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
July 24,2020

Pune, Jul 24: Agile and dexterous, 85-year-old Shantabai Pawar wields sticks with absolute ease as she displays 'lathi-kathi' on the streets of Pune.

A video of her, displaying her skills in the Indian martial art form for livelihood, has gone viral on social media.

Pawar told media persons that she learnt the art form when she was only eight and has been practising it since then. The ancient martial art s believed to be linked to Dombari community, a nomadic tribe in Maharashtra.

"I have been pursuing the art of lathi-kathi since I was eight. I have never left it. It is part of me and it is an honour to practice it. My father taught me this. He taught me to work hard," Pawar told media persons.

In the video, the sari-clad octogenarian takes a warrior-like stride and effortlessly rotates a stick several times in a second in her hand and around her head and then does it with two sticks together with a smile on her face. She also tosses a stick in the air and catches it with ease.

The assembled gathering is impressed and enthused.

"People come and say, 'Well done Daadi!' I practice it to earn money for my children and grandchildren," she said.

Pawar leaves her home in the morning in the conditions created by coronavirus and performs the art form on roads and streets.

"I go to various areas to perform the art form and people give money," she said.

The artiste also uses thali and stick to gather the attention of people as most of them are indoors due to conditions created by COVID-19.

Senior citizens have been advised against venturing out due to their greater susceptibility to coronavirus but Pawar said she is not afraid to step out.

"People do advise me to not go out due to fear of COVID-19 but I am not scared. Whenever I step out, I pray to my God and he has kept me safe so far," she said.

Aishwarya Kale, a dancer and the person who uploaded the video on social media, said that it is "only an artist who can understand what help another artist needs".

"I was in that area shopping for some items and it was then I saw her performing and thought that I should film her and upload her video on social media. But I never thought that the video would go viral and she would receive financial help not just from people in the country but overseas as well," Kale told media persons.

"She is now getting honour for her craft that she couldn't get in the last 85 years. I feel good that through my small video, her art form has become viral," she added. 

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Agencies
February 6,2020

Washington D.C., Feb 6: An international team of astronomers has found an unusual monster galaxy that existed about 12 billion years ago when the universe was only 1.8 billion years old.

The team of astronomers was led by scientists at the University of California, Riverside.

Dubbed XMM-2599, the galaxy formed stars at a high rate and then died. Why it suddenly stopped forming stars is unclear.

"Even before the universe was 2 billion years old, XMM-2599 had already formed a mass of more than 300 billion suns, making it an ultra massive galaxy," said Benjamin Forrest, a postdoctoral researcher in the UC Riverside Department of Physics and Astronomy and the study's lead author.

"More remarkably, we show that XMM-2599 formed most of its stars in a huge frenzy when the universe was less than 1 billion years old and then became inactive by the time the universe was only 1.8 billion years old," Forrest added.

The team used spectroscopic observations from the W. M. Keck Observatory's powerful Multi-Object Spectrograph for Infrared Exploration or MOSFIRE, to make detailed measurements of XMM-2599 and precisely quantify its distance.

The study results appear in the Astrophysical Journal.

"In this epoch, very few galaxies have stopped forming stars, and none are as massive as XMM-2599," said Gillian Wilson, a professor of physics and astronomy at UCR in whose lab Forrest works.

"The mere existence of ultramassive galaxies like XMM-2599 proves quite a challenge to numerical models. Even though such massive galaxies are incredibly rare at this epoch, the models do predict them."

"The predicted galaxies, however, are expected to be actively forming stars. What makes XMM-2599 so interesting, unusual, and surprising is that it is no longer forming stars, perhaps because it stopped getting fuel or its black hole began to turn on. Our results call for changes in how models turn off star formation in early galaxies," the professor stated.

The research team found XMM-2599 formed more than 1,000 solar masses a year in stars at its peak of activity -- an extremely high rate of star formation. In contrast, the Milky Way forms about one new star a year.

"XMM-2599 may be a descendant of a population of highly star-forming dusty galaxies in the very early universe that new infrared telescopes have recently discovered," said Danilo Marchesini, an associate professor of astronomy at Tufts University and a co-author on the study.

