Real-World effectiveness of voxelotor for the treatment of sickle cell disease

Introduction: Voxelotor is a first-in- class sickle haemoglobin polymerisation inhibitor that targets the pathophysiology of sickle cell disease (SCD). Studies have shown that voxelotor increases haemoglobin and reduces markers of haemolysis. Emerging evidence suggests that voxelotor may improve the clinical symptoms of SCD, lower vaso-occlusive crisis (VOC) rates, and reduce transfusion needs. Objective(s): To examine the real-world impact of voxelotor on transfusion, VOC, and hospitalisation rates among patients with SCD. Method(s): Medical and pharmacy claims data for patients >=4 years with SCD who started voxelotor between November 2019 and March 2022 were obtained from the Symphony Health database. Patients with >=1 year of data before the index date (date of first voxelotor claim) were included. Annualised study outcomes were calculated for patients with >=1 occurrence of the corresponding event in the 3-month preindex period. Outcomes from a 90-day lookback were reported for the total and paediatric (aged 4 to <18 years) populations. Result(s): Of 4023 eligible patients from the Symphony Health database included in the analysis, 596 were <18 years. Compared with the 3-month preindex period, significantly lower annualised rates of transfusions, VOCs, and hospitalizations, and lower annualised mean number of inpatient days, were observed in the total population and paediatric subgroup over the 3-month postindex period. For the total population, the annualised event rates declined by 50.6% for transfusions (n = 248), 23.1% for VOCs (n = 1368), 35.5% for VOC-related hospitalizations (n = 757), and 39.4% for all-cause hospitalizations (n = 928). The annualised mean number of inpatient days declined by 29.6% for VOC-related hospitalizations (n = 757) and by 22.9% for all-cause hospitalizations (n = 928). For paediatric patients, the annualised event rates declined by 79.6% for transfusions (n = 18), 42.4% for VOCs (n = 157), 56.8% for VOC-related hospitalizations (n = 81), and 51.5% for all-cause hospitalizations (n = 106). The annualised mean number of inpatient days declined by 54.1% for VOC-related hospitalizations (n = 81) and by 45.8% for all-cause hospitalizations (n = 106). Conclusion(s): Treatment with voxelotor may provide a clinical benefit to patients with SCD by reducing the frequencies of transfusions, VOCs, and hospitalizations and decreasing inpatient days. Greater reductions were observed in the paediatric subgroup, potentially due to the smaller sample size, historically greater treatment compliance in paediatric patients, or younger patients having accumulated fewer SCD-related complications, enabling a greater clinical response. Limitations include the study's non-randomized design, reliance on claims data, and changes in healthcare use during the COVID-19 pandemic confounding the data.

A Case of Primary Biliary Cirrhosis With New Onset Hyperthyroidism and Supratherapeutic INR

Introduction: Hyperthyroidism is known to increase catabolism of vitamin-K-dependent clotting factors (II, VII, IX, X) and increase the response of vitamin K antagonists, usually warfarin. Primary biliary cirrhosis (PBC) has been associated with thyroid dysfunction (TD), especially with autoimmune thyroid disease. In the below case, a patient with known PBC on warfarin is found to have severely elevated INR related to new-onset hyperthyroidism with clinical consequences of hemorrhage including upper GI bleed. Case Description/Methods: A 64-year-old female with PBC and antiphospholipid antibody syndrome on warfarin was admitted for hemorrhagic epiglottitis requiring emergency intubation and supratherapeutic INR. Her PBC was diagnosed as stage II on biopsy 23 years ago and has remained clinically stable on ursodiol therapy. On presentation, the patient was tachycardic, tachypneic, and had O2 saturations <90% on HFNC prior to intubation. Physical exam significant for larger goiter with diffuse upper airway swelling. She was admitted and found to have COVID-19 infection, INR .16.0 and PT>200.0 (limit of lab), WBC of 22.8, and lactate of 2.5. LFTs WNL aside from albumin of 2.0. TSH was <0.0017 (limit of lab) and free T4 of 3.4, free T3 of 5.3. TSH receptor antibody (TRAB) and thyroid stimulating immunoglobulin (TSI) levels were normal. Her last TSH was normal a year ago. CTA chest found a 5.7cm heterogeneous, partially calcified superior mediastinal mass consistent with multinodular thyroid goiter. Patient was initially given prothrombin complex concentrate and vitamin K with correction of INR over the following few days. She was extubated and started on methimazole. During the hospital course, she was found to have coffee ground emesis for which an EGD was done with findings of non-bleeding gastric ulcer (Forrest Class IIc) and LA Grade D esophagitis with adherent clot and bleeding for which hemostatic spray was applied. Patient was discharged a few days later following resumption of warfarin and on pantoprazole and methimazole. Discussion(s): The above case demonstrates a rare case of PBC and new-onset hyperthyroidism due to multinodular thyroid goiter causing significantly elevated INR in the setting of warfarin use with hospital course complicated by GI bleed. PBC is associated with TD - hyperthyroidism, hypothyroidism, and thyroid cancer. Hyperthyroidism is less commonly associated with PBC compared to other TDs but should be considered especially with a finding of elevated INR.

