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Volunteer review Joshua Manning in Honduras La Ceiba PreMed Program at local hospital by A Broader View Volunteers Corp

Volunteer review Joshua Manning in Honduras La Ceiba PreMed Program at local hospital

1.-How was the local ABV Coordinator and the support provided in-country?

Our ABV coordinator, was a trooper. He dealt with our constant nonsense, our heartless mangling of his language, and our odd hours with no complaints. Without him our efforts would have collapsed into a haphazard mess. John Nurse, our contact at the clinic and hospital, was a stronger character. The nurses and doctors almost universally enjoy helping us gringos, and the ABV office keeps a presence with occasional emails. I always felt as if there was a safety net.

2- What was the most surprising thing you experienced?

At the program: Don’t expect the same standard of sterility and urgency which is commonplace in the States. As frustrating as it will likely become, the laid back central american nature encapsulated by the word ‘siesta’ permeates into even the emergency rooms. At the same time, their ‘sterile field’ is usually nothing more than the paper they took their gloves out of.

At the accommodation: I did not stay with the coordinator, and I was surprised to find that my host family was changing their daily lives to accommodate our program schedule, to an extent. Señora Argentina was wonderful, and the food at the house was great. Bear in mind that if you live with a different family, they need to be kept in the loop. Don’t stroll up at 9pm for dinner when they eat at 5:30 unless you told them beforehand, follow the local time for meals.

About the country: La Ceiba doesn’t reflect the reputation Honduras has garnered in recent years. Expect relative poverty, expect a language barrier if your Spanish is no bueno, but don’t expect to fear for your life. Don’t be too stupid, don’t wander the streets at midnight, don’t challenge people on the streets, and you’ll be A-OK.

3- What was most difficult to experience?

At the program: Pain is a constant presence in Honduran medicine. I understand that it exists everywhere, and sometimes medicine requires it. However, I feel for our patients here. It broke my heart nearly every morning to see an old woman cry in the clinic while simply having an ulcer on her foot cleaned. It’s necessary here, but was almost alien to me.

At the accommodation: Our showers are cold, and my water shut off at 10. It’s a petty complaint, don’t let it deter you. The trip is well worth it.

The country: Honduras is beautiful, often in a mind-bending sort of way. The most difficult, and fun, experience here was navigating the city while still coming to terms with Spanish.

4- Any tips for future volunteers…

Clothing: Definitely a must. There are options for washing clothes, but they will cost you money, so prepare for a small expense, something in the realm of $5-10. Pack for a week, wash your clothes on the weekends. Also, watching surgeries requires changing into a clean pair of scrubs, so always have one with you. At least 10 or a week.

Donations: Everything on the emailed list is important. They need medicine like ibuprofen, desperately need antibiotic creams and medicines, and treat medical tools and supplies like gold. For things like sterile gloves, BP cuffs, Pulse Oxes, and tape, I would suggest keeping it in case you need it and donating it at the end. Also, anything you leave out or set on a table and lose sight of will likely become a donation as well.

Weather: It’s so hot here. The only time I don’t feel like I am or might start sweating is when I’m in the shower. Don’t worry about it though, it builds character.

4.1-Other things volunteers should know:

a.- If you speak high school Spanish, and you’re comfortable looking like a bit of an idiot sometimes, just go for it. If you don’t speak any, be clear on wanting the translator, else you’ll be relying on your new volunteer friends a lot if they know spanish.

b.- Decide beforehand what you’ll be comfortable doing. The possibilities are nearly limitless. You won’t be performing an appendectomy, but you’ll be able to learn procedures here that would be more off-limits back home. Also, definitely have sterile gloves, along with normal gloves, if you can find them.

c.- Figure out spending money beforehand as well. The exchange rate is L22 lempiras to a dollar, taxi rides to the volunteer sites are L25 limps, you’ll be taking between two and four on a normal day, if the coordinator can he will give transportation (its not included) so be flexible, and weekend excursions could be as little as US$50 or as much as US$250, depending on what you want to do and spend.

d.- Be vocal. Learn the word for ‘can’ (poder) and ‘try’ (tratar), and use them. ‘I want to learn’ (Quiero aprender) is a great sentence to have and use. If you ask, they’ll usually let you, and if you don’t know how, they almost invariably will show you.

5- Personal Paragraph (ABV Program Testimonial), don’t leave blank:

A Broader View offers an extremely fascinating and largely unique opportunity with this type of trip. I figured out early on that as a pre-med student, my donations were invaluable, and my help was tolerated, though tolerated happily as near as I could tell. In the clinic, we took blood pressure, cleaned wounds, and removed stitches. At the hospital, we were able to watch some surgeries and live births. In the emergency room, we set casts, helped with suturing, and witnessed real life for a group of impoverished people. Sometimes, tragically, people didn’t make it. This trip was real, and most certainly not a vacation. On top of everything else, one of the most valuable things I gained was perspective.

6- How would you describe your accommodation, meals and security:

The accommodations were better than I honestly expected, despite the lack of AC. My fan was usually perfectly fine. I never really felt unsafe, and didn’t take any undue risks. The meals were mostly tremendous, with a couple of exceptions involving white bread, beans and rice. I was never hungry, frequently tired, and always hot. I’m also strongly considering coming back.

7- What was your favorite memory of this trip?

