Discoveries & Impact highlights publications per section across the Department of Internal Medicine.
A Yale-led study published in November in JAMA explores the relationship between physician payments from industry and the selection of implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy-defibrillator (CRT-D) devices. According to the study, 96 percent of ICD or CRT-D implants were performed by physicians who had received at least one payment from device manufacturers.
Annapureddy, Amarnath R.; Henien, Shady; Wang, Yongfei; Minges, Karl E.; Ross, Joseph S.; Spatz, Erica S.; Desai, Nihar R.; Peterson, Pamela N.; Masoudi, Frederick A.; Curtis, Jeptha P.. JAMA. 2020;324(17):1755–1764. doi:10.1001/jama.2020.17436
Nonalcoholic fatty liver disease is the fastest growing chronic liver disease in the world, and its prevalence is expected to increase by 30% in the next 10 years. In “Drug development of nonalcoholic fatty liver disease: challenges in research, regulatory pathways, and study endpoints,” the authors detail difficulties with drug development, but outline a multifaceted approach in rapid drug development. Read the.
Do, Albert; Ilagan-Ying, Ysabel C; Mehal, Wajahat Z; Lim, Joseph K. Drug development of nonalcoholic fatty liver disease: challenges in research, regulatory pathways, and study endpoints. Expert Opin Drug Discov. 10.1080/17460441.2020.1811674. PMID: 33086894.
Endocrinology & Metabolism
In the new study, “,” researchers found that the SGLT2 inhibitor, empagliflozin, reduced body weight and improved cardiovascular and renal outcomes in patients with obstructive sleep apnea (OSA). Empagliflozin also appeared to reduce the risk of new-onset OSA – a novel finding involving this newer glucose lowering medication. 7020 patients with type 2 diabetes and cardiovascular disease were randomized to empagliflozin or placebo, in addition to the standard of care, and followed for an average of three years. To learn more, read the report in Diabetes Care.
Neeland, Ian J; Eliasson, Bjorn; Kasai, Takatoshi; Marx, Nikolaus; Zinman, Bernard; Inzucchi, Silvio E; Wanner, Christoph; Zwiener, Isabella; Wojeck, Brian S; Yaggi, Henry K; Johansen, Odd E; EMPA-REG OUTCOME Investigators.. Diabetes Care. doi: 10.2337/dc20-1096. PMID: 33004464.
General Internal Medicine
In “Racial and Ethnic Disparities in Population-Level Covid-19 Mortality,” the research team found that the availability of COVID-19 data across the country regarding race varied drastically. They performed a cross-sectional study which not only identified substantial racial and ethnic disparities in population-level COVID mortality, but they also demonstrated that accurate measurement of these disparities requires age-adjustment. These findings have had an impact on how some states are reporting their covid mortality data. Read the.
Gross, Cary P; Essien, Utibe R; Pasha, Saamir; Gross, Jacob R; Wang, Shi-Yi; Nunez-Smith, Marcella.. J Gen Intern Med. doi: 10.1007/s11606-020-06081-w. 32754782; PMCID: PMC7402388.
In the recent study, “,” Yale researchers looked at 754 people, 70 years or older, and evaluated their functional outcomes in the year after having a major surgery. They found that the adults who experienced an illness or injury in the year after their surgery were at the greatest risk for having poor functional outcomes. They urge more aggressive care to prevent and manage these intervening illnesses and injuries. Read the report in Annals of Surgery.
Gill, Thomas M; Han, Ling; Gahbauer, Evelyne A; Leo-Summers, Linda; Murphy, Terrance E; Becher, Robert D.. Ann Surg. PMID: 33074902.
For patients with relapsed/refractory acute myeloid leukemia, treatment options are limited. In “,” a multi-center study, researchers treated 40 such patients with onvansertib with either LDAC or decitabine. The team found that the combination of onvansertib and decitabine was well tolerated with preliminary evidence of clinical activity, but stressed the need for future studies.
Zeidan, Amer M.; Ridinger, Maya; Lin, Tara L; Becker, Pamela S.; Schiller, Gary; Patel, Prapti A.; Spira, Alexander I; Tsai, Michaela L.; Samuëlsz, Errin; Silberman, Sandra L.; Erlander, Mark; Wang, Eunice S.Clin Cancer Res. doi: 10.1158/1078-0432.CCR-20-2586.
