Pakistan’s COVID-19 cases steadily go up to 56,349; death toll at 1,167

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."

Seoul, Jun 24: North Korea on Wednesday said leader Kim Jong Un suspended a planned military retaliation against South Korea, possibly slowing the pressure campaign it has waged against its rival amid stalled nuclear negotiations with the Trump administration.

Last week, the North had declared relations with the South as fully ruptured, destroyed an inter-Korean liaison office in its territory and threatened unspecified military action to censure Seoul for a lack of progress in bilateral cooperation and for activists floating anti-Pyongyang leaflets across the border.

Analysts say North Korea, after weeks deliberately raising tensions, may be pulling away just enough to make room for South Korean concessions.

Pyongyang's official Korean Central News Agency said Kim presided by video conference over a meeting Tuesday of the ruling Workers' Party's Central Military Commission, which decided to postpone plans for military action against the South brought up by the North's military leaders.

KCNA didn't specify why the decision was made. It said other discussions included bolstering the country's "war deterrent".

Yoh Sang-key, spokesman of South Korea's Unification Ministry, said Seoul was "closely reviewing" the North's report but didn't further elaborate.

Yoh also said it was the first report in state media of Kim holding a video conferencing meeting, but he didn't provide a specific answer when asked whether that would have something to do with the coronavirus.

The North says there hasn't been a single COVID-19 case on its territory, but the claim is questioned by outside experts.

Kim Dong-yub, an analyst from Seoul's Institute for Far Eastern Studies, said it's likely that the North is waiting for further action from the South to salvage ties from what it sees as a position of strength, rather than softening its stance on its rival.

"What's clear is that the North said (the military action) was postponed, not cancelled," said Kim, a former South Korean military official who participated in inter-Korean military negotiations.

Other experts say the North would be seeking something major from the South, possibly a commitment to resume operations at a shuttered joint factory park in Kaesong, which was where the liaison office was located, or restart South Korean tours to the North's Diamond Mountain resort.

Those steps are prohibited by the international sanctions against the North over its nuclear weapons programme.

The public face of the North's recent bashing of the South has been Kim Yo Jong, the powerful sister of leader Kim Jong Un, who has been confirmed as his top official on inter-Korean affairs.

Issuing harsh statements through state media, she had said the North's demolishing of the liaison office would be just the first in a series of retaliatory action against the enemy South and that she would leave it to the North's military to come up with the next steps.

The General Staff of the North's military has said it would send troops to the mothballed inter-Korean cooperation sites in Kaesong and Diamond Mountain and restart military drills in frontline areas.

Such steps would nullify a set of deals the Koreas reached during a flurry of diplomacy in 2018 that prohibited them from taking hostile action against each other.

Also condemning the South over North Korean refugees floating anti-Pyongyang leaflets across the border, the North said Monday it printed 12 million of its own propaganda leaflets to be dropped over the South in what would be its largest ever anti-Seoul leafleting campaign.

It wasn't immediately clear whether Kim's decision to hold back military action would affect the country's plans for leafleting. The North's military had said it would open border areas on land and sea and provide protection for civilians involved in the leafleting campaigns.

The North has a history of dialling up pressure against the South when it fails to get what it wants from the United States. The North's recent steps came after months of frustration over Seoul's unwillingness to defy US-led sanctions and restart the inter-Korean economic projects that would breathe life into its broken economy.

Nuclear negotiations between Pyongyang and Washington largely stalled after Kim's second summit with President Donald Trump last year in Vietnam, where the Americans rejected North Korea's demands for major sanctions relief in exchange for a partial surrender of its nuclear capabilities.

Dubai/Washington, Jan 7: Iran's Supreme Leader Ayatollah Ali Khamenei wept in grief with hundreds of thousands of mourners thronging Tehran's streets on Monday for the funeral of military commander Qassem Soleimani, killed by a U.S. drone on U.S. President Donald Trump's orders.

The coffins of General Qassem Soleimani and Iraqi militia leader Abu Mahdi al-Muhandis, who also died in Friday's attack in Baghdad, were draped in their national flags and passed from hand to hand over the heads of mourners in central Tehran.

Responding to Trump's threats to hit 52 Iranian sites if Tehran retaliates for the drone strike, Iran's President Hassan Rouhani pointedly wrote on Twitter: "Never threaten the Iranian nation." And Soleimani's successor vowed to expel U.S. forces from the Middle East in revenge.

Khamenei, 80, led prayers at the funeral, pausing as his voice cracked with emotion. Soleimani, 62, was a national hero in Iran, even to many who do not consider themselves supporters of Iran's clerical rulers.

