Singapore passport world's 'most powerful', India ranks 75

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.

Bengaluru, Mar 13: In the wake of fresh cases of Covid-19 reported in Karnataka, Infosys Foundation chairperson Sudha Murty has urged the Karnataka government to take steps to shut malls and theatres, saying the coronavirus multiplies in air-conditioned areas.

In a letter to the government, she said preventive measures should be taken to control the spread of coronovirus before it gets worse.

Murty, who also leads the State government-constituted Karnataka Tourism Task Force, said she has discussed the current situation with Chairman and Executive Director of Narayana Health, Devi Prasad Shetty.

She suggested closure of all schools and colleges with immediate effect, malls, theatres and “all air-conditioned areas where the virus multiplies”, and allow only essential services like pharmacy, grocery and petrol bunks.

“It is not scientifically proven that the virus dies in high temperature,” she said pointing to spread of the virus -- despite heat -- in peak summer in Australia and Singapore, which have “summer all 12 months”.

“I request you to vacate one government hospital with at least 500 - 700 beds for this purpose (to deal with coronavirus cases), which requires oxygen lines and pipes,” she said.

“Infosys Foundation, the philanthropic and CSR arm of software major Infosys, would do the civil work and Devi Shetty has agreed to share resources like medical equipment,” she added.

“We would like to work with the government proactively so that we can prevent this as early as possible,” Sudha Murty said.

The total number of confirmed coronavirus positive cases in Karnataka is five, including the 76-year old man from Kalaburagi who died on Tuesday night.

New Delhi, Jun 29: Witnessing azure skies and breathable air for the last three months, Delhi on Monday recorded deterioration in its air quality, with particulate matter with diameter of 2.5 and 10 microns -- too small to be filtered out of the human body -- standing at 52 and 297 micrograms per cubic respectively.

Gufran Beig, Project Director of System of Air Quality Weather Forecasting and Research (SAFAR), said that the sudden spike in air pollution is due to a mild dust storm blowing from Rajasthan.

"Since the wind direction is changing and moist air is coming in, the air quality in Delhi will become better by tomorrow," Beig told IANS.

Central Pollution Control Board (CPCB) data showed that the overall air quality near Delhi Technical University (DTU) area stood at 326 micrograms per cubic, followed by 308 at Narela and 307 at Mundka.

Out of 36 stations, the AQI in as many as 30 stations was above 200 micrograms per cubic till 1 pm on Monday.

The System of Air Quality Weather Forecasting and Research categorises air quality in the 0-50 range as good, 51-100 as satisfactory, 101-200 as moderate, 201-300 as poor, 301-400 as very poor, and above 400 as severe.

According to SAFAR's website, "PM 10 (coarser dust particle) is the lead pollutant. AQI is likely to improve to moderate category by tomorrow, and further improvement is expected by July 1."

Researchers indicated that PM 10 and PM 2.5 will be 170 and 47 micrograms per cubic on Tuesday.

With no vehicles plying on the roads or industries shut due to the lockdown since March 25, Delhi's air quality had improved drastically.

According to a study conducted by the Indian Institute of Technology (IIT), Delhi, if the low levels of air pollution reached during the lockdown period are maintained, India's annual death toll could reduce by 6.5 lakh.