The 1st Annual UMHS Research Symposium, held Thursday, November 12, 2015, gave UMHS students a chance to discuss all the research they have been working on recently. Held in the Warren Ross Auditorium, the event was sponsored by the UMHS Research Committee, chaired by Dr. Jane Harrington, Course Director and Assistant Professor of Microbiology and Immunology and consisting of committee members Dr. Abayomi Afolabi, Dr. Peter Lee, Dr. Desia Grace, Dr. Agnes Beachman, Dr. Rebecca Cusack and Ann Celestine, Director of Library and Educational Applications and Assistant Professor of Library Research. To kick off the Symposium, the following students participated in a poster session to share the research findings: Soraya Darwood, Samah Halbouni, Ellen Lorenzen, Christina Varela, James Riddle, Stefan Campbell and Nawsheen Khan. Students presented oral talks on current research projects, including Geneviève Aubé and Katie Plemmons and Laura Mena-Albors and Wined Ramirez or research conducted prior to enrollment at UMHS, including Jameison Rolle and Freddie Irizarry-Delgado. Dr. Will Cobb, Assistant Professor of Anatomy and Dr. Rebecca Cusack, Gross Anatomy Lab Instructor, gave the faculty presentation “The Physiology of Neuromusculoskeletal Tissue.” Dr. Amy Beierschmitt from Ross University School of Veterinary Medicine gave a keynote speech on “Non-Human Primate Models of Disease, Genetics, Addictive Behavior and Behavioral/Cognitive Disorders.” Also present were faculty from the Windsor School of Medicine, people from the St. Kitts Board of Education, as well as other members of the St. Kitts community.
In addition, eight poster presentations were given by UMHS students, including: Stefan Campbell, “Epiform transients in the occipital lobe in pediatrics;” Soraya Darwood, “Evaluation of microbial contaminants in tap water and efficacy of home filtration systems;” Samah Halbouni, “What are the risk factors for Arboviral infection in UMHS medical students?;” Nawsheen Khan, “The anti-bacterial effect of single-walled carbon nanotubes on Bacillus Anthracis;” Tom Kowalksi, “Impact of the implanted cough system on the quality of life (QoL) of spinal cord injury (SCI) subjects;” Ellen Lorenzen, “An investigation of pork products from imported and domestic origins in local St. Kitts grocery stores for levels of coliforms and resistance to antibiotics;” Kamalpreet Mann and James Riddle, “Antimicrobial properties of indigenous tropical plants Moringa and Neem;” Christina Varela, “Detection of Salmonella and E.coli contamination from imported and domestically produced poultry from retail markets in St. Kitts.”
The UMHS Endeavour spoke with Dr. Harrington about the 1st Annual UMHS Research Symposium and the important research the students presented. Dr. Harrington discussed research on bacteria on cell phones on the UMHS campus; methicillin-resistant staph aureus (MRSA) and the best methods to clean surfaces to avoid harmful bacteria. Dr. Harrington filled us in on “Microbiology Lessons to Create Awareness of the Importance of Hand Hygiene and Surface Cleaning” and how UMHS students are helping kids in St. Kitts learn about hygiene, the difference between “good” and “bad” germs. In addition, she talked about risk factors for arboviral infection (such as Chikungunya and Dengue Fever) in UMHS students, and methods to help repel mosquitoes that carry these tropical diseases; how Neem and Moringa plants can help combat strep throat and the current presence of bacteria and fungus in tap water. Dr. Harrington also updated us on the Research Elective “Detection of Salmonella and E.coli Contamination from Imported and Domestically Produced Poultry from Retail Markets in St. Kitts,” which began last month and will be completed in spring 2016.
UMHS Endeavour: Tell us a bit about the 1st Annual UMHS Research Symposium and why you decided to do this annually.
Dr. Jane Harrington: It’s very much an opportunity to showcase student research activities. Since I’ve come to the campus, we’ve gone from pretty much a nonexistent research culture to productive projects at present which is very, very important for the learning process. It was fantastic to show our fellow students and faculty as well as the opportunity to present to the community. We had a very large attendance from outside the community. It was fantastic giving students the experience of presenting at a research symposium. We have some fantastic leads for establishing collaborations.
For starters, let’s focus specifically on the study you did with Geneviève Aubé and Katie Plemmons, “Microbial Isolates from Personal Mobile Devices on the UMHS Campus.” Your study, conducted with cell phones and wall phones with an operating room, found that 83% had pathogenic bacteria prior to disinfectant, and you noted that St. Kitts has a large population of individuals with immunocompromised status due to chronic illnesses such as diabetes mellitus, HIV and asthma. What is one thing people in St. Kitts can do to protect themselves? Feel free to elaborate.
