At least 113 buried alive in Myanmar jade mine landslide

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, Feb 19: US President Donald Trump has said he is "saving the big deal" with India for later and he "does not know" if it will be done before the presidential election in November, clearly indicating that a major bilateral trade deal during his visit to Delhi next week might not be on the cards.

"We can have a trade deal with India. But I'm really saving the big deal for later," he told reporters at Joint Base Andrews Tuesday afternoon (local time).

The US and India could sign a "trade package" during the visit, according to media reports.

Asked whether he expects a trade deal with India before the visit, Trump said, "We're doing a very big trade deal with India. We'll have it. I don't know if it'll be done before the election, but we'll have a very big deal with India."

US Trade Representative Robert Lighthizer, the point-person for trade negotiations with India, is likely to not accompany Trump to India, sources said. However, officials have not ruled it out altogether.

In an apparent dissatisfaction over US-India trade ties, Trump said, "We're not treated very well by India." But he praised Prime Minister Narendra Modi and said he is looking forward to his visit to India.

"I happen to like Prime Minister Modi a lot," Trump said.

"He told me we'll have seven million people between the airport and the event. And the stadium, I understand, is sort of semi under construction, but it's going to be the largest stadium in the world. So it's going to be very exciting... I hope you all enjoy it," he told reporters.

Meanwhile, the US-India Strategic and Partnership Forum (USISPF) in a report said the latest quarterly data depict continuation of overall positive bilateral trade trends. The third quarter data reflects some downslide in growth rates.

"It may be due to several reasons, including the unexpected economic slowdown in India's economic growth, impact of US-China trade war, GSP withdrawal from the US side and retaliatory tariffs on specific US goods from the Indian side," USISPF said.

According to the report, the data available for the first three quarters of 2019 (January-September) pulled the overall growth rate in cumulative bilateral trade down to 4.5 percent from 8.4 percent registered for the first two quarters.

Goods and services trade performance in third quarter was dismal at -2.3 percent, in contrast with the impressive 9.6 percent growth witnessed for the first two quarters of the year; while trade in services was up two percent goods trade dropped five percent, the report said.

The cumulative US-India trade in goods and services (USD 110.9 billion) for the first three quarters of 2019 increased 4.5 percent with US exports and imports growing at four percent and five percent respectively.

The US exported USD 45.3 billion worth of goods and services to India in the first three quarters 2019, up 4 percent from the corresponding period in the previous year; and the US imported USD 65.6 billion worth of goods and services from India, up five percent from the previous year's USD 62.5 billion level for the same period, it said.

The USISPF has projected that the total bilateral trade can touch USD 238 billion by 2025 if the current 7.5 percent average annual rate of growth sustains; however, higher growth rates can result in bilateral trade in the range of USD 283 billion and USD 327 billion.

The US remains the top trading partner for India in terms of trade in goods and services, followed by China. While the bilateral trade between US and India is approximately 62 percent in goods and 38 percent in services, the bilateral trade between India and China is dominated by goods.

China had a huge trade surplus of USD 58 billion with India, indicating Beijing's strength in the Indian market, especially in sectors, such as electronics, machinery, organic chemicals, plastics and medical devices.

The US goods exports to India, in comparison, were mainly concentrated in mineral fuels, precious stones, and aircraft. The US faces tough competition with China in the Indian market in areas such as electronics, machinery, organic chemicals and medical devices.

Washington, Mar 27: The United States has seen a record 18,000 new confirmed coronavirus cases and 345 deaths over the past 24 hours, according to a Johns Hopkins University tracker.

There are now 97,028 declared virus cases in the country and there have been 1,475 deaths, Johns Hopkins said.