A Study on the Significance of Nasal Smear Eosinophil Count and Blood Absolute Eosinophil Count in Patients with Allergic Rhinitis of Varied Severity of Symptoms

Introduction: Rhinitis is defined as inflammation of nasal mucosa. Allergic rhinitis is the most common type of chronic rhinitis with increasing prevalence. Tests such as nasal smear for eosinophilia, Skin prick test, Serum absolute eosinophil count and Immunoglobulin IgE helps us in diagnosis of allergic rhinitis. Objective: To evaluate the efficacy of the nasal smear for eosinophilia and blood absolute eosinophil count tests to diagnose allergic rhinitis in patients with varied severity of symptoms. Materials and methods: In this prospective study, all patients above 12 years of age with symptoms suggestive of allergic rhinitis were enrolled in our study. Severity assessment was done by visual analog scoring and Total nasal outcome scoring. Diagnostic nasal endoscopy with nasal smear for eosinophilia, complete blood count and blood absolute eosinophil count tests were done. Results: A total of 60 patients were enrolled in the present study. Age ranged from 13 to 55 years with female preponderance. The most common symptom was rhinorrhea found in 100% of study population, followed by sneezing present in 57 (93.5%) patients. 10 out of 12 patients with mild intermittent symptoms had < 5% of eosinophil elicited in nasal smear and 2 patients had negative smear of eosinophils. Only 13% had mild eosinophilia. In this study, in those patients with mild intermittent symptoms neither nasal smear eosinophilia nor Blood absolute eosinophil count was found to be significant. Conclusions: Nasal smear cytology and blood absolute eosinophil count were found to be significant only in patients with moderate-severe symptoms. Those patients with mild intermittent symptoms need not be tested as it will be insignificant. In these patients, we must rely on the visual analogue score based on the severity of symptoms rather than laboratory tests.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03945-5.

Management of allergic rhinitis with Rajanyadi Churna and Guduchi Kwatha- A case report

Allergic Rhinitis is an immunological inflammatory response of the nasal mucosa to airborne allergens. Although Allergic Rhinitis is not a life-threatening disease, the symptoms of Allergic Rhinitis can be particularly bothersome and disruptive to a patient's sleep and overall quality of life. The coexistence of other allergic conditions like Asthma is very common. No satisfactory treatment is available in modern medicine for this disease. There is a need to search for satisfactory treatment available in another medical system. We present a case of Allergic Rhinitis that was successfully treated with Ayurvedic medicines. Allergic Rhinitis is characterized by watery nasal discharge, nasal obstruction, nasal mucosal pallor, sneezing, and itching in the eyes, palate, and pharynx. A 18-year-old female patient presented with complaints of sneezing (80-100/day), rhinorrhea (watery discharge from nose), heaviness in the head region, weakness, and loss of concentration hampering daily life activity for one year. The patient's clinical findings and symptoms were suggestive of Allergic Rhinitis, which is of perennial type. According to Ayurveda diagnosis was done as Vata-Kaphaj Pratishyay. Rajanyadi Churna was given to the patient for 15 days along with Guduchi Kwath (∼Guduchi decoction) followed by Shaman Snehapan (∼internal oleation) with Mahatiktak Ghrita. The patient experienced a reduction in all the symptoms after 15 days. Allergy markers i.e. Absolute Eosinophil Count reduced to 360 cells/cu mm from 704 cells/cu mm and eosinophils in CBC reduced to 4.1%. The primary complaint of sneezing was significantly reduced to 3-4 times/day after completing the treatment. Ayurvedic therapeutic interventions other than Nasya (∼Nasal oleation), and Dhoompana (∼medicated smoke) modalities showed encouraging results in managing Allergic Rhinitis in a short duration of time. This approach may be taken into consideration for further treatment and research work for Allergic Rhinitis.

Role of high-sensitivity C-reactive protein (hs-CRP) in assessment of asthma control in children

INTRODUCTION

Data are scarce on hs-CRP as a biomarker for airway inflammation in pediatric asthma. We aimed to examine correlation between hs-CRP and asthma control levels.

METHODS

Children with physician-diagnosed asthma, ages 6-15 years, were enrolled. GINA-2016 criteria were used to assess the level of asthma control. The relationships between serum hs-CRP and each of asthma control measures (asthma control criteria, spirometry, impulse oscillometry, eosinophil counts and fractional exhaled nitric oxide (FeNO) were assessed.

