Crohn's disease and ulcerative colitis are chronic, immune-mediated inflammatory bowel diseases (IBDs) of unknown etiology with high morbidity in patients who are not receiving adequate medical treatment. A variety of medical therapies are currently available, and much progress has been made to alleviate symptoms and restore quality of life. The mainstay of treatment in those with moderate to severe disease consists of medications that alter or suppress the body's immunologic attack on its own gastrointestinal tract. The medications currently in use are highly effective when given in the appropriate clinical context, but side effects are not uncommon and must be treated expeditiously when they occur. One class of immunosuppressive medication, 6-mercaptopurine and its prodrug azathioprine, is effective at inducing remission and improving the lives of patients with IBD. The most common side effects of these drugs are allergic reactions and rarely can they be severe and life threatening. These reactions can sometimes be overcome by desensitizing the immune system to the drug. This review emphasizes allergy to 6-mercaptopurine and azathioprine and the process of desensitization when these allergic reactions occur in order to continue use of this important class of medication in the total treatment of IBD.
Background: Several biomarkers, such as C-reactive protein (CRP) and Procalcitonin have been used to indicate bacterial infection in sepsis. They have limited sensitivity and specificity with high cost, placing them practically out of reach for poor patients in developing countries like India. Hence the need to evaluate eosinophil count and neutrophil-lymphocyte count ratio (NLCR) as an indicator of sepsis considering their lower cost and easier accessibility. The present study was done to establish that eosinopenia and the neutrophil-lymphocyte count are simple and effective tools as prognostic biomarkers for sepsis.Methods: A prospective observational study consisting of 50 patients with SIRS and sepsis on admission were studied. Neutrophil and lymphocyte count for first 4 consecutive days and then on alternate days up to one week was done. Absolute eosinophil count for first 2 consecutive days and then on alternate days up to one week was done.Results: Eosinopenia was noted to have 79.3% sensitivity, 76.2% specificity, positive predictive value 82.2% and negative predictive value 95.4% in predicting diagnosis and prognosis of sepsis. Neutrophil-lymphocyte ratio was found to have 86.2% sensitivity, 85.7% specificity, positive predictive value of 89.2%, negative predictive value of 81.1% in predicting diagnosis and prognosis of sepsis.Conclusions: Eosinophil count and neutrophil - lymphocyte count ratio are simple and effective prognostic markers of sepsis with low cost.
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