US lawmakers urge American envoys to facilitate de-escalation of Indo-Pak tension

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."

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.

Washington, May 20: The United States recorded another 1,536 coronavirus deaths over the past 24 hours, the Johns Hopkins University tracker said.

That figure, tallied as of 8:30 pm (0030 GMT), raises to 91,845 the total number of COVID-19 deaths in the US.

The US tops the global rankings both for the highest death toll and the highest number of infections, with more than 1.5 million cases.