Increasing Access to a Diverse Mental Health Workforce through Emergency Reciprocity Licensure

New Jersey's COVID-19 Temporary Emergency Reciprocity Licensure Program provided temporary licenses to more than 31000 out-of-state healthcare practitioners, over a quarter of whom were mental health providers. As the need for mental health care accelerated during the pandemic, especially among health disparity populations, expanding mental health provider pools may be a critical tool to increase access to care. In January 2021, we surveyed New Jersey's temporary licensees. We analyzed over 4500 mental health provider responses to examine the impact of the temporary licensure program on access to mental health care overall and on enhancing a diverse mental health workforce. Over 3700 respondents used their temporary license to provide mental health care to New Jersey patients. About 7% of respondents self-identified as Hispanic, 12% Black, 6% Asian, 1% American Indian or Alaska Native, and 0% (more than 5) Native Hawaiian or other Pacific Islander. They treated about 30100 New Jersey patients, 40% of whom were new to the provider, and 81% delivered care exclusively using telehealth. Respondents conversed with patients in at least 13 languages. About 53% served at least one patient from an underserved racial/ethnic minority group. Our findings suggest that temporary out-of-state mental health providers helped enhance mental health care continuity and access. Copyright 2023 Federation of State Medical Boards. All Rights Reserved.

Misinformation on Tiktok About the Effect of Covid-19 Infections and Vaccinations on Male Fertility

INTRODUCTION AND OBJECTIVE: The effect of the SARSCoV- 2 infection and vaccine on male fertility has been a cause of controversy. Studies have found that while COVID-19 disease can be associated with decreased sperm counts and quality, the vaccine is not. Despite evidence about the lack of association between the COVID-19 vaccine and male fertility, social media platforms, including TikTok, continue to spread misleading information. Objective(s): To identify how TikTok contributes to misinformation regarding the COVID-19 virus, vaccination, and male infertility. METHOD(S): After excluding unrelated videos, 58 videos using the terms #covidvaccine and #malefertility were identified on Tiktok from January 1 to December 31, 2021. Videos were reviewed by five independent researchers. Information collected included video publication date, length, views, likes, comments, presence of US certified medical professional, demographic details, scientific article cited, belief held on COVID-19 vaccine, infection and infertility, modified DISCERN score and Patient Materials Assessment Tool (PEMAT). The PEMAT score evaluated 17 items regarding understandability and actionability. The modified DISCERN based reliability score ranked quality from 1=poor, to 5=excellent. Data was analyzed using SPSS statistics software v24. RESULT(S): The average video was 51 seconds long, received 34,678 views, 3,301 likes, and 160 comments. A majority of videos featured a medical professional (67.2%). Most videos were of the opinion that the COVID-19 infection causes infertility in men (48.3%) but not the vaccine (37.9%). Few videos believed that the vaccine was responsible for male infertility (6.9%). The average DISCERN score for the 58 videos was 2.93, PEMAT Understandability score was 76.1%, and PEMAT Actionability score was 25.7%. With the presence of a certified US Medical Professional in the TikTok video, the average DISCERN score (2.00 vs. 3.38, p=.001), PEMAT Understandability Score (67.68 vs. 80.26, p=.015), and PEMAT Actionability Score (13.16 vs. 31.82, p=.024) increased significantly. Videos with medical professionals present had a lower average number of views (31,996 vs. 40179, p=.691), fewer likes (1,902 vs. 6,173, p=.290), and fewer comments (150 vs. 182, p=.737), but none of these differences were statistically significant. CONCLUSION(S): This study demonstrates that TikTok videos endorsing misinformation are popularly viewed. Among all the misinformation in social media, it is reassuring to see that there are medical professionals interested in promoting medically accurate information.

