Discoveries & Impact (January 2021)

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

Cardiovascular Medicine

A study published last month in the American Heart Journal by explores whether mortality trends benefited from the presence of top NIH-funded institutions. "Cardiovascular mortality rates have decreased with no apparent incremental benefit for communities with top NIH-funded institutions, underscoring the need for an increased focus on implementation science in cardiovascular diseases," the authors wrote.

Angraal S, Caraballo C, Kahn P, Bhatnagar A, Singh B, Wilson FP, Fiuzat M, O’Connor CM, Allen LA, Desai NR, Mamtani R, Ahmad, T. Geographical affiliation with top 10 NIH-funded academic medical centers and differences between mortality from cardiovascular disease and cancer. American Heart Journal. Volume 230, 2020, Pages 54-58, ISSN 0002-8703, https://doi.org/10.1016/j.ahj.2020.08.014.

Digestive Diseases

In new research in Clinical Gastroenterology and Hepatology, researchers reviewed 502 total patients with low-risk pancreatic cysts, the progression of disease, and mortality rate. The study

supports the use of the Charlson Comorbidity Index (CACI) to help determine the appropriate management of patients with precancerous mucinous pancreatic cysts. They found that most mortality in patients with low risk pancreatic cysts is derived from patient medical comorbidities ( i.e. high CACI) rather than pancreatic malignancy.

Chhoda A, Yousaf MN, Madhani K, Aslanian H, Jamidar PA, Suarez AL, Salem RA, Muniraj T, Kunstman J, Farrell JJ. Comorbidities Drive the Majority of Overall Mortality in Low-Risk Mucinous Pancreatic Cysts Under Surveillance. Clin Gastroenterol Hepatol. 2020 Dec 10:S1542-3565(20)31665-7. doi: 10.1016/j.cgh.2020.12.008. PMID: 33309984.

Endocrinology & Metabolism

In a 16-week randomized clinical trial, researchers found that a low-fat plant-based diet led to weight loss, increased insulin sensitivity, a reduction in fat, and increased metabolism. They suggest this diet may be an effective treatment for weight loss in adults. Learn more in JAMA Network Open.

Kahleova H, Petersen KF, Shulman GI, Alwarith J, Rembert E, Tura A, Hill M, Holubkov R, Barnard ND. Effect of a Low-Fat Vegan Diet on Body Weight, Insulin Sensitivity, Postprandial Metabolism, and Intramyocellular and Hepatocellular Lipid Levels in Overweight Adults: A Randomized Clinical Trial. JAMA Netw Open. 3(11):e2025454. doi: 10.1001/jamanetworkopen.2020.25454. PMID: 33252690; PMCID: PMC7705596.

General Internal Medicine

In this prospective analysis, researchers repeatedly surveyed Ugandan pharmacies to determine the weekly availability and cost of essential medicines for chronic non-communicable diseases. The team found that the availability and cost-to-patients of these medicines fluctuated substantially over short periods of time. This is the first time that such variation has been documented and has major implications for sustaining access to medicines for patients with chronic conditions. Learn more in PLOS One.

Armstrong-Hough M, Sharma S, Kishore SP, Akiteng AR, Schwartz JI. Variation in the availability and cost of essential medicines for non-communicable diseases in Uganda: A descriptive time series analysis. PLoS One. 2020 Dec 23;15(12):e0241555. doi: 10.1371/journal.pone.0241555. PMID: 33362249; PMCID: PMC7757794.

Geriatrics

A study of 5300 older adults over four years found that those with chronic kidney disease, dementia, heart failure, and chronic obstructive pulmonary disease had increased risk of hospitalization, a skilled nursing facility admission, and/or death. The Yale study demonstrated how to use joint models to explain the patient-specific variation in the risk of these outcomes. Read more in The Journals of Gerontology: Series A.

McAvay GJ, Vander Wyk B, Allore H. Individual heterogeneity in the probability of hospitalization, skilled nursing facility admission and mortality. J Gerontol A Biol Sci Med Sci. 2020 Dec 15:glaa314. doi: 10.1093/gerona/glaa314. PMID: 33320184.

Hematology

In a multi-center, retrospective study of 276 patients with relapsed/refractory B-cell acute lymphoblastic leukemia, researchers evaluated the sequencing of therapy using the novel agents blinatumomab and inotuzumab ozogamicin. They found that blinatumomab and inotuzumab ozogamicin might have comparable results as first or second therapy in with relapsed/refractory B-cell acute lymphoblastic leukemia. They hope their study provides some guidance when sequencing these therapies and acknowledge that future studies are needed.

