Discoveries & Impact (September 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

This nationwide study examines whether the volume of COVID-19 hospitalizations is independently associated with adverse outcomes. The research team evaluated overall hospitalization volume and case-growth, which is the average weekly change in the proportion of hospitalized patients relative to number of beds across 85 U.S. hospitals. The authors found a significant variation in patient mortality and case-growth. Learn more in The American Journal of Medicine.

Khera R, Liu Y, de Lemos JA, Das SR, Pandey A, Omar W, Kumbhani DJ, Girotra S, Yeh RW, Rutan C, Walcoch J, Lin Z, Bradley SM, Velazquez EJ, Churchwell KB, Nallamothu BK, Krumholz HM, Curtis JP. Association of Coronavirus Disease-19 Hospitalization Volume and Case Growth at United States Hospitals with Patient Outcomes. Am J Med. 2021 Jul 31:S0002-9343(21)00468-X. doi: 10.1016/j.amjmed.2021.06.034. Epub ahead of print. PMID: 34343515; PMCID: PMC8325555.

Digestive Diseases

A recent case series published in Molecular Genetics and Metabolism finds that patients with Gaucher disease who contracted COVID-19 appeared to experience a milder course of COVID-19 despite their underlying immune system dysfunction, and often harboring other known high risk co-morbidities. Read more here.

Narayanan P, Nair S, Balwani M, Malinis M, Mistry P. The clinical spectrum of SARS-CoV-2 infection in Gaucher disease: Effect of both a pandemic and a rare disease that disrupts the immune system. Molecular Genetics And Metabolism 2021 doi: 10.1016/j.ymgme.2021.08.004. PMID: 34412940. PMCID: PMC8361210.

Endocrinology & Metabolism

A recent study in The Journal of Nutrition examined the effects of diets varying in carbohydrate content on brain regions involved in hunger and reward, finding significant increases in regional cerebral brain flow in participants with high carbohydrate content diets, writes Janice Hwang, MD, in an editorial comments.

Hwang JJ. Food for Thought. The Journal Of Nutrition 2021, 151(8):2089-2091. doi: 10.1093/jn/nxab210. PMID: 34195820.

General Internal Medicine

Breast cancer screening costs have risen considerably as digital breast tomosynthesis (DBT) has become the predominant screening mode in the U.S., according to a recent research letter in JAMA Internal Medicine. “Our findings highlight how shifting to DBT has been associated with substantial national expenditures, despite questions about value,” the authors write.

Richman IB, Long JB, Kunst N, Kyanko K, Xu X, Busch S, Gross CP. Trends in Breast Cancer Screening Costs Among Privately Insured Women Aged 40 to 64 Years. JAMA Internal Medicine 2021 doi: 10.1001/jamainternmed.2021.4832. PMID: 34459853.

Geriatrics

In this new study, researchers found that the under- and over-reporting of short sleep duration (less than or equal to six hours of sleep) was common in people over 65 years of age. They suggest the objective confirmation of sleep duration when evaluating its effects on a patient. Learn more.

Miner B, Stone KL, Zeitzer JM, Han L, Doyle M, Blackwell T, Gill TM, Redeker NS, Hajduk A, Yaggi HK. Self-reported and actigraphic short sleep duration in older adults. Journal Of Clinical Sleep Medicine : JCSM : Official Publication Of The American Academy Of Sleep Medicine 2021 doi: 10.5664/jcsm.9584. PMID: 34338629.

Hematology

In the August issue of The Lancet, Alfred I. Lee, MD, PhD, and Cornell Hematologist Eun-Ju Lee, MD, a Yale hematology/oncology fellowship graduate, comment on a landmark UK study of vaccine-induced immune thrombotic thrombocytopenia (VITT), a rare complication of the Johnson & Johnson and AstraZeneca COVID-19 vaccines in women 50 and younger. Read more in The Lancet.

