Mystery infections traced

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FILE - In this Sunday, Oct. 9, 2016 file photo, Shiite Muslim men beat themselves with knives attached to chains during a procession to mark Ashoura in Kabul, Afghanistan. In a report released on Wednesday, March 13, 2019, researchers say self-flagellation should be added to the list of ways to spread a dangerous viral blood infection. (AP Photo/Rahmat Gul)

FILE - In this Sunday, Oct. 9, 2016 file photo, Shiite Muslim men beat themselves with knives attached to chains during a procession to mark Ashoura in Kabul, Afghanistan. In a report released on Wednesday, March 13, 2019, researchers say self-flagellation should be added to the list of ways to spread a dangerous viral blood infection. (AP Photo/Rahmat Gul)

Blood-shedding religious ritual


AP Medical Writer

Wednesday, March 13

NEW YORK (AP) — Add self-flagellation to the list of ways to get a dangerous viral blood infection.

Researchers said Wednesday that they were initially puzzled how 10 British men had become infected with a little-known virus, because the men hadn’t taken risks usually associated with the infection.

But then investigators learned they had participated in blood-shedding religious rituals — cutting or whipping themselves — in Iraq, Pakistan, India and the United Kingdom.

“There have been suggestions that you might spread infections through this route, but it has never been described before” in a published medical study, said Dr. Divya Dhasmana of St. Mary’s Hospital in London.

She is one of the authors of the study released Wednesday in a journal published by the U.S. Centers for Disease Control and Prevention.

The men were infected with human T-cell leukemia virus type 1. Most people infected with the virus never develop symptoms, but some develop terrible illnesses, like a deadly blood cancer or a debilitating nervous system condition.

HTLV-1 spreads through breastfeeding, sex, blood transfusion and sharing of needles. Experts have estimated that up to 10 million people worldwide are infected, though it is considered relatively rare in the United States and United Kingdom.

None of the men in the study had symptoms. They were diagnosed through tests that preceded blood donations or in vitro fertilization procedures, tests that are not routinely performed in other settings.

They came to the attention of researchers at St. Mary’s Hospital, which is a referral center in England for HTLV-1 cases. The mystery was solved when Dhasmana noticed scars on the back of one man, leading to questions that revealed all 10 men had participated in religious self-flagellation.

One ritual involves striking the forehead with a knife and then passing it along to other men. Another involves striking the back with a chain of blades or other bladed implement.

One man said that when he did it, the blades being passed around were soaked in a bucket containing an over-the-counter antiseptic solution. But that is inadequate to prevent spread of HTLV-1, Dhasmana said.

The practice of whipping or cutting oneself has been practiced among different religious groups, most notably by Shiite Muslims on the holy day Ashoura. Usually only men do it, and it’s controversial even within religious communities.

Dhasmana said: “Our message is not ‘Don’t do it.’ Our message is ‘If you do it, don’t share equipment.’”

The Associated Press Health & Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

The Conversation

Global study of pancreatic cancer offers possible insights into treatment and early detection

March 18, 2019

Author: Aatur Singhi, Professor of Anatomy and Pathology, University of Pittsburgh

Disclosure statement: Aatur Singhi receives funding from the Pancreatic Cancer Action Network, the Sky Foundation, and the National Cancer Institute Early Detection Research Network.

Partners: University of Pittsburgh provides funding as a member of The Conversation US.

When “Jeopardy!” episode 7059 aired on April 30, 2015, the category was “The Human Body,” the price was $2,000, and the clue was “This gland’s main duct, the duct of Wirsung, collects its juices & empties into the duodenum.”

The question was “What is the pancreas?” Unbeknownst to Alex Trebek, the show’s beloved host, the cells that line the duct of his pancreas would develop into pancreatic cancer, or pancreatic ductal adenocarcinoma. Trebek announced on March 6, 2019 that he has pancreatic cancer, but that he will fight the disease and keep hosting the show. And in fact, he was back at work March 12.

Alex Trebek announces he has pancreatic cancer.

“Truth told, I have to because under the terms of my contract, I have to host ‘Jeopardy’ for three more years,” he said jokingly. “So help me. Keep the faith, and we’ll win. We’ll get it done.”

I am a surgical and molecular pathologist at the University of Pittsburgh Medical Center and routinely evaluate patients with pancreatic cancer. As a pathologist, I establish the diagnosis and evaluate the genetics of pancreatic cancer to improve early detection and treatment of pancreatic cancer.

