Moyamoya disease with Sjogren disease and autoimmune thyroiditis presenting with left intracranial hemorrhage after messenger RNA-1273 vaccination: A case report.

RATIONALE: The new vaccines are emergently authorized and currently approved for use to protect against the coronavirus disease 2019 (COVID-19) pandemic and serious adverse events are uncommon. Moyamoya disease (MMD) with autoimmune disease is a rare entity and usually presents with intracranial hemorrhage in adults. PATIENT CONCERNS: We reported a 40-year-old female patient with Sjogren disease and autoimmune thyroiditis, who had received the second dose of Moderna (mRNA-1273) vaccination. Three days later, she presented with left intraventricular and intracerebral hemorrhage as a complication. DIAGNOSIS: After a series of diagnostic workups, left intracranial hemorrhage was associated with MMD. INTERVENTIONS: Emergent external ventricular drainage and subsequent stereotactic evacuation of hematoma with insertion of intracranial pressure monitoring were performed. OUTCOMES: Under the care of the neurocritical care team, her physical condition improved gradually. The neurological sequelae was noted by defects of cognitive function, apraxia, agnosia, and impaired executive function. She was discharged after eight weeks with a follow-up in the vascular neurology clinic planning for performing revascularization. LESSONS: To the best of our knowledge, no similar case has been reported before, and this is the first case of MMD complicated with intracerebral and intraventricular hemorrhage after mRNA-1273 vaccination. It is noticeable to assess the vaccine safety surveillance and raise the alertness about moyamoya in patients with autoimmune diseases during the COVID-19 pandemic. Further studies for risk evaluation of COVID-19 vaccines in patients with autoimmune diseases might be required in the future.

Investigating air travellers' travel motivation during a pandemic crisis.

The growth of the air transport industry has been accompanied by various crises including aircraft incidents and accidents, terrorist attacks, and pandemics such as COVID-19. These crises to a great extent affect air travelers' motivation, which in turn affects the air travel demand that justifies airlines' legitimate existence and sustainability. However, there has been relatively little research into understanding air travelers' motivation during and after such crises, despite some studies having been conducted in the tourism domain to understand the motivation of tourists to travel to specific destinations. An enhanced knowledge in this field is important and would benefit the airline industry, which is facing increasing competition from other transportation modes as well online conferencing technologies. By applying the Push and Pull Factor model, this study has sought to identify the travel motivation and further determine whether Push factors have any positive influence on Pull factors. To this end, 760 questionnaires were collected from Taiwan. Both descriptive and inferential statistical analyses were conducted to test the hypotheses. Our findings reveal that the Destination image remains the most influential Pull factor, while Aviation-specific products and services is the least attractive Pull factor. Self-realization/achievement topped the rankings for the Push factors, while Flying experience was a selling point in its own right among the Push factors, although it was not as appealing as anticipated. The millennium generation, fewer frequent flyers and low-income consumers are more likely to take advantage of flying deals. This paper suggests that a more collaborative approach between airlines, airports and destination organizations could be adopted to design and promote tailor-made aviation and travel products to stimulate segmented consumers' demand for air travel during crises. Effective marketing strategies need to be in place to promote the specially-designed travel products.