Snub for Imran Khan: No US welcome at airport, takes metro to Pakistan envoy’s house

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."

New Delhi, Jan 29: The Supreme Court on Wednesday dismissed the plea by Mukesh Kumar Singh, one of the four death row convicts in the Nirbhaya gang rape and murder case, challenging the rejection of his mercy petition by the President.

A three-judge bench headed by Justice R Banumathi said that expeditious disposal of mercy plea by the President doesn't mean non-application of mind by him.

The court also said that alleged sufferings in prison can't be grounds to challenge the rejection of mercy petition.

The bench said all relevant material including judgments pronounced by trial court, high court and Supreme Court were placed before the President when he was considering the mercy plea of the convict.

The bench also comprising justices Ashok Bhushan and A S Bopanna rejected the contentions of the counsel appearing for Singh that entire materials of the case were not placed before the President when he was considering his mercy plea.

The bench, while referring to two files placed before it by the Centre on Tuesday, said that as per the January 15 covering letter which was sent by the Delhi government to the Ministry of Home Affairs, all relevant documents were sent.

The bench noted that detailed judgements of trial court, high court and the Supreme Court, curative petition filed by Singh, his past criminal history and his family background were sent to the Home Ministry by the Delhi government.

"All the documents were taken into consideration by the President while rejecting the mercy petition," the bench said.

The bench also dealt with submissions advanced by the convict's counsel, who had argued that the mercy plea was rejected at "lightning speed".

The bench said that if a mercy petition is expeditiously dealt with, it cannot be assumed that it has been adjudicated upon in a pre-conceived mind.

The total number of global coronavirus cases has topped 15.4 million, while the deaths have increased to over 631,000, according to the Johns Hopkins University.

As of Friday morning, the total number of cases stood at 15,439,456, while the fatalities rose to 631,926, the University's Center for Systems Science and Engineering (CSSE) revealed in its latest update.

The US accounted for the world's highest number of infections and fatalities at 4,034,831 and 144,242, respectively, according to the CSSE.

Brazil came in the second place with 2,287,475 infections and 84,082 deaths.

In terms of cases, India ranks third (1,238,798), and is followed by Russia (793,720), South Africa (408,052), Peru (371,096), Mexico (370,712), Chile (334,683), the UK (298,721), Iran (284,034), Spain (270,166), Pakistan (269,191), Saudi Arabia (260,394), Italy (245,338), Turkey (223,315), Colombia (218,428), France (216,667), Bangladesh (216,110), Germany (204,881), Argentina (148,027), Canada (114,398), Qatar (108,244) and Iraq (102,226), the CSSE figures showed.

The other countries with over 10,000 deaths are the UK (45,639), Mexico (41,908), Italy (35,092), France (30,185), India (29,861), Spain (28,429), Iran (15,074), Peru (17,654) and Russia (12,873).