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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.

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.

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.