Left ventricular thrombus (LVT) has historically been reported as a complication of acute left ventricular (LV) myocardial infarction. It is most commonly observed in cases of LV systolic dysfunction attributed to ischemic or nonischemic etiologies. Conversely, the occurrence of LVT in normal LV systolic function is an exceptionally rare presentation and is predominantly associated with conditions such as hypereosinophilic syndrome (HES), cardiac amyloidosis, left ventricular noncompaction, hypertrophic cardiomyopathy (HCM), hypercoagulability states, immune-mediated disorders, and malignancies. Notably, hypereosinophilia (HE) has been linked with thrombotic events. Intracardiac thrombus is a well-known complication of eosinophilic myocarditis (EM) or Loeffler endomyocarditis, both of which are considered clinical manifestations of HES. We present a case of a 63-year-old male with normal LV systolic function, HE, and noncontributory hypercoagulability workup, who presented with thromboembolic complications arising from LVT. Interestingly, the diagnostic evaluation for EM and Loeffler endocarditis was nonconfirmatory. Additionally, we performed a literature review to delineate all similar cases. This article also outlines the pathophysiology, diagnosis, and treatment approaches for hypereosinophilic cardiac involvement with a specific focus on LVT.

UNASSIGNED: Elevated eosinophils typically indicate hypersensitive inflammation; however, their involvement in cardiovascular events remains incompletely understood. We investigated the association between the absolute eosinophil count (AEC) and major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Additionally, we determine whether the integration of AEC with the SYNTAX II score could improve predictive ability.
UNASSIGNED: The AECs of 1711 patients with ACS undergoing PCI from June 2016 to November 2017 were analyzed on admission. All recruitments were splitted into three groups based on AEC tertiles and 101 participants underwent one or more noteworthy outcomings. The association between AEC and MACCEs (defined as a composite of cardiovascular death, myocardial infarction [MI], and stroke) was tested by Cox proportional-hazards regression analysis. After adjusting for confounders, AEC was independently associated with MACCEs (HR 11.555, 95% CI: 3.318-40.239). Patients in the lowest AEC tertile (T1) as a reference, those in the higher tertiles had an incrementally higher risk of MACCEs (T3: HR 1.848 95% CI: 1.157-2.952; P for trend=0.008). Inclusion of AEC enhanced the predictive accuracy of the SYNTAX II score for MACCEs (AUC: from 0.701 [95% CI: 0.646-0.756] to 0.728 [95% CI: 0.677-0.780]; DeLong\'s test, P = 0.020).
UNASSIGNED: AEC is independently linked to MACCEs in ACS patients who underwent PCI, and adds incremental predictive information to the SYNTAX II score.

Eosinophilic fasciitis (EF) is an uncommon disorder of unknown etiology and poorly understood pathogenesis. In this report, we present a case of a 68-year-old female presented with a rapidly progressing skin tightening condition in her extremities associated with eosinophilia. Four months prior, the patient\'s initial complaint was skin sensitivity in the legs and forearms. Over time, this led to severe skin tightening, edema, and decreased range of motion. Clinical examination showed tightening of the skin over the anterior forearms, posterior knees, and calves without sclerodactyly or Raynaud\'s phenomenon. Laboratory investigations showed eosinophilia, elevated antinuclear antibody titer, and negative rheumatoid factor. This presentation raised suspicion of EF, and biopsy results showed scattered lymphocytic infiltrate involving associated fibrous tissue and perivascular lymphocytic inflammation that involved vessel walls. She was treated with low-dose steroids due to her diabetes but the stiffness continued. She was started with immunomodulators methotrexate, which showed improvement in symptoms, including softening in her arm tissues.

Celiac disease (CeD) and eosinophilic esophagitis (EoE) are immune-mediated disorders that can occur in the same patient. A retrospective study at a tertiary care hospital was conducted to determine the prevalence of EoE in a pediatric population with CeD and to compare characteristics of patients with both diseases to patients with CeD-only. Among the 148 patients with CeD identified in the study, 11 patients had both CeD and EoE (7.4%). Patients with both CeD and EoE had a higher absolute eosinophil count (per μL) at diagnosis compared to patients with CeD-only (454.1 ± 122.7 vs 231.9 ± 19.4, P = .003). In conclusion, there was a higher proportion of EoE in patients with CeD than would be expected in the general population, suggesting a potential pathophysiological overlap between the 2 diseases. An elevated peripheral absolute eosinophil count may help predict which patients with CeD may additionally have EoE.

暂无摘要。

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.

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

Allergic rhinitis is one of the most rampant diseases in the world and many studies have been conducted to find its risk factors. Various studies have shown that there is a correlation between allergic rhinitis and increased Body Mass Index (BMI). Obesity has several effects on the immune system that could play a major role in increasing allergic disease. Allergic rhinitis is known to produce mild eosinophilia. The purpose of this study is to assess the correlation between BMI and allergic rhinitis using the Absolute Eosinophil Count (AEC). Over a period of 6 months, 55 cases of allergic rhinitis were selected. The patients were investigated by Absolute Eosinophil Count and their Body Mass Index values were calculated based on weight and height measurement. There was a positive correlation between Absolute Eosinophil Count and BMI with a p value of < 0.0001 which in turn revealed a positive correlation between BMI and allergy. We conclude that patients with high BMI are more prone to allergic rhinitis and have higher Absolute Eosinophil Counts probably due to the immunological effects of adipose tissue on the progress of the allergic disease.

BACKGROUND: Eosinophilic gastroenteritis is a rare inflammatory disorder in children. However, there is still no standard guideline in the treatment of pediatric eosinophilic gastroenteritis.
OBJECTIVE: 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.
CONCLUSIONS: 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%).

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.