Turner-Kieser Syndrome or Iliac Horn Syndrome, a Challenge for the Anesthesiologist: A Case Report and a Literature Review

Turner-Kieser syndrome is a rare genetic disorder, autosomal dominant, which is related to variable gene expression and high penetrance, due to mutations in the LMX1B gene that affects connective tissue. The clinic has characteristics with alterations in nails, knees, elbows, and presence of iliac horns that makes the anesthetic difficult. However, data in the literature needs more research on this area. The present report is a cesarean section under general intravenous anesthesia performed on a 32-week pregnant woman due to the maternal risk of full-term evolution and aims to contribute to the anesthetic management of patients with this syndrome as there are few descriptions in the literature regarding the anesthetic management in Turner-Kieser syndrome. Even being a case report, the syndrome is rare and it is important to be reported to all anesthesiologists becoming aware of its management and to choose the best technique and anticipate possible complications. During general anesthesia, the technique chosen for the case reported here, we emphasize the risks of possible difficulty in intubating and positioning the patient, as well as renal impairment caused by changes in the cardiovascular autonomic response due to the choice of some drugs. Therefore, in the present report, our option was intravenous general anesthesia because of maternal complications, where fast acting drugs without renal metabolism or excretion were selected, resulting in an uneventful anesthetic procedure.

The differential genetic signatures related to climatic landscapes for jaguars and pumas on a continental scale

Modern and paleoclimate changes may have altered species dynamics by shifting species’niche suitability over space and time.We analyze whether the current genetic structure and isolation of the two large American felids,jaguar(Panthera onca)and puma(Puma concolor),are mediated by changes in climatic suitability and connection routes over modern and paleoclimatic landscapes.We estimate species distribution under 5 climatic landscapes(modern,Holocene,last maximum glaciations[LMG],average suitability,and climatic instability)and correlate them with individuals’genetic isolation through causal modeling on a resemblance matrix.Both species exhibit genetic isolation patterns correlated with LMG climatic suitability,suggesting that these areas may have worked as“allele refuges.”However,the jaguar showed higher vulnerability to climate changes,responding to modern climatic suitability and connection routes,whereas the puma showed a continuous and gradual transition of genetic variation.Despite differential responsiveness to climate change,both species are subjected to the climatic effects on genetic configuration,which may make them susceptible to future climatic changes,since these are progressing faster and with higher intensity than changes in the paleoclimate.Thus,the effects of climatic changes should be considered in the design of conservation strategies to ensure evolutionary and demographic processes mediated by gene flow for both species.