Background: Obesity and obstructive sleep apnea (OSA) are both associated with the prevalence of major cardiovascular illnesses and certain common factors they are considered responsible for, such as stress oxidative increase, sympathetic tonus and resistance to insulin. Objective: The aim of the present study was to compare the effect of continuous positive airway pressure (CPAP) on oxidative stress and adiponectin levels in obese patients with and without OSA. Methods: Twenty-nine obese patients were categorized into 3 groups: group 1: 10 individuals without OSA (apnea-hypopnea index, AHI ≤5) who did not have OSA diagnosed at polysomnography; group 2: 10 patients with moderate to severe OSA (AHI ≧20) who did not use CPAP; group 3: 9 patients with moderate to severe OSA (AHI ≧20) who used CPAP. Results: Group 3 showed significant differences before and after the use of CPAP, in the variables of diminished production of superoxide, and increased nitrite and nitrate synthesis and adiponectin levels. Positive correlations were seen between the AHI and the superoxide production, between the nitrite and nitrate levels and the adiponectin levels, between superoxide production and the HOMA-IR, and between AHI and the HOMA-IR. Negative correlations were found between AHI and the nitrite and nitrate levels, between the superoxide production and that of nitric oxide, between the superoxide production and the adiponectin levels, between AHI and the adiponectin levels, and between the nitrite and nitrate levels and the HOMA-IR. Conclusions: This study demonstrates that the use of CPAP can reverse the increased superoxide production, the diminished serum nitrite, nitrate and plasma adiponectin levels, and the metabolic changes existing in obese patients with OSA.

-Moyamoya disease (MMD) is a chronic occlusive cerebrovascular disease of unknown etiology reported mainly in the Japanese. Most cases occur in children. The disease is rare in non-Oriental adults manifesting itself mostly as intracerebral hemorrhages. We describe MMD in 2 non-Oriental young adults and one adolescent that developed cerebral infarctions. The adults were medicated with aspirin and no medication was given to the adolescent. All patients did not deteriorate in a follow-up period from 1 to 4 years. Although rare, MMD is an important cause of stroke in young individuals and may well be underreported: only 18 patients have been reported till 1997 in Brazil. Neurologists should include MMD in differential diagnosis of ischemic and hemorrhagic strokes in young adults.KEY WORDS: moyamoya disease, adult, chronic occlusive cerebrovascular disorder, stroke. Doença de Moyamoya: relato de três pacientes brasileirosRESUMO -A doença de moyamoya (DMM) é patologia cerebrovascular oclusiva crônica de etiologia desconhecida, descrita inicialmente em japoneses. A maioria dos casos ocorre em crianças. Relatamos três casos de DMM, dois adultos e um adolescente não-orientais que apresentaram a forma isquêmica da doença, embora adultos apresentem principalmente a forma hemorrágica. Todos foram submetidos a tratamento conservador e acompanhados durante um a quatro anos, sem piora ou recorrência dos déficits neurológicos. A DMM é uma incomum mas importante causa de acidente vascular cerebral isquêmico, sendo subdiagnosticada em nosso país, onde apenas 18 casos foram descritos até o 1997. PALAVRAS-CHAVE: doença de moyamoya, adulto, doença cerebrovascular, acidente vascular cerebral.

Introduction: Coronavirus pandemic began in China in 2019 (COVID-19), causing not only public health problems but also great psychological distress, especially for physicians involved in coping with the virus or those of the risk group in social isolation, and this represents a challenge for the psychological resilience in the world population. Studies showed that health professionals had psychological symptoms such as depression, anxiety, insomnia, stress, among others. Objectives: To investigate the quality of sleep and the prevalence rate of sleeping disorders among physicians during COVID-19 pandemic, and identify the psychological and social factors associated with the condition. Methods: A cross-sectional study of an online questionnaire was applied for physicians in Brazil. Among the 332 participants included, 227 were women. Sociodemographic assessment was used in the questionnaire, as well as the scale of impact on the events of modifications caused by COVID-19, assessment on sleep quality (PSQI), presence and severity of insomnia (ISI), depressive symptoms (PHQ-9), and anxiety (GAD-7). Results: Most physicians (65.6%) had changes in sleep. Poor sleep quality was reported by 73.1%, depressive symptoms were present in 75.8%, and anxiety in 73.4%. Conclusion: Our study found that more than 70% of the physicians assessed had impaired sleep quality, characterizing insomnia symptoms during COVID-19 outbreak. Related factors included an environment of isolation, concerns about COVID-19 outbreak and symptoms of anxiety and depression. Special interventions are needed to promote health professionals’ mental well-being and implement changes in this scenario.

