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Fogelson B, Baljepally R, Heidel E, Ferlita S, Moodie T, Coombes T, Goodwin RP, Livesay J. Rural versus urban outcomes following transcatheter aortic valve implantation: The importance of the heart team. Cardiovasc Revasc Med 2024; 62:3-8. [PMID: 38135570 DOI: 10.1016/j.carrev.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Rural patients face known healthcare disparities and worse cardiovascular outcomes compared to urban residents due to inequitable access and delayed care. Few studies have assessed rural-urban differences in outcomes following Transcatheter Aortic Valve Implantation (TAVI). We compared short-term post-TAVI outcomes between rural and urban patients. METHODS We performed a retrospective analysis of n = 413 patients who underwent TAVI at our large academic medical center, between 2011 and 2020 (rural/urban patients = 93/320. Rural/urban males = 53/173). Primary outcomes were all-cause mortality and cardiovascular mortality. Secondary outcomes included stroke/transient ischemic attack, myocardial infarction, atrial fibrillation, acute kidney injury, bleeding, vascular complications, and length of stay. RESULTS The mean age in years was 77 [IQR 70-82] for rural patients and 78 [IQR 72-84] for urban patients. Baseline characteristics were similar between groups, except for a greater frequency of active smokers and diabetics as well as a greater body mass index in the rural group. There were no statistically significant differences in all-cause or cardiovascular mortality between the groups. There was also no statistically significant difference in secondary outcomes. CONCLUSION Rural and urban patients had no statistically significant difference in all-cause mortality or cardiovascular mortality following TAVI. Given its minimally invasive nature and quality-centric, multidisciplinary care provided by the TAVI Heart Teams, TAVI may be the preferred modality for the treatment of severe aortic stenosis in rural populations.
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Affiliation(s)
- Benjamin Fogelson
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.
| | - Raj Baljepally
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Eric Heidel
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Steve Ferlita
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Travis Moodie
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Tyler Coombes
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Rachel P Goodwin
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - James Livesay
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
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Vierhout T, Blaseg N, Moodie T, McCauley R, Singh A, Larson E, Stys A, Stys T. Impact of Emergency Medical Service Provider Training and Institutional Volume Experience on ST-Elevation Myocardial Infarction Patient Outcomes in Rural Setting. S D Med 2022; 75:342-346. [PMID: 36745980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Rural sites provide management challenges for ST-elevation myocardial infarction (STEMI) patients. The impact of emergency medical service (EMS) training and institutional volume experience on STEMI outcomes was examined. METHODS All STEMI patients transferred to Sanford from 32 sites in rural South Dakota from 2010-2019 were analyzed. "Time to electrocardiogram (EKG)" (TEKG) and "Time from EKG to Thrombolytics" (TThrom) were calculated. Sites were compared based on EMS training (advanced life support (ALS) vs. basic life support (BLS)) and institutional volume experience (less than or equal to five vs. greater than five STEMI). RESULTS 514 STEMI patients from 32 sites in South Dakota were analyzed. Average TEKG was 20 (±15) and 14 (±10) minutes for ALS and BLS trained services, respectively (p=0.25). More experienced sites had an average TEKG of 26 (±15) minutes, while sites with ≤ five STEMI patients had an average time of 15 (±13) minutes. TThrom did not differ significantly between sites based on our metrics. CONCLUSION The present study concludes that EMS provider training (BLS vs ALS) and institutional volume experience do not significantly impact patient-related outcomes when treating STEMI patients. This result is possibly attributed to increased educational efforts for rural health care providers in general and the establishment of the South Dakota statewide STEMI Network "Mission: Lifeline" which standardized STEMI care and improved connectivity between remote responders and the larger PCI-capable facilities.
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Affiliation(s)
- Thomas Vierhout
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Nate Blaseg
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Travis Moodie
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | | | - Aditya Singh
- Sanford Heart Hospital, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Eric Larson
- Department of Internal Medicine, Division of General Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Adam Stys
- ardiovascular Disease and Interventional Cardiology Fellowship Program, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Tomasz Stys
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
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Alshaqi O, Moodie T, Alchaki A. Involuntary crying episodes with Susac's syndrome-a rare presentation of a rare disease: a case report. BMC Neurol 2022; 22:155. [PMID: 35468771 PMCID: PMC9036746 DOI: 10.1186/s12883-022-02639-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this case, we reported the pseudobulbar affect (PBA) in a patient with Susac's syndrome-a rare condition that was caused by a rare syndrome. Previous case reports of Susac syndrome described psychiatric symptoms such as emotional disturbances or personality changes. Only a few case reports have reported psychiatric disorders in patients with Susac's syndrome. There were no reported cases of Susac syndrome with PBA as an initial presentation. CASE PRESENTATION Our patient was 56 years old and presented with involuntary crying, left-sided headache, left-sided hearing loss, and tinnitus. Brain MRI showed numerous areas of restricted diffusion and enhancement involving the corpus callosum, bilateral hemispheres, and brainstem. Ophthalmological evaluation showed bilateral branch retinal artery occlusion. She was diagnosed with Susac's syndrome and PBA. She was treated with cyclophosphamide and dextromethorphan hydrobromide/quinidine sulfate with excellent recovery. This is a 2-year clinical course. DISCUSSION AND CONCLUSIONS Recognition of the clinical presentation of Susac's syndrome and PBA with early diagnosis and treatment are the keys to preventing further disability and impact on patients and their families.
