Former student Nikolas Cruz shoots 17 people to death in Florida school

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."

New Delhi, Feb 23: Hailing the role of first Prime Minister Jawaharlal Nehru in shaping India a modern nation state, former Prime Minister Manmohan Singh on Saturday hit out at the Narendra Modi-led Central government, saying "nationalism" and the slogan of 'Bharat Mata Ki Jai' are being misused to construct a militant and purely emotional idea of India.

Speaking at the launch of a book on Jawaharlal Nehru's works and speeches, Singh said: "I am extremely happy that this book makes an effort to revisit Pandit Nehru. He had led this country in its volatile, formative days when we adopted democratic way of life, accommodating divergent social and political views."

The former Prime Minister said that Nehru, who was very proud of Indian heritage, "assimilated it", and harmonised them into the needs of a "new modern" India.

"A great visionary, Nehruji laid the foundation for shaping India as a modern nation state," he said.

Highlighting the works of the first Prime Minister, Singh said: "If India is recognized in the comity of nations as a vibrant democracy and, if it is considered as one of the important world powers, it was Nehru, who should be recognised as its main architect."

He said Nehru was not only a statesman of high international standing, but a great historian and literary figure too.

"With an inimitable style, and a multi-linguist, Nehru laid the foundation of the universities, academies and cultural institutions of Modern India. But for Nehru's leadership, Independent India would not have become what it is today," he said.

Taking an apparent dig at the BJP government, he said: "But unfortunately, a section of people who either do not have the patience to read history or would like to be deliberately guided by their prejudices, try their best to picture Nehru in a false light.

"But I am sure, history has a capacity to reject fake and false insinuations and put everything in proper perspective," he said.

He said the book "Who is Bharat Mata" is such an attempt to set the narrative in the right direction.

Singh said that selecting appropriate pieces from Nehruji's works, the book justifies its title "Who is Bharat Mata?"

"As this book contains a timely collection of writings by and on Pandit Jawaharlal Nehru- the leader, who shaped India and the Icon whose legacy is the subject of intense and often angry reaction today.

The book also comprises reminiscences and assessments of Nehru by some of his contemporaries and near contemporaries-among them, including Mahatma Gandhi, Bhagat Singh, Sardar Patel, Maulana Azad, Aruna Asaf Ali, Sheikh Abdullah, Ramdhari Singh Dinkar, Ali Sardar Jafri, Baldev Singh, Martin Luther King Jr, Richard Attenborough, Lee Kuan Yew and Atal Bihari Vajpayee.

"It is a book of particular relevance at a time when nationalism and the slogan of ‘Bharat Mata Ki Jai' are being misused to construct a militant and purely emotional idea of India that excludes millions of residents and citizens," Singh said attacking the BJP government.

The two time Prime Minister further said that in the pages of the carefully complied anthology-which also carries illuminating introductions by the authors Nehru emerges as a "remarkable man of ideas and action", who had an instinctive understanding of India's civilisational spirit and as a visionary with clear commitment to the promotion of scientific temper, who despite the compulsions of politics, remained a true democrat.

"His legacy continues to be of immense significance-perhaps more today than at any other time in our history," he said.

He also warned that "Nehru makes a very significant and time relevant remark on the dangers of leaderships falling into a trap and getting removed far away from the common people whom they are supposed to serve".

"In an atmosphere, when emotions are deliberately get provoked and the gullible are misled by false propaganda, misusing communication technology, this book makes a refreshing break through," Singh added.

Mumbai, Mar 6: Harried Yes Bank depositors rushed to ATMs to withdraw cash but faced multitude of problems including closed down machines and long queues, after the RBI placed the bank under a moratorium, capping maximum withdrawals at Rs 50,000 per account for a month.

Aggravating the problems of depositors were difficulties accessing the internet banking channel, which ensured that they can't transfer the funds online as well. At an ATM in south Mumbai's Horniman Circle, with the RBI headquarters overlooking it, the shutters were pulled down.

The guard on duty said the machine was non-operational before he reported to work late in the evening and he was ordered to shut it after 2200 hrs. In the residential area of suburban Chembur, one ATM was dispensing cash but had a long queue of anxious depositors.

One man said it was still possible to withdraw up to Rs 50,000 in multiple transactions from the machine.

However, another machine nearby had run dry within minutes of the RBI announcement, a woman said.

The regulatory actions, undertaken by the RBI and the government, came hours after finance ministry sources confirmed that SBI was directed to bail out the troubled lender.

For the next month, Yes Bank will be led by the RBI-appointed administrator Prashant Kumar, an ex-chief financial officer of SBI.