Lights, Camera, Action

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).

A series of fortunate events

The 2019 malaria season is the second year of our clinical trial — enrollment is slow because malaria control efforts in Malawi are working: more children are being diagnosed and treated earlier in their illness, so we are seeing many fewer patients at “Queens.” We’re all thrilled, of course, but it does add to the challenge of carrying out the clinical trial

During the malaria season of 2011, we carried out a pilot study of a new-ish imaging technique, transcranial Doppler ultrasound (TCD). It is similar to any other kind of ultrasound — a probe is placed on the skin and records information. In this case, it is information about blood flow velocity, and if the probe is placed properly, we learn about blood flow into and out of the brain.

Back in 2011, the equipment was large, clunky and finicky — but it was clear that the approach was useful. We could see distinctly different wave patterns in different patients.

The technology has improved greatly, now. The equipment can be carried in a backpack, acquiring the wave forms is easily taught to ancillary health personnel, and the “post-processing” of the wave forms has become much more sophisticated. We thought that combining all we are learning about the patients in the clinical trial with the additional information provided by the TCD machine would be very helpful in understanding why the brains become swollen in some children with cerebral malaria.

There were two stumbling blocks: acquiring a machine, and involving a TCD expert. I was telling Bob Garvey of the Warm Hearts Foundation (the co-host of this summer’s Malawi Update at the Garvey Barn) about the machine during the summer of 2017. He realized how much we might learn from adding it in to our routine assessent of patients — and he offered to buy a TCD machine, through the foundation. ZIKOMO!!

Nicole O'Brien in CongoAt the SAME TIME, summer of 2017, one of our new colleagues on the clinical trial, the aptly named Dr. Allan Doctor, of Washington University in St. Louis (his med school nametag read “A. Doctor”) was professor for a day at Ohio State University. When he mentioned that he was working on a cerebral malaria project in Malawi, he was immediately introduced to Dr. Nicole O’Brien, an adult and pediatric critical care specialist who had established a research capacity in the Democratic Republic of Congo. As it happened (you can’t make this stuff up …), Dr. O’Brien had just finished a large study using TCD on cerebral malaria patients in Congo. Dr. Doctor arranged for Dr. O’Brien to present her work to our group and we were wowed (check it out for yourself: O’Brien N, et al., Pediatr. 2018 Sep 14. pii: S0022-3476(18)31074-6.8).

Dr. O’Brien has visited Malawi several times already and — serendipity alert — when I was talking about her work with our NIH program officer at the American Society of Tropical Medicine and Hygiene annual meeting a year ago, he suggested I write a supplement to our grant to support her research with us. The supplemental grant was awarded and as a result, Dr. O’Brien will be able to spend four months in Malawi during each of the next four malaria seasons.

Our Fall 2018 newsletter

Read it online here or download a PDF here.

Let’s gather!

The Malawi Gathering is Sunday, Aug. 5, 6 p.m. at the Garvey Barn, 7490 Lautner Road, Williamsburg MI 49690. This is a joint gathering with the Warm Hearts Foundation and Imaging The World and we’re grateful to the Garvey family for letting us join in the fun. May Erlewine, a wonderful singer/songwriter, will perform for us! See the poster here. We’ll also have an open beach at the Taylor/Williams home, 873 Peninsula Drive, Traverse City MI 49686, beginning at noon that day.

Some recent papers

Type I Interferon Receptor Variants in Gene Regulatory Regions are Associated with Susceptibility to Cerebral Malaria in Malawi.

Simulation models predict that school-age children are responsible for most human-to-mosquito Plasmodium falciparum transmission in southern Malawi.

Noninvasive measures of brain edema predict outcome in pediatric cerebral malaria.

Cerebrospinal fluid Plasmodium falciparum histidine-rich protein-2 in pediatric cerebral malaria.

A targeted approach for routine viral load monitoring in Malawian adults on antiretroviral therapy.

Pathology-Based Research in Africa.

1.5 Tesla Magnetic Resonance Imaging to Investigate Potential Etiologies of Brain Swelling in Pediatric Cerebral Malaria.

