Buy American, hire Americans: Trump's 2 simple rules

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."

Washington, Jan 9: The U.S. and Iran stepped back from the brink of possible war Wednesday as President Donald Trump signaled he would not retaliate militarily for Iran's missile strikes on Iraqi bases housing U.S. troops. No one was harmed in the strikes, but U.S. forces in the region remained on high alert.

Speaking from the White House, Trump seemed intent on deescalating the crisis, which spiralled after he authorized the assassination of Iran's top general, Qassem Soleimani. Iran responded overnight by firing more than a dozen missiles at two installations in Iraq, its most direct assault on America since the 1979 seizure of the U.S. Embassy in Tehran.

Trump's takeaway was that “Iran appears to be standing down, which is a good thing for all parties concerned and a very good thing for the world.”

The region remained on edge, however, and American troops including a quick-reaction force dispatched over the weekend were on high alert. Hours after Trump spoke, an ‘incoming’ siren went off in Baghdad's Green Zone after what seemed to be small rockets “impacted” the diplomatic area, a Western official said. There were no reports of casualties.

Iran's Supreme Leader Ayatollah Ali Khamenei said the overnight strike was not necessarily the totality of Iran's response. “Last night they received a slap,” Khamenei said. “These military actions are not sufficient (for revenge). What is important is that the corrupt presence of America in this region comes to an end.”

The strikes had pushed Tehran and Washington perilously close to all-out conflict and left the world waiting to see whether the American president would respond with more military force. Trump, in his nine-minute, televised address, spoke of a robust U.S. military with missiles that are “big, powerful, accurate, lethal and fast.'' But then he added: “We do not want to use it."

Iran for days had been promising to respond forcefully to Soleimani's killing, but its limited strike on two bases--one in the northern Iraqi city of Irbil and the other at Ain al-Asad in western Iraq--appeared to signal that it too was uninterested in a wider clash with the U.S. Foreign minister Mohammad Javad Zarif tweeted that the country had “concluded proportionate measures in self-defence.”

Trump said the U.S. was “ready to embrace peace with all who seek it.” That marked a sharp change in tone from his warning a day earlier that “if Iran does anything that they shouldn't be doing, they're going to be suffering the consequences, and very strongly.”

Trump opened his remarks at the White House by reiterating his promise that “Iran will never be allowed to have a nuclear weapon.” Iran had announced in the wake of Soleimani's killing that it would no longer comply with any of the limits on uranium enrichment in the 2015 nuclear deal crafted to keep it from building a nuclear device.

The president, who had earlier pulled the U.S. out of the deal, seized on the moment of calm to call for negotiations toward a new agreement that would do more to limit Iran's ballistic missile programmes and constrain regional proxy campaigns like those led by Soleimani.

Trump spoke of new sanctions on Iran, but it was not immediately clear what those would be.

Davos, Jan 22: President Donald Trump has said that the US is watching the developments between India and Pakistan over Kashmir "very closely" and repeated his offer to "help" resolve the longstanding dispute between the two neighbours as he met Prime Minister Imran Khan on the sidelines of the World Economic Forum here in the Swiss ski resort.

Addressing the media with the Pakistan Prime Minister prior to their private meeting on Tuesday, President Trump asserted that trade and borders were both critical points for discussion, while Khan said that for him, Afghanistan was the top priority.

Trump told Khan, whom he referred to as "my friend", that he would speak to Prime Minister Narendra Modi about the ongoing Kashmir issue. The US president is expected to visit India in the coming weeks, marking his first visit after taking up his post in the White House.

"What's going on between Pakistan and India … if we can help, we certainly will be willing to. We have been watching it very closely and it's an honour to be here with my friend," he said.

"The Pakistan-India conflict is a very big issue for us in Pakistan and we expect the US to always play its part in deescalating the tensions, because no other country can," Khan said.

President Trump has repeatedly offered to mediate following India's August 5 decision to revoke the special status to Jammu and Kashmir and bifurcate the state into two Union Territories, evoking strong reaction from Pakistan which has been trying to internationalise the Kashmir issue.

New Delhi has defended the move, saying Jammu and Kashmir is an integral part of India and the issue was strictly internal to the country, and the special status provisions only gave rise to terrorism in Jammu and Kashmir.

"The country took the decision of abrogation of Article 370, which had only given separatism and terrorism to that state," Prime Minister Narendra Modi said at a function in October last year.

This is the third meeting between Trump and Khan since Pakistan premier assumed office in 2018 and it came against the backdrop of Pakistan Foreign Minister Shah Mehmood Qureshi's recent trip to the US, amid reports that the US and Afghan Taliban were close to striking a peace deal.

"There are issues we want to talk about. The main issue is Afghanistan because it concerns the US and Pakistan. Fortunately, we are on the same page. Both of us are interested in peace there and an orderly transition in Afghanistan with talks with Taliban and the government," Khan said.

When a reporter asked Trump if he would visit Pakistan considering he was already set to visit India, the US president said he was meeting the Pakistan premier in Davos.

"Well, we're visiting right now. So we don't really have to. I wanted to say that from a relationship standpoint, we got a great relationship. From the standpoint our two countries, we're getting along very well. I would say we've never been closer with Pakistan the way we're right now. And this is a big statement," Trump said.

Khan left for Switzerland to attend the World Economic Forum and meet the world leaders, including President Trump, on the sidelines of the annual event which kicked off at the ski resort town of Davos on Tuesday.

The four-day summit marks the 50th anniversary of the forum.

A total of 53 heads of State are on the guest list. Nearly 3,000 participants from 118 countries are expected to attend the event during which political leaders, business executives, heads of international organisations and civil society representatives are set to deliberate on contemporary economic, geopolitical, social and environmental issues.