This paper introduces a multilingual dataset of COVID-19 vaccine misinformation, consisting of annotated tweets from three middle-income countries: Brazil, Indonesia, and Nigeria. The expertly curated dataset includes annotations for 5,952 tweets, assessing their relevance to COVID-19 vaccines, presence of misinformation, and the themes of the misinformation. To address challenges posed by domain specificity, the low-resource setting, and data imbalance, we adopt two approaches for developing COVID-19 vaccine misinformation detection models: domain-specific pre-training and text augmentation using a large language model. Our best misinformation detection models demonstrate improvements ranging from 2.7 to 15.9 percentage points in macro F1-score compared to the baseline models. Additionally, we apply our misinformation detection models in a large-scale study of 19 million unlabeled tweets from the three countries between 2020 and 2022, showcasing the practical application of our dataset and models for detecting and analyzing vaccine misinformation in multiple countries and languages. Our analysis indicates that percentage changes in the number of new COVID-19 cases are positively associated with COVID-19 vaccine misinformation rates in a staggered manner for Brazil and Indonesia, and there are significant positive associations between the misinformation rates across the three countries.

COVID-19 Vaccine Misinformation in Middle Income Countries | VIDEO

Background
The COVID-19 pandemic resulted in changes to healthcare delivery for peripartum patients. Hospital location and population have been shown to be factors that can influence birth outcomes. The purpose of this study was to examine the impact of the COVID-19 pandemic on adverse birth outcomes between urban and suburban hospitals.

Methods
This retrospective cohort study compared gestational age and birth weights of 650 non-COVID infected pregnant patients, 400 of whom were seen at an Level III urban perinatal medical center in New York City and 250 of whom were seen at its affiliated Level IV suburban perinatal medical center approximately 25 miles away during the pandemic (August 2020 to February 2021) and the corresponding pre-pandemic period (August 2019 to February 2020) using student t-test, Mann-Whitney, and chi-squared tests.

Results
The COVID-19 pandemic was not a statistically significant predictor for preterm births (OR 1.078 95%Cl 0.644-1.804 p< 0.776) or low birth weights (OR 1.307 95%Cl 0.770-2.218 p<0.321) for patients giving birth at either an urban or suburban hospitals. Giving birth at an urban hospital was associated with a reduced likelihood of preterm birth (OR 0.241 95%Cl 0.141-0.411 p<0.001) and low birth weights (OR 0.289 95%Cl 0.170-0.492 p<0.001) during the study period. Patient’s race, insurance status, or delivery method were not statistically significant predictors of low birth weight or preterm births.

Conclusion
In this principal study of the influence of the pandemic upon adverse birth outcomes, we find that the stresses associated with the COVID-19 pandemic did not influence the likelihood of preterm birth or low birth weight. Our results verify the existence of an urban-suburban disparity in birth outcomes, with urban centers caring for pregnancies associated with preterm birth and low birth weight but suggest that the pandemic did not exacerbate this existent disparity.

Evaluating the Influence of the COVID-19 Pandemic on Adverse Birth Outcomes

Background
Most of the available COVID-19 outcome data in Solid Organ Transplant (SOT) recipients does not suggest a higher mortality rate in the SOT population. Though theoretically immunosuppressive medications might be associated with worse outcome, its immunomodulatory effect might be beneficial.

Methods
We retrospectively analyzed the effect of dose-reduction of mycophenolate, tacrolimus, and prednisone on the severity of COVID-19 in SOT recipients diagnosed with COVID-19 at the Center for Transplantation of the University of Kansas Medical Center between January 1, 2020 and December 31, 2022. Severe COVID-19 was defined as development of hypoxia while the patient is on room air during a 21-day period following COVID-19 diagnosis. To evaluate the effect of dose changes after the diagnosis of COVID-19 on the odds of severe COVID-19, we subset our data based on whether patients were taking mycophenolate (n = 449), tacrolimus (n = 537) or prednisone (n = 386) at the time of diagnosis. Within each subgroup, we fit a logistic regression model with severe COVID-19 as the response variable and adjusted for the relevant immunosuppressant and a set of covariates.

