A 38-year-old man had fever and fatigue for the past 6 days and tenderness in the left upper abdominal quadrant for the past 3 days. He also had a facial butterfly rash that had been present for 10 years and a 1-year history of lupus nephritis, treated with prednisone and mycophenolate. He denied respiratory complaints or recent weight loss.
A 92-year-old woman presented with a 6-month history of progressively worsening fatigue, weight loss, generalized bone pain, and dyspnea on exertion. Click here for the laboratory results. Read more
A middle-age man presents to the ED with intermittent right shoulder pain. A check of his finger strength reveals abnormal looking fingernails. Click here to see how chronic shoulder pain and recent onset of fingernail clubbing relate.Read More
There's no need to abandon abacavir as an option for AIDS treatment fearing adverse effects. This podcast features a new guideline that shows how to use easily ordered genetic tests to judge who can take the drug safely. More »
An algorithm to diagnose amnestic mild cognitive impairment (MCI) may possibly be used as a risk marker for further cognitive decline and dementia. New evidence suggests the process may begin as early as age 45. More »
A 42-year-old Hispanic woman with a past medical history of HIV infection and noncompliance with highly active antiretroviral therapy was admitted to the emergency department with a new-onset generalized tonic-clonic seizure episode, followed by Todd paralysis. More »
Malignancies have been detected in approximately 40% of all patients with acquired immunodeficiency syndrome (AIDS) sometime during the course of their illness. More »
Thanks to the widespread use of highly active antiretroviral therapy (HAART), AIDS patients continue to live longer after their initial diagnosis. More »
Historically, radiologists have been leaders in the adoption of new technologies. The first radiology computer-assisted coding (CAC) product went into commercial production in early 2000. Since that time, hundreds of millions of radiology reports have been coded and audited using CAC. More »
The term “bone marrow edema” was first introduced in 1988.1 It is characterized by ill-defined areas of decreased signal intensity on T1-weighted MRI and increased signal intensity on T2-weighted images. More »
A debate is raging in the HIV-AIDS community about which is the most important aspect of transmission: multiple partnerships or sexually transmitted infections. The latter is where circumcision enters the dispute. More »
HIV’s disruption of immune system function may cause the immune system cells themselves to become cancerous, NCI researchers have concluded. If so, this might explain why patients with AIDS are 100 times more likely to be diagnosed with non-Hodgkin’s lymphoma than the general population. More »
More than 34 million people are presently living with HIV infection. Antiretroviral therapy (ART) can help these people to live longer, healthier lives, but because of side-effects, adherence (taking these medications every day) can be difficult. Mobile...
Many people are given a transfusion of blood from an unrelated donor as part of their medical treatment. There are, however, risks involved. In particular, infections (including HIV and certain types of hepatitis) may be passed on to the person receivin...
Injectable hormonal contraceptives remain in extensive use in many developing countries. There are two progestogen-only injectable contraceptives that have been available in many countries since the 1980's. These are depot medroxyprogesterone acetate (D...
HIV transcription is regulated at the step of elongation by the viral Tat protein and the cellular positive transcription elongation factor b (P-TEFb; Cdk9/cyclin T1). Herein, a human cyclin T1 mutant, cyclin T1-U7, which contains four substitutions and one deletion in the N-terminal cyclin box, was stably expressed in HeLa cells. HIV transcription was efficiently inhibited in HeLa-HA-CycT1-U7 stable cells. Cyclin T1-U7 bound Tat but did not modulate its expression levels, which remained high. Importantly cyclin T1-U7 failed to interact with Cdk9 or HEXIM1 and did not interfere with endogenous P-TEFb activity to stimulate MEF2C or NFkB mediated transcription. In a T cell line and primary CD4+ cells, cyclin T1-U7 also inhibited HIV transcription. We conclude that cyclin T1-U7 sequesters Tat from P-TEFb and inhibits HIV transcription. Importantly, N-terminal residues in cyclin T1 are specifically involved in the binding of cyclin T1 to HEXIM1 but not to Tat.
Inflammatory cytokines have a significant role in altering the innate and adaptive arms of immune responses. Here, we analyzed the effect of GM-CSF on a RABV-vaccine vector co-expressing HIV-1 Gag. To this end, we immunized mice with RABV expressing HIV-1 Gag and GM-CSF and analyzed the primary and recall CD8(+) T cell responses. We observed a statistically significant increase in antigen presenting cells (APCs) in the spleen and draining lymph nodes in response to GM-CSF. Despite the increase in APCs, the primary and memory anti HIV-1 CD8(+) T cell response was significantly lower. This was partly likely due to lower levels of proliferation in the spleen. Animals treated with GM-CSF neutralizing antibodies restored the CD8(+) T cell response. These data define a role of GM-CSF expression, in the regulation of the CD8(+) T cell immune responses against RABV and has implications in the use of GM-CSF as a molecular adjuvant in vaccine development.
For Moloney murine leukemia virus (M-MuLV), sustained viral infections require expression from an integrated provirus. For many applications, non-integrating retroviral vectors have been utilized to avoid the unwanted effects of integration, however, the level of expression from unintegrated DNA is significantly less than that of integrated provirus. We find that unintegrated DNA expression can be increased in the presence of HDAC inhibitors, such as TSA, when applied in combination with integrase (IN) mutations. These mutants include an active site mutation as well as catalytically active INs bearing mutations of K376 in the MuLV C-terminal domain of IN. MuLV IN K376 is homologous to K266 in HIV-1 IN, a known substrate for acetylation. The MuLV IN protein is acetylated by p300 in vitro, however, the effect of HDAC inhibitors on gene expression from unintegrated DNA is not dependent on the acetylation state of MuLV IN K376.
Hydrocarbon stapling of peptides is a powerful technique to transform linear peptides into cell-permeable helical structures that can bind to specific biological targets. In this study, we have used high resolution solution NMR techniques complemented by dynamic light scattering to characterize extensively a family of hydrocarbon stapled peptides with known inhibitory activity against HIV-1 capsid assembly to evaluate the various factors that modulate activity. The helical peptides share a common binding motif but differ in charge, the length, and position of the staple. An important outcome of the study was to show the peptides, share a propensity to self-associate into organized polymeric structures mediated predominantly by hydrophobic interactions between the olefinic chain and the aromatic side-chains from the peptide. We have also investigated in detail the structural significance of the length and position of the staple, and of olefinic bond isomerization in stabilizing the
Physician Performance Goals Are Great, But Balance Is More Realistic Jennifer Frank, MD, May 15, 2012 Performance measurements for physicians are well-intentioned and get me to rethink how I practice. But in the end I won't make the goals, so I'll have to go with balance over perfection.
Designing the Perfect Business Card for Your Medical Practice C. Noel Henley, MD, May 11, 2012 Does your business card say anything substantive about the valuable work you do in your practice? Here’s how to re-design your next business card for maximum impact and engagement.
Registered Nurses an Ideal Fit for Primary Care Practices Audrey "Christie" McLaughlin, RN, May 10, 2012 Here are four good reasons to hire a registered nurse for your primary care practice …maybe even instead of a medical assistant.
The Five Biggest Medical Practice Marketing Mistakes James Doulgeris, May 10, 2012 There are best practices to marketing your practice, but often, success is more about knowing what not to do. Here are the five most common pitfalls …and how to avoid them.
Can You Practice Medicine and Manage Your Practice? Rosemarie Nelson, May 9, 2012 Whether you practice alone, or in a group, if you're trying to see patients in this pay-for-volume environment and also run the business of your practice, you may be missing out on important opportunities.