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Background: Sleep-disordered breathing (SDB) is a highly prevalent disorder with major consequences for cardiopulmonary health, public safety, use of health-care, and mortality. Hypoxia is a known risk factor for SDB, yet the prevalence and effect of SDB in high-altitude settings remain largely unknown. Methods: The CRONICAS Cohort Study is a longitudinal study of non-communicable diseases in an age-stratified and sex-stratified random sample of more than 3000 Peruvian adults (≥35 years), including more than 1000 individuals residing at high altitude. Participants were surveyed for sociodemographics, anthropometry, spirometry, and metabolic and inflammatory biomarkers beginning in September, 2010. We recruited a convenience sample of 127 participants living at high altitute (3825 m) for home-based nocturnal physiological recordings including respiratory effort, air flow, oxyhaemoglobin saturation, and actigraphy. We estimated the prevalence of SDB and examined its associations with traditional risk factors and non-communicable diseases. Findings: Our sample was middle-aged (mean 57·2 years [SD 12·2]), 55·1% were men, and the mean body-mass index (BMI) was 27·3 kg/m2 (SD 4·1). Most participants were urban residents (112 of 127, 88·2%). We identified several nocturnal respiratory phenotypes, including obstructive sleep apnoea (48 of 127, 37·8%), central sleep apnoea (21, 16·5%), mixed sleep apnoea (three, 2·4%), and substantial isolated oxyhaemoglobin desaturation during sleep (two, 1·6%), wakefulness (two, 1·6%), and normal nocturnal breathing (51, 40·2%). The overall prevalence of SDB was 56·7% (72 of 127). SDB was significantly associated with older age (p=0·042, test for trend in odds), male sex (OR 2·29, 95% CI 1·05–4·99, p=0·023), and rural residence (5·84, 1·22 −55·04, p=0·013). SDB was not significantly associated with BMI, chronic obstructive pulmonary disease, hypertension, cardiovascular disease, diabetes, or depression. Interpretation: We noted a high prevalence of SDB in the high-altitude sample, encompassing several distinct phenotypes. SDB was associated with age, male sex, and rural residence, but not BMI or chronic diseases. This pilot study shows the feasibility of home-based nocturnal recordings in this setting, and will guide further investigation in larger representative samples. Funding: National Heart, Lung and Blood Institute, National Institutes of Health (HHSN268200900033C); Johns Hopkins University School of Medicine Dean's Funding; University of Chicago Pritzker School of Medicine Global Health Scholarship; University of Chicago Pritzker School of Medicine Scholarship; and Discovery Innovation Fund.

Summary:. For gender-diverse individuals assigned male at birth, postpubertal estrogen and testosterone-lowering therapies alone are often inadequate to reverse the testosterone-related facial characteristics projecting a male sex identity. Facial feminization surgery significantly improves quality-of-life outcomes for gender-diverse patients by relieving this gender incongruence of the face. Because the shape of the forehead is so radically different between men and women, feminization of this area is critical for many individuals. Several techniques are typically used in combination, including hairline advancement, browlift, burring of the supraorbital rims, frontal bone contouring, and anterior table setback. This report describes the use of fat grafting as an adjuvant technique to forehead contouring as means to avoid frontal bone osteotomy, which carries a higher complication profile and often requires hardware placement.

Background: Chagas cardiomyopathy (CCM) is the debilitating result of a parasitic infection that causes structural and electrical abnormalities. Yet, optimal CCM management is challenging in the resource-poor communities where it predominates. Objectives: The authors sought to investigate current practice patterns and barriers to CCM care through an online survey of cardiologists in Bolivia, the country with the highest CCM prevalence. Methods: Cardiologists were recruited through the national cardiologist directory. The Qualtrics survey was distributed anonymously. Survey questions were developed by Bolivian and U.S. researchers with extensive Chagas disease experience. Results: Of 194 cardiologists, 67 (35%) completed ≥80% of the survey. Responses were collected from every major Bolivian city. More than 70% of cardiologists cared for CCM patients daily or weekly. More frequent prescription of angiotensin-converting enzyme inhibitors (73%) and mineralocorticoid receptor antagonists (82%) for heart failure was reported compared to β-blockers. Ventricular tachycardia treatment was achieved more often with amiodarone (92%) than implantable cardioverter-defibrillators (46%). Anticoagulation was prescribed if CCM patients had atrial fibrillation (91%) or apical aneurysm with thrombus (86%), yet few cardiologists prescribed anticoagulation in left ventricular systolic dysfunction or CCM diagnosis alone. While pacemaker therapy was generally available to cardiologists (66%), patients received devices only through private insurance or philanthropy, with few physicians (28%) offering implantable cardioverter-defibrillators regularly. Conclusions: Cardiologists cited lack of device access as the predominant challenge in CCM management rather than insufficient knowledge or experience. These findings suggest that significant health equity gaps remain in CCM care, particularly in the availability of commonly indicated, potentially life-saving devices.