High Incidence of Sleep-Related Breathing Disorders in Children with Down Syndrome Referred to a High-Altitude Sleep Laboratory.

Aims: The aim of the study was to assess the incidence of sleep-related breathing disorders (SRBD) in children with Down Syndrome (DS) living at high altitude. Methods: A retrospective descriptive study was conducted on 53 children with DS who underwent polysomnography (PSG) at San Ignacio University Hospital (2640 m/8660 ft above sea level) from 2009 to 2016. Data were extracted from official PSG reports and analyzed using measures of central tendency and dispersion, frequency calculation, ranges, and confidence intervals. Associations were examined using t-test, chi-square test, and analysis of variance test. Results: Obstructive sleep apnea (OSA) was present in 90.5% of children. Central sleep apnea was evident in 11.3%. Periodic breathing was seen in 15.1% of patients. Snoring was able to predict OSA with a sensitivity of 61.7%, a specificity of 100%, and negative predictive value of 25%. Conclusion: Children with DS who live at high altitude have a high incidence of SRBD. Our findings show a higher incidence of SRBD than previously reported in the population with DS. Furthermore, snoring was not sensitive enough to predict OSA. This high risk of SRBD may increase the risk of other comorbid conditions seen in the population with DS. Our results support the need for routine PSG screening independent of symptoms such as snoring status.

Cardiogenic shock as the first manifestation of large vessel vasculitis in a young patient: case report.

BACKGROUND: Cardiogenic shock secondary to coronary involvement in large vessel vasculitis (LVV) is an unsuspected finding, even more, when no other vascular territories are compromised and when it constitutes the initial clinical manifestation. This case report illustrates a case in which a complete diagnostic study uncovered this aetiology. CASE SUMMARY: A 33-year-old woman with cough and chest pain who was diagnosed with acute bronchitis returned with worsening dyspnoea, chest pain, and developed cardiogenic shock. The initial differential diagnoses included myocarditis and takotsubo cardiomyopathy (TCM) owing to a positive troponin I, and echocardiogram with left ventricular dilation, dyskinesia in mid-ventricular and apical segments, systolic dysfunction, and functional mitral regurgitation. A cardiac magnetic resonance showed contractility abnormalities resembling the pattern of TCM but lacked the characteristic myocardial oedema. Subsequently, a coronary angiography expected to result without obstructions showed a critical narrowing of the left main coronary artery. Surgical management consisted of a pericardium patch grafted in the stenotic ostium to restore adequate perfusion. The surgical specimens were sent to the pathology laboratory that reported findings compatible with LVV. Four days after the surgical intervention the patient was discharged alive with a complete recovery of left ventricular systolic function. DISCUSSION: Chest pain symptoms in a young woman, could be caused by multiple entities, and an ischaemic aetiology from a non-atherosclerotic origin should be kept in mind. A complete study with coronary angiography is crucial to rule out an ischaemic cause even in low-risk groups for atherosclerotic coronary heart disease.

Manejo perioperatorio de hemoptisis masiva durante la realización de fibrobroncoscopia: reporte de caso / Perioperative management of massive hemoptysis during flexible bronchoscopy: Case report

Abstract Flexible bronchoscopy is a diagnostic or therapeutic procedure with a low incidence of complications (0.08-6.8%). Bleeding after transbronchial biopsy is a rare complication (0-2.8% of the cases), usually resulting in minor bleeding that resolves with local measures. There is no clear definition of massive hemoptysis and due to the low incidence of this condition, there are no practical guidelines for the treatment of this complication that may be catastrophic. This case discusses the occurrence of massive hemoptysis during a transbronchial biopsy under flexible bronchoscopy, including a literature review on perioperative management.

Resumen La broncoscopia flexible es un procedimiento diagnóstico o terapéutico con baja incidencia de complicaciones (0,08-6,8%). El sangrado por biopsia transbronquial es una complicación rara (0-2,8% de los casos), suele ser leve y resuelve con medidas locales. No existe una definición clara de hemoptisis masiva y, por su baja incidencia, no hay guías de práctica clínica para el tratamiento de esta complicación, que puede ser catastrófica. Presentamos un caso de hemoptisis masiva durante la realización de una broncoscopia flexible más biopsia transbronquial y revisamos la literatura acerca del manejo intraoperatorio.