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May 30: Patients undergoing surgery after contracting the novel coronavirus are at an increased risk of postoperative death, according to a new study published in The Lancet journal which may lead to better treatment guidelines for COVID-19.

In the study, the scientists, including those from the University of Birmingham in the UK, examined data from 1,128 patients from 235 hospitals from a total of 24 countries.

Among COVID-19 patients who underwent surgery, they said the death rates approach those of the sickest patients admitted to intensive care after contracting the virus.

The scientists noted that SARS-CoV-2 infected patients who undergo surgery, experience substantially worse postoperative outcomes than would be expected for similar patients who do not have the infection.

According to the study, the 30-day mortality among these patients was nearly 24 per cent.

The researchers noted that mortality was disproportionately high across all subgroups, including those who underwent elective surgery (18.9 per cent), and emergency surgery (25.6 per cent).

Those who underwent minor surgery, such as appendicectomy or hernia repair (16.3 per cent), and major surgery such as hip surgery or for colon cancer also had higher mortality rates (26.9 per cent), the study said.

According to the study, the mortality rates were higher in men versus women, and in patients aged 70 years or over versus those aged under 70 years.

The scientists said in addition to age and sex, risk factors for postoperative death also included having severe pre-existing medical problems, undergoing cancer surgery, undergoing major procedures, and undergoing emergency surgery.

"We would normally expect mortality for patients having minor or elective surgery to be under 1 per cent, but our study suggests that in SARS-CoV-2 patients these mortality rates are much higher in both minor surgery (16.3%) and elective surgery (18.9%)," said study co-author Aneel Bhangu from the University of Birmingham.

Bhangu said these mortality rates are greater than those reported for even the highest-risk patients before the pandemic.

Citing an example from the 2019 UK National Emergency Laparotomy Audit report, he said the 30-day mortality was 16.9 per cent in the highest-risk patients.

Based on an earlier study across 58 countries, Bhangu said the 30-day mortality was 14.9 per cent in patients undergoing high-risk emergency surgery.

"We recommend that thresholds for surgery during the SARS-CoV-2 pandemic should be raised compared to normal practice," he said.

"For example, men aged 70 years and over undergoing emergency surgery are at particularly high risk of mortality, so these patients may benefit from their procedures being postponed," Bhangu added.

The study also noted that patients undergoing surgery are a vulnerable group at risk of SARS-CoV-2 exposure in hospital.

It noted that the patients may also be particularly susceptible to subsequent pulmonary complications, due to inflammatory and immunosuppressive responses to surgery and mechanical ventilation.

The scientists found that overall in the 30 days following surgery 51 per cent of patients developed a pneumonia, acute respiratory distress syndrome, or required unexpected ventilation.

Nearly 82 per cent of the patients who died had experienced pulmonary complications, the researchers said.

"Worldwide an estimated 28.4 million elective operations were cancelled due to disruption caused by COVID-19," said co-author Dmitri Nepogodiev from the University of Birmingham.

"Our data suggests that it was the right decision to postpone operations at a time when patients were at risk of being infected with SARS-CoV-2 in hospital," Nepogodiev said.

According to the researchers, there's now an urgent need for investment by governments and health providers in to measures which ensure that as surgery restarts patient safety is prioritised.

They said this includes the provision of adequate personal protective equipment (PPE), establishment of pathways for rapid preoperative SARS-CoV-2 testing, and consideration of the role of dedicated 'cold' surgical centres.

New Delhi, Jun 25: India registered its worst single-day increase in COVID-19 cases on Thursday, recording more than 16,000 coronavirus infections, to push the overall tally to 4.73 lakh as the number of fatalities also jumped by 418, the Union Health Ministry said.

This was the sixth consecutive day when coronavirus cases increased by more than 14,000. On June 20, the country registered an increase of 14,516 cases. On June 21, the increase was of 15,413 cases; 14,821 cases on June 22; 14,933 cases on June 23; and 15,968 cases on June 24.

Consequently, India added 92,573 cases since June 20, and over 2.82 lakh this month since June 1.

The health ministry data updated at 8am on Thursday showed the daily tally increased by the highest-ever 16,922 cases to reach 4,73,105, while the total deaths climbed to 14,894 with 418 new fatalities.

However, according to the data, the recovery rate has improved to 57.43 per cent. The number of active cases stands at 1,86,514 while 2,71,696 people have recovered; one patient has migrated.