How COVID-19 Emergency Practitioner Licensure Impacted Access to Care: Perceptions of Local and National Stakeholders

The COVID-19 public health emergency required US states to respond rapidly on regulatory issues, including the process for licensing healthcare practitioners. At least 45 states enacted some form of a licensure waiver, enabling practitioners to temporarily work across state lines. We conducted 22 interviews with national and local (New Jersey) licensure stakeholders in September and October 2021 to capture perceptions of how emergency licensure impacted access to care. Five themes emerged: (1) Emergency licensing helped shift the nation's healthcare workforce supply into regions and specialties of high need;(2) Expanded telehealth capacities complemented emergency licensure programs;(3) Concerns about care quality were mitigated by the urgency of the pandemic, credentialing processes, and investigative authorities;(4) Relocation packages and the need to replace staff could lead to higher costs of care;and (5) Views on licensure reciprocity and interstate compacts were favorable, but smaller provider organizations need to be protected. Overall, stakeholders perceived emergency licensure as successful in expanding access to care during the pandemic. Findings suggest that stakeholders view interstate licensure compacts more favorably now than pre-COVID. While stakeholders may be in favor of licensure reciprocity, they raised concerns about its feasibility, cost, and quality. Copyright 2022 Federation of State Medical Boards. All Rights Reserved.

Green financing for sustainable development: Insights from multiple cases of Vietnamese commercial banks

Although the public sector is seen as the main party responsible for taking action on climate change and sustainable development, private commercial banks are in a unique position to support or shift the funding focus on green investment. By employing a qualitative research approach based on six commercial banks, this paper aims to investigate the current practices of how commercial banks are contributing to advance green business initiatives. Accordingly, this research examines and identifies the facilitators and challenges in domestic and foreign commercial banks in Vietnam which support green business initiatives. In addition to addressing the recent calls for the investigation of the role of commercial banks in facilitating green finance, our study expands the emerging literature by demonstrating the current efforts of Vietnam's commercial banks in fostering green finance during the Covid-19 pandemic. © 2022 ERP Environment and John Wiley & Sons Ltd.

AI-app development for Yolov5-based face mask wearing detection

Corona is one of the most destructive viruses that has ever produced a pandemic in human life, not only in terms of direct victims but also in terms of the socio-economic consequences of the virus' transmission. The 2nd anniversary of the global coronavirus pandemic passed away in 2021. However, it's still impossible to say how long the epidemic will last. After reviewing a study by the World Health Organization on COVID-19, the country's national government urged residents to use facemask in order to reduce the incidence of COVID-19 transmission. As a result of COVID-19, there are presently no facemask detection app that are in great demand for ensuring safety in public area. In the context of the outbreak of COVID-19, A facemask detection model based on deep learning approach of state-of-the-art YOLOv5 may be useful in real-time applications. In this paper, we propose a web app for detecting if the people wears facemask or not in real-time via webcam or public camera. In the app, we deployed and persisted many different YOLOv5-based models that the users can switch between them to guarantee the performance and timing trade-off. Furthermore, our system is able to detect if an individual person captured by surveillance cameras is wearing facemask in acceptable counting time at staging level. In our opinion, this kind of system is extremely efficient for use in airports, train stations, offices, and other public areas, as well as in military. © 2022 IEEE.

Towards De Novo Drug Design for the Coronavirus: A Drug-Target Interaction Prediction Approach using Atom-enhanced Graph Neural Network with Multi-hop Gating Mechanism

