At least 15 Rohingya refugees drown after boat sinks off Bangladesh

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."

Nakhon Ratchasima, Feb 9: The Thai soldier who killed at least 20 people and holed up in a mall overnight was shot dead Sunday morning by commandos, ending a near-17-hour ordeal which left dozens wounded and stunned the country.

It was unclear how many people remained trapped inside the Terminal 21 mall in Nakhon Ratchasima -- also known as Korat -- where the gunman held out through the night, armed with assault weapons stolen from his barracks.

Volleys of gunfire rang out as the siege ran into dawn, hours after Thai security services stormed the ground floor and freed scores of stunned, terrified shoppers from a bloody rampage that the gunman -- a junior army officer identified as Sergeant-Major Jakrapanth Thomma -- had relayed via Facebook posts.

"He was shot dead thirty minutes ago" (0200 GMT), chief of the Crime Suppression Division Jirabhob Bhuridej told AFP.

Commandos from elite Thai police units killed the gunman, a police spokesman added, after an operation involving hundreds of security personnel.

"The official death toll is 20 and wounded 42... nine are in surgery," Narinrat Pitchayakamin, a Korat doctor told reporters, revising down an initial death toll of 21.

But it was unclear if there were more victims inside the multi-level complex which was packed with Saturday shoppers when the gunman stormed in.

A fleet of ambulances left the front of the complex and forensic police poured into the grim crime scene, shortly before the gunman's death was confirmed.

The night was peppered with heavy exchanges of gunfire and sporadic evacuations.

A police officer who took part in a raid to flush out the gunman died, according to deputy prime minister Anutin Charnvirakul. "He had been hit and unfortunately, he couldn't make it," said Anutin.

Shocked evacuees recounted how an ordinary Saturday shopping day at the busy mall descended into horror as the gunman entered.

"It was like a dream... I'm grateful I survived," Sottiyanee Unchalee, 48, told AFP, explaining she hid in the toilet of a gym inside the mall as she heard the gunfire.

"I'm so sorry for those who died... (and) the people still trapped inside."

Stolen weapons

Jakrapanth relayed his shooting spree through Facebook posts which charted the attack from the army barracks in the city to the mall, where an unknown number of shoppers remained trapped.

A volunteer rescue worker recounted a bloody scene of horror after his team carried four corpses to the hospital.

"I've never seen anything like this," Peerapong Chatadee told AFP.

"I just feel so sad. He is a soldier, he should not have fired at unarmed people."

The bloodshed began Saturday afternoon when Jakrapanth shot three people -- among them at least one soldier -- at a senior officer's house and then at the nearby army barracks, before driving an army vehicle to the town centre.

There the gunman used weapons stolen from the military arsenal to unleash carnage in the town centre.

He "used a machine gun and shot innocent victims resulting in many injured and dead", said police spokesman Krissana Pattanacharoen.

Throughout the day, Jakrapanth posted images of himself and wrote several posts on his Facebook page as the attack unfolded.

In one Facebook video -- since deleted -- the assailant, wearing an army helmet, filmed from an open-top jeep, saying, "I'm tired... I can't pull my finger anymore" as he made a trigger symbol with his hand.

There were also photos of a man in a ski mask holding up a pistol.

A Facebook spokesperson said: "We have removed the gunman's accounts from our services and will work around the clock to remove any violating content related to this attack as soon as we become aware of it."

The city is home to one of the largest barracks in Thailand, a country where the military is enmeshed in politics and society.

The nation also has one of the highest rates of gun ownership in the world, and several shootings at courthouses last year renewed concern about gun violence.