Mysterious blood clots are COVID-19's latest lethal surprise

News Network
April 28, 2020

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."

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News Network
July 20,2020

Islamabad, Jul 20: Six advisors of Pakistan Prime Minister Imran Khan posses dual citizenships and several of top 20 aides have admitted of owning movable and immovable assets worth millions of dollars abroad.

The list was published on the official website of Pakistan government's cabinet division.
All the dual nationals were working as special assistants to the prime minister (SAPM). 

These people include SAPM on Overseas Pakistanis Syed Zulfiqar Abbas Bukhari (UK), SAPM on Power Division Shahzad Qasim (US), SAPM on Petroleum Nadeem Babar (US), SAPM on Political Affairs Shahbaz Gill (US), SAPM on Parliamentary Coordination Nadeem Afzal Gondal (Canada) and SAPM on Digital Pakistan Tania Aidrus (Canadian citizenship by birth).

According to Gulf News report, the wealthiest SAPM is Power Division and Mineral Resources Assistant Shahzad Syed Qasim who has assets worth over Rs 4 billion followed by SAPM on Petroleum Nadeem Babar with assets worth Rs 2.75 billion. Meanwhile, Adviser for Overseas Pakistanis Syed Zulfiqar Abbas Bukhari's net assets is estimated over Rs 2 billion.

Giving further details of the wealthiest SAPM, the official website stated that the PM's aide on Power Division and Coordination of Marketing and Development of Mineral Resources owns assets in Pakistan, UAE and US. His three properties in UAE include two villas in Jumeirah Golf Estates and Sienna Lakes, Jumeirah Golf Estates and an apartment at Park Towers, DIFC - all worth Dh20,688,000. He has three cars in the UAE worth Dh400,000 and in the US, he has property worth US$865,000 while he has Rs 4 billion in various local and foreign bank accounts and retirement funds including $2.1 million in US.

Meanwhile, Nadeem Babbar, who is Special Assistant on Petroleum Division, owns assets worth over Rs 2.7 billion, including several properties in Pakistan and abroad and stakes in more than 30 local and foreign companies.

The Gulf News further reported that in the list Dr Moeed Yusuf's, Special Assistant to the Prime Minister on National Security Division and Strategic Policy Planning, the name was also included but was later withdrawn as it was clarified that he had the US residency and only holds the citizenship of Pakistan as per the affidavit submitted to the government. "I have not returned to the US since I took up my current responsibility, have no employment or income in the US nor do I have any millions worth properties abroad" Dr Yusuf was quoted as saying.

The latest list on PM Imran Khan's advisors possessing dual nationalities has sparked strong criticisms by the Opposition leaders.

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News Network
May 12,2020

May 12: Gunmen stormed a hospital on Tuesday in an ongoing attack in the Afghan capital Kabul, as a suicide blast killed 15 people at a funeral in the country's restive east.

Special forces rescued 80 people including mothers and babies from the Kabul hospital after three gunmen launched a morning assault, killing at least four people, the interior ministry said in a statement.

Heavily armed forces were seen carrying babies wrapped in blankets away from the scene, as the clearance operation continued.

The facility, which has a large maternity ward, is located in the west of the city, home to the capital's minority Shiite Hazara community -- a frequent target of Sunni militants from the Islamic State group.

The flare-up in violence comes as Afghanistan grapples with myriad crises including a rise in militant operations across the country and a surge in coronavirus infections.

A paediatrician who fled the hospital told AFP he heard a loud explosion at the entrance of the building.

"The hospital was full of patients and doctors, there was total panic inside," he said, asking not to be named.

The maternity services at the hospital are supported by humanitarian organisation Doctors Without Borders (MSF).

"Hospitals and health workers must not be attacked. We call on all sides to stop attacking hospitals and health workers," said deputy health minister in the city, Waheed Majroh.

Around an hour later, a suicide bomber killed at least 15 people at the funeral of a local police commander in the country's eastern Nangarhar province, according to provincial spokesman Ataullah Khogyani.

The attacker detonated his explosives in the middle of the ceremony.

Zaher Adel, spokesman for the government hospital in Jalalabad, earlier said 12 bodies had arrived from the blast site and more than 50 people were being treated for injuries.

Amir Mohammad, who was wounded in the blast, said thousands of people had gathered for the funeral, an event which often draws huge crowds in Afghanistan.

The violence comes just a day after four roadside bombs exploded in a northern district of Kabul, wounding four civilians including a child.

The bombings were later claimed by the Islamic State group, according to the SITE intelligence group.

They were just the latest in a string of IS attacks on the capital.

In March, at least 25 people were killed by a gunman at a Sikh temple in Kabul, which was later claimed by the group.

IS is also responsible for an infamous attack in March 2017 on one of the country's largest hospitals, when gunmen disguised as doctors stormed the Kabul building and killed dozens.

In recent months, the jihadist group has suffered mounting setbacks after being hunted by US and Afghan forces as well as Taliban offensives targeting their fighters, but it still retains the ability to launch major assaults on urban centres.

The Taliban have largely refrained from launching large attacks on Afghan cities since February when they signed a landmark withdrawal deal with the US meant to pave the way for peace talks with the Kabul government.

Under the agreement, the Taliban promised not to target forces from the US-led coalition, but made no such pledge toward Afghan troops and have stepped up attacks in the provinces.

The Taliban have denied involvement in both of Tuesday's attacks.

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News Network
February 11,2020

Feb 11: China reported 108 new coronavirus deaths on February 10, the highest daily toll since the outbreak began in Wuhan late last year, as two senior officials in the hard-hit province of Hubei were removed from their jobs.

The total number of deaths on the mainland reached 1,016 in the 24 hours until midnight, the National Health Commission said on Tuesday.

Some 2,478 new cases were confirmed, bringing the total to 42,638.

Of the new deaths, 103 were in the province of Hubei, including 67 in the provincial capital of Wuhan. The virus is thought to have originated there in a market that sold seafood as well as wild animals.

Two senior health officials in the province - Zhang Jin who was Party Secretary of the health commission for Hubei and Ling Yingzi who was director of the Hubei Provincial Health Commission - were both removed from their posts, state media reported on Tuesday,  a day after Chinese President Xi Jinping visited health facilities in Beijing.

In his first public appearance since the outbreak began, Xi donned a face mask and had his temperature checked while visiting medical workers and patients in the capital.

"We have seen very little of Xi Jinping since the outbreak began but he was out and about in Beijing on Monday," Al Jazeera's Katrina Yu said from Beijing. "He has been trying to rally the troops saying: 'We can win this battle.' But it's also a sign that the battle is far from over."

The other fatalities on Monday were in the provinces of Heilongjiang, Anhui and Henan and the cities of Tianjin and Beijing, the National Health Commission said.

During a meeting chaired by Premier Li Keqiang on Monday, a group of leaders tasked with beating the virus said it would work to solve raw material and labour shortages and boost supplies of masks and protective clothing.

They said nearly 20,000 medical personnel from around the country had already been sent to Wuhan, and more medical teams were also on the way.

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