Taking University to the Students: Forging Connections and Inclusion Through Regional University Centres (RUCs). A Practice Report

For regional students, going to university frequently involves moving away from important home, family and community connections to forge new connections in unfamiliar environments. This is a daunting prospect discouraging many from considering university as an option. But what if university could come to them, allowing them to stay where they feel most connected, whilst also becoming connected with other students and developing a sense of inclusion within university culture? Recent research with high school students in regional South Australia indicates that the combination of online delivery (increasingly mainstreamed due to COVID-19) and the growing presence of Regional University Centres (RUCs) may provide the opportunity for this to happen. This paper discusses these findings within the context of the challenges for regional students in moving away from their connections. It argues that, instead, important learning connections may be offered within their local communities through the collaboration between universities and RUCs. © The Author/s 2022.

Multi-organ system failure in a patient with sickle cell disease and COVID-19 infection

Introduction: Patients with sickle cell disease (SCD) may be at increased risk from COVID-19 infection due to their known immune dysfunction, hyposplenism, and hypercoagulability. Thus far, a spectrum of disease severity has been observed ranging from asymptomatic to severe;most commonly increased pain and acute chest syndrome (ACS) are observed. Hyperhemolysis syndrome (HHS) is a rare but highly fatal condition characterized by hemolysis of donor and patient red blood cells (RBCs) post-transfusion. We present a case of COVID-19 infection in a patient with SCD complicated by HHS, ACS and multi-organ system failure. Case: A 39-year-old female with hemoglobin (Hb) SS disease, post-capillary pulmonary hypertension (PH), recurrent venous thromboembolism on apixaban, and chronic kidney disease, presented with epistaxis, vaginal bleeding, and progressive dyspnea. Laboratory findings included a white blood cell count 13.6 K/mL, Hb 2.4 g/dL (baseline 7 g/dL), platelet count 215 K/mL, bilirubin 4.8 mg/dL, lactate dehydrogenase 1485 U/L, blood urea nitrogen 70 mg/dL and creatinine 4.06 mg/dL (baseline 0.9 mg/dL). Anti-coagulation was held and she was transfused 8 units of packed RBCs without an appropriate response despite cessation of hemorrhage. Labs revealed a rising ferritin (peak 1912 ng/mL), bilirubin (peak 11.2 mg/dL) and LDH (peak 2202 U/L). Serial hemoglobin electrophoreses demonstrated a stable HbA/HbS ratio, direct antiglobulin and alloantibody tests were negative, supporting the diagnosis of HHS. On hospital day (HD) 2, SAR-CoV-2 PCR resulted positive. Over 6 days, she developed worsening acute on chronic renal failure requiring renal replacement therapy, progressive acute hypoxic respiratory failure, and severe ACS with diffuse bilateral infiltrates on chest radiography (Figure 1). After intubation on HD 8 due to worsening hypoxemia, she sustained a cardiac arrest due to pulseless electrical activity and was unable to be resuscitated.Discussion: This is the first known case of COVID-19 infection in a patient with SCD presenting with hemorrhage, HHS, severe ACS and multi-organ system failure. While the hypercoagulability of SCD and severe COVID- 19 infections are well known, presentation with hemorrhage is unusual. HHS can occur from multiple transfusions, but also can be triggered by infections. ACS, renal failure, and PH may be risk factors for mortality in SCD patients infected with COVID-19. We present this case to alert critical care physicians to unusual presentations of COVID-19 infection in our patients with sickle cell disease.