Community-Engaged Assessment of Soil Lead Contamination in Atlanta Urban Growing Spaces

Urban agriculture is emerging as a method to improve food security and public health in cities across the United States. However, an increased risk of exposure to heavy metals and metalloids (HMM) exists through interaction with contaminated soil. Community-engaged research (CEnR) is one method that can promote the inclusion of all partners when studying exposures such as HMM in soil. Researchers and community gardeners co-designed this study to measure the concentrations of lead (Pb), using X-Ray Fluorescence (XRF) verified with Inductively Coupled Plasma-Mass Spectrometry (ICP-MS) in soils from 19 urban agricultural and residential sites in the Westside of Atlanta and three rural sites in Georgia. Seventeen other HMM were measured but not included in this study, because they did not pose risks to the community comparable to elevated Pb levels. Pb concentrations were compared to the Environmental Protection Agency (EPA)'s regional screening levels (RSLs) for residential soil and the University of Georgia (UGA) extension service's low-risk levels (LRLs) for agriculture. Soils from the majority of sites had levels below EPA RSLs for Pb, yet above the UGA LRL. However, soil Pb concentrations were three times higher than the EPA RSL on some sites that contained metal refining waste or slag. Our findings led to direct action by local and federal government agencies to initiate the cleanup of slag residue. Studies involving exposures to communities should engage those affected throughout the process for maximum impact.

Multivessel spontaneous coronary artery dissection: clinical features, angiographic findings, management, and outcomes

Background

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. The rate of SCAD patients with multivessel (MV) involvement varies between series (6–13%)1,2. MV SCAD might be potentially associated to a worse prognosis due to a higher ischemic burden compared with patients with single-vessel (SV) involvement. However, comparative data between patients with MV versus SV SCAD is lacking.

Methods

The Spanish multicentre nationwide SCAD registry prospectively included 389 consecutive patients from 34 university hospitals. Patients were classified according to the number of affected vessels in two groups: SV or MV SCAD. In-hospital major adverse event (MAE) was defined as a composite of death, myocardial reinfarction, unplanned revascularization, cardiogenic shock, ventricular arrhythmia or stroke. A major cardiac or cerebrovascular adverse event (MACCE) was defined as a composite of death, myocardial reinfarction, unplanned revascularization, SCAD recurrence or stroke.

Results

A total of 41 patients (10.5%) presented MV SCAD (Table 1). There were no significant differences between groups regarding age, sex and distribution of most cardiovascular risk factors, with a non-significant trend towards more hypertension in the MV group (49% vs 34%, p=0.06). MV SCAD patients had more often previous history of hypothyroidism (22% vs 11%, p=0.04) and anxiety disorder (32% vs 16%, p=0.01), with a trend towards more fibromuscular dysplasia (50% vs 29%, p=0.12) among those patients screened. MV SCAD patients presented more often with NSTEMI (73% vs 52%, p=0.01). Regarding angiographic findings, MV SCAD patients presented more frequently focal type 3 lesions (19% vs 6%, p<0.01) and fewer type 1 double-lumen lesions (12% vs 21%, p=0.04). The rate of lesions with an impaired initial Thrombolysis In Myocardial Infarction (TIMI) flow 0–1 was lower (14% vs 29%, p<0.01) in MV SCAD. In both groups, most patients were treated conservatively (71% vs 79%, p=NS). We found no significant differences between groups in MAE during admission. At long-term follow-up (median 29 months), there were no significant differences in MACCE between groups (18% vs 12%, p=0.28). However, the rate of stroke was higher in patients with MV SCAD, both in-hospital (2.4% vs 0%, p<0.01) and at follow-up (5.1% vs 0.6%, p=0.01). This finding could be explained by the basal differences found in hypertension and fibromuscular dysplasia between MV and SV SCAD patients.

Conclusions

Patients with MV SCAD have some distinctive clinical and angiographic features. We found no significant differences in our primary composite outcomes, both in-hospital and at long-term follow-up, between patients with SV and MV SCAD. Rate of stroke was significantly higher in patients with MV SCAD.

Funding Acknowledgement

Type of funding sources: None.

