AMILOIDOSE CARDÍACA: SUPERANDO A LACUNA ENTRE O RECONHECIMENTO E O MANEJO EFETIVO

Introduction: Cardiac amyloidosis (CA) is a rare condition caused by the accumulation of amyloid proteins in the heart, resulting in impaired cardiac function. CA is often underdiagnosed due to its nonspecific clinical presentation and lack of awareness about the disease. This article aims to understand the pathophysiology, diagnosis, and management of CA. Methodology: A systematic review was conducted using databases such as Scielo and PubMed, with the descriptors "Amyloidosis" AND "Cardiovascular System," yielding 3306 studies, of which 23 were selected for better addressing the chosen topic and being published in English or Portuguese. Inclusion and exclusion criteria were applied to ensure the quality of the selected studies. Results: CA can be caused by different types of amyloidosis, with light-chain amyloidosis (AL) and transthyretin amyloidosis (ATTR) being the most common. Symptoms are nonspecific and include dyspnea, fatigue, and edema, often leading to diagnostic errors. Diagnosis involves a combination of methods, including imaging tests and tissue biopsy. Treatment aims to slow disease progression and alleviate symptoms, tailored according to the type and stage of CA. Conclusion: CA represents a diagnostic and therapeutic challenge due to its varied clinical presentation and complexity. Awareness of the signs and symptoms of the disease is crucial for early diagnosis and better patient management. Continuous development of clinical and therapeutic approaches is necessary to optimize outcomes for patients affected by this debilitating condition.Introdução: A amiloidose cardíaca (AC) é uma condição rara causada pelo acúmulo de proteínas amiloides no coração, resultando em comprometimento da função cardíaca. A AC é frequentemente subdiagnosticada devido à sua clínica inespecífica e à falta de conscientização sobre a doença. Este artigo visa compreender a fisiopatologia, diagnóstico e manejo da AC. Metodologia: Realizou-se uma revisão sistemática utilizando bases de dados como Scielo e Pubmed, utilizando os descritores “Amyloidosis” AND “Cardiovascular System”, obtendo-se 3306 estudos, dos quais 23 foram selecionados por abordarem melhor o tema escolhido e serem publicados em inglês ou português. Os critérios de inclusão e exclusão foram aplicados para garantir a qualidade dos estudos selecionados. Resultados: A AC pode ser causada por diferentes tipos de amiloidose, sendo a amiloidose de cadeia leve (AL) e a amiloidose associada à transtirretina (ATTR) as mais comuns. Os sintomas são inespecíficos e incluem dispneia, fadiga e edema, levando frequentemente a erros diagnósticos. O diagnóstico envolve uma combinação de métodos, incluindo exames de imagem e biópsia tecidual. O tratamento visa retardar a progressão da doença e aliviar os sintomas, sendo personalizado de acordo com o tipo e estágio da AC. Conclusão: A AC representa um desafio diagnóstico e terapêutico devido à sua apresentação clínica variada e complexidade. A conscientização sobre os sinais e sintomas da doença é crucial para um diagnóstico precoce e um melhor manejo dos pacientes. O desenvolvimento contínuo de abordagens clínicas e terapêuticas é necessário para otimizar os resultados para os pacientes afetados por essa condição debilitante

Exploring Viral Metagenomics in Pediatric Patients with Acute Respiratory Infections: Unveiling Pathogens beyond SARS-CoV-2

The emergence of SARS-CoV-2 and the subsequent pandemic have prompted extensive diagnostic and clinical efforts to mitigate viral spread. However, these strategies have largely overlooked the presence of other respiratory viruses. Acute respiratory diseases in pediatric patients can be caused by a diverse range of viral agents, and metagenomics represents a powerful tool for their characterization. This study aimed to investigate the viral abundance in pediatric patients with acute respiratory symptoms who tested negative for SARS-CoV-2 during the Omicron pandemic wave. To achieve this, viral metagenomics and next-generation sequencing were employed on 96 nasopharyngeal swab samples, which were organized into 12 pools, with each pool consisting of eight individual samples. Metagenomic analysis revealed that the most prevalent viruses associated with acute disease in pediatric patients were respiratory syncytial virus (detected in all pools) and enteroviruses, which are known to cause significant morbidity and mortality in children. Additionally, clinically significant viruses such as mumps orthorubulavirus, human metapneumovirus, influenza A, and a wide array of human herpesviruses (1, 3–7) were identified. These findings highlight the extensive potential of viral metagenomics in identifying viruses other than SARS-CoV-2 that contribute to acute infections in children. Consequently, this methodology should garner clinical attention in terms of differential diagnosis and the development of public policies to address such conditions in the global pediatric population

Dynamics of SARS-CoV-2 Variants of Concern in Vaccination Model City in the State of Sao Paulo, Brazil

