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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.

Leiden, Jul 2: Astronomers have discovered a luminous galaxy caught in the act of reionizing its surrounding gas only 800 million years after the Big Bang.

The research, led by Romain Meyer, PhD student at UCL in London, UK, has been presented at the virtual annual meeting of the European Astronomical Society (EAS).

Studying the first galaxies that formed 13 billion years ago is essential to understanding our cosmic origins. One of the current hot topics in extragalactic astronomy is 'cosmic reionization,' the process in which the intergalactic gas was ionized (atoms stripped of their electrons).

Cosmic reionization is similar to an unsolved murder: We have clear evidence for it, but who did it, how and when? We now have strong evidence that hydrogen reionization was completed about 13 billion years ago, in the first billion years of the universe, with bubbles of ionized gas slowly growing and overlapping.

The objects capable of creating such ionized hydrogen bubbles have however remained mysterious until now: the discovery of a luminous galaxy in which 60-100 percent of ionizing photons escape, is likely responsible for ionizing its local bubble. This suggests the case is closer to being solved.

The two main suspects for cosmic reionization are usually 1) a population of numerous faint galaxies leaking ~10 percent of their energetic photons, and 2) an 'oligarchy' of luminous galaxies with a much larger percentage (>50 percent) of photons escaping each galaxy.

In either case, these first galaxies were very different from those today: galaxies in the local universe are very inefficient leakers, with only <2-3 percent of ionizing photons escaping their host. To understand which galaxies governed cosmic reionization, astronomers must measure the so-called escape fractions of galaxies in the reionization era.

The detection of light from excited hydrogen atoms (the so-called Lyman-alpha line) can be used to infer the fraction of escaping photons. On the one hand, such detections are rare because reionization-era galaxies are surrounded by neutral gas which absorbs that signature hydrogen emission.

On the other hand, if this hydrogen signal is detected it represents a 'smoking gun' for a large ionized bubble, meaning we have caught a galaxy reionizing its surroundings. The size of the bubble and the galaxy's luminosity determines whether it is solely responsible for creating this ionized bubble or if unseen accomplices are necessary.

The discovery of a luminous galaxy 800 million years after the Big Bang supports the scenario where an 'oligarchy' of bright leakers emits most of the ionizing photons.

"It is the first time we can point to an object responsible for creating an ionized bubble, without the need for a contribution from unseen galaxies.

Additional observations with the upcoming James Webb Space Telescope will enable us to study further what is likely one of the best suspects for the unsolved case of cosmic reionization," said Meyer.