Program: Picking out a single memory is difficult. My first really good memory with the program helping with casts in my first couple of days. I got along well with the doctor, I could understand a lot of what he told me, we got a good picture with the girl, and she asked us to sign her cast. The medical interns here are used to crazy volunteers making a near-spectacle in the ER, and it’s cool so long as there isn’t an emergency at the time.

Country: I only had one weekend excursion, and it was amazing. Utila is a beautiful island similar to Roatan, but infinitely cheaper. I went with some new friends I met here, we visited bars and the beach, went shopping, and played cards incessantly. I wish I could’ve had more weekends like it, but I’m thankful for the one I had.

8.- How was the ABV USA support prior traveling?

Communication (Phone/emails/Online chat): While I was setting up my trip here, I relied heavily on phone calls to the office with random questions. Their hours are somewhat short, and you may not always have someone pick up on the first ring, but they always get back. Email communication is more frequent and consistent. Read the emails thoroughly, there could always be important information in them. They also sent me a ‘Happy Birthday’ email, which was pretty nice.

Website Information: From what I recall, the website info is generally correct, but almost slightly misleading. A lot of things done here are free form. If you pay for classes, but would rather go to the hospital one afternoon, you certainly can. Just make sure your teacher finds out. If you don’t want to go to the clinic that morning, or you want to work a night shift in the ER, it can usually be worked out. Be ready and willing to change tracks quickly.

9 – Are you willing to speak to other potential ABV volunteers?

Sure, we can be pen pals. Emails would probably be your best bet. I’m more than happy to answer questions.

10 – Can you tell us how did you find or know about A Broader View?

A group of my friends found the trip, we planned it together, and then they decided to go later. As a result, I’m here by myself, and I couldn’t be happier with the way things worked out. However you found this trip, don’t be afraid to leave your comfort zone.

www.abroaderview.org

#volunteerabroad #honduras #laceiba #premed #abroaderview

The Microbiome: the forgotten organ of the astronaut's body - Probiotics beyond terrestrial limits. by Uber Nutra

Abstract

Space medicine research has drawn immense attention toward provision of efficient life support systems during long-term missions into space. However, in extended missions, a wide range of diseases may affect astronauts. In space medicine research, the gastrointestinal microbiome and its role in maintaining astronauts' health has received little attention.

We would like to draw researchers' attention to the significant role of microbiota. Because of the high number of microorganisms in the human body, man has been called a 'supra-organism' and gastrointestinal flora has been referred to as 'a virtual organ of the human body'.

In space, the lifestyle, sterility of spaceship and environmental stresses can result in alterations in intestinal microbiota, which can lead to an impaired immunity and predispose astronauts to illness. This concern is heightened by increase in virulence of pathogens in microgravity. Thus, design of a personal probiotic kit is recommended to improve the health status of astronauts.

Introduction

Living in space has been a great desire for mankind, leading to the development of space stations for long-duration manned space missions. The design of a life support system is needed to maintain the minimum life requirements for humans in space by conserving a stable body temperature, a standard pressure on the body and by managing waste products.

So far, the majority of research in this area has been devoted to the human primary requirements such as air, water and food. Furthermore, a life support system deals with astronauts' healthcare. Although health status of the astronauts such as immunological and physiological problems has been investigated, less attention has been paid to the intestinal microbiome and its significant role in the astronaut's health.

Immunological and physiological health problems could occur when considering the identified increase in the virulence and antibiotic resistance of some infectious bacteria exposed to microgravity, along with possible weakening of the immune system during space flight. Compensating for these alterations may not only enhance the health and immunity status of astronauts, but might have possible effects on enhancing the duration of space journeys.

For many years, the importance of intestinal flora in human health and disease has been known to man. Researchers have suggested a possible association between the changes in the balance of gut flora and several diseases. At the end of the Human Genome Project, the aggregation of flora genes within the human genome was named the 'human metagenome, highlighting the crucial role of the microbiome in the maintenance of health.

This perspective highlights the crucial role of the microbiome in the health and/or disease status in astronauts. Considering astronauts' special health and nutrition needs in orbit, it could be advantageous to develop probiotics for each crew member. These healthy bacteria could then be consumed during long-duration missions to replenish the intestinal microbiome.

The Human Intestine & the Microbiome

Today 'gut health' is a term increasingly used in the medical literature to describe effective digestion and absorption, the absence of gastrointestinal lesions, presence of normal intestinal microflora and proper immune function. However, from a scientific point of view, it is still extremely unclear what gut health is or how it can be defined and/or measured.

The interactions between the gastrointestinal barrier and the microbiome appear to be a complex mechanism that assists in maintaining gut health. The gastrointestinal tract contributes to digestion and absorption of nutrients, minerals and fluids, osmoregulation, endocrine regulation and host metabolism, mucosal and systemic tolerance, immunoenhancement, defense against potential pathogens and harmful substances, signaling from the periphery to the brain, and detoxification of toxic molecules originating from the environment or the host.

Recognition of the importance of gastrointestinal health and microflora can be an important asset to astronauts' health.

Across the large surface of the digestive tract, healthy and pathogenic bacteria compete for dominance. With such a huge exposure area, the immune system has a hard task of hindering pathogens from entering the blood and lymph. The presence of a balance between beneficial and potentially harmful bacteria is considered normal and contributes to a dynamic and healthy human gut.

One way to maintain this homeostasis is to introduce helpful bacteria or probiotics. After the first suggestion of the health benefits of probiotics in the early 20th century by Nobel Laureate Metchnikoff, many bacterial strains have been clinically tested as potential probiotics. Probiotics are thought to play a health-promoting role by improving intestinal microbial infections.