RESULTS

150 asthmatic children were enrolled; 52 (35%) had well controlled asthma, 76 (51%), and 22 (14%) children had partly controlled and uncontrolled asthma, respectively. Median (IQR) values of hs-CRP were 0.47 (0.1, 1.67) mg/L in well controlled, 0.30 (0.1, 1.83) mg/L in partly controlled, and 2.74 (0.55, 3.74) mg/L in uncontrolled asthma (p = 0.029). Using receiver operator characteristic (ROC) curve analysis, area under the curve for hs-CRP (mg/L) to discriminate between uncontrolled and (controlled + partly controlled) asthma was 0.67 (95% CI 0.55, 0.80) and a cutoff 1.1 mg/L of serum hs-CRP level had a sensitivity of 68.1% with specificity of 67.97%. In two groups of hs-CRP (<3 mg/L) and hs-CRP (≥3 mg/L), high hs-CRP group had higher proportion of uncontrolled asthmatic children (p = 0.03).

CONCLUSION

We observed higher serum hs-CRP values in children with uncontrolled asthma, suggesting its potential role as a biomarker of asthma control.

Absolute eosinophil count may be an optimal peripheral blood marker to identify the risk of immune-related adverse events in advanced malignant tumors treated with PD-1/PD-L1 inhibitors: a retrospective analysis

Background

This study aimed to investigate the predictive values of serum biomarkers including absolute eosinophil count (AEC), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) with respect to immune-related adverse events (irAEs) during anti-PD-1/PD-L1 inhibitor treatment in patients with advanced malignant tumors.

Methods

We retrospectively analyzed 95 patients with advanced cancer who were treated with anti-PD-1/PD-L1 inhibitors from January 1, 2017, to May 1, 2020, in our cancer center. We then analyzed associations between irAEs and anti-PD-1/PD-L1 inhibitor responses and evaluated the predictive values of serum biomarkers with respect to the risk of irAEs.

Results

The incidence of irAEs was 55.8%. There were no statistically significant differences between the irAEs and no-irAEs groups in an objective response rate (ORR) or disease control rate (DCR). However, landmark analysis showed that the irAEs group had better survival after 120 days following the initiation of anti-PD-1/PD-L1 inhibitor treatment, compared with the no-irAEs group. The incidences of irAEs were greater in the high-AEC and low-NLR groups than in the low-AEC and high-NLR groups. Univariate logistic analysis showed that low NLR, ECOG performance status (0–1), and high AEC were risk factors for irAEs. Multivariate logistic analysis showed that high AEC and good ECOG performance status were independent predictors for irAEs.

Conclusions

irAEs may be associated with a survival benefit. Baseline AEC is a strong predictor of irAEs in patients undergoing treatment with anti-PD-1/PD-L1 inhibitors.

Preliminary evidence in treatment of eosinophilic gastroenteritis in children: A case series

BACKGROUND

Eosinophilic gastroenteritis is a rare inflammatory disorder in children. However, there is still no standard guideline in the treatment of pediatric eosinophilic gastroenteritis.

AIM

To report our experience with the diagnosis and treatment of children with eosinophilic gastroenteritis.

METHODS

From January 2017 to December 2019, a total of 22 children were diagnosed with eosinophilic gastroenteritis.

RESULTS

Endoscopic examination showed eosinophil infiltration in the duodenum [mean number of eosinophils/high-power field (HPF) = 53.1 ± 81.5], stomach (mean number of eosinophils/HPF = 36.8 ± 50.5), and terminal ileum (mean number of eosinophils/HPF = 49.0 ± 24.0). All 18 children with low eosinophil infiltration (< 14%) responded well to the initial drug treatment without relapse, while two of four children with high eosinophil infiltration (> 14%) relapsed after initial methylprednisolone/montelukast treatment. In addition, children with high eosinophil infiltration (> 14%) showed symptomatic relief and histological remission without further relapse after receiving budesonide/methylprednisolone as initial or relapse treatment.

CONCLUSION

Methylprednisolone/montelukast is still the best treatment for children with low eosinophil infiltration (< 14%). Budesonide can be considered as the initial or relapse treatment for children with high eosinophil infiltration (> 14%).

