Amma: A tenacious leader who broke the glass ceiling

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 12: The Supreme Court on Friday asked Solicitor General Tushar Mehta to convene a meeting of the Finance Ministry and RBI officials over the weekend to decide whether interest incurred on EMIs during the moratorium period can be charged by banks.

A bench comprising Justices Ashok Bhushan, Sanjay Kishan Kaul and M.R. Shah queried Mehta as the court was concerned since the Centre has deferred loan for three months.

"Then how can interest of these 3 months be added?" the apex bench asked. Mehta replied: "I need to sit down with the RBI officials and have a meeting."

SBI's counsel, senior advocate Mukul Rohatgi, intervened during the proceedings and said "all banks are of the view that interest cannot be waived for a six month EMI moratorium period".

"We need to discuss it with the RBI," insisted Rohatgi.

Justice Bhushan then asked Mehta to convene a meeting of the RBI and Finance Ministry officials over the weekend, and listed the matter for further hearing on June 17.

The top court, during the hearing, indicated that it was not considering a complete waiver of interest but was only concerned that postponement of interest shouldn't accrue further interest on it.

After the RBI said the waiver of interest charges on EMIs during moratorium will lead to loss of 1 per cent of the nation's GDP, the top court had earlier asked the Finance Ministry to reply, whether the interest could be waived or it would continue during the moratorium period.

The top court said these are not normal times, and it is a serious issue, as on one hand moratorium is granted and then, the interest is charged on loans during this period.

"There are two issues in this (matter). No interest during the moratorium period and no interest on interest," said Justice Bhushan. The observation from the bench came on a petition by Gajendra Sharma, in which he sought a direction to declare portion of the RBI's March 27 notification as ultra vires to the extent it charged interest on the loan amount during the moratorium period.

In a first, the Supreme Court on Friday allowed the service of summons and notices, a necessity in almost all legal proceedings, through instant messenger like WhatsApp as well as by e-mail and fax.

A bench headed by Chief Justice SA Bobde observed that it has been brought to the notice of the court that it is not feasible to visit post offices for service of notices, summons, and pleadings. The bench also comprising Justices AS Bopanna and R Subhash Reddy observed that notice and summons should be sent through e-mail on the same day along with instant message through WhatsApp and other phone messenger services.

The bench clarified that all methods should be deployed for a valid service on the party. "Two blue ticks would convey that the receiver has seen the notice," noted the bench.

The bench declined the request of the Attorney General for specifically naming WhatsApp as a mode of effectuating service. The top court noted that it would not be practical to specify only WhatsApp. The apex court also permitted RBI to extend the validity of cheques in the backdrop of lockdown to contain the coronavirus outbreak.

Senior advocate V Giri representing RBI informed the bench that he had circulated the note regarding validity of a cheque as directions issued on the previous hearing.

The bench noted that it will be in discretion of the RBI to issue orders which are suitable to alter the validity of the period of a cheque.

During an earlier hearing on the matter on July 7, the Attorney General contended before the top court that the Centre had some reservations in connection with the utilization of mobile applications like WhatsApp and other apps for service of summons. The Centre's top law officer informed the apex court that these apps claimed to be encrypted, and they were not trustworthy.

The RBI counsel had contended before the top court that it was considering clarifying the validity of a cheque which has been reduced to 3 months from 6 months.