Autoinflammatory diseases: Mimics of Autoimmunity or part of its spectrum? Case presentation

Introduction: Autoinflammatory diseases are very rare diseases presenting within a wide clinical spectrum. Recognition of the main clinical features are challenging due to overlapping or mimicking with autoimmune diseases. Discussion: A case series is reviewed to illustrate typical and atypical features and the difficulties of these diagnoses in the low prevalence areas-a typical unrecognized case of familial Mediterranean fever (FMF) in a youngster, an atypical adult case with overlapping of IMF with Behcet disease, and an early presentation of FMF in infant presenting with inflammatory colitis, as well as the overlapping features within the cryopirin diseases spectrum in an 8-year-old boy who presented with systemic onset arthritis. Conclusion: These cases may represent examples of a very puzzling relationship among disorders of innate and adaptive immune systems and inflammation.

Molecular characteristics of extended-spectrum beta-lactamase-producing Escherichia coli from Rio de Janeiro, Brazil

Twenty-five extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli clinical isolates from Rio de Janeiro, Brazil were characterized by isoelectric focusing, PCR and sequencing of bla(ESBL) genes, plasmid-mediated quinolone resistance determinants, phylogenetic groups, replicon typing, pulsed-field electrophoresis, and multilocus sequencing typing. Twenty-three (92%) ESBL-producing E. coli isolates were positive for bla(CTX-M) genes, aac(6`)-lb-cr, and qnrB. Genetic relatedness of ESBL producers clustered seven (28%) CTX-M-15-producing isolates as sequence type (ST) 410, clonal complex (CC) 23, and two (8%) as clone O25-ST131. Our results illustrate the predominance of phylo-group A (52%), ST410 (CC 23) and CTX-M-15 among ESBL-producing E. coli isolates from hospitals in Rio de Janeiro.

Emergence of Klebsiella pneumoniae carrying the novel extended-spectrum beta-lactamase gene variants bla(SHV-40), bla(TEM-116) and the class 1 integron-associated bla(GES-7) in Brazil

A clinical Klebsiella pneumoniae isolate carrying the extended-spectrum beta-lactamase gene variants bla(SHV-40), bla(TEM-116) and bla(GES-7) was recovered. Cefoxitin and ceftazidime activity was most affected by the presence of these genes and an additional resistance to trimethoprim-sulphamethoxazole was observed. The bla(GES-7) gene was found to be inserted into a class 1 integron. These results show the emergence of novel bla(TEM) and bla(SHV) genes in Brazil. Moreover, the presence of class 1 integrons suggests a great potential for dissemination of bla(GES) genes into diverse nosocomial pathogens. Indeed, the bla(GES-7) gene was originally discovered in Enterobacter cloacae in Greece and, to our knowledge, has not been reported elsewhere.

Oculoauriculovertebral spectrum: report of nine familial cases with evidence of autosomal dominant inheritance and review of the literature

Oculoauriculovertebral spectrum (OAVS; OMIM 164210) is a complex condition characterized by defects of aural, oral, mandibular and vertebral development. The aetiology of this condition is likely to be heterogeneous; most cases are sporadic, however, familial cases suggesting autosomal recessive end autosomal dominant inheritance have been reported. In this study, we describe the clinical aspects of nine familial cases with evidence of autosomal dominant inheritance and compare them with reports in the literature. Interfamilial and intrafamilial clinical variabilities were observed in this study (reinforcing the necessity of careful examination of familial members). We suggest that oculoauriculovertebral spectrum with autosomal dominant inheritance is characterized mainly by bilateral auricular involvement and rarely presents extracranial anomalies. Clin Dysmorphol 18:67-77 (C) 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Rossby wave propagation tracks in southern hemisphere mean basic flows associated to generalized frosts over southern South America

