Search This Blog

Showing posts with label brain. Show all posts
Showing posts with label brain. Show all posts

Wednesday, 4 November 2015

The Father - remarkable play portraying decline into dementia


In recent decades, Alzheimer’s disease has become an epidemic cause of dementia, typically now affecting increasingly older patients than in the initial encounter in 1901 between German psychiatrist and neuropathologist Alois Alzheimer and a 51 year old woman suffering from progressive short-term memory loss. In 1906, he was the first  to relate the finding of amyloid plaques and neurofibrillary tangles in the brain to clinical symptoms of pre-senile dementia, abnormalities which are still the focus of research into causes, biomarkers and clues to treatment of this currently inexorable dementia syndrome.
Although families and health and community care services around the world are increasingly pressed by the condition, it is only recently that Alzheimer’s disease and other common causes of decline into dementia, such as vascular disorders of the brain, have been portrayed to public audiences in print and on the screen, for example in Iris, Amour, Still Alice, and The Iron Lady. 
A new remarkable addition on this theme is 2014 Molière award winning The Father (Le Père), by 35 year old French playwright Florian Zeller, now on stage in the West End in a translation by Christopher Hampton: moving, faithful to the condition and its wider consequences, and well acted by an outstanding cast led by Kenneth
Cranham and Claire Skinner. The play was first produced in France in 2012 at the Théâtre Hébertot in Paris and is due for transfer to Broadway in March 2016.
Important not to say too much so as not to spoil the impact on a future audience of the many themes of the play and the dramatic effects used by the writers, scene designers and musical director. Zeller is very effective, with a surprising amount of humour, in involving the audience directly in the confusing experiences of the failing protagonist Andre, his family and carers, and in the natural history of the condition. He is also excellent at describing interactions between the relative with dementia and relatives who take on the caring role, as well as possible attitudes and the behaviour of a carer’s partner.
The programme notes – and interviews in the French and English press – give little away on Zeller’s inspiration for the themes of the play. In interview, the translator Hampton – around twice Zeller’s age – alludes to universal concerns about the significance of senior moments, such as forgetting a name, as hints of the possibility of much worse to come. The programme notes also provide beautiful colour scans of the brain in health and in patients with dementia. The images are left to the reader to interpret. However little effort is needed to decipher the dramatic general and local effects of dementia shown in the images.

Public domain image from the Center For Functional Imaging, Lawrence Berkeley National Laboratory Alzheimer’s Disease Neuroimaging Initiative (ADNI)

The Father merits adapting for film as soon as possible, so that the play can be seen as widely as possible by all health professionals dealing with patients with dementia, their family and carers. Despite the many poignant facets of The Father, it will also be appreciated by the increasing many with direct experience of a family member or friend with the syndrome.

Friday, 22 May 2015

2015 Hippocrates Prize awarded to New York City teacher, retired counsellor from Cornwall, and young New Jersey poet


The winners of the 2015 Hippocrates Prize for Poetry and Medicine were announced on Friday May 22nd at an Awards Ceremony in London at the close of an International Symposium on Poetry and Medicine.



The £5000 First Prize in the Open Category was awarded to teacher and writer Maya Catherine Popa


   Maya Catherine Popa   Kate Compston  Parisa Thepmankorn
from New York City for a poem inspired by her neuroscientist great grandfather. 
 

About her poem A Technique for Operating on the Past, Maya said: "There is something pleasantly elliptical about the fact that a neuroscientist relies on the very instrument that is the subject of his study. I had long wanted to write a poem about Gr.T. Popa, my great-grandfather, after whom the Medical University in Iași, Romania, is named.

Listen to Maya Popa reading her winning poem 



He worked on neuro-morphology in the 1930s and 40s, but his remarkable research was ultimately cut short in light of his anti-fascist, and anti-communist affiliations. That he was forced into hiding and died of a routine ailment while escaping the communists still seems a dark irony. In a way, writing this poem felt like a letter to him, an acknowledgement of that unfairness."


Poet Pascale Petit from France and now living in London was awarded the £1000 Second Prize for In the Giraffe House, with the £500 Third Prize going to teacher Catherine Ayres from Northumberland for Making Love to LINAC. 



The Hippocrates £5000 NHS first prize went to former counsellor Kate Compston from Cornwall for a poem about revealing the diagnosis of dementia.


