Acute Eosinophilic Appendicitis Immunohistochemical Study

Hussein, Jawad Hussein (2023) Acute Eosinophilic Appendicitis Immunohistochemical Study. Masters thesis, Koya University.

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Abstract

Acute appendicitis (AA) is the most common abdominal surgical emergency in the world and most cases develop as a result of luminal obstruction. The incidence of AA is strongly age dependent reaching a peak incidence in the teenagers and early 20s. Mainly clinically diagnosed based on history, physical examination and imaging with adjuvant laboratory test, but a histopathological study remains a gold standard for diagnosis of AA. Histopathologic finding of AA is the presence of neutrophils in the muscularis propria. However, an unusual variant of appendicitis which is called acute eosinophilic appendicitis (AEA) has eosinophilic infiltration of the muscularis propria and edema separating the muscle fibers without the presence of neutrophilic infiltration as its pathologic hallmark and type I hypersensitivity is responsible for its pathogenesis. So, this research was aimed to find simple and rapid way for detection of unusual form of AA that may require postoperative special treatment. This retrospective study was carried out at Shahid Dr. Khalid teaching Hospital in (Koya city/ Kurdistan region/ Iraq), which included a randomized collection of 50 appendectomy samples during the period of six months from 1st Nov. 2021 to 1st May. 2022. The patients were admitted to emergency department suspected to have AA on the basis of history, physical examination, investigation and abdominal ultrasound. Preoperative blood samples were taken from all these patients for demonstrations of complete blood count (CBC) parameters, C. reactive protein (CRP) and peripheral blood eosinophils in blood film. After appendectomy, all samples were grossly examined (weight, dimensions & photographed) immediately fixed in 10% neutral buffered formalin for overnight then processed, paraffin embedded and stained by routine Hematoxylin & Eosin (H&E), May Grunwald Giemsa (MGG), Congo red and Immunohistochemistry (IHC) stains. In present study 28 patients were male (56%) and 22 were females (44%). The age of the patients was ranging from (4 to 43 years), with mean (20.98) years old, and the majority of cases (60%) fall in the age group (≤20) years. Tissue sections stained by IHC (14.73 ± 1.05) and Congo red (3.50 ± 0.9540) revealed that tissue eosinophil count was highly significantly (P < 0.0001) increased when compared with H&E (4.082 ± 0.3769) and MGG (5.136 ± 0.3602).while the IHC significantly (P < 0.05) yielded a higher eosinophil counting than Congo red. There was a significant gradual increase in weight of appendix with age groups, but the dimensions except the height were significantly decreased. The actual means of CBC parameters were significantly XVII different from theoretical means, but there was non-significant sex difference in CBC parameters. Although a negative correlation between eosinophil infiltration and white blood cell (WBC) counts found which was statistically highly significant (P<0.0019), However a positive correlation between tissue and peripheral blood eosinophils was seen which was statistically significant with (P < 0.01). In conclusion, this study has determined that the tissue eosinophils were demonstrated very effectively by IHC and Congo red staining as compared to H&E and MGG staining while IHC staining was significantly higher than Congo red staining and there was a positive correlation between tissue and peripheral blood eosinophils in patients with AA.

Item Type:	Thesis (Masters)
