Saeed appeals in Lahore High Court against action under U.S. pressure

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."

Kuala Lumpur, Feb 24: Malaysian Prime Minister Mahathir Mohamad has submitted his resignation to the king, two sources with direct knowledge of the matter told Reuters on Monday, amid talks of forming a new coalition to govern the country.

Mahathir, 94, assumed office in May 2018 for his second stint as prime minister.

A spokesman from the prime minister's office declined to comment, saying only that a statement will be issued soon.

The sources declined to be named as they were not authorised to talk to the media.

New Delhi, April 6: The United States has donated $2.9 million assistance package for India to help the Narendra Modi government brace itself against the coronavirus as countries across the world are coming together to combat the outbreak.

On March 28, the US government, via US Agency for International Development, announced $2.9 million to support India in its response to COVID-19.

"It builds on a foundation of over $1.4 billion in health assistance and nearly $3 billion in total assistance that the US provided to India over the last 20 years," the US Embassy in India said in a statement.

"These new funds will support two organisations, including $2.4 million for USAID's health strengthening project, implemented by Jhpiego, an international non-profit health organisation affiliated with Johns Hopkins University and $500,000 for the World Health Organization (WHO)," the statement said.

The funds will also help India combat the spread of COVID-19, provide care for the affected and support local communities with the tools needed to contain the disease, it added.

Moreover, being a global leader in health and humanitarian response to COVID-19, the US has provided approximately $18.3 million assistance package to ASEAN member countries to fight the contagion.

The funds will be used to prepare laboratories for large-scale testing for the lethal virus, infection prevention and control, enable risk communication, implement public-health emergency plans for border points of entry, activate case-finding and event-based surveillance for influenza-like illnesses, train and equip rapid-responders in investigation and contact-tracing and update training materials for health workers.