Obstructive sleep apnea syndrome (OSAS) is considered a sleep-related respiratory disorder, characterized by repetitive episodes of complete (apnea) or partial (hypopnea) obstruction of airflow in the upper airway (UA) during sleep. The pathophysiology of upper airway obstruction in OSAS is multifactorial, leading to a chronic recurrent state of intermittent hypoxemia and reoxygenation during sleep, maintaining a state of oxidative stress, which seems to be the key to the pathophysiological manifestations of OSAS, and is associated with the development of a number of high morbidity-mortality systematic complications, such as obesity, type 2 diabetes, metabolic syndrome, and cardiovascular and neuropsychological diseases. This study is an open, cross-sectional, and comparative clinical trial, whose general objective was to assess the correlation between OSAS severity, oxidative stress markers, and the presence of affective symptoms (depressive and anxious) in OSAS patients. We studied 38 adult males, who had been diagnosed with OSAS by overnight polysomnography, between 18 and 60 years of age, divided into three groups: group 1-10 individuals with mild OSAS (AHI between 5 and 14.9/h), group 2-13 individuals with moderate OSAS (AHI between 15 and 30/h), and group 3-15 individuals with severe OSAS (AHI >30/h). All individuals were evaluated for level of subjective sleepiness using the Epworth Sleepiness Scale, for depressive and anxiety symptoms by the Hamilton Depression (HAM-D) and Anxiety (HAM-A) Scales, and for parameters of the oxidative stress state, measuring superoxide radical and serum nitrates and nitrites levels. There was a progressive and significant increase in the state of oxidative stress (p < 0.05), in the total score of depressive symptoms (p = 0.001) and in the overall score of anxiety symptoms (p = 0.004) directly proportional to the severity of apnea when comparing the mild group to the severe group. Positive correlations were identified between superoxide production and the apnea-hypopnea index (AHI) (r = 0.48), Epworth sleepiness score (r = 0.36), and Hamilton depression score (HAM-D) (r = 0.40); between serum nitrates and nitrites levels and SO(2) min (r = 0.44); and between the AHI and the HAM-D (r = 0.51) score and HAM-A (r = 0.40) score. Negative correlations were observed between the AHI and serum nitrates and nitrites levels (r = -0.42), between superoxide production and SO(2) min (r = -0.31), between serum nitrates and nitrites levels and HAM-D (r = -0.50) and HAM-A (-0.42) scores, and between SO(2) min and HAM-D (r = -0.48) and HAM-A (r = -0.40) scores. According to the results of this study, we can conclude that (1) individuals with OSAS show an increase in the production of superoxide radical and a decrease in serum nitrates and nitrites levels, which are objective signs of a state of oxidative stress. (2) The more severe the OSAS, the more fragmented the sleep and the greater the nocturnal hypoxemia, the more severe is the oxidative stress state and the greater is the incidence of d...

Objective To assess whether the month of birth in different latitudes of South America might influence the presence or severity of multiple sclerosis (MS) later in life. Methods Neurologists in four South American countries working at MS units collected data on their patients' month of birth, gender, age, and disease progression. Results Analysis of data from 1207 MS patients and 1207 control subjects did not show any significant variation in the month of birth regarding the prevalence of MS in four latitude bands (0–10; 11–20; 21–30; and 31–40 degrees). There was no relationship between the month of birth and the severity of disease in each latitude band. Conclusion The results from this study show that MS patients born to mothers who were pregnant at different Southern latitudes do not follow the seasonal pattern observed at high Northern latitudes.