Atlanta Residents' Knowledge Regarding Heavy Metal Exposures and Remediation in Urban Agriculture

Urban agriculture and gardening provide many health benefits, but the soil is sometimes at risk of heavy metal and metalloid (HMM) contamination. HMM, such as lead and arsenic, can result in adverse health effects for humans. Gardeners may face exposure to these contaminants because of their regular contact with soil and consumption of produce grown in urban areas. However, there is a lack of research regarding whether differential exposure to HMM may be attributed to differential knowledge of exposure sources. In 2018, industrial slag and hazardous levels of soil contamination were detected in West Atlanta. We conducted community-engaged research through surveys and follow-up interviews to understand awareness of slag, HMM in soil, and potential remediation options. Home gardeners were more likely to recognize HMM health effects and to cite health as a significant benefit of gardening than community gardeners. In terms of knowledge, participants were concerned about the potential health effects of contaminants in soil yet unconcerned with produce in their gardens. Gardeners’ knowledge on sources of HMM exposure and methods for remediation were low and varied based on racial group.

1095 Effective image-guided medical management in effusive constrictive pericarditis

A 59 year old man was admited to hospitalization for persistent chest pain related to acute pericarditis. Within the admision tests, a transthoracic echography was performed, showing a moderate pericardial effusion with ventricular septal bounce and significant respiratory variations in mitral and tricuspid inflows, all of it consistent with effusive-constrictive pericarditis (Panel A). Anti-inflammatory treatment with ibuprofen and colchicine was started.

During the first 48 hours of admission there was a clinical and hemodinamic worsening in the patient’s condition that forced the performance of a pericardial window, obtaining a very little quantity of dense pericardial fluid. Looking for a more accurate study of the pericardium, a cardiovascular magnetic resonance (CMR) was performed, revealing a thick heterogeneous pericardial effusion (Panel B) and a significant late gadolinium enhancement of both pericardial layers (Panel C). All these findings where consistent with an effusive constrictive pericarditis with persistent inflammatory activity despite high doses of conventional inflammatory treatment. Furthermore, the growth of Propionibacterium acnes in the pericardial fluid disclosed the etiology of this condition.

Medical treatment was enhanced with high doses of intravenous corticosteroid, ceftriaxone and doxycycline. During the following days, the patient showed an excellent response achieving the complete clinical and echocardiographic relief of constrictive signs (Panel D).

Effusive constrictive pericarditis is characterized by the presence of pericardial effusion and constriction secondary to an inflammatory process of the pericardium. Pericardiectomy might be necessary in case of failure of medical treatment, a very common scenario in this kind of .pericarditis.

Our case is remarkable because it demonstrates the value of CMR to detect persistent inflammation of pericardium despite high doses of conventional medical treatment for pericaricarditis guiding the successful escalation to intravenous corticosteroid and avoiding the risk of an unnecessary cardiac surgery.

Abstract 1095 Figure.

Responsiveness of ovaries to exogenous gonadotrophins and laparoscopic artificial insemination with frozen-thawed spermatozoa in ocelots (Felis pardalis)

Adult female ocelots (Felis pardalis) were treated with one of four dosages of equine chorionic gonadotrophin (eCG) and human chorionic gonadotrophin (hCG) (100 iu eCG/75 iu hCG, n = 3; 200 iu eCG/150 iu hCG, n = 4; 400 iu eCG/150 iu hCG, n = 5; 500 iu eCG/225 iu hCG, n = 5); hCG was administered 80 h after eCG. Ovaries of each animal were evaluated by laparoscopy 39-43 h after hCG, and blood was collected for progesterone and oestradiol analysis. With progressive increases in gonadotrophin dosage, female ocelots produced more (P < 0.05) unovulated follicles (> or = 2 mm in diameter), ranging from 1.3 +/- 0.7 (mean +/- SEM) follicles per female at the lowest dosage to 8.8 +/- 2.8 follicles per female at the highest dosage. Similarly, ocelots produced more (P < 0.05) corpora lutea with increasing gonadotrophin dosages, with mean values ranging from 0-5.0 +/- 1.2 corpora lutea. However, across treatment groups, a similar proportion (P > 0.05) of females ovulated in response to each dosage. At laparoscopy, serum concentrations of oestradiol (overall mean, 330.2 +/- 62.2 pg ml-1) and serum concentrations of progesterone (overall mean, 18.5 +/- 6.4 ng ml-1) in ovulating females did not differ (P > 0.05) across treatment groups. Ten ovulating ocelots were laparoscopically inseminated with fresh (4.7 +/- 0.2 x 10(6); n = 2 females) or frozen-thawed (10.7 +/- 1.8 x 10(6); n = 8 females), motile spermatozoa. One female treated with 500 iu eCG/225 iu hCG and inseminated with 7.5 x 10(6) motile, frozen-thawed spermatozoa conceived and gave birth to a healthy male kitten after a gestation of 78 days. We conclude that ocelots are relatively insensitive to exogenous gonadotrophins, requiring much higher dosages (on a per body mass basis) to elicit an appropriate ovarian response than do any other felid species studied to date. Nonetheless, the gonadotrophin-treated female can become pregnant and carry offspring to term after laparoscopic intrauterine insemination with frozen-thawed spermatozoa.