The surface area, apparent balance of microflora and health impact of the human gut reminds us that this complex organ must not be forgotten as one factor in long-duration spaceflight health.

Stress & Gut Microbiome

The Human Genome Project revealed that the human body is the habitat of microbial symbionts ten-times more in number than Homo sapiens cells. The recognition of the complex interactional environment between the human and our symbiotic microflora led researchers to name this the 'human microbiome'.

In the human gut, the microbiome directly influences biochemical, physiological and immunological pathways and is the first line of resistance to various diseases.

Traveling can act as an environmental stress causing changes in the microbiome composition or its gene expression. This may lead to the transient (as in travelers' diarrhea) or permanent dominance of pathogenic gut bacteria. Recently, it was shown that exposure to a social stressor altered the composition of the intestinal microbiome, indicating stressor-induced immunomodulation.

It was demonstrated that stressor exposure changes the stability of the microflora and leads to bacterial translocation. Circulating levels of IL-6 and MCP-1 increased with stressor exposure and these increases were significantly and positively correlated to changes in three bacterial genera (i.e., Coprococcus, Pseudobutyrivibrio and Dorea) in the cecum.

This suggested that the microbiome somehow contributed to stressor-induced immunoenhancement. To test the theory, in follow-up experiments, mice were treated with an antibiotic cocktail to determine whether reducing microflora would annul this stressor-induced increase in circulating cytokines.

In the antibiotic-treated mice, exposure to the same stressor failed to increase IL-6 and MCP-1 confirming that intestinal microflora were necessary for the observed increase in circulating cytokines.

Microgravity Stress Alters Bacterial Virulence

Studies have shown an increase in the virulence, changes in growth modulation and alterations in response to antibiotics in certain bacteria both in space and simulated microgravity. Significant technological and logistical hurdles have hindered thorough genotypic and phenotypic analyses of bacterial response to actual space environment.

In this line, Wilson et al. cultured Salmonella enterica Typhimurium aboard space shuttle mission STS-115 with identical cultures as ground controls. Global microarray and proteomic analyses were carried out and 167 differentially expressed transcripts and 73 proteins were identified among which conserved RNA-binding protein Hfq was suggested as a likely global regulator involved in the response to spaceflight.

Similar results were obtained with ground-based microgravity culture model. Furthermore, spaceflight-grown S. enterica Typhimurium had enhanced virulence in murine models and exhibited extracellular matrix accumulation consistent with a biofilm. Typhimurium grown in spaceflight analog exhibited increased virulence, increased resistance to environmental stresses (acid, osmotic and thermal stress), increased survival in macrophages and global changes in gene expression.

Low-shear modeled microgravity rendered adherent–invasive Escherichia coli more adherent to a mammalian gastrointestinal epithelial-like cell line, Caco-2. Simulated microgravity conditions markedly increased production of the heat-labile enterotoxin from enterotoxigenic E. coli. Upon a 12-day exposure to low-shear modeled microgravity, Candida albicans exhibited increased filamentation, formation of biofilm communities, phenotypic switching and more resistance to the antifungal agent amphotericin B.

Only one virulence gene was found among 163 differentially expressed genes in simulated microgravity grown S. Typhimurium and actually, most virulence genes were expressed at a lower level (including genes involved in lipopolysaccharide production). Furthermore, sigma factor (a transcription factor responsible for a general stress response) was not thought to be a cause, since a decreased level of its gene expression was observed in simulated microgravity.

The mechanism of enhanced virulence of S. Typhimurium grown in actual spaceflight and rotating wall vessel culture conditions does not involve an increased expression of traditional genes that regulate the virulence of this bacterium under normal gravity conditions; however, Hfq pathway is required for full virulence in S. Typhimurium.

Biofilm formation is part of the normal growth cycle of most bacteria and this film is linked to chronic diseases that are difficult to treat such as endocarditis, cystitis and bacterial otitis media. Bacterial biofilm creates superior resistance to oxidative, osmolarity, pH and antibiotic stresses.

Theoretically, bacterial biofilm production, which enhances bacterial survival by resistance to the immune system and antimicrobial agents, may increase the risk and/or severity of infection in long-term space missions. Diminished gravity has been shown to stimulate bacterial biofilm formation both in E. coli and Pseudomonas aeruginosa. In a study by Crabbe et al. in 2008, rotating wall vessel technology was exploited to study the effect of microgravity on growth behavior of P. aeruginosa PAO1.

Rotating wall vessel cultivation resulted in a self-aggregating phenotype, which subsequently led to formation of biofilms. In a second study in 2010, the same researchers employed microarrays to investigate the response of P. aeruginosa PAO1 to low-shear modeled microgravity both in rotating wall vessel and random position machine.

P. aeruginosa demonstrated increased alginate production and upregulation of AlgU-controlled transcripts (including those coding for stress-related proteins) in modeled microgravity. Results of the study also implicated the involvement of Hfq in response of P. aeruginosa to simulated microgravity. Involvement of Hfq in response of P. aeruginosa to actual spaceflight was later confirmed in another study.

In addition, there is concern that antibiotic-resistance increases during short-term spaceflight. The MIC of both colistin and kanamycin increased significantly in E. coli grown aboard the flight module compared with the MIC on the ground. A similar increase in the MIC of oxacillin, erythromycin and chloramphenicol was reported in Staphylococcus aureus. This has led to concerns that the efficacy of antibiotics may be diminished during even short orbital missions.

