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Hong Kong, consistently ranked as one of the world’s leading smart cities, is undergoing a period of disruptive change.1 While still shaped fundamentally by the “one country, two systems” arrangement, Hong Kong is increasingly integrated into the political (Liaison Office) and economic (Greater Bay Area, GBA) logics of mainland China (Ho and Tran 2019). The “dynamic zero-Covid approach” has also significantly impeded Hong Kong’s place branding as “Asia’s World City,” with the relocation of corporations to cities that have adopted a back-tonormal outlook, and the exodus of tens of thousands of residents. These counter-winds were captured by a territory-wide survey and a purposive sample of interviewees, selected at a specific point in the recent history of the Hong Kong Special Administrative Region (HKSAR), namely that of the transformation of the hybrid “one country, two systems” arrangement and the emergency politics of the post-National Security Law era. © 2022,China Perspectives. All Rights Reserved.
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SESSION TITLE: Thrombosis Jamboree: Rare and Unique Cases SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Deep vein thrombosis (DVT) formation is widely recognized as Virchow's Triad of hypercoagulability, venous stasis, and endothelial injury. Based on this definition, congenital aberrations of the inferior vena cava (IVC) such as atresia or coarctation classify as major risk factors to incite a DVT (1). A congenital IVC anomaly with evidence of post-COVID-19 vaccination hypercoagulability (2) suggests a risk association with thrombotic episodes. We present a case of congenital IVC interruption with development of a DVT nine days after Pfizer COVID-19 booster administration. While it is known that IVC anomalies may contribute to DVT development (1), there is scarce data identifying a COVID-19 mRNA vaccine as a direct source of massive DVT in a young adult. CASE PRESENTATION: A 28 year old male with a history of repaired coarctation of the aorta presented with severe right thigh pain that began days after the Pfizer COVID-19 booster. Four days prior, an outpatient ultrasound (US) was negative for DVT. Physical exam revealed a dusky right foot with good distal pulses. Sensation was intact throughout. The left lower extremity (LE) had no edema or tenderness. An US of the right LE showed a DVT extending from the common femoral vein to the posterior tibial vein and DVT of the greater saphenous and deep femoral vein. Left LE US showed an anterior tibial DVT. Attempted thrombolysis was made with tissue plasminogen activator therapy and thrombectomy. Given the patient's atretic IVC anatomy, some residual clot remained in the common iliac vein, and was treated with anticoagulation therapy. After two extensive surgical lyses and aggressive medical lysis, the DVT's were resolved and the patient slowly improved. Upon follow up, he is feeling much better with no further pain. Ultimately this patient will require lifelong anticoagulation and may require an IVC stent to prevent future thrombotic events. DISCUSSION: Coarctation of the aorta is a common congenital heart defect and is often coupled with additional cardiovascular anomalies (1). In our patient, imaging showed a small and near-occluded IVC, which predisposed him to vasculitic events. There is no literature describing a massive DVT in a young adult patient within days of an mRNA COVID-19 vaccine. While these thrombotic events are rare (2), this report portrays one case in which the Pfizer COVID-19 mRNA vaccine may have prompted a vascular event in a susceptible patient. CONCLUSIONS: It has been previously established that congenital IVC anomalies may contribute to increased risk of DVT (1). In this case, we observe an association of the mRNA COVID-19 vaccine with massive DVT in a young male. While this is not meant to discourage patients with congenital IVC anomalies from receiving the COVID vaccine series, it prompts the need for open discussion with healthcare providers to discuss possible adverse effects. Reference #1: Chee, Y.-L., Culligan, D.J. and Watson, H.G. Inferior vena cava malformation as a risk factor for deep venous thrombosis in the young. British Journal of Haematology. 2001;114:878-880. doi.org/10.1046/j.1365-2141.2001.03025.x Reference #2: Bilotta C, Perrone G, Adelfio V, et al. COVID-19 Vaccine-Related Thrombosis: A Systematic Review and Exploratory Analysis. Front Immunol. 2021;12:729251. doi:10.3389/fimmu.2021.729251 Reference #3: Ruggeri M, Tosetto A, Castaman G, Rodeghiero F. Congenital absence of the inferior vena cava: a rare risk factor for idiopathic deep-vein thrombosis. The Lancet. 2001;357(9254):441. doi.org/10.1016/S0140-6736(00)04010-1 DISCLOSURES: No relevant relationships by Melanie Krongold no disclosure on file for Majed Samarneh;No relevant relationships by Elena Tran No relevant relationships by Lakshmi Sheetala Vijaya