Based on previous observational studies on cold extreme events over southern South America, some recent studies suggest a possible relationship between Rossby wave propagation remotely triggered and the occurrence of frost. Using the concept of linear theory of Rossby wave propagation, this paper analyzes the propagation of such waves in two different basic states that correspond to austral winters with maximum and minimum generalized frost frequency of occurrence in the Wet Pampa (central-northwest Argentina). In order to determine the wave trajectories, the ray tracing technique is used in this study. Some theoretical discussion about this technique is also presented. The analysis of the basic state, from a theoretical point of view and based on the calculation of ray tracings, corroborates that remotely excited Rossby waves is the mechanism that favors the maximum occurrence of generalized frosts. The basic state in which the waves propagate is what conditions the places where they are excited. The Rossby waves are excited in determined places of the atmosphere, propagating towards South America along the jet streams that act as wave guides, favoring the generation of generalized frosts. In summary, this paper presents an overview of the ray tracing technique and how it can be used to investigate an important synoptic event, such as frost in a specific region, and its relationship with the propagation of large scale planetary waves.

Resonant Wave Interactions in the Equatorial Waveguide

Weakly nonlinear interactions among equatorial waves have been explored in this paper using the adiabatic version of the equatorial beta-plane primitive equations in isobaric coordinates. Assuming rigid lid vertical boundary conditions, the conditions imposed at the surface and at the top of the troposphere were expanded in a Taylor series around two isobaric surfaces in an approach similar to that used in the theory of surface-gravity waves in deep water and capillary-gravity waves. By adopting the asymptotic method of multiple time scales, the equatorial Rossby, mixed Rossby-gravity, inertio-gravity, and Kelvin waves, as well as their vertical structures, were obtained as leading-order solutions. These waves were shown to interact resonantly in a triad configuration at the O(epsilon) approximation. The resonant triads whose wave components satisfy a resonance condition for their vertical structures were found to have the most significant interactions, although this condition is not excluding, unlike the resonant conditions for the zonal wavenumbers and meridional modes. Thus, the analysis has focused on such resonant triads. In general, it was found that for these resonant triads satisfying the resonance condition in the vertical direction, the wave with the highest absolute frequency always acts as an energy source (or sink) for the remaining triad components, as usually occurs in several other physical problems in fluid dynamics. In addition, the zonally symmetric geostrophic modes act as catalyst modes for the energy exchanges between two dispersive waves in a resonant triad. The integration of the reduced asymptotic equations for a single resonant triad shows that, for the initial mode amplitudes characterizing realistic magnitudes of atmospheric flow perturbations, the modes in general exchange energy on low-frequency (intraseasonal and/or even longer) time scales, with the interaction period being dependent upon the initial mode amplitudes. Potential future applications of the present theory to the real atmosphere with the inclusion of diabatic forcing, dissipation, and a more realistic background state are also discussed.

SURFACE ALFVEN WAVE DAMPING IN A THREE-DIMENSIONAL SIMULATION OF THE SOLAR WIND

Here we investigate the contribution of surface Alfven wave damping to the heating of the solar wind in minima conditions. These waves are present in the regions of strong inhomogeneities in density or magnetic field (e.g., the border between open and closed magnetic field lines). Using a three-dimensional (3D) magnetohydrodynamics (MHD) model, we calculate the surface Alfven wave damping contribution between 1 and 4 R(circle dot) (solar radii), the region of interest for both acceleration and coronal heating. We consider waves with frequencies lower than those that are damped in the chromosphere and on the order of those dominating the heliosphere: 3 x 10(-6) to 10(-1) Hz. In the region between open and closed field lines, within a few R(circle dot) of the surface, no other major source of damping has been suggested for the low frequency waves we consider here. This work is the first to study surface Alfven waves in a 3D environment without assuming a priori a geometry of field lines or magnetic and density profiles. We demonstrate that projection effects from the plane of the sky to 3D are significant in the calculation of field line expansion. We determine that waves with frequencies >2.8 x 10(-4) Hz are damped between 1 and 4 R(circle dot). In quiet-Sun regions, surface Alfven waves are damped at further distances compared to active regions, thus carrying additional wave energy into the corona. We compare the surface Alfven wave contribution to the heating by a variable polytropic index and find it as an order of magnitude larger than needed for quiet-Sun regions. For active regions, the contribution to the heating is 20%. As it has been argued that a variable gamma acts as turbulence, our results indicate that surface Alfven wave damping is comparable to turbulence in the lower corona. This damping mechanism should be included self-consistently as an energy driver for the wind in global MHD models.

