Discoveries & Impact (April 2021)

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

Cardiovascular Medicine

In the Journal of the American Heart Association researchers from the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology and the Section of Cardiovascular Medicine found that events identified with claims data in the Dual Antiplatelet Therapy (DAPT) Study were prognostically significant for mortality.

Butala NM, Faridi KF, Secemsky EA, Song Y, Curtis J, Gibson CM, Kazi D, Shen C, Yeh RW. “Prognosis of Claims‐ Versus Trial‐Based Ischemic and Bleeding Events Beyond 1 Year After Coronary Stenting.” Journal of the American Heart Association. doi:10.1161/JAHA.120.018744.

Digestive Diseases

While Black Americans are disproportionately diagnosed with hepatitis C (HCV) compared to other groups, they are under-represented in clinical trials for patients with HCV. Two hundred people with a current or prior HCV diagnosis participated in this cross-sectional survey, aimed to determine desired participation level in clinical studies. The study concluded that Black participants would partake in medical research with more knowledge but greater community outreach, access, education, and understanding may be necessary.

McGuire FH, André K, Bradsher ML, Harrison D, Sterling RK, Reddy KR, Serper M, Golin CE, Reau N, Lim JK, Nelson DR, Sarkar S, Evon DM. Willingness to Participate in Research among Black Patients with Liver Disease: A National Cross-Sectional Study. J Viral Hepat. 2021 Mar 4. doi: 10.1111/jvh.13493. PMID: 33665897.

Endocrinology & Metabolism

Authors of an Invited Commentary in JAMA Internal Medicine examine findings from a study of older Medicare beneficiaries with type 2 diabetes that showed higher rates of hypoglycemic events among new users of insulin isophane suspension compared with those among new users of long-acting insulin analogs. The commentary discusses how the age of the beneficiaries affects their risk of hypoglycemia, among other issues. The authors argue that understanding patient-centered goals of care is critical to the decision to begin insulin use, as is the patient’s ability to implement the treatment plan safely, and to cover out-of-pocket costs.

Sejling AS, Wang P, Zhu W, Farhat R, Knight N, Appadurai D, Chan O. Repeated Activation of Noradrenergic Receptors in the Ventromedial Hypothalamus Suppresses the Response to Hypoglycemia. Endocrinology. 2021 Mar 1;162(3). doi: 10.1210/endocr/bqaa241. PMID: 33570117.

General Internal Medicine

In this publication, the authors, all faculty at Yale Center for Asylum Medicine, highlight a case report of a 35-year-old Venezuelan woman who fled to the U.S. due to threats on her life and a fear of persecution. The report details the psychological evaluation performed at Yale Center for Asylum Medicine, and describes the PTSD and traumatic bereavement of the woman, along with background on asylum claims from Venezuela.

McQuaid JH, Silva MA, McKenzie KC. Surviving violent, traumatic loss after severe political persecution: lessons from the evaluation of a Venezuelan asylum seeker. BMJ Case Reports CP 2021;14:e239025.

Geriatrics

Adults 75 and older with moderate to severe cognitive impairment have an increased risk of death in the months after they are hospitalized for a heart attack. Routine cognitive screening may identify older heart attack survivors who are at risk for poor outcomes, and who may benefit from closer oversight and support after they are discharged, according to a recent study in The American Journal of Medicine.

Hajduk AM, Saczynski JS, Tsang S, Geda ME, Dodson JA, Ouellet GM, Goldberg RJ, Chaudhry SI. Presentation, Treatment, and Outcomes of Older Adults Hospitalized for Acute Myocardial Infarction according to Cognitive Status: the SILVER-AMI Study. Am J Med. 2021 Mar 15:S0002-9343(21)00155-8. doi: 10.1016/j.amjmed.2021.03.003. PMID: 33737057.

Hematology

The increased availability of newer and targeted drugs to treat acute myeloid leukemia (AML), such as oral hypomethylating agents, protein modifiers, and immune checkpoint inhibitors, has renewed interest in providing maintenance therapy for patients with AML. The recent positive findings from clinical trials in support of maintenance therapy for certain subgroups of AML patients reinforce the need for properly designed, randomized studies using unified and standardized measurable residual disease (MRD) techniques, the authors of an article in Current Opinions in Hematology argue.

