Hey Reader,

Welcome to another edition of Bursting The Bubbles, DTFB's newsletter with some top tips, evidence highlights, and the best dad jokes.

This week we look at malaria testing, bed bugs, and teeth.

Let's do it...

WEEKLY BUBBLE WRAP: DIAGNOSING MALARIA

What’s It About?

Microscopy is the gold standard for diagnosing malaria. However, it is a labour-intensive process requiring trained personnel and up to 3 negative films to rule out malaria. This puts a high financial and resource cost on front-line settings. Rapid diagnostic testing (RDT) forms the mainstay of diagnosis in areas without access to high-quality microscopy.

This paper aimed to evaluate the use of RDT for diagnosing or ruling out malaria in paediatric patients with typical presentations.

This was a multi-centre, retrospective diagnostic accuracy study carried out by the PERUKI network and required sites to routinely perform both microscopy for malarial parasites and RDT.

15 PERUKI sites gave data with 1,414 eligible patients, 615 (43%) females, and a median age of 4. There were 47 (3.3%) cases of malaria in this group. P. falciparum totaled 36 (77%). The sensitivity of RDT to detect P. falciparum was 100%, with a specificity of 98.8% and a negative predictive value of 100%. However, malaria caused by any Plasmodium species was 93.6%, with a specificity of 99.4%.

The RDTs held a 15% false positive rate and three false negative cases using the RDT caused by different Plasmodium species.

Standard practice dictates that three films be used to rule out malaria. In this study, only 15% of cases had three films. This potentially could have missed a positive malaria case. (However, 46 out of 47 confirmed cases in this study were confirmed on the first film alone).

Why Does It Matter?

Using quicker diagnostic tools for malarial infection could significantly reduce repeat attendance to emergency departments and laboratory time and equipment costs.

UK estimates are that around 10% of all imported malaria cases are found in children.

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Clinically Relevant Bottom Line:

Despite the RDT having a 100% sensitivity for P. falciparum, it only has 93.6% for all Plasmodium species and a high number of false negatives for non-Falciparum species, approximately 25% of cases are non-Falciparum. There’s no current scope for a change in practice in the UK moving away from microscopy as the gold standard.

Reviewed by: Graham Clarke. Read the full Bubble Wrap here.

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TOPIC OF THE WEEK: HOW TO BE AN LGBTQIA+ YOUNG PERSON ALLY

You know what the rainbow symbol is, right? It’s become synonymous with LGBT+ identity, solidarity and support, and from Pride week to day-to-day living, you’re likely to spot one fairly regularly. But, you probably also know that LGBT+ people are a minority group within our society, with huge inequalities in the provision of healthcare, which is tragic given that this group have huge healthcare needs.

If you’re reading this, you’re probably an advocate for LGBT+ rights. You might even have an NHS or HSE rainbow badge. Great! But wearing a badge is only one step towards being an ally.

So, how can you be an LGBT+ young person’s ally?

You don’t need a rainbow badge (of course you don’t) to be an LGBT+ young person’s ally. But there are a few things that will help you on your way.

First, you need to understand what LGBT+ means.

Let’s start with some definitions.

+: inclusive of all identities (queer, questioning, intersex, asexual, pansexual, amongst others), regardless of how people define themselves.

There are some key definitions of sexual and gender orientation and expression. Let’s go through them:

Sexual orientation describes who we are attracted to romantically or sexually, such as lesbian, gay, bisexual, asexual, or heterosexual.

Gender orientation describes an internal sense of being male, female, neither or both, a psychological sense of who we are and who we feel we are.

Transgender: a person’s gender identity differs from the gender they were assigned at birth.

Cisgender: a person’s gender identity matches the gender they were assigned at birth.

Non-binary: a person who doesn’t identify as exclusively male or exclusively female.

Gender expression describes how we portray ourselves to the world: how we act, speak, talk and dress. It ranges from feminine through androgynous to masculine.

These definitions are explained perfectly by the Genderbread person.

OK. So you know a bit of the lingo. What can you do to be an LGBT+ young person’s ally?

Don’t make assumptions.

We live in a heteronormative environment (where being heterosexual is the norm), and people often make heteronormative assumptions. This means we may unconsciously assume that heterosexuality is ‘normal’ without realizing we’re doing it.