Absolute eosinophil count predicts clinical outcomes and toxicity in non-small cell lung cancer patients treated with immunotherapy

OBJECTIVES

Immune checkpoint inhibitors (ICIs) have led to a paradigm shift in non-small cell lung cancer (NSCLC) treatment. We investigated absolute eosinophil count (AEC) as a predictor of clinical outcomes and toxicity in NSCLC patients receiving ICIs.

MATERIALS AND METHODS

AEC was retrospectively collected at baseline and during treatment from 158 advanced NSCLC patients treated with single agent anti-PD1/anti-PDL1 monoclonal antibody in first or subsequent line of therapy at Medical Oncology Unit, Careggi University Hospital, Florence (Italy), between January 2016 to October 2020.

RESULTS

We found a significant association between high baseline AEC (≥130/μL) and better clinical outcomes. The response rates were 64.4% and 35.6% for patients with high and low AEC, respectively (p = 0.009). The high-AEC group showed a significantly longer PFS and OS than the low-AEC group (mPFS = 7.0 months, 95% CI 5.0-10.0 vs 2.5 months, 95% CI 2.0-4.0, p = 0.007 and mOS = 9.0 months, CI 95% 7.0-15.0 vs 5.5 months, 95% CI 4.0-8.0, p = 0.009, respectively). An increased risk of immune-related adverse events (irAEs) was reported in the high-AEC group (p = 0.133). IrAEs resulted an independent prognostic factor for both better outcomes (mPFS = 8.0 months, 95% CI 7.0-12.0 vs 2.0 months, 95% CI 2.0-3.0, p<0.001; mOS = 13.0 months 95% CI 9.0-19.0 vs 4.0 months 95% CI 3.0-6-0, p<0.001) and response to ICIs (response rate = 33.8% vs 14.9%, disease control rate = 72.0% vs 32.1%, p<0.001).

CONCLUSION

High baseline AEC value (≥130/μL) is a predictive biomarker of clinical benefit and irAEs occurrence in NSCLC patients treated with ICIs.

A study of Spirometric parameters in non asthmatic allergic rhinitis

Introduction

Allergic rhinitis (AR) is a common IgE -mediated inflammatory condition characterised by sneezing, nasal congestion, itching and rhinorrhoea. Nasal allergy is a strong risk factor for the onset of asthma in adults. Bronchial hyper-responsiveness (BHR) is a distinct feature of pathophysiology in asthma. Spirometric parameters like Forced Expiratory Volume in first second [FEV1] and Forced Expiratory Flow [FEF _25-75%] are known to be impaired in patients with allergic rhinitis. We studied these parameters in subjects of AR who have never experienced any chest symptoms. It is well known that, subjects with allergic rhinitis are at greater risk of developing overt bronchial asthma in future.

Methods

All patients presented with symptoms of allergic rhinitis without history of bronchial asthma were included. Patients those who were clinically diagnosed with allergic rhinitis were evaluated with absolute eosinophilic count, serum IgE and Spirometric assessment. In spirometry, post bronchodilator FEV1 reversibility and post bronchodilator FEF _25-75% values were used to assess lower airway abnormalities.

Results

Among 61 subjects, 32 were males and 29 were females. The maximum numbers [28] of patients were in 21-35 age group. Absolute eosinophil count was elevated in 38% of patients. 33% of patients showed elevated IgE values above 1000. 43% of patients showed FEV1 reversibility which is a sign of Bronchial hyperreactivity. 5% of patients showed impaired post bronchodilator FEF _25-75% which indicates presence of small airway disease. There was significant correlation between FEV1 reversibility and elevated IgE.

Conclusion

Impaired spirometric parameters indicate coexistence of bronchial impairment and hence predisposition to progression from allergic rhinitis alone to overt asthma in future. Thus careful evaluation of lower airway has to be done to rule out coexisting subclinical asthma.

To evaluate the efficacy and safety of olopatadine 0.1% ophthalmic solution and bepotastine 1.5% ophthalmic solution in patients with vernal keratoconjunctivitis in a tertiary care hospital

INTRODUCTION

Vernal conjunctivitis comprises 0.5% of allergic eye diseases. The study is intended to collate the effectiveness of drugs by observing the reduction in signs and symptoms.