For humans, the COVID-19 pandemic and Coronavirus have undeniably been a nightmare. Although there are effective vaccines, specific drugs are still urgent. Normally, to identify potential drugs, one needs to design and then test interactions between the drug and the virus in an in silico manner for determining candidates. This Drug-Target Interaction (DTI) process, can be done by molecular docking, which is too complicated and time-consuming for manual works. Therefore, it opens room for applying Artificial Intelligence (AI) techniques. In particular, Graph Neural Network (GNN) attracts recent attention since its high suitability for the nature of drug compounds and virus proteins. However, to introduce such a representation well-reflecting biological structures of biological compounds is not a trivial task. Moreover, since available datasets of Coronavirus are still not highly popular, the recently developed GNNs have been suffering from overfitting on them. We then address those issues by proposing a novel model known as Atom-enhanced Graph Neural Network with Multi-hop Gating Mechanism. On one hand, our model can learn more precise features of compounds and proteins. On the other hand, we introduce a new gating mechanism to create better atom representation from non-neighbor information. Once applying transfer learning from very large databanks, our model enjoys promising performance, especially when experimenting with Coronavirus. © 2022 IEEE.

Current obstacles, contemporary practices, and potential solutions for recovery in Vietnam tourism after the COVID-19 pandemic: Tour operators' perspectives

This paper explores the current obstacles, contemporary practices, and potential solutions for recovery in Vietnam tourism, based on the views of tour operators after the COVID-19 pandemic. This research utilizes twenty-three semi-structured interviews with senior managers and business leaders from five leading tour operators in Vietnam. The findings of this research highlight that, given the current difficulties in operation, Vietnam tourism enterprises developed various response strategies to help their tourism businesses to survive during the pandemic. This research is among the first attempts aims to extend the literature on the implications of COVID-19 to the tourism industry by reflecting the perceptions of tour operators. Furthermore, findings from this study can assist the tourism businesses by highlighting potential solutions and proposing recommendations for the recovery of tourism after the COVID-19 pandemic.

Utility of Fungal Biomarkers in Critically Ill Patients with Covid-19 and Fungal Coinfection

INTRODUCTION: Fungal co-infection in ICU patients hospitalized with COVID-19 pneumonia has been described. Biomarkers such as galactomannan (GM) from serum and bronchoalveolar lavage have low sensitivity. 1,3 Beta-d-glucan (BdG) may have higher sensitivity, but it lacks specificity. In this study, we examined the clinical outcome and utility of fungal biomarkers in the diagnosis of fungal co-infections in ICU COVID-19 patients. METHOD(S): Intensive care Unit (ICU) COVID-19 patients treated for fungal co-infections (COVID+ Fungal co-infection) were compared to ICU COVID-19 patients without fungal co-infections as controls. The primary outcome of this study were to determine the utility of fungal biomarkers in COVID+ Fungal-co-infected patients compared to similar patients without fungal infection (control group). Patients were entered into a spreadsheet and then analyzed using SPSS (ver. 27, IBM, Inc.). Mean (+/- SD) and percentages were reported. RESULT(S): A total of 76 ICU COVID-19+ patients were identified. 54 were COVID+ fungal co-infected, 22 were COVID+ control patients. 53 (69.7%) were male. Most patients were Caucasian (76%), with 7.9% Hispanic and 6% African American. Mean (+/- SD) age was 59.6 +/- 12.0. Eightysix percent of patients received mechanical ventilation, 59% underwent bronchoscopy and expired during hospitalization, respectively. COVID associated pulmonary aspergillosis (CAPA) was diagnosed in 21% of COVID+ Fungal coinfected group. BdG was obtained in 17 (31.5%) COVID+ Fungal+ compared to 4.5% in control patients (p=0.012). Fungal culture was obtained in 40 (74%) COVID+ Fungal+ group compared to 5.4% in control group (p< 0.001). Aspergillus antigen in BAL in 52% COVID+ Fungal+ patients compared to 5.4% in controls (p< 0.001). Similarly, 54 (71%) patients received antifungal therapy (97% with positive fungal culture was treated compared to 41% with negative culture, p< 0.001). Most patients (84%) with positive fungal culture were treated with voriconazole. CONCLUSION(S): Fungal biomarkers including BdG and GM were more likely to be positive in COVID-19+ Fungal-coinfection. Use of the fungal biomarkers (BdG, GM) were used in a minority COVID+ patients for diagnosis. Fungal culture did prompt anti-fungal therapy, mainly voriconazole treatment.