Results
In our SOT population, 570 patients were diagnosed with COVID-19 (458 kidney, 73 liver, 54 heart, 43 pancreas, and 8 lung recipients). The median patient age was 54 years, 59% were male, and 70% were white. After adjusting for other covariates, a mycophenolate dose-reduction of < 50% was associated with an odds ratio of 1.89 (95% CI: 0.96-3.70; p=0.06) for developing severe COVID-19. Similarly, decreasing the dose of mycophenolate by  50% was associated with an odds ratio of 2.44 (95% CI: 1.02-5.85, p=0.05) for developing severe disease. Tacrolimus dose reduction did not increase the risk of severe COVID-19. An increase or a decrease of prednisone dose was not associated with severe COVID-19. 

Conclusion
The reduction of mycophenolate dose when a SOT patient is diagnosed with COVID-19 should be discouraged, especially if the patient has mild disease. 


Reducing the dose of Mycophenolate in Solid Organ Transplant Recipients Diagnosed with SARS-CoV-2 Infection Increases the Risk of Severe COVID-19

Background
This study aimed to investigate the impact of COVID-19 on perioperative adverse outcomes in patients undergoing Per Oral Endoscopic Myotomy (POEM) procedures. As the COVID-19 pandemic has presented unique challenges in healthcare, understanding its association with adverse outcomes during POEM is crucial for optimizing patient care and management. 

Methods
The study utilized data from the Nationwide Inpatient Sample (NIS) 2020, a comprehensive and nationally representative database. 464% (p<0.001) more likely to experience pulmonary embolism during POEM.
Results
The cohort included 5,776 adults who underwent POEM, with 118 individuals diagnosed with COVID-19. Demographic variables, comorbidities, and perioperative adverse outcomes were examined. Univariable and multivariable logistic regression analyses were conducted to assess the relationship between COVID-19 and adverse outcomes, while controlling for potential confounding factors. Among the cohort, individuals with COVID-19 had higher rates of complications, including pneumonia, DVT or other thromboembolism, pulmonary collapse or atelectasis, pulmonary embolism, and portal vein thrombosis, compared to those without COVID-19 (p<0.001). In the univariable analysis, individuals with COVID-19 254% (p<0.001) more likely to develop pneumonia and 515% (p<0.001) more likely to develop pulmonary embolism during POEM. In the multivariable analysis, after adjusting for age, gender, race, hospital characteristics, region of the country, insurance, and comorbidities, individuals with COVID-19 were 230% (p<0.001) more likely to develop pneumonia and 464% (p<0.001) more likely to experience pulmonary embolism during POEM. 
Conclusion
This study reveals a significant association between COVID-19 and increased risk of perioperative adverse outcomes, particularly pneumonia and pulmonary embolism, in patients undergoing POEM. These findings emphasize the importance of considering COVID-19 status when evaluating perioperative risks and implementing appropriate preventive measures to improve patient outcomes. The results underscore the need for tailored approaches to mitigate the impact of COVID-19 in the perioperative period and enhance patient safety.


Perioperative Outcomes in Patients Undergoing Per Oral Endoscopic Myotomy (POEM) During the COVID 19 pandemic, a Nationally Representative Study

Background
This case report describes a rare extragonadal germ cell tumor, primary yolk sac tumor (YST) of the liver, which should be included in the differential of a young adult presenting with painless jaundice. There have been approximately 20 reported cases, the first being in 1975, of which only 5 are adult males. The estimated mortality rate for patients diagnosed with YST of the liver is greater than 50%.
Case Presentation
A 32-year-old male was referred from an outside facility for evaluation of painless jaundice. He had multiple prior hospitalizations which revealed a recurring distal common bile duct (CBD) stricture despite multiple biliary stent placements. A computed tomography (CT) scan was obtained and redemonstrated the distal CBD stricture. An endoscopic ultrasound (EUS) was then performed, showing enlarged peri-portal and peri-ductal lymph nodes in addition to a dilated CBD secondary to a distal stricture. A fine need biopsy (FNB) was obtained from the largest peri-ductal lymph node. An endoscopic retrograde cholangiopancreatography (ERCP) was then performed with placement of a plastic biliary stent to decompress the biliary tree and relieve the CBD obstruction secondary to lymphadenopathy. His serum bilirubin levels normalized 1 week later. FNB staining was consistent with YST. Subsequently, a testicular ultrasound was performed, but showed no evidence of a primary testicular mass, which confirmed the diagnosis of a primary YST of the liver. The patient was referred to oncology where he started a curative-intent chemotherapy regimen of bleomycin, etoposide, and cisplatin.
Discussion
There are three existing hypotheses for YST of the liver pathogenesis: aberrant migration of primordial germ cells, reverse migration of the transformed germ cells from the testes, and abnormal differentiation of somatic cells. FNB stained positive for cytokeratin 7, alpha fetoprotein, and glypican-3, which suggested either adenocarcinoma or YST. A positive sal-like protein 4 stain confirmed the presence of YST. Given this similar staining pattern between adenocarcinoma and YST, it is important to consider YST in the differential diagnosis, especially in young patients presenting with jaundice. Primarily because its management is very different often needing only chemotherapy and not a Whipple procedure which is usually seen with adenocarcinoma.


