Discoveries & Impact (May 2021)

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

Cardiovascular Medicine

Procedural urgency, cardiovascular instability, and consciousness after cardiac arrest were accurate predictors of in‐hospital mortality following percutaneous coronary intervention according to research led by Yulanka Castro-Dominguez, MD in the Journal of the American College of Cardiology.

Castro-Dominguez YS, Wang Y, Minges KE, McNamara RL, Spertus JA, Dehmer GJ, Messenger JC, Lavin K, Anderson C, Blankinship K, Mercado N, Clary JM, Osborne AD, Curtis JP, Cavender MA. Predicting In-Hospital Mortality in Patients Undergoing Percutaneous Coronary Intervention. J Am Coll Cardiol. 2021 Apr 28:S0735-1097(21)04934-2. doi: 10.1016/j.jacc.2021.04.067. Epub ahead of print. PMID: 33957239.

Digestive Diseases

Globally, the incidence and burden of chronic liver disease is increasing, and because many patients with abnormal liver function do not show symptoms until late stages, diagnosis is critically important. In “Undiagnosed liver diseases,” the authors characterize undiagnosed liver diseases into four broad categories, and outline a proposed clinical framework for the evaluation and diagnosis of liver diseases, with a focus on those with an unknown cause.

Gao E, Hercun J, Heller T, Vilarinho S. Undiagnosed liver diseases. Transl Gastroenterol Hepatol. 2021 Apr 5;6:28. doi: 10.21037/tgh.2020.04.04. PMID: 33824932; PMCID: PMC7829073.

Endocrinology & Metabolism

Implementation of a pharmacist-led management of acute post-transplant hyperglycemia reduced hospital admissions and emergency department visits for kidney transplant recipient patients as they transition back to receiving care from their primary care providers or endocrinologists. “There was a significant reduction in hospitalizations due to hyperglycemia in the postimplementation versus the preimplementation group (9 vs 1, P < 0.05); there was a reduction in ED visits due to hyperglycemia (5 vs 0, P = 0.06),” the authors said.

Do V, Haakinson D, Belfort De Aguiar R, Cohen E. Implementing a pharmacist-led transition of care model for posttransplant hyperglycemia. Am J Health Syst Pharm. 2021 Apr 4:zxab151. doi: 10.1093/ajhp/zxab151. PMID: 33821878; PMCID: PMC8083386.

General Internal Medicine

In this new study, researchers used a cross-sectional design with a negative binomial regression model to learn if HIV testing behavior differed between those who use non-injected drugs as compared to those people who inject drugs and if a person’s social support would be a contributing factor. They found that HIV testing differed by injection status and in fact, that the relationship may be dependent on emotional support.

Gordon KS, Chiasson MA, Hoover DR, Martins SS, Wilson PA, Lewis CF. Difference in HIV testing behavior by injection status, among users of illicit drugs. AIDS Care. 2021 Apr 15:1-8. doi: 10.1080/09540121.2021.1913716. PMID: 33856945.

Geriatrics

During the COVID-19 pandemic, 235 first-year Yale MD, PA and Graduate Entry Pre-specialty in Nursing (GEPN) students practiced virtual patient-centered interviewing with over 200 volunteers aged 65 and older. COVID-19 required the redesign of parts of the MD, Physician Associate (PA), and (GEPN) curricula, including the Interprofessional Longitudinal Clinical Experience (ILCE) course to include virtual learning for first-year students. In 2019, ILCE leaders recognized the need to add geriatrics competencies to the curriculum and partnered with Yale's Geriatrics Workforce Enhancement Program. Read more in the Journal of the American Geriatrics Society.

Wu BJ, Honan L, Tinetti ME, Marottoli RA, Brissette D, Wilkins KM. The virtual 4Ms: A novel curriculum for first year health professional students during COVID-19. J Am Geriatr Soc. 2021 Apr 16. doi: 10.1111/jgs.17185. PMID: 33861865.

Hematology

In this new paper in Bone Marrow Transplantation, researchers across many cancer centers evaluated the use of allogeneic hematopoietic stem cell transplantation (alloHCT) consolidation after blinatumomab for patients with relapsed refractory (RR) acute lymphocytic leukemia (ALL). This real-world analysis suggests that alloHCT is feasible and effective post blinatumomab in patients with RR ALL.

Badar T, Szabo A, Litzow M, Burkart M, Yurkiewicz I, Dinner S, Hefazi M, Shallis RM, Podoltsev N, Patel AA, Curran E, Wadleigh M, Balasubramanian S, Yang J, Arslan S, Aldoss I, Mattison R, Cenin D, Siebenaller C, Advani A, Liedtke M, Atallah E. Multi-institutional study evaluating clinical outcome with allogeneic hematopoietic stem cell transplantation after blinatumomab in patients with B-cell acute lymphoblastic leukemia: real-world data. Bone Marrow Transplant. 2021 Apr 6. doi: 10.1038/s41409-021-01279-w. Epub ahead of print. PMID: 33824440.

