5 things you need to know about Mugabe’s Zimbabwe

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, Feb 26: Islamabad on Tuesday declared former Prime Minister Nawaz Sharif an absconder while simultaneously denying extending bail to him.

The federal cabinet presided over by Prime Minister Imran Khan, cited that Sharif failed to provide required medical reports and has violated the bail terms.

The government has also decided to freeze gas and electricity tariffs for the next four months, The Dawn reported.

"After Nawaz Sharif failed to submit his medical report of any hospital in London, the medical board rejected a medical certificate sent by him and [the government] declared him an absconder. From today, Nawaz Sharif is an absconder according to the law of land and if he does not return to the country he will be declared a proclaimed offender," said Dr Firdous Ashiq Awan, Special Assistant to the Prime Minister on Information, in a press conference.

She further asserted that the Punjab government, which was authorized by the Islamabad High Court (IHC) to decide Sharif's case on medical grounds, had written several letters asking him to submit his medical report from any hospital in London. However, he failed to do so and only sent a certificate that was not accepted by the medical board.

"If he (Nawaz Sharif) is seriously ill then why a comprehensive medical report is not being submitted to the medical board," Firdous added.

Further, she said that the office of the opposition leader was also waiting for his younger brother and Leader of the Opposition in the National Assembly Shahbaz Sharif, who was also staying in London for 'no reason'.

"He is getting a monthly salary and enjoying luxurious offices and other perks and privileges but not performing his duties required by his office and the people. Shahbaz Sahib, return to the country and justify your salary and other benefits being given from taxpayers' money," Firdous added.

On October 29 last year, the IHC granted bail for eight weeks to Sharif, who was convicted and disqualified in corruption cases, on medical grounds.

Sharif left Pakistan for London along with Shahbaz on November 19, 2019, for his medical treatments there.