The Safety Profile of Common COVID-19 Vaccines in Patients With Multiple Sclerosis.

Background and objective Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). In light of the COVID-19 pandemic that emerged in late 2019, the World Health Organization (WHO) has endorsed mass immunization to enhance the population's immunity against the virus. However, certain concerns have been raised about the safety of COVID-19 vaccines among patients with autoimmune disorders, including those with multiple sclerosis (MS). Further research is required to address these concerns and to gain deeper insights into the possible complications of COVID-19 vaccines among MS patients. This study aimed to assess the side effects of COVID-19 vaccines among MS patients. Methods An observational cross-sectional study was conducted between May and November 2023 at the National Guard Hospital, Jeddah, Saudi Arabia. All MS patients enrolled in our local registry system and provided phone numbers were included in the study. A total of 208 MS patients were surveyed via phone interviews, and data were collected regarding their demographics, MS history, COVID-19 history, SARS-CoV-2 vaccination status, and their exposure to disease-modifying therapies (DMTs). All results were analyzed using Stata software. Statistical significance was set at a CI of 95% and a p-value <0.05. Results In our cohort, 128 (61.5%) patients had received three doses of the COVID-19 vaccine, while 68 (32.7%) had received two doses; four patients (2.0%) had received only one dose, five (2.4%) had not received the vaccine, and the number of doses was unknown for the remaining three patients (1.4%). The BNT162b2 mRNA COVID-19 Vaccine from Pfizer-BioNTech was the most commonly administered (n=136 patients, 66.0%), followed byChAdOx1 nCoV-19 Vaccine from Oxford-AstraZeneca (n=47 patients, 22.8%), and mRNA-1273 SARS-CoV-2 Vaccine from Moderna (n=5 patients, 2.4%). Of note, 139 patients (69.5%) reported experiencing adverse events after receiving the vaccine, and the ChAdOx1 nCoV-19 Vaccine from Oxford-AstraZeneca was significantly associated with higher rates of side effects, in 87.8% of the patients. Conclusion A sizable proportion of MS patients experienced self-limiting side effects from exposure to the COVID-19 vaccine. The rates and incidence of side effects were similar to those encountered in the general population. None of the adverse effects recorded in our population of MS patients were serious or life-threatening. We recommend that physicians encourage patients with MS who have never received COVID-19 vaccination to get promptly vaccinated as the risks of COVID-19 infection far outweigh the minor risks associated with COVID-19 vaccination.

Retraction: Lemierre's Syndrome: A Case of Life-Threatening Infection From Family Medicine Practice.

[This retracts the article DOI: 10.7759/cureus.20684.].

Retraction: Emphysematous Cystitis: A Radiological Diagnosis of Potentially Life-Threatening Infection.

[This retracts the article DOI: 10.7759/cureus.20201.].

Emphysematous Cystitis: A Radiological Diagnosis of Potentially Life-Threatening Infection.

Urinary tract infections are very prevalent among women. The majority of urinary tract infections are uncomplicated and can be managed empirically with no further investigations. However, imaging studies may be indicated in patients with severe or persistent symptoms. Complicated urinary tract infections typically develop in the setting of diabetes mellitus. We report a case of a 52-year-old woman who presented to the emergency department with severe lower abdominal pain for two days that was associated with nausea, vomiting, and fever. There was no history of change in urine or bowel habits. Besides the history of well-controlled asthma, the patient was not known to have any comorbid medical condition. Upon examination, the patient had tachycardia, low-grade fever, and a localized suprapubic tenderness with guarding. Laboratory investigation revealed leukocytosis, elevated erythrocyte sedimentation rate and C-reactive protein, and deranged renal functions. Further, urinalysis revealed numerous white blood cells, red blood cells, positive nitrite, and leukocyte esterase. A computed tomography scan demonstrated the presence of small locules of gas within the lumen and the wall of the bladder representing emphysematous cystitis. The patient was admitted to the intensive care unit. She received aggressive hydration therapy and a short course of opioid therapy for pain control. Broad-spectrum antibiotic therapy in the form of piperacillin-tazobactam was initiated. Over the following few days, the patient exhibited significant improvement in his symptoms and resolution of the laboratory parameters. Emphysematous cystitis is a rare infection of the lower urinary tract with gas formation. The case highlighted that such a condition may develop in the absence of diabetes mellitus or other risk factors. Prompt treatment is crucial as emphysematous cystitis can be life-threatening if the diagnosis is missed or delayed.

Lemierre's Syndrome: A Case of Life-Threatening Infection From Family Medicine Practice.

The use of antibiotic therapy has led to a major transformation in medicine with a substantial reduction in mortality. Due to the adverse effects associated with inappropriate antibiotic use, antibiotic stewardship interventions have been promoted to improve antibiotic prescription. However, delayed antibiotic therapy, when clinically needed, may result in increased morbidity. Here, we report the case of a previously healthy young man with an untreated acute upper respiratory infection for two weeks, who presented with headache and fever. Physical examination suggested meningitis as evident by neck stiffness and positive Kernig sign. Purulent tonsilitis was also noted. Laboratory findings showed leukocytosis and elevated inflammatory markers. The patient underwent a computed tomography scan to rule out space-occupying lesions prior to lumbar puncture. The scan revealed thrombophlebitis of the left internal jugular vein that extended to the dural venous sinuses. Magnetic resonance imaging confirmed the intracranial dissemination of the disease. Such findings conferred the diagnosis of Lemierre's syndrome. The patient was admitted to the intensive care unit where he received systemic anticoagulation and prolonged intravenous antibiotics. He developed a good response and was discharged with no residual deficits after six weeks of hospitalization. Lemierre's syndrome is a serious infection that develops after a pharyngeal infection. Considering the high mortality rate of untreated Lemierre's syndrome, physicians should keep a high index of suspicion for this condition when they encounter a patient with upper respiratory tract infection with clinical or radiological findings consistent with internal jugular thrombophlebitis.

The Association Between Vitamin D Deficiency and Recurrent Tonsillitis: A Systematic Review and Meta-analysis.

OBJECTIVES: The role of vitamin D deficiency has been linked with recurrent upper respiratory tract infections, but its impact on the frequency of tonsillitis is not yet fully understood. The objective of this study is to determine the association between vitamin D deficiency and recurrent tonsillitis based on current literature. DATA SOURCE: A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Data were collected from online medical databases (PubMed, MEDLINE, EMBASE, and Cochrane Collaboration Registry of Controlled Trials). REVIEW METHODS: All studies addressing the association of vitamin D deficiency and recurrent tonsillitis prior to March 2019. The data were collected in different phases: screening review using search words and controlled vocabularies followed by detailed review of screened articles based on inclusion and exclusion criteria, then a full review that included screening the references of selected articles. RESULTS: Fifty-three studies were potentially eligible; of these, 4 publications met the inclusion criteria and were included in the quantitative synthesis. There was a statistically significant reduction of vitamin D levels in patients with recurrent tonsillitis as compared to healthy controls (mean difference, -10.71; 95% CI, -19.12 to -2.31; P = .01). The odds of vitamin D insufficiency were significantly higher in patients with recurrent tonsillitis as compared to the control group (odds ratio, 4.37; 95% CI, 2.78-6.88; P < .001). CONCLUSION: Vitamin D deficiency was present in patients with recurrent tonsillitis and might be associated with an increase in the risk of recurrent tonsillitis. There is a need to explore these findings via clinical trials based on large populations.