Additional Information:	ABDALA‐VALENCIA, H., CODEN, M. E., CHIARELLA, S. E., JACOBSEN, E. A., BOCHNER, B. S., LEE, J. J. & BERDNIKOVS, S. 2018. Shaping eosinophil identity in the tissue contexts of development, homeostasis, and disease. Journal of leukocyte biology, 104, 95-108. ABDEL-LATIF, M., HAFREL-BATIN, E., SHAHIN, R., SHAWQY, A., ARAFA, M. & GHAFAR SALEH, A. A. 2016. Value of Additional Corpus Biopsy for Diagnosis of Helicobacter Pylori in Atrophic Gastritis. Clin Surg, 1, 1093. AGGELIDOU, M., KAMBOURI, K., KOUROUPI, M., CASSIMOS, D., FOUTZITZI, S. & DEFTEREOS, S. 2019. Acute eosinophilic appendicitis after generalized skin reaction due to unknown cause in a child: Case report and literature review. Clinics and practice, 9, 1177. AHMED, S., JHA, A., ALI, F. M., GHAREEB, A. E., GARG, D. & JHA, M. 2019. Sensitivity and Specificity of the Neutrophil-lymphocyte Ratio in the Diagnosis of Acute Appendicitis. Annals of Clinical & Laboratory Science, 49, 632-638. AHN, S. R. & LEE, J. H. 2021. Acute Eosinophilic Appendicitis: A Rare Cause of Lower Gastrointestinal Hemorrhage. The Korean Journal of Gastroenterology, 78, 134-137. AKBULUT, S., KOC, C., KOCAASLAN, H., GONULTAS, F., SAMDANCI, E., YOLOGLU, S. & YILMAZ, S. 2019. Comparison of clinical and histopathological features of patients who underwent incidental or emergency appendectomy. World Journal of Gastrointestinal Surgery, 11, 19. AKBULUT, S., TAS, M., SOGUTCU, N., ARIKANOGLU, Z., BASBUG, M., ULKU, A., SEMUR, H. & YAGMUR, Y. 2011. Unusual histopathological findings in appendectomy specimens: a retrospective analysis and literature review. World journal of gastroenterology: WJG, 17, 1961. AL-JAWDAH, K. & KAMAL, Z. 2022. Complete Blood Count Parameters in The Diagnosis of Acute Appendicitis. Journal of Pharmaceutical Negative Results¦ Volume, 13, 205. AL-MULHIM, A. S. 2011. Unusual findings in appendicectomy specimens: Local experience in Al-Ahsa region of Saudi Arabia. Age, 10, 10-9. ALRADDADI, A. 2021. Literature review of anatomical variations: clinical significance, identification approach, and teaching strategies. Cureus, 13. ALVARADO, A. 2016. How to improve the clinical diagnosis of acute appendicitis in resource limited settings. World journal of emergency surgery, 11, 1-4. ANAND, S., KRISHNAN, N., JUKIĆ, M., KRIŽANAC, Z., LLORENTE MUñOZ, C. M. & POGORELIĆ, Z. 2022. Utility of red cell distribution width (RDW) as a noninvasive biomarker for the diagnosis of acute appendicitis: A systematic review and meta-analysis of 5222 cases. Diagnostics, 12, 1011. ANDERSSON, R. E. 2007. The natural history and traditional management of appendicitis revisited: spontaneous resolution and predominance of prehospital perforations imply that a correct diagnosis is more important than an early diagnosis. World journal of surgery, 31, 86-92. AOKI, A., HIRAHARA, K., KIUCHI, M. & NAKAYAMA, T. 2021. Eosinophils: Cells known for over 140 years with broad and new functions. Allergology International, 70, 3-8. ASHBROOK, M., CHENG, V., SANDHU, K., MATSUO, K., SCHELLENBERG, M., INABA, K. & MATSUSHIMA, K. 2022. Management of complicated appendicitis during pregnancy in the US. JAMA Network Open, 5, e227555-e227555. AZZOUZ, L. L. & SHARMA, S. 2018. Physiology, large intestine. BANCROFT, J. D. & GAMBLE, M. 2008. Theory and practice of histological techniques, Elsevier health sciences. BANDYOPADHYAY, A., MAJUMDAR, K. & MISHRA, V. 2022. Non-neoplastic Lesions of the Appendix. Surgical Pathology of the Gastrointestinal System: Volume I-Gastrointestinal Tract. Springer. BASS, L. M. & WERSHIL, B. K. 2016. Anatomy, histology, embryology and developmental anomalies of the small and large intestine. Sleisenger and Fordtran's gastrointestinal and liver disease. 