Tension rises as Turkey sends troops to Syria's Afrin

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."

New Delhi, Mar 13: Delhi's Tis Hazari Court on Friday sentenced expelled Bharatiya Janata Party (BJP) MLA Kuldeep Singh Sengar and six others to 10 years imprisonment for the death of Unnao rape survivor's father. Sengar is already serving life imprisonment for raping the minor.

While sentencing them, District Judge Dharmesh Sharma said, "There can be no denying that rule of law was broken. Sengar was a public functionary and had to maintain the rule of law. The way the crime has been committed, it does not call for leniency."

Sengar and his brother Atul has been directed to give 10 lakh compensation to family of the victim for loss of their father. "There are four minor children involved, three girls and one boy. They have also been uprooted from native place," the judge said.

Seven people, including Sengar, his brother and two police personnel, were held guilty for culpable homicide and criminal conspiracy, earlier this month.

The case pertains to the death of rape survivor's father in custody on April 9, 2018. It was alleged that he was assaulted following a quarrel with some of the accused in the case.

He was taken to the police station and then framed for allegedly possessing an illegal firearm. Pursuant to this, he was sent to custodial remand, during which he died.

The case was transferred to Delhi from a trial court in Uttar Pradesh on the Supreme Court's directions in August last year. Both the death and illegal firearm case was later clubbed by the court.

During the arguments on sentencing on March 12, Sengar had told the court that he should be "hanged and acid poured into his eyes if he has done anything wrong".

The former MLA had also raped the daughter of the deceased in 2017 in Uttar Pradesh's Unnao district and was sent to jail for "remainder of his natural biological life", last year.

New Delhi, May 30: As the NDA government completes one year of its second term, Prime Minister Narendra Modi listed several achievements and initiatives taken by his government in the past year in an audio message addressed to the people of the country.

PM Modi said, "This day last year began a golden chapter in the history of Indian democracy. It was after several decades that the people of the country voted back a full-term government with a full majority."

"Your role has played a pivotal role in creating this chapter. In such a situation, this day is an opportunity for me to bow to the citizens of the country and the democratic ethos of our nation," said PM Modi.

"Had the situation been normal, I would have got the chance to meet you. Your affection and active support in the past year have given me new energy and inspiration. During this period, the way you have shown the collective powers of democracy, they have become an example for the whole world," he added.

PM Modi talked about several important initiatives taken by his government in 2014 as well as India's demonstration of its mettle through the surgical strike and airstrike.

"Six years ago in 2014, the people of this country voted to bring a major change in the country. You voted to change the country's policy and manner. During that tenure where surgical strike and airstrike took place, one rank one pension, one nation one tax GST, and better MSP for farmers were also fulfilled. That period was dedicated to fulfilling many needs of the country."

He further said that in these years the country has seen systems coming out of the quagmire of inertia and corruption. The country has seen governance change to make life easier for the poor.

"During that period, India's stature in the world increased. By opening bank accounts of poor people, by giving them gas connections, by providing free electricity connections, by building washrooms, by building houses, the dignity of the poor has also been increased," said PM Modi.