UMHS, students have the opportunity to participate in cutting-edge medical research. Recent projects include a study on what is or isn’t in St. Kitts drinking water. UMHS students explored the general safety of drinking water in St. Kitts by searching for the possible presence of certain disease-causing bacteria.
Another project on molds was developed in 2013 to answer key questions about fungal presence in the air, food, and formulations. The research explored whether the 2012 meningitis outbreak in the United States could have been averted and if a similar outbreak can be prevented in the future.
A manuscript detailing a model for global surveillance of the air—based on studies in St. Kitts—was published in February 2014 in the online journal Virology & Mycology. The project involved mapping areas of high mold counts around the island that could potentially cause opportunistic infections and food spoilage from fungal growth. Students were involved in all aspects of the research project from planning, to fieldwork, to manuscript preparation and authorship.
UMHS students have also worked with Dr. Avery, a worldrenowned epidemiologist and UMHS Senior Research Fellow.
Students worked with Dr. Avery on the 2012 presentation “How Well Is St. Kitts and Nevis Handling Epidemiologic Transition?” This was presented at a Royal Society of Tropical Medicine Research Symposium at the University of Warwick in England. This report was also presented as a poster on “The Case for the Early Introduction of HPV Vaccine in St. Kitts and Nevis” at the Caribbean Public Health Agency (CARPHA) Annual Scientific Meeting in Barbados in 2013.
The faculty at UMHS are also involved in research. Dr. Mungli, associate professor of biochemistry at UMHS, published a study on India’s Koraga community in an international medical journal. Dr. Mungli also gave a presentation on type 2 diabetes at the 20th International Conference on Yoga Research and Its Applications in 2014 in Bangalore, India.
UMHS students doing air-borne mold research in the Microbiology lab on the St. Kitts campus. Left to right are Zachary Ciochetto, Dr. Girish Kotwal, Irshad Prasla and Harleen Saini. Photograph by medical student, Matthew Carpenter.
Could the 2012 meningitis outbreak in the United States have been averted?
Can a similar outbreak be prevented in the future?
The mold research at the University of Medicine and Health Sciences (UMHS) was initiated at the beginning of the 2013 precisely to develop a model for answering key questions about fungal presence in the air, food and formulations. A manuscript detailing a simple model that is proposed for global surveillance of the air, based on studies in the island of St. Kitts, has been accepted for publication in 2014 in the online journal Virology and Mycology.
The project led by Dr. Girish J. Kotwal UMHS Professor of Microbiology and Biochemistry, attracted a team of UMHS medical students eager to do research. The students then had the opportunity to be involved in all aspects of the research project from planning, to field work, to manuscript preparation and authorship. The UMHS medical students and faculty participating in the project were James Bassford, Atandra Burman, Nalliene Chavez, Zachary Ciochetto, Kristen Duman, Elise Landa, Alyssa Mahon, Samuel Park, Irshad Prasla, Harleen Saini, Torib Uchel, as well as Dr. James Adekeye.
The project involved mapping areas of high mold counts around the island that could potentially cause opportunistic infections and food spoilage from fungal growth. If the FDA had required similar environmental air and subsequent outgoing product testing by the company making the formulations in Massachusetts, they would have been able to determine the presence of fungi and therefore that the air in that facility did not provide a suitable environment for dispensing injectables.
If they had tested the formulated products for fungal contamination, those contaminated lots of the injectable steroid methylprednisolone acetate (MPA) would have been deemed unfit for administration into the human spinal fluid, the path of least immunological resistance. The multiple deaths, hospitalizations and suffering that resulted from the presence of Exerholium rostratum could have been averted by this simple testing, as being proposed in the manuscript.
Professor Kotwal with student researcher Harleen Saini in the UMHS Microbiology Lab discussing mold growth results. Photograph by medical student, Matthew Carpenter.
Hopefully, the FDA can impose a requirement on all manufacturers of injectables in the future, that they test both the air in their facilities where the formulation takes place, and the product before it is shipped to market. As with all products for human consumption, safety is of paramount importance. Procedures to ensure their safety are simply part of good manufacturing practice.
But what were the results for St. Kitts you ask? Is St. Kitts air mold-free? Areas of high mold count were identified and once the research study report is published in 2014, a link will be provided to the journal article where you will be able to read the detailed results.
The UMHS Research Committee is pleased to announce that this case report has now been published in the latest edition of the online open access journal Virology & Mycology (ISSN: 2161-0517).