Progress can be made if a concentrated effort is made to increase diversity within the specialty of infectious diseases says Mahalia S. Desruisseaux, MD, associate professor in the Section of Infectious Diseases and author of a recent publication in The Journal of Infectious Diseases. Desruisseaux and her co-author, Tina Tan, MD, of Northwestern University, identify the benefits of diversity, equity, and inclusion in business organizations including medicine, and five focus areas identified by the Infectious Diseases Society of America’s Inclusion, Diversity, Access, and Equity task force. Learn more in “Inclusion, Diversity, Access, and Equity (IDA&E) Roadmap: Infectious Diseases Society of America’s Commitment to the Future.”
Desruisseaux, Mahalia S; Tan, Tina Q.. The Journal of Infectious Diseases. https://doi.org/10.1093/infdis/jiaa153
In “,” Yale Cancer Center authors were able to increase the number of minority patients who participated in clinical trials over a two-year span at the facility, but also note the participation rate among Black and Hispanic patients is likely low for a number of factors. They detailed the efforts and impact of the Oncology Welcomes New Haven into Trials (OWN IT) initiative and acknowledge patient education may play a role in low enrollment. Read the study in Breast Cancer Research and Treatment.
Trant, Amelia A.; Walz, Lucas; Allen, Whitney; DeJesus, Jose; Hatzis, Christos; Silber, Andrea.. Breast Cancer Res Treat 184, 499–505 (2020). https://doi.org/10.1007/s10549-020-05873-2
Acute interstitial nephritis (AIN) is treated with immunosuppressive therapy but not all patients respond favorably. Researchers looked at 55 patients with AIN to determine kidney function at six month post-diagnosis and found that those with higher (IL)-9 levels were more likely to have higher kidney function with corticosteroid therapy than those with lower IL-9 levels. Researchers hope that this leads to better prediction of who should receive immunosuppressive therapy with AIN. Read “Urine interleukin-9 and tumor necrosis factor-α for prognosis of human acute interstitial nephritis,” in Nephrology Dialysis Transplantation.
Moledina, Dennis G; Wilson, F Perry; Kukova, Lidiya; Obeid, Wassim; Luciano, Randy; Kuperman, Michael; Moeckel, Gilbert W; Kashgarian, Michael; Perazella, Mark A; Cantley, Lloyd G; Parikh, Chirag R. Urine interleukin-9 and tumor necrosis factor-α for prognosis of human acute interstitial nephritis. Nephrol Dial Transplant. doi: 10.1093/ndt/gfaa169. PMID: 33125471.
Pulmonary, Critical Care & Sleep Medicine
A recent study published in the Journal of Leukocyte Biology may lead to an increased understanding of the varied clinical responses of asthmatic inflammation. Yale researchers analyzed sputum samples from healthy controls and asthmatic patients using single cell CyTOF to identify the distinct cellular phenotypes of each participant. Using the in-depth profiling, the authors of “Profiling cellular heterogeneity in asthma with single cell multiparameter CyTOF” identified differences in airway cells which may to future understanding of who may respond to a therapeutic asthma treatment.
Stewart, Emma; Wang, Xiaomei; Chupp, Geoffrey L; Montgomery, Ruth R.J Leukoc Biol. doi: 10.1002/JLB.5MA0720-770RR. PMID: 32911570.
Rheumatology, Allergy & Immunology
The COVID-19 related cytokine storm which drives disease severity is associated with increased levels of inflammatory cytokines and chemokines as well as specific biomarkers such as C-reactive protein, ferritin, and D-dimer, says a new study from Yale School of Medicine researchers in Expert Review of Molecular Diagnostics. Identifying the most significant upstream pathways that dictate systemic inflammatory responses will be critical in uncovering further biomarkers to assess COVID-19 severity. Learn more in “Diagnosis of SARS-CoV-2 infection in the setting of the cytokine release syndrome.”
Azar, Marwan M; Shin, Junghee J; Kang, Insoo; Landry, Marie.. Expert Rev Mol Diagn. doi: 10.1080/14737159.2020.1830760. PMID: 32990479.
VA Connecticut Healthcare System
In “,” researchers reviewed 173,194 patients with and without HIV and the incidence of sarcoidosis in each population using data from the Veterans Aging Cohort Study (VACS). They found that people with HIV had a lower risk of sarcoidosis, but despite the lower risk, the disease severity was similar across both populations. Read the complete report in Open Forum Infectious Diseases.
Hanberg, Jennifer S; Akgün, Kathleen M; Hsieh, Evelyn; Fraenkel, Liana; Justice, Amy C; VACS Project Team.. Open Forum Infectious Diseases. https://doi.org/10.1093/ofid/ofaa441