OBJECTIVES

The objective of the study is to evaluate the effectiveness and safety of olopatadine 0.1% ophthalmic drops with bepotastine besilate 1.5% ophthalmic drops in patients with vernal keratoconjunctivitis (VKC).

MATERIALS AND METHODS

A randomized, open-label, comparative study conducted in Sarojini Devi Eye Hospital, Telangana. The study included 50 patients diagnosed with VKC, of which Group A and Group B were given olopatadine 0.1% ophthalmic drops and bepotastine besilate 1.5% ophthalmic drops, respectively, twice a day for 8 weeks. The reduction in signs and symptoms in both groups was compared. The observations and results were tabulated accordingly, and data were analyzed using the SPSS. The unpaired t-test is used as the test of significance in between two groups. P value is statistically significant when it is less than 0.05.

RESULTS

Overall, 50 cases were included in the study, 72% of total patients were in the age group of 5-10 years, and 28% were in the age group of 11-15 years. There were 39 males and 11 females. After 8 weeks of follow-up, the mean reduction in the scoring of symptoms and signs provided better and quicker relief of watering, ocular discomfort, and conjunctival hyperemia with bepotastine 1.5% eye drops. Olopatadine 0.1% eye drops provided faster improvement in papillary hypertrophy. Both drugs were equally effective in reducing itching. Laboratory findings of absolute eosinophil count had no statistical significance in between the two groups.

CONCLUSIONS

In this study, based on the evaluation of therapeutic performance, bepotastine eye drops proved quicker relief of symptoms and signs compared to olopatadine eye drops but was not statistically significant which would prove beneficial for the patients.

Associations of dermal diethyl phthalate level with changes in lung function test value mediated by absolute eosinophil count: A panel study of adults in southern Taiwan

Phthalate concentrations in indoor and outdoor dust are associated with respiratory disease. Both immunoglobulin E (IgE) and eosinophil count are associated with airway inflammation from exposure to environmental allergens. Dermal phthalate level can be used as a matrix for assessing personal exposure through direct absorption from the air, particle deposition, or contact with contaminated products. However, the association between dermal phthalate level and changes in lung function test values, as mediated by immunological response, remains unclear. In total, 237 adults in southern Taiwan were recruited. Spirometry measurements (in L) of forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were taken on visits 1 (2016-2018) and 2 (2019). Dermal phthalate level, absolute eosinophil count, and IgE level were recorded on visit 1. Mean changes in FVC and FEV1 decrease pear year, as determined through pairwise comparisons, were significant (^diffFVC_{per year}: -0.46, 95% CI: -0.51, -0.41; p < 0.001; ^diffFEV1_{per year}: -0.37, 95% confidence interval [CI]: -0.41, -0.34; p < 0.001). For FEV1 decrease, log-unit increases in dermal diethyl phthalate (DEP) were positively associated with ^diffFEV1_{per year} (β = 0.096; 95% CI: 0.042, 0.150; p = 0.001) and negatively associated with absolute eosinophil count (β= -0.201; 95% CI: -0.380, -0.023; p= 0.027). Log-unit increases in absolute eosinophil count were negatively associated with ^diffFEV1_{per year} (β= -0.109; 95% CI: -0.150, -0.068; p < 0.001). Absolute eosinophil count mediated 19.70% of the association between dermal DEP level and ^diffFEV1_{per year}. For FVC decrease, log-unit increases in dermal DEP were positively associated with ^diffFVC_{per year} (β = 0.095; 95% CI: 0.035, 0.155; p = 0.002) and negatively associated with absolute eosinophil count (β = -0.243; 95% CI: -0.427, -0.060; p = 0.010). Log-unit increases in absolute eosinophil count were negatively associated with ^diffFVC_{per year} (β= -0.122; 95% CI: -0.168, -0.076; p < 0.001). Absolute eosinophil count mediated 29.98% of the association between dermal DEP level and ^diffFVC_{per year}. The results suggest that dermal DEP level is positively associated with changes in lung function test values and is mediated by absolute eosinophil count.

A nomogram to early predict isolation length for non-severe COVID-19 patients based on laboratory investigation: A multicenter retrospective study in Zhejiang Province, China

BACKGROUND

Majority coronavirus disease 2019 (COVID-19) patients are classified as mild and moderate (non-severe) diseases. We aim to develop a model to predict isolation length for non-severe patients.