Badar T, Szabo A, Dinner S, Liedtke M, Burkart M, Shallis RM, Yurkiewicz IR, Kuo E, Khan MA, Balasubramanian S, Yang J, Hefazi M, Podoltsev N, Patel A, Curran E, Wang A, Arslan S, Aldoss I, Siebenaller C, Mattison RJ, Litzow MR, Wadleigh M, Advani AS, Atallah E. Sequencing of novel agents in relapsed/refractory B-cell acute lymphoblastic leukemia: Blinatumomab and inotuzumab ozogamicin may have comparable efficacy as first or second novel agent therapy in relapsed/refractory acute lymphoblastic leukemia. Cancer. 2020 Dec 1. doi: 10.1002/cncr.33340. PMID: 33259056.

Infectious Diseases

A new study out of Yale looked at how COVID-19 affects those patients with solid-organ transplants. Researchers conducted a retrospective chart analysis of 30 patients who underwent solid-organ transplants and were on active immunosuppression when diagnosed with COVID-19. When compared to non-solid-organ transplant recipients with COVID-19, mortality rates were comparable. They do suggest a larger trial to confirm their findings.

Ringer M, Azmy V, Kaman K, Tang D, Cheung H, Azar MM, Price C, Malinis M. A retrospective matched cohort single-center study evaluating outcomes of COVID-19 and the impact of immunomodulation on COVID-19-related cytokine release syndrome in solid organ transplant recipients. Transpl Infect Dis. 2020 Dec 30:e13556. doi: 10.1111/tid.13556. PMID: 33378571.

Medical Oncology

Published in JAMA Dermatology, Yale researchers performed a cross-sectional retrospective study of 3720 patients with Merkel cell carcinoma (MCC), a rare aggressive skin cancer. They suggest the rate of increase of the disease was due to heightened detection efforts, and is slowing down. But by 2030, there could still be up to 5130 new cases of MCC per year compared to 3023 in 2020. They urge continued risk factor mitigation and screening of older patients.

Jacobs D, Huang H, Olino K, Weiss S, Kluger H, Judson BL, Zhang Y. Assessment of Age, Period, and Birth Cohort Effects and Trends in Merkel Cell Carcinoma Incidence in the United States. JAMA Dermatol. 2020 Nov 4:e204102. doi: 10.1001/jamadermatol.2020.4102. PMID: 33146688; PMCID: PMC7643047.

Nephrology

1538 patients participated in a multicenter, prospective cohort study that sought to evaluate whether non-invasive biomarkers can identify future kidney disease progression. Urine samples were collected to measure select biomarkers at three months post-hospitalization. The researchers found that these biomarker levels can identify patients at risk for chronic kidney disease progression and end stage renal disease. Read more in The Journal of Clinical Investigation.

Puthumana J, Thiessen-Philbrook H, Xu L, Coca SG, Garg AX, Himmelfarb J, Bhatraju PK, Ikizler TA, Siew E, Ware LB, Liu KD, Go AS, Kaufman JS, Kimmel PL, Chinchilli VM, Cantley L, Parikh CR. Biomarkers of inflammation and repair in kidney disease progression. J Clin Invest. 2020 Dec 8:139927. doi: 10.1172/JCI139927. PMID: 33290282.

Pulmonary, Critical Care & Sleep Medicine

In the recent editorial in Critical Care Medicine, authors suggest the study of physiologic, physical, and cognitive resilience in addition to psychological resilience when evaluating the functional recovery of patients after an intensive care admission.

Ferrante, LE; Stevens, RD. Functional Loss and Resilience in Intensive Care. Crit Care Med. 2020 Nov;48(11):1690-1692. doi: 10.1097/CCM.0000000000004603. PMID: 33038158.

Rheumatology, Allergy & Immunology

To learn more about the inflammatory response driving severe asthma, a deeper analysis of the cell types present in sputum is needed. In this study from the Journal of Leukocyte Biology, Yale researchers used CyTOF to identify multiple subtypes of airway immune cells in asthmatic patients. Using this approach may lead to personalized treatments for patients with this disease.

Stewart E, Wang X, Chupp GL, Montgomery RR. Profiling cellular heterogeneity in asthma with single cell multiparameter CyTOF. J Leukoc Biol. 2020 Nov;108(5):1555-1564. doi: 10.1002/JLB.5MA0720-770RR. PMID: 32911570.