Ode to my hands – on my birthday…….
I look at my hands, old, withered, wrinkled
Nails unpainted on fingers that look crinckled
A few rings still adorn these weathered fingers
Absent some, on them, a while, my mind lingers
When did this happen, my hands grew so old
Or are my eyes to be faulted? Once fond
Of beauty, youth and smooth sexy skin
Even happiness is nothing but a wrinkled grin
But let me explain the story of my old hands
Sometimes thrown about by mighty waves
My fingers held on to piercing rocks, caves
I wasn’t going to give up my place in life
I fought, persisted, determined in strife
And then the baggage that I carried
You’d say I was wrong, had me tarried
But nay, long I have lived and learned
Carrying baggage is much needed
On the Himalayan expedition
Raw and filled with imperfection
I was told to take stuff so nothing I lack
First lesson was to pick and pack
Things that’d keep us alive, the right baggage
Yes, indeed it weighed down the passage
Crampons, gloves, food, chapstick to wear
Ice axe, tent, carry mat, stove, all our gear
I now carry bravely my stuff, my baggage
Some friendships, some life lessons
Some values, to seek help, like lifelines
Journeying through life’s minefields and mines
I dare to assert, I carry gear in each of my old hand
Things to love, nurture, hug, care and mend
Go not by how my hands look, they’re stronger for the wear
Reliable, loving magic of these hands fills the air
મહિનાના બીજા અથવા ત્રીજા શનિવારે આ કોલમ પ્રકાશિત થશે અને તેમાં જુદા જુદા વિષયો ઉપર અને વિવિધ દ્રષ્ટિકોણ થી વાતો થશે. તો આજે એક નવા વિષય ઉપર વાતો કરીએ. આ પહેલાના દ્રષ્ટિકોણ વિષય ઉપર મારા 51 લેખ શબ્દોનું સર્જન બ્લોગ ઉપર સમાપ્ત થયા છે. મારા અને બીજા અન્ય લેખકોના લેખ ત્યાં વાંચવા મળશે.
જીવન માં આપણે કૈંક ને કૈંક શોધતા હોઈએ છીએ. કોઈકને પ્રેમ ની શોધ હોય તો કોઈક નું જીવન પૈસા, નામના કે મોક્ષ મેળવવાની શોધ માં વીતે। તે પ્રમાણે હેન્રી મિલર ના કહેવા અનુસાર લેખન ને પણ એક શોધ ની સફર માની શકાય. ઉપરાંત મિલર કહે છે કે લેખક લખવાના કાર્ય માં એક માર્ગ અપનાવે છે પણ આખરે લેખક પોતે જ એક માર્ગ બની જાય છે. આ તેમણે લેખન ઉપર ખુબ જ વિચારવાલાયક અને ઉમદા વાત કહી છે.
આજે તેમણે કહેલ વાત ને લઈને એક ખુબ જાણીતા લેખક વિષે થોડી વાત કરવા માંગુ છું. માર્ક ટ્વેઇન અમેરિકા ના ખુબ મોટા લેખક અને તે ઉપરાંત પ્રકાશક, ઉદ્યોગ સાહસિક, વિનોદી, અને રમૂજ કરાવનાર વ્યક્તિ તરીકે જાણીતા છે. અલબત્ત, તેમના વિષે કહેવાયું છે કે તે આ દેશમાં સૌથી વધુ રમુજી વ્યક્તિ છે. વિલિયમ ફોકનર, જેમને લેખન માટે નોબેલ પ્રાઈઝ મળેલી છે તેમણે માર્ક ટ્વેઇન વિષે કહેલું કે ટ્વેઇન “અમેરિકન લેખન સાહિત્યના પિતા સમાન છે”.
આ દેશના ઉમદા નસીબ હતા કે ટ્વેઇન ને લેખન સાથે સફર નો પણ શોખ હતો. તેમણે થોડો સમય મિસિસિપી નદી ઉપર કામ કરવામાં વિતાવેલ। સેમ્યુઅલ ક્લેમેન્સ નામે જન્મેલ તેમણે તેમનું માર્ક ટ્વેઇન ઉપનામ આ નદી ઉપરજ અપનાવ્યું। માર્ક ટ્વેઇન ઉપનામ નો અર્થ છે કે જયારે બોટ 12 ફૂટ ઊંડા પાણી ઉપર હોય તે માર્ક ને માર્ક ટ્વેઇન કહેવાય છે અને તેટલી ઊંડાઈ બોટ માટે સુરક્ષિત ગણાય છે.
