If you fail to act against terrorists, we will get it done: US tells Pakistan

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, Jun 16: Despite Prime Minister Narendra Modi led government’s attempt to downplay the border dispute with China, matters have heated up unprecedentedly along the Line of Actual Control (LAC)- the effective Sino-India border in Eastern Ladakh. 

The country has lost three precious lives – an army officer and two soldiers. The last time blood was spilled on the LAC, before the latest episode, was 45 years ago when the Chinese ambushed an Assam Rifles patrol in Tulung La.

India had lost four soldiers on October 20, 1975 in Tulung La, the last time bullets were fired on the India-China border though both the countries witnessed bitter stand-offs later at Sumdorong Chu valley in 1987, Depsang in 2013, Chumar in 2014 and Doklam in 2017.

Between 1962 and 1975, the biggest clash between India and China took place in Nathu La pass in 1967 when reports suggest that around 80 Indian soldiers were killed and many more Chinese personnel.

While three soldiers, including a Commanding Officer, were killed in the latest episode in Galwan Valley, the government describes it as a "violent clash" and does not mention opening fire.

New Delhi described the locality where the 1975 incident took place as "well within" its territory only to be rebuffed by Beijing as "sheer reversal of black and white and confusion of right and wrong".

The Ministry of External Affairs had then said that the Chinese had crossed the LAC and ambushed the soldiers while Beijing claimed the Indians entered their territory and did not return despite warnings.

The Indian government maintained that the ambush on the Assam Rifles' patrol in 1975 took place "500 metres south of Tulung" on the border between India and Tibet and "therefore in Indian territory". It said Chinese soldiers "penetrating" Indian territory implied a "change in China's position" on the border question but the Chinese denied this and blamed India for the incident.

The US diplomatic cables quoted an Indian military intelligence officer saying that the Chinese had erected stone walls on the Indian side of Tulung La and from these positions fired several hundred rounds at the Indian patrol.

"Four of the Indians had gone into a leading position while two (the ones who escaped) remained behind. The senior military intelligence officer emphasised that the soldiers on the Indian patrol were from the area and had patrolled that same region many times before," the cable said.

One of the US cables showed that former US Secretary of State and National Security Adviser Henry Kissinger sought details of the October 1975 clash "without approaching the host governments on actual location of October 20 incident". He also wanted to know what ground rules were followed regarding the proximity of LAC by border patrols.

A cable sent from the US mission in India on November 4, 1975 appeared to have doubts about the Chinese account saying it was "highly defensive".

"Given the unsettled situation on the sub-continent, particularly in Bangladesh, both Chinese and Indian authorities have authorised stepped up patrols along the disputed border. The clash may well have ensued when two such patrols unexpectedly encountered each other," it said.

Another cable from China on the same day quoted another October 1974 cable, which spoke about Chinese officials being concerned for long that "some hotheaded person on the PRC (People's Republic of China) might provoke an incident that could lead to renewed Sino-Indian hostilities. It went on to say that this clash suggested that "such concerns and apprehensions are not unwarranted".

According to the United States diplomatic cables, Chinese Foreign Ministry on November 3, 1975 disputed the statement of the MEA spokesperson, who said the incident took place inside Indian territory.

The Chinese had said "sheer reversal of black and white and confusion of right and wrong". In its version of the 1975 incident, they said Indian troops crossed the LAC at 1:30 PM at Tulung Pass on the Eastern Sector and "intruded" into their territory when personnel at the Civilian Checkpost at Chuna in Tibet warned them to withdraw.

Ignoring this, they claimed, Indian soldiers made "continual provocation and even opened fire at the Chinese civilian checkpost personnel, posing a grave threat to the life of the latter. The Chinese civilian checkpost personnel were obliged to fire back in self defence."

The Chinese Foreign Ministry spokesperson had also said they told the Indian side that they could collect the bodies "anytime" and on October 28, collected the bodies, weapons and ammunition and "signed a receipt".

The US cables from the then USSR suggested that the official media carried reports from Delhi on the October 1975 incident and they cited only Indian accounts of the incident "ridiculing alleged Chinese claims that the Indians crossed the line and opened fire first".

Washington, Jan 12: The US State Department has described the recent visit of envoys of 15 countries to Jammu and Kashmir as an "important step" but expressed concern over the continued detention of political leaders and restrictions on internet in the region.

Alice Wells, the Acting Assistant Secretary of State for South Asia, tweeted on Saturday that she was "closely following" the visit of the envoys to Kashmir, describing it an "important step".

Wells, who will be visiting India this week, added: "We remain concerned by detention of political leaders and residents and Internet restrictions. We look forward to a return to normalcy."

The group of diplomats made a two-day visit to the Union Territory on Thursday and Friday to see the conditions thereafter Jammu and Kashmir's special constitutional status was removed last August.

While some US politicians and media have criticised the action by Prime Minister Narendra Modi's government, the US has officially appeared to support the abrogation of the Constitution's Article 370 on the special status.

Last October, Wells told the House of Representatives Subcommittee on Asia and the Pacific that the State Department supported the objectives behind it, while not directly mentioning the abrogation.

"The Indian government has argued that its decision on Article 370 was driven by a desire to increase economic development, reduce corruption, and uniformly apply all national laws in Jammu and Kashmir, particularly in regard to women and minorities.

"While we support these objectives, the Department remains concerned about the situation in the Kashmir Valley, where daily life for the nearly eight million residents has been severely impacted since August 5," she had said.

Washington has banked on India's democratic institutions - the judiciary and public debates - being able to steer the country.

Bearing this out, the Supreme Court last week ordered the government to review its decision to shut down the internet in Kashmir, which it declared was a fundamental right, thus taking a step to address Wells's concern.