Concerns have been raised about allergic reactions to messenger ribonucleic acid (mRNA) coronavirus disease 2019 (COVID-19) vaccines. A history of allergic reactions, including anaphylaxis to drugs, has been frequently reported in individuals with anaphylaxis to mRNA vaccines. To estimate the rate of immediate allergic reactions in patients with a history of drug allergy or other allergic disorders. We included adult patients who had received at least 1 dose of an mRNA COVID-19 vaccine at the Special Hospital for Pulmonary Diseases between March 1, 2021, and October 1, 2021, and who reported a history of drug allergy or other allergic diseases (asthma, allergic rhinitis, atopic dermatitis, food or insect venom allergy, mastocytosis, idiopathic anaphylaxis, acute or chronic urticaria, and/or angioedema). Immediate allergic reactions, including anaphylaxis, occurring within 4 hours of vaccination were recorded. Six immediate allergic reactions were noted in the cohort of 1679 patients (0.36%). One patient experienced anaphylaxis (0.06%), which resolved after epinephrine administration, and the other reactions were mild and easily treatable. Most patients with a history of allergies can safely receive an mRNA COVID-19 vaccine, providing adequate observation periods and preparedness to recognize and treat anaphylaxis.

Key Clinical Message: Alpha‐gal syndrome is an immunoglobulin E‐mediated hypersensitivity characterized by delayed allergic reactions to ingested products containing alpha‐gal carbohydrate. We present a patient with recurrent urticaria and suspected repaglinide hypersensitivity, who was eventually diagnosed with alpha‐gal syndrome, wanting to emphasize possible drug allergy misdiagnosis and required caution with the medication choice.

Objectives: COVID-19 in it is more severe form is characterized by a hyperinflammatory condition, hypercoagulation state and the appearance of pulmonary microembolism. In this study we wanted to correlate levels of D-Dimer, protein C, protein S and antithrombin 3 with severity of disease and clinical outcome. Methods: We included 134 of patients who were divided in 3 groups regarding oxygen support (high flow oxygen therapy, mechanical ventilation and oxygen supplementation with nasal cannula or mask). Results: Concentration of D-Dimer, and activity of protein C and antithrombin 3 are presented as mean±SD and differed significantly between patients on mechanical ventilation (3.26 ± 1.15 mg/L, 86 ± 22.55 %, 81.21 ± 17.61 %)/HFNO (2.35 ± 1.68 mg/L, 109.6 ± 26.96 %, 94.67 ± 17.49 %)/BNC (1.37 ± 1.17 mg/L, 116.92 ± 28.16 %, 103.29 ± 15.63 %) with p<0.001 for all parameters. Mortality in oxygen group was 10.9 %, in HFNC group 40.7 % and in mechanical ventilated group 80 %. Conclusions: determination of anticoagulant factors in COVID-19 patients may indicate which of them are at increased risk of developing severe disease, venous thromboembolism and fatal clinical outcome.

Introduction: As a widespread malignancy in women throughout the world, breast cancer has an extremely high incidence and mortality rate and therefore poses a serious public health concern. Metastasis of breast carcinoma in the urinary bladder wall poses a challenge in diagnosis because it is a rare and sometimes asymptomatic disease. This paper aims to present a rare case of urinary bladder metastasis originating from invasive lobular breast carcinoma and to emphasize the importance of recognizing atypical metastatic sites. Case Report: A 58-year-old woman with a three-year history of lobular carcinoma of the right breast presented with urinary symptoms and bilateral hydronephrosis. The initial tumor was triple-negative, staged T4bN3M0. Following neoadjuvant chemotherapy (anthracyclines and taxanes), radiotherapy, and modified radical mastectomy. The histopathological assessment of tumor response to therapy: almost complete response (pNCR), and two of ten lymph nodes were positive for metastases. The treatment was continued with Capecitabine in an adjuvant approach (8 cycles), and the patient remained asymptomatic for two years. Subsequently, she developed urosepsis and was hospitalized for bilateral hydronephrosis and renal calculi. Imaging (CT) revealed retroperitoneal lymphadenopathy, and cystoscopy showed bullous edema of the bladder wall. The histopathological examination after TUR showed infiltratory carcinoma of the urinary bladder wall, and immunohistochemical staining was positive for GATA3, GCDFP-15, CDX2, and Mamaglobin. It was concluded that it was a metastasis of breast carcinoma in the urinary bladder wall. Conclusion: Despite therapeutic advances, prognosis remains poor. Awareness of this unusual metastatic pattern is crucial for timely recognition, accurate diagnosis, and multidisciplinary management.