Work: Diarrhea, DNA, Documents

Indeed, amidst all of the traveling, beaches, and football games, I am actually working. I admittedly have not spent much time discussing my work in this forum, and so I endeavor to share at least an overview of my work. I'm currently involved in a number of research projects and also have some opportunities to see clinical medicine practiced here in Fortaleza.

Research Projects:
1. Effect of Chronic Early Childhood Diarrhea on Physical Fitness
In this study, we are looking at children who now are roughly ages 8-16, whom were surveilled for diarrhea during their first 2 years of life. Our lab previously showed that children with high diarrheal burdens early in life had decreased physical fitness at ages 5-10, and now we will investigate whether these adverse effects on physical fitness persist. Currently, I spend 4-6 half days a week in the community administering physical fitness tests, and checking blood pressure, height, weight, and other anthropometrics. Administering the physical fitness test involves supervising a balloon game in which children wear watches with motion detectors, and admnistering a test called the Harvard Step Test. This has turned into a physical fitness challenge for me as well, as I perform each harvard Step Test along with the children to help them maintain the appropriate pace. This involves five minute stair climbing sessions that complement my evening runs well as I try to improve/maintain my own physical fitness. This study is very enjoyable as it allows me to spend time each day in a favela near our lab working with the children in the community.

2. Effect of Chronic Early Childhood Diarrhea on Vision
This is a study for which I am currently writing protocols for submission to the Institutional Review Board. This study is a study that I will hopefully be coordinating from start to finish, beginning with developing the hypotheses and writing protocols, continuing with data collection and analysis, and ultimately with reporting the results in the form of a paper. Currently, my time on this project mostly involves writing protocols and preparing documents, but by January or February should be in the community conducting vision tests with a similar time commitment as the physical fitness study, which will have concluded by that point.

3. PCR Studies
I'm also involved in multiple other studies that utilize PCR (Polymerase Chain reaction). PCR is a mechanism for amplifying DNA. It is used for multiple diagnostic tests for various infections. Effectively, I start with a stool sample which contains human DNA, and the DNA of many normally present bacteria, as well as any pathogenic bacteria or parasites. I then extract DNA using a series of chemicals that allow me to progress from a stool sample to a solution that looks more like water, which contains the DNA. I then need to isolate the DNA for the bacteria or parasite for which I am testing. For this we use special sequences of DNA called primers, which allow us to use PCR to amplify only a specif region of DNA corresponding to the organism of interest. We then can assess samples for the presence or absence of this sequence of amplified DNA using a process known as gel electrophoresis. In summary, these projects will involve me conducting laboratory tests to determine whether patients have one of two parasitic causes of diarrhea (Cryptosporidium or Giardia) or a bacterial cause of diarrhea (Enteroaggregative Escherichia Coli). There are also other PCR tests for many other bacterial and parasitic causes of diarrhea, but I will focus on the three mentioned above. I'll be using these tests in three different populations to assess the causes of diarrhea in those populations. Currently, I spend a few days a week working on these assays, trying to get them up and running before I begin receiving stool samples to analyze en masse.

Aside from this research, I also have opportunities to observe the practice of medicine at the local hospitals. I was able to round at the ID hospital and hear many diagnoses discussed that rarely are mentioned in the US. I hope to take advantage of these clinical opportunities more often as the research begins to flow more smoothly.

And so, indeed I am working in addition to enjoying the football, food, and praias (beaches) of Brazil. I should also qualify this description of my work by mentioning that this Thursday is yet another Federal holiday, which means another four day weekend. On this occasion, our fellow Fogarty fellow from Salvador, Brazil will be visiting Fortaleza. We plan to visit Morro Branco and another beach 3 hours east of Fortaleza called Canoa Quebrada, in addition to seeing a bit of Fortaleza. We'll return to Fortaleza some time Saturday, and head back to work on Monday. November brings with it two holidays, and plans for those are still in the works. The latter holiday may present a good time for a 7-10 day trip to the Amazon. I had planned to try to visit there during the second half of the year, but have learned that during that time (the rainy season), the weather may not be as optimal. For that reason, we may consider undertaking this journey in mid-November. For now, its off to bed to rest in advance of another expedition to the Policia Federal to attempt to register as a foreign citizen in Brazil. I received my passport via DHL today (although a bit wet as they apparently lost it briefly en route) and it now has all of the appropriate notations, thus I expect that this will be less of a pain than my last few trips to their office.