Yet another assumption people make is cis-normativity, the belief or unconscious assumption that it is ‘normal’ to be cis-gendered. It’s explained all too well by Emily, an 11-year-old transgender girl in the Mermaid’s #IfIHadAVoice video.

Once you feel you can actively make an effort not to make any assumptions, what else can you do to be an LGBT+ young person ally?

Use inclusive language

It can feel artificial to start with, but try and break the heteronormative barrier and ask a young person what their chosen gender or pronouns are.

If you accidentally misgender someone, apologize and correct yourself. We often don’t know what name or pronouns someone would like us to use, and it’s safest to assume nothing and ask (and I mean ask everyone because you will be caught out if you don’t), “How would you like us to record your details in the medical record?”

What about sexual orientation? A sensitive way to ask a young person about their sexual identity is to ask if they have a partner or if they’re in a relationship. If they don’t have a partner, ask them if they’re attracted to boys, girls, either or neither.

Reassure the young person their sexual or gender identity will be kept confidential.

Confidentiality is a huge one. We may feel torn between sharing information about a young person at risk and maintaining confidentiality. Before taking a history, explain to a young person that anything you discuss will be kept confidential and private between the young person and the team looking after them. Still, if you discuss anything really serious, like suicide or that someone was abusing them, then you’ll come up with a plan together to get the help needed. But, and this is an important but, even if there’s something that you need to seek help for, you’ll keep their sexual or gender identity confidential if this is what they want – this is private to them, and you shouldn’t be outing the young person against their wishes.

To read more about how to be an LGBTQIA+ ally check out our DFTB post.

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HIGHLIGHT: BED BUGS

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What are bed bugs?

Bed bugs are small brown insects (Cimex hemipterus or Cimex letularius) that feed on human blood. It only takes a handful to infest a new location, creating a vast colony. The bites are painless but cause a local immune reaction, leading to itchy lesions.

Bed bugs carry up to 45 known pathogens, including hepatitis C, and the bacteria responsible for trench fever. Fortunately, no transmission has been recorded from bedbugs to humans.

Bedbugs live around 4-5 months, and they can live up to 70 days without a meal. They sense their prey by detecting expired CO2 from your breath.

How do you get rid of bedbugs?

Exterminators may be needed to rid homes of infestations entirely. They have access to chemical and heating methods to help rid homes of bugs. But the following strategies may also help in reducing the population of parasites living with your patients.

Catch them

You can buy scented traps to catch the bed bugs. These will release CO2, or other chemicals, to attract them. This can help detect even mild infestations, but this does nothing to reduce the population.

Apply heat

Bedbugs don’t survive in temperatures below -20°C or temperatures above 60°C. Your families should wash all the bedsheets at a high temperature. This can eliminate any of the adult bedbugs as well as any eggs. Commercially available steamers reduce population numbers quickly and drastically.

Bag them up

Using a vacuum cleaner with a removal bag can reduce the population size. Your patients won’t get every single bug, but doing this repeatedly will drastically reduce population sizes. The bags should be immediately removed and sealed in plastic after use.

Chemical control

Anti-parasitic drugs such as ivermectin can reduce the population of bugs feeding on humans. Sheele et al. showed that this effect could be detected in insects fed on human blood up to 96 hours after the dose. It was a small sample size, so is a weak recommendation. However, it is a promising start.

Unfortunately, bedbugs have developed resistance to DDT, organophosphates, carbamates, and pyrethroids. Permethrin will likely have little effect.

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Read more about bed bugs here.

EVENT OF THE WEEK

Tomorrow is World Dentist Day.

We have an opportunity to talk about dental health when we see children in clinical practice. It's easy to dodge this because...well, we aren't dentists.

But we're missing the chance.

Check out Rosanne and Navneet's post on 10 basic dental facts we all should know here.

TIP OF THE WEEK

​Post-drowning prophylactic antibiotics have not been shown to be helpful though they are sometimes prescribed after immersion in contaminated water.

JOKE OF THE WEEK

Why did the bicycle fall over?

It was two-tired!

That's it for this week, Reader.

Remember, your work makes a difference in the lives of paediatric patients every day.

Stay tuned for next week's edition of Bursting The Bubble.

From Tessa (on behalf of Team DFTB)

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