Missing AirAsia plane may have crashed: Indonesia

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."

Davos, Jan 24: Pakistan Prime Minister Imran Khan claimed that he met with a “brick wall” when he approached Indian Prime Minister Narendra Modi with a peace proposal, soon after assuming office.

In an interview to Foreign Policy magazine on the sidelines of WEF 2020 here, Khan also said he told Modi that Pakistan will act firmly if it was given evidence of any involvement in the Pulwama terror attack, but India instead “bombed” Pakistan.

Tensions have escalated between the two countries, following India withdrawing the special status of Jammu and Kashmir in August 2019. Even since, Khan has been trying to seek global intervention to de-escalate the tensions between the two countries.

On Thursday, India's External Affairs Ministry spokesperson Raveesh Kumar categorically ruled out any third party role on the Kashmir issue, asserting that any issue between the two countries should be resolved bilaterally.

In the interview, Khan said that he is a firm believer that military means are not a solution to ending conflicts. “After assuming office, I immediately reached out to Prime Minister Modi. I was amazed by the reaction I got, which was quite weird.

The subcontinent hosts the greatest number of poor people in the world, and the best way to fight poverty is to have a trading relationship between the two countries rather than spending money on arms. This is what I said to the Indian Prime Minister. But I was met by brick wall,” Khan said.

Khan took charge as Prime Minister in August 2018. Referring to the suicide attack in Pulwama, Khan said he immediately told Modi ,“if you can give us any actionable intelligence (that Pakistanis were involved), we will act on it. But rather than do so, they bombed us.”

Noting that the both countries are not close to conflict right now, Khan said that it is important that the UN and the US act.

When asked about US President Donald Trump’s close relationship with Modi, Khan said the relationship is understandable because India is a huge market. “My concern is not about the US-India relationship. My concern is the direction in which India is going,” Khan said.

Khan also sought to compare the events in India to what happened in Nazi Germany.

“Between 1930 and 1934, Germany went from a liberal democracy to a fascist, totalitarian, racist state. If you look at what is happening in India under the BJP in the last five years, look where it's heading, you'll see the danger. And you're talking about a huge country of 1.3 billion people that is nuclear-armed,” he said.

Paris, Jun 29: More than half a million people have been killed by the novel coronavirus, nearly two thirds of them in the United States and Europe, according to an news agency tally at 2200 GMT Sunday based on official sources.

The official death count for the disease now stands at 500,390 deaths from 10,099,576 cases recorded worldwide. The United States has suffered the highest death count (125,747), followed by Brazil (57,622) and the United Kingdom (43,550).

The tallies, using data collected by AFP from national authorities and information from the World Health Organization (WHO), probably reflect only a fraction of the actual number of infections.

Many countries are testing only the most serious cases.