SPATIAL DISTRIBUTION AND HEALTH RISK ASSESSMENT OF HEAVY METALS IN URBAN PARKS AND GARDENS SOILS IN LAGOS STATE, NIGERIA

Distribution and health risk assessment of heavy metals in urban parks and gardens Gani Fawehinmi Park, Ojota, (GFP), Oshodi Heritage Park Oshodi (OHP), Ikorodu/Ipado Garden (IIG), MKO Abiola Gardens, Ojota (MKO), and MOE Garden, Alausa (MOE) soils in Lagos Metropolis, Nigeria were examined using Index of Geo-accumulation (Igeo), Potential Ecological Risk Index (RI) and health risk model. Urban parks and gardens soils were substantially polluted by Cu and Pb due closeness to highways where heavy metals emitted from motor vehicles are deposited.  Geoaccumulation index (Igeo) values for Pb were 10.616, 10.060, 9.027, 8.862 and 8.665 for GFP, OHP, IIG, MKO and MOE respectively. RI values for all the sites showed high pollution as they were all above 200. Health risk assessment revealed that children who visit the urban parks and garden in Lagos State are more exposed to cancer risk from Pb especially through ingestion. Results from this study provided valuable information on the pollution levels of urban parks in Lagos, Nigeria as a result of traffic related emissions and calls for proper monitoring of anthropogenic activities in the metropolis and reduce the human health impacts. The planting of hedge plants and erection of low walls could serve as shield against traffic pollution for the roadside parks     &nbsp

Association of immunotherapy and immunosuppression with severe COVID-19 disease in patients with cancer

Background: Cytokine storm due to COVID-19 can cause high morbidity and mortality. Patients with cancer treated with immunotherapy (IO) and those with immunosuppression may have higher rates of cytokine storm due to immune dysregulation. We sought to evaluate the association of IO and immunosuppression with COVID-19 outcomes and cytokine storm occurrence among patients with cancer and COVID-19, based on data from the COVID-19 and Cancer Consortium (CCC19). Methods: A registry-based retrospective cohort study was conducted on patients reported to the CCC19 registry from March 2020 to September 2021. The primary outcome was defined as an ordinal scale of COVID-19 severity. The secondary outcome was the occurrence of a cytokine storm using CCC19 variables, defined as biological and clinical evidence of severe inflammation, with end-organ dysfunction (Fajgenbaum D.C. et al., N Engl J Med., 2020). The association of IO or immunosuppression with the outcomes of interest were evaluated using a multivariable logistic regression balanced for covariate distributions through inverse probability of treatment weighting (IPTW). Results: A total of 10,214 patients were included, among which 482 (4.7%) received IO, 3,715 (36.4%) received non-IO systemic therapies, and 6,017 (58.9%) were untreated in the 3 months prior to COVID-19 diagnosis. No difference in COVID-19 severity or the development of a cytokine storm was found in the IO group compared to the untreated group (aOR: 0.77; 95%CI:0.45-1.32, and aOR: 1.06; 95%CI:0.42-2.67, respectively). On multivariable analysis, baseline immunosuppression was associated with worse outcomes both in relation to COVID-19 severity (aOR: 1.89; 95%CI:1.51-2.35) and the presence of a cytokine storm (aOR: 1.75; 95%CI:1.30-2.35). Conclusions: Administration of IO was not associated with severe outcomes in patients with cancer and COVID-19, whereas pre-existing baseline immunosuppression appears to be independently associated with worse clinical outcomes including cytokine storm

COVID-19 Severity and Cardiovascular Outcomes in SARS-CoV-2-Infected Patients With Cancer and Cardiovascular Disease

BACKGROUND: Data regarding outcomes among patients with cancer and co-morbid cardiovascular disease (CVD)/cardiovascular risk factors (CVRF) after SARS-CoV-2 infection are limited. OBJECTIVES: To compare Coronavirus disease 2019 (COVID-19) related complications among cancer patients with and without co-morbid CVD/CVRF. METHODS: Retrospective cohort study of patients with cancer and laboratory-confirmed SARS-CoV-2, reported to the COVID-19 and Cancer Consortium (CCC19) registry from 03/17/2020 to 12/31/2021. CVD/CVRF was defined as established CVD RESULTS: Among 10,876 SARS-CoV-2 infected patients with cancer (median age 65 [IQR 54-74] years, 53% female, 52% White), 6253 patients (57%) had co-morbid CVD/CVRF. Co-morbid CVD/CVRF was associated with higher COVID-19 severity (adjusted OR: 1.25 [95% CI 1.11-1.40]). Adverse CV events were significantly higher in patients with CVD/CVRF (all CONCLUSIONS: Co-morbid CVD/CVRF is associated with higher COVID-19 severity among patients with cancer, particularly those not receiving active cancer therapy. While infrequent, COVID-19 related CV complications were higher in patients with comorbid CVD/CVRF. (COVID-19 and Cancer Consortium Registry [CCC19]; NCT04354701)

Clinical Characteristics, Racial Inequities, and Outcomes in Patients with Breast Cancer and COVID-19: A COVID-19 and Cancer Consortium (CCC19) Cohort Study