Yolk Sac Tumor of the Liver: A Rare Cause of Bile Duct Obstruction

The association between viral illness, inflammation, and organ dysfunction and damage is well-established throughout the literature. The interaction between angiotensin-converting enzyme 2 (ACE2) receptors and SARS-CoV-2 has been associated with the pathogenesis of SARS-CoV-2-related illness. COVID-19 can result in gastrointestinal complications due to direct or indirect insult (cytokine storm). Diarrhea is a common gastrointestinal manifestation of pancreatic insufficiency, inflammatory bowel disease, and SARS-CoV-2 infection. In COVID-19 patients, it’s the most common GI manifestation. We describe a unique case of COVID-19-induced concurrent exocrine Pancreatic Insufficiency and Inflammatory Bowel Disease that presented as chronic diarrhea. Given that the long-term effects of COVID-19 remain unknown, this case underscores the importance of systematically documenting COVID-19 manifestations to establish a temporal pattern of post-infection pathology for future research.

Long COVID: A Case of Concomitant Pancreatic Insufficiency with Inflammatory Bowel Disease

The COVID-19 pandemic has made a huge global impact and cost millions of lives. As COVID-19 vaccines were rolled out, they were quickly met with widespread hesitancy. To address the concerns of hesitant people, we launched VIRA, a public dialogue system aimed at addressing questions and concerns surrounding the COVID-19 vaccines. Here, we release VIRADialogs, a dataset of over 8k dialogues conducted by actual users with VIRA, providing a unique real-world conversational dataset. In light of rapid changes in users' intents, due to updates in guidelines or in response to new information, we highlight the important task of intent discovery in this use-case. We introduce a novel automatic evaluation framework for intent discovery, leveraging the existing intent classifier of VIRA. We use this framework to report baseline intent discovery results over VIRADialogs, that highlight the difficulty of this task.

Benchmark Data and Evaluation Framework for Intent Discovery Around COVID-19 Vaccine Hesitancy

This presentation reviews the latest evidence concerning the association of COVID-19 in women with PCOS. Topics within it will include whether women with PCOS are known to be at greater risk for COVID-19 and whether they are at a higher likelihood of severe disease.

Risk of SARS-COV-2 infection and PCOS

ABSTRACT 

Addisonian Crisis Exacerbation Secondary to COVID-19 Infection
Taylor L. Brewer, OMS III, Edward Via College of Osteopathic Medicine - Auburn Campus, Auburn, AL.; Hayley P. Nichols, OMS III, Edward Via College of Osteopathic Medicine - Auburn Campus, Auburn, AL.; Jordan S. Nolan, OMS III, Edward Via College of Osteopathic Medicine - Auburn Campus, Auburn, AL.; Heath W. Shelton, M.S., OMS III, Alabama College of Osteopathic Medicine, Dothan, AL.; Daniel C. Burnes, M.D., Crestwood Medical Center, Huntsville, AL. 