It has been hypothesized that reduction in the natural, terrestrial diversity of the gastrointestinal bacterial microflora in spaceflight may give rise to an increase in the presence of the drug-resistant bacteria. It has also been postulated that the emergence of such resistant clones could be facilitated by the administration of antibiotics either before or during the flight.

Emergence of drug resistance is also facilitated by bacterial mutation which occurs more frequently in long-term spaceflights. Overall, there is the possibility that drug-resistant bacteria could colonize all crew members on a mission, giving rise to a difficult-to-treat healthcare problem.

Spaceflight & the Microbiome

In an attempt to protect astronauts from exposure to novel pathogens preflight, several guidelines are carried out. Prelaunch, crew members are limited both in travel and visitors to limit pathogen exposure. Therefore, crew members tend to launch with normal gut microflora and with a reduced risk of gut infection.

Items flown to the International Space Station (ISS) are cleaned before loading to limit introducing bacteria to the environment. Once in orbit, all areas in the ISS have ultra-high-efficiency bacterial filters in the air supply ducts to reduce the levels of bacteria and fungi. Finally, cleaning of the surfaces of the modules is a regular 'housekeeping' chore to limit bacterial and fungal growth.

Still, microorganisms exist on the ISS. No matter how much cleaning is done, microorganisms are continuously shed from skin, mucous membranes, gastrointestinal and respiratory tracts or can be released by sneezing, coughing and talking. Specimens were obtained for mycological examination from the skin, throat, urine and feces of the six astronauts who conducted the Apollo 14 and Apollo 15 lunar exploration missions both before and after flight.

Analysis of preflight data demonstrated that the process of severely restricting opportunities for colonization for 3 weeks before flight resulted in a 50% reduction in the number of isolated species. Postflight data indicated that exposure to the spaceflight environment for up to 2 weeks resulted in an even greater reduction with a relative increase in the potential pathogen C. albicans.

The compositions of intestinal, oral and nasal flora have been shown to change even during short spaceflights. In one study, a reduction in the number of nonpathogenic bacteria and an increase in the number of opportunistic pathogens has been reported in the nasal flora of cosmonauts. A significant reduction in the number of bacterial species of the intestine has been seen after 2 weeks of spaceflight.

These observations were similar to changes seen in ground volunteers who were kept in isolation, in which volunteers were fed only sterilized, dehydrated foods. A significant decrease in the number of bifidobacteria, lactobacilli and other bacteria was seen. In a Russian experiment, a decrease in lactobacilli (and replacement with pathogens) were seen in mouth and throat cavities in all mission members in in-flight period.

Spaceflights and even the preparation phase before take-off can exert dysbiosis in the human microflora which results in reduction of the defense group of microorganisms (bifidobacteria and lactobacilli) and appearance of opportunistic pathogens such as E. coli, enterobacteria and clostridia. Subsequently, this procedure can lead to accumulation of the potentially pathogenic species and their long-term persistence.

Colonization resistance is one of the factors that needs to be taken into account to stabilize the microflora of the cosmonauts during space flights. Indigenous microflora are vital for preservation of microecological homeostasis. It has been hypothesized that a regular intake of probiotic foods might be helpful in correcting this change.

Human microflora functions as a barrier against antigens from microorganisms and food. Alterations in the microbiome composition have been reported in inflammatory bowel disease, inflammatory conditions, ulcerative colitis and more. Healthy immunophysiologic regulation in the gut has been hypothesized to depend on the establishment of indigenous microflora that create specific immune responses at the gut and system levels.

Furthermore, gut microflora has a role in induction and maintenance of oral tolerance in experimental animal models. Changes in the diversity and number of gut microflora have been linked to a deficient immune system as well as immunological dysregulation which is associated with many human noninfectious diseases such as autoimmunity, allergy and cancer.

Reinforcing this concept of health symbiosis, studies of germ-free animal showed wide-ranging defects in the development and maturation of gut-associated lymphoid tissues. Another way of viewing this health interaction comes from the data that ten Salmonella bacteria have been shown to induce infection in germ-free mice, while 109 bacteria are needed to induce infection in a conventional animal possessing intact intestinal microflora.

To maintain astronaut health on orbit, an awareness of the importance of a balanced gut microbiome to maintaining the immune homeostasis and resistance to infections is valuable.

Previous studies have shown that important immune parameters are decreased during spaceflight. Reductions in the number and proportion of lymphocytes and their cytokine production, depression of dendritic cells function and T-cell activation, and finally reduction in numbers of monocytes and precursors of macrophages, have been noted.

In one study, stresses associated with spaceflight were shown to alter important functions of neutrophils and monocytes. In another study, the astronauts' monocyte functions showed reductions in their ability to engulf E. coli, elicit an oxidative burst and degranulation. Non-MHC-restricted (CD56) killer cell cytotoxicity tends to decrease after short-term spaceflight.

In the latter study, the authors examined the age, gender (nine men and one woman), flight experience, mission factors and mission role (e.g., pilot, scientist or crew) of the astronauts and found no correlation between these variables and individual non-MHC killer cell function levels.

Therefore, other factors may contribute to the compromised immune system in space. Decreased natural killer cell cytotoxicity in cosmonauts after short- and long-term spaceflights have also been reported. Reductions in absolute numbers of lymphocytes, eosinophils and natural killer cells, reduced lymphocyte mitogenic response, diminished delayed-type hypersensitivity, changes in CD4+:CD8+ ratios and reduced production of IL-2 and IFN-γ have also been reported.

