Friday, April 21, 2017

Mosquitos, Manicurist and HIV

Medical Mythbusting #3

HIV transmission from mosquitoes and from manicurist

Question:  Can HIV be transmitted from a mosquito or from a manicurist?

P – Patient Information:  15-55 year old men/women in Central Africa
I – Intervention:  transmission through mosquito or manicurist
C – Comparison: Transmission through sexual contact, breast feeding, labor/delivery, Contaminated blood
O – Outcome: an HIV + case from mosquito or manicurist

The stigma that is attached to HIV in Africa is still a huge contributing factor to the high death rate.  In Equatorial Guinea, HIV/AIDS continues to be the #1 cause of death in the country.  Many myths have risen from this because there is a desire to find an ulterior means of transmission than the normal “sexual sin” modes.  Because of that, the myth that mosquitoes and manicurists can transmit the HIV virus remains the most believed mode of transmission to most people here.

Here is what my research has found:

Only saliva is injected into humans when a mosquito bites.  HIV positive blood that a mosquito may have previously ingested is never transmitted to other humans.  Unlike mosquito borne diseases, HIV is unable to replicate within the mosquito’s gut and therefore is broken down.

HIV is extremely weak outside of the human body. It breaks down immediately once it comes into contact with the air. This being said, it is not possible for HIV positive blood to be transferred onto/dry on a surface (i.e. a pedicure tool) and then transmit HIV to you. All the tools at the salon were fully exposed to the air, which means any HIV in the body fluids that you fear were on the tools would have died before coming into contact with you.” - AIDS Vancouver Helpline for HIV related information.

Tuesday, April 18, 2017

Stun guns and Snake Bites

Medical Mythbusting Situation #2

Snake bites - there are a lot of nasty snakes here in Africa - just a few are: black cobras, both green and black mambas, boomslang, gaboon viper, and African rock python.  The availability of anti-venom is all but non-existent.  And these aren't "nice" snakes - so I really really really wanted this to be true...let's see what I found out...

1.      Question:  Will a stun-gun or other means of electrical current be effective as an anti-venom treatment?

P – Patient Information:  35 year old snake-bite victim
I – Intervention: stun-gun
C – Comparison:  anti-venom vaccine
O – Outcome:  effective anti-venom properties

Because anti-venom is difficult if not impossible to come-by in many third world countries, the concept of using some sort of electrical current by means of a car battery or stun-gun is a widely-accepted method in the prevention of death due to a snake bite.  Here is what my research found:

“Articles have been written in many outdoor magazines and other literature stating that stun guns can be utilized to treat venomous bites and stings.  This method is still considered to be an option by some medical practitioners and enthusiasts of the outdoors.  A Medline search was done using the search of venomous bites, venomous stings, snake bites, spider bites, electrical, stun gun, high voltage electricity, low amperage electricity, direct current, and shock therapy.  Some of the articles selected included laboratory-based isolated venom studies, animal studies, and case report where humans were involved in which a stun gun or other source of high voltage, low amperage direct current electric shocks were used to treat actual or simulated venomous bites or stings.  The conclusion that was found in these studies indicated that the use of stun guns or other sources of high voltage, low amperage direct current electric shock to treat venomous bites and stings is NOT supported by the literature.”  

 I really wanted this one to be true – but as it is not supported by the literature, I couldn’t, in good conscious, use it as a go-to for medical treatment.  So there you have it - if you get bit - don't shock yourself, go seek aid immediately.  Or in our case, pray a lot, and look to be evacuated to another country for assistance.

Welch, B., Gales BJ; (2001).  Use of Stun Guns for Venomous Bites and Stings:  A Review.; Wilderness Environ Med. 12(2): 111-7

Additional references:
“… continued use of HVDC shock therapy for treatment of snakebites is another instance in which favorable results of anecdotal reports have not been reproduced in controlled studies.” (Gold, 1993).

Gold, BS. (1993). Electric shock: a potentially hazardous approach to treating venomous snakebites. Md Med J, 42, pp. 244–245

Johnson, EK, Kardong, KV, Mackessy, SP. (1987). Electric shocks are ineffective in treatment of lethal effects of rattlesnake envenomation in mice. Toxicon, 25, pp. 1347–1349

Thursday, April 13, 2017

The "doctor" is in...

