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Monday, June 21, 2021

Mucormycosis: 21 surgeries performed in SSG in a day

On an average, the hospital sees close to 12 indoor admissions for the invasive fungal infection of mucormycosis every day — a majority of patients being from other districts.

Written by Aditi Raja , Sohini Ghosh , Kamaal Saiyed | Ahmedabad, Surat, Vadodara |
May 21, 2021 3:41:41 am
Black fungus, Covid-19A covid patient in critical condition gets admitted at the Civil hospital, Asarwa in Ahmedabad. (Express Photo by Nirmal Harindran)

SSG Hospital in Vadodara performed 21 surgeries on mucormycosis patients on Thursday — highest single-day procedures performed on such patients in recent times in any city hospital in the state.

In 48 hours until 8 pm Thursday, SSG hospital saw 15 transnasal endoscopic partial maxillectomy (removal of maxillary sinuses located below the cheek), 22 procedures of local debridements (cleaning up of the rhino-celebral passage surgically) and four orbital exenterations (removal of the infected eyeball).

On an average, the hospital sees close to 12 indoor admissions for the invasive fungal infection of mucormycosis every day — a majority of patients being from other districts. Medical Superintendent of SSG hospital, Dr Ranjan Aiyer, who is also the Head of Department of ENT, said, “Other than the actual surgical procedures that involve the extraction of affected parts, there are also certain surgical procedures that are diagnostic in nature. For instance, almost every patient needs a nasal endoscopy, which allows us to ascertain the damage that has been caused and pinpoint the scale of the surgical procedure that will be involved. The second step is a KOH (potassium hydroxide) exam of a part of the lesion extracted and the third step is the tissue biopsy. Almost all patients admitted have undergone these procedures, but only those who have tested negative for Covid-19 can be taken up by the surgical teams for debridements and extractions,” Aiyer said.

Aiyer added that the Vadodara administration is considering creating a separate facility in the city, where the patients who have already undergone surgery can be sent for the administration of the injection — Amphotericin-B — and continue to be monitored by their physician for safety profiling of their blood sugar levels. “This will take the load off from the main hospital as patients from other districts, who have to stay back for the drug administration can be shifted to the facility and only critical surgical cases can be admitted in the main wards,” Aiyer said.

SSG hospital in Vadodara has a total of 154 patients admitted to the two mucormycosis wards. Of these 33 are Covid19 positive and 23 RTPCR reports are still awaited, the hospital said. The hospital, on Thursday, also began admitting patients in a third ward created to treat the infection. The hospital has so far seen 12 mortalities and five recoveries, Aiyer said.

Gujarat Medical Education and Research Society (GMERS)-run Gotri hospital has an additional 35 patients admitted. The health department is yet to ascertain the total number of patients affected by mucormycosis in the city as several patients have sought treatment at private hospitals, officials said. The city has also seen several mortalities due to mucormycosis, especially in patients who remained Covid-19 positive and could not be operated upon, officials said.

However, the non-availability of the Liposomal form of Amphotericin-B — the anti-fungal drug that is known to treat mucormycosis — in private hospitals are drawing patients to government facilities.

Aiyer said, “…We receive a lot of patients from other districts because they have realised that the drugs would be made available to the government hospitals first…”

Aiyer said that since 1992, SSG hospital had seen only about 20 cases of mucormycosis. “With Covid-19 now… the number of cases in the current wave has surpassed lifetime figures of such patients. The steroids may have helped in Covid19 but immunity and glycemic levels of the patients were compromised,” Aiyer said.

Aiyer said that each patient undergoing treatment for mucormycosis needs close to seven vials of Amphotericin-B every day.

In Rajkot, Dr R S Tivedi, superintendent at PDU Hospital, said the hospital is conducting eight to 10 surgeries on mucormycosis patients each day. The hospital has increased its bed capacity for mucormycosis patients to 500, with 430 patients admitted at present. According to an Ahmedabad Civil Hospital source, there are 371 mucormycosis patients admitted at the hospital with a total of 156 surgeries conducted till date.

In Surat, Dr Bhavin Patel, head of ENT department at Kiran hospital, confirmed that a total of 70 surgeries have been performed so far with a daily average of eight. The hospital has a pending list of 75 patients awaiting surgery. At Surat’s New Civil Hospital, a total of 27 surgeries have been conducted with a daily average of seven, while SMIMER hospital has seen 12 surgeries at a rate of two per day so far.

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