COVID-19 patients undergo surgery at increased death risk: Lancet study

News Network
May 30, 2020

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.

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Agencies
June 5,2020

With the scrapping of Mitron and Remove China Apps from its Play Store gaining a lot of attention in India, Google on Thursday said that it removed a video app "for a number of technical policy violations", while adding that it also does not allow an app that "encourages or incentivizes users into removing or disabling third-party apps".

Both the apps became immensely popular in India within a short span of time due to the prevailing anti-China sentiment amid border tensions between India and China in Ladakh and calls by Indian activists to boycott Chinese products.

Reports suggested that the Mitron app is a repackaged version of TicTic, which is a TikTok clone.

The Remove China Apps was designed to help users identify applications of Chinese origin.

Without naming the apps, Google hinted that the Mitron app may make a comeback on the Play Store once it fixes some technical issues, but the chances of the Remove China Apps are thin.

"We have an established process of working with developers to help them fix issues and resubmit their apps. We've given this developer (of the video app) some guidance and once they've addressed the issue the app can go back up on Play," Sameer Samat, Vice President, Android and Google Play, said in a statement.

Google said that its Android app store was designed to provide a safe and secure experience for the consumers while also giving developers the platform and tools they need to build sustainable businesses.

Samat said that Google Play recently suspended a number of apps for violating the policy that it does not allow an app that "encourages or incentivizes users into removing or disabling third-party apps or modifying device settings or features unless it is part of a verifiable security service".

"This is a longstanding rule designed to ensure a healthy, competitive environment where developers can succeed based upon design and innovation. When apps are allowed to specifically target other apps, it can lead to behaviour that we believe is not in the best interest of our community of developers and consumers," Samat said.

"We've enforced this policy against other apps in many countries consistently in the past - just as we did here," he added.

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Agencies
March 15,2020

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.

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Agencies
January 10,2020

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.

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