A Real Gut Punch: An Unexpected Diagnosis of Spontaneous Splenic Rupture.

Atraumatic or spontaneous splenic rupture is a rare but life-threatening complication of infectious mononucleosis. We present a case of a 26-year-old man presenting with a 1-week history of sharp epigastric and right upper quadrant pain, associated with malaise and subjective fever. Although initial findings were concerning for acute cholangitis, abdominal computed tomography angiography scan revealed splenic rupture. Further exploration confirmed acute Epstein-Barr virus infection. Infectious mononucleosis must be considered in young patients with lymphocytosis, splenomegaly, and prolonged malaise. Awareness of this presentation will allow for timely diagnosis and treatment, thereby preventing potentially fatal complications of infectious mononucleosis such as splenic rupture.

Sevelamer-Induced Ischemic Enteritis.

Sevelamer, a nonabsorbable dietary phosphate binder, is essential for patients with renal impairment since hyperphosphatemia is associated with an increase in all-cause mortality. Sevelamer is generally well tolerated; however, it is rarely been documented to cause gastrointestinal mucosal injury by forming sevelamer crystals and depositing within the gastrointestinal walls. We present a 35-year-old man with end-stage renal disease on peritoneal dialysis who developed abdominal pain and hematochezia. Initial imaging and endoscopic examination were concerning for ischemic enteritis, and histopathology revealed crystalloid structures surrounded by necrosis consistent with sevelamer-induced ischemic enteritis.

Virologic outcomes of antiretroviral therapy in patients with HIV-1 following bariatric surgery: A case series and review of the literature.

BACKGROUND: Selection of an antiretroviral regimen for people living with HIV (PLWH) involves various clinical considerations, such as comorbidities, archived drug resistance mutations, concomitant medications, and potential drug interactions and side effects. Alterations in the surface area and pH of the gastrointestinal tract following bariatric surgery may alter absorption, antiretroviral pharmacokinetics and viral suppression. Data on the efficacy of antiretroviral (ARV) therapy in PLWH who have undergone bariatric surgery are limited or lacking for new antiretrovirals, such as dolutegravir and bictegravir. METHODS: This case series reports virologic outcomes and side effects in eight cases of PLWH receiving ARV therapy who underwent bariatric surgery. A systematic literature review was performed to review the available literature on the efficacy and safety of antiretroviral regimens in PLWH who have undergone bariatric surgery. RESULTS: Virologic suppression was not impacted for obese PLWH who underwent bariatric surgery following failure of life-style modifications and pharmacological therapy. CONCLUSIONS: There were no deleterious effects on HIV progression for PLWH that underwent bariatric surgery. More prospective research is required to validate the effects of bariatric surgery on immunologic and virologic function outcomes. Close involvement of HIV and surgical specialists is recommended to manage ARV therapy in patients undergoing bariatric surgery.

Transcriptional pausing factor M1BP regulates cellular homeostasis by suppressing autophagy and apoptosis in Drosophila eye.

During organogenesis cellular homeostasis plays a crucial role in patterning and growth. The role of promoter proximal pausing of RNA polymerase II, which regulates transcription of several developmental genes by GAGA factor or Motif 1 Binding Protein (M1BP), has not been fully understood in cellular homeostasis. Earlier, we reported that M1BP, a functional homolog of ZKSCAN3, regulates wingless and caspase-dependent cell death (apoptosis) in the Drosophila eye. Further, blocking apoptosis does not fully rescue the M1BPRNAi phenotype of reduced eye. Therefore, we looked for other possible mechanism(s). In a forward genetic screen, members of the Jun-amino-terminal-(NH2)-Kinase (JNK) pathway were identified. Downregulation of M1BP ectopically induces JNK, a pro-death pathway known to activate both apoptosis and caspase-independent (autophagy) cell death. Activation of JNK pathway components can enhance M1BPRNAi phenotype and vice-versa. Downregulation of M1BP ectopically induced JNK signaling, which leads to apoptosis and autophagy. Apoptosis and autophagy are regulated independently by their genetic circuitry. Here, we found that blocking either apoptosis or autophagy alone rescues the reduced eye phenotype of M1BP downregulation; whereas, blocking both apoptosis and autophagy together significantly rescues the M1BP reduced eye phenotype to near wild-type in nearly 85% progeny. This data suggests that the cellular homeostasis response demonstrated by two independent cell death mechanisms, apoptosis and autophagy, can be regulated by a common transcriptional pausing mechanism orchestrated by M1BP. Since these fundamental processes are conserved in higher organisms, this novel functional link between M1BP and regulation of both apoptosis and autophagy can be extrapolated to humans.