Although Trebek’s recovery is still unknown, researchers are trying to develop diagnostic tests that will let people know earlier that they have this form of cancer. A study my colleagues and I recently published identified genetic differences in patients that might make current chemotherapies more effective.

Hard to detect, hard to treat

Each day in the U. S., an estimated 155 Americans will be diagnosed with pancreatic cancer and an estimated 125 Americans will die of pancreatic cancer. About 55,440 will be diagnosed this year.

Within the first year of diagnosis, 74 percent of patients with pancreatic cancer will die from this dismal disease and 90 percent of patients will die within five years of their diagnosis.

What makes pancreatic cancer so deadly is that it is often found late in its disease course, as in the case of Trebek. Hence, time is of the essence when it comes to treatment.

Current options for most patients are chemotherapy, radiation and, for a minority, surgery. But every pancreatic cancer is different, and therefore it requires a personalized approach, such as understanding the different genetic changes occurring in each patient’s pancreatic cancer.

At the University of Pittsburgh Medical Center (UPMC), we try to genetically profile every patient with pancreatic cancer to define their best course of treatment. While pancreatic cancer is so dire, there are genetic changes that can be targeted with currently available medications, and it’s important to identify them sooner than later.

But, in order for us to accomplish this, we have to know what genomic changes to look for in pancreatic cancer. Hence, in collaboration with Foundation Medicine, my research team and I genetically profiled 3,594 patients from all over the world. We were looking for genetic changes that are linked to known therapeutic regimens for not only pancreatic cancer, but all cancer types. This approach has had some success with other cancer types. For example, a genetic mutation was found in some types of lung cancer that was sensitive to immunotherapy drugs such as Keytruda. That drug had first gained FDA approval for treatment of melanoma.

With such a large and diverse patient population, it is not surprising that there were a number of key findings from our study.

Mutations that could be targeted

First, we found that 17 percent of pancreatic cancers contained genetic mutations that may be susceptible to currently available anti-cancer therapy. While many of the genetic mutations we detected in pancreatic cancer have been described previously, we also identified genetic changes that were reported in other cancer types, but never described in pancreatic cancer. Moreover, these mutations are known to be targetable with existing drug regimens and are potentially therapeutic for patients with pancreatic cancer as well.

Second, we discovered a significant number of pancreatic cancer patients harbored mutations in their germline DNA, or in other words, a genetic change that has been incorporated into every cell in their body.

Previous studies have shown that 10 percent of patients with pancreatic cancer report a family history of the disease, and a subset have been linked to specific genomic alterations. For example, germline alterations in the genes BRCA1 and BRCA2, which are known to be associated with hereditary breast and ovarian cancer, have also been linked to pancreatic cancer.

We were not surprised that these genes were frequently mutated among patients within our study and additional genes related to them were also found to be altered. This information paves the way for improved germline testing for patients that may have a history of pancreatic cancer with implications for their loved ones.

Our last bit of insight came from looking at the genomic changes in pancreatic cyst fluid. About 15 percent of pancreatic cancers are known to arise from pancreatic cysts, or fluid collections within the pancreas. Pancreatic cysts are often identified on routine abdominal imaging and, therefore, amenable to early detection. Because early detection of pancreatic cancer is an important cornerstone to improving patient survival, my team examined those pancreatic cancers arising from pancreatic cysts.

Pancreatic cysts, however, are very common in the U.S. population. In fact, 1 to 2 percent of Americans who undergo an abdominal scan are found to have a pancreatic cyst. Certainly, not all pancreatic cysts will progress to pancreatic cancer and, therefore, tests to detect a pancreatic cancer arising within a pancreatic cyst early is needed.

In 2017, our team at UPMC reported the creation and validation of a clinically available test to evaluate patients with pancreatic cysts called PancreaSeq. PancreaSeq evaluates the genetic changes in pancreatic cyst fluid to identify those cysts that are likely to transform into pancreatic cancer. It is used by several institutions throughout the U.S.

Among the 3,594 pancreatic cancers profiled for our recent study, we identified key genetic alterations among pancreatic cancers arising from pancreatic cysts that could be incorporated into PancreaSeq and improve its ability to detect pancreatic cancer early.

We believe that our study provides a compendium of known genetic alterations for pancreatic cancer that may serve as a clinical resource to not only guide future treatment for patients undergoing targeted genetic profiling, but familial pancreatic cancer testing and early detection.

