Discoveries & Impact (March 2021)

Discoveries & Impact highlights publications per section across the Department of Internal Medicine.

Cardiovascular Medicine

Artificial intelligence will play a pivotal role in the future of health care, medical experts say, but so far, the industry has been unable to fully leverage this tool. A Yale study has illuminated the limitations of these analytics when applied to traditional medical databases — suggesting that the key to unlocking their value may be in the way datasets are prepared.

Khera R, Haimovich J, Hurley NC, et al. Use of Machine Learning Models to Predict Death After Acute Myocardial Infarction. JAMA Cardiol. Published online March 10, 2021. doi:10.1001/jamacardio.2021.0122

Digestive Diseases

In the recent study published in the Journal of Hepatology, researchers found liver sinusoidal endothelial cell (LSEC) can metabolize alcohol, similar to hepatocytes (the most well-known liver cells damaged by alcohol), leading to liver injury. Repairing LSEC function is important for restoring liver function.

Yang Y, Sangwung P, Kondo R, Jung Y, McConnell MJ, Jeong J, Utsumi T, Sessa WC, Iwakiri Y. Alcohol-induced Hsp90 acetylation is a novel driver of liver sinusoidal endothelial dysfunction and alcohol-related liver disease. J Hepatol. doi: 10.1016/j.jhep.2021.02.028. PMID: 33675874.

Endocrinology & Metabolism

The American Diabetes Association recommends that patients at risk for hypoglycemia be prescribed glucagon. However, prescription rates are lower than expected for patients with type 1 and type 2 diabetes. A study of prescription patterns among type 1 and 2 diabetes patients found that glucagon was rarely filled, including by fewer than 5% of patients with prior hypoglycemia requiring emergency care. Among patients with type 1 diabetes, glucagon fills were unpredictable and not targeted to the highest-risk patients, according to a recent study published in the Journal of Diabetes and its Complications.

Kahn PA, Liu S, McCoy R, Gabbay RA, Lipska K. Glucagon use by U.S. adults with type 1 and type 2 diabetes. J Diabetes Complications. 2021 Feb 6:107882. doi: 10.1016/j.jdiacomp.2021.107882. PMID: 33593689.

General Internal Medicine

An analysis that provides a more comprehensive understanding of how trajectories of self-reported opioid use impact overall disease severity for people with HIV was reported in a recent article in AIDS and Behavior.

Adams JW, Li Y, Barry DT, Gordon KS, Kerns RD, Oldfield BJ, Rentsch CT, Marshall BDL, Edelman EJ. Long-term Patterns of Self-reported Opioid Use, VACS Index, and Mortality Among People with HIV Engaged in Care. AIDS Behav. 2021 Feb 10. doi: 10.1007/s10461-021-03162-7. PMID: 33569682.

Geriatrics

Inpatient geriatric medicine and palliative care consult teams at Yale New Haven Health collaborated to provide targeted inpatient consultations for older patients. They focused their initiative on hospitalized adults ≥65 with COVID-19 in non-ICU settings. Read about their experience in an editorial commentary in the Annals of Palliative Medicine.

Prsic EH, Ouellet JA, Lai JM. The value of triggered geriatrics and palliative care consults in hospital medicine during the COVID-19 response. Ann Palliat Med. 2021 Feb 16:apm-20-2297. doi: 10.21037/apm-20-2297. PMID: 33615802.

Hematology

Yale hematologists were part of a team that recently reported on the evaluation and management of toxicity in patients with myeloid neoplasms (MNs) treated with immune checkpoint inhibitors (ICIs) with a focus on diagnostic and therapeutic challenges. Read more in Clinical Lymphoma, Myeloma & Leukemia.

Shallis RM, Bewersdorf JP, Swoboda DM, Wei W, Gowda L, Prebet T, Halene S, Pillai MM, Parker T, Neparidze N, Podoltsev NA, Seropian S, Sallman DA, Gore SD, Zeidan AM. Challenges in the Evaluation and Management of Toxicities Arising From Immune Checkpoint Inhibitor Therapy for Patients With Myeloid Malignancies. Clin Lymphoma Myeloma Leuk. doi: 10.1016/j.clml.2021.01.003. PMID: 33551344.

