Severe Rhabdomyolysis Temporally Associated with sars-cov-2 Vaccine in an Adolescent

Introduction: Serious pediatric systemic adverse events following receipt of the messenger ribonucleic acid (mRNA) vaccines such as Pfizer/BioNTech vaccine (BNT162b2-V) are rare, with the most common being myocarditis. We report a case of severe rhabdomyolysis following receipt of BNT162b2-V and review the literature for reports in children. To our knowledge, this is the first case of severe rhabdomyolysis temporally associated with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccine in a healthy adolescent without a predisposing cause. Case Description: A previously healthy16-year-old female developed extensive and severe myalgias and generalized weakness following dose two of BNT162b2-V. She had severe rhabdomyolysis with a peak creatinine kinase (CK) of 246,900 U/L at 92 hours post-vaccination. SARS-CoV-2 polymerase chain reaction (PCR) testing and antibody to nucleocapsid were negative. Extensive workup revealed no alternative causes. The patient was treated effectively with intravenous hyperhydration over a 3-day hospital admission. As of July 9th, 2021, four pediatric cases of rhabdomyolysis temporally associated with SARS-CoV-2 vaccination were identified in the Vaccine Adverse Event Reporting System (VAERS) database. Case 1 was a 17-yearold male with drug overdose (loratadine and doxylamine) 5 days post dose two of BNT162b2-V. He was found to have rhabdomyolysis and myocarditis. Case 2 was a 12-year-old female with bilateral arm weakness post dose two of BNT162b2-V and a peak CK of 7000 U/L. Rigorous exercise was implicated as a cause in this case. Case 3 was a 14-year-old female who accidently received a triple BNT162b2-V dose (undiluted dose) and developed chest pain, her CK was 7000 U/L. Case 4 was a 14-year-old male who developed myalgias post dose one of BNT162b2-V and had mild rhabdomyolysis with a CK of 1600 U/L. Discussion: Rhabdomyolysis has been reported following vaccines including BNT162b2-V but without a causal link. Although our case is the fifth adolescent reported, our case is unique given the absence of an identifiable trigger and the severity of rhabdomyolysis. The development of symptoms in close proximity to vaccine administration and in the absence of another identifiable trigger raises concerns about a potential link. Although exaggerated immune response in vaccine recipients who have had previous SARS-CoV-2 infection has been postulated, the absence of nucleocapsid antibodies does not support this in our patient. Immune mediated or aberrant autoimmune responses to adjuvants in the SARS-CoV-2 vaccine, as seen in the autoimmune inflammatory syndrome induced by adjuvants (ASIA) is another possibility. Post-vaccination autoimmune phenomena have been documented in connection to various vaccines. Conclusion: As more healthy adolescents with robust immune systems become vaccinated, it is important for clinicians to identify rhabdomyolysis post- SARS-CoV-2 vaccination to allow for timely intervention and prevent adverse outcomes such as acute kidney injury.

Insights into solvation effects, spectroscopic, Hirshfeld Surface Analysis, reactivity analysis and anti-Covid-19 ability of doxylamine succinate: Experimental, DFT, MD and docking simulations

In the present work, the experimental and theoretical reports on electronic and vibrational features of doxylamine succinate (DXS) are presented. The vibrational spectra were documented and wavenumbers were obtained theoretically assigned by means of potential energy distribution. In DXS, N-H…O and C-H…O intermolecular hydrogen bonding contacts are associated with O…H/H…O interactions. Solvation free energy (SFE) for DXS in water, methanol and DMSO, are -10.67, -10.95 and -10.61 eV/mol respectively. Interpretation of electrostatic potential, electron localization function (ELF), localized orbital locator (LOL) as well as atoms-in-molecules (AIM) analysis is also performed. Presence of non-covalent interactions is evident from the non-covalent interaction (NCI) isosurface. Molecular docking and simulations were used to determine the binding energy of DXS in order to investigate its potential activity against the SARS-CoV-2 protease.

Psychiatric and neurological aspects of sleep disturbance after coronavirus infection (COVID-19)

There are both scientific interest and practical value to study the medical consequences of the Coronavirus disease 2019 (COVID-19) due to its pandemic status and high prevalence of different complaints among COVID-19 survivors. These complaints are called “post-COVID” or “long COVID” syndrome. One of the frequent symptoms of post-COVID syndrome is sleep disturbances, predominantly insomnia. The article provides epidemiological data, pathogenesis, socioeconomic factors, and therapeutic approach to insomnia associated with post-COVID syndrome. The increase of sleep disturbances prevalence in pandemic conditions has a comprehensive nature. It includes the disease consequences itself and change of lifestyle due to lockdown. The lifestyle change leads to physical activity decrease and inadequate sleep hygiene. Besides, the high stress level is also the reason for sleep disturbances. The direct effects of COVID-19 on the central nervous system are understudied at the moment. Nevertheless, there are reasons to suggest neurotropic characteristics of SARS-CoV-2 to underlie post-COVID neurological and psychiatric disturbances. Taking into account that general practitioners are mainly addressed post-COVID complaints, the recommended hypnotics should be safe, easily prescribed, and highly effective. The probable presence of the psychiatric pathology should be also assessed because the sleep complaints might be its manifestation. © 2022, Remedium Group Ltd. All rights reserved.