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Article ; Online: Cogan's sign in a patient with suspected post-COVID-19 vaccine-associated myasthenia gravis.

Tavares-Júnior, José Wagner Leonel / Sobreira-Neto, Manoel Alves / Braga-Neto, Pedro

Revista da Sociedade Brasileira de Medicina Tropical

2023 Volume 56, Page(s) e0007

Abstract: The Cogan's sign is indicative of myasthenia gravis. This is the first report of neurological signs in a patient with post-COVID-19 vaccine-associated myasthenia gravis in Brazil. In this case, a previously healthy 68-year-old woman presented with ... ...

Abstract	The Cogan's sign is indicative of myasthenia gravis. This is the first report of neurological signs in a patient with post-COVID-19 vaccine-associated myasthenia gravis in Brazil. In this case, a previously healthy 68-year-old woman presented with proximal limb weakness, left ptosis, and diplopia 1 month after receiving her fourth dose of the COVID-19 vaccine. Neurological examination revealed the presence of Cogan's sign, and she recovered rapidly after treatment. To our knowledge, this is the first reported case of myasthenia gravis associated with the COVID-19 vaccine in Brazil.
MeSH term(s)	Humans ; Female ; Aged ; COVID-19 Vaccines/adverse effects ; COVID-19/complications ; Myasthenia Gravis/chemically induced ; Myasthenia Gravis/diagnosis ; Myasthenia Gravis/complications ; Blepharoptosis/complications ; Blepharoptosis/diagnosis ; Blepharoptosis/drug therapy ; Diplopia/complications ; Diplopia/drug therapy
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2023-06-02
Publishing country	Brazil
Document type	Case Reports
ZDB-ID	1038126-0
ISSN	1678-9849 ; 0037-8682
ISSN (online)	1678-9849
ISSN	0037-8682
DOI	10.1590/0037-8682-0007-2023
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Article ; Online: Could an increased risk of obstructive sleep apnoea be one of the determinants associated with disability in individuals with cardiovascular and cerebrovascular diseases?

de Lima, Eriádina Alves / Castro, Shamyr Sulyvan / Viana-Júnior, Antonio Brazil / Sobreira-Neto, Manoel Alves / Leite, Camila Ferreira

Sleep & breathing = Schlaf & Atmung

2024

Abstract: Purpose: To investigate a possible association between the risk of obstructive sleep apnoea (OSA) and disability in individuals with cardiovascular or cerebrovascular diseases.: Methods: Cross-sectional study was conducted with 373 individuals (313 ... ...

Abstract	Purpose: To investigate a possible association between the risk of obstructive sleep apnoea (OSA) and disability in individuals with cardiovascular or cerebrovascular diseases. Methods: Cross-sectional study was conducted with 373 individuals (313 with cardiovascular or cerebrovascular diseases and 60 healthy). Disability was assessed by the 12-item World Health Organization Disability Assessment Schedule (WHODAS), and the risk of OSA was assessed by STOP-BANG. Anxiety and depression symptoms, daytime sleepiness, and cognition were assessed by the Hospital Anxiety and Depression Scale (HADS), Epworth Sleepiness Scale (ESS), and Mini Mental State Examination (MMSE). Results: Greater disability was found in individuals with intermediate or high risk of OSA, considering healthy individuals (p=0.03), or individuals diagnosed with arrhythmia (p<0.01) or coronary artery disease (p=0.04). A high risk of OSA and higher WHODAS scores was significant among women as well as between OSA risk categories (p<0.01). Cognitive deficit and level of education also showed differences between OSA risk categories. Age, depression, and sleepiness were also associated with the subjects' disability (p<0.01). Gamma regression model showed higher WHODAS scores in female, in those with intermediate and high risk of OSA, and in those with depressive symptoms and cognitive deficit. Age also showed a correlation with higher WHODAS scores. The presence of all investigated cardio and cerebrovascular diseases showed an increase in the WHODAS score, implying a greater disability compared to healthy individuals. Conclusion: Moderate and high risk of OSA is associated with disability, as well as gender, age, depressive symptoms, cognitive deficit, and cardiovascular diseases.
Language	English
Publishing date	2024-01-22
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1500381-4
ISSN	1522-1709 ; 1520-9512
ISSN (online)	1522-1709
ISSN	1520-9512
DOI	10.1007/s11325-024-02989-3
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Article ; Online: REM sleep behavior disorder: update on diagnosis and management.

