Este trabalho foi apresentado no 19º Congresso Paranaense de Clínica Médica em Curitiba - PR, na forma de apresentação em poster. TÍTULO: O seguimento de um paciente com síndrome de Prader-Willi com puberdade precoce: um relato de caso. INTRODUÇÃO: A síndrome de Prader-Willi (SPW) é uma desordem resultante da perda de expressão de genes na região 15q11-q13 do cromossomo paterno. Manifesta-se com disfunção endócrina e comportamental. A clínica é atribuída a um desequilíbrio dos eixos hipotálamo-hipófise-gonadal e hipotálamo-hipófise-adrenal, alterando o metabolismo energético e apetite. Cursa com deficiência de hormônio do crescimento (GH), hipogonadismo, criptorquidismo, desenvolvimento puberal incompleto ou tardio, e infertilidade. MOTIVO DA COMUNICAÇÃO: Descrever a evolução clínica de um paciente adulto que apresentou PPC de forma inabitual dentro do diagnóstico de SPW. RELATO DO CASO: Paciente homem, 24 anos, diagnóstico de SPW confirmada em 2006 através de teste genético. Histórico de criptorquidia corrigida cirurgicamente, PPC após terapia com hormônio liberador de gonadotrofinas (GnRH), sem alterações hipotalâmicas, e insuficiência adrenal central de reserva, confirmada pelo teste de cortrosina em 2019. Pouco comunicativo, infantilizado, com quadros esparsos de agressividade, sonolência, incontinência fecal e diarreia. Altura: 1,65m; Peso: 98kg; IMC: 36 - obesidade grau 2. Em uso: topiramato 100mg, sertralina 50mg 2cp/1x/dia, omeprazol 10mg 2x/dia, aripiprazol 10mg 1cp/dia, cloridrato de naltrexona 50mg 1cp/dia, somatropina 0,45 UI/dia, canabidiol 20mg/ml 5ml/dia. Apresentou melhora da compulsão alimentar com a naltrexona e na agressividade com o canabidiol. No último ano, iniciou glifage XR 2g/dia profilático, sem efeitos adversos. DISCUSSÃO: A SPW é rara e complexa, causando disfunções endócrinas, metabólicas e comportamentais. O tratamento inclui reposição de GH para manejo da estatura e distribuição de gordura corporal, intervenções psicológicas e nutricionais. O paciente em questão iniciou terapia com GH aos 7 anos, apresentando PPC, de modo que GnRH foi associado aos 8.8 anos, com bloqueio do avanço puberal aos 9.4 anos. O sucesso do tratamento se reflete na altura alcançada: 1,65m. Ademais, são recomendados fármacos com ação no humor e apetite (topiramato e naltrexona-bupropiona), associados ou não a medicamentos para profilaxia de diabetes mellitus (metformina e agonistas do GLP1). A combinação de metformina, naltrexona e canabidiol mostrou-se promissora, de modo que associada a hábitos de vida saudáveis, o paciente possa alcançar qualidade de vida satisfatória.

Introduction: Although it has been said that 'health is priceless', it certainly has its costs. In the last decades, the growing expenditure on health has raised concerns about better management of resources destined for this purpose. Among the factors related to the increase in health costs, changes in morbidity and mortality patterns in contemporary societies are evident, which can be explained by the reduction in infectious and contagious diseases and the increase in chronic degenerative ones. Hereditary Angioedema is a chronic disease that requires regular medical follow-up and treatment. The aim of this study was to evaluate the direct and indirect costs of Hereditary Angioedema with C1 inhibitor deficiency (C1-INH-HAE) treatment in specialized centers in Brazil. Methods: The present study is part of the National Network for Rare Diseases. It has a prospective and retrospective design that aims to understand and measure the Care Value Journey (CVJ) of patients with C1-INH-HAE in Brazil. It was carried out in 116 patients of 7 reference centers. Questionnaires were applied to patients/caregivers, one retrospective and one prospective (v1), containing general data about the patient; diagnosis, treatment, productivity, costs and evolution of the disease. In addition, interviews were conducted with nurses, doctors and administrators allocated in the centers to understand the reality of the resources used within the protocols used for management of C1-INH-HAE in each institution. Results: The most frequently used drug for long-term prophylaxis was oxandrolone [25/116; 21,5%], followed by danazol [14/116; 12.6%] and tranexamic acid [14/116; 12.06%]. The average monthly cost of oxandrolone was US$ 19.94; danazol, US$ 24.05 and tranexamic acid, US$ 8.61. Icatibant Acetate was the most commonly used medication for on demand treatment [14/116; 12.06%], with a mean use of 3 shots every 4 months for each patient. This drug was obtained through lawsuit and the cost per application was US$ 1,416.26. The total cost of this patient's care journey, including medical appointments, exams and medications was US$ 23,391.31 per year. Loss of productivity at work, which is an indirect cost, must also be taken into account in a pharmacoeconomic study. The time spent in a 1-year follow-up of a patient with C1-INH-HAE, taking into account medical appointments and exams, was 372.5 minutes. This time can reflect on absenteeism at work and school. The assessment of productivity loss, assessed using the Work Productivity and Activity Impairment - General Health (WPAI-GH) questionnaire, was answered by 7 caregivers and 87 patients. Of these, 46 patients and 4 caregivers answered that they were employed. The percentage of commitment during work (presenteeism) was 32.4% and the absenteeism (time lost from work) was 17.2%. Conclusion: The direct and indirect costs that patients with C1-INH-HAE have with the treatment of the disease are excessively high considering the socioeconomic level of Brazilian population. More investments in pharmacoeconomic studies are needed to think of strategies that minimize these costs

Long intergenic noncoding RNAs (lincRNAs) are a class of noncoding RNAs implicated in several biological processes. LincRNA 299 ( LINC00299 ) maps to 2p25.1 and its function is still unknown. However, this gene has been proposed as a candidate for intellectual disability (ID) in a patient with a balanced translocation where the breakpoint disrupted its ORF. Here, we describe a new case of LINC00299 disruption associated with ID. The individual, a 42-year-old woman, was referred to the clinical geneticist because of her son who had severe syndromic ID. G-banding and chromosomal microarray analysis were performed. Karyotyping of the boy revealed an extranumerary derivative chromosome identified as an unbalanced translocation between chromosomes 2 and 9 of maternal origin. The mother's karyotype showed a balanced translocation 46,XX,t(2;9)(p25;q13). Chromosomal microarray indicated a disruption of LINC00299 . These data corroborate the role of LINC00299 as a causative gene for ID and broadens the spectrum of LINC00299 -related phenotypes