She said: "the poem Lovely young consultant charms my husband was prompted by the visit, 13 years ago, of the very attractive and talented psycho-geriatrician, who came to our home to give us the news of my husband Malcolm’s diagnosis. Brain scans had indicated beyond reasonable doubt that he had Dementia with Lewy Bodies. What stayed with me for years afterwards was the tension I could see being played out within her, between professional scientific excitement about something unusual, and her humanity.


The Second Prize of £1000 went to former GP Ann Lilian Jay from West Wales for Night Visit, with the £500 Third Prize shared between tutor Carole Bromley from York for On Hearing for the First Time and radiologist Rowena Warwick from Buckinghamshire for Mrs Noone.


Parisa Thepmankorn from Rockaway, New Jersey received the £500 2015 Hippocrates Young Poet Prize for Intraocular Pressure.


She said: "I wrote the poem Intraocular Pressure after a visit to the optometrist revealed that my eyes' intraocular pressures were on the higher side of "normal". Inspired by the idea of certain diseases as time bombs, my poem is the result of both my personal fears and my attempt to extrapolate the future implications and physical effects of the condition if it worsened.”


The other shortlisted young poets were Daniella Cugini from Warwick in England for the surgeon dissects his lover and US poets Alex Greenberg from New York City for Dusting and Alexandra Spensley from Ohio for Geography of a Bone.


Judge Simon Rae said "Judging the entries for the Young Poets Award has been both exciting and moving.  The standard has been high, with both winners and commended poets producing strong, unflinching poems which will remain long in the memory."


Now in its 6th year, the short-listed entries for the 2015 Hippocrates Prize for Poetry and Medicine were selected from around 1000 entries from 31 countries by judges poet Rebecca Goss, poet Simon Rae, psychiatrist Professor Femi Oyebode and doctor and writer Theodore Dalrymple.


The judges also agreed 13 commendations in the NHS category and 18 commendations in the Open category, to poets from England, Northern Ireland, Scotland, Wales, Germany, the Netherlands, Norway, the USA and New Zealand.


The Hippocrates Initiative – winner of the 2011 Times Higher Education Award for Innovation and Excellence in the Arts – is an interdisciplinary venture that investigates the synergy between medicine, the arts, and health. At £5000 first prize both in the NHS category and the Open category, and £500 for the Young Poets Prize, this is one of the highest value poetry awards in the world for a single poem.


Judge Rebecca Goss said: “The subject of medicine is sprawling and complex, but poetry is the perfect medium to explore it closely and aid our understanding of human experience at its most raw. A variety of voices make up the winning and commended entries in this year’s Hippocrates Prize.


Experiences of both medic and patient are explored, but so too, are the insights of the bystander. Included in this list are the carers, the relatives, the friends, revealing the impact illness also has on their lives."

Judge Theodore Dalrymple remarked: “Once again, the Hippocrates Prize has stimulated poets and health workers around the word to put their experiences of hope, despair, sadness, and compassion into poetic form, with impressive success."

Judge Professor Femi Oyebode said “I feel very privileged to be involved in the Hippocrates poetry prize. This experience has been most humbling."


He added: “The wondrous thing is to imagine that these are poems written by healthcare workers who, in their everyday work, deploy their technical expertise with emotional commitment and compassion, all over the world, in a variety of settings in order to care for people; and yet, in-between times, having observed the most extraordinary human situations of trauma, tragedy, hope, despair, death and suffering, find the words to communicate these with sensitivity, with original and unique images, and sometimes with humor.”



Notes to editors

Photos of all finalists, along with biographies and extracts of their poems are available on request. Contact 07447 441666 or hippocrates.poetry@gmail.com

Awards: In each category there are: 1st prize £5,000, 2nd prize £1,000, 3rd prize of £500, and further commendations each of £50.
The 2015 Hippocrates Anthology of winning and commended poems was launched at the Awards Ceremony in London on Friday 22nd May.



The Hippocrates Prize judges

Rebecca Goss grew up in Suffolk. She returned to live in the county in 2013, after living in Liverpool for twenty years. Her first collection The Anatomy of Structures was published by Flambard Press in 2010. Her second collection, Her Birth (Carcanet/Northern House), was shortlisted for The 2013 Forward Prize for Best Collection and winner of the Poetry Category in The 2013 East Anglian Book Awards. In 2014 she was selected for The Poetry Book Society's Next Generation Poets.


