Crashed PIA plane's pilot ignored 3 warnings to lower altitude: Report

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."

Islamabad, Jul 20: Six advisors of Pakistan Prime Minister Imran Khan posses dual citizenships and several of top 20 aides have admitted of owning movable and immovable assets worth millions of dollars abroad.

The list was published on the official website of Pakistan government's cabinet division.
All the dual nationals were working as special assistants to the prime minister (SAPM). 

These people include SAPM on Overseas Pakistanis Syed Zulfiqar Abbas Bukhari (UK), SAPM on Power Division Shahzad Qasim (US), SAPM on Petroleum Nadeem Babar (US), SAPM on Political Affairs Shahbaz Gill (US), SAPM on Parliamentary Coordination Nadeem Afzal Gondal (Canada) and SAPM on Digital Pakistan Tania Aidrus (Canadian citizenship by birth).

According to Gulf News report, the wealthiest SAPM is Power Division and Mineral Resources Assistant Shahzad Syed Qasim who has assets worth over Rs 4 billion followed by SAPM on Petroleum Nadeem Babar with assets worth Rs 2.75 billion. Meanwhile, Adviser for Overseas Pakistanis Syed Zulfiqar Abbas Bukhari's net assets is estimated over Rs 2 billion.

Giving further details of the wealthiest SAPM, the official website stated that the PM's aide on Power Division and Coordination of Marketing and Development of Mineral Resources owns assets in Pakistan, UAE and US. His three properties in UAE include two villas in Jumeirah Golf Estates and Sienna Lakes, Jumeirah Golf Estates and an apartment at Park Towers, DIFC - all worth Dh20,688,000. He has three cars in the UAE worth Dh400,000 and in the US, he has property worth US$865,000 while he has Rs 4 billion in various local and foreign bank accounts and retirement funds including $2.1 million in US.

Meanwhile, Nadeem Babbar, who is Special Assistant on Petroleum Division, owns assets worth over Rs 2.7 billion, including several properties in Pakistan and abroad and stakes in more than 30 local and foreign companies.

The Gulf News further reported that in the list Dr Moeed Yusuf's, Special Assistant to the Prime Minister on National Security Division and Strategic Policy Planning, the name was also included but was later withdrawn as it was clarified that he had the US residency and only holds the citizenship of Pakistan as per the affidavit submitted to the government. "I have not returned to the US since I took up my current responsibility, have no employment or income in the US nor do I have any millions worth properties abroad" Dr Yusuf was quoted as saying.

The latest list on PM Imran Khan's advisors possessing dual nationalities has sparked strong criticisms by the Opposition leaders.

Islamabad, Apr 26: Pakistan Prime Minister Imran Khan has been trumped by the country's powerful military yet again, this time over his government's inadequate steps and its poor response in curbing the coronavirus outbreak in the country, even as cases soared over 12,500.

In his address to the nation on March 22, Khan explained the reasons for not imposing a countrywide lockdown, asserting that millions would lose their jobs and affect families, who are below the poverty line, struggling to find enough food to eat. However, less than 24 hours later, Pakistan Army spokesperson Major General Babar Iftikhar announced the implementation of lockdown in the country having a population of over 200 million, contradicting the statements made by Imran Khan.

As lockdown was imposed, the military has deployed troops across Pakistan and is orchestrating the COVID-19 response through the National Core Committee, a body set up to coordinate policy between the national and provincial governments.

"The government left a big gap in its handling of the coronavirus. The army has tried to fill that gap, there was no choice," an unnamed retired general was quoted by Financial Times as saying.

The virus crisis in Pakistan has once again made things crystal clear about who is calling the shots -- the military, widely believed to bring Imran Khan to power in 2018.

The armymen have taken over the COVID-19 crisis as an opportunity to prove their competency in contrast to Imran Khan, who was mocked after urging youth to come forward and join Corona Relief Tigers Force, a volunteer body to wage "jihad" against the virus.

According to analysts, the military's seizure of the coronavirus response marks yet another policy failure for Imran Khan in the eyes of the generals, as per the Financial Times report.

The 67-year-old cricketer-turned-politician has repeatedly failed to gain international traction over the Kashmir issue and has struggled to convince the Financial Action Task Force (FATF) in getting his country removed from 'grey list' for terror funding.

In times of emergency, one has to take clear decisions and take them through. You can't dither. The whole world is advising strong lockdown. If the prime minister does not show that he is decisive, somebody else will," said Nafisa Shah, a Member of Parliament from the opposition Pakistan Peoples Party (PPP).

Even after the lockdown was imposed, Imran Khan continued to question the need for its implementation, raising eyebrows over the country's response in tackling the virus, as cases continue to rise. This comes even as such drastic measures are in place in many countries across the world, including neighbouring India.

According to The Dawn, the country has 12,657 confirmed cases of COVID-19, which includes 2,755 recoveries and 265 deaths. Punjab has the highest number of cases -- 5,326 --, followed by 4,232 in Sindh.

However, experts suggest that the actual numbers could be more given the low testing rates and inadequate supply of testing kits.

Doctors and nurses across the country have staged protests over the lack of personal protective equipment, as increasing numbers of health workers contract COVID-19.

"Because of the lack of resources, there is chaos among the doctors and healthcare workers. They know people are dying, they know the severity of the illness and they have to work without PPE," Shoaib Hasan Tarar, a doctor working in Rawalpindi, was quoted as saying.

As the coronavirus crisis continues to ravage Pakistan, the country's overwhelming health infrastructure has put a toll on its already floundering economy. The IMF said that the GDP will shrink 1.5 per cent in 2020. The cash-strapped nation is set to be the first major emerging economy to apply to a G-20 initiative to request debt repayment relief, according to Financial Times.

In early March, Pakistan saw a surge in coronavirus cases, when infected pilgrims and workers crossed the border from Qom, a religious city in Iran, which is a hotspot.

Pakistan's limited resources were exposed when quarantined pilgrims agitated against unhealthy conditions at Taftan camp on Pakistan-Iran border, where five people were living in a tent with no access to toilets.

While the lockdown is in place, authorities have been confronted by hardline clerics who have defied social distancing terms and downplayed the threat of the virus. During Friday prayers every week, worshippers violate the restrictions by gathering at various mosques.

Last week, Islamabad inked an agreement allowing mosques to stay open for Ramzan. It stipulated that people should follow 20 rules, including maintaining a six feet distance from each other.

"There is little consistency in terms of how the lockdown is being approached. Coronavirus has shown the disconnect between the national government, regional governments and the military. Imran Khan has been left behind as the cheerleader for keeping Pakistan's morale high. I think people are starting to ask, 'How long is he going to last?'", said Sajjan Gohel, South Asia expert and guest teacher at the London School of Economics.