From a country with one of the highest SARS-CoV-2 morbidity and mortality rates, Brazil has implemented one of the most successful vaccination programs. Brazil’s first model city vaccination program was performed by the CoronaVac vaccine (Sinovac Biotech) in the town of Serrana, São Paulo State. To evaluate the vaccination effect on the SARS-CoV-2 molecular dynamics and clinical outcomes, we performed SARS-CoV-2 molecular surveillance on 4375 complete genomes obtained between June 2020 and April 2022 in this location. This study included the period between the initial SARS-CoV-2 introduction and during the vaccination process. We observed that the SARS-CoV-2 substitution dynamics in Serrana followed the viral molecular epidemiology in Brazil, including the initial identification of the ancestral lineages (B.1.1.28 and B.1.1.33) and epidemic waves of variants of concern (VOC) including the Gamma, Delta, and, more recently, Omicron. Most probably, as a result of the immunization campaign, the mortality during the Gamma and Delta VOC was significantly reduced compared to the rest of Brazil, which was also related to lower morbidity. Our phylogenetic analysis revealed the evolutionary history of the SARS-CoV-2 in this location and showed that multiple introduction events have occurred over time. The evaluation of the COVID-19 clinical outcome revealed that most cases were mild (88.9%, 98.1%, 99.1% to Gamma, Delta, and Omicron, respectively) regardless of the infecting VOC. In conclusion, we observed that vaccination was responsible for reducing the death toll rate and related COVID-19 morbidity, especially during the gamma and Delta VOC; however, it does not prevent the rapid substitution rate and morbidity of the Omicron VOC

Correction: Lesbon et al. Nucleocapsid (N) Gene Mutations of SARS-CoV-2 Can Affect Real-Time RT-PCR Diagnostic and Impact False-Negative Results. <i>Viruses</i> 2021, <i>13</i>, 2474

The authors hereby request the inclusion of two authors (Olivia Teixeira and Maria Cristina Nonato) in the recently published article in Viruses entitled “Nucleocapsid (N) gene mutations of SARS-CoV-2 can affect real-time RT-PCR diagnostic and impact false-negative results” [...

Retrospective Insights of the COVID-19 Epidemic in the Major Latin American City, S&atilde;o Paulo, Southeastern Brazil

S&atilde;o Paulo is the financial center of Brazil, with a population of over 12 million, that receives travelers from all over the world for business and tourism. It was the first city in Brazil to report a case of COVID-19 that rapidly spread across the city despite the implementation of the restriction measures. Despite many reports, much is still unknown regarding the genomic diversity and transmission dynamics of this virus in the city of S&atilde;o Paulo. Thus, in this study, we provide a retrospective overview of the COVID-19 epidemic in S&atilde;o Paulo City, Southeastern, Brazil, by generating a total of 9995 near-complete genome sequences from all the city&rsquo;s different macro-regions (North, West, Central, East, South, and Southeast). Our analysis revealed that multiple independent introduction events of different variants (mainly Gamma, Delta, and Omicron) occurred throughout time. Additionally, our estimates of viral movement within the different macro-regions further suggested that the East and the Southeast regions were the largest contributors to the Gamma and Delta viral exchanges to other regions. Meanwhile, the North region had a higher contribution to the dispersion of the Omicron variant. Together, our results reinforce the importance of increasing SARS-CoV-2 genomic monitoring within the city and the country to track the real-time evolution of the virus and to detect earlier any eventual emergency of new variants of concern that could undermine the fight against COVID-19 in Brazil and worldwide

Retrospective Insights of the COVID-19 Epidemic in the Major Latin American City, São Paulo, Southeastern Brazil

São Paulo is the financial center of Brazil, with a population of over 12 million, that receives travelers from all over the world for business and tourism. It was the first city in Brazil to report a case of COVID-19 that rapidly spread across the city despite the implementation of the restriction measures. Despite many reports, much is still unknown regarding the genomic diversity and transmission dynamics of this virus in the city of São Paulo. Thus, in this study, we provide a retrospective overview of the COVID-19 epidemic in São Paulo City, Southeastern, Brazil, by generating a total of 9995 near-complete genome sequences from all the city’s different macro-regions (North, West, Central, East, South, and Southeast). Our analysis revealed that multiple independent introduction events of different variants (mainly Gamma, Delta, and Omicron) occurred throughout time. Additionally, our estimates of viral movement within the different macro-regions further suggested that the East and the Southeast regions were the largest contributors to the Gamma and Delta viral exchanges to other regions. Meanwhile, the North region had a higher contribution to the dispersion of the Omicron variant. Together, our results reinforce the importance of increasing SARS-CoV-2 genomic monitoring within the city and the country to track the real-time evolution of the virus and to detect earlier any eventual emergency of new variants of concern that could undermine the fight against COVID-19 in Brazil and worldwide