Femi Oyebode is Professor of Psychiatry University of Birmingham & Consultant  Psychiatrist National Centre for Mental Health Birmingham. His research interests include clinical psychopathology and medical humanities. His publications include Sims’ Symptoms in the Mind: textbook of descriptive psychopathology 5th edition (translated into Italian, Portuguese and Estonian); Mindreadings: literature and psychiatry; & Madness at the Theatre.


He is a poet and his published works include Naked to your softness and other dreams; Forest of transformations; Master of the leopard hunt; Indigo, camwood and mahogany red; & Femi Oyebode: Selected poems (edited O. Okome). For a critical review of his poetry see Home and exile in Femi Oyebode’s poetry (edited by Obododimma Oha).

Theodore Dalrymple is the pen name for Dr Anthony Daniels, who has worked as a doctor in Sub-Saharan Africa, the Gilbert Islands, London and Birmingham, most recently as a psychiatrist and prison doctor. His writing has appeared regularly in the press and in medical publications, including the British Medical Journal, the Times, Telegraph, Observer and the Spectator and he has published around 20 books, most recently Admirable Evasions: How Psychology Undermines Morality (2015).



Hippocrates Prize Organisers

Professor Donald Singer is President of the Fellowship of Postgraduate Medicine. His interests include research on discovery of new therapies, and public understanding of drugs, health and disease. He co-authors Pocket Prescriber, the 8th edition of which is published by Taylor & Francis in the summer of 2015.

Professor Michael Hulse is a poet and translator of German literature, and teaches creative writing and comparative literature at the University of Warwick. He is also editor of The Warwick Review. His latest book of poems, Half-Life (2013), was named a Book of the Year by John Kinsella.



The 2015 Hippocrates Prize was supported by:

The Fellowship of Postgraduate Medicine, a national medical society founded in 1918 and publisher of the Postgraduate Medical Journal and Health Policy and Technology, has supported the Hippocrates Prize since its launch in 2009.

The Cardiovascular Research Trust, a charity founded in 1996, which promotes research and education for the prevention and treatment of disorders of the heart and circulation.


Saturday, 13 April 2013

BMS Young Investigators' Symposium: Advances in the Microcirculation

An excellent scientific event held at the University of Warwick, with international participants from Russia, Italy, Poland and Germany.
An outstanding series of young scientists presented undergraduate projects, PhD research and post-doctoral studies, topics ranging from fundamental endothelial signalling to cancer, retinal, cardiovascular and stroke mechanisms, biomarkers and treatments.
The organisers are to be congratulated on a well-run, well-chaired and lively event, fully justifying its generous support by major UK cognate societies and organisations, including the British Pharmacological Society, the Physiology Society, the Company of Biologists, The Richard Bright VEGF Research Trust, and the British Heart Foundation, complementing core support by the British Microcirculation Society, and making the event affordable for young life scientists interested in the microcirculation, including support in the form of travel bursaries for abstract presenters.
Future BMS Young Investigators' Symposia deserve to be a priority in the meetings' diary for young UK and international scientists interested in the microcirculation and in a friendly forum for first presentations, asking a first question of colleagues and more senior presenters, and making research contacts for their future careers: next provisionally set for 2 years time.
Look out for BMS events at the International Union of Physiological Societies Congress in Birmingham 21-26 July 2013 and the joint BMS-BPS symposium on new pharmacological targets in the microcirculation at Pharmacology 2013 in December in London.
See more at BMS Young Investigators blog.

Thursday, 29 September 2011

Toll-like receptor on brain glial cells - a new target to reduce acute toxic effects of alcohol?

@HealthMed Researchers in Adelaide, Australia led by Mark Hutchinson have attracted international media interest with headlines heralding a new treatment to protect from hazards of alcohol. How close is the research to human treatment? And is there a risk this could be a drug of abuse for people over-indulging in alcohol and hoping to avoid harmful effects? My discussion below complements two radio interviews, one with a Californian station, the other with BBC Radio Ulster. To listen to the interviews, use the podcast links at the foot of this blog.