Prasla I, Duman K, Ciochetto Z, Burman A, Mahon A, et al. (2013) Significant Heterogeneity in Airborne Mold Quantities on the Caribbean Island Of St. Kitts: Health Implications and Impact on Food Preservation. Virol Mycol 3:123. doi: 10.4172/2161-0517.1000123
The latest UMHS research project findings have been released. The project undertook to determine the general safety of the drinking water on the Caribbean island of St. Kitts by searching for the possible presence of certain disease causing bacteria.
An average person is supposed to drink eight 8-ounce glasses or 1.9 liters of drinking water every day (see Mayo Clinic current guideline). In most countries around the world drinking water is free of disease causing bacteria. However, countries that cannot ensure the safety of their drinking water advise citizens to use bottled or boiled water.
UMHS medical student research participants (l-r): Anthony Moon, Denise Ellis, Nalin Lalwani, and Raven Price.
Watery diarrheas are a common occurrence in several places around the world as well as on cruise ships. It is caused by any of the multiple pathogens that may be transmitted through contaminated water, especially water that is contaminated with fecal material. The presence of Escherichia coli or E coli, coliforms, a normal gut flora of the body, is an indication of fecal contamination. Certain strains of Escherichia coli are toxic to humans. It is therefore critical to regularly test the drinking water supply for the possible presence of bacteria and toxins.
According to the CDC, Escherichia coli strain O157:H7 causes 73,000 illnesses in the United States annually (Rangel, 2004). Dr. James Adekeye, former UMHS Professor of Microbiology, undertook this study to investigate water quality in terms of infectious agents in the local St. Kitts drinking water supply and to further determine whether there were pathogenic strains present.
Six UMHS medical students (Nalin Lalwani, Raven Price, Anthony Moon, Dennis Ellis, Edidong David and Elise Landa) assisted with the research, collecting water samples from around the island. Ms Dacia Fraser, the Lab Technical Assistant, together with Dr. Adekeye, isolated then characterized several coliforms indicating the presence of possible fecal contamination or toxin forming strains of Escherichia coli in the water samples. Upon the departure of Dr. James Adekeye to take up a new position as Professor of Microbiology with St. Matthews School of Veterinarian Medicine in the Cayman Islands; colleague and project collaborator, Dr. Girish J. Kotwal, UMHS Professor of Microbiology and Biochemistry, was then entrusted to assist with supervising the task of re-growing and performing the genotypic characterization of the isolates. Four of the six students participated in the release of DNA from the individual cultures, marking the first time DNA from any organism was prepared in the UMHS Microbiology Lab.
The samples were sent to a bacteriologist at the Food and Drug Administration in the USA where they were run through a few multiplex polymerase chain reaction (PCR) assays (Cebula, 1995). All the samples had amplifiable DNA; however the researchers reported that none of them were shigatoxigenic E. coli strains.
The report may not seem exciting as none of the isolates are from strains that produce shiga-like toxin; nonetheless the trail to study microbial DNA has been mapped. This will impact other ongoing UMHS research projects such as the study of molds in the air, as well as the search for other strains of bacteria which could produce diarrhea causing toxins. [Submitted by Dr. G. Kotwal]
Stay tuned to The UMHS Pulse blog for more UMHS research updates.
The UMHS Research Committee is pleased to announce that this case report has now been published in the latest edition of the online open access journal Virology & Mycology (ISSN: 2161-0517).
Adekeye JO, Ellis D, Kotwal GJ (2014) Significant Presence of Nontoxinogenic Coliforms in the Drinking Water Supply of the Mattingly Residential Area of St. Kitts Suggests that the Most Common Cause of Gastroenteritis could be Transmission due to Enteric Viruses in Drinking Water. Virol Mycol 3:126. doi: 10.4172/2161-0517.1000126
1. Rangel JM, Sparling PH, Crowe C, Griffin PM, Swerdlow DL. (2004) Epidemiology of Escherichia coli O157:H7 outbreaks, United States, 1982–2002. Emerg Infect Dis [serial on the Internet]. 2004 Apr [date cited]. Available from http://wwwnc.cdc.gov/eid/article/11/4/04-0739.htm
2. Cebula, T., Payne, W., & Feng, P. (1995). Simultaneous identification of strains of Escherichia coli serotype O157:H7 and their Shiga-like toxin type by mismatch amplification mutation assay-multiplex PCR. Journal Of Clinical Microbiology, 33(1), 248-250. http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=7535315&site=ehost-live
UMHS clinical student Aaron Vazquez in front of the Lou Ruvo Center for Brain Health at the Cleveland Clinic in Las Vegas, NV
It’s always fascinating hearing about what UMHS students are doing in clinicals, and we recently spoke with Aaron Vazquez about his work at the Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas. Mr. Vazquez was one of the co-authors of an eating disorders study published in Psychotherapy Research last year, “Effects Of Providing Patient Progress Feedback And Clinical Support Tools To Psychotherapists In An Inpatient Eating Disorders Treatment Program: A Randomized Controlled Study.”
