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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.

New Delhi, Jan 26: Google on Sunday marked India's 71st Republic Day by dedicating a doodle illustrating the country's rich cultural heritage that permeates and unites the diverse nation.

From its world-famous landmarks like the Taj Mahal and India Gate, to the wide array of fauna such as its national bird (the Indian peafowl), to classical arts, textiles, and dances, the doodle, designed by Singapore-based artist Meroo Seth, brings together the rich cultural heritage of the country.

Republic Day marks the completion of India's transition towards becoming an independent republic after its constitution came into effect. The governing document had taken nearly three years of careful deliberation to finalise, and its eventual enactment was joyfully celebrated across the country.

While the Constitution was adopted by the Indian Constituent Assembly on 26 November 1949, it came into effect on January 26 -- a day when Declaration of Indian Independence (Purna Swaraj) was proclaimed by the Indian National Congress back in 1929, as opposed to the Dominion status offered by the British Regime.

Festivities embody the essence of diversity found in one of the world's most populous nations, celebrated over a three-day period with cultural events displaying national pride.

Last year's doodle on Republic Day, designed by artist Reshidev RK, had featured Rashtrapati Bhavan in the background along with a display of the country's iconic monuments and heritage.

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.