મિસિસિપી નદી મિનેસોટા થી નીકળીને 2320 માઈલ, અમેરિકા ના 10 સ્ટેટ માંથી વહીને અંતે ગલ્ફ ઓફ મેક્સિકો માં ઠલવાય છે. આ નદી ઉપર ટ્વેઈને બોટ ચલાવતા બારીકાઈથી નદીના કિનારે રહેતા લોકો અને તેમની રહેણીકહેણી નું નિરીક્ષણ કર્યું। તેમના વિચારોમાં પણ બદલાવ આવ્યો અને તેમના લેખન દ્વારા વાચકોને અમેરિકાની સાંસ્કૃતિક લેન્ડસ્કેપ વિષે જાણવા મળે છે.
ટ્વેઈને કહેલું કે “મુસાફરી પૂર્વગ્રહ માટે જીવલેણ છે”. તેનો મતલબ કે તમે સફર કરતા, વિવિધ લોકો ના સંપર્ક માં આવો અને તેમના વિષે જાણો અને સંબંધ કેળવો, તે સાથે સાથે તમારું દ્રષ્ટિકોણ પણ વિકસે છે અને કોઈજ પૂર્વગ્રહ ટકી શકતા નથી. ટ્વેઇન ના લખાણ માં નદી કિનારે વસતા અને નદી ઉપર કામ કરતા પાઇલોટ, ખેડૂતો, તેમની પત્નીઓ, જુગારીઓ, નેટિવ અમેરિકનો, બ્લેક અમેરિકનો, મોટા ઝાડ કાપનાર લમ્બરજેક્સ વગેરે નો ઉલ્લેખ છે અને તેમના જીવન વિષે જાણવા મળે છે.
સાલ 1985 માં ટ્વેઇન ની મશહૂર નવલકથા “ધ એડવેન્ચર્સ ઓફ હક્લબેરી ફિન” પ્રસિદ્ધ થઇ. ટુંકાણ માં ભૂમિકા કહું તો હક નામના છોકરા ઉપર દયા ખાઈને મિસ ડગ્લાસ તેને ઘરે લઇ ગઈ. હક ની મુલાકાત ત્યાં જિમ કરીને એક સ્લેવ (ગુલામ)સાથે થઇ. તે સમયે આ દેશમાં મોટા બદલાવ ની હવા ફૂંકાઈ રહી હતી અને બ્લેક અમેરિકનો આઝાદી મેળવવા માટે દક્ષિણ માંથી તેમના મલિક ને છોડીને ઉત્તર તરફ પ્રયાણ કરતા હતા. જીમે પણ તેની માલકણ બાઈને છોડીને ઉત્તર તરફ ભાગવાનો નિર્ણય કર્યો અને હક તે સફર માં જિમ સાથે જોડાયો। આ સફર માં હક અને જિમ વિખુટા પડી ગયા, ફરી મળ્યા અને તેઓએ સાહસ ખેડ્યાં અને વિરોધીઓનો સામનો કર્યો।
આમ જોઈએ તો આ એક બાળવાર્તા છે. પણ તેનું અર્થઘટન કરતા વિવેચકો કહે છે કે ટ્વેઈને પોતે તેમના જીવનકાળ દરમિયાન નિરીક્ષણ કરીને જોયેલ સમાજના વિવિધ પાસાઓ ને રમૂજી રીતે વણી લીધા છે. તેટલુંજ નહિ પણ વારંવાર હક ને સત્ય અને જૂઠ, આડંબર અને પ્રામાણિકતા જેવા સિદ્ધાંતો વચ્ચે થી પસાર થઇ ને પોતાનો માર્ગ કાઢવાનો હોય છે. જેમ કે એકવાર હક કહે છે “પપ્પા હંમેશાં કહેતા હતા કે જો તમે પાછી આપવાના હો તો શાંતિથી કોઈની વસ્તુઓ ઉધાર લઈએ છીએ તેમ માની ને લઇ લેવામાં કોઈ હાનિ નથી. પરંતુ માલકણ કહે છે કે કોઈને પૂછ્યા વિના કંઈપણ લેવું તે ચોરી કર્યા બરોબર જ છે”. ગરીબ અને અશિક્ષિત હક નું પાત્ર આ રીતે સફર કરતા અને જિંદગીના વિઘ્નોમાંથી પસાર થતા થતા ઘડાય છે અને વાસ્તવિક સફર સાથે આ તેના જીવનના સિદ્ધાંતો ની શોધ ની પણ સફર છે. આ લખાણ માં માર્ક ટ્વેઈને તેમની સફર, તેમણે મિસિસિપી નદી ઉપર માણેલ મોજ, અને નદીનું આબેહૂબ વર્ણન તો કર્યું જ છે. પણ સાથે સાથે આ લેખન માં તેમણે જીવન ના સિદ્ધાંતો જે જિંદગીને એક નિશ્ચિત દિશા બતાવે છે તેમને પણ અનોખી ખૂબી થી વણી લીધા છે.