Sobreira-Neto, Manoel Alves / Stelzer, Fernando Gustavo / Gitaí, Lívia Leite Góes / Alves, Rosana Cardoso / Eckeli, Alan Luiz / Schenck, Carlos H

Arquivos de neuro-psiquiatria

2023 Volume 81, Issue 12, Page(s) 1179–1194

Abstract: REM sleep behavior disorder (RBD) is characterized by a loss of atonia of skeletal muscles during REM sleep, associated with acting out behaviors during dreams. Knowledge of this pathology is important to predict neurodegenerative diseases since there is ...

Title translation	Transtorno comportamental do sono REM: atualização no diagnóstico e manejo.
Abstract	REM sleep behavior disorder (RBD) is characterized by a loss of atonia of skeletal muscles during REM sleep, associated with acting out behaviors during dreams. Knowledge of this pathology is important to predict neurodegenerative diseases since there is a strong association of RBD with diseases caused by the deposition of alpha-synuclein in neurons (synucleinopathies), such as Parkinson's disease (PD), multiple system atrophy (MSA), and dementia with Lewy bodies (DLB). Proper diagnosis of this condition will enable the use of future neuroprotective strategies before motor and cognitive symptoms. Diagnostic assessment should begin with a detailed clinical history with the patient and bed partner or roommate and the examination of any recorded home videos. Polysomnography (PSG) is necessary to verify the loss of sleep atonia and, when documented, the behaviors during sleep. Technical recommendations for PSG acquisition and analysis are defined in the AASM Manual for the scoring of sleep and associated events, and the PSG report should describe the percentage of REM sleep epochs that meet the criteria for RWA (REM without atonia) to better distinguish patients with and without RBD. Additionally, PSG helps rule out conditions that may mimic RBD, such as obstructive sleep apnea, non-REM sleep parasomnias, nocturnal epileptic seizures, periodic limb movements, and psychiatric disorders. Treatment of RBD involves guidance on protecting the environment and avoiding injuries to the patient and bed partner/roommate. Use of medications are also reviewed in the article. The development of neuroprotective medications will be crucial for future RBD therapy.
MeSH term(s)	Humans ; REM Sleep Behavior Disorder/diagnosis ; REM Sleep Behavior Disorder/therapy ; REM Sleep Behavior Disorder/etiology ; Parkinson Disease ; Movement ; Multiple System Atrophy ; Diagnosis, Differential
Language	English
Publishing date	2023-12-29
Publishing country	Germany
Document type	Journal Article
ZDB-ID	418916-4
ISSN	1678-4227 ; 0004-282X
ISSN (online)	1678-4227
ISSN	0004-282X
DOI	10.1055/s-0043-1777111
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Article ; Online: Genetic Epidemiology and Clinical Characteristics of Patients with Spinocerebellar Ataxias in an Unexplored Brazilian State, Using Strategies for Resource-Limited Settings.

Moraes, Débora Beserra Vilar / Coradine, Tácio Luis Cavalcante / Silva, Everton Vieira Lopes / Sobreira-Neto, Manoel Alves / Marques, Wilson / Gitaí, Lívia Leite Góes / Tumas, Vitor

Cerebellum (London, England)

2023 Volume 23, Issue 2, Page(s) 609–619

Abstract: Spinocerebellar ataxias (SCAs) have a worldwide average prevalence of 2.7 cases per 100,000 individuals, with significant geographic variability. This study aimed to develop resource-limited strategies to detect and characterize the frequency and genetic- ...

