Lights: Our research activities in 2019 are unfolding in three settings: Ndirande Health Centre in Blantyre, the Paediatric Research Ward at the Queen Elizabeth Central Hospital and out in “the districts”: Namanolo Health Centre (in Balaka District) and Ntaja Health Centre (in Machinga District). In each setting, auxiliary power supplies are required to “keep the lights on” at all times. In the districts, we are based in small health centres — increasingly, those are powered via solar, but we maintain backup generators to keep reagents cold in the fridge, samples safely stored in the freezers, and to illuminate our central offices. The Huckle/Harrison generator continues to perform beautifully at the MSU House — the ESCOM power typically cuts out as we are preparing breakfast or supper, so to hear the generator kick into action is fantastic! The Research Ward is in a privileged position because our backup generator belongs to the Malawi/Liverpool/Wellcome Trust Clinical Research Programme — when the hospital lacks power (which is rare, but it does happen), the pediatric patients requiring oxygen and CPAP are rushed over to our wards.
Dr. Karl Seydel and I assess the Blantyre Coma Score on a study patient.
Camera: Through yet another series of serendipitous events, we have established a collaboration with Vision Quest Biomedical, LLC. They are interested in computer-supported algorithms applied to fundus photos. They’ve rolled out software and portable cameras to help with the diagnosis of diabetic retinopathy and, over the past three years, they’ve turned their attention to developing algorithms to recognize malarial retinopathy. I didn’t think they could do it, but they have — the cameras and software work well in our hands on the Research Ward, so we are rolling the activities out to include the six district/mission referral hospitals with whom we’ve been working over the past two years (they send CM patients in to the Research Ward to help sustain enrollment into our clinical trial). The teams at the six hospitals are very excited to expand their research capacity, With Dr. Gilberto Zamora (Vision Quest) and Mr. Lameck Khonde (Study Coordinator), we visited all six hospitals and provided introductory training with the cameras during the last week of April
Action: We are capturing lots of action with all kinds of new gadgets this year:
• Transcranial Doppler (TCD): Bob Garvey helped us buy a TCD machine from Neural Analytics (building on a long-term relationship with Dr. Robert Hamilton, Chief Scientific Officer at Neural Analytics). Drs. Nicole O’Brien and Yudy Fonseca have trained three members of the Malaria Project team (Bertha Chikaonda, Benard Montfort Gushu and Tusakire Phiri) to capture the TCD parameters on all patients enrolled in the ongoing clinical trial, “Treating Brain Swelling.” It’s early, but TCD appears to be very promising.
• Heart rate variability (HRV): Using yet another gadget, Dr. Gavin Wooldridge is capturing data on HRV, in conjunction with Drs. Allan Doctor and Phyllis Stein from Washington University in St. Louis. We are looking for markers of increased brain volume, and disruptions of the autonomic nervous system, reflected in decreased HRV, may be helpful.
• Optic nerve sheath diameter (ONSD): This is not exactly “action,” as it is a static ultrasound image, but it may be a way of detecting raised intracranial pressure without having to use an MRI.
Our interventional clinical trial, “Treating Brain Swelling in Pediatric Cerebral Malaria,” is going well — we are keeping “Old Faithful,” the 0.35T MRI donated by General Electric Healthcare in 2008, up and running. What a workhorse! We’ve been randomizing cerebral malaria patients with increased brain volume to one of two arms (“usual care” or “immediate ventilatory support”) to date. We have been working closely with the Malawi equivalent of the FDA, the Malawi Pharmacy, Medicine and Poisons Board, to allow an osmotic agent, 3% hypertonic saline, to be imported into Malawi. Once we have secured that permission, we will introduce the third arm. Watch this space!
March for Science: will be part of the international “Day of Action” and will focus on climate change as it pertains to the floods in the Lower Shire. Likely to include a screening of “The Boy Who Harnessed the Wind.”
World Malaria Day will mark the 11th anniversary of the arrival of Malawi’s only MRI in 2008 (a.k.a, Old Faithful).