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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.

As millions of people get hooked to online dating platforms, their proliferation has led to online romance scams becoming a modern form of fraud that have spread in several societies along with the development of social media like Facebook Dating, warn researchers.

For example, extra-marital dating app Gleeden has crossed 10 lakh users in India in COVID-19 times while dating apps like Tinder and Bumble have gained immense popularity.

According to researchers from University of Siena and Scotte University Hospital led by Dr Andrea Pozza, via a fictitious Internet profile, the scammer develops a romantic relationship with the victim for 6-8 months, building a deep emotional bond to extort economic resources in a manipulative dynamic.

"There are two notable features: on the one hand, the double trauma of losing money and a relationship, on the other, the victim's shame upon discovery of the scam, an aspect that might lead to underestimation of the number of cases," the authors wrote in a paper published in the journal Clinical Practice & Epidemiology in Mental Health.

Around 1,400 dating sites/chats have been created over the last decade in North America alone. In the UK, 23 per cent of Internet users have met someone online with whom they had a romantic relationship for a certain period and even 6 per cent of married couples met through the web.

"The online dating industry has given rise to new forms of pathologies and crime, said the authors.

The results showed that 63 per cent of social media users and 3 per cent of the general population reported having been a victim at least once.

Women, middle-aged people, and individuals with higher tendencies to anxiety, romantic idealization of affective relations, impulsiveness and susceptibility to relational addiction are at higher risk of being victims of the scam.

Online romance scams are, in other words, relationships constructed through websites for the purpose of deceiving unsuspecting victims in order to extort money from them.

The scammer always acts empathetically and attempts to create the impression in the victim that the two are perfectly synced in their shared view of life.

"The declarations of the scammer become increasingly affectionate and according to some authors, a declaration of love is made within two weeks from initial contact," the study elaborated.

After this hookup phase, the scammer starts talking about the possibility of actually meeting up, which will be postponed several times due to apparently urgent problems or desperate situations such as accidents, deaths, surgeries or sudden hospitalizations for which the unwitting victim will be manipulated into sending money to cover the momentary emergency.

Using the strategy of "testing-the-water", the scammer asks the victim for small gifts, usually to ensure the continuance of the relationship, such as a webcam, which, if successful, leads to increasingly expensive gifts up to large sums of money.

When the money arrives from the victim, the scammer proposes a new encounter.

The request for money can also be made to cover the travel costs involved in the illusory meeting. In this phase, the victim may start having second thoughts or showing doubt about the intentions of the partner and gradually decide to break off the relationship.

"In other cases, the fraudulent relationship continues or even reinforces itself as the victim, under the influence of ambivalent emotions of ardor and fear of abandonment and deception, denies or rationalizes doubts to manage their feelings," said the study.

In some cases, the scammer may ask the victim to send intimate body photos that will be used as a sort of implicit blackmail to further bind the victim to the scammer.

Once the scam is discovered, the emotional reaction of the victim may go through various phases: feelings of shock, anger or shame, the perception of having been emotionally violated (a kind of emotional rape), loss of trust in people, a sensation of disgust towards oneself or the perpetrator of the crime and a feeling of mourning.

"Understanding the psychological characteristics of victims and scammers will allow at-risk personality profiles to be identified and prevention strategies to be developed," the authors suggested.

Cybercriminals continue to exploit public fear of rising coronavirus cases through malware and phishing emails in the guise of content coming from the Centers for Disease Control and Prevention (CDC) in the US and World Health Organisation (WHO), says cybersecurity firm Kaspersky.

In the APAC region, Kaspersky has detected 93 coronavirus-related malware in Bangladesh, 53 in the Philippines, 40 in China, 23 in Vietnam, 22 in India and 20 in Malaysia. 

Single-digit detections were monitored in Singapore, Japan, Indonesia, Hong Kong, Myanmar, and Thailand. 

Along with the consistent increase of 2019 coronavirus cases comes the incessant techniques cybercriminals are using to prey on public panic amidst the global epidemic, the company said in a statement. 

Kaspersky also detected emails offering products such as masks, and then the topic became more commonly used in Nigerian spam emails. Researchers also found scam emails with phishing links and malicious attachments.

One of the latest spam campaigns mimics the World Health Organisation (WHO), showing how cybercriminals recognise and are capitalising on the important role WHO has in providing trustworthy information about the coronavirus.

"We would encourage companies to be particularly vigilant at this time, and ensure employees who are working at home exercise caution. 

"Businesses should communicate clearly with workers to ensure they are aware of the risks, and do everything they can to secure remote access for those self-isolating or working from home," commented David Emm, principal security researcher.

Some malicious files are spread via email. 

For example, an Excel file distributed via email under the guise of a list of coronavirus victims allegedly sent from the World Health Organisation (WHO) was, in fact, a Trojan-Downloader, which secretly downloads and installs another malicious file. 

This second file was a Trojan-Spy designed to gather various data, including passwords, from the infected device and send it to the attacker.