METHODS

Among 188 non-severe patients, 96 patients were enrolled as training cohort to identify factors associated with isolation length via Cox regression model and develop a nomogram. Other 92 patients formed as validation cohort to validate nomogram. Concordance index (C-index), area under the curve (AUC) and calibration curves were used to evaluated nomogram.

RESULTS

Increasing absolute eosinophil count (AEC) after admission was correlated with shorter isolation length (P = 0.02). Baseline activated partial thromboplastin time (APTT) > 30 s was correlated with longer isolation length (P = 0.03). A nomogram to predict isolation probability at 11-, 16- and 21-day was developed and validated. The C-indices of training and validation cohort were 0.604 and 0.682 respectively. Both cohorts showed a good discriminative ability (AUC, 11-day: 0.646 vs 0.730; 16-day: 0.663 vs 0.750; 21-day: 0.711 vs 0.783; respectively) and calibration power.

CONCLUSIONS

Baseline APTT and dynamic change of AEC were two significant factors associated with isolation length of non-severe patients. Nomogram could predict isolation probability for each patient to estimate appropriate quarantine length.

Computed Tomography Score an Excellent Marker: Differentiates Eosinophilic and Non-eosinophilic Variants of Chronic Rhinosinusitis with Nasal Polyp

Eosinophilic and non-eosinophilic subtypes of chronic rhinosinusitis with nasal polyp (CRSwNP) have different clinical profile and management. Currently the 2 subtypes are differentiated based on tissue eosinophilic infiltration, which is identified after surgery by histopathological examination. Hence this study was conducted to compare utility of computed tomography (CT) scans, serum IgE levels, absolute eosinophil count (AEC) and Sino-nasal Outcome Test (SNOT)-20 score for discriminating the 2 subtypes. In this prospective study of 1 year duration, patients suspected of CRSwNP were recruited. Serum IgE levels and AEC estimation were performed by ELISA and standard numerical formula respectively, along with histopathological examination of nasal polyp biopsies. CT score and ratio of CT score for ethmoid sinus and maxillary sinus (E/M ratio) were calculated. Patients were asked to fill SNOT-20 questionnaire. Receiver-operating characteristic (ROC) curve analysis was performed. Out of 52 patients studied, 38 and 14 were no. of eosinophilic and non-eosinophilic CRSwNP cases respectively on the basis of histopathological examination. E/M ratio and overall CT score were found to be highly accurate with area under ROC curve of 0.990 and 0.964 respectively, while rest 3 parameters had low accuracy. Optimal cut-off of CT score and E/M ratio for eosinophilic CRSwNP were 6 and 2.065 respectively. This study demonstrated E/M ratio and total CT score as the most useful surrogate markers for preoperative differentiation of eosinophilic and non-eosinophilic CRSwNP, and hence can be used to predetermine postoperative management before surgery.

Early-onset eczema is associated with increased milk sensitization and risk of rhinitis and asthma in early childhood

BACKGROUND

Atopic eczema and food allergy most commonly occur in the early childhood. However, the relationships between eczema onset and their relevance to the occurrence of atopic diseases relating to allergen sensitization remain unclear.

METHODS

We investigated 186 children who were followed up regularly at the clinic for 4 years in a birth cohort study. The children were classified into three groups: early-onset eczema (<2 years old, n = 55), late-onset eczema (≥2 years old, n = 40), and never eczema groups (n = 91). The associations between the different onsets of eczema and total immunoglobulin E levels, absolute eosinophil count, sensitization to food and inhalant allergens, and allergic outcomes were assessed.

RESULTS

A significantly higher prevalence of sensitization to food, especially milk was observed in children with early-onset eczema compared with those without eczema at age 1, 1.5, 2, 3, and 4 years. Furthermore, a significantly higher number of eosinophils was detected in children with early or late-onset eczema at the age of 1.5 years. Both the early- and late-onset eczema were significantly associated with a higher prevalence of allergic rhinitis at age 2, 3, and 4 years, and asthma at age 2. Moreover, the early-onset eczema group showed a significantly increased risk of allergic rhinitis (P = 0.010) and asthma (P = 0.032) at age 4.

CONCLUSION

The children with early-onset eczema (<2 years old) appear to be associated with an increased prevalence of milk sensitization and risk of rhinitis and asthma in early childhood.