Mapping Mobile Health Clinics in Canada: Delivering Equitable Primary Care to Children and Vulnerable Populations

BACKGROUND: Low-income and racially diverse populations often have multiple barriers in accessing healthcare and are at increased risk of poor health outcomes. COVID-19 exacerbated these health inequities: decreased in-person appointments, difficult access to virtual care and deprioritization of elective clinical activity led to delays in well-child visits and vaccination. This public health emergency highlighted a need to develop alternative models to enable access to primary care for vulnerable children. While mobile clinics are well-established in the United States, little is known about them in Canada. OBJECTIVE(S): This study aims to characterize Canadian mobile clinics providing primary care health services to vulnerable populations, including children, and seeks to inform the implementation of a pediatric mobile clinic under development. DESIGN/METHODS: This environmental scan screened scientific databases and the grey literature using a combination of terms designating mobile health clinics and Canadian locations. Relevant Canadian primary care mobile clinic initiatives were subsequently included. We defined primary care mobile clinics as movable health care units providing primary healthcare services delivered by general medical practitioners (pediatricians and family physicians). Examples of excluded initiatives were mobile clinics focused on education/literacy, dental care, vision care, endocrinology, cancer screening, safe injection sites, vaccination, physical rehabilitation and urgent care. Descriptive statistics and qualitative analysis were performed. RESULT(S): 29 clinics were identified, of which 26 are still active. Most clinics were located in Ontario (n=11), followed by British Columbia (n=8), Alberta (n=5), Quebec (n=2) and the Maritimes (n=2). The first mobile clinic in Canada was launched in 1996, with an increasing number of new clinics in 2021. While all clinics served vulnerable populations, some targeted specific groups, such as children, people experiencing homelessness, immigrants, LGBTQ+ individuals and Indigenous peoples. We identified three pediatric mobile clinics, two of which targeted teenagers. Onboard the clinics, physicians often worked with nurses, outreach workers and social workers. These professionals provided primary care services, as well as healthcare navigation, sexual education, mental health care, harm reduction supplies, vaccination and emergency care. All mobile clinics partnered with their local government, charities or businesses to fund their initiative. CONCLUSION(S): Mobile health clinics are a growing model of primary care in Canada. They are the result of a multidisciplinary collaboration between healthcare providers, social workers and outreach workers. To this date, Canadian pediatric mobile clinics remain a handful and represent an interesting avenue to address health inequities in children, during the pandemic and beyond.

A Pilot Study to Evaluate the Effectiveness of Nasal and Oral Povidone Iodine in Reducing the Burden of Severe Acute Respiratory Syndrome 2 RNA in Patients with COVID-19

Background. Nasal and oral application of topical antiseptics such as povidone iodine could potentially reduce the risk for transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, limited information is available on the efficacy of such agents in reducing the burden of SARS-CoV-2. Methods. We conducted a pilot non-blinded, randomized trial to compare the effectiveness of 3 doses of povidone iodine (each dose with 10% intranasal and 1% gargle) administered every 8 hours versus the control with phosphate-buffered saline in reducing the burden of SARS-CoV-2 RNA in the nares and oropharynx of patients with COVID-19. Swabs were used to collect anterior nares and oropharynx samples before the first and second doses and 8 hours after the final dose (24 hours after the initial dose). Real-time polymerase-chain reaction (RT-PCR) was used to assess the burden of viral RNA. Analysis of variance was used to compare cycle threshold values for povidone iodine versus control patients. Subjects were surveyed about adverse reactions to treatment. Results. As shown in the figure, SARS-CoV-2 cycle thresholds were similar in the povidone iodine (N=10 subjects) and control (N=8 subjects) groups prior to treatment. After initiation of treatment, there was no significant difference in cycle thresholds for the povidone iodine versus control subjects (P >0.05). No adverse effects of treatment were reported. Effect of intranasal and oral application of povidone iodine versus phosphate-buffered saline on nasal and oropharyngeal SARS-CoV-2 RNA. Error bars show standard error. Conclusion. Our findings suggest that that nasal and oral application of povidone iodine have limited effectiveness in reducing the burden of SARS-CoV-2. Future studies are needed to assess for effectiveness of more frequent dosing intervals and to determine if povidone iodine reduces recovery of viable virus by culture.

