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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.

Indian enterprises were flooded with a whopping 14.6 crore malware threats in 2019 - a growth of 48 per cent (year-on-year) compared to 2018, a new report said on Friday.

Manufacturing, BFSI (banking, financial services and insurance), education, healthcare, IT/ITES, and the government were the most at-risk industries in the country, said the report from Seqrite, the enterprise arm of Pune-based IT security firm Quick Heal Technologies.

Interestingly, almost a quarter (23 per cent) of the threats were identified through 'Signatureless behaviour-based' detection by Seqrite, indicating how a growing number of cybercriminals were deploying new or previously unknown threat vectors to compromise enterprise security.

"With the latest Seqrite annual threat report, we want to empower CIOs, CISOs, business leaders and all key public stakeholders with the insights they need to combat the growing complexity of the threat landscape," said Sanjay Katkar, Joint Managing Director and CTO, Quick Heal Technologies.

The most prominent trend was the drastic increase in the volume, intensity, and sophistication of cyber-attack campaigns targeting Indian enterprises in 2019.

The rapid integration of IoT devices, BYOD (bring your own device), and third-party APIs into enterprise networks has created newer security vulnerabilities that might go unnoticed until a major breach occurs.

Threat researchers at Seqrite observed several large-scale advanced persistent threats (APT) attacks deployed against organisations in the government sector.

"The entry of nation-states and organised cybercrime cells into the fray is expected to add more complication to this situation and will require Indian government bodies and corporate enterprises to shore up their cyber defence strategies in 2020 and beyond," the report noted.

More alarming, however, was the continued lack of security awareness amongst enterprises and government organisations.

"Unsecured Remote Desktop Protocol (RDP) and Server Message Block (SMB) protocols continued to be targeted through brute-force attacks," said the report.

Spear phishing attack campaigns leveraging Office exploits and infected macros were also used extensively by cybercriminals to gain access to enterprise networks and steal critical data.

"India's digital journey depends on ensuring robust cybersecurity for all stakeholders within the enterprise ecosystem," said Katkar.

The sharp spike should be a cause of concern for CIOs and CISOs in the country, especially given the growing digital penetration within their enterprise networks.

"With network vulnerabilities and potential entry points increasing at a rapid pace, threat actors are expected to leverage artificial intelligence (AI) capabilities to power their malware campaigns in the future to capitalise on newer attack vectors," the report added.