Mr. Vazquez told the UMHS Pulse last summer that he became interested in psychology and psychiatry because he has always been fascinated by human behavior. We caught up with Mr. Vazquez to talk about his work with the Neuropsychology team and the Clinical Trials Department at the Cleveland Clinic, and what students at American and Caribbean medical schools should know about the shortage in psychiatry in the USA.
You became involved in volunteer research at the Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas last year. What initially attracted you there?
Aaron Vazquez: I was doing my Family Medicine clerkship at a hospital one mile away. I became aware of their Lunch-n-Learn program offered free of charge to the community and I began eating my lunch over there. It was a great decision. I discovered how passionate the clinicians were about community education and was very impressed with how approachable they were.
Within the Neurological Institute, you are working on a few projects. Tell us about some of the important things that the Neuropsychology Department does there.
They do different cognitive tests on a wide array of patients suffering from Dementias, Aphasias, MS, Movement Disorders and other brain diseases. They play a critical role in research and provide education and support to family members of patients.
In what capacity do you work with the Neuropsychology team?
They have very skilled professionals on staff. I play an ancillary role to help free up some time for them. I organize and transfer data from cognitive assessments and radiological studies in order to make it usable in potential publications. In the grand scheme, my role is quite narrow, but I am learning a lot about various scales and measures, which will help me in my career. I’m grateful for the opportunity.
You are volunteering as well within their Clinical Trials Dept. How did that happen?
I walked up to the Senior Director of Research and said, “I’d like to help.” She was able to match up my professional tech background nicely with a project they needed help on.
You are working on developing a centralized platform of technology that will enhance future clinical trials. Can you tell us about that?
Currently, vital data is gathered from study participants in a cross-sectional way, across multiple checkpoints during the course of the study. There are a few disadvantages to this practice. For one, there could be changes that occur between the checkpoint intervals that we are not capturing.
Furthermore, some of the data we collect is subjective in nature and therefore, subject to recall bias or other flaws if not collected in a timely manner. We are preparing to improve this aspect of clinical trials by deploying existing technology into participants’ homes so that the data is collected in real time and in a continuous manner. As physicians and researchers, we want the most up-to-date and precise information in order to make accurate conclusions.
What is the biggest challenge so far in accomplishing this?
This project is a big undertaking. It can be difficult to identify potential partners that can support the level of service that we demand. It is also challenging to integrate different types of technology into one centralized platform so that it can be monitored with one Dashboard and make it seamless and simple to the end user. Many can relate to the frustration of a printer not working properly with a single PC. Now imagine trying to get: Activity Trackers, Wireless BP Monitors, Electronic Pill Bottle Monitors, Blue Tooth Pulse Oximeters, Wireless Weight Scales and more to work flawlessly with participants who will have dementia. It’s a fun project!
What was the best thing about the experience?
I love the autonomy and challenge that I’ve been given. I was basically told conceptually what was needed and then tasked to bring it to life. I have also learned a lot more about how clinical trials operate in and of themselves.
What is the plan to bring this experiment to life? Can you talk about that now?
A proof-of-concept study is in the works. We will start with a few participants and monitor closely how the participants and their caregivers respond to the technology. From there, the quirks can be worked out and further implementation can be addressed on a study-by-study basis.
Everyone says there is a shortage of primary care physicians, but we ran an article recently that there are also looming shortages in psychiatry and neurology. Do you agree and if so, what should medical students and future doctors know about these areas of medicine?
Many might not like my answer to this, but regardless, here it is. I have been aware of the shortage in psychiatry since undergrad. It is one aspect that drew me to the field. I just returned from the American Psychiatric Association Annual Conference where this shortage was spoken of in nearly every lecture. The shortage in Child and Adolescent Psychiatry is particularly worrisome. When there is a mismatch between supply and demand in any market, the problem can be addressed in two ways.
Solution 1 (Commonly argued): Increase the supply of psychiatrists. It is commonly proposed that psychiatry needs better compensation so that medical students are swayed in that direction. I don’t necessarily disagree with that argument (as it would be self-defeating) but the type of medical students who are easily swayed by financial incentives may not be the best clinicians to work with this highly vulnerable population.
