Approve name-change or face 'hopelessness': Zoran Zaev

Washington, Apr 28: After nearly three weeks in an intensive care unit in Los Angeles, doctors treating 41-year-old Broadway actor Nick Cordero for COVID-19 were forced to amputate his right leg.

The flow of blood had been impeded by a blood clot: yet another dangerous complication of the disease that has been bubbling up in frontline reports from China, Europe and the United States.

To be sure, so-called "thrombotic events" occur for a variety of reasons among intensive care patients, but the rates among COVID-19 patients are far higher than would be otherwise expected.

"I have had 40-year-olds in my ICU who have clots in their fingers that look like they'll lose the finger, but there's no other reason to lose the finger than the virus," Shari Brosnahan, a critical care doctor at NYU Langone said.

One of these patients is suffering from a lack of blood flow to both feet and both hands, and she predicts an amputation may be necessary, or the blood vessels may get so damaged that an extremity could drop off by itself.

Blood clots aren't just dangerous for our limbs, but can make their way to the lungs, heart or brain, where they may cause lethal pulmonary embolisms, heart attacks, and strokes.

A recent paper from the Netherlands in the journal Thrombosis Research found that 31 percent of 184 patients suffered thrombotic complications, a figure that the researchers called "remarkably high" -- even if extreme consequences like amputation are rare.

Behnood Bikdeli, a doctor at New York-Presbyterian Hospital, assembled an international consortium of experts to study the issue. Their findings were published in the Journal of The American College of Cardiology.

The experts found the risks were so great that COVID-19 patients "may need to receive blood thinners, preventively, prophylactically," even before imaging tests are ordered, said Bikdeli.

What exactly is causing it? The reasons aren't fully understood, but he offered several possible explanations.

People with severe forms of COVID-19 often have underlying medical conditions like heart or lung disease -- which are themselves linked to higher rates of clotting.

Next, being in intensive care makes a person likelier to develop a clot because they are staying still for so long. That's why for example people are encouraged to stretch and move around on long haul flights.

It's also now clear the COVID-19 illness is associated with an abnormal immune reaction called "cytokine storm" -- and some research has indicated this too is linked to higher rates of clotting.

There could also be something about the virus itself that is causing coagulation, which has some precedent in other viral illnesses.

A paper in the journal The Lancet last week showed that the virus can infect the inner cell layer of organs and of blood vessels, called the endothelium. This, in theory, could interfere with the clotting process.

According to Brosnahan, while thinners like Heparin are effective in some patients, they don't work for all patients because the clots are at times too small.

"There are too many microclots," she said. "We're not sure exactly where they are."

Autopsies have in fact shown some people's lungs filled with hundreds of microclots.

The arrival of a new mystery however helps solve a slightly older one.

Cecilia Mirant-Borde, an intensive care doctor at a military veterans hospital in Manhattan, told AFP that lungs filled with microclots helped explain why ventilators work poorly for patients with low blood oxygen.

Earlier in the pandemic doctors were treating these patients according to protocols developed for acute respiratory distress syndrome, sometimes known as "wet lung."

But in some cases, "it's not because the lungs are occupied with water" -- rather, it's that the microclotting is blocking circulation and blood is leaving the lungs with less oxygen than it should.

It has just been a little under five months since the virus emerged in Wuhan, China, and researchers are learning more about its impact every day.

"While we react surprised, we shouldn't be as surprised as we were. Viruses tend to do weird things," said Brosnahan.

While the dizzying array of complications may seem daunting, "it's possible there'll be one or a couple of unifying mechanisms that describe how this damage happens," she said.

"It's possible it's all the same thing, and that there'll be the same solution."

Seoul, Jun 16: North Korea blew up an inter-Korean liaison office on its side of the border on Tuesday, the South's Unification Ministry said, after days of increasingly virulent rhetoric from Pyongyang.

"North Korea blows up Kaesong Liaison Office at 14:49," the ministry, which handles inter-Korean relations, said in a one-line alert sent to reporters.

The statement came minutes after an explosion was heard and smoke seen rising from the long-shuttered joint industrial zone in Kaesong where the liaison office was located, Yonhap news agency reported citing unspecified sources.

Its destruction came after Kim Yo Jong, the powerful sister of North Korean leader Kim Jong Un, said at the weekend: "Before long, a tragic scene of the useless north-south joint liaison office completely collapsed would be seen."

Since early June, North Korea has issued a series of vitriolic condemnations of the South over activists sending anti-Pyongyang leaflets over the border -- something defectors do on a regular basis.

Last week it announced it was severing all official communication links with South Korea.

The leaflets -- usually attached to hot air balloons or floated in bottles -- criticise North Korean leader Kim Jong Un for human rights abuses and his nuclear ambitions.

Analysts say Pyongyang may be seeking to manufacture a crisis to increase pressure on Seoul while nuclear negotiations with Washington are at a standstill.

Earlier Tuesday, North Korea's army said it was "fully ready" to take action against the South, included re-entering areas that had been demilitarised under an inter-Korean agreement.

"North Korea is frustrated that the South has failed to offer an alternative plan to revive the US-North talks, let alone create a right atmosphere for the revival," said Cheong Seong-chang, a director of the Sejong Institute's Center for North Korean Studies.

"It has concluded the South has failed as a mediator in the process."

Washington, Mar 27: The United States has seen a record 18,000 new confirmed coronavirus cases and 345 deaths over the past 24 hours, according to a Johns Hopkins University tracker.

There are now 97,028 declared virus cases in the country and there have been 1,475 deaths, Johns Hopkins said.