India using Kashmir to oppose Silk Road project: Chinese media

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.

For the first time in the 15 years of the Global Risks Report, the climate change and environment risk has occupied all the top five slots.

According to the 15th edition of the World Economic Forum's (WEF) Global Risks Report, the top five risks in terms of likelihood are extreme weather, climate action failure, natural disasters, biodiversity loss and human-made environmental disasters. They all fall in the one category of climate change and related environmental disasters.

WEF President Borge Brende said the world was feeling long-mounting and interconnected risks.

The report also points to how citizens are protesting across the world as discontent rises with failed systems that are creating inequality. The citizens' discontent had hardened with systems that had failed to promote advancement, it said.

"Disapproval of how governments are addressing profound economic and social issues has sparked protests throughout the world, potentially weakening the ability of governments to take decisive action should a downturn occur. Without economic and social stability, countries could lack the financial resources, fiscal margin, political capital or social support needed to confront key global risks," it said.

Listing the grim scenario, Borge said the global economy was faced with "synchronised slowdown", the past five years had been the warmest on record and cyber attacks were expected to increase this year.

The report warns that while the myriad risks were rising, time was running out on how to prevent them.

Borge said the growing palpability of shared economic, environmental and societal risks indicated that the horizon had shortened for preventing "or even mitigating" some of the direst consequences of global risks.

"It's sobering that in the face of this development, when the challenges before us demand immediate collective action, fractures within the global community appear to only be widening," he said.

The report points to grave concern about the consequences of continued environmental degradation, including the record pace of species decline.

Pointing to an unsettled geopolitical environment, the report said today's risk landscape was one in which new centres of power and influence were forming and old alliance structures and global institutions were being tested.

"While these changes can create openings for new partnership structures in the immediate term, they are putting stress on systems of coordination and challenging norms around shared responsibility. Unless stakeholders adapt multilateral mechanisms for this turbulent period, the risks that were once on the horizon will continue to arrive," it said.

Calling it a "an unsettled world", the WEF report notes that powerful economic, demographic and technological forces were shaping a new balance of power. "The result is an unsettled geopolitical landscape in which states are increasingly viewing opportunities and challenges through unilateral lenses," it said.

"What were once givens regarding alliance structures and multilateral systems no longer hold as states question the value of long-standing frameworks, adopt more nationalist postures in pursuit of individual agendas and weigh the potential geopolitical consequences of economic decoupling. Beyond the risk of conflict, if stakeholders concentrate on immediate geo-strategic advantage and fail to re-imagine or adapt mechanisms for coordination during this unsettled period, opportunities for action on key priorities may slip away," the WEF said.

In a chapter on risks to economic stability and social cohesion, it said a challenging economic climate might persist this year and members of the multi-stakeholder community saw "economic confrontations" and "domestic political polarisation" as the top risks in 2020.

The report also warned of downward pressure on the global economy from macroeconomic fragilities and financial inequality. These pressures continued to intensify in 2019, increasing the risk of economic stagnation.

Low trade barriers, fiscal prudence and strong global investment, once seen as fundamentals for economic growth, are fraying as leaders advance nationalist policies. The margins for monetary and fiscal stimuli are also narrower than before the 2008-2009 financial crisis, creating uncertainty about how well countercyclical policies will work.

The strategic partners for the WEF report included Marsh & McLennan and Zurich Insurance Group. The academic advisers were National University of Singapore, Oxford Martin School, University of Oxford and Wharton Risk Management and Decision Processes Center, University of Pennsylvania.