Coenuriasis in a spectacled langur (Presbytis obscura): praziquantel treatment and the antibody response to cyst antigens

A diagnosis of coenuriasis was made in a spectacled langur raised in captivity. Multiple cysts removed from the subcutaneous tissues and later from the abdominal cavity were identified as coenuri, typical of the genus Taenia. Post-surgical treatment of the remaining cysts with praziquantel was assessed with whole body computerized tomography (CT). CT at 6 weeks post-treatment revealed a reduction in size and increased calcification of abdominal cysts as compared to pretreatment CT. Cyst fluid antigens in ELISA assays showed a high titer (1:5, 120) IgG response in the langur serum, while no IgM response could be detected. No decrease in IgG titer was seen 6 weeks after treatment. Immunoblot analyses identified several parasite-specific antigens with apparent molecular weights of greater than 92.5 (3 bands), 88, 41, 37, and 34 kDa.

Prophylaxis of oropharyngeal candidiasis with clotrimazole

A total of 202 evaluable cancer patients were randomly assigned to receive or not receive oral clotrimazole as antifungal prophylaxis during hospitalization. Oropharyngeal candidiasis occurred in 1% of the former patients and 27% of the latter patients (P less than .00001). Candida sp were cultured from the initial throat specimens of 53 control patients and 55 patients who received prophylaxis. Oropharyngeal candidiasis subsequently developed in 2% of the former patients and 38% of the latter patients (P = less than .00001). Oral clotrimazole is an effective agent for prophylaxis of oropharyngeal candidiasis in susceptible cancer patients.

Increasing resistance to trimethoprim-sulfamethoxazole among isolates of Escherichia coli in developing countries

Resistance of Escherichia coli to trimethoprim (TMP)-sulfamethoxazole remains at 3%-8% at many medical centers within the United States. In this study a 44% resistance rate was observed among E. coli isolated at a pediatric hospital in Santiago, Chile, and a 40% resistance rate at a general teaching hospital in Bangkok, Thailand. Most isolates were from urinary tract infections and showed high-level resistance (minimal inhibitory concentration of TMP greater than 1,000 micrograms/ml). Nineteen of 35 isolates tested transferred resistance to TMP; most cotransferred resistance to streptomycin and sulfonamides. Dihydrofolate reductase type I was detected by gene probing in 14 of 35 strains. Subsequent investigations in Brazil, Honduras, and Costa Rica revealed that this high rate of resistance was not an isolated phenomenon.

Faecal leucocytes in patients with infectious diarrhoea

The value of faecal leucocyte examination was assessed in 376 hospital in-patients with acute diarrhoea. Comparison was made with 50 controls. All faecal samples were examined for bacteria, viruses and parasites. 91% of diarrhoeal cases caused by Shigella had faecal leucocytes. Similar findings were obtained from cases infected by Campylobacter or Salmonella. In contrast, those diarrhoeal cases due to viruses, parasites or bacterial toxins were not associated with faecal leucocytes. The test is a practical, inexpensive and reliable screening procedure to recognize probable invasive bacterial diarrhoea and to decide in which case a stool culture could be advantageous.