English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

of Turner syndrome with multiple co-morbidities, namely, long-standing coronary triple vessel disease, diabetes, hypertension, hypothyroidism, gastro-esophageal reflux disease, psychiatric illness, severe osteoporosis, and severe sensorineural hearing loss. She was scheduled to undergo repair of an intertrochanteric fracture of the femur. Evaluation of her symptoms revealed episodes of autonomic dysfunction in relation to stressful events and illness, characterized by hypotension and tachycardia, which were responsive to fluids. Her medications at the time included clopidogrel, ecosprin, ramipril, metoprolol, atorvastatin, quetiapine, zoledronic acid, vitamin D3, prednisolone, L-thyroxine, metformin, and multivitamins. She was admitted to the neurology department with complaints of hallucinations, memory disturbances, and agitation. During the course of her hospital stay, she experienced a fall in the bathroom that resulted in a fracture of the right femur. Her cerebrospinal fluid examination was within normal limits; magnetic resonance imaging of the brain revealed features suggestive of limbic encephalitis, and infectious etiologies and other possible causes of encephalitis were ruled out. Considering her background of Turner syndrome, an autoimmune workup was done. She was found to have anti-N-methyl D-aspartate receptor (NMDA) receptor limbic encephalitis; treatment was started with steroids and intravenous immunoglobulin therapy. Subsequently, she demonstrated marked improvement in symptomatology. On examination, she was found to be short-statured (140 cm), weighing 48 kg, with webbed neck, and webbed toes. Her heart rate was 88 beats per minute, blood pressure 100/60 mmHg, respiratory rate 14 cycles per min, and peripheral oxygen saturation 97%. Auscultation of her chest revealed diffusely reduced air entry, particularly in the lung bases. Her biochemical investigations revealed the following: hemoglobin 11.2 g/ dl and platelet count 220 × 10/L with high titers of anti-thyroid peroxidase, anti-thyroglobulin, and anti-NMDA antibodies; the results of other investigations (liver and kidney function tests, serum electrolytes etc.) were grossly within normal limits. High resolution computed tomography of her thorax suggested bilateral pleural effusion with adjacent subsegmental lung collapse and moderate pericardial effusion. The condition of the patient was explained to the patient’s relatives, and written informed consent was obtained. Clopidogrel was stopped seven days prior to surgery, and ramipril and metformin were stopped on the day of surgery. Turner syndrome is a chromosomal disorder with XO genotype and affects females. Phenotypically, it is associated with short stature and multiple autoimmune diseases such as type 1 diabetes mellitus, Hashimoto’s thyroiditis, ulcerative colitis, rheumatoid arthritis, and Addison’s disease. Limbic encephalitis Letter to the Editor

Anesthesia management in a case of Turner syndrome with anti-NMDA limbic encephalitis and multiple co-morbidities for repair of fracture femur