The immune system changes of astronauts as well as environmental stress may have been a factor in known incidents of infectious illness in crew members. During the Apollo 8 preflight period for instance, all crew members suffered viral gastroenteritis. During flight, the effects of mission duration on the neuroimmune responses in astronauts were studied and changes in plasma cortisol, epinephrine, norepinephrine, total IgE levels, number of white blood cells, polymorphonuclear leukocytes and CD4+ T cells were found at different times.

Upper respiratory problems, influenza, viral gastroenteritis, rhinitis, pharyngitis or mild dermatologic problems were among the illnesses that astronauts faced during Apollo spaceflights. Reactivation of varicellas zoster virus, herpes virus and shedding of Epstein–Barr virus was also found in space shuttle crew members.

In astronauts of the Mir station, analyses demonstrated a significant number of episodes of microbial infections, including conjunctivitis, acute respiratory events and dental infections. Future Perspective: Considering Probiotics as a Countermeasure

On Earth, probiotics have been shown to improve both innate and adaptive immune responses. Oral bacteriotherapy with probiotic bacterial strains is believed to improve the intestine's immunologic barrier, particularly through intestinal IgA responses and alleviation of inflammatory reactions. A gut-stabilizing effect seems to occur through a balance between proinflammatory and anti-inflammatory cytokines.

Lactobacillus rhamnosus GG has been shown to inhibit TNF-α-induced IL-8 secretion of human colon adenocarcinoma (HT29) cells and to reduce elevated fecal concentration of TNF-α in patients with atopic dermatitis and cow milk allergy. On the other hand, ingestion of lactobacilli in fermented milk products or as live-attenuated bacteria potentiated the IFN-γ production by peripheral blood mononuclear cells.

Oral administration of lactobacilli increased the systemic and mucosal IgA response to dietary antigens. Oral supplementation with Bifidobacterium bifidum and Bifidobacterium breve enhanced the antibody response to ovalbumin and stimulated the IgA response to cholera toxin in mice. An increase in the humoral immune response including an increase in rotavirus-specific antibody-secreting cells in the IgA class was also detected in children and individuals receiving L. rhamnosus GG.

Isolauri et al. reported that infants receiving a reassortant live oral rotavirus vaccine in conjunction with L. rhamnosus GG had a higher frequency of rotavirus-specific IgM class antibody-secreting cells. An increased incidence of rotavirus-specific IgA antibody class seroconversion compared with placebo subjects was also seen. IgA+ cells and IL-6-producing cells increased in number after 7 days of Lactobacillus casei administration.

In another study, administration of lactic acid bacteria stimulated the gut immune cells to release inflammatory cytokines such as TNF-α, IFN-γ and IL-12, and regulatory cytokines like IL-4 and IL- 10 in a dose- and strain-dependent manner. Several lactobacilli strains have been shown to promote the immunopotentiator capacity of cells of the innate immune system, including macrophages. Examples of probiotics that can modulate the gut immune system are abundant and have been reviewed extensively.

Buckley et al. have suggested that consumption of soy-based fermented products (containing lactic acid bacteria) can prevent the health problems of astronauts associated with long-term space travel. Assessment of soy-based fermented products by in vitro challenge system (using TNF-α) with human intestinal epithelial and macrophage cell lines has demonstrated the ability of the intervention to downregulate production of the proinflammatory cytokine IL-8.

Considering the importance of the human gut in healthy digestion, nutrient absorption and exposure to pathogens across its large surface area, a healthy digestive tract is important to a healthy human. Diet, lifestyle, antibiotic therapy, different kinds of stressful conditions and so on, can exert alterations in an astronaut's gut microbiome in space.

Considering potential immune system alterations from gut microflora changes, antibiotic use in orbit and changes of increased virulence and antibiotic resistance of bacteria in space, physicians who care for astronauts must remember the importance of the intestinal microbiome to their health status. From this perspective, an impaired digestive system might endanger the mission as well as the health of the astronaut. One countermeasure to be considered would be replenishing the astronaut's intestinal microflora by introducing immune-enhancing probiotic bacteria periodically during the mission.

Diet, lifestyle, antibiotic therapy and various environmental stresses, and so on, can exert alterations in an astronaut's gut microbiome in space and impair their immune system.

Although single probiotics have sometimes been shown to promote health, the human microbiome is composed of more than 400 microbial species, most of which remain uncultured and have as yet unknown functions. The Human Microbiome Project will certainly pave the way for us to increase our understanding of these microbial entities.[4] Thus, providing only a single probiotic might not be the answer.

Contrary to numerous previous investigations and clinical trials in which only effects of single or a couple of probiotics have been studied, we think multiprobiotic therapy and/or designing individualized probiotic kits seems a more reasonable option. A series of experiments need to be launched to confirm the efficacy and safety of using probiotics in space.

Safety studies are of equal importance as efficacy studies, since astronauts are immunocompromised (although as discussed above, much of this may return to washing out of microflora in space). These studies can be carried out initially in ground-based space analogs and further followed in actual space (first on animal models and then on humans). The lifestyle of astronauts can be simulated in these studies and after interventions; the composition of microbiota (including opportunistic pathogens) along with immunological markers should be determined.

