Discoveries & Impact (October 2021)

Discoveries & Impact highlights select scientific discoveries per section across the Department of Internal Medicine

To see the complete list of publications from the Department of Internal Medicine, please refer to the report under Related Documents.

Cardiovascular Medicine

Over 300,000 post-9/11 veterans with a history of sexual harassment and assault developed high blood pressure according to a new preliminary study led by Allison E. Gaffey, PhD. The findings were presented at the American Heart Association’s Hypertension Scientific Sessions 2021. The authors concluded that further research may be required to determine if early identification of military sexual trauma and related treatment may improve cardiovascular disease risk management.

Gaffey, Allison E, et al. “Abstract 48: Military Sexual Trauma Is Associated with Incident Hypertension in a 16-Year Cohort Study of 1.2 Million Young and Middle-Aged Men and Women.” Hypertension, vol. 78, no. Suppl_1, 27 Aug. 2021, https://doi.org/10.1161/hyp.78.suppl_1.48.

Digestive Diseases

Over half of patients with substance use disorder who were cured of hepatitis C virus infection (HCV) received follow-up viral load testing (FUVL). Researchers investigating the factors associated with adoption of FUVL found a relationship between FUVL and primary care and substance use treatment that highlights the importance of integrated systems in providing long-term care for patients cured of HCV. Read more in the Journal of Addiction Medicine.

Lamia Y Haque, Jenna L Butner, Julia M Shi, Susan Henry, Yanhong Deng, Maria M Ciarleglio, Lynn M Madden, Jeanette M Tetrault. PMID: 34483278. DOI: 10.1097/ADM.0000000000000910

Endocrinology & Metabolism

Diabetes care has largely focused on reducing the risk of complications by achieving hemoglobin A1c (HbA1c) targets; yet, treating the whole person may be more effective and desirable. Yale researchers analyzed how frequently topics related to quality of life, treatment burden, hypoglycemia, sexual function, and social support were raised in recorded patient-clinician encounters, and observed how clinicians responded. Learn more from their original article in Endocrine.

Haider S, El Kawkgi O, Clark J, Breslin M, Boehmer KR, Montori V, Lipska K. Beyond hemoglobin A1c: a videographic analysis of conversations about quality of life and treatment burden during clinical encounters for diabetes care. Endocrine 2021, 73(3):573-579. doi: 10.1007/s12020-021-02757-3. PMID: 34189680.

General Internal Medicine / Office of Global Health

A perspectives piece in the Journal of General Internal Medicine argues for the importance of global health experiences for North American physicians during the COVID-19 crisis, as previous work in resource-limited contexts prepared many physicians for the challenges of the pandemic at home. “Demonstrating the value of global health education within high-resource healthcare environments, highlights the need for academic institutions to support global health training, to hire faculty with global health expertise, and to invest in equitable collaborations with partners in vulnerable communities,” the authors said.

Global Health Crisis, Global Health Response: How Global Health Experiences Prepared North American Physicians for the COVID-19 Pandemic. Alexandra L Coria, Tracy L Rabin, Amy R L Rule, Heather Haq, James C Hudspeth, Leah Ratner, Ingrid Walker-Descartes PMID: 34561829 PMCID: PMC8475882 DOI: 10.1007/s11606-021-07120-w

Geriatrics / General Internal Medicine

Researchers conducted a cross-sectional study of a nationally representative cohort of legal U.S. immigrants over the age of 50 to analyze how they perceived their own health status after immigrating to the U.S. They found that greater acculturation was associated with worse perceived health status among these older immigrants and that the oldest immigrant group (those aged ≥75) were more likely to report worse health after migration (although this was attenuated after adjustment for potential confounders). Learn more here.

Kang G, Hajduk A, Marottoli R, Nunez-Smith M. Older immigrants perceived health after migration to the United States: Influence of age and level of acculturation. Journal Of The American Geriatrics Society 2021, 69(9):2625-2637. doi: 10.1111/jgs.17363. PMID: 34252200. PMCID: PMC8440395.

Hematology

Yale researchers discuss the available therapies for myelodysplastic syndrome as they specifically relate to older adults diagnosed at age ≥ 75 years. They also assess the emerging therapeutics that may lead to personalized treatment, improving the outcomes and quality of life of the older patient with myelodysplastic syndrome. Read their Abstract here.

