40 Indians 'uncontactable' in Iraq's Mosul town: Govt

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, Jul 21: Democrat Joe Biden urged Muslim Americans on Monday to join him in the fight to defeat President Donald Trump as he addressed an online summit hosted by the advocacy organisation Emgage Action to mobilise Muslim voters ahead of the presidential election.

I want to earn your vote not just because he's not worthy of being president, the presumptive presidential nominee told participants.

I want to work in partnership with you, make sure your voices are included in the decision-making process as we work to rebuild our nation.

Biden also reiterated a pledge to overturn a Trump administration ban on travelers from several predominantly Muslim countries, calling it vile.

Wa'el Alzayat, CEO of Emgage Action, said by email that the organisation was seeking to maximise Muslim American turnout in key battleground states.

In Michigan alone one of the states where the organisation has chapters and where Trump won in 2016 by fewer than 11,000 votes he said he believed there are more than 150,000 registered Muslim voters.

Several prominent Muslim American elected officials endorsed Biden for president in a letter organised by Emgage Action ahead of the summit.

Among those who signed the letter are Minnesota Rep. Ilhan Omar, Minnesota Attorney General Keith Ellison and Indiana Rep. Andre Carson, all Democrats.

Omar, one of the first Muslim women elected to Congress, served as a high-profile surrogate for Bernie Sanders before he exited the presidential race in April making her support for Biden potentially helpful as the former vice president seeks to mobilise Muslim voters this fall.

Muslim American voices matter to our communities, to our country, Biden said.

But we all know that your voice hasn't always gotten recognised or represented.

Emgage Action has titled the event Million Muslim Votes, underscoring its emphasis on boosting Muslim turnout in November.

Joe Biden's presence serves not only to galvanise Muslim Americans to cast their ballots, but to usher in an era of engaging with Muslim American communities under a Biden administration, Alzayat said by email before the summit.

The pro-Biden letter from Muslim American elected officials decried a number of Trump's domestic and international policies, including his administration's travel ban and his pullout from the Iran nuclear deal.

A Biden administration will move the nation forward on many of the issues we care about, the letter said, citing racial justice, affordable health care, climate change and immigration.

The Muslim American officials also praised Biden's agenda for their communities.

Among other goals, Biden has vowed to rescind the travel ban affecting Muslims on Day One if he's elected.

In his address, he pledged to include Muslim American voices in his administration, if elected, and to speak out against human rights abuses against Muslim minorities around the world.

I'll continue to champion the rights of Palestinians and Israelis to have a state of their own as I have for decades, each of them a state of their own, he said.

Other state- and local-level Muslim American officials signing onto the pro-Biden letter hail from several states, including Michigan.