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Affiliation(s)
- O Alshaqi
- Damascus University, Damascus, Syria
| | - T Moodie
- University of South Dakota, Vermillion, USA
| | - A Alchaki
- University of South Dakota, Vermillion, USA.
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Moodie T, Alshaqi O, Alchaki A. Longitudinal extensive transverse myelitis after chemoradiation therapy with durvalumab, a rare complication: case report. BMC Neurol 2022; 22:107. [PMID: 35305566 PMCID: PMC8933995 DOI: 10.1186/s12883-022-02576-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 02/01/2022] [Indexed: 11/24/2022] Open
Abstract
Background Longitudinal extensive transverse myelitis is a rare and potentially life-threatening complication of chemoradiation. Certain chemotherapy agents have been proposed to increased neurotoxicity with chemoradiation therapy. One such agent is durvalumab, a human IgG1 monoclonal antibody that blocks programmed death ligand 1, allowing T-cells to recognize and kill tumor cells. Durvalumab and other immune checkpoint inhibitors may also cause transverse myelitis without concomitant treatment with radiation. Durvalumab is a standard therapy for non-small cell lung carcinoma. Here we present a case of a 68-year-old male who presented after chemoradiation and durvalumab therapy with transverse myelitis extending outside the irradiation site. Case presentation A 68-year-old male presented to the emergency department with pain and weakness in his feet and hesitancy of urination. Medical history is significant for non-small cell lung cancer treated with chemoradiotherapy and consolidation therapy with durvalumab for one year. His last radiation treatment was 15 months prior, and his last infusion of durvalumab was 3 months prior. Exam revealed severe weakness of bilateral legs with absent vibration sensation. MRI showed central longitudinal extensive transverse myelitis extending from C4-T11. CSF studies showed 8 WBC with 63% lymphocyte predominance and a protein of 48. Oligoclonal bands and angiotensin-converting enzyme were negative. Serum Neuromyelitis Optica antibody (AQP4-IgG) and Myelin oligodendrocyte glycoprotein antibody (MOG-IgG) were negative. Infectious workup came back negative. The patient was treated with steroids and plasma exchange with mild improvement. Etiology remained unknown, but longitudinal extensive transverse myelitis following durvalumab chemoradiotherapy was thought to be the likely cause. He was discharged on a high-dose prednisone taper with outpatient follow-up. His condition worsened near the end of the steroid taper. High-dose prednisone and cyclophosphamide infusions were started with mild improvement and stabilization of the patient’s condition. He transitioned to methotrexate after completion of six cyclophosphamide infusions. The patient expired due to complications from his cancer. Conclusion Longitudinal extensive transverse myelitis is a rare and potentially life-threatening complication of durvalumab therapy. As durvalumab has become a standard treatment for non-small cell lung cancer, it is important to be able to identify and treat side effects.