Infectious Diseases

Yale School of Medicine and Yale New Haven Hospital researchers tested N95 respirators contaminated with bacteriophages and reprocessed using Bioquell vaporized hydrogen peroxide for viricidal activity and wear. They determined that reprocessing should be limited to three cycles. Learn more in Infection Control & Hospital Epidemiology.

Kenney PA, Chan BK, Kortright KE, Cintron M, Russi M, Epright J, Lee L, Balcezak TJ, Havill NL, Martinello RA. Hydrogen Peroxide Vapor Decontamination of N95 Respirators for Reuse. Infect Control Hosp Epidemiol. 2021 Feb 9:1-14. doi: 10.1017/ice.2021.48. PMID: 33557979.

Medical Oncology

In new research published in The New England Journal of Medicine, researchers confirmed the efficacy of enfortumab vedotin in patients with advanced urothelial carcinoma who underwent prior treatment with chemotherapy and PD-1 or PD-L1 inhibitors. They found that enfortumab vedotin resulted in a 30% lower risk of death than seen with treatment with chemotherapy. Overall response and disease control was also improved with enfortumab vedotin.

Powles, Thomas; Rosenberg, Jonathan E.; Sonpavde, Guru P.; Loriot, Yohann; Durán, Ignacio; Lee, Jae-Lyun; Matsubara, Nobuaki; Vulsteke, Christof; Castellano, Daniel; Wu, Chunzhang; Campbell, Mary; Matsangou, Maria; Petrylak, Daniel P. Enfortumab Vedotin in Previously Treated Advanced Urothelial Carcinoma. N Engl J Med. doi: 10.1056/NEJMoa2035807

Nephrology

A blended learning approach to a hemodialysis curriculum for nephrology fellows combines E-learning with traditional methods of teaching, and offers advantages over either approach alone. “We have designed and implemented a formalized hemodialysis curriculum at our institution that is based on blended learning, utilizing faculty-created E-learning tools combined with traditional pedagogical methods (bedside and classroom),” says Namrata Krishnan, MBBS, assistant professor of internal medicine (nephrology) in an abstract recently published in the Journal of Nephrology.

Krishnan N. A hemodialysis curriculum for nephrology fellows using a blended learning approach: best of both worlds? J Nephrol. 2021 Jan 21:1–4. doi: 10.1007/s40620-020-00945-4. PMID: 33476037; PMCID: PMC7818058.

Pulmonary, Critical Care & Sleep Medicine

We hypothesized that PTEN-induced kinase 1 (PINK1) plays an important role in the regulation of multimeric mitochondrial antiviral signaling (MAVS) aggregation and its consequent pathobiology. Our test results establish a new role of PINK1 in the regulation of MAVS signaling and the consequent pulmonary pathobiology. Find details in the American Journal of Respiratory Cell and Molecular Biology.

Kim SH, Shin HJ, Yoon CM, Lee SW, Sharma L, Dela Cruz CS, Kang MJ. PINK1 Inhibits Multimeric Aggregation and Signaling of MAVS and MAVS-dependent Lung Pathology. Am J Respir Cell Mol Biol. 2021 Feb 12. doi: 10.1165/rcmb.2020-0490OC. PMID: 33577398.

Rheumatology, Allergy & Immunology

In “Aging with HIV in Latin America and the Caribbean: a Systematic Review,” the authors call for more research focused on aging-associated chronic comorbidities among people living with HIV in Latin America. They identified a need for more longitudinal studies and screening tools validated in PWH in LAC. Finally, they suggest research into the impact of genetic variation and ancestry, and other sociocultural factors on chronic comorbidities in this population.

Cabrera DM, Diaz MM, Grimshaw A, Salvatierra J, Garcia PJ, Hsieh E. Aging with HIV in Latin America and the Caribbean: a Systematic Review. Curr HIV/AIDS Rep. 2021 Feb;18(1):1-47. doi: 10.1007/s11904-020-00538-7. PMID: 33400168.