હેન્રી મિલરે કહેલું કે – “કોઈ પણ સફર નું લક્ષ્ય એક સ્થાને પહોંચવાનું નથી હોતું પરંતુ સફર નું મહત્વ એક નવી દ્રષ્ટિ અપનાવવાનું હોય છે”. અને તેમના કહેવા અનુસાર લેખક માહિતી તો પીરસે જ છે પરંતુ ઘણીવાર તે માહિતીને નોલેજ અને વિઝડમ માં બદલાવવાની કોશિશ કરે છે. માર્ક ટ્વેઈને માહિતી સાથે અને રમૂજ સાથે અમેરિકાને ઘણું શાણપણ (વિઝડમ) આપ્યું છે.
Good Newwz is yet another beautiful comedy coming out of Bollywood, after a series of lovely recent comedies, including #LukaChuppi #SkyIsPink and #ZoyaFactor . Current genre of Bollywood films depict real issues facing Indian society, in a light-hearted manner.
In Good Newwz, two couples are trying to get pregnant, with some professional medical help. Deepti (Kareena Kapoor Khan) and Varun Batra (Akshay Kumar) are upscale, high-flying married couple, engaged in their respective careers, while trying to conceive a baby, after 7 years of marriage. Meanwhile, Honey Batra (Diljit Dosanjh) and his wife Monika (Klara Advani) are “the Batras from Chandigarh” and are trying to get pregnant, after 6 years of marriage, numerous tries to conceive, and a couple of miscarriages. Both couples soon find out they are “happily pregnant” —— or are they?
Director Raj Mehta maintains a tight pace, keeps preaching and emotional drama lighthearted and to a minimum, and presents the challenging situation, as naturally as possible. It’s a beautiful movie. On a scale of 1 to 5, with 5 being excellent, I rate the movie 4.6.
Director Greta Gerwig’s adaptation of Louisa May Alcott’s classic novel “Little Women” is a heart warming story of tender ties of sisterhood. The story weaves in and out of past and present events in the lives of four March sisters, passionate and fiercely independent Jo March (Saoirse Ronan), wise and practical eldest sister, Meg March (Emma Watson), tender, shy and deeply caring, Beth March (Eliza Scanlen), and artistic one with a flair for dramatics, Amy March (Florence Pugh). This talented cast is further enhanced with Laura Dern as infinitely patient, wise and loving, Marmee, Timothee Chalamet as Laurie, their neighbor, and Meryl Streep as deliciously sharp and judgmental, Aunt March.
Alcott herself was a fascinating woman who served as a nurse during the Civil War, survived typhoid fever, took lessons from Henry David Thoreau, was an abolitionist and feminst and remained unmarried and was committed to her writing throughout her life. In LIttle Women, she raises questions pertinent to women’s rights and society’s expectations of how women should live their lives. Her characters raise these issues in a candid and forthright manner. Gerwig’s masterful adaptation of this timeless classic is not only bold but beautiful; it’s not just a story of life and death, but story of life, energy and hope; not just a story of adapting to change but staying true to one’s mission. Previously having seen the theater version (http://bit.ly/2QqNTNN), I recently saw the entire television adaptation series of Little Women, on PBS. It was a treat to see this beautiful movie on the silver screen, while the characters were so fresh in my mind. (Image courtesy Lydia Wang’s article on Entertainment).
