Analysis of the HIV protease gene from the plasma of HIV-infected patients revealed substitutions at nine different codons selected in response to monotherapy with the protease inhibitor ritonavir. Mutants at valine-82, although insufficient to confer resistance, appeared first in most patients. Significant phenotypic resistance required multiple mutations in HIV protease, which emerged subsequently in an ordered, stepwise fashion. The appearance of resistance mutations was delayed in patients with higher plasma levels of ritonavir. Early mutants retained susceptibility to structurally diverse protease inhibitors, suggesting that dual protease inhibitor therapy might increase the duration of viral suppression.

Concentrations in plasma and safety of 7 days of intravenous itraconazole followed by 2 weeks of oral itraconazole solution in patients in intensive care units.

This study investigated the use of interventional bronchoscopic techniques in the management of patients with symptomatic tracheobronchial stenosis from tuberculosis.The current authors evaluated their experience with interventional bronchoscopic techniques in 21 consecutive patients at the Singapore General Hospital, Singapore, from November 1994 to March 2001. All patients underwent rigid bronchocopy using the Dumon rigid ventilating bronchosope under general anaesthesia. A combination of techniques was used (mechanical or balloon dilatation, Nd-YAG laser and stenting using the Dumon stent).The mean±sdincrease in luminal diameter of the tracheal lesions was from 4.5±2.5 mm pre-procedure to 11.9±1.7 mm post-procedure, whereas that for the mainstem bronchi stenosis was from 2.6±1.0 mm to 8.3±2.4 mm. All patients had immediate relief of symptoms post-intervention. Two patients who presented with acute respiratory failure could be weaned off mechanical ventilation immediately post-procedure. At the end of the study period, 52% (11 out of 21) remained asymptomatic.Bronchoscopic intervention provided immediate symptomatic relief in all of the studied patients. However, repeated sessions may be required to maintain this improvement. It is concluded that interventional bronchoscopic techniques are useful in the management of patients with tracheobronchial stenosis from tuberculosis.

The protease inhibitor ritonavir is well tolerated and has a potent antiviral effect, as shown by substantial decreases in plasma viremia and significant elevations in CD4 cell counts. Expanded clinical trials of ritonavir are warranted.

This study estimated age and growth of the largest extant fish, the whale shark (Rhincodon typus) by counting vertebral band pairs from 92 specimens comprising 43 males (2.68–9.88 m total length [TL]), 30 females (1.60–7.02 m TL), and 19 unsexed individuals (2.83–6.67 m TL) taken by Taiwanese commercial fisheries during 2001–06. Growth band pairs up to 25 and 42 were counted for a 6.38-m TL female and a 9.88-m TL male, respectively. Using marginal increment ratio and centrum edge analysis, band pairs were postulated to be formed twice a year. The two-parameter von Bertalanffy growth function provided the best fit without significant differences between sexes. Growth parameters were calculated for both sexes as L∞ = 16.80 m TL, k = 0.037 year–1; annual band pair formation would modify these parameters to L∞ = 15.34 m TL, k = 0.021 year–1. Using data reported in another study for 50% size at maturity for males (8.1 m TL), and the largest immature and smallest mature females (8.7 and 9.6 m TL, respectively) in the Indo-Pacific, these TLs converted to ages at maturity of 17 years for males and 19–22 years for females. The longevity was calculated to be 80.4 years.