10th ed. Philadelphia, PA: Saunders, Elsevier Inc, 1649. BELLER, A., RAUSCH, S., STRANDMARK, J., ZäNKER, M., ARBACH, O., KRUGLOV, A. & BEREK, C. 2014. Eosinophils promote generation and maintenance of immunoglobulin-A-expressing plasma cells and contribute to gut immune homeostasis. Immunity, 40, 582-593. BHARTI, J. P., OMAR, S. & PANDEY, N. K. 2016. Morphological and Histological Study on Vermiform Appendix in Rabbit, Goat and Human Being. BIRCHLEY, D. 2006. Patients with clinical acute appendicitis should have pre-operative full blood count and C-reactive protein assays. The Annals of The Royal College of Surgeons of England, 88, 27-32. BOCHNER, B. S. 2018. The eosinophil: For better or worse, in sickness and in health. Annals of Allergy, Asthma & Immunology, 121, 150-155. BRIGGER, D., RIETHER, C., VAN BRUMMELEN, R., MOSHER, K. I., SHIU, A., DING, Z., ZBäREN, N., GASSER, P., GUNTERN, P. & YOUSEF, H. 2020. Eosinophils regulate adipose tissue inflammation and sustain physical and immunological fitness in old age. Nature metabolism, 2, 688-702. ÇALLI, G., ÖZBILGIN, M., YAPAR, N., SARIOGLU, S. & ÖZKOC, S. 2014. Acute appendicitis and coinfection with enterobiasis and taeniasis: a case report. Türkiye Parazitolojii Dergisi, 38, 58. CARVALHO, N., CAROLINO, E., COELHO, H., CóIAS, A., TRINDADE, M., VAZ, J., CISMASIU, B., MOITA, C., MOITA, L. & COSTA, P. M. 2022. IL-5 Serum and Appendicular Lavage Fluid Concentrations Correlate with Eosinophilic Infiltration in the Appendicular Wall Supporting a Role for a Hypersensitivity Type I Reaction in Acute Appendicitis. International Journal of Molecular Sciences, 23, 15086. CERESOLI, M., ZUCCHI, A., ALLIEVI, N., HARBI, A., PISANO, M., MONTORI, G., HEYER, A., NITA, G. E., ANSALONI, L. & COCCOLINI, F. 2016. Acute appendicitis: Epidemiology, treatment and outcomes-analysis of 16544 consecutive cases. World journal of gastrointestinal surgery, 8, 693. CHANDAN, V. S. 2019. Normal Histology of Gastrointestinal Tract. Surgical Pathology of Non-neoplastic Gastrointestinal Diseases. Springer. CHANDRASEKARAN, T. V. & JOHNSON, N. 2014. Acute appendicitis. Surgery (Oxford), 32, 413-417. CHARFI, S., SELLAMI, A., AFFES, A., YAICH, K., MZALI, R. & BOUDAWARA, T. S. 2014. Histopathological findings in appendectomy specimens: a study of 24,697 cases. International journal of colorectal disease, 29, 1009-1012. CHHABRA, S. & KENNY, S. E. 2018. Appendicitis and non-specific abdominal pain in childhood. Paediatrics and Child Health, 28, 231-235. CHOI, Y., SIM, S. & PARK, H.-S. 2020. Distinct functions of eosinophils in severe asthma with type 2 phenotype: clinical implications. The Korean Journal of Internal Medicine, 35, 823. CHUSID, M. J. 2018. Eosinophils: friends or foes? The Journal of Allergy and Clinical Immunology: In Practice, 6, 1439-1444. COLLINS, M. H., CAPOCELLI, K. & YANG, G.-Y. 2018. Eosinophilic gastrointestinal disorders pathology. Frontiers in medicine, 4, 261. DALDAL, E. & DAGMURA, H. The correlation between complete blood count parameters and appendix diameter for the diagnosis of acute appendicitis. 2020. Mdpi, 39. DANISH, A. 2022. A retrospective case series study for acute abdomen in general surgery ward of Aliabad Teaching Hospital. Annals of Medicine and Surgery, 73, 103199. DE COSTA, A. 2022. The appendix‐mucosal immunity and tolerance in the gut: consequences for the syndromes of appendicitis and its epidemiology. ANZ journal of surgery, 92, 653-660. DEBTA, P., DEBTA, F. M., CHAUDHARY, M. & DANI, A. 2012. Evaluation of infiltration of immunological cells (tumour associated tissue eosinophils and mast cells) in oral squamous cell carcinoma by using special stains. British Journal of Medicine and Medical Research, 2, 75. DEBTA, P., DEBTA, F. M., CHAUDHARY, M. & WADHWAN, V. 2010. Evaluation of infiltration of immunological cells (tissue eosinophil and mast cell) in odontogenic cysts by using special stains. J Clin Cell Immunol, 1, 103. DESHMUKH, S., VERDE, F., JOHNSON, P. T., FISHMAN, E. K. & MACURA, K. J. 2014a. Anatomical variants and pathologies of the vermix. Emergency radiology, 21, 543-552. DESHMUKH, S., VERDE, F., JOHNSON, P. T., FISHMAN, E. K. & MACURA, K. J. 2014b. Anatomical variants and pathologies of the vermix. Emergency radiology, 21, 543-552. DI SAVERIO, S., BIRINDELLI, A., KELLY, M. D., CATENA, F., WEBER, D. G., SARTELLI, M., SUGRUE, M., DE MOYA, M., GOMES, C. A. & BHANGU, A. 2016. