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Brazilian city uses tilapia fish skin to treat burn victims (pbs.org)
144 points by curtis on May 21, 2017 | hide | past | favorite | 71 comments



> Given the substantial supply of donated human skin, tilapia skin is unlikely to arrive at American hospitals anytime soon.

I'm surprised that there's no shortage of donated skin in the USA. We're always hearing about the critical shortage of organs and appeals for blood. I wonder what makes skin different?


Speculation: skin grafts can be grown basically endlessly from a donated foreskin. Circumcision is more common in the US than in Brazil. As for other organ shortages, well, if a single foreskin can produce even ~100 square meters of skin grafts, you don't need very many of them to meet a country's skin needs. And ~100 m^2 of grafts per foreskin appears to be quite the lowball: http://archive.wired.com/science/discoveries/news/1999/02/17...


I'd guess also cosmetic surgery in the US produces quite a bit of human skin, although that's not expandable into skin grafts like the foreskin technique you link to.


You can donate your skin that is being removed after heavy weight loss: http://www.livestrong.com/article/126643-donate-skin-after-b...

I can imaging that this is a big source of donated skin.


This is a complete guess. I'd imagine, though, that it's significantly harder to abuse or destroy than other organs. Internal organs can be bad candidates for transplant due to a variety of dietary, lifestyle, or health factors. Skin seems subject to fewer of those.


This is so cool! I learned about tilapia when looking into closed-loop hydroponics; apparently they are good at growing in tanks, growing fast, and fertilising the water.

(if you look it up in youtube though you will get tilapia harvesting videos, which are not the nicest)


> closed-loop hydroponics

Aquaponics?


I guess; I didn't realise there was a difference in the terms.


Hydroponics and aquaponics are both considered closed-loop (compared to other agricultural methods). Hydroponics involves growing plants.

If you're raising fish in addition to crops in your system, with the fish excrement providing the nutrients the crops need, then you're engaged in aquaponics.


It's not really closed-loop though, is it? You still need to buy food to feed the fish (and maybe fish food, which will end up in your vegetables, can be contaminated, e.g. with heavy metals?)

Or am I missing something?


Those closed systems involve growing algae which is used to feed the fish.


> closed-loop hydroponics

Aquaponics


I'm using banana skins to treat wounds, its great, makes the wounds heal much better and they also offer that good protection!! I don't know the science behind it, I heard a lot of women talking about using it on the breast when breast feeding to feel better so I started to experiment with myself and I'm very happy with it too.


My mom would give me these white sugar pills when I was a kid and when I woke up saying I was sick (I had a phase where I did that often to avoid school). They'd just happen to treat my condition specifically and always made me feel better!

This is why I grew up to learn to only trust medical studies over anecdote. Even then it's good to be skeptical. Placebo can be incredibly powerful.

Any sources?


Placebo can be incredibly powerful.

Sounds like it works and achieved the intended effect. This is why I grew past my "I only believe what the scientists tell me to" phase and decided to selectively trust medical studies, since it's my life and my anecdote, and I'll decide what does or does not work in my anecdote.


Learning to appreciate the results of medical grade studies does not translate to blindly accepting the results of any result some scientist claims.

I was merely pointing out the persuasive power of placebo affect which has resulted in a billion dollar 'holistic' industry to treat medical conditions and my personal experience growing up with someone who believes that non-sense. Which gave me a strong bias towards scientific results over 'natural' ones.


Doesn't surprise me that sugar makes a kid feel better - they love the stuff.


Google "plantains wound healing site:nih.gov"


Only the banana peel is not that placebo since it offers really good protection even though if it don't have any healing property. The last time I used banana peel was when I accidentally got two toes's nails removed at once! I went to the hospital and they just made a bandage but when I got home and replaced them with banana peels, something like if my nails were the banana peels, the inside part of the peel touching my skin (or meat?) and i felt so much better than the hospital's bandage that I could even wear shoes, it was 5 months ago. I tried to search for some science I found only this: http://www.scielo.br/scielo.php?pid=S0102-86502013000100006&... but they tested unriped and I just use the inside part of the peel of a ripe banana, I didn't find anything so specific yet, I need to dig deeper.


There are two dangers in what you are saying here.

Firstly, The thing is about the placebo effect, is that it is an actual effect.

