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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.

Chennai, Jun 22: Commuting the death sentence to life imprisonment for five convicts, the Madras High Court on Monday set free Chinnasamy, the main convict, who had also been sentenced to death in the Udumalpet Shankar honour killing case.

A Division Bench comprising Justice M. Sathyanarayanan and Justice M. Nirmal Kumar also dismissed the appeal by the state police against the acquittal of three persons by a lower court.

The Bench ordered the five convicts sentenced for life to undergo a jail term of not less than 25 years.

In 2016, V. Shankar, who had married C. Kausalya, was killed by a gang in Udumalpet in Tamil Nadu. The gang also injured Kausalya in the attack.

It was alleged the parents of Kausalya -- Chinnasamy, Annalakshmi -- were against the marriage.

P. Pandidurai, the uncle of Kausalya at the behest of Chinnasamy and Annalakshmi had hired a gang to kill Shankar.

The gang killed Shankar in broad daylight in a public place and Kausalya too got injured in the attack as she tried to save her husband.

The Principal District and Sessions Court in Tiruppur had convicted and sentenced to death six accused persons -- Chinnasamy, P. Jagadeesan, P. Selvakumar, M. Manikandan, M. Mathan alias Michael and P. Kalaithamilvaanan.

The court also sentenced two other accused, K. Dhanraj for life and Manikandan to a five year jail term, while acquitting Annalakshmi, Pandidurai and Prasanna.

The convicts had filed an appeal against their sentence in the Madras High Court while the police filed an appeal against the acquittal of three persons.

New Delhi, Apr 17: The Indian Railways turned 167 years old on Thursday and for the first time ever, its trains did not carry any passengers on its birthday and instead stood idle in the yards waiting for the nationwide lockdown to end.

On this day 167 years ago, the wheels of the first passenger train in the country from Mumbai to Thane started rolling.

In 1974, Indians experienced life without trains for the first time. In May 1974 during the strike of the railways that lasted for around three weeks, drivers, station masters, guards, track staff and many others went on 'chakka jam' demanding fixed working hours for train drivers and an across-the-board pay hike.

"I can recall those times vividly. I remember that our leader George Fernandes had almost secured a deal with the then railway minister, but it fell through when it was taken to the then Prime Minister Indira Gandhi," All India Railwaymens Federation General Secretary Shiv Gopal Mishra, who was an apprentice in the railways at that time, told PTI.

"Fernandes was arrested in Lucknow. The workers went through a lot at that time. But those were days that angry workers had refused to give in and took great risks to get their demands met," he said.

However, just like this time, four decades ago too freight trains carrying essential supplies were run and the unions agreed to let some passenger trains run on the trunk routes like the Kalka Mail from Howrah to Delhi.

"Never ever in its history, there has been such a long interruption of services. Not during the World Wars, not during the 1974 railway strike, or any other national calamity or natural disaster," a railway spokesperson said.

The first Indian Railways passenger train was flagged off on April 16, 1853, from Mumbai to nearby Thane.

On Thursday, the Railway Ministry wished the railways a happy birthday on Twitter - "Today, 167 years ago with the zeal of 'never to stop' the wheels of the first passenger train from Mumbai to Thane started rolling. For the first time, passenger services are stopped for your safety. Stay indoors & make the nation victorious," it said.

Railway has suspended all passenger services since March 25 till May 3 due to the coronavirus outbreak. Around 15,523 trains run by the railways have been affected including 9,000 passenger trains and 3,000 mail express services which are run daily. It caters to over 20 million passengers every day.

According to the Union health ministry, the death toll due to coronavirus rose to 414 and the number of cases to 12,380 in the country on Thursday.