Aerial footage showed people, many clad in black, packing thoroughfares and side streets in the Iranian capital, chanting "Death to America!" - a show of national unity after anti-government protests in November in which many demonstrators were killed.

The crowd, which state media said numbered in the millions, recalled the masses of people that gathered in 1989 for the funeral of the Islamic Republic's founder, Ayatollah Ruhollah Khomeini. Soleimani, architect of Iran's drive to extend its influence across the Middle East, was widely seen as Iran's second most powerful figure behind Khamenei.

His killing of Soleimani has prompted concern around the world that a broader regional conflict could flare.

Trump on Saturday vowed to strike 52 Iranian targets, including cultural sites, if Iran retaliates with attacks on Americans or U.S. assets, and stood by his threat on Sunday, though American officials sought to downplay his reference to cultural targets. The 52 figure, Trump noted, matched the number of U.S. Embassy hostages held for 444 days after the 1979 Iranian Revolution.

Rouhani, regarded as a moderate, responded to Trump on Twitter.

"Those who refer to the number 52 should also remember the number 290. #IR655," Rouhani wrote, referring to the 1988 shooting down of an Iranian airline by a U.S. warship in which 290 were killed.

Trump also took to Twitter to reiterate the White House stance that "Iran will never have a nuclear weapon" but gave no other details.

'ACTIONS WILL BE TAKEN'

General Esmail Ghaani, Soleimani's successor as commander of the Quds Force, the elite unit of Iran's Revolutionary Guards charged with overseas operations, promised to "continue martyr Soleimani's cause as firmly as before with the help of God, and in return for his martyrdom we aim to rid the region of America."

"God the Almighty has promised to take martyr Soleimani's revenge," he told state television. "Certainly, actions will be taken."

Other political and military leaders have made similar, unspecific threats. Iran, which lies at the mouth of the key Gulf oil shipping route, has a range of proxy forces in the region through which it could act.

Iran's demand for U.S. forces to withdraw from the region gained traction on Sunday when Iraq's parliament passed a resolution calling for all foreign troops to leave the country.

Iraqi caretaker Prime Minister Abdel Abdul Mahdi told the U.S. ambassador to Baghdad on Monday that both nations needed to implement the resolution, the premier's office said in a statement. It did not give a timeline.

The United States has about 5,000 troops in Iraq.

Soleimani built a network of proxy militia that formed a crescent of influence - and a direct challenge to the United States and its regional allies led by Saudi Arabia - stretching from Lebanon through Syria and Iraq to Iran. Outside the crescent, Iran nurtured allied Palestinian and Yemeni groups.

He notably mobilised Shi'ite Muslim militia forces in Iraq that helped to crush ISIS, the Sunni militant group that had seized control of swathes of Syria and Iraq in 2014.

Washington, however, blames Soleimani for attacks on U.S. forces and their allies.

The funeral moves to Soleimani's southern home city of Kerman on Tuesday. Zeinab Soleimani, his daughter, told mourners in Tehran that the United States would face a "dark day" for her father's death, adding, "Crazy Trump, don't think that everything is over with my father's martyrdom."

NUCLEAR DEAL

Iran stoked tensions on Sunday by dropping all limitations on its uranium enrichment, another step back from commitments under a landmark deal with major powers in 2015 to curtail its nuclear programme that Trump abandoned in 2018.

In response, European signatories may launch a dispute resolution process against Iran this week that could lead to a renewal of the United Nations sanctions that were lifted as part of the deal, European diplomats said on Monday.

Diplomats said France, Britain and Germany could make a decision ahead of an EU foreign ministers' meeting on Friday that would assess whether there were any ways to salvage the deal.

After quitting the deal, the United States imposed new sanctions on Iran, saying it wanted to halt Iranian oil exports, the main source of government revenues. Iran's economy has been in freefall as the currency has plunged.

Trump adviser Kellyanne Conway said on Monday that he was still confident he could renegotiate a new nuclear agreement "if Iran wants to start behaving like a normal country."

Tehran has said Washington must return to the existing nuclear pact and lift sanctions before any talks can take place.

The United States advised American citizens in Israel and the Palestinian territories to be vigilant, citing the risk of rocket fire amid heightened tensions. As a U.S. ally against Iran, Israel is concerned about possible rocket attacks from Gaza, ruled by Iranian-backed Palestinian Islamists, or major Iran proxy Hezbollah in Lebanon.

Democratic critics of Trump have said the Republican president was reckless in authorising the strike, with some saying his threat to hit cultural sites amounted to a vow to commit war crimes. Trump also threatened sanctions against Iraq and said Baghdad would have to pay Washington for an air base in Iraq if U.S. troops were required to leave.