Placebos are tough to account for in studies specifically because they actually DO help, for something to have medicinal properties it needs to have a greater effect than a placebo. Placebos even have been known to work when people know they are placebos.

The second one is that humans are terrible at self diagnosis / analysis, we are way too emotionally influenced, too biased, and there are too many variables to make conclusions on treating yourself. That's where scientific studies do a good job of removing biases and variability from the equation.

I'm not saying banana peels definitely don't help, because I honestly don't have a bloody clue, but I would caution telling other people about it with such certainty until there is some well researched initial evidence behind it.


There's a huge field of research here. It's shocking to me how people jump in to disparage the commenter when it takes just a few seconds to check if there's research - try Googling "plantains wound healing site:nih.gov"


How about just linking to something compelling, instead of saying "search this site for this"


Because there are hundreds of studies, and everyone's better served by looking at what's out there for themselves. I could have linked to the Google search, but that would've been pretty condescending.


While that's true, I and many other people on here aren't qualified to decide which are compelling. Since you seem to be purporting to have those qualifications, why not link to a few notable studies, or an applicable literature review, instead of saying "search for this".


"Since you seem to be purporting to have those qualifications" - which qualifications did I purport to have? Googling to verify that research does indeed exist?

We all, by merit of commenting here and having access to the Internet, have these qualifications.


I agree with everything your saying, but he did link to an actual study which provides some support. Further, a lot of our drugs like aspirin where discovered in nature. So, while far from enough evidence to change my behavior it is interesting.


Does this work on burn wounds only? Or also on open wounds?


[deleted: sorry my bad, I thought it was a sarcastic comment]


It wasn't my intention to be sarcastic, english is my second language so maybe it was that, but anyway my main source is that its a tradicional and indigenous use of banana peel (thanks for pointing out its not skin. I never tried to search for the science behind it, I found this: http://www.scielo.br/scielo.php?pid=S0102-86502013000100006&...


You didn't come off as sarcastic. It sounded to me that you were matter of factly pointing out something that you use as a skin remedy, in an entirely unoffensive way. Don't worry about it, your English is fine.


Your English is fine...I also took it as sarcasm because it sounded so implausible.


There's actually a lot of research behind what you're talking about -- you'll find more looking for plantain or "Plantago Major L" and search NIH (restrict the search using site:nih.gov if you're using Google or DuckDuckGo).


Someone please correct me if I misunderstood, but once on Regeneratively Speaking podcast one of the researchers explained the reason why burn scars appear is that body is over-producing stem cells (same with many cancers) to fight the inflammation and they've found which compounds can actually slow it down. Was hoping this is something from the same area, but seems like a different step.


I saw this news when it first broke in Brazil, and the one thing that I still haven't fully understood is just what benefit the Tilapia skin is actually offering.

When I read up on it, it seems that it goes through several different aggressive sterilization and processing stages before they are given to the patient. With all this processing, isn't the tilapia skin at that point just a gimmick?


From the article, it appears they're after the high levels of collagen (for repair), the tensile properties (for holding the wound together) and the physical barrier (for protection). I'm guessing those are unaffected by their sterilization techniques as they are using radiation.


The biggest benefit I see that it offers is that it doesn't need to be changed daily and can stay on for the course of the treatment. That's a huge benefit saving patients a lot of pain.


Another thing is that when the bandages are replaced, it tears off bits of new skin that have started to grow.

I know a girl that had 3rd degree burns on ~85-90% of her body. The doctors said she'd die, but her family brought in some people that applied sterile honey and a certain type of leaf over her entire body, which was far more gentle than the bandages. It was one of the fastest recoveries doctors had seen.

The constant care and timely honey and leaf replacement probably played a large part to the speedy recovery, but there's a point to be made that the standard methods for treating burns seem almost backwards as it doesn't promote skin growth as much as protection from infection.

I'm not a doctor though, so maybe someone else has more input on this.


Sterilization just means "the process of making something free from bacteria or other living microorganisms", the only "processing" besides that is adding glycerol which is a lubricant/moisturizer, perhaps also helps to "glue" it all up. At the end it is still raw fish skin being implanted over healing wounds, it just needs to be clean as heck because healing wounds are very pron to acute infections (and the worst of them require the amputation of the limb).


I have seen the use of boiled tea water used as antiseptic for burn victims in rural India. The results were great for the one patient I saw getting treated. Necessity is truly the mother of invention.


