US, India begin talks amid escalating trade tensions

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."

Karachi, May 23: Ninety-seven people were killed and two survived when a passenger plane crashed into homes in Pakistan's southern city of Karachi, health officials said Saturday.

The Pakistan International Airlines (PIA) plane had made multiple approaches to land at the city's airport when it came down in a residential area, damaging buildings and sparking a rescue operation that lasted into the night.

All passengers and crew had been accounted for and the bodies of those killed had been recovered from the crash site, the Sindh Health Ministry said, adding that 19 had been identified.

A local hospital earlier reported it had received the bodies of people killed on the ground.

The site remained cordoned off on Saturday morning.

The crash sent plumes of smoke were into the air as rescue workers and residents searched the debris for people and as firefighters tried to extinguish the flames.

An AFP reporter witnessed charred bodies being loaded into ambulances.

PIA said the plane lost contact with air traffic control just after 2:30 pm (0930 GMT) travelling from Lahore to Karachi.

The disaster comes as Pakistanis prepare to celebrate the end of Ramadan and the beginning of Eid al-Fitr, with many travelling back to their homes in cities and villages.

London, Feb 14: Five years ago Britain’s new finance minister Rishi Sunak wasn’t even a member of parliament and now he is running the world's fifth largest economy.

The 39-year-old former Goldman Sachs banker was appointed in dramatic fashion on Thursday when incumbent Sajid Javid unexpectedly quit — in a row over advisers — during what Downing Street had cast as a routine ministerial reshuffle.

Sunak is married to the daughter of Infosys co-founder NR Narayana Murthy, and was hand-picked to take over an ultra-safe seat in northern England, previously represented by former Conservative Party leader William Hague. The Murthy family was not reachable for comment.

In July, when he was promoted chief secretary to the Treasury, Murthy had said: “Our advice to our children, including Rishi, has been to work hard, be honest, and do good for society…We wish him well.”

After Thursday’s announcement, Sunak said: “Delighted to be appointed... Lots to get on with.”

Tipped for Promotion

As Boris Johnson moves to increase control of the finance ministry, one of the youngest chancellors in history will face a prime minister who wants to increase government spending on everything from infrastructure and police to health and education.

Sunak, seen as a rising star in the ruling Conservative Party since he entered Parliament in 2015, had been tipped for promotion to a senior post in the ministerial rejig as Johnson put together his post-Brexit cabinet.

But, despite an already rapid ascent through the ranks of government, few expected the Oxford University Politics, Philosophy and Economics graduate to ascend to one of the highest offices in the land.

Sunak had been serving as Javid’s deputy in the finance ministry since Johnson promoted him upon taking office in July 2019. Prior to that he had served as a junior housing minister.

“From working in my mum’s tiny chemist shop to my experience building large businesses, I have seen first-hand how politicians should support free enterprise and innovation to ensure our future prosperity,” Sunak says on his website.

Smooth and loyal

Seen as a smooth media performer and ultra-loyal member of the Conservative Party, Sunak has been used by the government to present and defend their policies in television interviews — a sign of trust from Johnson, who has a fraught relationship with Britain’s media.

Sunak takes control at a critical juncture for Britain’s $2.7 trillion economy. He will have to steer the economy through the turbulence of leaving the European Union and the forging of new trade links that will define Britain’s new relationship with the world.

However, the power struggle that forced his predecessor Javid to quit hints at a more diminished role for what is the second most powerful position in the government — with Johnson’s office wanting to centralise control and minimise dissent.

Sunak is one of the three ministers of Indian origin in Johnson’s cabinet, the other two being Priti Patel and Alok Sharma. Patel remains the interior minister after the cabinet reshuffle while Sharma, a former minister for international development, was appointed the new minister for business. Sunak’s father was a doctor and his mother ran a chemist shop. Before entering politics he worked for Goldman Sachs and a hedge fund, then co-founded an investment firm. He also has an MBA from Stanford University.