The total number of confirmed cases included foreigners.

According to ICMR, a total of 75,60,782 samples have been tested up to June 24 with 2,07,871 samples being tested on Wednesday.

Of the 418 new deaths, 208 were in Maharashtra, 64 in Delhi, 33 in Tamil Nadu, 25 in Gujarat, 14 in Karnataka, 11 in West Bengal, 10 each in Rajasthan and Haryana, nine in Madhya Pradesh, eight each in Uttar Pradesh and Punjab, five each in Andhra Pradesh, Telangana and Uttarakhand.

Bihar, Goa and Jammu and Kashmir have reported one COVID-19 fatality each.

Of the total fatalities, Maharashtra tops the tally with 6,739 deaths followed by Delhi (2,365), Gujarat (1,735), Tamil Nadu (866), Uttar Pradesh (596), West Bengal (591), Madhya Pradesh (534), Rajasthan (375) and Telangana (225).

The COVID-19 death toll reached 188 in Haryana, 164 in Karnataka, 124 in Andhra Pradesh, 113 in Punjab, 88 in Jammu and Kashmir, 57 in Bihar, 35 in Uttarakhand, 22 in Kerala and 17 in Odisha.

Chhattisgarh has registered 12 deaths, Jharkhand 11, Assam and Puducherry nine each, Himachal Pradesh eight, Chandigarh six, Goa two and Meghalaya, Tripura and Ladakh have reported one fatality each.

More than 70 per cent deaths took place due to comorbidities, the health ministry said.

Maharashtra has reported the highest number of cases at 1,42,900 followed by Delhi at 70,390, Tamil Nadu at 67,468, Gujarat at 28,943, Uttar Pradesh at 19,557, Rajasthan at 16,009 and West Bengal at 15,173, according to ministry data.

The number of COVID-19 cases has gone up to 12,448 in Madhya Pradesh, 12,010 in Haryana, 10,444 in Telangana,10,331 in Andhra Pradesh and 10,118 in Karnataka.

It has risen to 8,209 in Bihar, 6,422 in Jammu and Kashmir, 6,198 in Assam and 5,752 in Odisha. Punjab has reported 4,627 novel coronavirus infections so far, while Kerala has 3,603 cases.

A total of 2,623 people have been infected by the virus in Uttarakhand, 2,419 in Chhattisgarh, 2,207 in Jharkhand, 1,259 in Tripura, 970 in Manipur, 951 in Goa, 941 in Ladakh and 806 in Himachal Pradesh.

Puducherry has recorded 461 COVID-19 cases, Chandigarh has 420, Nagaland has 347, Arunachal Pradesh has 158 and Mizoram has 142 cases.

Dadra and Nagar Haveli and Daman and Diu together have reported 120 COVID-19 cases.

Sikkim has 84, Andaman and Nicobar Islands has registered 56 infections so far while Meghalaya has recorded 46 cases.

"Our figures are being reconciled with the ICMR (Indian Council of Medical Research)," the ministry said, adding 8,493 cases are being reassigned to states.

State-wise distribution is subject to further verification and reconciliation, it added.

Lucknow, Jan 6: Undeterred by the large scale protests that claimed as many as 20 lives in the state, Uttar Pradesh government has started the process of implementing the controversial Citizenship (Amendment) Act.

According to sources in the government, the district magistrates have been directed to identify the migrants from Pakistan, Bangladesh and Afghanistan, who have been living in their districts.

Sources said that the state home department has given oral instructions to the district magistrates. ''No written orders have been issued,'' said a senior official here preferring anonymity.

The official said that the district magistrates would be preparing a list containing names of those minorities, who had migrated from these countries following their persecution and had been living without obtaining the citizenship of India.

According to sources, the government expected that the migrants, who could be eligible for the Indian citizenship in accordance with the CAA, could be more in number in the districts, including Rampur, Ghaziabad, Shahjahanpur, Lucknow and some others.

''The list will be sent to the union home ministry,'' the official added.

Sources said that the state government will also inform the centre about the ''illegal Muslim migrants'' for their ultimate deportation to their countries of origin.

Different parts of UP had witnessed large scale violence last month during the protests against the CAA. At least 20 people, mostly youngsters, were killed allegedly in police firing and many others were injured. The state government had denied the charge. 

Alleged police excesses during and after the protests triggered a nationwide outrage with several rights organisations and activists slamming the BJP government and demanding a high-level probe into the allegations.