Heroines in Little Women don’t hesitate to have big dreams and voice big ideas as in “I’d be respected, if I didn’t feel loved”; and “girls have to go into the world and make up their own minds about things”. Gerwig has injected freshness and vitality and love into this timeless classic. Last 30 minutes of the film is just priceless. As you settle into the rhythm of life of March household, you are so uniquely drawn into their home that when it ends, you feel you are walking away from a family, you’re certain to meet again soon.
It was so nourishing to my soul, today it was just what I needed. On a scale of 1 to 5, with 5 being excellent, I rate the movie 4.8.
In “The Wickhams: Christmas at Pemberley”, Lauren Gunderson and Margot Melcon have brought back to life, delightful characters from Jane Austin’s Pride and Prejudice. The show also brings back fond memories of Downton Abby, with most of the action happening below stairs at Pemberley, home of Mr. and Mrs. Darcy (Keenan Flagg and Asha Kelly).
Action is again with George Wickham (Alexander Draa), the profligate, wayward, philanderer husband of Lydia (Barbara Jackson). Younger sister of Elizabeth Darcy and Jane Bingly, Lydia, it seemed, with her silly giggles and girlish exuberance, was incapable of maturity and wisdom that her older sisters displayed, in dealing with matters of the heart, but the show has a surprise for the audience. As the family gathers to celebrate Christmas, Mr. Wickham is expressly not invited to the gathering.
George Wickham arrives nevertheless, uninvited and unwanted, creating a headache for the below stairs residents, the housekeeper, Mrs. Reynols (Deb Anderson) and her assistants, Brian (Kyle Dayrit) and new hire, Cassie (Marlena Westley). Anderson is clearly the star of the show and her natural ease and stage presence is reminiscent of Downton Abby’s Mrs. Carson (Elsie Carson).
Writers Lauren Gunderson and Margot Melcon have moved along the story to fit into the 21st century narrative. Elizabeth Bennet, the dynamic protagonist in Pride and Prejudice, sought actual goodness over superficial goodness, especially when it came to choosing a life partner. That role is assumed by Cassie, and even good men sometimes require women to lead them in accepting role equality. Accordingly, Cassie tells her beau, “Love is about seeing someone and allowing them to be exactly as they are”.
In “The Wickhams”, George Wickham is certainly a flawed character, but can Jane Austen’s heroine remain flawed forever? If your curiosity is piqued, then don’t miss the play. “The Wickhams: Christmas at Pemberley” will be playing at Citylights theater in San Jose, till December 22. Tickets can be obtained at www.cltc.org .
The Humans by playwright Stephen Karam, offers a funny, sad and blisteringly realistic portrait of American family drama, at a thanksgiving meal. The Humans was a finalist for the 2016 Pulitzer Prize for Drama and won the 2016 Tony Award for Best Play.
Blake family, father Erick (Tim Kniffin), mother Deirdre (Marie Shell), daughter Brigid (Madeline Rouverol), daughter Aimee (Lyndsy Kail), Brigid’s live-in lover, Richard (George Psarras) and Momo, (Jessica Powell) have gathered for the meal at Richard and Brigid’s run down apartment in Manhatten, New York. These are the people we know; they are our neighbors, friends; indeed they are us.
Like many families, the Blakes have strong bonds and deep resentments. At times, they differ and argue over what appears to be inconsequential stuff. There are generational differences. Erick and Deirdre want the best for their two daughters but their best is not the same as what their daughters desire. At times, subtly and at times overtly the parents show their disapproval of Brigid’s choice of apartment and her decision to co-habit with her partner, without a marriage. Blake parents agonize over their daughter Aimee’s apparent anxiety, her major bowel disorder and her apparent losses in life. While Richard tries hard to get approval from Aimee’s family and convey to them that he has cleaned up his life, it is not easy to come by. Jessica Powell’s acting as momo suffering from dementia, is absolutely amazing and realistic.