A lot of it has to do with the type of safe handwashing. You should wash your hands frequently and you should wash your hands after you go to the bathroom, which some of us take for granted. Some people don’t do it routinely. That’s going to lead to microbial colonization on your cell phone. In the medical context, doctors need to be washing their hands before they interact with a patient, after they interact with a patient. For the students that are rotating at the JNF Hospital, that’s [washing hands] an important control measure.
You also included information on methicillin-resistant staph aureus (MRSA) in the USA. Is this what we commonly call “staph”?
Staphylococcus aureus is what we normally call the bacteria. We casually refer to it as “staph.” Staph is pretty present everywhere. There’s a specific type of staph that is resistant to methicillin/oxacillin class of drug. MRSA [pronounced MER-SA]–that’s what we call it for short–is the type of staph that is resistant to medication and is a serious medical condition because they are often resistant to a lot of antibiotics. If you have a staph infection, you can treat it with normal antibiotics. That’s fine, but if you get a MRSA infection, that can potentially be deadly. It can lead to mass complications if you have an underlying condition.
You noted a 54% decline in hospital-acquired MRSA cases between 2005 and 2011, resulting in 9,000 fewer deaths. Why the large decline?
Better control within the hospitals and washing hands is the solution. Previously we could treat the staph infections with antibiotics with a little more casual hygiene practices in the clinical setting. But with the emergence of antibiotic resistance, it became much more imminent to have strict protocols. I keep coming back to washing hands but that’s what was associated with a lot of that reduction of infections.
I know that when you go into the hospitals in New York, they make you use Purell or a hand sanitizer before you visit a patient and preferably after you visit a patient. I don’t know if that’s helped.
It has helped. The antiseptic solutions, they don’t really help with staph. But they’ll help with viral infections.
You also noted that 33% of people carry Staphylococcus aureus in their nose. What is the significance of this?
You can’t get rid of it. [Laughs.] I carry it in my nose. From our microbiology lab class, we have students culture novel samples. Part of their lab activity is culturing their nose. I’ve cultured my nose multiple times and I always have staph aureus in my nose. I should wash my hands frequently.
Let’s talk about the project aims and research methods. You determined the relative counts and identification of microbes growing on personal mobile devices and investigated if standard cleaning methods such as alcohol swabs are effective for reduction of microbes. The samples were collected from personal devices of UMHS students, before cleaning and 24 hours post cleaning with an alcohol swab. What was the most surprising thing about the outcome of this?
I was surprised at the increase in the bacterial numbers. For the most part, most of the strains of bacteria did not reduce. Actually there was a slight increase.
In conclusion, you stated that alcohol swabs are effective at reducing fungal species but ineffective at reducing bacteria, especially virulent strains like MSRA from mobile devices. You noted that other cleaning methods should be investigated to prevent infections in at-risk populations of St. Kitts. What are some of the better cleaning methods?
The Clorox wipes. We find that really dramatically reduces even the bacterial counts from when we did the experiments with the students when we did outreach. But do you want to wipe your cell phone with a Clorox wipe? There are now some commercially available covers and screen covers that are antibacterial themselves, so you could go online and do a search for an antibacterial screen cover or case. That’s actually being advertised within the medical community.
Is there anything else about this particular study you’d like to address?
I’d like to praise the particular students involved, Katie Plemmons and Geneviève Aubé. This was their idea. They put in an amazing amount of hours. I just highly commend these particular students for the amount of hard work that they’ve put in.
Let’s talk about the study “Microbiology Lessons to Create Awareness of the Importance of Hand Hygiene and Surface Cleaning” by Laura C. Mena Albors and Wined Ramirez Lopez.
Oh, it was so much fun. The students, prior to the lesson, the majority of them did not know what germs meant. They knew the word “germs”; they had an abstract concept that germs are on your hands and you should wash your hands. After the lessons, they actually learned about the bacteria and we used the word “microorganism” and the fact that microorganisms can be beneficial. That’s important because of the bigger picture in medicine we’ve had such a focus on the disease-causing organisms and there’s a new field of study for the microbiota that are beneficial that we were starting to investigate in the last 10 years. We want to plant that idea in children early that some microbes are actually beneficial. We don’t want to get rid of all of them. And we had a conversation about the antibacterial soap which is actually bad to get rid of all bacteria. So I’m hoping that lesson early on will teach children to not be “hyper clean.” Going “hyper clean” has negative consequences. It leads to the autoimmune diseases, asthma, allergies, and also autism and the chronic stuff. If people are on antibiotics too much and using too much antibacterial soap and antiseptic solutions too much, it’s killing your natural defenses. In regards to staph aureus, I wash my hands after I go to the bathroom, but I’m not “hyper clean.” So I have my normal flora, my normal bacteria on my hands, which can actually help combat staph for you. I told you that I have it in my nose. Why don’t I get boils and carbuncles and all those skin infections? Because my good bacteria protects me. If I was “hyper clean,” and again this is anecdotal, I know a family on the island and I’m super, super clean. My daughter plays with her daughter and her daughter gets skin infections repeatedly. Why is that? Well, if you’re too clean, you get rid of your protection, you get rid of the good guys—the good bacteria, and that makes you more susceptible to the pathogenic ones. In the U.K. there was a study on binkys [pacifiers]. Some mothers, whenever the baby drops the pacifier on the ground, the mothers sterilize it. Some mothers pick up the pacifier and they put it in their mouth. What they’re doing is they’re inoculating their baby with their own microbiota. Pre mastication—that’s another thing that we mothers do, we’ve been doing it for a long time—we’re inoculating our babies. That’s great, that’s wonderful. The consequences of treating your children with sterile gloves is the immune system can turn on itself. Such children can get a lot of allergies. There is a very strong association with autoimmune diseases and with being too clean.