Comparison of Steroid and Itraconazole for Prevention of Recurrence in Allergic Fungal Rhinosinusitis: A Randomized Controlled Trial

INTRODUCTION

Allergic Fungal Rhinosinusitis (AFRS) is due to the continuous exposure of fungal antigens to an atopic individual. Medical treatment following the surgery is the standard protocol often practiced for the treatment of AFRS. Steroid (systemic/topical) has been considered as the standard medical treatment for the control of the disease in AFRS although most of the patients show recurrence with long term follow up. Instead, antifungals (itraconazole) can be tried to decrease the recurrence rate which acts by inhibiting the fungal growth in the postoperative period.

AIM

In the current study, we have compared the efficacy between steroid and the itraconazole in preventing the recurrence of the disease in patients with AFRS in postoperative period.

MATERIALS AND METHODS

This prospective study was conducted in the Department of Otorhinolaryngology in a tertiary care referral hospital from October 2013 to February 2015. Total 60 patients with AFRS with nasal polyposis, diagnosed by Bent-Kuhn's criteria were included in the study. For patients of Group A (containing 30 patients), systemic steroid (oral prednisolone 30 mg OD) was continued for one month and afterwards topical steroid (nasal spray) was continued till six months after surgery. In Group B (containing 30 patients), oral itraconazole (100 mg BID) was continued for six months. Clinical and haematological parameters were compared at the end of six months.

RESULTS

The average pre-treatment and post treatment scores of Absolute Eosinophil Count (AEC) in the patients of Group A was 532 μg/l and 482 μg/l respectively and the corresponding values in Group B were 578 μg/L and 438 μg/L respectively at the end of six months (p=0.912). Similarly, the preoperative and postoperative serum IgE level in Group A was 886.20 IU/ml and 620 IU/ml and the respective values in Group B were 935 IU/ml and 570 IU/ml (p=0.555). Mean preoperative and postoperative mean SNOT score in Group A and Group B were 52.5 in 34.3 and respective values in Group B were 55.7 and 29.5.

CONCLUSION

Itraconazole can be considered as an effective treatment alternative to the steroid for postoperative management of AFRS. Although there was no significant difference noted between two groups, patients treated with itraconazole had a better symptomatic relief and endoscopic clearance of disease.

Significance of Blood Eosinophil Count in Patients with Chronic Rhinosinusitis with Nasal Polyposis

INTRODUCTION

Chronic Rhino Sinusitis (CRS) is one of the most prevalent chronic illnesses across the globe, affecting persons of all ages. It is an inflammatory process that involves the paranasal sinuses with symptoms lasting longer than 12 weeks.

AIM

To establish the significance of blood eosinophil (count) levels in CRS with nasal polyps and to compare blood eosinophil count with eosinophil count in the histopathology specimens of the polyps.

MATERIALS AND METHODS

This was a retrospective study done to review the medical records of 63 patients who underwent endoscopic sinus surgery for CRS with Nasal polyps. The patients were divided into two groups, 1 and 2 based on the number of patients suffering from non eosinophilic rhino sinusitis (Group 1) and those from eosinophlic rhino sinusitis (Group 2). The clinical examination findings, nasal endoscopy observations and MDCT-Paranasal sinuses were notified. Also, the mean Eosinophil Count (EC), Absolute Eosinophil Count (AEC), and Histopathology Eosinophil Count (HPE) was compared between two groups. This was aided by CT Scan Lund Mackay Scores (LMS).

RESULTS

Among the patients from Group 1, the male to female ratio was found to be 1.14:1 with 53.3% males and in Group 2 the same were noted as 1.75:1 and 63.6% respectively and found a male preponderance. With regard to symptomatology, significantly higher number of patients in the Group 2 suffered from nasal block (97% vs. 46.7%; p<0.001), nasal obstruction (90.9% vs. 46.7%; p<0.001), nasal discharge (81.8% vs. 56.7%; p=0.030), hyposmia (97% vs. 30%; p<0.001) and asthma (69.7% vs. 3.3%; p<0.001). However, facial pain (66.7% vs. 81.8%; p=0.168) and para nasal sinus tenderness (53.3% vs. 54.6%; p=0.923) were comparable in Groups 1 and 2. Mean EC, AEC and HPE were significantly high in Group 2 compared to Group 1.