BACKGROUND: Limited information is available for patients with breast cancer (BC) and coronavirus disease 2019 (COVID-19), especially among underrepresented racial/ethnic populations. METHODS: This is a COVID-19 and Cancer Consortium (CCC19) registry-based retrospective cohort study of females with active or history of BC and laboratory-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection diagnosed between March 2020 and June 2021 in the US. Primary outcome was COVID-19 severity measured on a five-level ordinal scale, including none of the following complications, hospitalization, intensive care unit admission, mechanical ventilation, and all-cause mortality. Multivariable ordinal logistic regression model identified characteristics associated with COVID-19 severity. RESULTS: 1383 female patient records with BC and COVID-19 were included in the analysis, the median age was 61 years, and median follow-up was 90 days. Multivariable analysis revealed higher odds of COVID-19 severity for older age (aOR per decade, 1.48 [95% CI, 1.32-1.67]); Black patients (aOR 1.74; 95 CI 1.24-2.45), Asian Americans and Pacific Islander patients (aOR 3.40; 95 CI 1.70-6.79) and Other (aOR 2.97; 95 CI 1.71-5.17) racial/ethnic groups; worse ECOG performance status (ECOG PS ≥2: aOR, 7.78 [95% CI, 4.83-12.5]); pre-existing cardiovascular (aOR, 2.26 [95% CI, 1.63-3.15])/pulmonary comorbidities (aOR, 1.65 [95% CI, 1.20-2.29]); diabetes mellitus (aOR, 2.25 [95% CI, 1.66-3.04]); and active and progressing cancer (aOR, 12.5 [95% CI, 6.89-22.6]). Hispanic ethnicity, timing, and type of anti-cancer therapy modalities were not significantly associated with worse COVID-19 outcomes. The total all-cause mortality and hospitalization rate for the entire cohort was 9% and 37%, respectively however, it varied according to the BC disease status. CONCLUSIONS: Using one of the largest registries on cancer and COVID-19, we identified patient and BC-related factors associated with worse COVID-19 outcomes. After adjusting for baseline characteristics, underrepresented racial/ethnic patients experienced worse outcomes compared to non-Hispanic White patients. FUNDING: This study was partly supported by National Cancer Institute grant number P30 CA068485 to Tianyi Sun, Sanjay Mishra, Benjamin French, Jeremy L Warner; P30-CA046592 to Christopher R Friese; P30 CA023100 for Rana R McKay; P30-CA054174 for Pankil K Shah and Dimpy P Shah; KL2 TR002646 for Pankil Shah and the American Cancer Society and Hope Foundation for Cancer Research (MRSG-16-152-01-CCE) and P30-CA054174 for Dimpy P Shah. REDCap is developed and supported by Vanderbilt Institute for Clinical and Translational Research grant support (UL1 TR000445 from NCATS/NIH). The funding sources had no role in the writing of the manuscript or the decision to submit it for publication. CLINICAL TRIAL NUMBER: CCC19 registry is registered on ClinicalTrials.gov, NCT04354701

Insurance Coverage of Patch Testing: A Retrospective Review in a University Dermatology Clinic

Background: Patch testing is considered both cost effective and beneficial to quality of life in patients with allergic contact dermatitis (ACD). Furthermore, increased number of allergens tested has been shown to correlate with increased relevant test results. However, health insurance providers and plans have differing allergen testing limits and guidelines for coverage. A more robust understanding of how patch testing contributes to patient financial burden is needed. Objective: To determine differences in insurance coverage and out-of-pocket (OOP) patient costs of patch testing. Methods: A retrospective chart review of patients at the George Washington University Dermatology Clinic receiving patch testing between January 1, 2015 and June 30, 2017 was performed. Data regarding patient demographics, testing plans, testing regimens, and calculated OOP costs were collected. Means of continuous variables were compared using Student’s T-test and proportions of categorical variables were compared using Fisher’s Exact Test. Results: Of the 414 charts reviewed, 367 met inclusion and exclusion criteria. Of the 367 patients, 316 had private insurance, including CareFirst® (N=162), United Healthcare® (UHC) (N=49), Aetna® (N=39), and Cigna® (N=38), while 51 patients were insured by Medicare. Patients with private coverage were 45.7 years old on average, compared to a mean age of 70.5 for Medicare patients. Medicare patients paid $180.06 in OOP costs on average, which was significantly less than CareFirst® patients ($396.58, p\u3c0.01) and all privately-insured patients combined ($403.70, p\u3c0.01). No significant differences in average OOP costs between patients of different individual private insurers were found. About 65% of UHC patients encountered allergen limits, in comparison to about 21% of Aetna® patients (p\u3c0.0001), 1.2% of CareFirst® patients (p\u3c0.0001), and 0% of Cigna® patients (p\u3c0.0001). The highest percentages of patients encountering treatment changes due to private insurance coverage were found in Aetna® (about 15%) and UHC (about 14%) patients, which contrasted 0% of both CareFirst® and Cigna® patients. Limitations: This study did not control for differences in insurance coverage due to age or patient preference for paying OOP costs. Conclusion: Allergen limitations imposed by insurance coverage are associated with altered treatment plans in patients undergoing patch testing. Further studies are warranted to delineate whether the cause of differences in OOP costs between privately and publically insured patients are due to confounding age-based differences in healthcare expenses and/or preferences