What are things children should know about hand washing, based on this study?
Playing with dirt. There are some pathogenic organisms like Bacillus species, a little bit of the dirt is fine, but wash your hands– if you’ve been playing in the dirt—before you eat. It’s about moderation. You don’t have to be washing your hands every five minutes. After playing with their dog, they should wash their hands.
If children–or anyone–needs to wash their hands and soap and water is not available, which is better: a hand sanitizer like Purell or a Clorox wipe?
I stress water. Between the antiseptic gels, I’m not going to say which, but I wouldn’t use the Clorox wipes on my hands. The wipes can be very irritating to your skin. Bleach is a very effective antimicrobial agent and the recommended disinfectant in the lab but don’t use it on your skin. I’d take the risk of being dirty over using a Clorox wipe on my hands. Water alone is actually very effective for literally washing off the bad bacteria without compromising your good bacteria.
So if you don’t have soap, using water alone is safer? The wiping motion removes the bacteria?
Yes. If I’m out on the town, I always have a water bottle with me. I can just take that water and pour it on me and that’s effective.
Let’s talk a bit now about the study “What Are the Risk Factors for Arboviral Infection in UMHS Students” you did with Samah Halbouni. I’ve written some blog posts on Chikungunya and Dengue Fever. You noted in the study that, based on an anonymous questionnaire on SurveyMonkey, examining the history of exposure and risk of infection, the majority of UMHS students are at risk for these diseases. In simple terms, what are the symptoms for each of these diseases, Chikungunya and Dengue Fever, and what can people do to protect themselves and prevent being bitten by mosquitoes that carry these diseases?
It’s a combination of the high fever, it’s a lot of aches and usually a rash. If they have the symptoms at the same time, both Chikungunya and Dengue are similar, so if you were to have those symptoms, you wouldn’t be able to tell the difference between them. It’s really the high fever that we’re most concerned about.
What can students do to prevent being bitten by mosquitoes that carry these diseases? Personally, I use Deep Woods Off when I go to areas with mosquitoes and I’m not sure what the chemical is in Deep Woods Off, probably potentially toxic, but it comes in travel-size packets that you can easily get through airport security and customs and it really does keep the bugs from biting. Is that a good one?
Personally, I use the natural products. There’s this one particular product that I get from St. Martin that’s got an almond oil base and citronella, eucalyptus, cinnamon. I actually make my own. I use a coconut oil base and I put a bunch of essential oils in it. I love them. I find that they are much more effective than any of the strong chemical sprays. Mosquito nets are something else that students should think about, particularly if they are away from the Frigate Bay area. In the Frigate Bay area, they do routine mosquito spraying so we find that there are not a lot of mosquitoes there. But if you live closer to campus or if you live in town, you need to be sleeping with a mosquito net. I think we should be educating the students first who are coming in that they should have mosquito nets on their packing list. We have two bedrooms and we have guests coming and they have to have the mosquito net. As well as my favorite thing, “The Wand.” It looks like a tennis racquet and it’s got a metal mesh in the middle of it and it’s charged with electric, so you can plug them into the wall. You can buy them for 20 EC [approximately $8 U.S.] here in St. Kitts. I don’t have very good eye-to-hand coordination so I can’t use a flyswatter but I can use The Wand. I’m like Luke Skywalker with the light sabre [Laughs.]
Getting back to repellants, you said almond oil and eucalyptus are good natural products to use?
Almond oil or eucalyptus with coconut oil as the base and then you add to it. Definitely citronella and eucalyptus are very strong mosquito repellants. Lemongrass is good. At home, I add lemongrass to water and I spray it on my plants. I spray it around my windows. Does it actually work? I don’t know but I know I use the oils. I go from being eaten alive to nothing biting me when I use the oils. We were trying to brainstorm on how to actually test the products by scientific methods but I couldn’t come up with a way to have volunteers get bitten by mosquitoes.
