South Korea holds legislative election amid virus outbreak

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, Jan 9: The U.S. and Iran stepped back from the brink of possible war Wednesday as President Donald Trump signaled he would not retaliate militarily for Iran's missile strikes on Iraqi bases housing U.S. troops. No one was harmed in the strikes, but U.S. forces in the region remained on high alert.

Speaking from the White House, Trump seemed intent on deescalating the crisis, which spiralled after he authorized the assassination of Iran's top general, Qassem Soleimani. Iran responded overnight by firing more than a dozen missiles at two installations in Iraq, its most direct assault on America since the 1979 seizure of the U.S. Embassy in Tehran.

Trump's takeaway was that “Iran appears to be standing down, which is a good thing for all parties concerned and a very good thing for the world.”

The region remained on edge, however, and American troops including a quick-reaction force dispatched over the weekend were on high alert. Hours after Trump spoke, an ‘incoming’ siren went off in Baghdad's Green Zone after what seemed to be small rockets “impacted” the diplomatic area, a Western official said. There were no reports of casualties.

Iran's Supreme Leader Ayatollah Ali Khamenei said the overnight strike was not necessarily the totality of Iran's response. “Last night they received a slap,” Khamenei said. “These military actions are not sufficient (for revenge). What is important is that the corrupt presence of America in this region comes to an end.”

The strikes had pushed Tehran and Washington perilously close to all-out conflict and left the world waiting to see whether the American president would respond with more military force. Trump, in his nine-minute, televised address, spoke of a robust U.S. military with missiles that are “big, powerful, accurate, lethal and fast.'' But then he added: “We do not want to use it."

Iran for days had been promising to respond forcefully to Soleimani's killing, but its limited strike on two bases--one in the northern Iraqi city of Irbil and the other at Ain al-Asad in western Iraq--appeared to signal that it too was uninterested in a wider clash with the U.S. Foreign minister Mohammad Javad Zarif tweeted that the country had “concluded proportionate measures in self-defence.”

Trump said the U.S. was “ready to embrace peace with all who seek it.” That marked a sharp change in tone from his warning a day earlier that “if Iran does anything that they shouldn't be doing, they're going to be suffering the consequences, and very strongly.”

Trump opened his remarks at the White House by reiterating his promise that “Iran will never be allowed to have a nuclear weapon.” Iran had announced in the wake of Soleimani's killing that it would no longer comply with any of the limits on uranium enrichment in the 2015 nuclear deal crafted to keep it from building a nuclear device.

The president, who had earlier pulled the U.S. out of the deal, seized on the moment of calm to call for negotiations toward a new agreement that would do more to limit Iran's ballistic missile programmes and constrain regional proxy campaigns like those led by Soleimani.

Trump spoke of new sanctions on Iran, but it was not immediately clear what those would be.

Beijing/Zurich, Mar 4: China has approved the use of Swiss drugmaker Roche's anti-inflammation drug Actemra for patients who develop severe complications from the coronavirus as it urgently hunts for new ways to combat the deadly infection that is spreading worldwide.

China is hoping that some older drugs could stop severe cytokine release syndrome (CRS), or cytokine storms, an overreaction of the immune system which is considered a major factor behind catastrophic organ failure and death in some coronavirus patients.

Actemra, a biologic drug approved in 2010 in the United States for rheumatoid arthritis (RA), inhibits high Interleukin 6 (IL-6) protein levels that drive some inflammatory diseases.

China's National Health Commission said in treatment guidelines published online on Wednesday that Actemra can now be used to treat coronavirus patients with serious lung damage and high IL-6 levels.

Separately, researchers in the country are testing Actemra, known generically as tocilizumab, in a clinical trial expected to include 188 coronavirus patients and running until May 10.

Roche, which donated 14 million yuan ($2.02 million) worth of Actemra during February, said the trial was initiated independently by a third party with the aim of exploring the efficacy and safety of the drug in coronavirus patients with CRS.

It added that there was currently no published clinical trial data on the drug's safety or efficacy against the virus.

More than 3,000 people have died and 93,000 have been infected by the novel coronavirus thought to have originated in Wuhan, China, before spreading to around 90 countries including the United States, Italy, Switzerland, France and Germany.

The Swiss company, for which China is its No. 2 market behind the United States, also makes diagnostic gear to detect the coronavirus.

Since Actemra's approval a decade ago, it has become a go-to drug against other inflammatory conditions, including cytokine storms in cancer patients receiving cell therapies from Novartis and Gilead Sciences.

In 2012 it helped save the life of a young U.S. girl, the first child to be treated for leukaemia with Novatis' Kymriah, from a post-treatment rush of IL-6.

Priced at between $20-30,000 annually for RA according to SSR Health, Roche's medicine is also used for rare juvenile arthritis and giant cell arteritis, or inflammation of the blood vessels.