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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.

Claiming that e-commerce giants like Amazon import as much as 80 per cent of the items sold on their platforms, small manufacturers' body has said that their business models do not benefit local industry and are creating jobs of delivery boys only.

"Neither manufacturers nor traders are getting any benefit from the business models of Amazon and Flipkart because they largely import their products from China and Korea and sell here. Nearly 80 per cent of their products are imported," said Anil Bhardwaj, Secretary General, Federation of Indian Micro and Small & Medium Enterprises (FISME).

Bhardwaj said that the global e-commerce players generally source and sell products through their own preferred suppliers and as a result a large number of local manufacturers and traders get crowded out.

He listed out deep discounting and buying products from preferred companies as unfair practices.

"Even if they buy products from local suppliers the commission charged is very high," Bhardwaj said adding that the issues related to unfair practices have been raised with Commerce Ministry on multiple occasions.

FISME maintains that the technology-driven retail is way forward and one cannot be oblivious of the benefits it brings to consumers but at the same time the local industry can also not be ignored given its role in job creation.

"If both traders and local manufacturers are crowded out then how would the local industry survive and employment be generated?" asked Bhardwaj.

As Amazon Founder and CEO Jeff Bezos is currently on his three-day visit to India, the local traders are up in arms against the "unfair" trade practices of the tech giant. Delhi-based Confederation of All India Traders (CAIT) has launched a countrywide protest against the company and has organised protests across 300 cities.

In a setback to Amazon and Walmart-backed Flipkart, the fair market watchdog Competition Commission of India (CCI) has ordered probe into the business operations of both the companies on multiple counts including deep-discounts and exclusive tie-up with preferred sellers.

"For the first time some concrete step has been taken against Amazon and Flipkart who are continuously violating the FDI policy in indulging in a vicious racket of controlling and monopolising not only the e-commerce but even the retail trade as well," CAIT National Secretary General Praveen Khandelwal said after the CCI order.

Cybersecurity researchers on Monday warned of a Trojan malware campaign which is targeting India's co-operative banks using COVID-19 as a bait.

Seqrite, the enterprise arm of IT security firm Quick Heal Technologies, detected the new wave of Adwind Java Remote Access Trojan (RAT) campaign.

Researchers at Seqrite warned that if attackers are successful, they can take over the victim's device to steal sensitive data like SWIFT logins and customer details and move laterally to launch large scale cyberattacks and financial frauds.

According to the researchers, the Java RAT campaign starts with a spear-phishing email which claims to have originated from either the Reserve Bank of India or a nationalised bank.

The content of the email refers to COVID-19 guidelines or a financial transaction, with detailed information in an attachment, which is a zip file containing a JAR based malware.

Upon further investigation, researchers at Seqrite found that the JAR based malware is a Remote Access Trojan that can run on any machine which has Java runtime enabled and hence it can impact a variety of endpoints, irrespective of their base operating system.

Once the RAT is installed, the attacker can take over the victim's device, send commands from a remote machine, and spread laterally in the network.

In addition, this malware can also log keystrokes, capture screenshots, download additional payloads, and extract sensitive user information, Seqrite said, adding that such attack campaigns can effectively jeopardise the privacy and security of sensitive data at the co-operative banks and result in large scale attacks and financial frauds.

To prevent such attacks, users need to exercise ample caution and avoid opening attachments and clicking on web links in unsolicited emails.

Banks should also keep their operating systems updated and have a full-fledged security solution installed on all the devices, Seqrite advised.