Shallis RM, Zeidan AM. Management of the Older Patient with Myelodysplastic Syndrome. Drugs & Aging 2021, 38(9):751-767. doi: 10.1007/s40266-021-00881-3. PMID: 34342860.

Infectious Diseases

Hospitalized patients often have underlying health conditions that put them at risk for complications from COVID-19. Yale researchers looked at how screening, masking, and testing help to mitigate healthcare worker (HCW) to patient transmission of the virus, and how vaccination has resulted in dramatic reduction in the incidence of COVID-19 among HCWs. And yet, healthcare-associated COVID-19 continues to occur in hospitals and other inpatient settings. What is the impact of vaccinations on healthcare-associated COVID-19, and is there a correlation between HCW vaccination and healthcare-associated COVID-19 occurrence? Find out more in Infection Control & Hospital Epidemiology.

Roberts SC, Aniskiewicz MJ, Choi SJ, Pettker CM, Martinello RA. Correlation of healthcare worker vaccination on inpatient healthcare-associated COVID-19. Infection Control And Hospital Epidemiology 2021, 1-6. doi: 10.1017/ice.2021.414. PMID: 34544506.

Medical Oncology

In a News & Views in Nature Reviews Clinical Oncology, Yale experts discuss the findings from two recent studies that address the functional properties and clinical significance of tumor antigen-specific effector T cells in human melanoma and lung cancer using single-cell strategies. The Yale researchers also suggest possible therapeutic options, and highlight the need for studies including larger patient cohorts, and additional experimental approaches.

Lopez de Rodas M, Schalper KA. Tumour antigen-induced T cell exhaustion - the archenemy of immune-hot malignancies. Nature Reviews. Clinical Oncology 2021 doi: 10.1038/s41571-021-00562-5. PMID: 34556846.

Nephrology

Yale researchers report that high oxalate concentrations correlate with increased risk of sudden cardiac death in patients with kidney failure requiring dialysis, basing their findings on analysis of the German Diabetes Dialysis (4D) Study. Read more in the Journal of the American Society of Nephrology.

Pfau A, Ermer T, Coca S, Tio M, Genser B, Reichel M, Finkelstein F, März W, Wanner C, Waikar S, Eckardt KU, Aronson P, Drechsler C, Knauf F. High Oxalate Concentrations Correlate with Increased Risk for Sudden Cardiac Death in Dialysis Patients. Journal Of The American Society Of Nephrology : JASN 2021, 32(9):2375-2385. doi: 10.1681/ASN.2020121793. PMID: 34281958.

Pulmonary, Critical Care & Sleep Medicine

Through a longitudinal analysis of 15 consecutive days and nights of wrist actigraphy recordings, researchers examined the bidirectional relationships between within-person day-to-day fluctuations in physical activity and sleep characteristics among people with heart failure and insomnia. Depending on age and heart failure class, daytime physical activity was associated with longer same-night sleep and/or longer sleep was associated with greater next-day physical activity. Furthermore, for those with more significant heart failure, improvements in sleep were associated with more clinically meaningful increases in physical activity the next day.

Ash G, Jeon S, Conley S, Knies AK, Yaggi HK, Jacoby D, Hollenbeak CS, Linsky S, O'Connell M, Redeker NS. Day-to-day Relationships between Physical Activity and Sleep Characteristics among People with Heart Failure and Insomnia. Behavioral Sleep Medicine 2021, 19(5):602-614. doi: 10.1080/15402002.2020.1824918. PMID: 33048589.

Rheumatology, Allergy & Immunology

Researchers analyzed a dataset of 13, 642 patients with COVID-19, including 566 younger patients and 717 older. They found that increased levels of circulatory sIL-2R(alpha) and IL-10 were associated with disease progression and mortality in younger and older adults respectively, perhaps suggesting that disease progression may proceed by different immunologic mechanisms based on age.

Shin, J.J., Jeon, S., Unlu, S., Par-Young, J., Shin, M., Kuster, J.K., Afinogenova, Y., Kang, Y., Simonov, M., Buller, G., Bucala, R. and Kang, I. A distinct association of inflammatory molecules with outcomes of COVID-19 in younger versus older adults. 2021. Clinical Immunology. https://doi.org/10.1016/j.clim.2021.108857