As metástases cerebrais ocorrem comumente em pacientes com câncer. A freqüência dessa complicação está aumentando em decorrência do tratamento mais agressivo do câncer, bem como do uso de métodos de neuroimagem que permitem um diagnóstico mais preciso. Com o melhor controle dos tumores primários, permitido pelos tratamentos atuais, a importância do tratamento dessas metástases é óbvia. Os principais objetivos do tratamento são melhorar os déficits neurológicos e aumentar a expectativa e a qualidade de vida. Os autores revisam as manifestações clínicas, o diagnóstico e as principais opções para o tratamento das metástases cerebrais.

Parkinson's disease (PD) is associated with sleep complaints as excessive daytime sleepiness (EDS) and several factors have been implicated in the genesis of these complaints. Objective. To correlate the subjective perception of EDS with variables as the severity of the motor symptoms, medications, and the presence of depressive symptoms. Materials and Methods. A cross-sectional study, using specific scales as Epworth sleepiness scale (ESS), Beck depression inventory (iBeck) and Hoehn and Yahr (HY), in 42 patients with PD. Results. The patients had a mean age of 61.2 ± 11.3 years and mean disease duration of 4.96 ± 3.3 years. The mean ESS was 7.5 ± 4.7 and 28.6% of patients reached a score of abnormally high value (>10). There was no association with gender, disease duration, and dopamine agonists. Patients with EDS used larger amounts of levodopa (366.7 ± 228.0 versus 460.4 ± 332.25 mg, P = 0.038), but those who had an iBeck >20 reached lower values of ESS than the others (5.9 ± 4.1 versus 9.3 ± 4.8, P = 0.03). Conclusions. EDS was common in PD patients, being related to levodopa intake. Presence of depressed mood may influence the final results of self-assessment scales for sleep disorders.

RESUMOObjetivo: O objetivo do trabalho foi verificar a influência da apnéia obstrutiva do sono (AOS) sobre o estresse oxidativo da obesidade e o efeito do pressão positiva de vias aéreas (CPAP) nestes pacientes. Métodos: Os pacientes com IMC 30 kg/m 2 foram divididos em: a) grupo 1: dez indivíduos sem AOS; b) grupo 2: dez portadores de AOS que não fizeram o uso do CPAP; e c) grupo 3: nove portadores de AOS que fizeram uso do CPAP durante dois meses. Resultados: O grupo 3 apresentou, após o uso do CPAP, redução na produção de superóxido (SO) [13,2 (10,3-19,6) versus 10,5 (5,8-11,8) ABSTRACTObstructive Sleep Apnea Contribution to Oxidative Stress in Obesity. Objective: The aim of this paper was to check the influence of obstructive sleep apnea (OSA) on obesity oxidative stress and CPAP (Continuous Positive Airway Pressure) effect on oxidative stress and in these patients. Methods: Twenty nine male patients considered obese (BMI 30kg/m 2 ) were divided into 3 groups: a) Group I: 10 OSA free patients (apnea-hipopnea index (AHI) 5); b) Group 2: 10 with moderate to serious OSA (AHI 20); c) Group 3: 9 with OSA from moderate to serious (AHI 20) using CPAP,, minimum 4 hours/ night for 2 months. Results: Significant differences before and after CPAP usage were observed in group 3 in the following variables: reduction of superoxide (SO) production [13,2 (10,3-19,6) vs. 10,5 (5,8-11,8) nmoles O 2 -/2x106 PMN] and increase in serum nitrite/nitrates levels [24,5 (16,7-33,5) vs. 49,5 (39,3-58,1) M]. Positive correlation between Apnea-Hypopnea Index (AHI) and SO (r = 0,726) and negative correlation was observed between AHI and serum nitrite/nitrates levels (r = 0,867