The Conversation

Thich Nhat Hanh, the Buddhist monk who introduced mindfulness to the West, prepares to die

March 18, 2019

Author: Brooke Schedneck, Assistant Professor of Religious Studies, Rhodes College

Disclosure statement: Brooke Schedneck does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Thich Nhat Hanh, the monk who popularized mindfulness in the West, has returned home to Vietnam to enjoy the rest of his life. Devotees from many parts of the world are visiting the ailing 92-year-old, who has retired to a Buddhist temple outside Hue.

This thoughtful and accepting approach to his own failing health seems fitting for the popular Buddhist teacher, whose followers include a thousand Buddhist communities around the world and millions more who have read his books. For everyone, his teachings encourage being present in the moment.

As a scholar of the contemporary practices of Buddhist meditation, I have studied his simple yet profound teachings, which combine mindfulness along with social change.

Peace activist

In the 1960s, Thich Nhat Hanh played an active role promoting peace during the years of war in Vietnam. Hanh was in his mid-20s when he became active in efforts to revitalize Vietnamese Buddhism for peace efforts.

Over the next few years, Thich Nhat Hanh set up a number of organizations based on Buddhist principles of nonviolence and compassion. His School of Youth and Social Service, a grassroots relief organization, consisted of 10,000 volunteers and social workers offering aid to war-torn villages, rebuilding schools and establishing medical centers.

He also established the Order of Interbeing, a community of monastics and lay Buddhists who made a commitment to compassionate action and supported war victims. In addition, he founded a Buddhist university, a publishing house, and a peace activist magazine as a way to spread the message of compassion.

In 1966, Thich Nhat Hanh traveled to the United States and Europe to appeal for peace in Vietnam.

In lectures delivered across many cities, he compellingly described the war’s devastation, spoke of the Vietnamese people’s wish for peace and appealed to the U.S. to cease its air offensive against Vietnam.

During his years in the U.S., he met Martin Luther King Jr., who nominated him for the Nobel Peace Prize in 1967.

However, because of his peace work and refusal to choose sides in his country’s civil war, both the communist and noncommunist governments banned him, forcing Thich Nhat Hanh to live in exile for over 40 years.

During these years, the emphasis of his message shifted from the immediacy of the Vietnam War to being present in the moment – an idea that has come to be called “mindfulness.”

Being aware of the moment

Thich Nhat Hanh first started teaching mindfulness in the mid-1970s. The main vehicle for his early teachings was his books. In “The Miracle of Mindfulness,” for example, Thich Nhat Hanh gave simple instructions on how to apply mindfulness to daily life. This book was translated into English for a global audience.

In his book, “You Are Here,” he urged people to pay attention to what they were experiencing in their body and mind at any given moment, and not dwell in the past or think of the future. His emphasis was on the awareness of the breath. As you follow the breath, he taught his readers to say internally, “I’m breathing in; this is an in-breath. I’m breathing out: this is an out-breath.”

People interested in practicing meditation didn’t need to spend days at a meditation retreat or find a teacher. His teachings emphasized that mindfulness could be practiced anytime, even when doing routine chores.

Even when doing the dishes, people could simply focus on the activity and be fully present. Peace, happiness, joy and true love, he said, could be found only in the moment.

Mindfulness in America

Hanh’s mindfulness practices don’t advocate disengagement with the world. Rather, in his view, the practice of mindfulness could lead one toward “compassionate action,” like practicing openness to other’s viewpoints and sharing material resources with those in need.

Jeff Wilson, a scholar of American Buddhism, argues in his book, “Mindful America,” that it was Hanh’s combination of daily mindfulness practices with action in the world that contributed to the earliest strands of the mindfulness movement. This movement eventually became what Time Magazine in 2014 called the “mindful revolution.” The article argues that the power of mindfulness lies in its universality, as the practice has entered into corporate headquarters, political offices, parenting guides and diet plans.

For Thich Nhat Hanh, however, mindfulness is not a means to a more productive day but a way of understanding “interbeing,” the connection and codependence of everyone and everything. In a documentary “Walk With Me,” he illustrates interbeing in the following way:

A young girl asks him how to deal with the grief of her recently deceased dog. He instructs her to look into the sky and watch a cloud disappear. The cloud has not died but has become the rain and the tea in the teacup. Just as the cloud is alive in a new form, so is the dog. Being aware and mindful of the tea offers a reflection on the nature of reality.

He believes this understanding could lead to more peace in the world.

In 2014, Thich Nhat Hanh suffered a stroke. Since then, he has been unable to speak or continue his teaching. In October of 2018 he expressed his wish, using gestures, to return to the temple in Vietnam where he was ordained as a young monk.

