Efficacy of Retreatment After Failed Direct-acting Antiviral Therapy in Patients With HCV Genotype 1-3 Infections

Hepatitis C virus infection is causing chronic liver disease, cirrhosis, and hepatocellular carcinoma. By combining direct-acting antivirals (DAAs), high sustained virologic response rates (SVRs) can be achieved. Resistance-associated substitutions (RASs) are commonly observed after DAA failure, and especially nonstructural protein 5A (NS5A) RASs may impact retreatment options.^1-3 Data on retreatment of DAA failure patients using first-generation DAAs are limited.^4-7 Recently, a second-generation protease- and NS5A-inhibitor plus sofosbuvir (voxilaprevir/velpatasvir/sofosbuvir [VOX/VEL/SOF]) was approved for retreatment after DAA failure.⁸ However, this and other second-generation regimens are not available in many resource-limited countries or are not reimbursed by regular insurance, and recommendations regarding the selection of retreatment regimens using first-generation DAAs are very important. This study aimed to analyze patients who were re-treated with first-generation DAAs after failure of a DAA combination therapy.

[Clinical symptoms and duration of anamnesis in patients with hypophyseal tumors]

In 88 patients with operated pituitary tumours a retrospective statement of the duration of the disease up to the beginning of the therapy was carried out. In the case of the prolactin secreting tumours the times of anamnesis are approximately only half as long as in the comparable data of literature. The cause of this may by the large proportion of macroprolactinomas among our patients. In acromegaly the duration of the disease is from 3/4 to 25 years. By their insiduous clinical progression hormone-inactive tumours render an exact dating of the beginning of the disease impossible. Issuing from the still too long times of anamnesis the clinical symptoms of the endocrine-active and endocrine-inactive pituitary tumours relevant to practice are demonstrated. Including these symptoms into differential-diagnostic consideration an early diagnosing should be possible at least in endocrine-active tumours.

Excretion of urinary acids during inverted sleep-waking rhythm

Some organic acids that occur in human urine are excreted in very different amounts during the day and the night. The day-night rhythm in the excretion rate of citric acid and propylurofuran acid changes only gradually if the normal rhythm of life is inverted, e.g., if a person sleeps during the day and works at night (shift of 12 h), paralleling the gradual adjustment of steroid metabolism under the same conditions. In contrast, the typical rhythm in the excretion rate of tetrahydrofuran acids and tartaric acid inverts immediately if the sleep-waking rhythm of a person is inverted. In contrast to propylurofuran acid, pentylurofuran acid is excreted unrhythmically. No change in the excretion rate of amino acids was observed if the daily rhythm was inverted. Quantifications were achieved by liquid-liquid extraction, derivatization and gas chromatography computerized peak area integration.

Changes in the excretion of organic acids in human urine after physical exertion

The excretion of some acids in urine is subject to a circadian rhythm, if diversified nutrition is offered to the body sufficiently. The effect of physical exertion upon the excretion rates of acids in urine is very similar to that of a zero diet, resulting in an increase of final degradation products and a decrease of metabolic intermediates.

Distinction between urinary acids originating from nutrition and those produced in the human body

A simple procedure to distinguish between urinary acids originating from nutrition and beverages and those produced from compounds stored in the body is described. Acids originating from nutrition disappear in urine samples after a few days of a zero diet, whereas those produced from body compounds do not. The zero diet can be substituted by a diet of peeled rice and water.