Honey also works pretty well if applied immediately on the skin and if the burns are not that serious to begin with. My ex-wife managed to pour burning edible oil on her hand while she was cooking some fries, but no scar remained because we applied honey on the affected skin almost immediately.


Burns need to be kept cool and moist. Applying anything thick and cool (within reason - lotions for example) to the burn will help. Cool the burn under cold running water if possible ('take the heat out'), then put something on it to keep it moist. Anything serious requires a trip to the ER of course.

Even if you forget to put sunscreen on and get sunburned, putting sunscreen on afterwards can help keep the skin moist and improve the outcome.


Your advice is dangerous and wrong.

>> cool the burn with cool or lukewarm running water for 20 minutes – don't use ice, iced water, or any creams or greasy substances such as butter

http://www.nhs.uk/Conditions/Burns-and-scalds/Pages/Introduc...

> You should go to a hospital A&E department for:

> all chemical and electrical burns

> large or deep burns – any burn bigger than your hand

> burns that cause white or charred skin – any size

> burns on the face, hands, arms, feet, legs or genitals that cause blisters


I was unaware that ice came out of a cold running water tap. That doesn't happen here down under.

You can definitely use creams like sunscreens or similar. True, I did overstate a bit - you don't want to use something like butter that will turn to oil and keep in the heat.


You should not use cold water.

You should not apply creams, lotions, or sunscreens.

https://www.healthdirect.gov.au/burn-and-scald-treatments

> don’t use any ointments or creams on a burn. They seal heat in and cause more damage.


Fair enough. I guess I was thinking of shallow burns like sunburn rather than serious ones with destroyed skin. After all, two sentences after the one you've just quoted is If the burn does not have any blisters or broken skin, such as sunburn, a simple moisturiser such as sorbolene is the best treatment - sorbolene is a cream :)


Honey should extract water from the area. Is sugar. Could avoid blisters formation?


Having had oil burns heal without honey I'd want to see some peer-reviewed studies on its efficacy as a burn treatment first.


Honey dressings were being used in some English NHS hospital settings.

This from 2008 isn't great, but it's not calling it woo: http://www.nhs.uk/news/2008/10October/Pages/Honeyandburns.as...

This from 2016 is a bit better: http://www.cochrane.org/CD005083/WOUNDS_honey-as-a-topical-t...

> There is high quality evidence that honey heals partial thickness burns around 4 to 5 days more quickly than conventional dressings. There is moderate quality evidence that honey is more effective than antiseptic followed by gauze for healing wounds infected after surgical operations.

I think "partial thickness" is called "second degree" in the US.

That's different from just pouring it on a new burn, and I definitely don't think people should do that.


The best and quickest link that I could find was this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4158441/

> Having had oil burns heal without honey

I'd say you need to have Terminator-like skin in order to (relatively) quickly heal your skin (with no scars) after pouring more than half of pan of burning oil on your arm.


That would be a very serious burn, and in that situation it's important (to avoid death or loss of limb) to get the person to the nearest emergency department, and then to the nearest burns unit.


Yeah, this seems like woo. At best I would hazard to guess that the honey provides an antibiotic effect and is perhaps a slightly acidic pH causing high cell turnover.


Honey has an antimicrobial effect that's been known for thousands of years. This isn't the article I went looking for about it, but interesting all the same:

http://www.academia.edu/2189571/Pdf_6_The_antibacterial_acti...


The antibiotic effect all by itself would be nothing to scoff at. I mentioned it as a reply to a previous comment, but I don't personally think that the human skin is made to re-generate all by itself after pouring more than half of a pan of burning oil on the arm section.


Brewed black tea (very strong, cold, the stuff you dilute with water to get black tea you drink) was used where I grew up in Russia on eyes after mild trauma. I'm not sure if there are any formal studies on but it didn't hurt.


The Shadow over Innsmouth?


*Fortaleza


Hah, funny, I did a double take when I read the article, but couldn't see the typo (my brain just knew something was "weird" about the word.) Thanks for solving that mystery. (For reference, I lived in Brazil for several years.)


Good catch, the article typoed it. I hadn't noticed at all, and that city's name is very familiar to me. By the way of curiosity, the name means "fortress".


[flagged]


Please stop posting like this here.

https://news.ycombinator.com/newsguidelines.html


Just because you're not familiar with a treatment doesn't make it second-rate. Would you be surprised to learn that US hospitals use maggots and leeches in FDA approved treatments? [1] It sounds like this therapy may have come out of difficult conditions though it appears to be quite effective -- the point of the article.