Australia says tensions with Turkey ease after WWI remarks


Associated Press

Thursday, March 21

SYDNEY (AP) — Australian Prime Minister Scott Morrison said on Thursday tensions between his country and Turkey had eased after President Recep Tayyip Erdogan’s office said comments by the Turkish leader that sparked the row had been taken out of context.

A diplomatic dispute flared over Erdogan’s comments in the wake of Friday’s gun massacre in which 50 people were killed at two mosques in Christchurch, New Zealand, attacks for which an Australian white supremacist has been charged with murder.

Speaking while campaigning for local elections, Erdogan warned Australians and New Zealanders going to Turkey with anti-Muslim views would return home in coffins, like their ancestors who fought at Gallipoli in World War I.

Morrison slammed the comments as “highly offensive,” and on Wednesday summoned Turkish Ambassador to Australia, Korhan Karakoc, to explain the remarks. Australia also placed under review its travel advisory for its citizens visiting Turkey, which was already set at “exercise a high degree of caution” due to the threat of terrorism.

But on Thursday, Morrison said progress had been made on mending bilateral ties after a spokesman for Erdogan said the president’s words were “taken out of context.” Fahrettin Altun, director of communications for the Turkish presidency, said Erdogan was in fact responding to the manifesto posted online by the man arrested in the mosque attacks.

Altun also said Erdogan had made his remarks in a historical context relating to attacks past and present against Turkey, a move partly inspired, he said, by the fact the president was speaking near commemorative sites near the Gallipoli battlefields.

“President Erdogan’s words were unfortunately taken out of context,” Altun said on Twitter.

“He was responding to the so-called ‘manifesto’ of the terrorist who killed 50 innocent Muslims in Christchurch, New Zealand. Turks have always been the most welcoming & gracious hosts to their Anzac (Australia and New Zealand) visitors.

“The terrorist’s manifesto not only targeted Erdogan himself but also the Turkish people and the Turkish state.

“As he was giving the speech at the Canakkale (Gallipoli) commemoration, he framed his remarks in a historical context of attacks against Turkey, past and present.”

Morrison on Thursday welcomed what he called a “moderation” of Erdogan’s views, which followed a series of high-level bilateral diplomatic communications on the matter.

“Overnight, progress has been made on this issue and overnight we’ve already seen a moderation of the president’s views,” Morrison told reporters in Melbourne.

“It’s my intention to break any cycle of recklessness, to work through these issues practically, to register in the strongest and clearest of terms the offence that was taken — I believe rightly — by those comments yesterday, but now to work constructively,” Morrison told reporters in Melbourne.

“Australia and Turkey, the peoples of both countries, have a tremendous relationship, built up over generations.”

Thursday’s developments came as New Zealand Foreign Minister and Deputy Prime Minister Winston Peters was en route to Turkey to meet with Erdogan and seek clarification over his comments.

The 1915 Gallipoli campaign, marked by heavy casualties on both sides, was a disastrous defeat for the allies against the then Ottoman Empire. Although the battle later helped cement friendship among the three countries, it remains a highly sensitive subject in Australia and New Zealand.

Erdogan has also sparked outrage abroad by showing video excerpts at his campaign rallies of the footage broadcast by the Christchurch gunman, to denounce what he has called rising hatred and prejudice against Islam. Three Turkish citizens were among the dozens wounded in the attack.

It is not the first time Erdogan has sparked outrage abroad by making controversial statements about foreign countries, particularly during pre-election periods to stir up nationalist sentiment and consolidate his support base. He has sought to patch up relations after the elections.

Local elections are set to be held in Turkey on March 31. With the economy struggling, Erdogan’s party risks losing the capital, Ankara, to the opposition. Such an outcome would be a severe blow to the president, whose ruling Justice and Development Party and its predecessor have run the city for the past quarter century.

FILE – In this Sunday, Oct. 9, 2016 file photo, Shiite Muslim men beat themselves with knives attached to chains during a procession to mark Ashoura in Kabul, Afghanistan. In a report released on Wednesday, March 13, 2019, researchers say self-flagellation should be added to the list of ways to spread a dangerous viral blood infection. (AP Photo/Rahmat Gul) – In this Sunday, Oct. 9, 2016 file photo, Shiite Muslim men beat themselves with knives attached to chains during a procession to mark Ashoura in Kabul, Afghanistan. In a report released on Wednesday, March 13, 2019, researchers say self-flagellation should be added to the list of ways to spread a dangerous viral blood infection. (AP Photo/Rahmat Gul)
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