"We have caught XMM-2599 in its inactive phase," Wilson said, who led the W. M. Keck Observatory data acquisition
Co-author Michael Cooper, a professor of astronomy at UC Irvine, said this outcome is a strong possibility.

"Perhaps during the following 11.7 billion years of cosmic history, XMM-2599 will become the central member of one of the brightest and most massive clusters of galaxies in the local universe," he said.

"Alternatively, it could continue to exist in isolation. Or we could have a scenario that lies between these two outcomes," he stated.

The study was supported by grants from the National Science Foundation and NASA.

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News Network
April 28,2020

Los Angeles, Apr 28: People who experience loss of smell as one of the COVID-19 symptoms are likely to have a mild to moderate clinical course of the disease, according to a study which may help health care providers determine which patients require hospitalisation.

The findings, published in the journal International Forum of Allergy & Rhinology, follows an earlier study that validated the loss of smell and taste as indicators of infection with the novel coronavirus, SARS-CoV-2.

According to the scientists from the University of California (UC) San Diego Health in the US, patients who reported loss of smell were 10 times less likely to be hospitalised for COVID-19 compared to those without the symptom.

"One of the immediate challenges for health care providers is to determine how to best treat persons infected by the novel coronavirus," said Carol Yan, first author of the current study and rhinologist from the UC San Diego Health.

"If they display no or mild symptoms, can they return home to self-quarantine or will they likely require hospitalisation? These are crucial questions for hospitals trying to efficiently and effectively allocate finite medical resources," Yan said.

The findings, according to the researchers, suggest that loss of smell may be predictive of a milder clinical course of COVID-19.

"What's notable in the new findings is that it appears that loss of smell may be a predictor that a SARS-CoV-2 infection will not be as severe, and less likely to require hospitalisation," Yan said.

"If an infected person loses that sense, it seems more likely they will experience milder symptoms, barring other underlying risk factors," she added.

Risk factors for COVID-19 previously reported by other studies include age, and underlying medical conditions, such as chronic lung disease, serious heart conditions, diabetes, and obesity.

In the current study, the scientists made a retrospective analysis between March 3 and April 8 including 169 patients who tested positive for COVID-19 at UC San Diego Health.

They assessed olfactory and gustatory data for 128 of the 169 patients, 26 of whom required hospitalisation.

According to the researchers, patients who were hospitalised for COVID-19 treatment were significantly less likely to report anosmia or loss of smell -- 26.9 per cent compared to 66.7 per cent for COVID-19-infected persons treated as outpatients.

Similar percentages were found for loss of taste, known as dysgeusia, they said.

"Patients who reported loss of smell were 10 times less likely to be admitted for COVID-19 compared to those without loss of smell," said study co-author Adam S. DeConde.

"Moreover, anosmia was not associated with any other measures typically related to the decision to admit, suggesting that it's truly an independent factor and may serve as a marker for milder manifestations of Covid-19," DeConde said.

The researchers suspect that the findings hint at some of the physiological characteristics of the infection.

"The site and dosage of the initial viral burden, along with the effectiveness of the host immune response, are all potentially important variables in determining the spread of the virus within a person and, ultimately, the clinical course of the infection," DeConde said.

If the SARS-CoV-2 virus initially concentrates in the nose and upper airway, where it impacts olfactory function, that may result in an infection that is less severe and sudden in onset, decreasing the risk of overwhelming the host immune response, respiratory failure, and hospitalisation, the scientists added.

"This is a hypothesis, but it's also similar to the concept underlying live vaccinations," DeConde explained.

"At low dosage and at a distant site of inoculation, the host can generate an immune response without severe infection," he added.

Loss of smell, according to the study, might also indicate a robust immune response which has been localised to the nasal passages, limiting effects elsewhere in the body.

Citing the limitations of the study, the scientists said they relied upon self-reporting of anosmia from participants, which posed a greater chance of recall bias among patients once they had been diagnosed with COVID-19.

They added that patients with more severe respiratory disease requiring hospitalisation may not be as likely to recognise or recall the loss of smell.

So the researchers said more expansive studies are needed for validating the results.

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