David Zinn’s fascinating two-tiered set with a spiral staircase connecting the floors enables the family drama and action to move between upstairs and downstairs, just like the ebb and flow of their emotions. Kudos to director Tony Kelly and to the scenic team including Guilio Perrone and Michael Truman Cavanaugh for this insightful show.
This family drama is a penetrating portrayal of psychological unease. And yet, even as imperfect individuals and imperfect families travel through uncertainties and challenges, it’s the same ties that create the discomfort that also give hope for the future.
The Humans will be running at San Jose Stage Theater in San Jose, CA till December 15, 2019. For tickets, contact www.thestage.org .
During every theater season, I select best plays as not-to-miss plays of the theater season. Right up front, I will say this is a must-see, not-to-miss-play of this theater season. It is running at theatreworks in Mountain View. Mark Twain’s discerning eye and sharp pen is immortalized by master directors, Randal Myler and Dan Wheetman, in this theatrical production.
A musical devoid of any motive, morals or plot has plenty of all that, if you look deep and listen intuitively. Mighty Mississippi is witness to many heartaches, sorrows, and celebrations and there is much to learn. It is indeed America’s good fortune that this masterfully witty storyteller also traveled up and down the country. Born Samuel Langhorne Clemens, he took on the pseudonym Mark Twain on the banks of Mississippi, a term to mark when the depth of the water is two fathoms, meaning the vessel is on safe water,
For a short period when Twain worked in the river trade on Mississippi, a river that flows from Northern Minnesota all the way south for 2,320 miles, Twain astutely observed. As he explored America’s iconic cultural landscape, winds of change were blowing through the country. In his observations, people working on the river, feeding off of the river, living on the banks of the river, come to life. Stories of the riverboat pilots and brazen gamblers, farm wives who longingly looked back at carefree days as young girls, field hands looking for opportunity to run to freedom somewhere up North, the skillful hardworking lumberjacks and the boatmen all enrich this masterpiece.
In theatreworks musical, Dan Hiatt does a fabulous job as Mark Twain, giving commentary in speech that comes directly from Twain’s many novels, lectures, and essays as well as from actual histories on the lives of lumbermen, farmers, slaves, dock workers and others who stayed and toiled on the banks of the river. Big Kudos to Emily Anderson Wolf and Taylor McQuesten for fabulous stage design and to David Lee Cuthbert for brilliant scenic and media design in this journey on the muddy river.
Of the mighty river Twain says, “you can hang on to her but you can’t control her” and “The Mississippi River will always have its own way; no engineering skill can persuade it to do otherwise….”
Music direction by Dan Wheeetman is brilliant. Songs are entertaining….
Well, I went on the mountain
And I gave my horn a blow
Thought I heard some purty gal say
“Yonder come my beau”
Crow black chicken and crow for a day
Crow black chicken and fly away
There’s longing and lament in some of the soulful songs
When I was a single girl, dressed in clothes so fine,
Now I am a married girl, go ragged all the time
Wish I was a single girl again
When I was a single girl, had shoes of the very best kind
Now I am a married girl, go barefoot all the time
Wish I was a single girl again
Some songs offer images of incredibly skilled lumberjacks doing infinitely challenging tasks
Now, boys, if you will listen, T will sing to you a song,
It’s all about the shanty-boys, and how they get along;
They are a jovial set of boys, so merry and so fine.
They spend a pleasant Winter, in cutting down the pine.
And so the musical continues weaving in stories of wild lumberjacks, rovin’ gamblers, and dreamers of the Delta.
There are farmers, and sailors, likewise mechanics, too,
And all sorts of tradesmen, found with a lumber crew;
The choppers and the sawyers, they lay the timber low.
While the swampers and the skidders, they haul it to and fro.
The cast, Valisia LeKae, Tony Marcus, Rondrell McCormick, Chic Street Man, and Dan Wheetman bring to life all the stories of river folks. They entertain and enthrall, educate and elucidate and keep the audience on the edge of their seats, with foot thumping melodies.
Indeed America is the land of the free but Twain immortalizes the mighty Mississippi as the waters that carried many slaves to freedom, to the Northern states.