Abstract	Spinocerebellar ataxias (SCAs) have a worldwide average prevalence of 2.7 cases per 100,000 individuals, with significant geographic variability. This study aimed to develop resource-limited strategies to detect and characterize the frequency and genetic-clinical profile of SCAs in an unexplored population from Alagoas State, a low Human Development Index state in northeastern Brazil. Active search strategies were employed to identify individuals with a diagnosis or clinical suspicion of SCAs, and a protocol for clinical and molecular evaluation was applied in collaboration with a reference center in Neurogenetics. A total of 73 individuals with SCAs were identified, with a minimum estimated prevalence of 2.17 cases per 100,000 inhabitants. SCA3 was the most common type (75.3%), followed by SCA7 (15.1%), SCA1 (6.8%), and SCA2 (2.7%). Patients with SCA3 subphenotype 2 were the most predominant. Detailed analysis of patients with SCA3 and SCA7 revealed age at onset and clinical features congruent with other studies, with gait disturbance and reduced visual capacity in SCA7 as the main initial manifestations. The study also identified many asymptomatic individuals at risk of developing SCAs. These findings demonstrate that simple and collaborative strategies can enhance the detection capacity of rare diseases such as SCAs in resource-limited settings and that Alagoas State has a minimum estimated prevalence of SCAs similar to the world average.
MeSH term(s)	Humans ; Brazil/epidemiology ; Molecular Epidemiology ; Resource-Limited Settings ; Spinocerebellar Ataxias/diagnosis ; Spinocerebellar Ataxias/epidemiology ; Spinocerebellar Ataxias/genetics
Language	English
Publishing date	2023-07-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2112586-7
ISSN	1473-4230 ; 1473-4222
ISSN (online)	1473-4230
ISSN	1473-4222
DOI	10.1007/s12311-023-01581-x
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Zs.A 5795: Show issues

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Article ; Online: Voxel-Based Morphometry and Relaxometry Demonstrate Macro- and Microstructural Damages in Spinocerebellar Ataxia Type 3.

Gitaí, Lívia Leite Góes / Sobreira-Neto, Manoel Alves / Diniz, Paula Rejane Beserra / Éckeli, Alan Luiz / Fernandes, Regina Maria França / Marques, Wilson / Santos, Antonio Carlos

Cerebellum (London, England)

2022 Volume 22, Issue 5, Page(s) 818–824

Abstract: Spinocerebellar ataxia type 3/Machado-Joseph disease (SCA3/MJD) is the most common SCA worldwide and comprises about 70% of SCA patients in Brazil. Magnetic resonance imaging (MRI) sequences have been used to describe microstructural abnormalities in ... ...

Abstract	Spinocerebellar ataxia type 3/Machado-Joseph disease (SCA3/MJD) is the most common SCA worldwide and comprises about 70% of SCA patients in Brazil. Magnetic resonance imaging (MRI) sequences have been used to describe microstructural abnormalities in many neurodegenerative diseases and helped to reveal the excessive iron accumulation in many of these conditions. This study aimed to characterize brain changes in gray matter (GM) and white matter (WM), detected by voxel-based morphometry (VBM) and relaxometry in patients with SCA3/MJD. A group of consecutive individuals, older than 18 years of age, with symptomatic and genetically proven SCA3/MJD diagnosed, and a control group, were submitted to clinical evaluation and MRI. The images were analyzed using VBM technique and relaxometry. The global assessment of brain volume by region of interest showed a significant difference in GM between SCA3/MJD and normal controls. VBM was used to locate these volumetric changes and it revealed a noticeable difference in the GM of the cerebellum and the brainstem. The global assessment of the brain by relaxometry also showed a significant difference in the comparison of GM between SCA3/MJD and normal controls, detecting noticeable prolongation of T2 time in the medulla oblongata (p < 0.001) and in the pontine tegmentum (p = 0.009) in SCA3/MJD compared to control group. Our study suggests that SCA3/MJD affects the macrostructure of the cerebellum and brainstem and microstructure of pons and medulla oblongata GM, as already demonstrated in the pathological study.
MeSH term(s)	Humans ; Machado-Joseph Disease/diagnosis ; Spinocerebellar Ataxias/diagnosis ; Cerebellum/diagnostic imaging ; Cerebellum/pathology ; Brain/diagnostic imaging ; Brain/pathology ; Brain Stem
Language	English
Publishing date	2022-08-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	2112586-7
ISSN	1473-4230 ; 1473-4222
ISSN (online)	1473-4230
ISSN	1473-4222
DOI	10.1007/s12311-022-01452-x
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Article ; Online: Hemodialysis-induced chronodisruption and chronotype distribution in patients with chronic kidney disease.

