Blast kills at least 28 in Pakistan on election day

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."

Bhopal, Mar 13: The Madhya Pradesh Economic Offences Wing (EOW) on Thursday decided to verify facts afresh in a complaint against former Union Minister Jyotiraditya Scindia and his family, in which they are accused of falsifying a property document while selling land.

The development came after Mr Scindia quit the Congress and joined the BJP on Wednesday. 22 MLAs who belong to his camp also resigned, threatening the survival of the Kamal Nath government in the state.

"Yes, an order has been given for re-verification of facts in the complaint filed by Surendra Shrivastava," an Economic Offences Wing official told PTI.

An EOW release said Mr Shrivastava on Thursday filed a new complaint against Mr Scindia and his family, alleging that by falsifying a registry document, they sold him a piece of land at Mahalgaon which was smaller by 6,000 sq feet than the original agreement in 2009.

He had lodged the complaint first on March 26, 2014. But it was investigated and closed in 2018, the EOW official said. "As he again petitioned us today, we will re-verify the facts," the officer said.

Jyotiraditya Scindia's close aide Pankaj Chaturvedi alleged that it was political vendetta.

"The case had been closed for want of evidence. Now for vengeance, it is being reopened. We have full faith in the Constitution and law. We will get justice and Kamal Nath government a befitting reply," Mr Chaturvedi said.

Wellington, Jun 8: New Zealand lifted all domestic coronavirus restrictions on Monday after its final COVID-19 patient was given the all clear, with Prime Minister Jacinda Ardern revealing she danced around her living room when told about the milestone.

While strict border controls will remain in place, Ardern said restrictions such as social distancing and limits on public gatherings were no longer needed.

"We are confident we have eliminated transmission of the virus in New Zealand for now," she said in a televised address, saying Kiwis had "united in unprecedented ways to crush the virus".

The South Pacific nation, with a population of five million, has had 1,154 confirmed COVID-19 cases and 22 deaths.

There have been no new infections for 17 days and, until Monday, just one active case for more than a week.

Details of the final patient were not released for privacy reasons but it is believed to be a woman aged in her 50s who was linked to a cluster at an Auckland nursing home.

Ardern said the sacrifices made by New Zealanders, including a drastic seven-week lockdown that helped curb infection rates, had been rewarded now that there were no active cases in the country.

Asked about her reaction upon hearing the news, she replied: "I did a little dance" with baby daughter Neve.

"She was caught a little by surprise but she joined in, having absolutely no idea why I was dancing around the lounge."

New Zealand's move down to Level 1, the lowest rating on its four-tier virus response system, means nightclubs can operate without dance floor restrictions and theatres will reopen.

It also means sporting events can proceed with crowds in the stands, a change New Zealand Rugby (NZR) said offered its Super Rugby Aotearoa competition the opportunity to achieve a world first when it kicks off this weekend.

"We're incredibly proud, and grateful, to be the first professional sports competition in the world to be in a position to have our teams play in front of their fans again," NZR chief executive Mark Robinson said.

While many other sporting competitions around the globe have announced plans to restart, the vast majority will be played either with no crowds or with numbers severely restricted.

On a broader level, Ardern said easing restrictions would help New Zealand's economy.

"We now have a head start on economic recovery because at level one we become one of the most open, if not the most open, economies in the world," she said.

The prime minister said modelling showed the economy would operate at just 3.8 percent below normal at Level 1, compared with a 37 percent impairment at Level 4 lockdown.