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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, Jul 13: The Income Tax Department has facilitated a new functionality for banks and post offices to ascertain TDS applicability rates on cash withdrawal of above Rs 20 lakh in case of a non-filer of the income-tax return and that of above Rs 1 crore in case of a filer of the income-tax return.

In a statement, the Central Board of Direct Taxes (CBDT) said that now banks and post offices have to only enter the PAN of the person who is withdrawing cash for ascertaining the applicable rate of TDS.

So far, more than 53,000 verification requests have been executed successfully on this facility, a statement by the CBDT said.

"CBDT today said that this functionality available as 'Verification of applicability u/s 194N' on www.incometaxindiaefiling.gov.in since 1st July 2020, is also made available to the Banks through web-services so that the entire process can be automated and be linked to the Bank's internal core banking solution," it said.

On entering PAN by the bank or the post office, a message will be instantly displayed on the departmental utility: "TDS is deductible at the rate of 2 per cent if cash withdrawal exceeds Rs 1 crore", in case the person withdrawing cash is a filer of the income-tax return.

In case the person withdrawing cash is a non-filer of income tax return, the message shown would be: "TDS is deductible at the rate of 2 per cent if cash withdrawal exceeds Rs 20 lakh and at the rate of 5 per cent if it exceeds Rs 1 crore."

The CBDT said that the data on cash withdrawal indicated that huge amount of cash is withdrawn by the persons who have never filed income-tax returns.

To ensure filing of return by these persons and to keep track on cash withdrawals by the non-filers, and to curb black money, the Finance Act, 2020 with effect from July 1, 2020 further amended IT Act to lower threshold of cash withdrawal to Rs 20 lakh for the applicability of this TDS for the non-filers and also mandated TDS at the higher rate of 5 per cent on cash withdrawal exceeding Rs 1 crore by the non-filers.

New Delhi, Jun 7: The Government of India (GoI) must strengthen the laws to protect animals, said People for the Ethical Treatment of Animals (PETA) India CEO Dr Manilal Valliyate on Sunday, following an elephant's death in Kerala and cow injured due to ingestion of explosives in Himachal Pradesh.

"Such incidents are not just restricted to certain regions but are happening all across the country. PETA receives more than 100 similar cases every day. People send in their complaints to us, not just for cows and elephants but for so many other animals as well," he said.

The PETA chief urged the GoI to strengthen the laws established to protect animals.

"As per the current laws set out against animal cruelty, the perpetrator would only be charged Rs 50,000 as a fine. That is equivalent to no punishment at all," added PETA India CEO.

He expressed his anguish against municipal agencies as well, saying that they are not doing "serious" work. He also highlighted how cows are left on the roads to wander, after milking them, to feed on garbage, in several parts of the country.

"These injustices against animals through explosives has been going on for quite a while. But for the first time, it has received such public attention," he said.

After a pregnant elephant was fed cracker-filled pineapple and her eventual death on May 27 in Kerala's Palakkad district, a pregnant cow sustained fatal injuries on May 25 due to accidental ingestion of explosives in Dadh village of Bilaspur district of Himachal Pradesh.

One person has been arrested in the Dadh village for allegedly hurting the cow.