Both short- and long-term confinement and actual spaceflight studies can be designed. The administration and/or consumption of probiotics is supposed to have immune-enhancing effects, hinder alterations in the human microbiome to a large extent and prevent colonization of potential pathogens. Upon observation of possible benefits, probiotics can be incorporated into astronauts' food or supplied periodically as a probiotic kit.

This line of research can be followed by NASA scientists and other space agencies to enhance the quality of life of astronauts and to contribute to human presence in space.

Surprisingly, this may bring a future where astronauts utilize probiotic bacteria to counteract the potential effect of pathogenic bacteria during spaceflight.

www.uber-nutra.com

This image is taken from United States Naval Medical Bulletin Vol. 14, Nos. 1-4, 1920 by Medical Heritage Library, Inc.

Go to the Book with image in the Internet Archive

Title: United States Naval Medical Bulletin Vol. 14, Nos. 1-4, 1920

Creator: U.S. Navy. Bureau of Medicine and Surgery

Publisher:

Sponsor:

Contributor:

Date: 1920

Language: eng

Table of Contents

Number 1

PREFACE V

NOTICE TO SERVICE CONTRIBUTORS VI

SPECIAL ARTICLES:

ANTHROPOMETRIC STUDY AT ANNAPOLIS.

By Lieutenant L. B. Solhaug, Medical Corps, U. S. N 1

Medical and Hygienic Aspects of Submarine Service.

By Lieutenant Commander E. W. Brown, Medical Corps, U. S. N 8

Report on Facial and Jaw Injuries.

By Lieutenant Commander L. W. Johnson, Medical Corps, U. S. N 17

Military Orthopedic Hospitals in the British Isles.

By Lieutenant R. Hammond. Medical Corps, U. S. N. R. F. 65

HISTORICAL :

Medicine in Rome 103

EDITORIAL :

The New Year — Standards of Duty 127

IN MEMORIAM :

Edward Grahame Parker.

By Captain C. E. Riggs, Medical Corps, U. S. N 135

SUGGESTED DEVICES:

Changes in Scuttle Butts Aboard Ship.

By Lieutenant Commander J. A. B. Sinclair, Medical Corps,

U. S. N. R. F 137

An Emergency Evacuation Device 145

CLINICAL NOTES :

Bronchopulmonary Spirochetosis in an American.

By Lieutenant G. W. Lewis, Medical Corps, U. S. N 149

Encephalitis Lethargica.

By Lieutenant A. F. Kuhlman, Medical Corps, U. S. N 151

Defense of the Open-Air Treatment of Pneumonia.

By Lieutenant D. Ferguson, jr., Medical Corps, U. S. N 153

NOTES AND COMMENTS :

Carbon tetrachloride poisoning. —Civil service positions. — Serum treatment

in yellow fever. —" Deer-fly disease." — Request for specimens.—

Medical personnel of the French Navy.—Centenary celebrations. —Situs inversus.

—Italian view of prohibition. — Effects of prohibition In Chicago. — Treatment

of sterility. — Pilocarpine in influenza. —A death from anesthesia.- — Free

hospital service in Oklahoma City. —Birth rate of Manila. —Expansion of the

Faculty of Medicine, Paris. —Statistics on blindness. —French eight-hour law. —

Corporation philanthropy 155

REPORTS :

The Receiving Ship Barracks, New York.

By Commander W. G. Farwell and Lieutenant R. M. Krepps, Medical Corps,

U. S. N 163

Grounding of the U. S. S. Northern Pacific.

By Lieutenant J. C. Ruddock, Medical Corps, U. S. N 185

Impressions of a Reservist.

By Commander L. R. G. Crandon, Medical Corps, U. S. N. R. F 188

Number 2

PREFACE v

NOTICE TO SERVICE CONTRIBUTORS vi

SPECIAL ARTICLES:

Types of Neurological and Psychiatric Cases.

By Lieutenant Commander E. C Taylor, Medical Corps, U. S. N. R. F 191

Yellow Fever.

By Lieutenant Commander T. Wilson, Medical Corps, U. S. N 200

Asepsis of Abdominal Incisions.

By Lieutenant Commander F. H. Bowman, Medical Corps, U. S. N 208

Calcium Chloride Intravenously for Hemoptysis.

By Lieutenant Commander W. H. Fickel, Medical Corps, U. S. N 210

Hospital Records 213

HISTORICAL:

The Arabians and the First Revival of Learning 225

SUGGESTED DEVICES:

Hospital Garbage Disposal.

By Captain A. Farenholt, Medical Corps, U. S. N 237

The Flat-Foot Ladder 240

CLINICAL NOTES:

Chondrodysplasia with Exostoses.

By Lieutenant R. W. Hutchinson, Medical Corps, U. S. N 243

A Case of Vascular Syphilis.

By Lieutenant A. E. Kuhlmann, Medical Corps, U. S. N., and Lieutenant

Commander C. C. Ammerman, Medical Corps, U.S.N.R. F 245

Two Cases of Encephalitis Lethargica.

By Lieutenant Commander R. I. Longabaugh, Medical Corps, U. S. N 249

A Case of Foreign Body in the Head.

By Lieutenant Commander L. M. Schimdt, Medical Corps, U. S. N. 254

The Late Treatment of War Osteomyelitis.

By Lieutenant E. I. Salisbury, Medical Corps, U. S. N. R. F 255

Two Cases of Gas Gangrene.

By Lieutenant Commander L. M. Schmidt, Medical Corps. U. S. N 257

Gastric Ulcer with Perforation.