Shallis RM, Podoltsev NA. Maintenance therapy for acute myeloid leukemia: sustaining the pursuit for sustained remission. Curr Opin Hematol. 2021 Mar 1;28(2):110-121. doi: 10.1097/MOH.0000000000000637. PMID: 33394722.

Infectious Diseases

Tuberculosis is the leading cause of death among people with HIV globally. South Africa has the highest incidence of HIV/TB co-infection. TB preventive therapy (TPT) is a cornerstone of global TB prevention strategy with little attention to rural settings. TPT is recommended for all patients with HIV and this retrospective chart review found that 57.8% of 552 patients with HIV in rural settings initiated TPT. The authors identify contextual factors contributing to suboptimal TPT implementation and present evidence-based strategies for facilitating implementation. Learn more in Global Public Health.

Chandra DK, Moll AP, Altice FL, Didomizio E, Andrews L, Shenoi SV. Structural barriers to implementing recommended tuberculosis preventive treatment in primary care clinics in rural South Africa. Glob Public Health. 2021 Mar 2:1-14. doi: 10.1080/17441692.2021.1892793. PMID: 33650939.

Medical Oncology

The molecular profiling of tumors can supplement diagnostic classification. Researchers explain how the detection of BAP1 variants was crucial in confirming a rare and unexpected diagnosis of primary peritoneal mesothelioma that was initially misclassified as adenocarcinoma. The case also highlights the value of a precision medicine tumor board that integrates pathological, oncological, and genetic information in the care of cancer patients. Read their perspective in The Lancet Oncology.

Gibson JA, Finberg KE, Nalbantoglu I, Cecchini M, Ganzak A, Walther Z, Sklar JL, Eder JP, Goldberg SB. Yale Cancer Center Precision Medicine Tumor Board: molecular findings alter a diagnosis and treatment plan. Lancet Oncol. 2021 Mar;22(3):306-307. doi: 10.1016/S1470-2045(20)30683-5. PMID: 33662283.

Nephrology

In their review of the study by Cashion et al. in the Clinical Journal of the American Society of Nephrology, the authors discuss the reported study findings of differential veteran patient mortality in kidney transplant recipients on the basis of source of post-transplant care. They emphasize the need to better understand veteran patient choices related to site of care and payor source and how that may differentially affect patient outcomes, especially given new legislation expanding community care choices for Veterans.

Krishnan N, Crowley ST. Postkidney Transplant Care and Health Outcomes of US Veterans. Clin J Am Soc Nephrol. 2021 Feb 18:CJN.00580121. doi: 10.2215/CJN.00580121. PMID: 33602754.

Pulmonary, Critical Care & Sleep Medicine

In this new study, 42 people with connective tissue disease (CTD) without cardiopulmonary disease were retrospectively analyzed to understand the role of systemic vascular distensibility in the reduction of exercise capacity. The authors concluded that reduced exercise capacity is associated with decreased systematic oxygen extraction and oxygen delivery to the exercising muscle. Learn more in Rheumatology.

Singh I, Oliveira RKF, Naeije R, Oldham WM, Faria-Urbina M, Waxman AB, Systrom DM. Systemic vascular distensibility relates to exercise capacity in connective tissue disease. Rheumatology (Oxford). 2021 Mar 2;60(3):1429-1434. doi: 10.1093/rheumatology/keaa510. PMID: 33001175.

Rheumatology, Allergy & Immunology

Most colorectal cancers (CRC) are proficient in mismatch repair and respond poorly to immunotherapy. Researchers are seeking to clarify the specific immune responses evoked by single versus dual checkpoint inhibition in a mismatch repair proficient model of CRC in an effort to promote robust anti-tumor immune response. Read more in Scientific Reports.

Slovak RJ, Park HJ, Kamp WM, Ludwig JM, Kang I, Kim HS. Co-inhibitor expression on tumor infiltrating and splenic lymphocytes after dual checkpoint inhibition in a microsatellite stable model of colorectal cancer. Sci Rep. 2021 Mar 26;11(1):6956. doi: 10.1038/s41598-021-85810-5. PMID: 33772035; PMCID: PMC7997991.