SARS-CoV-2 variants have distinct features of transmissibility, infectivity, and aggressiveness that may cause different clinical manifestations. A better understanding of the disease presentation and progression could help to outline more precise preventive and treatment frameworks. This study describes the differences in COVID-19 presentation and outcomes across five variant waves. This prospective cohort was conducted in Serrana, São Paulo State, Brazil. Clinical and demographic data was obtained from June 2020 to December 2022 as part of an enhanced health surveillance system for COVID-19, based on increasing access to diagnostic testing for SARS-CoV-2 and patient follow-up. Individuals were assessed for COVID-19 symptoms and comorbidities. Mild cases were followed up for at least 14 days, and severe cases until discharge or death. Samples were genetically sequenced, and variant waves were determined based on global SARS-CoV-2 variant predominance (>90 % sequenced samples), being as follows: Ancestral, Delta, Gamma, Omicron BA.1, and Omicron BA.2 waves. The relationship between clinical data and disease outcomes was analyzed in each variant wave. Patients infected during the Delta wave were the youngest (36.1 ± 18.2 years, p < 0.001). The proportion of female patients was higher across all waves. Positivity rate, disease severity, and COVID-19-related deaths varied among them. Ageusia and anosmia were related to SARS-CoV-2 positivity during the Ancestral, Gamma, and Delta waves but not in Omicron BA.1 and Omicron BA.2 waves. Diarrhea presented a lower chance of positivity only in Omicron BA.1 and Omicron BA.2. Dyspnea was the most consistent risk factor for severity across all waves. Although patients with COVID-19 from different SARS-CoV-2 variants shared some clinical-epidemiological characteristics, each variant presented distinguishable features related to positivity and severity. This could help to understand the dynamics of COVID-19 variants and update recommendations for clinical practice.

A Amiloidose cardíaca é uma cardiomiopatia restritiva causada pelo acúmulo de proteína amiloide no coração. Anteriormente considerada uma condição rara, avanços no diagnóstico não invasivo têm aumentado sua identificação entre pacientes com Insuficiência Cardíaca (IC). Atualmente, representa cerca de 13% dos casos de Insuficiência Cardíaca com Fração de Ejeção Preservada (ICFEP). Neste estudo, relatamos o caso de um paciente do sexo masculino, com 72 anos de idade, que compareceu à clínica relatando dispneia e fadiga em atividades de baixo esforço. Foram realizados exames laboratoriais que revelaram marcadores cardíacos aumentados, juntamente com evidência de hipertrofia ventricular na análise eletrocardiográfica. À imagem cardíaca, o ensaio de cadeias leves (AL) livres no soro e a biópsia endomiocárdica indicaram o diagnóstico de amiloidose por AL. Um modelo tridimensional foi construído com dados de ressonância magnética (RM). O modelo visa aumentar a conscientização sobre a amiloidose como possível diagnóstico diferencial de IC, além de promover a educação de pacientes e familiares, demonstrando as alterações estruturais típicas da doença.

Systemic immunoglobulin light chain amyloidosis is characterized by the extracellular deposition of misfolded light chains, leading to progressive dysfunction of multiple organs. Diagnosis remains a significant clinical challenge and is frequently delayed due to the presence of nonspecific symptoms, coupled with limited access to specialized diagnostic tools and expertise. Currently, no established national recommendations for the diagnosis and management of this condition exist in Brazil. These expert recommendations were developed following a structured advisory meeting in May 2025. The guidelines were formulated after a national survey of 96 Brazilian institutions (50 private and 46 public). Key diagnostic and therapeutic challenges were identified, including delayed diagnosis, limited access to biopsy techniques and biomarker testing, and uneven availability of treatment options. Recommendations focused on areas where consensus would benefit healthcare professionals in establishing best practices. The recommendations included: 1) Early detection: Educational initiatives for patients and healthcare professionals and the establishment of multidisciplinary specialized centers are needed to improve time to diagnosis and subsequent prognosis. 2) Accurate diagnosis: Clear, standardized procedures for tissue biopsy and timing are necessary to ensure accurate diagnosis and efficient testing. Improved access to Congo red staining and polarized light microscopy is critical. 3) Evaluation and classification: Biomarker testing should be used at all stages. Validated biomarker cut-offs and scoring systems should be implemented to standardize patient evaluation and risk stratification. 4) Optimal management and treatment: A multidisciplinary approach is crucial. Daratumumab should be added, if available, to bortezomib, cyclophosphamide and dexamethasone. Bortezomib and melphalan based regimens are an alternative. These expert-guided recommendations aim to support earlier diagnosis, standardized evaluation, and optimized treatment of light chain amyloidosis in Brazil.

Cardiac Amyloidosis is a restrictive cardiomyopathy caused by the accumulation of amyloid protein in the heart. The advances in non-invasive

(1) Background: Older adults with multiple myeloma (MM) contend with multifaceted physical, psychological, and existential challenges that may compromise quality of life (QoL). This study examined associations between physical symptom burden, functional capacity, depression severity, meaning in life, and QoL in older adults with MM. (2) Methods: Fifty outpatients (mean age = 67.7 ± 8.8 years) completed the EORTC QLQ-C30, PHQ-9, and Meaning in Life Questionnaire (MLQ). QoL was the primary outcome. Secondary outcomes included physical symptom burden (fatigue and pain), functioning domains, depression severity, and meaning in life. Internal consistency of all instruments was satisfactory (Cronbach’s α > 0.70). Analysis and associations among variables were done using Pearson’s and Spearman’s correlation coefficients (p < 0.05). (3) Results: Participants reported high global QoL and preserved functioning. Fatigue and pain were most strongly associated with lower global QoL. Greater depression severeness, although mild, was correlated with higher physical symptom burden and poorer functioning. Higher Presence of Meaning was related to better QoL and lower depression severity, whereas Search for Meaning showed no significant associations. Women reported greater physical symptom burden than men. (4) Conclusions: In older adults with MM, QoL appears to be linked to interrelated physical, psychological, functional, and existential factors. Fatigue, pain, depression severity, and established meaning in life were identified as clinically relevant correlates, highlighting targets for integrated supportive care.