Infectious Diseases

Infectious disease (ID) specialists are uniquely positioned to intervene when people with opioid use disorder (OUD) are hospitalized with an infection. The ID specialists can engage patients and administer an injectable long-acting monthly formulation of buprenorphine (LAB) for the medication treatment of OUD. A randomized multi-site trial tests this new model of care (ID/LAB), in which OUD and infections are managed by ID specialists and hospitalists using LAB coupled with referrals to community resources. The study’s findings will provide insight into the feasibility and effectiveness of integrated treatment of OUD and serious infections, and will have the potential to reduce morbidity and mortality in this vulnerable population. Read more in Contemporary Clinical Trials.

Seval N, Frank CA, Litwin AH, Roth P, Schade MA, Pavlicova M, Levin FR, Brady KT, Nunes EV, Springer SA. Design and methods of a multi-site randomized controlled trial of an integrated care model of long-acting injectable buprenorphine with infectious disease treatment among persons hospitalized with infections and opioid use disorder. Contemp Clin Trials. 2021 Apr 7;105:106394. doi: 10.1016/j.cct.2021.106394. PMID: 33838307.

Medical Oncology

Because little is known about the genetic makeup of inflammatory breast cancer (IBC), researchers in the new research in Genome Medicine used whole-genome sequencing to look for genomic differences between non-inflammatory breast cancer (non-IBC) samples. While IBC genome was similar to non-IBC, the researchers identified germline alterations in TGFβ pathway genes and MAST2 kinase mutations that could be potential therapeutic targets.

Li X, Kumar S, Harmanci A, Li S, Kitchen RR, Zhang Y, Wali VB, Reddy SM, Woodward WA, Reuben JM, Rozowsky J, Hatzis C, Ueno NT, Krishnamurthy S, Pusztai L, Gerstein M. Whole-genome sequencing of phenotypically distinct inflammatory breast cancers reveals similar genomic alterations to non-inflammatory breast cancers. Genome Med. 2021 Apr 26;13(1):70. doi: 10.1186/s13073-021-00879-x. PMID: 33902690; PMCID: PMC8077918.

Nephrology

In a new large prospective cohort study published in Transplantation, researchers determined that the ratio of two kidney proteins, uromodulin and osteopontin, is associated with lower risk of delayed graft function, a higher six-month estimated glomerular filtration rate, and a lower risk of graft failure, and can help with deceased kidney allocation.

Mansour SG, Liu C, Jia Y, Reese PP, Hall IE, El-Achkar TM, LaFavers KA, Obeid W, Rosenberg AZ, Daneshpajouhnejad P, Doshi MD, Akalin E, Bromberg JS, Harhay MN, Mohan S, Muthukumar T, Schröppel B, Singh P, El-Khoury JM, Weng FL, Thiessen-Philbrook HR, Parikh CR. Uromodulin to Osteopontin Ratio in Deceased Donor Urine Is Associated With Kidney Graft Outcomes. Transplantation. 2021 Apr 1;105(4):876-885. doi: 10.1097/TP.0000000000003299. PMID: 32769629.

Pulmonary, Critical Care & Sleep Medicine

In an effort to better understand the mechanisms promoting the pathogenesis and progression of sarcoidosis, a systemic granulomatous disease predominantly affecting the lungs, Yale researchers looked at the possibility of interleukin-15 (IL-15) as a biomarker. Their findings show that although IL-15 is enriched in the sarcoidosis lung, it was independent of disease pathogenesis or clinical manifestations in the models used. Read more in the American Journal of Physiology Lung Cellular and Molecular Physiology

Minasyan M, Sharma L, Pivarnik T, Liu W, Adams T, Bermejo S, Peng X, Liu A, Ishikawa G, Perry C, Kaminski N, Gulati M, Herzog EL, Dela Cruz CS, Ryu C. Elevated IL-15 concentrations in the sarcoidosis lung is independent of granuloma burden and disease phenotypes. Am J Physiol Lung Cell Mol Physiol. 2021 Apr 14. doi: 10.1152/ajplung.00575.2020. PMID: 33851886.

Rheumatology, Allergy & Immunology

Focusing on advances in understanding how dendritic cell (DC) subsets regulate distinct CD4 T helper (Th) cell differentiation outcomes, Yale researchers reviewed DC subset intrinsic properties, local tissue microenvironments, and other immune cells that determine Th cell differentiation during homeostasis and inflammation. Read more in the Annual Review of Immunology.

Yin, X; Chen, S; Eisenbarth, SC. Dendritic Cell Regulation of T Helper Cells. Annual Review of Immunology 2021 39:1, 759-790. https://doi.org/10.1146/annurev-immunol-101819-025146