CONCLUSION

The study demonstrated that there was a significant correlation between tissue and blood eosinophil counts with increased severity of symptoms in patients with Eosinophilic CRS with nasal polyps in the Indian population.

Exploration of eosinopenia as a diagnostic parameter to differentiate sepsis from systemic inflammatory response syndrome: Results from an observational study

Aim of the Study:

Initial differentiation of sepsis from systemic inflammatory response syndrome (SIRS) is of prime importance for early institution of appropriate treatment. This study aimed to compare the differential diagnostic efficacy of absolute eosinophil count (AEC - a routinely available economic marker) with total leukocyte count (TLC) and procalcitonin (PCT - a costly marker available only in specialized settings).

Materials and Methods:

In this prospective observational study, 170 patients of sepsis (severe sepsis = 125; SIRS = 45) were enrolled. AEC, TLC, and PCT were measured in the blood of all patients at the time of admission and data analyzed statistically.

Results:

Median AEC was 0 cells/mm³ in both SIRS and sepsis. TLC and PCT levels were significantly higher (P < 0.001) in culture negative, culture positive, and overall sepsis groups in comparison to SIRS group. At a cutoff of < 50 cells/mm³, AEC demonstrated a sensitivity and specificity of 23% and 68%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of TLC were 57%, 71%, 85%, 37% and of PCT were 82.4%, 82.2%, 93%, and 63%, respectively with area under curve of 0.455 for AEC, 0.640 for TLC, 0.908 for PCT.

Conclusions:

This study suggests that eosinopenia is not a reliable diagnostic tool to differentiate sepsis from SIRS. PCT and TLC are better differential diagnostic biomarkers.

Hepatic visceral larva migrans, a resilient entity on imaging: Experience from a tertiary liver center

INTRODUCTION

Hepatic visceral larva migrans (VLM) is an uncommon parasitic manifestation seen in the liver. It presents as coalescing, conglomerated, or solitary abscess cavities in the liver on imaging. We conducted a retrospective clinico-radiological analysis of 24 patients with biopsy proven VLM who were reviewed and followed up at our tertiary liver institute over a period of 4 years.

MATERIALS AND METHODS

The study was performed to correlate the radiological features and imaging response to therapy for hepatic VLM. The disease course, imaging findings, progressive, absolute eosinophil counts (AEC), hydatid serology, and the extent of radiological regression of the liver lesions, on follow-up were analyzed.

RESULTS

Imaging showed a diagnostic accuracy of 42%. Hydatid serology was positive in 46% patients before starting treatment. The median pretreatment AEC of 507 showed a significant posttreatment AEC decline to median value of 117. The Wilcoxon signed ranks test showed significant decline in the AEC (P < 0.001). Radiological regression was present in all lesions. However, patients showed residual abscesses on imaging, up to 2 years on follow-up.

CONCLUSION

This study reveals that AEC has a significant predictive value in diagnosis and as a marker for disease regression. Complete radiological resolution of hepatic lesions does not correlate with total clinical remission. This finding warrants the need for further studies to look into the role of prolonged medical therapy or surgery as an alternate to current therapy module in cases of hepatic visceral larva abscesses.

Clinico-immunological profile and their correlation with severity of atopic dermatitis in Eastern Indian children

OBJECTIVE

To study the clinical features, absolute eosinophil count, and total immunoglobulin E (IgE) level and their association with severity of atopic dermatitis in Eastern Indian children (Bihar).

DESIGN

Prospective hospital-based study.

SETTINGS

Pediatrics out-patient Department (OPD) and Dermatology OPD of a Tertiary Care Teaching Hospital located in Rohtas District of Bihar. The study was carried out over a period of 2 years during January 2010 to December 2011.

PARTICIPANTS

One hundred and thirty two children aged 0 month to 15 years were diagnosed with atopic dermatitis.

MAIN OUTCOME

Demographic profile, common clinical features, absolute eosinophil count, and total IgE level and their correlation with severity of atopic dermatitis in Eastern Indian children.