Addisonian Crisis, or adrenal crisis, is an uncommon condition characterized by severe hypotension, hypoglycemia, and hyperkalemia. If not treated promptly this condition can lead to organ failure or shock. It typically presents in patients who have had a prior diagnosis of Addison’s disease, or primary adrenal insufficiency (PAI). Manifestations of primary adrenal insufficiency include hyperpigmentation of skin, fatigue, nausea, vomiting, hypoglycemia, and hypotension. In this particular case a 55-year-old male with a past medical history significant for atrial fibrillation, hypothyroidism, and Addison’s disease was found unresponsive in his home. Upon presentation to the hospital the patient’s labs and vitals revealed an anion gap metabolic acidosis, fever of 103.2 degrees, altered mental status, an extremely hypotensive blood pressure of 69/49 mmHg, and was positive for COVID-19. He was given a bolus of normal saline IV fluids, ceftriaxone, ampicillin, and acyclovir as a prophylactic treatment regimen for possible meningitis that was later ruled out with a negative lumbar puncture. Cardizem was also initiated to combat tachycardia secondary to atrial fibrillation. Upon investigation into this patient’s prior hospitalizations, the electronic medical record revealed a previous diagnosis of primary adrenal insufficiency. At that time, IV hydrocortisone and fludrocortisone were initiated, followed by a rapid recovery and subsequent discharge from the hospital within 48 hours of admission. Since he was asymptomatic, COVID-19 directed therapy was never initiated. Upon discharge, fludrocortisone was reincorporated into the patient’s home medications. The purpose of this case report is to discuss an atypical presentation of Addison’s disease in a patient presenting in a crisis state due to COVID-19 infection.


Addisonian Crisis Exacerbation Secondary to COVID-19 Infection

Background: The COVID-19 pandemic has affected society's quality of life worldwide. Everyday aspects of life have been obliged to change, allowing individuals a safer lifestyle revolving around COVID-19. Once vaccines against COVID-19 were introduced, daily practices were expected to remit to normalcy. In this study, we aimed to identify if vaccination influenced the way of living of vaccinated individuals.
Methods: A questionnaire containing sociodemographic inquiries was administered via QR Code at the Universidad Central del Caribe (UCC) vaccination clinics and social media platforms to assess the quality of life (QoL) before the pandemic (BP), during the pandemic before vaccination (DPBV), and after vaccination (AV) against COVID-19. The study ran from January 2022 to May 2022.
Results: Participant recruitment reached 203 participants, 138 identified as female and 55 as male, all aged 21 and older. Participants received the following vaccines: 69.5% received Pfizer- BioNTech, 25.6% received Moderna, 3.4% received a combination of Pfizer-BioNTech/Moderna, and 1.5% received Johnson&Johnson. We analyzed that DPBV, 60% of participants did not visit food establishments (P < .001). Likewise, 62.3% did not visit malls (P < .001). However, there was a statistical difference AV with 67.5% of participants visiting food establishments (P < .001) and 74.2% visiting malls 1-2 times per week (P < .001). Regarding feeling of safety, while spending time with vaccinated or non-vaccinated people, we observed that 72.8% felt assured about hanging around vaccinated people, and 19.9% did not feel safe spending time with non-vaccinated people (P < .001). Concerning safety attending public events: 9.3% of participants said they felt safe DPBV, while 33.7% said they felt secure AV (P < .001).
Conclusion: The COVID-19 vaccine positively impacted the QoL of Puerto Ricans participating in the study. The statistical analysis indicates an increase in the measured daily activities amongst individuals post-vaccination compared to pre-vaccination in several variables, such as visits to food establishments, malls, and public events. 


Quality of Life After COVID-19 Vaccination in an Adult Hispanic Cohort

Background
COVID-19 has had severe impacts both in terms of human health and disruption to society since appearing in December 2019. Our project aims to look at changes in biophysical properties of the surface glycoprotein (S) of SARS-COV-2 to understand the evolution of variants within the human population. 

Methods
We obtained SARS-COV-2 amino acid sequences from the NIH NCBI Virus database and imported them into Microsoft Excel. Each amino acid residue within the full-length sequences was assigned a parametric value based on total accessible surface area (ASAtot), non-polar accessible surface area (ASAnp), polar accessible surface area (ASApol), and net charge at pH 7.0 (Charge). These values were used to quantify differences between these properties in sequences. PYMOL was then used to plot areas of interest onto the molecular structure in both the open (RBD – “Up”) and closed (RBD – “Down”) conformations. Furthermore, changes in parametric values observed in the sequences were compared to a random amino acid sequence data set using KaleidaGraph to determine statistical significance. 