Let’s talk a bit about the study you did with Kamalpreet Mann and James K. Riddle on “Antimicrobial Properties of Indigenous Tropical Plants: Moringa and Neem.”You noted that people have used Moringa and Neem plants as a form of herbal remedy in the tropics, including therapeutic applications of “bush tea” in St. Kitts. What are some positive aspects of these plants in relation to medicine?
It’s actually quite astounding, the number of peer-viewed literature and articles on these specific plants regarding their anti-cancer and antioxidant properties. It’s already been published that these plants have antimicrobial properties so the old wives’ tale in this case is true. The particular published study only looked at a few species of staph aureus, so we’re expanding the studies to see if the properties are applicable to a wide range of species. We found that Neem specifically inhibited Streptococcus pyogenes, which causes strep throat, so you can envision somebody who’s got a strep throat infection and you give them a tea that has Neem in it. Neem would actually help. I was actually the most excited regarding this finding We already know that the staph aureus is partially inhibited by Neem and Moringa. I find the papers and their methodology to be kind of narrow for growth conditions, but whenever I saw that it can help fight Streptococcus pyogenes, from a microbiology background I knew this was exciting.
It would be great if you have a sore throat and you could just drink the tea with Moringa and Neem. It would be great if you didn’t have time to go to the doctor or it would help you until you could get in to see him or her and get a prescription.
What about throat lozenges that added a Neem extract to it?
Are Moringa and Neem widely available in the USA and Canada or only the Caribbean?
They are available globally [in health stores] and I would imagine the plants grow indigenous in Florida. They’re available in the tropics [fresh plants].
Your preliminary results demonstrated that both Neem and Moringa inhibit growth of various bacterial species in vitro. What’s the most important thing about this conclusion?
The intention is to apply it in an emergency situation where our water is compromised or you can’t wash your hands. So if we have a hurricane and our infrastructure is compromised and we’re going a week or two weeks without running water, are there resources that are available in your backyard? I have Neem in my yard. Can I use that to reduce my risk of contracting a bacterial infection? So that’s the big picture of where we want to take this project.
On the topic of clean water let’s talk a bit about the study you did with Soraya Darwood on “Evaluation of Microbial Contaminants in Tap Water and Efficacy of Home Filtration Systems.” What is present in the tap water?
This study was initiated during the campus microbial survey, when we discovered high microbial loads, both fungal and bacterial in the tap water from in the UMHS Western lab classroom. Sorarya posed the question if tap water from student residences contains more or less microbial loads as compared to water sources on campus. For the most part, Frigate Bay residences are fairly clean; whereas, campus and neighborhoods near campus have a lot of fungus and bacteria in the water. With that information, a student can decide to refill a reusable water bottle in morning or during school hours. Luckily, there has been a recent installation of water fountains with filters and spouts specifically for water bottles. This water displayed no microbial growth for 50mL. Additionally, we are interested if filters, such as Brita or Pur. In some cases, the water after filtration had higher counts than straight from the tap, indicating a dirty filter than needs to be replaced.
The last time we spoke we talked extensively about Salmonella and E Coli, but I do want to talk briefly about the studies “Detection of Salmonella and E.coli Contamination from Imported and Domestically Produced Poultry from Retail Markets in St. Kitts” with Christina Varela and “An Investigation of Pork Products from Imported and Domestic Origins in Local St. Kitts Grocery Stores for Levels of Coliforms and Resistance to Antibiotics” with Ellen Lorenzen. You are presently studying samples of poultry and pork meat that is randomly purchased from stores in St. Kitts over a 6-month period from October 2015 to April 2016. Is there anything you’d like to address regarding this study so far?
This is the first semester of the Research Elective, so in the first semester they are really learning the methodology and the literature review. This is a pilot study to determine if we detect levels that we could actually culture them in the lab. The bulk of the data collection is going to be during the months of February and March 2016. So just the fact that we were able to grow bacteria, that’s bad news for the consumer and good news for us regarding the research and we had all the media that are available. This is a “to be continued” project status.
Is there anything else you want to add about the UMHS Research Symposium or the studies that we have not discussed?
Again, I praise the students. The students are extremely enthusiastic. Today we me had our weekly meeting and I got the feedback from the experience and they all said it was absolutely wonderful and very exciting and it meant so much more to be contributing to the scientific field vs. just memorizing bullet points. I am looking forward to generating new data with next semester students (James, Kamal, Christina) and to publishing the work of the students who are completing the Research Elective.
1st Annual UMHS Research Symposium Program
Built in the tradition of the best US universities, the University of Medicine and Health Sciences focuses on individual student attention, maintaining small class sizes and recruiting high-quality faculty. We call this unique approach, “personalized medical education,” and it’s what has led to our unprecedented 96% student retention rate, and outstanding residency placements across the US and Canada. UMHS is challenging everything you thought you knew about Caribbean medical schools.