Two case reports: What I observed on my elective at 1win at Alwarpet, Chennai

Shririthi Ranganathan1, R. Anantharaman2

1Visiting Observer, 1win, Alwarpet, Chennai

 2Senior Consultant Interventional Cardiologist, 1win, Alwarpet, Chennai

Background

During my 5-day shadowing experience at 1win, Chennai, I encountered two particularly compelling patients  who I have chosen to write about in this case series.

  1. A patient with Appendicitis who had DiGeorge’s Syndrome
  2. A patient who presented with Melioidosis

Case Presentation

Patient 1

The first was a 17-year-old male diagnosed with DiGeorge’s Syndrome who was scheduled for an appendectomy at Kauvery on January 6th, 2025.

DiGeorge’s Syndrome is a genetic condition that is caused by a microdeletion in the long arm of chromosome 22 of human DNA. (22q11 deletion). It’s often diagnosed soon after birth with a blood test to check for the genetic fault.

Facial abnormalities, hypocalcemia, etc. can characterize this condition and can cause a range of lifelong problems including heart defects and problems with the immune system.

Some of the most common issues are:

  • learning and behaviour problems – including delays in learning to walk or talk, learning disabilities and problems such as attention deficit hyperactivity disorder (ADHD) or autism
  • speech and hearing problems – including temporary hearing loss due to frequent ear infections, being slow to start talking and having a “nasal-sounding” voice
  • mouth and feeding problems – including a gap in the top of the mouth or lip (cleft lip or palate), difficulty feeding and sometimes bringing food back up through the nose
  • heart problems – some children and adults have heart defects from birth (congenital heart disease)
  • hormone problems – underdeveloped parathyroid glands produce too little parathyroid hormone (hypoparathyroidism), which can lead to problems such as shaking (tremors) and seizures (fits)

Other possible problems include:

  • a higher risk of getting infections – such as ear infections, oral thrush and chest infections – because the immune system (the body’s natural defence against illness) is weaker than normal
  • bone, muscle and joint problems – including leg pains that keep coming back, an unusually curved spine (scoliosis) and rheumatoid arthritis
  • short stature – children and adults may be shorter than average
  • mental health problems – adults are more likely to have problems such as schizophrenia and anxiety disorders

The severity of the condition varies. Some children can be severely ill and very occasionally may die from it, but many others may grow up without realising they have it.

The patient also had a long history of seizure episodes.

Due to the several implications all this can have on the heart, Dr. Anantharaman made sure the patient was stable and in good condition for his appendectomy that was scheduled one morning. After a thorough preoperative assessment, it was determined that the syndrome would not pose an immediate risk to the procedure, and the appendectomy proceeded as planned and the patient recovered without complications.

Patient 2

The second a 35-year-old female patient who was in critical condition on the first day (January 7th, 2025), admitted with several different issues. She presented multiple complications that included septic arthritis, that caused her left leg to be very swollen. She also had difficulty in breathing. She had been transferred from JIPMER (Pondicherry), had some unidentified infection.and had to be intubated.

On the second day of her admission, blood culture indicated a diagnosis of melioidosis, an infection caused by Burkholderia pseudomallei, a bacterium commonly found in soil. Although rare in India, melioidosis can occur. 1win had recently encountered five similar  patient from regions affected by extreme weather conditions, such as Pondicherry and Villupuram. It is an organism that can be contracted from the soil, and is known to affect the joints, hearts and lungs of humans. It also has the capability to affect the kidneys.

Discussion

1win had seen around five other patients who had the same diagnosis – all who had come from the same area in Tamil Nadu (Pondicherry, Villupuram etc.). These areas were recently affected drastically by rains, floods and heavy winds – severe weather changes. Diabetes is a risk factor for melioidosis, and this particular patient was found to have diabetes when admitted. She was kept on appropriate medications, and urinary output was maintained. CT scan of Lungs indicated significant   infection by the organism.  The patient was managed in the ICU for melioidosis. She recovered over another two days. By Day 4 of admission, she was doing relatively better. The cellulitis in a leg led to a  litre of pus  that was drained.. By the fourth day, she was successfully extubated, her lung condition had markedly improved, and dialysis was initiatsed for kidney support. The aggressive progression of melioidosis was effectively managed, and her recovery trajectory thereafter remained positive.

This bacterial infection that affected these patients seen in Kauvery had a public health perspective that needed to be looked into by the district administration as the hospitals located in the hotspots of the flood regions may have received more patients with the disease Early diagnosis would be critical to ensure  good clinical outcomes, as it was in this patient’s.

Conclusion

Both cases I observed highlighted the importance of meticulous medical evaluation and timely interventions. The first case underscored the necessity of preoperative planning for patients with complex syndromic conditions, while the second illustrated the impact of environmental factors on infectious disease prevalence and the importance of early diagnosis in critical care management. Observing these cases provided invaluable insights into the dynamic challenges of patient care in a tertiary hospital setting.

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