lens.