RESULTS

Out of a total 1829 pediatric patients aged 0 month to 15 years with some pediatric dermatoses, 132 (7.21%) had atopic dermatitis. Of 132 patients, 57 (43.2%) were boys and 75 (56.8%) were girls, with a male to female ratio 1:1.3. Of these 29 were infants and 103 were children. Two (62.1%) patients belonged to rural area whereas 50 (37.9%) belonged to urban area. Personal history, family history (up to third degree relatives), and both personal and family history of atopy were present in 43.18%, 33.34%, and 12.1% of the subjects respectively. Majority (89.4%) of patients had onset before 5 years of age. In infantile Atopic dermatitis (AD), mean age ± SD at onset was 5.2 months ± 3.01 months. In infantile group, 8 (27.6%) had mild, 14 (48.3%) moderate, and 7 (24.1%) had severe atopic dermatitis. Infantile AD had statistically significant higher SCORing Atopic Dermatitis (SCORAD) index score in all three grades of severity of the disease. One hundred and three patients had childhood AD, out of which 40 (38.8%) were boys and 63 (61.2%) were girls, with a male to female ratio 1:1.57. In childhood AD, mean age ± SD at onset of the disease was 3.47 years ± 3.02 years. Sixty three (61.1%) belonged to rural area whereas 40 (38.9%) were from urban area. One hundred and thirty (98%) patients presented with itching. Ninety two (69.7%) patients had high absolute eosinophils count (AEC) with mean ± SD of 1004.1 ± 596.2 (range 325-2510). Eighty seven (65.9%) patients had increased total serum immunoglobulin E (TsIgE) with mean ± SD value of 1127.11 IU/ml ± 731.69 IU/ml (range: 125-2680 IU/ml).

CONCLUSION

Epidemiological data on atopic dermatitis in India are mainly hospital-based, true-point prevalence in community is still scanty. Although the prevalence of AD is considered to be increasing, it still remains low in comparison to developed countries. In Indian children, the disease is relatively milder than children of developed countries. This study identified that both AEC and TsIgE increased significantly in about 66% patient and directly correlated with the severity of the AD.

PCT as a Prognostic Marker in Cardiac Patients with Neutropenic Sepsis: Two Case Reports

Procalcitonin (PCT) is an innovative and highly specific marker for diagnosis of clinically relevant bacterial infection and sepsis. PCT supports early diagnosis and Clinical decision making. A retrospective study of two classical cases of neutropenic sepsis with elevated PCT levels in cardiac ICU was done. PCT was analyzed using Elecsys Brahms PCT kit. Serum PCT levels <0.5 ng/ml and ANC <1,000/mm(3) was taken as cutoff. The first patient had initial high levels of PCT 100 ng/ml, TLC 13,600/mm(3) and ANC 12,250/mm(3). It was followed by drop with subsequent rise in PCT levels and drop in TLC 1,000/mm(3) and ANC 70/mm(3). The second patient had normal PCT 0.116 ng/ml, TLC 5,600/mm(3) and ANC 4,420/mm(3) levels followed with sharp increase in all the values with subsequent drop in TLC 2,000/mm(3) and ANC 880 cells/mm(3). Both the patients died of neutropenic sepsis with multiorgan failure. The case reports showed the correlation of PCT with TLC and ANC levels in predicting the mortality of patients with neutropenic sepsis in cardiac ICU.

Loratadine versus levocetirizine in chronic idiopathic urticaria: A comparative study of efficacy and safety

BACKGROUND

Treatment of chronic idiopathic urticaria (CIU) is challenging because of its unpredictable course and negative influence on the quality of life. New treatments are being developed, but antihistaminics remain the cornerstone of the therapeutic approach. Newer generation antihistaminics such as loratadine and levocetirizine have already proved to be safe and efficacious for CIU.

OBJECTIVE

To choose the better drug between loratadine and levocetirizine for CIU, by comparing their efficacy and safety.

METHODS

A randomized, open, outdoor-based clinical study was conducted on 60 patients of CIU, to compare the two drugs. After initial clinical assessment and baseline investigations, loratadine was prescribed to 30 patients and levocetirizine to another 30 patients for four weeks. At follow-up, the patients were re-evaluated and then compared using different statistical tools.

RESULT

The comparative study showed that the changes in differential eosinophil count (P = 0.006) and absolute eosinophil count (P = 0.003) in the levocetirizine group was statistically significant. The results of the Total Symptom Score showed better symptomatic improvement of CIU with levocetirizine as compared to loratadine. The overall incidence of adverse drug reactions was also found to be less in the levocetirizine group.

CONCLUSION

An analysis of the results of all the parameters of safety and efficacy proves the superiority of levocetirizine over loratadine for CIU.