[1] http://bottomlineinc.com/health/medications/what-are-leeches...


Pardon my French, but I smell bullshit here.

Back in pre-scientific days one had very little choice when it came to medical advice: it was either a lobotomy, a healthy dose of poisonous compounds, or bloodletting. Naturally, having a bit of one's blood sucked out was far less dangerous in comparison, hence higher survival rates.

"Hirudotherapy" has not been scientifically proven to be effective, and no appeals to ancient wisdom will change that.


Read the link I included. It's an FDA approved treatment [1] particularly beneficial in limb transplants. FTL, blood pools in attached limbs before the network of blood vessels to recirculate it can form. The leeches extract that blood, preventing potential loss of the attached limb. Also, similarly, in skin grafts. And in lots of other diseases.

Maggots are used to remove necrotic tissues, because they consume it and leave living tissue untouched. Nasty, but quite effective.

Feel free to take a quick Google.

[1] http://www.nbcnews.com/id/5319129/ns/health-health_care/t/fd...


I worked in medicine for over a decade, I can confirm the use of maggots from sterile breeding programs and the effectiveness of wild maggots because I've documented it myself. If I had such a necrotic wound I would trust maggots implicitly and be thankful for them.


Would you mind explaining a bit more about the wild maggots part?

I wonder if this is something that could be used in a scarcity scenario, benefit vs risk of infection, etc..


The pieces of knowledge I learn on HN never ceases to amaze me.


> It's an FDA approved treatment

No, it's not. FDA approval only allowed Ricarimpex SAS to marketed as a "preamendment device". FDA approval does not make leeches a "treatment".

[1] https://www.accessdata.fda.gov/cdrh_docs/pdf4/k040187.pdf


> "Hirudotherapy" has not been scientifically proven to be effective, and no appeals to ancient wisdom will change that.

Certainly you have references to back your argument?

Leech therapy, can be safely and effectively used to evacuate blood and morbid humours from deeper tissues and in diseases like psoriasis, chronic ulcers and eczema. Leech therapy can produce better results as a mono or an adjunctive therapy in diseases like angina pectoris, coronary thrombosis, hypertension, atherosclerosis, varicose veins and in many surgical and traumatic conditions.[0]

[0]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4717768/


> Certainly you have references to back your argument?

So we're still using "bodily and morbid humours" in year 2017?

The belief is that majority of all diseases come from within, from foodstuff, blood and superfluous or corrupt humours or the metabolic products.

As for backing my statement up, here you go:

We have not determined whether the positive outcome of the leech therapy is caused by active substances released during the leeching, the placebo effect, or the high expectations placed on this unusual treatment form.

http://www.tandfonline.com/doi/full/10.1080/1745367071001503...


Hence, evacuating methods like bloodletting, purging, vomiting, sweating, diuresis and cauterization were the basis of the most effective general treatment until the beginning of 19th century [2–5]

You just forgot to include the subsequent statement.

> As for backing my statement up, here you go:

Funny that this same study is used in the article I mentioned:

A German study on 51 patients of knee osteoarthritis, showed a greater decrease in pain (seven days post leech therapy), as compared to control who received topical diclofenac application

Also from the same article you referenced:

An improvement in KOOS and WOMAC scores, and also in VAS, was found in all 3 groups following treatment. These improvements were statistically significant for treatment groups I and II during the complete follow-up period. The reduction in individual requirements for pain medication was also statistically significant. The greatest improvement was seen in the group treated twice with the leeches, with a long-term reduction of joint stiffness and improved function in the activities of daily living.

So I wouldn't qualify it as a rebuttal to the treatment if the whole Results section supports it.


What does (lack of) wealth have to do with the effectiveness of the treatment? The article mentions that in the US there's enough donated human skin for grafts; that appears not to be the case in Brazil. Until that changes, this appears to be a better solution, and who knows - maybe it turns out to be better in general too (e.g., the article also mentions the prepared grafts can be kept in storage for up to 2 years).


Besides what another sibling comment has already pointed out, one needs to consider the patient's wealth (that region is not poor, but has huge economic inequality issues) and the absence of research using regional resources.

Sometimes a lot of progress can be made with materials located regionally that could be even more effective than technology developed elsewhere.




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