Discoveries & Impact (December 2020)

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

Cardiovascular Medicine

High blood pressure is a major risk factor for cardiovascular disease. A new study published in JACC sought to answer the question of whether out-of-office blood pressure monitoring was more reliable for diagnosing hypertension and estimating the risk of cardiovascular disease. After comparing blood pressure measured in the office with ambulatory and home measured blood pressure, the data suggests that one week of home blood pressure monitoring may be the best approach for diagnosing hypertension.

Schwartz Joseph E., Muntner Paul, Kronish Ian M., Burg Matthew M., Pickering Thomas G., Bigger John Thomas, Shimbo Daichi. Reliability of Office, Home, and Ambulatory Blood Pressure Measurements and Correlation With Left Ventricular Mass. JACC. doi: 10.1016/j.jacc.2020.10.039

Digestive Diseases

Yale researchers and clinicians participated in a multicenter study examining how vedolizumab (VDZ) would affect extraintestinal manifestations (EIMs) of 201 patients with inflammatory bowel disease. The most common EIM type was peripheral arthritis. Up to one third of participants reported worsening of EIMs and approximately 10% of patients had to discontinue VDZ due to worsening EIMs. Read more in Inflammatory Bowel Diseases.

Ramos GP, Dimopoulos C, McDonald NM, Janssens LP, Hung KW, Proctor D, Ruggiero E, Kane S, Bruining DH, Faubion WA, Raffals LE, Loftus EV, Al-Bawardy B. The Impact of Vedolizumab on Pre-Existing Extraintestinal Manifestations of Inflammatory Bowel Disease: A Multicenter Study. Inflamm Bowel Dis. 2020 Nov 9:izaa293. doi: 10.1093/ibd/izaa293. PMID: 33165569.

Endocrinology & Metabolism

The inability of tissues to switch from glucose oxidation to fat oxidation, which is referred to as “Metabolic Inflexibility”, has long been thought to be the cause of muscle insulin resistance, a key factor in the pathogenesis of type 2 diabetes. In “Dissociation of Muscle Insulin Resistance from Alterations in Mitochondrial Substrate Preference,” Song et al. wanted to test this hypothesis in rodents and humans. Using novel tandem mass spectrometry and in vivo ¹³C NMR methods, that they developed, Song et al. found that muscle mitochondrial substrate preference was not altered in insulin resistant rat muscle or insulin resistant human muscle, thus disproving the Metabolic Inflexibility hypothesis of muscle insulin resistance. Read more in Cell Metabolism.

Song, Joongyu D.; Alves, Tiago C.; Befroy, Douglas E.; Perry, Rachel J.; Mason, Graeme F.; Zhang, Xian-Man; Munk, Alexander; Zhang, Ye; Zhang, Dongyan; Cline, Gary W.; Rothman, Douglas L.; Petersen, Kitt Falk; Shulman, Gerald I. Dissociation of Muscle Insulin Resistance from Alterations in Mitochondrial Substrate Preference. Cell Metabolism. https://doi.org/10.1016/j.cmet.2020.09.008

General Internal Medicine

Study authors instructed medical students to write a short, reflective essay using open ended writing prompts after completing a clinical elective in palliative care. Thirty-four essays were evaluated and four major themes emerged, with the most frequent these being the reflection on the mission of medicine or motivation for being in medicine. Authors concluded that palliative care education is an essential component of medical education. Read more in American Journal of Hospice and Palliative Medicine.

Sagin A, Ellman MS, Shariff RR, Jones CA, Tindall K, Siropaides CH. A Multicenter Qualitative Analysis of Medical Student Narratives After a Palliative Care Elective. Am J Hosp Palliat Care. 2020 Nov 4:1049909120971565. doi: 10.1177/1049909120971565. PMID: 33143465.

Geriatrics

Researchers studied 665 people aged 70 or older who were living in a community setting to evaluate the occurrence of restricting symptoms at the end of life from 1998 to 2019. In this prospective longitudinal study, they assessed 16 symptoms within the last six months of life and found that five were less common, eight showed little change, and three became more common over this 21-year period. They concluded that end of life care is improving, but further efforts to reduce symptom burden is needed. Learn more in The Journal of the American Geriatrics Society.

Gill TM, Gahbauer EA, Leo-Summers L, Murphy TE. Trends in Restricting Symptoms at the End of Life from 1998 to 2019: A Cohort Study of Older Persons. J Am Geriatr Soc. 2020 Nov 3. doi: 10.1111/jgs.16871. PMID: 33145752.

Hematology

In “Factor V activity in apheresis platelets: Implications for management of FV deficiency,” Yale researchers evaluated whether allogeneic platelet (PLT) infusion would raise Factor V (FV) levels in patients who were FV deficient. They found that plasma should be first line therapy, rather than PLT.