Living here I have found that I have a whole lot of house visits from people who are sick.  In Honduras, we lived fairly far away from the villages we worked in, but here, we live as every other Equatorial Guinean lives.  We live in a house just like theirs, in a community where they live - we live much closer to how the average person lives then we ever did in Honduras.  In Honduras we lived in the "upper class" neighborhood, so no one every visited us.  Here, we live like the rest of the country does.  Because of that we are much more accessible to the average Guinean.  What that looks like is I have people coming to my door 2 - 3 times a week looking for medical help.  Today that looked like a 2 year old that had vomiting since last night.  No other symptoms  - no fever, no diarrhea, no nothing.  The rest of the assessment was totally benign.  So, I gave him some Oral Rehydration Solution formula, and some parasite meds and sent him on his way.  I admit, I feel totally out of my depth, I don't have labs to help figure out what is wrong, I don't have a medical degree to perhaps get a better understanding of what he may have - I only have my wits, my nursing degree, and a lot of hands-on experience to pull me through.  This is more than most people here have, and I have to take comfort that I have given more than they are able to find at a local hospital, but I still have a feeling of complete inadequacy, a feeling of I'm "just" a nurse, and I know the limitations that I am...but I am praying that maybe oral rehydration  solution, and some parasite meds will put him right...because that's all I can offer...I pray it is enough. The reality is -I have NO idea what is wrong with this child - with my limited resources, and my limited knowledge I can only make an educated guess.  And in the grand scheme of things - I hope that that is enough...#feelinginadequate #justanurse

Monday, April 10, 2017

Papaya leaves and Malaria

Medical Myth #1

Having been on the mission field for almost 10 years, and mostly in the capacity of a medical provider, I have found some very interesting “natural remedies” along the way.  Not being one to discount anything that isn’t “standard care” – I wanted to give them the benefit of the doubt.  A lot of incredible medicine and care has come from “natural remedies.”  However, in my desire to educate people and give them accurate information, I wanted to do the research to determine if these “cures” actually worked or not.  Using a technique I’ve learned from my Public Health Masters class – here is what I have found:
1.      Question:  Do papaya leaves have anti-malaria properties?
P - Patient information:  A 25-year old, national (Equatorial Guinean) otherwise healthy man came to my clinic and wanted to know if chewing/eating papaya leaves will prevent malaria in a chloroquine resistant strain (primarily falciparum) strain of malaria.   
I - Intervention – eating papaya leaves to prevent malaria
C - Comparison – to conventional treatment of chloroquine resistant malaria using mefloquine, doxycycline, or malarone.
O - Outcome – no evidence of malaria in one year
I searched on PubMed using the key words “papaya leaves” and “malaria”.  The results brought up only two studies related to this issue.  This concept is used as a “natural” preventative and is believed in this area, and many other parts of the world. I was therefore a bit surprised at the limited amount of information I was able to find.  As there was limited information, I further looked for a correlation specifically to the alkaloid that is found in papaya leaves – carpaine – and did an additional search for “carpaine” AND “malaria” and came up with the same two articles.  If I attempted to limit the search to RCT (Randomized Control Trial – the gold standard), then no articles appeared.  Their conclusion on both articles was that there is a potential association with the alkaloid compound of carpaine that is found in papaya leaves and it’s ability to prevent malaria, however they had no definitive conclusion, stating that further studies needed to be done.  In addition, there was found to be a varying percentage of carpaine in each leaf from 0.02% - 0.31%.  This further leads to a difficulty in how to “prescribe” papaya leaves to a patient.  Based on this information, I would advise my patient that the best form of malaria prevention was the standard treatment of care, using one of the prescribed treatments for chloroquine resistant malaria. 
Ourif, M., Julianti, T., Hamburger, M. (2014).  Quantification of the antiplasmodial alkaloid carpaine in papaya (Carica papya) leaves.  Planta Med, 80 (13): 1128-42.

Julianti, T., De Mieri, M., Zimmermann, S., Ebrahimi, SN., Kaiser, M., Neuburger, M., Raith, M., Brun, R., Hamburger, M. (2014). HPLC-based activity profiling for antiplasmodial compounds in the traditional Indonesian medicinal plant Carica papaya L. Journal of Ethnopharmacology, 155(1): 426-34.