Nunes, Patrícia Pereira / Resende, Caroline Meneses / Barros Silva, Ellen Dayanne / Piones Bastos, Deryc Cleyner / Ramires Filho, Max Luiz Mendes / Leocadio-Miguel, Mario André / Pedrazzoli, Mario / Sobreira-Neto, Manoel Alves / de Andrade, Tiago Gomes / Góes Gitaí, Lívia Leite / Teles, Flávio

Chronobiology international

2024 Volume 41, Issue 2, Page(s) 283–293

Abstract: Changes in circadian rhythms have been observed in patients with chronic kidney disease (CKD), and evidence suggests that these changes can have a negative impact on health. This study aimed to investigate the existence of hemodialysis-induced ... ...

Abstract	Changes in circadian rhythms have been observed in patients with chronic kidney disease (CKD), and evidence suggests that these changes can have a negative impact on health. This study aimed to investigate the existence of hemodialysis-induced chronodisruption, the chronotype distribution, and their association with sleep quality and quality of life (QoL). This was a cross-sectional study that enrolled 165 patients (mean age: 51.1 ± 12.5 y, 60.6% male) undergoing hemodialysis from three local units. The following instruments were used: the Morning-Eveningness Questionnaire (MEQ); a modified version of the Munich Chronotype Questionnaire (MCQT) to estimate hemodialysis-induced chronodisruption (HIC); the Kidney Disease QoL Short Form (KDQOL-SF); the Epworth Sleepiness Scale (ESS); the Pittsburgh Sleep Quality Index (PSQI) and the 10-Cognitive Screener (10-CS). HIC was present in 40.6% of CKD patients. Morning chronotype was prevalent in CKD patients (69%) compared to evening-type (17.1%) and significantly different from a paired sample from the general population (
MeSH term(s)	Humans ; Male ; Adult ; Middle Aged ; Female ; Circadian Rhythm ; Sleep ; Quality of Life ; Chronotype ; Cross-Sectional Studies ; Surveys and Questionnaires ; Renal Insufficiency, Chronic/therapy ; Renal Dialysis
Language	English
Publishing date	2024-02-04
Publishing country	England
Document type	Journal Article
ZDB-ID	998996-1
ISSN	1525-6073 ; 0742-0528
ISSN (online)	1525-6073
ISSN	0742-0528
DOI	10.1080/07420528.2024.2306838
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Article ; Online: Persistent psychosis associated with extreme delta brush in anti-NMDA receptor encephalitis: a case report.

Nóbrega, Paulo Ribeiro / Lima, Paulo Reges Oliveira / de Oliveira Junior, Pedro Helder / Sanders, Lorena Pitombeira / Sobreira-Neto, Manoel Alves / Magalhães, Samir Câmara / Sanders, Lia Lira Olivier / Braga-Neto, Pedro

BMC psychiatry

2023 Volume 23, Issue 1, Page(s) 256

Abstract: Background: Anti-NMDAR encephalitis is an emerging differential diagnosis of first episode and persistent psychosis in the psychiatric community, as clinical manifestations include psychiatric symptoms, cognitive dysfunction, seizures, decreased ... ...