Lee EJ, Lee AI. Cerebral venous sinus thrombosis after vaccination: the UK experience. Lancet 2021 doi: 10.1016/S0140-6736(21)01788-8. PMID: 34370974. PMCID: PMC8346246.

Infectious Diseases

The Delta variant of the COVID-19 virus is a serious challenge that must be dealt with using an evidence-based responses such as vaccinations and public health mitigation strategies. Health care professionals are vital to increasing vaccinations. Learn more.

Del Rio C, Malani PN, Omer SB. Confronting the Delta Variant of SARS-CoV-2, Summer 2021. JAMA 2021 doi: 10.1001/jama.2021.14811. PMID: 34406361.

Medical Oncology

Kerin Adelson, MD, was among the members of an expert panel that recently developed standards for a pilot of the Oncology Medical Home (OMH) certification program. Among the areas that the standards cover are patient engagement, availability and access to care, equitable and comprehensive team-based care, and quality improvement. The goal of these standards is to ensure equitable access to high-quality care for cancer patients, as well as equitable research, while addressing structural barriers to these goals. Read more in JCO Oncology Practice. Yale New Haven Health’s Smilow Cancer Hospital is one of the pilot certification sites. “As one of only two large academic cancer centers that are participating in the pilot, we will help to determine the feasibility and impact of these standards,” Adelson said.

Woofter K, Kennedy EB, Adelson K, Bowman R, Brodie R, Dickson N, Gerber R, Fields KK, Murtaugh C, Polite B, Paschall M, Skelton M, Zoet D, Cox JV. Oncology Medical Home: ASCO and COA Standards. JCO Oncology Practice 2021, 17(8):475-492. doi: 10.1200/OP.21.00167. PMID: 34255551.

Nephrology

A case report in Clinical Nephrology describes the case of a 57-year-old man who presented multiple times with acute kidney injury and was ultimately diagnosed with perianeurysmal retroperitoneal fibrosis, suggesting that this diagnosis should be considered in older adults presenting with recurrent acute kidney injury, even in the absence of initial ultrasonographic evidence of obstruction.

Hodson DZ, Cantley LG, Perincheri S, Singh N. Perianeurysmal retroperitoneal fibrosis presenting as acute kidney injury: A case report. Clinical Nephrology 2021, 96(2):112-119. doi: 10.5414/CN110331. PMID: 34142944.

Pulmonary, Critical Care & Sleep Medicine

Persistent Exertional Intolerance After COVID-19 study compared 10 recovered COVID-19 patients to age and sex-matched control group and found that the decreased aerobic exercise capacity observed in the post-COVID-19 patients is the result of impaired oxygen extraction in the peripheral vasculature and not from limitations imposed by the heart and/or lungs. Additionally, the post-COVID-19 patients exhibited an exaggerated hyper-ventilatory response during exercise that contributes to their exercise limitations.

Singh I, Joseph P, Heerdt PM, Cullinan M, Lutchmansingh DD, Gulati M, Possick JD, Systrom DM, Waxman AB. Persistent Exertional Intolerance After COVID-19: Insights From Invasive Cardiopulmonary Exercise Testing. Chest 2021 doi: 10.1016/j.chest.2021.08.010. PMID: 34389297. PMCID: PMC8354807.

Rheumatology, Allergy & Immunology

Researchers propose a group 1, 2, and 3 classifications for CD4⁺ T cells that aid in B cell differentiation – a nomenclature applicable to both BCL6- dependent T follicular helper (Tfh) cells and BCL6-independent ‘Tfh-like’ cells. The classification system acknowledges cellular plasticity and categorizes cell states based on phenotype and function, paired with their anatomical state of action. Learn more here.

Eisenbarth SC, Baumjohann D, Craft J, Fazilleau N, Ma CS, Tangye SG, Vinuesa CG, Linterman MA. CD4+ T cells that help B cells - a proposal for uniform nomenclature. Trends In Immunology 2021, 42(8):658-669. doi: 10.1016/j.it.2021.06.003. PMID: 34244056. PMCID: PMC8324560.