Terrie Taylor

UPDATE FROM MALAWI, APRIL 2019

Dr. Karl Seydel and I assess the Blantyre Coma Score on a study patient.

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.

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.

Me with the sign painter and the sign for the MRI in progress. This version didn’t last very long.

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.

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).

WORLD MALARIA DAY 2018: IT'S WORKING!

We have seen A DROP in the number of cases of cerebral malaria over the last 6-7 years.

At first, we attributed this drop to the weather (too cold, too wet, too dry, too hot ...) but last year, the weather was perfect, and the low numbers still held. It's a real phenomenon, and is likely due to a combination of interventions — but, for severe disease in children, a lot of credit has to be given to the widespread use of malaria rapid diagnostic tests (which require no equipment and no electricity) and the availability, at no cost here in Malawi, of rapidly effective treatment (artemisinin combination therapies. or ACTs) to anyone who tests positive for malaria. Read more.

WORLD MALARIA DAY 2017: END MALARIA FOR GOOD

Recent success in the malaria field has shown that prevention works: expanded access to proven, cost-effective prevention tools has significantly reduced the disease's global burden. In Malawi, our community partners have stepped up with early diagnosis and effective treatment. On World Malaria Day 2017, WHO is shining the light on prevention and ending malaria for good. We are more confident about defeating malaria than we have been in a long time. We are thrilled to be shining a light — and making strides — on cerebral malaria, which still kills hundreds of children in sub-Saharan Africa. The Lancet recently published an article about our research, past present and future. Read it here.

Dr. Terrie Taylor, left, and Dr. Karl Seydel take a child's vitals in the malaria ward at Queen Elizabeth Hospital in Blantyre, Malawi.

Courtesy of Jim Peck/Michigan State University

TAKING THE NEXT STEP TO SAVE CHILDREN DYING FROM MALARIA

When Terrie E. Taylor, an internationally recognized physician and scientist, and her team discovered that massively swollen brains cause death in children with cerebral malaria, the deadliest form of the disease, it was an extraordinary first step toward finally saving children. Now Taylor and her colleagues are preparing to take the next crucial step.

With a $500,000 grant from the National Heart, Lung, and Blood Institute, Taylor will begin investigating what is causing the brains to swell, which is the next phase in developing treatments.

“Too many kids are still dying,” Taylor said. “We, as a global community, should be concerned and support efforts to save these children even as we try to eradicate the disease.”

MICHIGAN STATE MOUNTS MALARIA OFFENSIVE

In Malawi, children infected with malaria are dying with massively swollen brains.

Dr. Terrie Taylor and her team discovered this when Michigan State donated an MRI machine, "which illuminated the cause of death starkly and clearly," Taylor said. 

Taylor outlines her plan to leave the malaria parasite "cornered and quaking." 

TERRIE'S TED TALK: UNLOCKING THE MYSTERIES OF CEREBRAL MALARIA

“It’s gut-wrenching when children die from malaria, but what keeps us going is that we are making progress against this Voldemort of parasites. It’s an elusive quarry, but have it cornered.”

Dr. Terrie Taylor describes her 28+ years of research on cerebral malaria in children in Malawi. A new MRI machine there helped unlock mysteries and now she is working on new medical interventions. It’s an important problem, but it’s solvable, she says, with continued research and clinical trials. https://www.youtube.com/watch?v=hJNe2qUCfSw