Background 22q11.2 deletion syndrome (22q11.2DS) is a rare disease with an important characteristic—clinical heterogeneity. The diversity of organs, regions, and systems of the body that can be affected requires periodic updating of health professionals so that they can recognize these clinical signs as belonging to 22q11.2DS. Updated professionals are equally important for the appropriate and timely clinical management of individuals with a positive diagnosis. In this context, this article aimed to map and analyze the access to healthcare for individuals with 22q11.2DS until the moment of diagnosis. Results We analyzed the clinical data of 111 individuals with 22q11.2DS registered in the Brazilian Database on Craniofacial Anomalies (BDCA) from 2008 to 2020. In this study, individuals were diagnosed at a median age of 9 years (mean = 9.7 years). Before the genetic investigation, they accessed 68.75% of the internationally recommended evaluations available at BDCA. Recurrent 22q11.2DS clinical manifestations such as delayed neuropsychomotor development, lip and/or palate defects, cardiac malformation and/or hematological/immunological alteration co-occurred in at least 72.06% of individuals. Cardiac malformation was the only clinical alteration that lowered the median diagnostic age, corresponding to 6.5 years of age with a cardiac malformation versus 11 years of age without one (p = 0.0006). Conclusions In Brazil, 22q11.2 DS is under-recognized, and early diagnosis and management of affected individuals are still a distant reality. In this sense, 22q11.2 DS suspicion followed by the elimination of obstacles for its diagnosis confirmation is essential to increase life expectancy and improve the quality of life of these individuals in Brazil.

Background: 22q11.2 Deletion Syndrome (22q11.2DS) is a rare disease that has as an important characteristic the clinical heterogeneity. The diversity of organs, regions, and systems of the body that can be affected requires periodic updating of health professionals so that they can recognize this clinical signs as belonging to 22q11.2DS. Updated health professionals are equally important for the appropriate and timely establishment of clinical management for individuals with a positive diagnosis. In this context, this article aimed to map and analyse the access to health care for individuals with 22q11.2DS until the moment of diagnosis. Results: We analysed clinical data of 111 individuals with 22q11.2DS registered in the Brazilian Database on Craniofacial Anomalies (BDCA) from 2008 to 2020. In this study, individuals were diagnosed with a median age of 9 years (mean = 9.7 years). Before genetic investigation, they accessed 68.75% of the international recommended evaluations available at BDCA. Recurrent 22q11.2DS clinical manifestations as delayed neuropsychomotor development, lip and/or palate defects, cardiac malformation and/or hematological/immunological alteration co-occurred in at least 72.06% of individuals. Cardiac malformation was the only clinical alteration that led to a lower median diagnostic age, corresponding to 6.5 years of age with a cardiac malformation versus 11 years of age without a cardiac malformation (p = 0.0006). Conclusions: In Brazil, 22q11.2 DS is under recognized and early diagnosis and management of affected individuals are still a distant reality. In this sense, the identification followed by the correction of obstacles that do not allow this reality are essential to increase life expectancy and improve the quality of life of these individuals in Brazil

hypothesized that small CNVs (between 1 and 50 Kb), which are below the resolution of most commercial microarrays and and whose detection still has limitations for its detection detection through NGS, could contribute to the phenotype in a proportion of cases. As a first step to address this hypothesis, it was performed the methodology of custom aCGH 60K, covering a total of 269 ASD candidate genes, in order to select potentially pathogenic CNVs among 98Brazilian patients with idiopathic ASD. With this initial screening, the prevalence of potentially pathogenic CNVs obtained was 9%, with 20% of them characterized as small. The subsequent analysis was performed using the 180K custom aCGH methodology, which covered a total of 1527 TEA candidate genes. A total of 63 patients with autism were analyzed with this new array. From these hybridizations, the prevalence of potentially pathogenic CNVs obtained was 12.7%, with 62.5% of them classified as small. This detection rate is quite significant, particularly considering that the sample of patients used was prescreened, in order to exclude patients with the most prevalent CNVs in ASD in the regions 15q11-q13, 16p11.2 and 22q13.3. The last approach used in this work was to compare the detection of CNVs by the methodology of aCGH, gold standard reference for CNVs detection, with the next generation sequencing (NGS).Data from 9 patients obtained by NGS were analyzed using NextGene and XHMM software. The softwares, however, presented discrepant results among themselves and little overlap with the data of aCGH 180K, of 38.9% and 50%, considering NextGene and XHMM respectively. These results suggest that the customized aCGH represents a promising approach for the detection of small CNVs and that these, in turn, can contribute to the risk of ASD in at least 6,3 % of cases.

BACKGROUND Health-related data available online is the most used source of information. In Brazil, more than 80% of its population uses the Internet for this purpose, particularly those diagnosed with a rare multisystem genetic disease, such as 22q11.2 Deletion Syndrome (22Q11.2 DS). This is primarily due to the lack of knowledge on the part of physicians and incomplete information received during routine consultations. However, one of the risks associated with online health data is that it lacks scientific validation. OBJECTIVE To improve access to trusted information, this study aims to evaluate the potential use of social media in Brazil as disseminators of scientific knowledge regarding 22q11.2 DS. METHODS Two social media accounts were created with the name @science.sd22q11.2, one on Instagram, and the other on Facebook RESULTS During the one year (2020-2021) of accounts activity, the majority of followers were females (80-90%), aged 35-44 years from Southeast (18.1%). The most frequently used words relevant to healthcare in posts with the highest reach on both pages include velopharyngeal insufficiency, speech, immunological changes, lymphocytes, and psychiatric disorders. CONCLUSIONS The absence of a record of followers from the North and Northeast restricts the potential use of the internet for scientific dissemination in Brazil. The low diversity of followers points to the use of the internet as a predictor of topics associated with 22q11.2 DS which deserve extra attention during medical care. Furthermore, these results serve as an additional indicator of the difficulty of accessing molecular diagnosis in association with illiteracy rates in the North and Northeast.