Friday, November 27, 2009

Research in India

I'm just going to start out by saying hi to everyone after a long absence from posting. And by apologizing for my absence from this blog. Each day things happen here that I would love to write about and to share with all of you, but somehow, I never seem to get the actual posting done. Not really sure why posting is so difficult, but I am going to try to do better and I'm going to start looking at blogging from a new viewpoint. Rather than writing novel-like posts infrequently, I'm going to try to share short stories, thoughts, and impressions with all of you -- at the amazing rate of every day or every other day. We'll see how it works out...but I think that it will be manageable. And of course, I'm sure that these short posts will be interspersed with ones of mammoth length, because sometimes there is just too much to say.

Now, to be honest, a big part of why I haven't posted in the past weeks (the last two in particular) is because I have been really struggling - especially with my research. About two weeks ago I was given the news that my research project may be delayed by an additional two months. After three months of striving to get institutional approval, to meet and recruit physicians to work with me, to find funding, and to learn how to navigate the institution that is Indian research, the news that I might be spending the next two months making absolutely no progress and most likely doing little to no work, almost pushed me over the edge. As I'm sure my parents could tell you, I was very very upset and seriously contemplated throwing in the towel and heading back to the comforts of the United States. But it just isn't in me to up and quit things, so I pulled myself back together and set about figuring out how I can get the project up and running in the upcoming weeks... To make what could be a very long story short, after some meetings and discussions, I will now be beginning the patient recruitment phase of my study on Monday - something that I am extremely excited about! I'm hopeful that things will get off the ground and that in a few weeks time, I could have actual data coming in! I am sure that I will face many obstacles in getting patients involved in my work, but I would much rather be actively dealing with these obstacles than sitting around...

Up to this point, I haven't really used this blog as a forum to talk about my research in any depth. But, I thought that I'd share with you all a little bit more about my project. I came to India planning to do work on drug-resistant tuberculosis, particularly the methods used to diagnose and treat drug resistant strains. However, due to several complications, this project quickly became impossible and so I switched gears. I'm still working with tuberculosis, but from a completely different angle.

Every year, in India alone, there are 1.8 million new cases of tuberculosis - which is an astonishing number. Consider the fact that every year, in the U.S., there are less than 12,000 new cases; clearly TB isn't something that we often worry about. Here tuberculosis is a daily threat and there are estimates that up to 80% of the population has the latent (or inactive) form of tuberculosis. Of these 1.8 million new cases, approximately 180,000 will occur in children and approximately 500,000 people will die. The fact that 500,000 people are dying annually from tuberculosis in India is part of the reason that I get so frustrated when the media focuses on H1N1. Of course, the flu may pose a legitimate threat, but witnessing people in a panic due to the flu when there is a much greater killer being ignored and receiving no media attention truly irritates me.

But, anyway, back to my research... When I was looking for a new topic to work on, the numbers of children stricken by tuberculosis deeply affected me. TB has been and still is a major cause of mortality amongst children - and almost all of these children are in developing countries. Kids have immune systems that aren't yet strong enough to fight off the TB mycobacterium and so not only are they in danger of getting TB, they also develop the severe forms of TB at much higher rates than adults. For example, kids can develop meningeal TB, meaning that the tuberculosis infection spreads from the lungs into the brain - often causing death. So, in light of this, I decided to work with a pediatric patient population.

What my project has developed into is a study of tuberculosis diagnostic tools in kids. The tuberculin skin test (an injection of TB protein derivatives under the skin of your forearm) which I'm sure everyone reading this has received, is the standard initial diagnostic tool. But, in kids (and adults), it is highly inaccurate and can have false positives and false negatives due to a huge range of factors. Well, a company in Australia called Cellestis developed a new diagnostic tool that uses a blood sample about 4 years ago. There are hopes that this tool could replace the TST as a better indicator of tuberculosis infection. Until now, it has been widely studied in the adult population, but not in children. And that is where my study comes in.

What I am hoping to do over the next 5 months is to recruit approximately 80 children between the ages of 1 and 10. All of these kids will be suspected to have tuberculosis. As part of the study, we will administer the tuberculin skin test and the new diagnostic tool, which is called the Quantiferon-TB Gold In-Tube (a mouthful, I know - we shorten it to QFT) and then compare the results of these two tests with the final diagnosis of each patient. Basically, what we are hoping to find is that the QFT is more accurate than the TST and could be a replacement tool. I'm also going to be looking at the charts of 95 patients between 1 and 15 from the past two years, who received the QFT, in the hopes of gathering a bigger data pool. With more data, more significant statistics can be performed and hopefully, we can get an accurate look into how well the QFT works.

Well, that is my project in a nutshell - I hope that it was clear! As I said above, I'm sure that I will face many more obstacles in my pursuit of this project, particularly since it involves children and I will need to interact with people from all over India, many of whom won't speak English. But, I have decided that being negative and feeling defeated won't get me anywhere. I am going to be positive and proactive and do everything possible to conduct a legitimate scientific study during my remaining time - and maybe even make a bit of a contribution to the ongoing fight against tuberculosis...

A belated Happy Thanksgiving to everyone back in the States! I missed you all and although I was with a big group of people on Thanksgiving and had a wonderful day, it just wasn't the same as celebrating back home. I hope that you all had an awesome day with lots of turkey and potatoes and green bean casserole and pie! Oh, what I would give for a piece of my Dad's apple pie right now... Enjoy "Black Friday" those of you that are shopping and have a great weekend!