Results
Our analysis revealed evidence of sporadic changes occurring at amino acids at the surface of S. Interestingly, different regions seem to be mutated in different variants. The S2 domain, particularly in Delta and Zeta lineages, appears to be inherently mutable. Despite the fact mutations are well-tolerated in many parts of S, very few of these become fixed in the population, indicating these individual changes do not provide a global selective advantage. In the Delta linage, for example, we observed numerous sporadic mutations occurring particularly in the N domain, whereas in the Omicron lineage, a greater proportion of mutations become fixed in the population.

Conclusion
We conclude that mutations in SARS-COV-2 S may confer fitness in the infected individual, but may not be advantageous in an outbred population. The biophysical property changes observed can be applied to predicting T- and B-cell interactions with S, helping us assess the effectiveness of current vaccines against circulating variants and help formulate future vaccine targets to protect against a wider range of SARS-COV-2 variants.

Using Biophysical Properties of SARS-COV-2 Surface Glycoprotein to Determine its Ongoing Structural Evolution

Background
COVID-19 vaccine production shed light on using mRNA vaccines to prevent chronic illness. Moderna recently announced their quest to manufacture an mRNA vaccine against HIV, a chronic illness affecting approximately 38 million people worldwide. In order to develop an HIV vaccine, two properties are essential: antibody dependent cellular cytotoxicity and long-lived antibody response. Multiple somatic hypermutations and long complementarity determining regions pose challenges to this. Key vaccine trials and a reflection on lessons learned for future vaccine development are discussed.

Methods
One study described an mRNA-LNP vaccine encoding clade C HIV-1 Env 1086C and tested tier 1, 2, and 3 neutralization capability. A second compared a gp160 mRNA vaccine with a SOSIP gp140 mRNA vaccine and SOSIP gp140 protein vaccine. SOSIPs are trimers that resemble HIV virions with a more soluble form due to the additions of a disulfide bond (SOS) and point substitution (IP). A third experiment compared an mRNA vaccine encoding HIV-1 Gag, Pol, and Nef proteins to another mRNA vaccine with an additional 1-methyl-3’-pseudouridylyl modified vector. Subjects were boosted with a poxvirus booster carrying the same antigen. A fourth experiment compared the efficacy of a trivalent versus tetravalent adjuvanted protein vaccine. The final experiment analyzed the efficacy of an mRNA vaccine that co-expressed HIV-1 426c.3dg Env and SIVmac239 Gag proteins.

Results
The first study failed to produce recall antibody response and recommended that future trials use next-generation SOSIPs. The second study incorporated SOSIPs but did not produce significant recall antibody responses. The third study showed promising results with vaccination with a poxvirus booster. The fourth study showed a higher antibody response and enhanced recall in tetravalent vaccines and is currently undergoing further testing. The final trial showed a 79% reduction in per-exposure risk for vaccinated subjects as compared to controls.

Conclusion
mRNA vaccines have a marked advantage compared to other vaccines – there are less manufacturing challenges and decreased cost. Incorporating several boosters, particularly utilizing different mechanisms and vehicles, shows promising results. The COVID-19 vaccine rollout provides a layout for arranging international rollout. Communities must be engaged early on and support the diversity and flexibility necessary in HIV vaccine development.

Underline digital video library

COVID-19 Vaccine Misinformation in Middle Income Countries | VIDEO

Evaluating the Influence of the COVID-19 Pandemic on Adverse Birth Outcomes

Reducing the dose of Mycophenolate in Solid Organ Transplant Recipients Diagnosed with SARS-CoV-2 Infection Increases the Risk of Severe COVID-19

Perioperative Outcomes in Patients Undergoing Per Oral Endoscopic Myotomy (POEM) During the COVID 19 pandemic, a Nationally Representative Study

Yolk Sac Tumor of the Liver: A Rare Cause of Bile Duct Obstruction

Long COVID: A Case of Concomitant Pancreatic Insufficiency with Inflammatory Bowel Disease

Benchmark Data and Evaluation Framework for Intent Discovery Around COVID-19 Vaccine Hesitancy

Risk of SARS-COV-2 infection and PCOS

Addisonian Crisis Exacerbation Secondary to COVID-19 Infection

Quality of Life After COVID-19 Vaccination in an Adult Hispanic Cohort

Using Biophysical Properties of SARS-COV-2 Surface Glycoprotein to Determine its Ongoing Structural Evolution

Lessons Learned from HIV mRNA Vaccine Development in the Age of COVID-19 Vaccines

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