Rhinocerebral mucormycosis (RCM): To study the clinical spectrum and outcome of 61 cases of RCM managed at a tertiary care center in India.

Background: Mucormycosis is a life-threatening infection of the paranasal sinuses and nasal cavities that can easily spread to the orbit and the brain. It is caused by fungi of the family Mucoraceae. We present a case series of 61 patients diagnosed and treated for rhinocerebral mucormycosis (RCM) at a single tertiary health care center. Methods: After obtaining ethical clearance, all patient files with a final diagnosis of RCM were thoroughly analyzed in departmental records and a master chart was prepared. The study evaluated the etiology, clinical spectrum, diagnosis, management, complications, and outcome at 3 months of RCM cases. Results: About 93.4% of the RCM cases were diabetic and an equal number had a past history of COVID infection. About 85.2% had received steroids for the treatment of coronavirus disease 2019 infection. The most common presentation of RCM was temporal lobe abscess (25.7%) followed by frontal lobe abscess (16.6%). At 3 months post-diagnosis, mortality in our study was 42.6%. About 26.2 % of the RCM cases had no disease, 23% had a static disease, and 8.2% had progressive disease at the end of 3 months. Conclusion: We report the largest single-center case series of RCM, comprising 61 patients. This case series underscores the importance of the early diagnosis and prompt treatment for a better prognosis for this dreadful disease. The three pillars of treatment for RCM cases include reversal of the immunosuppressive state, administration of antifungal drugs, and extensive surgical debridement. In spite of all this, mortality remains high.

Effect of coronavirus disease 2019 pandemic on case volume, spectrum, and perioperative coronavirus disease 2019 incidence in neurosurgical patients: An experience at a tertiary care center in India.

BACKGROUND: The volume and spectrum of neurosurgical procedures being performed during the coronavirus disease 2019 (COVID-19) pandemic have significantly changed as compared to the pre-COVID-19 period. The objective of this study is to examine this change and draw useful conclusions. METHODS: We collected data retrospectively of all patients who attended outpatient clinics and who were operated at our institute under the department of neurosurgery from October 23, 2019, to August 23, 2020. These data were then divided into two groups (pre-COVID period and during the COVID pandemic) and compared. RESULTS: Out of the 388 surgeries performed, 284 surgeries were performed during the pre-COVID period, and 104 surgeries were performed during the COVID pandemic. During this ongoing COVID pandemic, the total number of surgeries performed by the department of neurosurgery decreased significantly by 63.38%, the proportion of routine surgeries performed decreased from 50.35% to 19.23% and the proportion of minor cases increased from 19.72% to 30.77%. The Outpatient Clinic Workflow decreased by 72.3% as compared to the pre-COVID period, and the perioperative COVID-19 reverse transcription-polymerase chain reaction positive incidence in our neurosurgical patients was 11.71%. CONCLUSION: This paper highlights the drastic reduction in the operative workflow and the outpatient clinic workflow during the ongoing corona pandemic which will have significant collateral damages in the long run. We will have to strike the right balance between providing our patients with the best medical treatment while limiting the spread of the COVID-19 infection.