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[Formula presented] Background-Aim: Infection from SARS-CoV-2 has emerged as new pathological entity within the global medical community. One of the earliest questions was in relation to the ability of the immunocompromised patients to clear the infection. In COST EuNet-INNOCHRON we were interested in the impact of SARS-CoV-2 infection in patients with different types of chronic neutropenia (CNP). The aim of the current study is to understand the impact of SARS-CoV-2 infection and to identify any possible characteristic patterns of the clinical course in patients with CNP. Patients and Methods: The COST EuNet-INNOCHRON Action in collaboration with the European Haematology Association - Scientific Working Group (EHA-SWG) on Granulocytes and Constitutional Marrow Failure Syndromes has conducted an online survey on SARS-CoV-2 infection in patients with CNP. The EuNet-INNOCHRON participants from different countries got access to an on-line platform fulfilling the General Data Protection Regulation (GDPR) and could register adult and paediatric CNP patients who had been infected by SARS-CoV-2 from March 2020 to June 2021. Data on demographic characteristics, type of CNP, patients' background and SARS-CoV-2 infection history (symptoms, laboratory features, radiological appearance, therapeutic approach and outcome) were collected. Results: Twenty-six patients with diagnosis of CNP, 7 males and 19 females were registered. Patient age distribution as follows: 16 patients >18 years old (y.o.)5 patients 5-18 y.o, 4 patients < 5 y.o whereas age was not available for one of the patients. Nine of the patients were diagnosed with idiopathic CNP, 7 patients with congenital neutropenia (6 of them with severe congenital neutropenia), 3 with secondary CNP, 2 with suspected autoimmune neutropenia of infancy (although antineutrophil Ab were negative), one with autoimmune neutropenia, one with drug induced neutropenia and 3 with other types of CNP. Twelve patients were on treatment with G-CSF and 6 patients had a history of previous viral or bacterial infections. Clonal Cytopenia(s) of Undetermined Significance (CCUS) was excluded in the eight patients who were investigated. Twenty-four out of 26 patients had positive PCR and one was found incidentally with positive antibodies for SARS-CoV-2. One more patient was symptomatic with history of close contact with SARS-CoV-2 infected family members. The commonest observed symptoms were fever >38 oC (19 patients), cough (10 patients), rhinorrhoea (10 patients), sore throat (6 patients), musculoskeletal pains (7 patients), taste/smell loss (5 patients), headache (5 patients), dyspnoea (4 patients), chest pain (one patient) and none of them had gastrointestinal symptoms. No other associated respiratory viral or bacterial infections were reported. Four patients who had one or more underlying conditions (immune deficiency, heart/respiratory/kidney disease) were admitted in hospital and needed anti SARS-CoV-2 treatment. Two of them had non-invasive ventilation and one of them needed admission in intensive care unit (ICU);both recovered. Another patient with Fallot's tetralogy needed mechanical ventilation in ICU and sadly passed away. No other deaths were observed. Deterioration of the pre-existing neutropenia was seen in two patients, two patients developed thrombocytopenia, one patient developed worsening lymphopenia and one anaemia. Twelve patients had chest X-ray and consolidation was found in two of them. All three patients who had chest CT scans were found with ground-glass changes. During the observation period (up to two months), no re-infection from SARS-CoV-2 was found. The Stockholm, Sweden experience is similar to the above data. One hundred fifty-four patients with CNP were followed up, for 10 months (March 1 to December 31, 2020) for SARS-CoV-2. Seventeen of these (i.e. 11 %) were infected. None needed hospitalization and there were no fatalities. Conclusion: Although the relative susceptibility of neutropenic patients to contract SARS-CoV-2 needs to be assessed with further studies the clinical course and severity of SARS-CoV-2 infection doesn't seem to be worse in CNP patients (regardless the type of neutropenia and the need for GCSF treatment) compared to the general population. Also, like what has been observed in non-neutropenic patients, underlying comorbidities is a significant risk factor for severe disease and adverse outcome. Disclosures: Dale: X4 Pharmaceuticals: Consultancy, Honoraria, Research Funding. Palmblad: Chiesi Ltd Sweden: Honoraria;Roche Sweden: Speakers Bureau;Chiesi Ltd Candada,: Honoraria.