This was an experimental study looking in mice at ways to prevent some of the harmful effects of a single large dose of alcohol. The authors were following up previous research suggesting a link between alcohol and the immune system. The Toll-like Receptor 4 is a member of a family of inflammation-inducing receptors, first described in the fruit fly. TLR-4 is present on immune defence white blood cells in the circulation. TLR-4 is also present on glial cells in the brain. Glial cells make up around 90% of cells in the brain and have an important defence role against brain infection.

The scientists used two approaches to find out whether TLR-4 is involved in unwanted effects of a large single intake of alcohol: animals with genetic absence of TLR-4 and its pro-inflammatory signalling pathway partner MyD88; and the drug (+)-naloxone.  This is the mirror-image version of the (-)-naloxone in clinical use to treat an overdose of an opiate such as diamorphine (heroin) or morphine. (+)-naloxone blocks TLR-4 without blocking the enkephalin receptor through which opiates act.

Hutchinson and colleagues studied two adverse effects of alcohol overdose: sedation and unsteadiness. Their model of sedation was the time taken to regain normal posture (loss of righting reflex). Their model of unsteadiness was the mouse equivalent of keeping balance on a rolling log.
What did they find? The drug (+)-naloxone halved the duration of sedation after acute alcohol and shortened the recovery time for loss of balance.  These effects could have been due to 'off-target' effects of the naloxone, however findings were similar in animals genetically deficient in TLR-4 and MyD88 - reduction in severity and duration of sedation and unsteadiness. The authors also showed that alcohol switched on inflammatory protein production by cells from the hippocampal part of the brain; and they ruled out differences in alcohol metabolism between models.

What do these results mean for people?
Firstly, they are important in raising the question whether genetic variation in activity of TLR-4 inflammatory pathways plays a role in explaining major differences in tolerance of alcohol.
These results provide an interesting complementary mechanism for protective effects of naloxone on alcohol-toxicity to those reported by Badawy and Evans 30 years ago using different experimental methods.
Secondly, these findings suggest that targeting TLR-4 in the brain may be a new way to reverse some of the serious adverse effects of major alcohol overdose in patients attending emergency departments.
What about (+)-naloxone as the drug to use? Studies would be needed to confirm that TLR-4 is also important in alcohol-mediated toxicity in humans, and if so to understand more about the wider range of adverse effects of alcohol which may be prevented or reduced.

What about cautions? 
- This is experimental research which would need to be repeated in human subjects with TLR-4 blocking strategies which pose minimal toxic risk.
- Naloxone has to be given by injection - it is not sufficiently absorbed by mouth to be clinically active.
- Use (+)-naloxone is no exception to the rule that all drugs can have harmful effects. There is concern that risks of harmful effects from (+)- naloxone mean that is unlikely to be safe to use in general alcohol users.
-  (+)-naloxone may block some of the wanted mood-altering effects of more moderate alcohol intake. For example, it is known to affect other brain pathways e.g. blocking stimulant effects of cocaine and amphetamines. This may well lead to loss with this drug of the wanted effects of alcohol.
- The published study showed reduction in severity and duration of alcohol's effects not their prevention: if confirmed in people, general hazards of alcohol, for example when driving, would remain.
- (+)- naloxone is unlikely to prevent the 'hangover' from alcohol, which is recognized to be due to many factors, including dehydration (alcohol is a diuretic), low blood sugar, and other chemicals (congeners) present in alcoholic drinks and contributing to colour and taste.

The most interesting aspects of this study are that:
- if confirmed in further research in humans, assessment of TLR-4 variability may be developed as a test for susceptibility to alcohol;
- safe, effective TLR-4 inhibitors for use in humans could be a treatment for some of the physical effects of a severe overdose of alcohol in people presenting to hospital.

See the article
-->
Podcasts of radio interviews with Professor Donald Singer about research on alcohol, the immune system and new potential treatment:
Interview with Jon Bristow on San Francisco KGO Radio     12.17 PDT 29th Sep, 2011.

© DRJ Singer

Friday, 9 September 2011

Why have a National Blood Pressure Week?


