News from Nov. 4, 2014 Annals of Internal Medicine

November 03, 2014

1. ACP kidney stone guidelines offer another reason to drink more water, less soda

Dietary changes including increased fluid intake are among recommendations in ACP's new evidence-based guideline

People who have had a kidney stone should increase their fluid intake to achieve at least two liters of urine per day to prevent a recurrence, according to a new evidence-based clinical practice guideline from the American College of Physicians (ACP) being published in Annals of Internal Medicine. A kidney stone occurs when tiny crystals in urine stick together to form a stone. About 13 percent of men and 7 percent of women in the U.S. will develop a kidney stone during their lifetime. Without treatment, up to 50 percent of those people will have a recurrence within five years. Researchers reviewed published literature from 1948 to March 2014 to inform ACP's guidelines. If increased fluid intake fails to reduce the formation of stones, medication or dietary changes may help. The evidence supports the use of medications such as thiazide diuretics, citrate, or allopurinol. Reducing dietary oxalate (found in chocolate, beets, nuts, rhubarb, spinach, strawberries, tea, and wheat bran), reducing dietary animal protein and purines, and maintaining normal dietary calcium may also help to prevent stone recurrence. The evidence also showed that patients who decreased intake of soda that was acidified by phosphoric acid (found in colas) had reduced kidney stone recurrence.

Note: The URL for this story will be live when embargo lifts. For a PDF, please contact Megan Hanks. To interview an ACP spokesperson, please contact Steve Majewski at or 215-351-2514.

2. Sofosbuvir plus ledipasvir shows promise in re-treating even the sickest patients after HVC GT-1 relapse

Relapse of chronic hepatitis C virus (HVC) genotype 1 (GT-1) after initial treatment with sofosbuvir plus ribavirin therapy can be effectively re-treated with a combination of sofosbuvir plus ledipasvir according to an open-label pilot study being published in Annals of Internal Medicine. Recently, the U.S. Food and Drug Administration approved sofosbuvir plus ribavirin as a treatment for HCV GT-1 in patients who are not eligible for first-line treatment with pegylated interferon (IFN) and ribavirin. Although well-tolerated and effective, patients with advanced liver disease and transplant recipients taking the IFN-free regimen have a modest rate of relapse. Sofosburvir combined with ledipasvir for 12 weeks showed high sustained virologic response (SVR) rates in treatment-naïve patients with HVC GT-1. Researchers sought to determine if this combination would be safe and effective for patients that relapsed after sofosbuvir plus ribavirin therapy. Fourteen patients (half of whom had advanced liver disease) with HCV GT-1 that relapsed after treatment with sofosbuvir plus ribavirin for 24 weeks were re-treated with sofosbuvir plus ledipasvir. After 12 weeks, all patients achieved SVR with no serious adverse events. The researchers suggest that the low incidence of adverse events, low pill burden, shorter treatment duration, and high efficacy may make the sofosbuvir/ledipasvir combination attractive in real-world settings.

Note: The URL for this story will be live when embargo lifts. For a PDF, please contact Megan Hanks. To interview an author, please contact Linda Huynh at or 301-402-1663.

3. Atrial fibrillation doubles risk for silent stroke

Atrial fibrillation (AF) is associated with a more than two-fold increase in the odds for silent cerebral infarction (SCI), or a stroke that has no outward signs or symptoms, according to a review being published in Annals of Internal Medicine. AF is the most common arrhythmia in the elderly, affecting more than 2.7 million Americans. Patients with AF have up to five times greater risk for stroke and poorer poststroke outcomes than those without AF. Research indicates that AF is associated with a 40 percent increase in the risk for cognitive impairment, independent of a history of symptomatic stroke and comorbid conditions, suggesting another underlying cause, such as SCI. Researchers reviewed 11 studies that reported on the association between AF and SCIs to estimate the association between AF and SCIs and the prevalence of SCIs in stroke-free patients with AF. They found strong evidence that AF is associated with more than 2-fold increase in the odds of SCI.

Note: The URL for this story will be live when embargo lifts. For a PDF, please contact Megan Hanks. To interview an author, please contact Cassandra Aviles at or 617-724-6433.

American College of Physicians

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