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STUDY OBJECTIVES: By measuring the apnea length, ventilatory phase, respiratory cycle length, and loop gain, we can further characterize the central apneas of high altitude (CAHA). METHODS: Sixty-three drivers of all-terrain vehicles, working in a Peruvian mine located at 2,020 meters above sea level (MASL), were evaluated. A respiratory polygraph was performed in the first night they slept at high altitude. None of the subjects were exposed to oxygen during the test or acetazolamide in the preceding days of the test. RESULTS: Sixty-three respiratory polygraphs were performed, and 59 were considered for analysis. Forty-six (78%) were normal, 6 (10%) had OSA, and 7 (12%) had CAHA. Key data from subjects include: residing altitude: 341 ± 828 MASL, Lake Louise scoring: 0.4 ± 0.8, Epworth score: 3.4 ± 2.7, apneahypopnea index: 35.7 ± 19.3, CA index: 13.4 ± 14.2, CA length: 14.4 ± 3.6 sec, ventilatory length: 13.5 ± 2.9 sec, cycle length: 26.5 ± 4.0 sec, ventilatory length/CA length ratio 0.9 ± 0.3 and circulatory delay 13.3 ± 2.9 sec. Duty ratio media [ventilatory duration/cycle duration] was 0.522 ± 0 0.128 [0.308-0.700] and loop gain was calculated from the duty ratio utilizing this formula: LG = 2π / [(2πDR-sin(2πDR)]. All subjects have a high loop gain media 2.415 ± 1.761 [1.175-6.260]. Multiple correlations were established with loop gain values, but the only significant correlation detected was between central apnea index and loop gain. CONCLUSIONS: Twelve percent of the studied population had CAHA. Measurements of respiratory cycle in workers with CAHA are more similar to idiopathic central apneas rather than Hunter-Cheyne-Stokes respiration. Also, there was a high degree of correlation between severity of central apnea and the degree of loop gain. The abnormal breathing patterns in those subjects could affect the sleep quality and potentially increase the risk for work accidents.

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PURPOSE: The severity of obstructive sleep apnoea (OSA) ranges from mild or moderate to severe sleep apnoea. However, there is no information available on the clinical characteristics associated with cases involving more than 100 events per hour. This is a preliminary report and our goal was to characterise the demographics and sleep characteristics of patients with Extreme OSA and compare with patients with sleep apnoea of lesser severity. We hypothesised that patients with Extreme OSA (AHI>100) is associated with an increased comorbidities and/or risk factors. METHODS: We carried out a case-control study on male patients with OSA who were seen in a private hospital in Lima, Peru between 2006 and 2012. Cases were identified if their apnoea/hypopnea index (AHI) was higher than 100 (Extreme OSA), and four controls were selected per case: two with 15-29 AHI and two with 30-50 AHI, matched according to case diagnosis dates. We evaluated demographic, past medical history, and oxygen saturation variables. RESULTS: We identified 19 cases that were matched with 54 controls. In the multivariate model, only arterial hypertension, neck circumference, age, and over 10% in SatO2Hb≤90% in total sleep time (T90) were associated with Extreme OSA. Arterial hypertension had an OR=6.31 (CI95%: 1.71-23.23) of Extreme OSA. Each 5-cm increment in neck circumference was associated with an increase of OR=4.34 (CI95%: 1.32-14.33), while T90>10% had an OR=19.68 (CI95%: 4.33-89.49). Age had a marginal relevance (OR=0.95; CI95%: 0.92-0.99). CONCLUSION: Our results suggest that arterial hypertension, neck circumference, and over 10% SatO2Hb≤90% in total sleep time were associated with a higher probability of Extreme OSA. We recommend investigators to study this population of Extreme OSA looking for an early diagnosis and the identification of prognostic factors in comparison with moderate to severe levels.

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Se observó 102 pacientes trasplantados renales internados en el Servicio de Nefrología del Hospital Nacional Edgardo Rebagliati Martins-EsSalud entre octubre de 1997 y mayo de 1998. Se registró los diagnósticos y características epidemiológicas. Setenta y dos pacientes habían sido trasplantados varios meses o años antes del período de estudio, algunos de ellos tuvieron más de un ingreso en ese lapso. Treinta trasplantados renales pudieron ser vigilados durante el período postoperatorio inmediato . Alrededor del 70 por ciento de ingresos de pacientes anteriormente trasplantados se debió a complicaciones infecciosas. Las infecciones más frecuentes fueron: infección de la vía urinaria (28,5 por ciento), gastroenteritis (18,5 por ciento) y bronquitis (10 por ciento). Los gérmenes más identificados fueron Escherichia coli, Pseudomonas aeruginosa y enterobacter aerogenes y E. cloacae. El 40 por ciento de los trasplantes observados tuvo una complicación infecciosa. Las infecciones más frecuentes en el primer período fueron: neumonía intrahospitalaria, infecciones por herpes simplex e infecciones de la herida operatoria. Se logró confeccionar una "tabla de tiempo" de las infecciones según el período del trasplante renal en nuestro medio.

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Se reporta un caso de mucormicosis en una paciente diabética transplantada renal, ocurrido en febrero de 1996. El caso fue detectado en el Servicio de Nefrología del Hospital Rebagliati-IPSS. Se realizó diagnóstico inicial de celulitis periorbital en el ojo derecho y luego de tratamiento antibacteriano con mala evolución se sospechó e identificó mucormicosis mediante examen anatomopatológico. Fue necesaria la enuclación quirúrgica del ojo afectado y tratamiento con anfotericina B. Se hace revisión bibliográfica y discusión respectiva.

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