By Lieutenant G. G. Holladay, Medical Corps, U. S. N. R. F 259

Internal Ophthalmoplegia.

By Lieutenant Commander E. E. Woodland, Medical Corps, U.S.N 260

Open Treatment of a Fractured Metacarpal Bone.

By Lieutenant R. W. Auerbach, Medical Corps, U. S. N 263

Supernumerary Phalanx.

By Lieutenant R. S. Reeves, Medical Corps, U. S. N. R. F 265

A Cask of Ruptured Kidney.

By Commander K. It. Richardson, Medical Corps, U. S. N

Mustard Gas and the Cardiovascular System.

Ry Lieutenant Commander W. H. Michael, Medical Corps, U. S. N

A Case of Ulcer of the Sigmoid Flexure.

By Lieutenant H. R. Coleman, Medical Corps, U. S. N

A Case of Malposition.

By Lieutenant A. C. Toll inner, Dental Corps, U. S. N

PROGRESS IN MEDICAL SCIENCES :

General Medicine — Blood pressure and posture —Intramuscular Injections

of quinine in malaria — Vincent's disease Surgery — Appendicitis amongst

sailors— Transplanting of bone— Rectal ether anesthesia

Hygiene and Sanitation — Destruction of lice by steam

Eye, Ear. Nose, and Throat — Ocular phenomena in the psychoneuroses of

warfare —Ocular complications due to typhoid inoculations

NOTES AND COMMENTS:

Syphilis and the war—Bone surgery —National Research Council— Laboratories

in Poland— National Anaesthesia Research Society — Vanderbilt Medical School —

Municipal education in Detroit — Female medical matriculates— Degrees conferred

by Royal College of Surgeons of Edinburgh — Speech defects — Typhoid fever in

New York — Venereal diseases in California- — Omissions in the Annual Report of

the Surgeon General, 1919

REPORTS :

U. S. Navy Ambulance Boat No. 1.

By Chief Pharmacist's Mate D. V. De Witt, U. S. N

Physical Development in the Navy.

By Lieutenant B. G. Baker, Medical Corps, U. S. N

Venereal Prophylaxis at Great Lakes, III.

By Lieutenants D. It. Blender and L. A. Burrows, Medical Corps, U. S.

N. R. F

Report of 505 Tonsillectomies.

By Lieutenant W. P. Vail, Medical Corps, U. S. N. R. F

BOOK NOTICES

Number 3

PREFACE v

NOTICE TO SERVICE CONTRIBUTORS vi

SPECIAL ARTICLES :

History of the U. S. Naval Hospital, Chelsea, Mass.

By Captain N. J. Blackwood, Medical Corps, U. S. N 311

INSTRUCTION FOR THE HOSPITAL CORPS.

By Lieutenant Commander W. M. Kerr, Medical Corps, U. S. N. 338

Study of Two Cases of Diabetes Mellitus.

By Lieutenant L. F. Craver, Medical Corps, TJ. S. N 345

Flat Foot in the Navy.

By Lieutenant C. F. Painter, Medical Corps, U. S. N. R. F 359

Static Defects of the Lower Extremities.

By Lieutenant A. A. Marsteller, Medical Corps, U. S. N 365

Treatment of Malaria.

By Lieutenant Commander W. H. Michael, Medical Corps, U. S. N 367

Navy Recruiting.

By Lieutenant W. H. Cechla, Medical Corps, U. S. N 371

HISTORICAL:

American Founders of Gynecology 373

EDITORIAL :

"Bring Forth Your Dead "—Is Educational Prophylaxis Effective

381

William Martin —John Wolton Ross —Oliver Dwight Norton, Jr 389

CLINICAL NOTES:

Interdental Ligation for Jaw Fractures.

By Lieutenant W. F. Murdy, Dental Corps, U. S. N 391

A Temporary Stopping.

By Lieutenant Commander H. E. Harvey, Dental Corps, U. S. N 394

ASCARIASIS AND APPENDICITIS.

By Lieutenant Commander E. G. Hakansson, Medical Corps, U. S. N 394

Malarial Crescents.

By Lieutenant Commander W. H. Michael, Medical Corps, U. S. N_ 395

Poisoning by Jelly Fish.

By Commander A. H. Allen, Medical Corps, U. S. N 396

Traumatic Rupture of Kidney.

By Lieutenant Commander F. H. Bowman, Medical Corps, U. S. N 397

A Case of Erythema Multiforme.

By Lieutenant M. F. Czubak, Medical Corps, U. S. N 399

PROGRESS IN MEDICAL SCIENCES:

General Medicine. — Static back trouble—Benzyl benzoate —Relation of

anaphylaxis to asthma and eczema —High enema —Treatment of typhus —Thilerium

hominis 401

Mental and Nervous Diseases. —Insanity as a defense in crime —The nervousness

of the Jew— The Babinski reflex —Problems of delinquency —Encephalomyelitis in

Australia 408

Surgery. — Radium — Surgery of peripheral nerves — Referred symptoms in

diseases of gall-bladder and appendix—Intracranial pressure —Protection of the

skin in surgical operations—Anesthesia

from drugs administered by the mouth —A new skin-suture material —

Roentgen-ray problems , 414

Hygiene and Sanitation. — Birth control—Typhoid fever in vaccinated

troops —Detection of typhoid carriers —Streptococci in market milk

—Tuberculosis in San Francisco —An experiment in sanitary education —Oral

hygiene —Differential diagnosis between trachoma and follicular conjunctivitis

—Left - handedness —The Negritos of the Philippine Islands —Tropical Australia

425

NOTES AND COMMENTS :

American Society for the Control of Cancer — Pay of Italian medical officers

— The passing of the book worm— The neurotic girl —Control of druggists in

Michigan — English statistics on alcoholism —Prevention of simple goiter— Value

of quarantine against influenza in Australia —W. P. C. Barton, first chief of

the Bureau of Medicine and Surgery—Information on blood-pressure estimation

—Automobile accidents —Egyptian Medical School — Educational movement In U. S.