ESPO AND HEALTH SCIENCES SECTION SYMPOSIUM: INCLUDING DIVERSE STAKEHOLDERS IN HEALTH INTERVENTION DESIGN: LESSONS LEARNED FOR ADVANCING HEALTH EQUITY

The COVID-19 pandemic exposed persistent disparities in the effectiveness of healthcare services and long-term care among the older adult population. For example, significant gaps disproportionately affected older adults living in rural areas, racial and ethnic minorities, individuals with cognitive impairments, and those from low socioeconomic backgrounds. To improve health equity, research is needed to design, implement, and disseminate health interventions that address the heterogeneity of older adults and caregivers. Reflecting on lessons learned from including underrepresented key stakeholder groups in intervention research may reveal strategies to design health interventions that are more accessible and effective for diverse populations of older adults and their caregivers. This symposium highlights five studies that included diverse populations of older adults and/or caregivers in the design of health interventions. Dr. Schiaffino will share how disparities in co-morbid cancer and dementia across racial, ethnic, and age groups will inform improvements to care delivery processes for this population. Ms. Crane will discuss barriers to designing exergame interventions that are accessible to older adults with multiple chronic conditions and functional limitations. Dr. Díaz-Santos will describe results of piloting and refining a social connection intervention to reduce loneliness among Latinx older adults at risk for dementia. Dr. del Pino will highlight strategies to improve implementation of a screening intervention for at-risk drinking among African American older adults living with HIV. Mr. Cotton will present results of tailoring a crisis intervention to improve cultural fit for African American caregivers of people with dementia.

Intention to Adopt E-Grocery Shopping Service in Vietnam During Covid-19 Pandemic

The purpose of this study is to determine the factors that influence the intention to adopt e-grocery shopping service of Vietnamese consumers during Covid-19 Pandemic. The sample size includes 235 responses collected from e-grocery shoppers in Vietnam. The research methodology includes Cronbach's Alpha analysis, EFA analysis and multiple regression analysis. Data is analysed in SPSS 20 software. The results have identified four factors that directly affect the intention to adopt e-grocery shopping service which are social influence, perceived ease of use, brand image and perceived usefulness. Social influence is the most significant factor that impacting the intention to adopt e-grocery shopping service among consumers during Covid-19 Pandemic in Vietnam. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Examining effects of students’ innovative behaviour and problem-solving skills on crisis management self-efficacy: Policy implications for higher education

COVID-19 has caused unprecedented challenges for the higher education community worldwide, one of which is that students have had to maintain their learning while dealing with the crisis conditions. However, a systematic understanding of students’ individual crisis management still remains absent despite its importance. The newly emerged and ongoing phenomenon has leveraged the role of crisis management in the context of education, which is even more essential with the forthcoming uncertain future. This study investigates factors related to students’ crisis management self-efficacy in higher education during the pandemic. Particularly, survey data were collected from 387 undergraduate students to investigate the effects of innovative behaviour and problem-solving skills on crisis self-efficacy. Structural Equation Modelling was applied to conceptualise and empirically test a model that examines the relationship between crisis self-efficacy and related factors. Moreover, the study aimed to assess the role of technology abilities in students’ crisis management self-efficacy and academic performance during the COVID-19 pandemic. The research results provided some compelling evidence for the positive effects of innovative behaviour and problem-solving skills on crisis management self-efficacy. This study also discusses some feasible implications for higher education policy and future research directions. © The Author(s) 2022.

The up-down-up pandemic news experience: A mixed-method approach to its negative and positive effects on psychological wellbeing

Existing research has documented the dynamics of increased news consumption alongside – paradoxically – increased news avoidance during the Covid-19 pandemic, highlighting its adverse effects on mental health and emotional wellbeing. However, for methodological and theoretical reasons, research still lacks specifics on what types of negative psychological responses were directly triggered by pandemic news, how prevalent they were in the population, how they manifested in daily life, and what could be the alternatives to them. Further, the almost exclusive focus on negative effects has led to a relative negligence of the positive sides of pandemic news. This study takes a mixed-method approach to address these gaps, combining 59 interviews and a follow-up survey with a representative sample of 2,015 adults across the UK. We found that pandemic news consumption, driven primarily by the need for personalised surveillance in an uncertain situation, oscillated in parallel with its severity and associated lockdown restrictions. The influx of repetitive bad news triggered many negative feelings besides general pandemic anxiety – namely fear, despair and moral outage (anger and disgust). This led to various alterations of daily routines, including news avoidance. Such adverse effects were offset by the reassurance, happiness and hope that the news did, at least occasionally, brought to audiences during the pandemic. Participants suggested several potential “good news” categories that point to the need for constructive news forms that not only inform but also inspire, motivate and/or empower people in personal or collective ways.

