Sofosbuvir plus ribavirin for the treatment of chronic genotype 4 hepatitis C virus infection in patients of Egyptian ancestry.

BACKGROUND & AIMS: We conducted an open-label phase 2 study to assess the efficacy and safety of the oral nucleotide polymerase inhibitor sofosbuvir in combination with ribavirin in patients of Egyptian ancestry, chronically infected with genotype 4 hepatitis C virus (HCV). METHODS: Treatment-naive and previously treated patients with genotype 4 HCV were randomly allocated in a 1:1 ratio to receive sofosbuvir 400mg and weight-based ribavirin, for 12 or 24 weeks. The primary efficacy endpoint was the proportion of patients with sustained virologic response (HCV RNA <25IU/ml) 12 weeks after cessation of therapy (SVR12). RESULTS: Thirty treatment-naive and thirty previously treated patients were enrolled and treated for 12 weeks (n=31) or 24 weeks (n=29). Overall, 23% of patients had cirrhosis and 38% had diabetes. 14% of treatment-naive patients were interferon ineligible and 63% of treatment-experienced patients had prior non-response. SVR12 was achieved by 68% of patients (95% CI, 49-83%) in the 12-week group, and by 93% of patients (95% CI, 77-99%) in the 24-week group. The most common adverse events were headache, insomnia, and fatigue. No patient discontinued treatment due to an adverse event. CONCLUSIONS: The findings from the present study suggest that 24 weeks of sofosbuvir plus ribavirin is an efficacious and well tolerated treatment in patients with HCV genotype 4 infection.

Retraction: Ménétrier's Disease and Its Atypical Presentation in Four Siblings.

[This retracts the article DOI: 10.7759/cureus.30759.].

Ménétrier's Disease and Its Atypical Presentation in Four Siblings.

Ménétrier's disease is a rare, acquired, premalignant disorder of the stomach distinguished by hypertrophic giant mucosal folds in the proximal part of the stomach (body and fundus), diminished acid secretion and excessive mucous production, resulting in hypoalbuminemia. Menetrier's is also known as hypoproteinaemic hypertrophic gastropathy and giant hypertrophic gastritis. We present a case of four siblings who presented between 2010 and 2017 with symptomatic iron deficiency anaemia or upper gastrointestinal symptoms with confirmed Ménétrier's disease. The etiology of Ménétrier's disease is unknown but it has been linked to raised TGF-α (transforming growth factor alpha protein) in the gastric mucosa causing increased signalling of epidermal growth factor. It is also associated with infections such as cytomegalovirus and Helicobacter pylori. Despite these associations, there have been cases without any of these viruses detected.  Diagnosis is usually made by barium swallow or endoscopic evaluation, which characteristically shows thickened gastric folds, while the biopsies' hallmark feature is massive foveolar hyperplasia. We present a case series of four siblings who presented between 2010 and 2017 with symptomatic iron deficiency anaemia or upper gastrointestinal symptoms with confirmed Ménétrier's disease.

Extensive aortic dissection (Stanford Type A) presenting with confusion in a patient: a case report.

Spontaneous extensive aortic dissection is rarely documented in the literature with a misdiagnosis rate of up to 38% in previous studies. Vital signs and clinical manifestations vary and depend on the extent of the dissection and location. We present a rare case of extensive Stanford Type A dissection in a 60-year-old female patient who presented with confusion. Type A aortic dissection is a surgical emergency that is important for clinicians to have a low threshold of suspicion of the life-threatening condition due to the diverse and potentially atypical clinical presentation of aortic dissection.

An Unusual Case of Pyrexia of Unknown Origin.

A previously fit and well 29-year-old man with no significant recent travel or contact history presented to the hospital with 11 days of feeling unwell, intermittent diarrhea, abdominal pain and a skin rash that was consistent with folliculitis. Despite resolution of these index symptoms he continued with recurring fever of 38.5 degrees centigrade and weight loss of six Kilograms over the next three weeks. Extensive investigations to find a cause for the unexplained persistent fever failed to reveal an etiology, hence fulfilling pyrexia of unknown origin definition (PUO). None of the three main causes of PUO, namely infections, autoimmune diseases or underlying malignancy, were confidently found. Colonoscopy was suggested following a review of the abdominal CT scan to investigate possible thickening of the bowel wall. A diagnosis of atypically presenting Crohn's disease was eventually made and confirmed by colonoscopy and histology. The fever responded promptly to treatment of the Crohn's disease and he remained well at follow-up at six and 12 months after the initial presentation. In conclusion, it is important to keep in mind that PUO can be a rare initial presentation of inflammatory bowel disease in young adults with little or no gastrointestinal symptoms.

Center Frequency Stabilization in Planar Dual-Mode Resonators during Mode-Splitting Control.

Shape symmetry in dual-mode planar electromagnetic resonators results in their ability to host two degenerate resonant modes. As the designer enforces a controllable break in the symmetry, the degeneracy is removed and the two modes couple, exchanging energy and elevating the resonator into its desirable second-order resonance operation. The amount of coupling is controlled by the degree of asymmetry introduced. However, this mode coupling (or splitting) usually comes at a price. The centre frequency of the perturbed resonator is inadvertently drifted from its original value prior to coupling. Maintaining centre frequency stability during mode splitting is a nontrivial geometric design problem. In this paper, we analyse the problem and propose a novel method to compensate for this frequency drift, based on field analysis and perturbation theory, and we validate the solution through a practical design example and measurements. The analytical method used works accurately within the perturbational limit. It may also be used as a starting point for further numerical optimization algorithms, reducing the required computational time during design, when larger perturbations are made to the resonator. In addition to enabling the novel design example presented, it is hoped that the findings will inspire akin designs for other resonator shapes, in different disciplines and applications.