Abstract	Background: Anti-NMDAR encephalitis is an emerging differential diagnosis of first episode and persistent psychosis in the psychiatric community, as clinical manifestations include psychiatric symptoms, cognitive dysfunction, seizures, decreased consciousness, and dyskinesias. This disease is associated with extreme delta brush (EDB), but the significance and temporal course of this EEG pattern still needs to be determined. Herein, we report a case of anti-NMDAR encephalitis with persistent psychosis associated with EDB occurrence on multiple occasions during a 5-year disease course. Case presentation: A 15-year-old girl was diagnosed with anti-NMDAR encephalitis and treated with progressive improvement. Four years after initial manifestations, an EDB pattern was seen on electroencephalogram (EEG) without new neurological symptoms. She had residual symptoms of episodic auditory hallucinations and impulsivity. One year later, the patient had a recurrence of neurological symptoms (seizures, dyskinesias and impaired attention), persisting with EDB on EEG. Clinical symptoms and EDB resolved after second-line treatment with rituximab. Conclusion: We describe the first case of persistent psychosis in anti-NMDAR encephalitis associated with extreme delta brush on multiple EEGs on prolonged follow-up. Electroencephalographic patterns such as EDB may serve as markers of residual disease activity, including psychiatric symptoms. Further studies with prolonged EEG monitoring are needed to better understand these findings.
MeSH term(s)	Female ; Humans ; Adolescent ; Anti-N-Methyl-D-Aspartate Receptor Encephalitis/complications ; Anti-N-Methyl-D-Aspartate Receptor Encephalitis/diagnosis ; Electroencephalography ; Seizures ; Psychotic Disorders/complications ; Psychotic Disorders/diagnosis ; Dyskinesias/complications
Language	English
Publishing date	2023-04-17
Publishing country	England
Document type	Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2050438-X
ISSN	1471-244X ; 1471-244X
ISSN (online)	1471-244X
ISSN	1471-244X
DOI	10.1186/s12888-023-04750-8
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Article: REM sleep behavior disorder: update on diagnosis and management

Sobreira-Neto, Manoel Alves / Stelzer, Fernando Gustavo / Gitaí, Lívia Leite Góes / Alves, Rosana Cardoso / Eckeli, Alan Luiz / Schenck, Carlos H.

Arquivos de Neuro-Psiquiatria

2023 Volume 81, Issue 12, Page(s) 1179–1194

Abstract	REM sleep behavior disorder (RBD) is characterized by a loss of atonia of skeletal muscles during REM sleep, associated with acting out behaviors during dreams. Knowledge of this pathology is important to predict neurodegenerative diseases since there is a strong association of RBD with diseases caused by the deposition of alpha-synuclein in neurons (synucleinopathies), such as Parkinson's disease (PD), multiple system atrophy (MSA), and dementia with Lewy bodies (DLB). Proper diagnosis of this condition will enable the use of future neuroprotective strategies before motor and cognitive symptoms. Diagnostic assessment should begin with a detailed clinical history with the patient and bed partner or roommate and the examination of any recorded home videos. Polysomnography (PSG) is necessary to verify the loss of sleep atonia and, when documented, the behaviors during sleep. Technical recommendations for PSG acquisition and analysis are defined in the AASM Manual for the scoring of sleep and associated events, and the PSG report should describe the percentage of REM sleep epochs that meet the criteria for RWA (REM without atonia) to better distinguish patients with and without RBD. Additionally, PSG helps rule out conditions that may mimic RBD, such as obstructive sleep apnea, non-REM sleep parasomnias, nocturnal epileptic seizures, periodic limb movements, and psychiatric disorders. Treatment of RBD involves guidance on protecting the environment and avoiding injuries to the patient and bed partner/roommate. Use of medications are also reviewed in the article. The development of neuroprotective medications will be crucial for future RBD therapy.
Keywords	REM Sleep Behavior Disorder ; Sleep ; REM ; Parasomnias ; Synucleinopathies ; Sleep Wake Disorders ; Polysomnography ; Drug Therapy ; Transtorno do Comportamento do Sono REM ; Sono REM ; Parassonias ; Sinucleinopatias ; Transtornos do Sono-Vigília ; Polissonografia ; Tratamento Farmacológico
Language	English
Publishing date	2023-12-01
Publisher	Thieme Revinter Publicações Ltda.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	418916-4
ISSN	1678-4227 ; 0004-282X
ISSN (online)	1678-4227
ISSN	0004-282X
DOI	10.1055/s-0043-1777111
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Article: Long COVID: neurological manifestations - an updated narrative review.