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Parents in academic careers face notable challenges that may go unrecognized by university management and/or policy makers. The COVID-19 pandemic has shed light on some of these challenges, as academic parents shifted to working from home while simultaneously caring for children. On the other hand, many parents found that the shift to working from home offered new opportunities such as working more flexible hours, development of digital skillsets, and increased involvement in the education of their children. In this article we explore the work-related challenges and opportunities experienced by academic parents as a result of the COVID-19 pandemic and offer potential long-term solutions for academic parents and their universities. We use the following methods: (1) a literature review focused on identifying the work-related challenges academic parents faced prior to the pandemic, as well as the impact of the pandemic on scientists and working parents and (2) administer a world-wide survey with the goal of identifying the challenges and opportunities associated with parenting and academic work through the COVID-19 lockdown (304 total responses; 113 complete). Moving forward these findings have enabled conclusions to be drawn in order to shape a new normal. Our aim is to offer university administrators, policy makers, and community service providers with ways to provide additional support for academic parents as well as provide tools for academic parents to learn successful strategies directly from their peers.
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Rationale: Lung ultrasound B-lines artifacts represent abnormal interstitial thickening or edema, have been related to patient mortality, and are often visualized when imaging the anteroapex of the lung. Unlike other probe locations, these 2 sites on the upper chest can be readily accessed by healthcare givers and patients alike. In COVID-19 infection, the potential value of these sites for detecting early lung involvement depends not only on accessibility, but also on the relationship of its findings with significant disease. Therefore, as few ultrasound data exist from the lung apex in hospitalized COVID-19 pneumonia, we sought to report the prevalence of apical lung B-line artifacts in inpatients and their association with illness severity. Methods: In a 300-bed community hospital, medical and imaging data from inpatients with known COVID-19 infection who had been referred for echocardiography with lung imaging or who had received a lung point-of-care ultrasound study was reviewed for the presence of ≥3 B-lines (COMETS) in either anteroapex of the lungs. COVID-19 disease was categorized by the CDC Clinical Severity Scale on presentation as mild (no dyspnea, normal CXR/CT), moderate (abnormal CXR/CT, O2 sat>94%), severe (tachypnea, O2 sat <94%, infiltrates >50%), or critical (respiratory failure, shock, multiorgan system failure). Age, gender, diabetes, hypertension, obesity, and time from onset of symptoms to the imaging study were analyzed for univariable associations with COMET presence and then considered with severity category in a reduced multivariable model using backwards elimination. Results: Of n=56 patients, age (mean±SD) was 63±16 years. COMETS were present in 35/56 (63%) of patients overall, and in 30/37 (81%) of severe-critical disease vs. 5/19 (26)% of mild-moderate disease (p=0.0002). Of the patients with vs. without COMETS, 31 (76%) vs. 10 (24%) had an abnormal CXR and 30 (79%) vs. 8 (21%) had O2 sat<94% on admission, respectively (p<0.05). In the multivariable model, obesity (OR=9.64[95%CI:2.19-68.48], p<0.007) and severe/critical disease (OR=19.47[95%CI:4.33-142.28], p<0.0006) best predicted the presence of COMETs. Conclusions: Ultrasound B-lines in the anteroapex of the lung are a prevalent finding in hospitalized COVID-19 infection and increase with disease severity and obesity, reaching >80% in severe/critical disease. This imaging site, in particular, may be ideal for outpatient screening, ER triage, or patient home imaging, where it may herald the need for early respiratory diagnosis, therapies or hospitalization. Future studies involving the prevalence, timing and outcome of outpatient ultrasound lung imaging may consider the use of this easily-accessed site on the chest wall. .