I’m comin’ Lord, for my heavenly reward
I’m comin’ home to you, can you see me comin’ thru
Thru clouds of persecution, and stumblin’ on my way
I ‘spect I’m only makin’, ’bout a half a mile a day
Masterfully woven into the lyrics below are subtle references to the operatives of the underground railroad and the markings they left on trees and other landmarks to point the way to freedom.
Well the river bank makes a mighty good road
Dead trees will show you the way
Left foot, peg foot, travelin’ on
Follow the drinkin’ gourd
For the old man is waiting to carry you to freedom
Follow the drinkin’ gourd
Well the river ends, between two hills
Follow the drinkin’ gourd
There’s another river on the other side
Follow the drinkin’ gourd
yearning for more.
The musical does not have a singular plot, motive, or moral But if you look through Twain’s eyes, you shall find plots within plots and plenty of motives and morals. It is small wonder that in Twain’s iconic novel, “Adventures of Huckleberry Finn”, the river becomes both the setting of the novel and its central theme. And as Huck continues on, charting his own course and defining his own morality, the river carries on, offering both it’s umpteen bounty and it’s menace.
I wants to go back to Helena, the high waters got me bogged.
I wants to go back to Helena, the high waters got me bogged.
I woke up early this mornin’, a water hole in my back yard.
They want me to work on the levee, I have to leave my home.
They want to work on the levee, that I have to leave my home.
I was so scared the levee might break out and I may drown.
Twain said, “Travel is fatal to prejudice, bigotry, and narrow-mindedness”. This journey down the Mississippi is an invitation for us to take an honest and also lighthearted look at the world around us. We may learn much and perhaps shed some baggage, if we can travel with Twain for some time, without malice and with genuine curiosity about the world around us. Mark Twain’s River of Song” will be running at Mountain View Center for the Performing Arts, till October 27, 2019. Tickets can be obtained at www.theatreworks.org .
A team of young soccer players in Sarah DeLappe’s play “The Wolves” start out with routine banter, typical of young girls, as they do pre-match warm-up sessions. A Pulitzer Prize finalist, the play offers a rich insight into the minds and hearts of young girls. It is inspiring and emotional, funny and sad and juxtaposes the trials and tribulations of growing up as a young girl in a manner that creates a rich tapestry of varying colors of adolescent life.
The play is not organized around a singular conventional theme. In fact, the points of tension are dispersed among many situations and issues and randomly emerge in the fast and fragmented girl talk. There is anxiety around being in love, getting recruited to a top college with athletic scholarship, being home schooled and moved around with a parent’s job, going for unsupervised parties with boys and more. Added to all the choices that young girls wade through, there’s the shame, guilt and secrecy around sex and sexuality.
What emerges is a rich tapestry of adolescent angst, amidst glaring fundamental truths, the many choices that will have long term consequences and many responsibilities that they delicately seek to balance and navigate through, relying on each other, where only they can understand the depth of emotions. Should destiny require them to deal with loss and grief, what adult can fully understand or speak honestly about the emotional anguish that young girls standing on the dawn of adult life experience? But as the play unfolds, every adult is likely reminded of his or her mental turmoil of adolescence and of their young girls they raised, mentored or taught. There is a certain steady building of empathetic investment into the characters that we experience. By the end of the play, we want each of these girls to go to Harvard or Stanford or heck a community college, indeed any vocation of choice; be on a winning team or not play on one if they so choose; find a partner of choice or be happily single; indeed we want them to fulfill their dreams and grow into kind and happy women. DeLappe’s faultless dialogues on a diverse range of topics, makes these girls so real, we love them like our own.
Big kudos to the talented cast, Leila Rosa, Carol Amalia ALban, Taylor Sanders, Alex Bokovikova, Alexandra Velasquez, Ariel Aronica, Annika Nori, Erin Southard, Beca Gilbert, and Janine Saunders Evans. Credits go to MacKenzie Blair and Sara Session for excellent staging. Director Kimberly Mohne Hill with assistance by Elena Maddy has done a fabulous job of giving on stage life to Sarah De Lappe’s The Wolves. This is an absolutely not-to-miss-play of this theater season and will be running The City Lights Theater in San Jose, CA until October 20, 2019. For tickets, go to www.cltc.org .