Leonel, José Wagner / Ciurleo, Gabriella Cunha Vieira / Formiga, Alissa Moura / Vasconcelos, Thais de Maria Frota / de Andrade, Marcello Holanda / Feitosa, Werbety Lucas Queiroz / Sobreira-Neto, Antônio Alves / Portugal, Chiara Gübel / Morais, Lorenzo Marinho / Marinho, Samuel Cavalcante / Gomes, Emanuel de Assis Bertulino Martins / Feitosa, Esther de Alencar Araripe Falcão / Sobreira, Emmanuelle Silva Tavares / Oriá, Reinaldo Barreto / Sobreira-Neto, Manoel Alves / Braga-Neto, Pedro

Dementia & neuropsychologia

2024 Volume 18, Page(s) e20230076

Abstract: Infection with the SARS-CoV-2 virus can lead to neurological symptoms in the acute phase and in the Long COVID phase. These symptoms usually involve cognition, sleep, smell disorders, psychiatric manifestations, headache and others. This condition is ... ...

Abstract	Infection with the SARS-CoV-2 virus can lead to neurological symptoms in the acute phase and in the Long COVID phase. These symptoms usually involve cognition, sleep, smell disorders, psychiatric manifestations, headache and others. This condition is more commonly described in young adults and women. This symptomatology can follow severe or mild cases of the disease. The importance of this issue resides in the high prevalence of neurological symptoms in the Long COVID phase, which entails significant morbidity in this population. In addition, such a condition is associated with high health care costs, with some estimates hovering around 3.7 trillion US dollars. In this review, we will sequentially describe the current knowledge about the most prevalent neurological symptoms in Long COVID, as well as their pathophysiology and possible biomarkers.
Language	English
Publishing date	2024-02-09
Publishing country	Brazil
Document type	Journal Article ; Review
ISSN	1980-5764
ISSN	1980-5764
DOI	10.1590/1980-5764-DN-2023-0076
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Article ; Online: Sleep disorders in NiemannPick disease type C, beyond cataplexy.

Rangel, Deborah Moreira / Sobreira-Neto, Manoel Alves / Nepomuceno, Camila Rodrigues / Marques, Erlane Ribeiro / Braga-Neto, Pedro

Sleep medicine

2019 Volume 57, Page(s) 122–127

Abstract: Purpose: The aim of this study was to clinically characterize sleep disorders in a cohort of Niemann-Pick type C (NPC) patients, correlating these findings with disease features and polysomnographic (PSG) results.: Methods: We evaluated eight ... ...

Abstract	Purpose: The aim of this study was to clinically characterize sleep disorders in a cohort of Niemann-Pick type C (NPC) patients, correlating these findings with disease features and polysomnographic (PSG) results. Methods: We evaluated eight consecutive patients with molecular confirmation of NPC followed at the Hospital Geral de Fortaleza. Patients underwent a comprehensive neurological and sleep evaluation. Four participants underwent polysomnography and then performed the multiple sleep latency test. Results: All eight patients evaluated had sleep disorders. Four participants performed polysomnography followed by multiple sleep latency test. Chronic insomnia and Obstructive Sleep Apnea (OSA) were the most frequent sleep disorders (62,5%). Two patients were diagnosed with Restless Legs Syndrome (RLS) (25%) and two with probable REM sleep behavior disorder (RBD) (25%). All the patients who did polysomnography had reduced and/or disorganized sleep, with reduction on sleep efficiency, total sleep time and REM sleep time. Conclusion: Our results suggest that sleep abnormalities in Niemann-Pick type C patients may be more prevalent than previously thought.
MeSH term(s)	Adult ; Cataplexy ; Cohort Studies ; Female ; Humans ; Male ; Niemann-Pick Disease, Type C/complications ; Niemann-Pick Disease, Type C/physiopathology ; Polysomnography ; REM Sleep Behavior Disorder/diagnosis ; Restless Legs Syndrome/diagnosis ; Sleep Apnea, Obstructive/diagnosis ; Sleep Initiation and Maintenance Disorders/diagnosis ; Sleep Latency
Language	English
Publishing date	2019-02-19
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2012041-2
ISSN	1878-5506 ; 1389-9457
ISSN (online)	1878-5506
ISSN	1389-9457
DOI	10.1016/j.sleep.2019.02.007
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