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

Plasma Interferon-gamma and IL-4, Immunoglobulin Classes and Nitric Oxide in Nigerians with Acute Leukaemia

Acute leukaemia are usually rapidly progressive with death often occurring in a few weeks to a few months in untreated patients as a result of abnormal hematopoietic function as well as impaired immune response. The risk of relapse which remains in 20% of patients in remission calls for more research on acute leukaemia. This study therefore, evaluated the plasma levels of nitric oxide (NO), interleukin-4 (IL-4), interferon-gamma (IFN-γ) and immunoglobulin classes (IgA, IgG, IgM, IgE) in twenty-five (25) patients with acute leukaemia (AL) and twenty-five (25) apparently healthy controls. The mean levels of plasma IgA, IgG and IgM were not significantly elevated in leukaemia patients compared with control. However, the mean plasma levels of IgE, NO, IL-4 and IFN-γ were significantly elevated in leukaemia patients compared with controls. It could therefore be concluded from this study that humoural immunity is not depressed in acute leukaemia patients

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

Insufficiencies in sensory systems reweighting is associated with walking impairment severity in chronic stroke: an observational cohort study

BackgroundWalking and balance impairment are common sequelae of stroke and significantly impact functional independence, morbidity, and mortality. Adequate postural stability is needed for walking, which requires sufficient integration of sensory information between the visual, somatosensory, and vestibular centers. “Sensory reweighting” describes the normal physiologic response needed to maintain postural stability in the absence of sufficient visual or somatosensory information and is believed to play a critical role in preserving postural stability after stroke. However, the extent to which sensory reweighting successfully maintains postural stability in the chronic stages of stroke and its potential impact on walking function remains understudied.MethodsIn this cross-sectional study, fifty-eight community-dwelling ambulatory chronic stroke survivors underwent baseline postural stability testing during quiet stance using the modified Clinical test of Sensory Interaction in Balance (mCTSIB) and assessment of spatiotemporal gait parameters.ResultsSeventy-six percent (45/58) of participants showed sufficient sensory reweighting with visual and somatosensory deprivation for maintaining postural stability, albeit with greater postural sway velocity indices than normative data. In contrast, survivors with insufficient reweighting demonstrated markedly slower overground walking speeds, greater spatiotemporal asymmetry, and limited acceleration potential.ConclusionAdequate sensory system reweighting is essential for chronic stroke survivors’ postural stability and walking independence. Greater emphasis should be placed on rehabilitation strategies incorporating multisensory system integration testing and strengthening as part of walking rehabilitation protocols. Given its potential impact on outcomes, walking rehabilitation trials may benefit from incorporating formal postural stability testing in design and group stratification

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

Review of applications of microneedling in dermatology

Christopher Iriarte,1 Olabola Awosika,2 Monica Rengifo-Pardo,1,2 Alison Ehrlich1,2 1George Washington University School of Medicine and Health Sciences, Washington, DC, USA; 2Department of Dermatology, The George Washington Medical Faculty Associates, Washington, DC, USA Abstract: Microneedling (MN) is a novel therapeutic modality in dermatology. Through physical trauma from needle penetration, MN induces a wound healing cascade with minimal damage to the epidermis. This allows for enhancement in the absorption of mainstay topical therapies across the thick stratum corneum. MN has become increasingly utilized over the last several years as it is a relatively simple procedure that is cost-effective, well tolerated, and offers both cosmetic and therapeutic benefits. The ability to treat localized areas of disease has led to numerous studies gauging its potential in focal diseases of inflammation, dyschromia, and photodamage. This review discusses the principles and evidence behind the expanding applications of MN. It has shown promising results as an adjuvant therapy for enhanced drug delivery in the treatment of atrophic scars, alopecia, actinic keratoses, and disorders of pigmentation such as melasma. The efficacy in treatment of vitiligo remains limited. Overall, the procedure has few adverse sequelae compared to other therapies, is highly efficacious, and is a viable resurfacing option for skin of color. Future research is needed to determine the frequency, interval, and specific device settings that foster optimal results. Additionally, large controlled trials are needed to shed light on the utility of MN as an evidence-based regimen for the treatment of various dermatologic conditions. Keywords: microneedling, scars, acne, alopecia, hyperpigmentation, actinic keratosi

Profile of dupilumab and its potential in the treatment of inadequately controlled moderate-to-severe atopic dermatitis

Olabola Awosika,1 Lori Kim,2 Momina Mazhar,2 Monica Rengifo-Pardo,1,2 Alison Ehrlich1,2 1Department of Dermatology, The George Washington Medical Faculty Associates, Washington, DC, USA; 2George Washington University School of Medicine & Health Sciences, Washington, DC, USA Abstract: Atopic dermatitis (AD) is a common inflammatory skin disorder that manifests as eczematous lesions, often associated with allergic rhinitis and asthma. Historically, moderate-to-severe disease has been managed with systemic immunosuppression, such as oral corticosteroids, which result in relapse and limiting side effects. Due to recent advancements in the identification of interleukin (IL)-4 and IL-13 as key mediators in AD, new biological agents have been developed for treatment. Dupilumab is a recently approved monoclonal antibody that targets the alpha subunit of the IL-4 receptor and, thus, downregulates activity of IL-4 and IL-13. This review discusses the profile of dupilumab and its potential for efficacy and safety in treating moderate-to-severe AD by reviewing data from Phase I–III clinical trials. Results suggest that dupilumab shows great therapeutic promise for AD. Further studies investigating extended use of dupilumab and dupilumab in comparison to other agents are needed to establish long-term efficacy and safety. Keywords: atopic dermatitis, dupilumab, IL-4, IL-13, biologic

Individual and socioeconomic factors associated with childhood immunization coverage in Nigeria

INTRODUCTION: Immunization is the world's most successful and cost-effective public health intervention as it prevents over 2 million deaths annually. However, over 2 million deaths still occur yearly from Vaccine preventable diseases, the majority of which occur in sub-Saharan Africa. Nigeria is a major contributor of global childhood deaths from VPDs. Till date, Nigeria still has wild polio virus in circulation. The objective of this study was to identify the individual and socioeconomic factors associated with immunization coverage in Nigeria through a secondary dataset analysis of Nigeria Demographic and Health Survey (NDHS), 2013. METHODS: A quantitative analysis of the 2013 NDHS dataset was performed. Ethical approvals were obtained from Walden University IRB and the National Health Research Ethics Committee of Nigeria. The dataset was downloaded, validated for completeness and analyzed using univariate, bivariate and multivariate statistics. RESULTS: Of 27,571 children aged 0 to 59 months, 22.1% had full vaccination, and 29% never received any vaccination. Immunization coverage was significantly associated with childbirth order, delivery place, child number, and presence or absence of a child health card. Maternal age, geographical location, education, religion, literacy, wealth index, marital status, and occupation were significantly associated with immunization coverage. Paternal education, occupation, and age were also significantly associated with coverage. Respondent's age, educational attainment and wealth index remained significantly related to immunization coverage at 95% confidence interval in multivariate analysis. CONCLUSION: The study highlights child, parental and socioeconomic barriers to successful immunization programs in Nigeria. These findings need urgent attention, given the re-emergence of wild poliovirus in Nigeria. An effective, efficient, sustainable, accessible, and acceptable immunization program for children should be designed, developed and undertaken in Nigeria with adequate strategies put in place to implement them