Upper-mantle seismic structure beneath SE and Central Brazil from P- and S-wave regional traveltime tomography

We present models for the upper-mantle velocity structure beneath SE and Central Brazil using independent tomographic inversions of P- and S-wave relative arrival-time residuals (including core phases) from teleseismic earthquakes. The events were recorded by a total of 92 stations deployed through different projects, institutions and time periods during the years 1992-2004. Our results show correlations with the main tectonic structures and reveal new anomalies not yet observed in previous works. All interpretations are based on robust anomalies, which appear in the different inversions for P-and S-waves. The resolution is variable through our study volume and has been analyzed through different theoretical test inversions. High-velocity anomalies are observed in the western portion of the Sao Francisco Craton, supporting the hypothesis that this Craton was part of a major Neoproterozoic plate (San Franciscan Plate). Low-velocity anomalies beneath the Tocantins Province (mainly fold belts between the Amazon and Sao Francisco Cratons) are interpreted as due to lithospheric thinning, which is consistent with the good correlation between intraplate seismicity and low-velocity anomalies in this region. Our results show that the basement of the Parana Basin is formed by several blocks, separated by suture zones, according to model of Milani & Ramos. The slab of the Nazca Plate can be observed as a high-velocity anomaly beneath the Parana Basin, between the depths of 700 and 1200 km. Further, we confirm the low-velocity anomaly in the NE area of the Parana Basin which has been interpreted by VanDecar et al. as a fossil conduct of the Tristan da Cunha Plume related to the Parana flood basalt eruptions during the opening of the South Atlantic.

Deep crustal structure of the Parana Basin from receiver functions and Rayleigh-wave dispersion: Evidence for a fragmented cratonic root

The deep crustal structure of the Parana Basin of southern Brazil is investigated by analyzing P- and PP-wave receiver functions at 17 Brazilian Lithosphere Seismic Project stations within the basin. The study area can be described as a typical Paleozoic intracratonic basin that hosts one of the largest Large Igneous Province of the world and makes a unique setting for investigating models of basin subsidence and their interaction with mantle plumes. Our study consists of (1) an analysis of the Moho interaction phases in the receiver functions to obtain the thickness and bulk Vp/Vs ratio of the basin`s underlying crust and (2) a joint inversion with Rayleigh-wave dispersion velocities from an independent tomographic study to delineate the detailed S-wave velocity variation with depth. The results of our analysis reveal that Moho depths and bulk Vp/Vs ratios (including sediments) vary between 41 and 48 km and between 1.70 and 1.76, respectively, with the largest values roughly coinciding with the basin`s axis, and that S-wave velocities in the lower crust are generally below 3.8 km/s. Select sites within the basin, however, show lower crustal S-wave velocities slightly above 3.9 km/s suggestive of underplated mafic material. We show that these observations are consistent with a fragmented cratonic root under the Parana basin that defined a zone of weakness for the initial Paleozoic subsidence of the basin and which allowed localized mafic underplating of the crust along the suture zones by Cenozoic magmatism.

Coda wave attenuation in the Parecis Basin, Amazon Craton, Brazil: sensitivity to basement depth