Speedy identification of pathogens: saves lives, reduces cost & lowers antibiotic resistance problem
Posted by Darshana V. Nadkarni, Ph.D. in Biotech - Medical Device - Life Science - Healthcare on September 24, 2019
At a recent Bio2DeviceGroup (www.bio2devicegroup.org) event, Kevin Hacker, CEO of BioAffinity Sciences talked about their new technology that when fully developed will identify pathogens more than 100 times faster than the traditional blood culture and related technologies currently in use.
Every year, in the US, 500 thousand people die due to sepsis related complications. Sepsis is a final common pathway for many infections, particularly when an individual’s immunity is low. Body normally releases chemicals into the bloodstream to fight an infection. When the body’s response to these chemicals is out of balance, it results in Sepsis. That is when body’s immune system launches a massive counter attack that harms body’s own tissues and organs. The triggering changes begin to damage body’s vital organ systems that results in dramatic drop in the blood pressure, ultimately leading to death.
Sepsis and septic shock are more common if the individual is very young or very old, have a compromised immune system, have diabetes or cirrhosis, is already sick and frequently in a hospital intensive care unit, have wounds or injuries or severe burns, have invasive devices inserted into the body, and have previously received antibiotics or corticosteroids. Often people can recover from mild sepsis. However, if the body goes into septic shock, the average mortality rate for septic shock is about 40%. Additionally, an episode of severe sepsis may place a person at higher risk of future infections.
Given that widespread infections can progress to Sepsis and Sepsis shock in a matter of few hours, it is imperative that such infections be treated immediately with antibiotics. When given the right antibiotics, there is often a dramatic improvement and speed of cure.
Problem with speedy identification of pathogens
Given that early treatment of sepsis is associated with vastly improved outcomes, rapid diagnosis is essential. However blood culture work is slow and often takes 1-3 days. The diagnosis of sepsis in critically ill patients, housed in hospitals is also challenging because it can be complicated by the presence of inflammation resulting from other underlying diseases and from prior use of antibiotics, making cultures negative. Most testing is done through mass spectrometry that gives mass to charge ratio of ions. Since culture-dependent diagnosis of infection is slow, sometimes patients are given antibiotics, before the results of the culture are available. Patients are given broad spectrum antibiotics and 40% are not effective. In such instances, antibiotics are withdrawn after one cycle of treatment, when the cause of the illness is found to be something else and this can lead to antibiotic resistance.
Bioaffinity Sciences solution will be able to identify pathogens within 10 minutes, 430 fold faster than blood culture. This is cell affinity based, low cost technology. Pathogens are run through microchannels comprising of a surface- grafted scaffold of reactive polymer onto which affinity molecules (sugars, aptamers, vancomycin, and methicillin) have been bio-conjugated. High capacity of the channels allows low numbers of microbes to be quickly identified. The unknown pathogen’s pattern of binding to the channels is recorded, and this pattern is compared to a library of known pathogens. When a match is made, the identity of the pathogen is reported. In addition to speed, this is also more sensitive in terms of the number of different pathogens detected than blood culture.
Disease burden to the healthcare system in the US due to Sepsis
Sepsis management is a major challenge and results in disproportionately high burden in terms of hospital utilization. The average length of stay for sepsis patients in the US is approximately 75% greater than for other conditions. The cost of sepsis management ranks highest among hospital admissions for all disease states. The cost is estimated to be between $25 billion and $27 billion, and represents 13% of total US hospital costs.
Considering that poor sepsis outcomes are directly tied to the delay in diagnosis and treatment, such a dramatic improvement in speed and accuracy of diagnosis leading to speedy and accurate treatment can not only dramatically improve outcome and quality of patient care but also significantly reduce cost of care for hospitals.
The talk was followed by Q&A.
Posted by Darshana V. Nadkarni, Ph.D. in Biotech - Medical Device - Life Science - Healthcare on September 17, 2019
Andre Bessette, CEO & Co-founder at Eclipse Regenesis talked about Short Bowel Syndrome at an event by Bio2DeviceGroup (www.bio2devicegroup.org) held at Wilson Sonsini (WSGR) in Palo Alto. Bessette shared information on prevalence of the disease, it’s impact, and the new technology that offers hope for restoration.
