Covid-19 disease, women’s predominant non-heparin vaccine-induced thrombotic thrombocytopenia and kounis syndrome: A passepartout cytokine storm interplay

Coronavirus disease 2019 (COVID-19) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) constitute one of the deadliest pandemics in modern history demonstrating cardiovascular, gastrointestinal, hematologic, mucocutaneous, respiratory, neurological, renal and testicular manifestations and further complications. COVID-19-induced excessive immune response accompanied with uncontrolled release of cytokines culminating in cytokine storm seem to be the common pathogenetic mechanism of these complications. The aim of this narrative review is to elucidate the relation between anaphylaxis associated with profound hypotension or hypoxemia with pro-inflammatory cytokine release. COVID-19 relation with Kounis syndrome and post-COVID-19 vaccination correlation with heparin-induced thrombocytopenia with thrombosis (HITT), especially serious cerebral venous sinus thrombosis, were also reviewed. Methods: A current literature search in PubMed, Embase and Google databases was performed to reveal the pathophysiology, prevalence, clinical manifestation, correlation and treatment of COVID-19, anaphylaxis with profuse hypotension, Kounis acute coronary syndrome and thrombotic events post vaccination. Results: The same key immunological pathophysiology mechanisms and cells seem to underlie COVID-19 cardiovascular complications and the anaphylaxis-associated Kounis syndrome. The myocardial injury in patients with COVID-19 has been attributed to coronary spasm, plaque rupture and microthrombi formation, hypoxic injury or cytokine storm disposing the same pathophysiology with the three clinical variants of Kounis syndrome. COVID-19-interrelated vaccine excipients as polysorbate, polyethelene glycol (PEG) and trometamol constitute potential allergenic substances. Conclusion: Better acknowledgement of the pathophysiological mechanisms, clinical similarities, multiorgan complications of COVID-19 or other viral infections as dengue and human immunodeficiency viruses along with the action of inflammatory cells inducing the Kounis syndrome could identify better immunological approaches for prevention, treatment of the COVID-19 pandemic as well as post-COVID-19 vaccine adverse reactions

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Relationships Between Capability Indices and Signal-to-Noise Ratios for Use in the Manufacturing Industry

This paper reports on the implications when using capability indices and signal-to-noise ratios for continuous improvements. The aim was to address the problems that are created when trying to use both at the same time, and forms part of a wider study into their implication. When robust designs are required on processes that have adequate capability indices it was found that in many cases the new parameters can reduce the capability index. Likewise, when trying to improve capability indices on robust designs the signal-to-noise ratio will no longer be at its optimum. Reviewing these two situations shows that for achieving robustness and acceptable capability a compromise must be achieved

Determining Capability Indices With Small Samples

The increased use of quality management standards in the last ten years has focused many organizations to investigate and apply statistical process control methods. Since QS 9000 has started to become widely used, capability indices are now a mandatory part of many quality systems. To calculate a capability index can be relatively simple when large samples are used. When sample sizes are low, typically less than 50, confidence limits can make the resulting index unacceptable. This investigates how Extreme Value Statistics can be used to calculate capability indices and comments on the potential for this method to replace existing methods

Preliminary Experiments on a Model to Relate Cpk and SNR Indices

This paper investigates the difficulties of using both Signal-to-Noise Ratios (SNR) and Capability Indices (Cpk) as quality improvement techniques. Recognising the possible contradictory indications of the indices, Cpk and SNR as process quality measures, a 2D geometrical construction is described which relates these indicators. The model has previously been demonstrated theoretically to be capable of clearly indicating the contradictions between indicators. Essentially, it is able to balance the requirements of robustness and reduction of rejects