Small local earthquakes from two aftershock sequences in Porto dos GaA(0)chos, Amazon craton-Brazil, were used to estimate the coda wave attenuation in the frequency band of 1 to 24 Hz. The time-domain coda-decay method of a single backscattering model is employed to estimate frequency dependence of the quality factor (Q (c)) of coda waves modeled usingwhere Q (0) is the coda quality factor at frequency of 1 Hz and eta is the frequency parameter. We also used the independent frequency model approach (Morozov, Geophys J Int, 175:239-252, 2008), based in the temporal attenuation coefficient, chi(f) instead of Q(f), given by the equation for the calculation of the geometrical attenuation (gamma) and effective attenuation Q (c) values have been computed at central frequencies (and band) of 1.5 (1-2), 3.0 (2-4), 6.0 (4-8), 9.0 (6-12), 12 (8-16), and 18 (12-24) Hz for five different datasets selected according to the geotectonic environment as well as the ability to sample shallow or deeper structures, particularly the sediments of the Parecis basin and the crystalline basement of the Amazon craton. For the Parecis basin for the surrounding shield and for the whole region of Porto dos GaA(0)chos Using the independent frequency model, we found: for the cratonic zone, gamma = 0.014 s (-aEuro parts per thousand 1), nu a parts per thousand 1.12; for the basin zone with sediments of similar to 500 m, gamma = 0.031 s (-aEuro parts per thousand 1), nu a parts per thousand 1.27; and for the Parecis basin with sediments of similar to 1,000 m, gamma = 0.047 s (-aEuro parts per thousand 1), nu a parts per thousand 1.42. Analysis of the attenuation factor (Q (c)) for different values of the geometrical spreading parameter (nu) indicated that an increase of nu generally causes an increase in Q (c), both in the basin as well as in the craton. But the differences in the attenuation between different geological environments are maintained for different models of geometrical spreading. It was shown that the energy of coda waves is attenuated more strongly in the sediments, (in the deepest part of the basin), than in the basement, (in the craton). Thus, the coda wave analysis can contribute to studies of geological structures in the upper crust, as the average coda quality factor is dependent on the thickness of sedimentary layer.

HTR1B and HTR2C in autism spectrum disorders in Brazilian families

Autism spectrum disorders (ASD) is a group of behaviorally defined neuro developmental disabilities characterized by multiple genetic etiologies and a complex presentation. Several studies suggest the involvement of the serotonin system in the development of ASD, but only few have investigated serotonin receptors. We have performed a case-control and a family-based study with 9 polymorphisms mapped to two serotonin receptor genes (HTR1B and HTR2C) in 252 Brazilian male ASD patients of European ancestry. These analyses showed evidence of undertransmission of the HTR1B haplotypes containing alleles -161G and -261A at HTR1B gene to ASD (P=0.003), but no involvement of HTR2C to the predisposition to this disease. Considering the relatively low level of statistical significance and the power of our sample, further studies are required to confirm the association of these serotonin-related genes and ASD. (C) 2008 Elsevier B.V. All rights reserved.

Carpenter Syndrome: Extended RAB23 Mutation Spectrum and Analysis of Nonsense-mediated mRNA Decay

Carpenter syndrome, a rare autosomal recessive disorder characterized by a combination of craniosynostosis, polysyndactyly, obesity, and other congenital malformations, is caused by mutations in RAB23, encoding a member of the Rab-family of small GTPases. In 15 out of 16 families previously reported, the disease was caused by homozygosity for truncating mutations, and currently only a single missense mutation has been identified in a compound heterozygote. Here, we describe a further 8 independent families comprising 10 affected individuals with Carpenter syndrome, who were positive for mutations in RAB23. We report the first homozygous missense mutation and in-frame deletion, highlighting key residues for RAB23 function, as well as the first splice-site mutation. Multi-suture craniosynostosis and polysyndactyly have been present in all patients described to date, and abnormal external genitalia have been universal in boys. High birth weight was not evident in the current group of patients, but further evidence for laterality defects is reported. No genotype-phenotype correlations are apparent. We provide experimental evidence that transcripts encoding truncating mutations are subject to nonsense-mediated decay, and that this plays an important role in the pathogenesis of many RAB23 mutations. These observations refine the phenotypic spectrum of Carpenter syndrome and offer new insights into molecular pathogenesis. (C) 2011 Wiley-Liss, Inc.