Sam Kampondeni honored

Dr. Samuel D. Kampondeni, a leader in brain imaging for cerebral malaria, has been recognized among leading global scientists at the Annual Meeting for the American Neurological Association.

Dr. Kampondeni’s presentation “MRI Brain Volume Measures as Proxy for Intracranial Pressure Predict Outcome in Pediatric Cerebral Malaria” was awarded Top Honors and a cash award from among over 500 scientific works presented.

Dr. Kampondeni works with QECH and and the Blantyre Malaria Project. His research has led to critical insights regarding how malaria affects the brain. The ANA, a professional organization representing the nation’s top academic neurologists and neuroscientists, announced it 2017 scientific awards at its annual meeting last week in San Diego.  The awards recognize leaders in academic neurology and neuroscience who have exemplified excellence in a number of areas, including stroke, dementia and neurodegenerative disease.

Founded in 1875, the American Neurological Association is the premier professional society of academic neurologists and neuroscientists devoted to the understanding of diseases of the nervous system and the profession’s ability to treat them.  The Association’s monthly Annals of Neurology was first published in 1977 and is considered one of the world’s leading medical journals on diseases of the central nervous system.

Good info, brisk breeze at Malawi Update gathering

We had a good turnout at the Malawi Update gathering in Traverse City in early August. Thank you so much to everyone who came; it was so nice to see you, to catch up and share our news with all of you. We had a slide show looping, a couple posters and lots of Blantyre Malaria Project and MSU employees on hand to talk about science. It wasn’t just the north wind that was invigorating.

Malawi Update poster (PDF download)

The Malawi flag flew proud over northern Michigan.

Dr. Karl Seydel (in towel-skirt, right) was fresh off the plane from Chileka. The water was warmer than the air, so there was a good bit of swimming going on.

Dr. Doug Postels channels his inner Malawian by wearing a puffy parka when the temperature drops below 70F.

One of the best Malawi-in-Michigan moments — bao on the beach!

ICEMR study receives $8.5 million grant

The work is part of the International Centers of Excellence in Malaria Research, a program created in 2010 and funded by the National Institutes of Health’s National Institute of Allergy and Infectious Diseases. This is the  second ICEMR grant Taylor and her team have been awarded. Read more.

Keep in touch

Here’s our July 2017 newsletter. And here’s our May 2017 newsletter. You can subscribe here.

Our 2017 Riegle Scholars have been chosen

Read more about them here.

Taking a stand for science

We’re hosting a satellite March for Science in Blantyre Saturday, April 22. Learn more and join us.

Gaining Ground Against Cerebral Malaria

The Lancet has a great article (free) about our work here. It emphasizes our collaborations, past research and upcoming study.

The State News wrote about our project, including the ICEMR grant. Read it here.

Save the date!

Malawi Party 2017 is on. Saturday, Aug. 12, 2-10 p.m., 873 Peninsula Drive, Traverse City MI 49684. Bring a dish to pass, something to drink, beach gear and please, park across U.S. 31 and cross over.

NIH grant is a go

OK, let’s figure this out! NIH awards $8.4 million for malaria research (via MSU Today).

Ben Kean Award

Photo by Michael A. Schwarz

Terrie Taylor, D.O., won the Ben Kean Award at this year’s gathering of the American Society for Tropical Medicine and Hygiene. Read more.

Nurse presents at ASTMH meeting


Felix Mkandawire

Felix Mkandawire, a nurse at the Blantyre Malaria Project, was a presenter at the 2016 meeting of the 2016 meeting of the American Society of Tropical Medicine and Hygiene after discovering a trend in the data coming from the Ndirande clinic. Read more.

Scholarship winners honored

scholarship-lunch1Winners of this year’s scholarships, funded by Dr. Gail and Mrs. Barbara Riegle, were honored at a lunch during the Silver Jubilee of the University of Malawi College of Medicine.

Read more.

Power to the people

generatorweb4We have a generator at the MSU House! We’ve christened it the “Huckle-Harrison Generator.” Find out why.