Interesting nuggets about phase-2 of polls

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.

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.

The US space agency has thrown open a challenge to win over Rs 26 lakh, calling the global community to send novel design concepts for compact toilets that can operate in both microgravity and lunar gravity.

NASA is preparing for return to the Moon and innumerable activities to equip, shelter, and otherwise support future astronauts are underway.

The astronauts will be eating and drinking, and subsequently urinating and defecating in microgravity and lunar gravity.

NASA said that while astronauts are in the cabin and out of their spacesuits, they will need a toilet that has all the same capabilities as ones here on Earth.

The public designs for space toilet may be adapted for use in the Artemis lunar landers that take humans back to the Moon.

"Although space toilets already exist and are in use (at the International Space Station, for example), they are designed for microgravity only," the US space agency said in a statement.

NASA's Human Landing System Programme is looking for a next-generation device that is smaller, more efficient, and capable of working in both microgravity and lunar gravity.

The new NASA challenge includes a Technical category and Junior category and the last date to send designs is August 17.

NASA's Artemis Moon mission will land the first woman and next man on the lunar surface by 2024.

The Artemis programme is part of America's broader Moon to Mars exploration approach, in which astronauts will explore the Moon and experience gained there to enable humanity's next giant leap, sending humans to Mars.