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Waldstein C, Moodie T, Ashworth S, Stuart K, Ahern V, Wang W. Feasibility of Arm-Draining Lymph Node-Sparing Radiotherapy of Breast Cancer: A Pilot Planning Study. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Keall P, Nguyen D, O'Brien R, Hewson E, Ball H, Poulsen P, Booth J, Greer P, Hunter P, Wilton L, Bromley R, Kipritidis J, Eade T, Kneebone A, Hruby G, Moodie T, Hayden A, Turner S, Arumugam S, Sidhom M, Hardcastle N, Siva S, Tai K, Gebski V, Martin J. PO-0842 Real-Time tracking improves treatment: The TROG Stereo Prostate Ablative Radiotherapy with KIM trial. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31262-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Shepardson K, Larson K, Cho H, Johns LL, Malkoc Z, Stanek K, Wellhman J, Zaiser S, Daggs-Olson J, Moodie T, Klonoski JM, Huber VC, Rynda-Apple A. A Novel Role for PDZ-Binding Motif of Influenza A Virus Nonstructural Protein 1 in Regulation of Host Susceptibility to Postinfluenza Bacterial Superinfections. Viral Immunol 2019; 32:131-143. [PMID: 30822217 DOI: 10.1089/vim.2018.0118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Influenza A viruses (IAVs) have multiple mechanisms for altering the host immune response to aid in virus survival and propagation. While both type I and II interferons (IFNs) have been associated with increased bacterial superinfection (BSI) susceptibility, we found that in some cases type I IFNs can be beneficial for BSI outcome. Specifically, we have shown that antagonism of the type I IFN response during infection by some IAVs can lead to the development of deadly BSI. The nonstructural protein 1 (NS1) from IAV is well known for manipulating host type I IFN responses, but the viral proteins mediating BSI severity remain unknown. In this study, we demonstrate that the PDZ-binding motif (PDZ-bm) of the NS1 C-terminal region from mouse-adapted A/Puerto Rico/8/34-H1N1 (PR8) IAV dictates BSI susceptibility through regulation of IFN-α/β production. Deletion of the NS1 PDZ-bm from PR8 IAV (PR8-TRUNC) resulted in 100% survival and decreased bacterial burden in superinfected mice compared with 0% survival in mice superinfected after PR8 infection. This reduction in BSI susceptibility after infection with PR8-TRUNC was due to the presence of IFN-β, as protection from BSI was lost in Ifn-β-/- mice, resembling BSI during PR8 infection. PDZ-bm in PR8-infected mice inhibited the production of IFN-β posttranscriptionally, and both delayed and reduced expression of the tunable interferon-stimulated genes. Finally, a similar lack of BSI susceptibility, due to the presence of IFN-β on day 7 post-IAV infection, was also observed after infection of mice with A/TX98-H3N2 virus that naturally lacks a PDZ-bm in NS1, indicating that this mechanism of BSI regulation by NS1 PDZ-bm may not be restricted to PR8 IAV. These results demonstrate that the NS1 C-terminal PDZ-bm, like the one present in PR8 IAV, is involved in controlling susceptibility to BSI through the regulation of IFN-β, providing new mechanisms for NS1-mediated manipulation of host immunity and BSI severity.
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Affiliation(s)
- Kelly Shepardson
- 1 Department of Microbiology and Immunology, Montana State University, Bozeman, Montana
| | - Kyle Larson
- 1 Department of Microbiology and Immunology, Montana State University, Bozeman, Montana
| | - Hanbyul Cho
- 1 Department of Microbiology and Immunology, Montana State University, Bozeman, Montana
| | - Laura Logan Johns
- 1 Department of Microbiology and Immunology, Montana State University, Bozeman, Montana
| | - Zeynep Malkoc
- 1 Department of Microbiology and Immunology, Montana State University, Bozeman, Montana
| | - Kayla Stanek
- 1 Department of Microbiology and Immunology, Montana State University, Bozeman, Montana
| | - Julia Wellhman
- 1 Department of Microbiology and Immunology, Montana State University, Bozeman, Montana
| | - Sarah Zaiser
- 2 Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota
| | - Jaelyn Daggs-Olson
- 2 Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota
| | - Travis Moodie
- 2 Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota
| | - Joshua M Klonoski
- 2 Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota
| | - Victor C Huber
- 2 Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota
| | - Agnieszka Rynda-Apple
- 1 Department of Microbiology and Immunology, Montana State University, Bozeman, Montana
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Hewson E, Nguyen D, O'Brien R, Poulsen P, Booth J, Bromley R, Kipritidis J, Moodie T, Greer P, Eade T, Kneebone A, Martin J, Hayden A, Hruby G, Hunter P, Wilton L, Turner S, Gebski V, Keall P. Kilovoltage Intrafraction Monitoring (KIM) Real-Time Tracking Improves Patient Dose Distributions: Interim Primary Hypothesis Results from the First 20 Patients on the TROG 15.01 Stereotactic Prostate Ablative Radiation Therapy SPARK Trial. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wang W, Ward R, Jia D, Ashworth S, Estoesta E, Moodie T, McCredie R, Ahern V, Stuart K, Ngui N, French J, Elder E, Farlow D. EP-1305: Location of arm draining lymph node in relation to breast cancer radiotherapy field and volume. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31615-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Salkeld A, Wang W, Nahar N, Hau E, Nahar N, Sykes J, Moodie T, Thwaites D. EP-2175: Improvement in radiosurgical plan dosimetry with implementation of a quality assurance program. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32484-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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