Solution 2 of the supply/demand mismatch is almost never mentioned by anyone. We need to decrease the demand for psychiatric services. It is well established that many mental illnesses are “triggered” by life events and that psychosocial factors are very relevant in the onset and progression of mental illness. Psychiatry should be equally focused on addressing this aspect of the supply/demand problem, particularly with our young ones, whose trajectory in life may still be altered towards positive outcomes. Sadly, there is no money to be made in promoting the improvement of our families and community organizations. Their role is both formative and supportive to mental, spiritual and emotional well-being. I’ve become aware that discussing the need to decrease the need for psychiatric services is not popular in many circles. Suggesting that as a society, we should become better community leaders, parents, siblings and children is now highly politicized.
What type of work and research do you want to do in the future?
My goal this year is to apply to a residency program that is exceptional at teaching clinical skills. I have already augmented my medical education with research so any scholarly work in residency would be secondary. Although Neurology is fascinating in so many ways, my calling is to enter Psychiatry. This is one of the last frontiers in medicine. The room for discovery and improvement is enormous in mental health. There is still so much we don’t know and that is the great appeal to me.
Medical Research Elective starts this summer, allowing students to work on diverse projects under supervision of Course Director Dr. Jane Harrington.
In the Summer 2015, UMHS will be launching the inaugural semester of the Medical Research Elective under the supervision of Course Director Dr. Jane Harrington.
Students will be involved in diverse projects, including hospital microbial surface sampling, environmental DNA-Barcoding, analyzing monkey fecal diversity and eradication methods of Pseudomonas from faucets. Each student will gain valuable experience using the Scientific Method and produce a publication-quality paper.
Through a competitive application process, the following students have been selected: EBS4 = Bernadette Schmidt and Victoria Gonzalez; EBS3 = Katie Plemmons and Genevieve Aube; EBS2 = Wined Ramirez-Lopez and Laura Mena-Albors; EBS1 = Tasia Bradley and Samah Halbouni.
Congratulations to all the students selected.
BUGS ON UMHS CAMPUS: Oxacillin-resistant Staph aureus isolate (pictured). UMHS students are collecting samples of bacteria on everything from computer keyboards to treadmill handles in the gym on campus as part of a microbial study.
What microbial bugs are on the UMHS campus, from computer keyboards to door handles? A group of EBS4 students is determined to find out as part of a new research project.
The UMHS Endeavour takes a brief look at what students at UMHS, one of the leading Caribbean medical schools, are doing to learn about bacteria right on the St. Kitts campus in an effort to understand how people can be exposed to potentially harmful human pathogens (things that can make us ill) on a daily basis.
UMHS students Bernadette Schmidt, Victoria Gonzalez and Freddie Irizarry, working under the supervision of bacteriologist and UMHS Course Director and Assistant Professor of Microbiology and Immunology Dr. Jane Harrington, Ph.D., are conducting a surface microbial survey of 100 sites on the UMHS campus.
“Many medically relevant bacteria have been identified, including Staph aureus, Staph epidermidis and Pseudomonas,” Dr. Harrington said. “Students are conducting antibiotic susceptibility profiles of all S.aureus isolates and we have already identified methicillin-resistant strains. We will be releasing the complete results at the end of the semester.”
Methicillin-resistant Staphylococcus aureus (MRSA) is a bacteria that is resistant to many antibiotics, the Centers for Disease Control and Prevention (CDC) says (http://www.cdc.gov/mrsa/ ). In many health-care settings, MRSA can cause dangerous bloodstream infections, pneumonia and surgical site infections.
The UMHS Research Wiki homepage (https://sites.google.com/site/umhsiuonresearch/Project-Overview/microbial-sampling-research-project) notes that students are participating in the project “to collect, identify and characterize bacterial species found within our local environment.” This helps future doctors understand just how we come into contact with “potential human bacterial pathogens such as Staphylococcus aureus.”
The project’s first stage examines surface contaminants on the UMHS campus. “Subsequent stages will include sampling of local hospital, environmental water runoff, mountain-fed streams and fecal samples of wild Vervet monkeys,” according to the UMHS Research Wiki homepage.
In addition to keyboards and computers, samples were swabbed in bathrooms, doorknobs, the library, treadmill handles in the gym, coffee pots, microwaves, and more (part of the 100 sites). The students are “currently characterizing more than 200 isolates,” the UMHS Research Wiki homepage says.