Karnataka witnesses a politically turbulent 2012

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, Jan 25: The Patiala House court on Saturday started hearing a plea filed by the Nirbhaya convicts that alleged that the Tihar Jail administration have "not presented the papers on time".

The Public Prosecutor informed the court that Tihar Jail authorities have already supplied the relevant documents. He further informed that these are mere delaying tactics adopted by the convicts.

Advocate A.P. Singh, lawyer for three of the four death row convicts in the Nirbhaya gang-rape case had moved an application before the court seeking directions to the Tihar Jail authorities to supply him the relevant documents in order to exercise the remaining legal remedies available with the death row convicts -- Vinay Pawan and Akshay.

The Public Prosecutor also told the court that he spoke to the jail authorities over the phone and a report in this regard will be filed shortly as the jail officials were on their way to the court.

The judge demanded from the convicts lawyer to show what he has filed.

The convicts lawyer, A.P. Singh, said that he received some documents, but has still not been supplied with the personal diary of one of the convict -- Vinay Kumar Sharma and also the medical documents.

Judge then asked the lawyer to wait for until the report arrives form the Tihar Jail.

On this, the convicts lawyer said he was not questioning the intention of the jail. "I know the jail has been changed. It isn't there fault, too," he said.

The Public Prosecutor refuted the allegation saying that the defence counsel was trying to defeat the speed of law.

"We have supplied all the documents to the counsel. We have supplied all the documents except the painting and some other documents. We have nothing apart from that," public prosecutor said.

Singh, in his plea filed before the Patiala House Court sought urgent orders of the court in order to file a mercy petition of Vinay Sharma and in relation to requests for documents for convicts Vinay Sharma, Pawan Kumar Gupta and Akshay Kumar Singh.

He further said that the convicts undertook several steps to obtain relevant information necessary for filing the mercy petitions. In regular interval, the convicts requested the concerned authority to supply documents pertaining to their medical records from 2012 to 2015 and 2019-2020, records of cellular confinement, records of the amount earned in prison through labour, records of educational and reformative activities like Tihar Olympics and Painting, etc.

The Supreme court had recently dismissed the curative petition for the other two convicts -- Vinay Kumar Sharma (26) and Mukesh Singh (32).

The court had recently issued death warrant against the convicts and fixed 6 a.m. on February 1 as the date and time of execution of the death penalty.

The 23-year-old victim in the case was brutally gang raped and tortured on December 16, 2012, which later led to her death. All the six accused were arrested and charged with sexual assault and murder. One of the accused was a minor and appeared before a juvenile justice court, while another accused committed suicide in Tihar Jail.

Four of the convicts were sentenced to death by a trial court in September 2013, and the verdict was confirmed by the Delhi High Court in March 2014 and subsequently upheld by the Supreme Court in May 2017, which also dismissed their review petitions.

A Juvenile involved in the crime was convicted by a juvenile justice board and released from a reformation home after serving a three-year term.

Hearing in a different case, Chief Justice of India S.A. Bobde on Thursday said a condemned person cannot fight the death penalty endlessly and it was important for the capital punishment to reach its finality.

The death penalty, he noted, cannot be questioned at every turn by the convict.

The Covid-19 pandemic has made an unprecedented impact on the Indian businesses, particularly small and medium enterprises (SMEs) and startups. According to a joint survey by FICCI and Indian Angel Network (IAN), the pandemic has hit the businesses of around 70% startups.

With uncertainty in the business environment and an unexpected shift in priorities of the government as well as corporates, many startups are struggling to survive, it says.

In a nationwide survey on the 'Impact of Covid-19 on Indian Startups' involving 250 startups, 70% participants said their businesses had been impacted by Covid-19 and around 12% had shut operations.

The survey shows only 22% startups have cash reserves to meet the fixed cost expenses over the next 3-6 months, and 68% are reducing operational and administrative expenses.

Around 30% of the companies said they would retrench employees if the lockdown was extended too long. The 43% startups have already started 20-40% salary cuts over April-June.

Over 33% startups said investors had put the investment decision on hold and 10% said the deals had been scrapped. Only 8% startups had received funds as per the deals signed before Covid-19 outbreak, the survey revealed.

The reduced funding has forced startups to put a hold on business development and manufacturing activities, which has resulted in loss of projected orders.

The survey highlights the need of an urgent relief package for startups, including possible purchase orders from the government, tax relief and swifter tax refunds, and immediate fiscal support measures, including grants, soft loans and payroll grants.

Besides 250 startups, 61 incubators and investors also participated in the survey.

While 96% of investors accepted that their investments in startups had been impacted by Covid-19, 92% said their investments in startups would continue to be low over the next six months.

Around 59% investors said they would prefer to work with the existing portfolio firms in the coming months. Only 41% said they would consider new deals.

"A comparison of priority investment sectors before and during Covid-19 shows 35% investors are now looking at investments in healthcare startups, followed by EdTech, AI/Deep Tech, FinTech and Agri," said the survey.

Around 44% incubators surveyed said their day-to-day operations had been considerably hit by Covid-19. Most incubators are now supporting their portfolio firms by providing them virtual platforms to interact with mentors, investors and industries.

Dilip Chenoy, FICCI Secretary General, said, "The startup sector is stressed for survival at the moment. The investment sentiment is also subdued and is expected to remain so in the coming months. Lack of working capital and cash flows may lead to major layoffs over the next 3-6 months."

Indian startups needed an enabling ecosystem and flow of funds to continue operations, the survey said.

Padmaja Ruparel, President, Indian Angel Network & Co-Chair of FICCI Startup Committee, said, "In these uncertain times, as investors, we must play an important role to provide the Indian startups funding, mentoring and hand-holding support to stay afloat and come out at the other end of this crisis."

To that end, IAN recently announced a debt fund to help IAN portfolio companies raise working capital and ensure business continuity by partnering with debt providers.

This must be replicated on a wider scale, so a larger number of startups are provided the capital support to make it during these tough times, Ruparel said.