SUBCLINICAL LYMPHADENOPATHY ON FDG-PET IN LUNG CANCER SCREENING AFTER COVID-19 VACCINE BOOSTER

SESSION TITLE: Using Imaging for Diagnosis Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Vaccine-related lymphadenopathy (VRL) is a local reaction like pain and swelling and has been associated with mRNA Pfizer/Moderna COVID-19 vaccines more than other vaccines (1). VRL can lead to false positives on nuclear imaging studies and confound the evaluation of patients during cancer screenings or treatments. The first COVID-19 VRL seen on imaging was reported in January 2021 in two patients undergoing breast mammogram (1). Since then, more cases have been reported in other nuclear imaging studies (1). Here, we report a case of subclinical unilateral VRL by FDG-PET 3 days after the patient received the Moderna COVID-19 booster. CASE PRESENTATION: 73-year-old male smoker returned for a 6 month follow up low dose CT for a 7 mm left upper lobe (LUL) nodule. He received the Moderna COVID-19 booster in the left deltoid the same day. The LUL nodule was found to be slightly larger at 8 mm and ipsilateral axillary nodes were not enlarged (Figure 1). He returned 3 days later for FDG-PET which showed mild uptake in the LUL nodule (SUV 1.8) and hypermetabolic left axillary nodes (Figure 2). COVID booster date/laterality was documented, and the FDG-PET summary included a comment about a possible inflammatory response to the booster. A repeat low dose chest CT in 3 months was recommended. DISCUSSION: After the first reported cases of COVID-19 VRL, recommendations were published to aid providers in evaluating clinical and imaging abnormalities. The Society of Breast Imaging recommended the "wait and watch” approach for unilateral COVID-19 VRL within the preceding 4 weeks only if appropriate in the clinical context;repeat exam in 4-12 weeks and lymph node sampling if VRL persists (1). All other screening exams should be scheduled prior to the first dose of the COVID-19 vaccine or 4-6 weeks after the second dose (1). Radiology experts recommended: 1) imaging screening exam to be scheduled at least 6 weeks after the final vaccination, 2) administer the vaccine in the arm contralateral to any primary or suspected cancer, and 3) record the vaccine date, injection site, and type (1). Months later, they recommended that in patients with a known vaccination history, ipsilateral VRL can be managed conservatively without further imaging (1). CONCLUSIONS: The current recommended COVID-19 Pfizer/Moderna vaccination consists of a two-dose primary series and a booster dose 5 months later. In a recent single-center study in oncologic patients in Israel who had FDG-PET after the Pfizer booster, the duration of unilateral axillary VRL was found to be shorter than the first and second dose (2). Therefore it has been suggested that FDG-PET can be scheduled 2 weeks after the third dose (3). Whether there will be any changes in the guidelines to accommodate this finding remains to be seen. More studies are needed to best inform clinicians because COVID-19 vaccinations will continue for the foreseeable future. Reference #1: Lehman CD, D'Alessandro HA, Mendoza DP, Succi MD, Kambadakone A, Lamb LR. Unilateral Lymphadenopathy After COVID-19 Vaccination: A Practical Management Plan for Radiologists Across Specialties. J Am Coll Radiol. 2021;18(6):843-852. doi:10.1016/J.JACR.2021.03.001 Reference #2: Cohen D, Hazut Krauthammer S, Wolf I, Even-Sapir E. A sigh of relief: vaccine-associated hypermetabolic lymphadenopathy following the third COVID-19 vaccine dose is short in duration and uncommonly interferes with the interpretation of [18F]FDG PET-CT studies performed in oncologic patients. Eur J Nucl Med Mol Imaging. 2021. doi:10.1007/S00259-021-05579-7 Reference #3: Thaweerat W. Optimization of FDG PET study after mRNA COVID-19 vaccination to reduce the interference of vaccine-associated hypermetabolic lymphadenopathy. Ann Nucl Med 2021 363. 2022;36(3):327-328. doi:10.1007/S12149-021-01712-6 DISCLOSURES: No relevant relationships by Anh Nguyen No relevant relationships by Perry Nystrom