Gupta GK, Hendrickson JE, Bahel P, Siddon AJ, Rinder HM, Tormey CA. Factor V activity in apheresis platelets: Implications for management of FV deficiency. Transfusion. 2020 Nov 9. doi: 10.1111/trf.16179. PMID: 33166428.

Infectious Diseases

In a new study published in Ticks and Tick-borne Diseases, researchers looked at the molecular processes of guinea pigs and mice to understand tick rejection. The team confirmed several immune pathways for tick rejection in guinea pigs, as detailed in previously published literature, which were not found in mice. They found that guinea pigs develop rapid tick immunity and rejection, while mice allowed deer ticks to feed repeatedly. This knowledge will be helpful for the development of an anti-tick vaccine to prevent Lyme disease. To learn more, read “Repeat tick exposure elicits distinct immune responses in guinea pigs and mice.”

Kurokawa, Cheyne; Narasimhan, Sukanya; Vidyarthi, Aurobind; Booth, Carmen J; Mehta, Sameet; Meister, Lea, Diktas, Husrev; Strank, Norma; Lynn, Geoffrey E; DePonte, Kathy; Craft, Joseph; Fikrig, Erol. Repeat tick exposure elicits distinct immune responses in guinea pigs and mice. Ticks Tick Borne Dis. 2020 Nov;11(6):101529. doi: 10.1016/j.ttbdis.2020.101529. PMID: 32993942; PMCID: PMC7530331.

Medical Oncology

In this newly released study, researchers evaluated whether the consumption of a probiotic Bifidobacterium-containing yogurt could alter the clinical outcomes of patients with renal cell carcinoma. Twenty patients were evaluated through stool sample testing and microbiome composition. The team found a similar clinical benefit rate between probiotic-supplemented patients compared to those who were probiotic-restricted. Furthermore, researchers identified a link between B. intestinihominis, A. muciniphila and clinical benefit from targeted therapies. Learn more in Cancer Medicine.

Dizman N, Hsu J, Bergerot PG, Gillece JD, Folkerts M, Reining L, Trent J, Highlander SK, Pal SK. Randomized trial assessing impact of probiotic supplementation on gut microbiome and clinical outcome from targeted therapy in metastatic renal cell carcinoma. Cancer Med. 2020 Nov 1. doi: 10.1002/cam4.3569. PMID: 33135866.

Nephrology

In this research letter, authors detail the variability in the care of hospitalized patients with severe acute kidney injury (AKI). The team evaluated best-practices in 9,534 patients at three university-affiliated tertiary care hospitals. They noted variation in various tests and/or monitoring and the continued use of NSAIDs in one-third of patients. Learn more in the American Journal of Kidney Diseases.

Moledina, Dennis G; Belliveau, Olivia; Yamamoto, Yu; Arora, Tanima; Carey, Kyle A; Churpek, Matthew; Martin, Melissa; Partridge, Caitlin M; Mansour, Sherry G; Parikh, Chirag R; Koyner, Jay L; Wilson, F. Perry. Variation in Best Practice Measures in Patients With Severe Hospital-Acquired Acute Kidney Injury: A Multicenter Study. Am J Kidney Dis. doi: 10.1053/j.ajkd.2020.08.013. PMID: 33075389.

Pulmonary, Critical Care & Sleep Medicine

In the new publication in Chest, Yale pulmonary and critical care physicians detail inherent challenges in post-COVID-19 survivorship care, explore potential long-term pulmonary complications, and describe the creation of the Winchester Chest Clinic Post-COVID-19 RECOVERY Program model. The RECOVERY Program was created to evaluate and treat post-COVID-19 pulmonary complications and to build a framework for cross-disciplinary collaboration. This paper lays out a roadmap for the development of multidisciplinary post-COVID-19 clinical programs.

Lutchmansingh DD, Knauert MP, Antin-Ozerkis DE, Chupp G, Cohn L, Dela Cruz CS, Ferrante LE, Herzog EL, Koff J, Rochester CL, Ryu C, Singh I, Tickoo M, Winks V, Gulati M, Possick JD. A clinic blueprint for post-COVID-19 RECOVERY: Learning from the past, looking to the future. Chest. 2020 Nov 4:S0012-3692(20)35125-4. doi: 10.1016/j.chest.2020.10.067. PMID: 33159907; PMCID: PMC7641526.

Rheumatology, Allergy & Immunology

Diagnosis of hereditary angioedema (HAE) can be elusive when patients or providers are not familiar with the varied presentations of this rare disease. HAE can cause swelling of the skin, with the face, genitals, and extremities being the most common locations affected. It can also however cause recurrent abdominal pain without clearly visible swelling. The majority of patients have a gene mutation that causes their HAE and decreased C1 inhibitor function or levels. Read more in Allergy and Asthma Proceedings.

Azmy, Veronica; Brooks, Joel P; Hsu, F Ida. Clinical presentation of hereditary angioedema. Allergy Asthma Proc. 2020 Nov 1;41(6):S18-S21. doi: 10.2500/aap.2020.41.200065. PMID: 33109320.