Feel free to skip the short tutorial below and jump to SBS and the technology solutions for treatment of SBS
Movement of the food
Typically digestion begins in the mouth where chewing and saliva begin to break down the food. As it passes through the esophagus, the contractions in the esophagus moves the food forward towards the stomach. In the stomach, the food breaks down further into liquid or paste and is mixed with acids and enzymes. The stomach slowly empties the contents, called chyme, into the small intestine.
It is the tube shaped organ and is located between the stomach and large intestine. The small intestine is regarded as the workhorse of the digestive system. It is 20 FEET LONG and includes the duodenum, jejunum, and ileum.
Duodenum is the first part of the small intestine where typically iron and other minerals are absorbed.
Jejunum is the middle section where cabs, proteins, fat and most vitamins are absorbed.
Ileum is the lower end of the small intestine where bile acids and vitamin B12 are absorbed.
From small intestine the food travels to the large intestine which is about 5 feet long in adults and helps in absorption of water and other remaining nutrients. It then changes waste from liquid to a solid matter called stool.
Short Bowel Syndrome (SBS)
Short Bowel Syndrome or SBS is a devastating condition where the small intestine is simply too short. The inadequate length of the small intestine leads to a whole host of problems primarily related to malabsorption of nutrients and depending on the degree of shortness, sometimes it drastically shortens lifespan. Typically SBS is diagnosed when people have at least half of their small intestine removed and sometimes all or part of their large intestine removed due to disease or injury and significant damage of the small intestine. Sometimes it is a congenital abnormality, where a baby is born with very short small intestine. Depending on the length, SBS may be mild, moderate or severe.
People with SBS cannot absorb enough water, vitamins, minerals, protein, fat, calories and other nutrients from food. Difficulty in absorbing nutrients depends upon the area of small intestine that is removed or non-existent. This inability to absorb nutrients and water causes severe and frequent diarrhea, weight loss and other symptoms related to loss of essential vitamins and minerals.
There are about 8 thousand new cases of SBS in the US, each year. About 65% of them are due to congenital or acquired defect. Typically pediatric patients die before they reach 3 years of age. Their short life is marked with TPN (Total Parenteral Nutrition) treatment where by nutrients are given directly into the bloodstream bypassing the gastrointestinal tract. Gattex (teduglutide) is a prescription medicine given through intravenous (IV) feeding or subcutaneous injection. Not only is it a costly treatment, averaging around 200-300K annually without much improvement but a baby would need to continuously be wearing or accompanying a backpack. Surgical treatment costs 150K to 400K and transplants cost over a million dollars and require life long care, possibility of rejection and infections and has about 5 year mortality for 50% of patients. NONE OF THE CURRENT TREATMENT OPTIONS RESTORE FULL BOWEL FUNCTION.
Eclipse Regenesis Solution
The Eclipse XL1 therapy is a restorative solution designed to grow a longer, healthy intestine rapidly in the course of 2-3 weeks. The solution is entirely mechanical and repeatable, without any harmful or toxic effects. Eclipse has devised a nitinol coil that is introduced into the small intestine via a stoma. Plication sutures are then applied outside the intestine to hold it in place. During the course of the therapy of 2-3 weeks, while the device is in place, nutrients continue to flow through the intestine. Over 2-3 weeks period, the coil gradually expands. As it expands, it gently pulls the small intestine, stimulating new tissue growth and lengthening the treated region 2 to 3 times. The solution is striking in its simplicity and beautiful uncomplicated. After expansion, the sutures dissolve, allowing the coil to move forward and finally get passed out naturally.
Besssette shared information on the team of co-founders with impressive credentials and answered various questions from the audience. Yes, the contractile function continues in the newly lengthened intestine, no the length sustains and does not snap back and the process is repeatable to produce clinical significant length of the intestine and all of these is indicated by the animal trials.
Small Bowel Syndrome is an orphan disease and as such the Eclipse XL1 has received a HUD designation (which requires incidence rate of less than 8000 new cases a year, in the US). Eclipse is anticipating using the HDE regulatory pathway which requires safety and probable benefit data. Eclipse plans to commercialize in pediatric market, in the near future.