Nepal Parliament approves new map that includes land controlled by India

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."

Jun 19: Billionaire Mukesh Ambani on Friday announced that his oil-to-telecom conglomerate Reliance Industries is now net debt-free after raising a record Rs 1.69 lakh crore from global investors and a rights issue in under two months.

Reliance raised Rs 1.15 lakh crore from global tech investors by selling a little less than a quarter of the firm's digital arm, Jio Platforms Ltd, and another Rs 53,124.20 crore through a rights issue in the past 58 days.

Taken together with last year's sale of 49 per cent stake in fuel retailing venture to BP Plc of UK for Rs 7,000 crore, the total fund raised is in excess of Rs 1.75 lakh crore, the company said in a statement.

Reliance had a net debt of Rs 1,61,035 crore as on March 31, 2020. "With these investments, RIL has become net debt-free," it said.

"I have fulfilled my promise to the shareholders by making Reliance net debt-free much before our original schedule of March 31, 2021," Ambani said.

Jio Platforms - which houses the country's youngest but largest telecom firm Reliance Jio, raised Rs 1,15,693.95 crore from leading global investors including Facebook, Silver Lake, Vista Equity Partners, General Atlantic, KKR, Mubadala, ADIA, TPG, L Catterton and PIF since April 22, 2020.

Saudi Arabian sovereign wealth fund PIF buying 2.32 per cent stake in the unit for Rs 11,367 crore on June 18 "marks the end of Jio Platforms' current phase of induction of financial partners," the statement said.

Alongside, Reliance launched India's biggest right issue, which was subscribed to 1.59 times.

Though the rights issue size was Rs 53,124 crore, the company has got only 25 per cent of the money as the remaining is to be paid only next fiscal.

Ambani had at the company's annual general meeting on August 12, 2019, announced a roadmap for Reliance to become a net debt-free company before March 31, 2021.

"We have a very clear roadmap to becoming a zero net-debt company within the next 18 months that is by March 31, 202," he had said last year highlighting strong interest from strategic and financial investors in consumer businesses, Jio and Reliance Retail.

In the statement on Friday, he said he was both delighted and humbled to announce the fulfillment of the promise.

"Exceeding the expectations of our shareholders and all other stakeholders, again and yet again, is in the very DNA of Reliance," he said.

"Therefore, on the proud occasion of becoming a net debt-free company, I wish to assure them that Reliance in its Golden Decade will set even more ambitious growth goals, and achieve them," he added.

He said over the past few weeks, phenomenal interest was received from the global financial investor community in partnering with Jio.

"As our fundraising milestone from financial investors is achieved, we sincerely thank the marquee group of financial partners and warmly welcome them into Jio Platforms," he said.

"I also express my heartfelt gratitude to all the retail and institutional investors, both domestic and foreign, for their overwhelming participation in our record-setting Rights Issue," he added.

Mumbai, Jan 3: The Shiv Sena on Friday targeted the Centre by questioning the "efficacy" of the 2016 surgical strike and said the perception that it would demoralise Pakistani terrorists remained an "illusion" as Indian soldiers continue to get killed in terror attacks in Kashmir.

Accusing the Modi government of boasting about how Pakistan was straightened out after the surgical strike, the Sena sought to know whether it has really happened.

It also observed that troubled borders were not good for the country's well-being.

The Sena's remarks come in the wake of the death of an Army soldier from Maharashtra, Naik Sandip Raghunath Sawant, who was killed during a counter-insurgency operation in Jammu and Kashmir on Wednesday.

"The New Year did not begin on a positive note in Kashmir. Our jawan from Satara, Sandip Sawant, attained martyrdom in Kashmir along with two other soldiers. In the last one month, seven to eight jawans from Maharashtra were killed in the line of duty. The Maha Vikas Aghadi government in Maharashtra is not responsible for this," the Sena said in an editorial in party mouthpiece 'Saamana'.

The party also questioned whether the situation in Kashmir has improved after the surgical strike and abrogation of Article 370 provisions.

The party, however, maintained that scrapping Article 370 was a good move.

India had conducted the surgical strike on September 29, 2016, across the Line of Control (LoC) as a response to a terrorist attack on an Indian Army base in Uri sector of Jammu and Kashmir earlier that month.

Without naming the Centre, the Sena alleged, "Circulating news that only the Pakistanis were getting killed in Kashmir will not change the reality as tricolour-draped bodies of Indian soldiers, like Sawant, are reaching their respective villages."

"There is a bloodshed along the Kashmir border and mounting anger among the families of martyred jawans. The perception that surgical strike will demoralise Pakistani terrorists has turned out to be an illusion. In fact, the (terror) attacks have increased," it added.

The Uddhav Thackeray-led party accused the ruling BJP of boasting about straightening out Pakistan after the surgical strike.

"But has Pakistan been really straightened out? Rather Pakistan has been indulging in ceasefire violations along the LoC every day," it added.

The Shiv Sena also questioned the government's claim that the situation in Kashmir was under control after the nullification of Article 370.

"It is good that Article 370 was scrapped. Before that, surgical strike was carried out in Pakistan. But has the situation in Kashmir improved? The terror attacks continue. It's only that there is a control in reporting (these incidents)," it said.

The Sena also alleged that there was no clarity as to what was transpiring in Kashmir after the scrapping of Article 370 and only the media reports of soldiers sacrificing their lives have been coming out from that state

In a veiled attack on the BJP, its erstwhile ally, the Sena, also accused it of exploiting the surgical strike for political gains.