 In the UK, over 1,500 venues are offering free blood pressure checks during National Blood Pressure Week (12-18 September 2011). Why all that effort?   High blood pressure is a major preventable and treatable risk factor for serious heart diseases and stroke syndromes throughout the world. And even at the age of 20 around one in 20 people may already have high blood pressure, increasing to around 1 in 2 people by the age of 70.
An annual blood pressure week provides an important focus to remind the public and health professionals about risks of high blood pressure, how to prevent it, measure it accurately and use lifestyle and drugs in people in whom blood pressure is too high.
Blood pressure should be as low as possible, with, for adults, the upper level, when the heart has contracted, below 140mmHg and the lower level below 90mmHg, when the heart is relaxed between heartbeats. These thresholds should be much lower in people at increased risk of blood pressure complications, such as diabetics and people with kidney disease.
Provided people are otherwise healthy, the ideal blood pressure is now considered by international experts for the upper value to below 120, the lower below 80, recorded as ‘below 120/80mmHg’.
It is very important that patients help by following a healthy lifestyle. This is both helpful to prevent high blood pressure, and for patients with hypertension, to reduce its severity. People should aim for a healthy weight, using fresh foods as far as possible, keep salt intake low, and alcohol intake within healthy limits, be active and have regular good sleep.
This year it is timely the UK’s National Blood Pressure Week comes just after the launch of important new blood pressure guidelines prepared by the National Institute for Health and Clinical Excellence (NICE) advised by experts from the British Hypertension Society (BHS).
The NICE guidelines contain new advice on blood pressure measurement, including involvement of patients in their own management, supported by home blood pressure readings.
It is of course very important that any blood pressure monitor, whether for clinical or home use, should be accurate. A helpful list of accurate devices is on the British Hypertension Society's website.’
If you have high blood pressure, you should make sure that your doctor knows about any over the counter tablets or herbal remedies you are taking, as these can interfere with the actions of blood pressure tablets.
There are now seven major types of blood pressure treatments. For best blood pressure control, prescribers need to the right drug options for the right kind of patient, taking into account, for example, age, ethnicity and potential risks in pregnancy. If single drugs are not sufficient to control blood pressure, the NICE guidelines provide advice on which drug combinations are best to use.

Useful websites:
British Hypertension Society – includes information on which blood pressure monitors are accurate  
http://www.bhsoc.org
Blood Pressure Association – includes a list of venues for free blood pressure checks http://www.bpassoc.org.uk/
NICE guidance on hypertension for patients and carers:
http://guidance.nice.org.uk/CG127/PublicInfo/pdf/English

Tuesday, 2 August 2011

New ideas on diet and cardiovascular health?


What foods may actively help to promote the health of the heart, brain and circulation? And for people who have cardiovascular risk factors, heart disease or stroke syndromes, are there dietary factors that can reduce disease severity or prevent recurrent disease?

To address these and related questions outlined below, the CVRT organised an afternoon symposium on the 'Cardiovascular effects of ‘Healthy’ foods in London on Thursday 8th December, at the Medical Society of London rooms - 11 Chandos Street - 5 minutes walk from Oxford Circus. The symposium considered evidence and mechanisms for cardiovascular benefits (or not) of ‘healthy’ foods. A key message from KT Khaw was that healthy lifestyle actions are cumulative in protecting against serious disorders of the heart and circulation.

See weblink for the programme.


Too many calories, and high intake of saturated and transfats, are well recognised to increase risk of obesity, diabetes mellitus and accelerated vascular disease (atheroma) and low salt (sodium chloride) and potassium rich foods to confer cardiovascular protection.

Outstanding questions include whether particular types of macro-nutrient (protein, carbohydrate and fats) or micronutrients (vitamins, flavenoids, trace minerals) are protective. An association between dietary factor(s) and apparent cardiovascular benefit may be causative, due to 'reverse causation' [e.g. because healthier people believe in the link or are more likely to be able to afford particular dietary constituents]; or may be a coincidental association.

Speakers at the Symposium included Professor Roger Corder from the William Harvey Institute in London, Professor KT Khaw from the University of Cambridge and Associate Professor Naila Rabbani from the University of Warwick. KT Khaw  discussed current controversies, Naila Rabbani  bioactives in fruit and vegetables, and Roger Corder dietary polyphenols and potential vascular benefits of red wine and chocolate. And Jinit Masania outlined a new EU research programme, applying nutrigenomics to assess health claims made for foods.

 

See also Dr Carolyn Staton’s excellent blog on 'Food and microcirculation' on the British Microcirculation Society site. 


© DRJ Singer