Army 443

REPORTS :

Health Conditions in Santo Domingo.

By Lieutenant Commander G. F. Cottle, Medical Corps, U. S. N 453

History of U. S. S. Pocahontas During the War,

By Lieutenant Commander M. Boland, Medical Corps, U. S. N 460

With the American Peace Commission.

By Commander A. D. McLean, Medical Corps, U. S. N 500

Testing Water for Storage Batteries.

502

Report from Naval Medical School Laboratory 505

BOOK NOTICES 505

Number 4

PREFACE V

NOTICE TO SERVICE CONTRIBUTORS VI

SURGICAL ACTIVITIES AT THE NAVAL

HOSPITAL, NEW YORK.

Interesting bone cases 512

Fractubes of the anterior tuberosity of the tibia and Osgood-Schlatter's

disease 516

Carrel-Dakin technique for empyema 527

Physical therapy 535

Occupational therapy 536

War wounds of the joints.

By Dr. L. Delrez, Faculty of Medicine Liege 537

A case or joint treatment by Willems's method 545

Chronic intestinal stasis 545

Carrel-Dakin technique in treatment of carbuncle 549

A case of sarcoma of the foot 550

A case of Jacksonian epilepsy with spastic contracture 551

A Case Of Osteoma Of The Humerus 552

A Case Of Bone Infection Resembling Sarcoma 552

Wound closures after Carrel-Dakin treatment 553

Ether in peritonitis 557

HISTORICAL:

The founders ok naval hygiene. Lind, Trotter, and Blane 563

EDITORIAL:

Hospital standards —As seen from within 629

SUGGESTED DEVICES :

Vision test apparatus.

By Lieutenant Commander H. W. Glltner, Medical Corps, U. S.N. R. F 637

Treatment of cement floors.

By Captain A. Farenholt, Medical Corps, U. S. N 638

CLINICAL NOTES:

Ophthalmitis in secondary syphilis.

By Lieutenant Commander W. H. Whitmore, Medical Corps, U. S. N 639

TWO CASES OF OPTIC ATROPHY.

By Lieutenant Commander C. B. Camerer, and Lieutenant G. L. McClintock,

Medical Corps, U. S. N 641

Arsphenamine in malaria.

By Lieutenant Commander W. H. Michael, Medical Corps, U. S. N 643

Ureteral calculus.

By Commander W. J. Zalesky and Lieutenant Commander P. F. Prioleau,

Medical Corps, U. S. N 644

PROGRESS IN MEDICAL SCIENCES :

General medicine. — Treatment of respiratory catarrhs.—Tests of thyroid

hypersensitiveness. —A diet sheet for nephritics.— Delayed arsenical poisoning

647

Surgery. —Open treatment of fractures. — Treatment of crushed extremities.

—Nerve injuries of the war 653

Hygiene and sanitation. —Disinfection of tubercular sputum. — Syphilis

in railroad employees 659

Tropical diseases. —Ulcerating granuloma 663

Eye, ear, .nose, and throat. — Frontal sinus drainage. —Anesthetics in throat

surgery. —Correction of nasal deformities

NOTES AND COMMENTS :

American Library Association.— Mental defects in the United States. —

"Tea-taster's " cough. — Scientific basis of carelessness. — "The

case against the prophylactic packet." —Treatment of leprosy. — Medical

training in London. —A new Army and Navy Club. — The Navy Mutual Aid

Association. — Medical school of the University of Virginia. —A new medical

quarterly. —Solar therapy. — Novarsenobenzol subcutaneously. —Economic loss

from rats. —The flight of mosquitoes. —A medical centenarian. — A French hospital

ship. — Potassium-mercuric-iodide.— Dermatitis in industrial work. —

Radium.— A twelfth century epitaph 663

REPORTS :

Arsenical preparations used intravenously.

By Captain E. S. Bogert, Medical Corps, U. S. N 679

Venereal disease in the Dominican Republic.

By Lieutenant J. W. Vann and Lieutenant B. Groesbeck, Medical Corps, U.

S. N 681

American legation guard, Managua, Nicaragua.

By Lieutenant Commander F. F. Murdock, Medical Corps, U. S. N_ 684

Sanitary conditions in Vladivostok.

By Lieutenant A S. Judy, Medical Corps, U. S. N 689

Hospital records.

Commander H. W. Smith, Medical Corps, U. S. N 698

HOSPITAL RECORDS.

By Commander E. U. Reed, Medical Corps, U. S. N 706

A DEATH FROM ETHER DUE TO STATUS LYMPHATICUS.

By Captain A. W. Dunbar, Medical Corps, U. S. N 714

Medical prophylaxis against venereal diseases.

By Lieutenant P. W. Dreifus, Medical Corps, U. S. N 715

BOOK NOTICES 718

INDEX 721

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