Risk factors for colonisation of newborn infants during an outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an intermediate-risk neonatal unit

We describe a cross-sectional, survey to identify risk factors for colonisation of neonates by extended-spectrum P-Lactamase (ESBL)-producing Klebsiella pneumoniae. This occurred following exposure to a colonised healthcare worker during an outbreak in an intermediate-risk neonatal. unit. In total, 120 neonates admitted consecutively during a three-month period were screened for ESBL-producing K. pneumoniae by rectal swabbing and 27 were identified as colonised. Multivariate analysis showed colonisation to be independently associated with use of antibiotics and absence of breastfeeding. Previous use of antibiotics presented an odds ratio (OR) of 12.3 [95% confidence interval. (Cl): 3.66-41.2, P < 0.001]. The most commonly used antibiotics were penicillin and amikacin. Breastfeeding was associated with reduced risk for colonisation (OR: 0.22; 95% Cl: 0.05-0.99; P = 0.049). Nine isotates recovered during the first stage of the outbreak and 27 isolates from surveillance cultures were typed thereafter by pulsed-field gel electrophoresis, revealing six different profiles (A-F). Clones A, C, and E were implicated in the first stage of the outbreak, whereas among the 27 strains recovered from surveillance cultures, all six clones were identified. Clone A was also found on the hand of a nursing auxiliary with onychomycosis. We concluded that prior antimicrobial use predisposed to colonisation. The possible role of breastfeeding as a protective factor needs to be further elucidated. Detection of different genotypes of ESBL-producing K. pneumonioe suggests that dissemination of mobile genetic elements bearing the ESBL gene may have been superimposed on the simple dissemination of a clone during the outbreak. (c) 2008 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

Craniosynostosis in Pycnodysostosis: Broadening the Spectrum of the Cranial Flat Bone Abnormalities

Pycnodysostosis is a rare autosomal recessive skeletal dysplasia caused by the absence of active cathepsin K, which is a lysosomal cysteine protease that plays a role in degrading the organic matrix of bones, acting in bone resorption and bone remodeling. The disease is primarily characterized by osteosclerosis, bone fragility, short stature, acro-osteolysis, and delayed closure of the cranial sutures. A differing feature, cranial synostosis, has occasionally been described in this disorder. We reviewed six unrelated patients with pycnodysostosis (mean age of 10 years and 4 months) in order to evaluate the presence of craniosynostosis. In addition to the typical findings of the condition, they all presented premature fusion of the corona! suture. Although none of them showed signs of cranial hypertension, one patient had had the craniosynostosis surgically corrected previously. These data suggest that the cranial sutures in pycnodysostosis can display contradictory features: wide cranial sutures, which are commonly described, and craniosynostosis. The clinical impact of this latter finding still remains to be elucidated. Further studies are necessary to address more precisely the role of cathepsin K in suture patency. (C) 2010 Wiley-Liss, Inc.

Screening of ARHSP-TCC Patients Expands the Spectrum of SPG11 Mutations and Includes a Large Scale Gene Deletion

Autosomal recessive spastic paraplegia with thinning of corpus callosum (ARHSP-TCC) is a complex form of HSP initially described in Japan but subsequently reported to have a worldwide distribution with a particular high frequency in multiple families from the Mediterranean basin. We recently showed that ARHSP-TCC is commonly associated with mutations in SPG11/KIAA1840 on chromosome 15q. We have now screened a collection of new patients mainly originating from Italy and Brazil, in order to further ascertain the spectrum of mutations in SPG11, enlarge the ethnic origin of SPG11 patients, determine the relative frequency at the level of single Countries (i.e., Italy), and establish whether there is one or more common mutation. In 25 index cases we identified 32 mutations; 22 are novel, including 9 nonsense, 3 small deletions, 4 insertions, 1 in/del, 1 small duplication, 1 missense, 2 splice-site, and for the first time a large genomic rearrangement. This brings the total number of SPG11 mutated patients in the SPATAX collection to 111 cases in 44 families and in 17 isolated cases, from 16 Countries, all assessed using homogeneous clinical criteria. While expanding the spectrum of mutations in SPG11, this larger series also corroborated the notion that even within apparently homogeneous population a molecular diagnosis cannot be achieved without full gene sequencing. (C) 2008 Wiley-Liss, Inc.