Oral Absorption of Trimethoprim-Sulfamethoxazole in Patients with AIDS

Study Objective . To determine the bioavailability of trimethoprim-sulfamethoxazole (TMP-SMX) in patients infected with the human immunodeficiency virus (HIV). Design . Open-label, randomized, two-way crossover trial. Setting . Outpatient clinical research center affiliated with a community-based teaching hospital. Patients . Ten individuals diagnosed with the acquired immunodeficiency syndrome (AIDS) with CD4+ counts less than 200 cells/mm³, receiving TMP-SMX one double-strength tablet 3 times/week as prophylaxis for Pneumocystis carinii pneumonia (PCP), and without documented gastroenteropathy or diarrhea agreed to participate in the trial. One patient withdrew from the study secondary to development of symptomatic PCP. Data were available for analysis from the remaining nine subjects. Interventions . Participants received TMP 160 mg and SMX 800 mg orally or intravenously during two study periods. Following dose administration, blood samples were collected at predetermined time points over 36 hours. Measurements and Main Results . Analysis of TMP-SMX pharmacokinetic parameters (half-life, total body clearance, area under the serum concentration versus time curve, and peak concentration) failed to reveal any significant differences between intravenous and oral preparations. The calculated bioavailabilities of oral TMP and SMX (mean ± SD) were 102.7% ± 19.8% and 109.4% ± 19.4%, respectively. Conclusion . The absorption of TMP-SMX is not adversely affected by HIV infection in the absence of HIV-induced gastroenteropathy or diarrhea.     

A wavelet-based approximation of surface coil sensitivity profiles for correction of image intensity inhomogeneity and parallel imaging reconstruction

We evaluate a wavelet-based algorithm to estimate the coil sensitivity modulation from surface coils. This information is used to improve the image homogeneity of magnetic resonance imaging when a surface coil is used for reception, and to increase image encoding speed by reconstructing images from under-sampled (aliased) acquisitions using parallel magnetic resonance imaging (MRI) methods for higher spatiotemporal image resolutions. The proposed algorithm estimates the spatial sensitivity profile of surface coils from the original anatomical images directly without using the body coil for additional reference scans or using coil position markers for electromagnetic model-based calculations. No prior knowledge about the anatomy is required for the application of the algorithm. The estimation of the coil sensitivity profile based on the wavelet transform of the original image data was found to provide a robust method for removing the slowly varying spatial sensitivity pattern of the surface coil image and recovering full FOV images from two-fold acceleration in 8-channel parallel MRI. The results, using bi-orthogonal Daubechies 97 wavelets and other members in this family, are evaluated for T1-weighted and T2-weighted brain imaging.     

World Workshop on Oral Medicine VI: a systematic review of medication‐induced salivary gland dysfunction

The aim of this paper was to perform a systematic review of the pathogenesis of medication‐induced salivary gland dysfunction (MISGD). Review of the identified papers was based on the standards regarding the methodology for systematic reviews set forth by the World Workshop on Oral Medicine IV and the PRISMA statement. Eligible papers were assessed for both the degree and strength of relevance to the pathogenesis of MISGD as well as on the appropriateness of the study design and sample size. A total of 99 papers were retained for the final analysis. MISGD in human studies was generally reported as xerostomia (the sensation of oral dryness) without measurements of salivary secretion rate. Medications may act on the central nervous system (CNS) and/or at the neuroglandular junction on muscarinic, α‐and β‐adrenergic receptors and certain peptidergic receptors. The types of medications that were most commonly implicated for inducing salivary gland dysfunction were those acting on the nervous, cardiovascular, genitourinary, musculoskeletal, respiratory, and alimentary systems. Although many medications may affect the salivary flow rate and composition, most of the studies considered only xerostomia. Thus, further human studies are necessary to improve our understanding of the association between MISGD and the underlying pathophysiology.     

STRESS FRACTURES OF THE FEMORAL SHAFT IN MILITARY RECRUITS

Stress fractures amongst military recruits are limited to the lower extremities; yet involvement of the shaft of the femur is unusual. Seven such cases in a series of 352 stress fractures are presented. The importance of early recognition and management is emphasized with a view to prevent bony disruption in an otherwise easily treatable condition.KEY WORDS: Fractures stress, Femoral fractures