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World Journal of Emergency Surgery, 11, 1-25. DI SAVERIO, S., PODDA, M., DE SIMONE, B., CERESOLI, M., AUGUSTIN, G., GORI, A., BOERMEESTER, M., SARTELLI, M., COCCOLINI, F. & TARASCONI, A. 2020. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World journal of emergency surgery, 15, 1-42. DIXON, F. & SINGH, A. 2020. Acute appendicitis. Surgery (Oxford), 38, 310-317. DOOKI, M. E., NEZHADAN, M., MEHRABANI, S., OSIA, S., HADIPOOR, A., HAJIAHMADI, M. & MOHAMMADI, M. 2022. Diagnostic accuracy of laboratory markers for diagnosis of acute appendicitis in children. Wiener Medizinische Wochenschrift, 172, 303-307. DU, L., SHEN, J., KIM, J. J., YU, Y., MA, L. & DAI, N. 2016. Increased duodenal eosinophil degranulation in patients with functional dyspepsia: a prospective study. Scientific reports, 6, 34305. DURAIYAN, J., GOVINDARAJAN, R., KALIYAPPAN, K. & PALANISAMY, M. 2012. Applications of immunohistochemistry. Journal of pharmacy & bioallied sciences, 4, S307. EGAN, M. & FURUTA, G. T. 2018. Eosinophilic gastrointestinal diseases beyond eosinophilic esophagitis. Annals of Allergy, Asthma & Immunology, 121, 162-167. EKICI, U., TATLI, F. & KANLIOZ, M. 2018. Is the appendix length/diameter ratio an early-indicator for the perforation in acute appendicitis? ELSHERBINY, M. W., EMILE, S. H., ABDELNABY, M., KHAFAGY, W. & ELSHOBAKY, A. 2020. Assessment of the diagnostic accuracy of alvarado scoring system combined with focused ultrasound in the diagnosis of acute appendicitis. Journal of British Surgery, 107, e594-e595. FAISAL, L., AJMAL, R., REHMAN, F., UL ISLAM, Z., QAYYUM, S. A. & ATHAR, S. 2022. Anatomical Variations of Vermiform Appendix on Plain MDCT and Its Association with Acute Appendicitis in Adult Urban Population of Karachi, A Tertiary Care Hospital Experience. Journal of Bahria University Medical and Dental College, 12, 77-82. FARAHI, N., SINGH, N. R., HEARD, S., LOUTSIOS, C., SUMMERS, C., SOLANKI, C. K., SOLANKI, K., BALAN, K. K., RUPARELIA, P. & PETERS, A. M. 2012. Use of 111-indium–labeled autologous eosinophils to establish the in vivo kinetics of human eosinophils in healthy subjects. Blood, The Journal of the American Society of Hematology, 120, 4068-4071. FEDKO, M., BELLAMKONDA, V. R., BELLOLIO, M. F., HESS, E. P., LOHSE, C. M., LAACK, T. A., LAUGHLIN JR, M. J. & CAMPBELL, R. L. 2014. Ultrasound evaluation of appendicitis: importance of the 3× 2 table for outcome reporting. The American Journal of Emergency Medicine, 32, 346-348. FELDMAN, A. T. & WOLFE, D. 2014. Tissue processing and hematoxylin and eosin staining. Histopathology: methods and protocols, 31-43. FERRIS, M., QUAN, S., KAPLAN, B. S., MOLODECKY, N., BALL, C. G., CHERNOFF, G. W., BHALA, N., GHOSH, S., DIXON, E. & NG, S. 2017. The global incidence of appendicitis: a systematic review of population-based studies. Annals of surgery, 266, 237-241. FISCHER, A. H., JACOBSON, K. A., ROSE, J. & ZELLER, R. 2008. Hematoxylin and eosin staining of tissue and cell sections. Cold spring harbor protocols, 2008, pdb-prot4986. FRASER, S. T., ISERN, J. & BARON, M. H. 2010. Use of transgenic fluorescent reporter mouse lines to monitor hematopoietic and erythroid development during embryogenesis. Methods in enzymology. Elsevier. GALI, R., THANUJA, K. M., GANGADHAR, C. & SMITA, M. 2022. Anatomical deviations in the position of vermiform appendix: the cadaveric study. Сибирский научный медицинский журнал, 42, 36-40. GARZA-SERNA, U., RAMOS-MAYO, A., LOPEZ-GARNICA, D., LOPEZ-MORALES, J., DIAZ-ELIZONDO, J. & FLORES-VILLALBA, E. 2016. Eosinophilic acute appendicitis and intra-abdominal granuloma caused by Enterobius vermicularis in a pediatric patient. Surgical Infections Case Reports, 1, 103-105. GEHART, H. & CLEVERS, H. 2019. Tales from the crypt: new insights into intestinal stem cells. Nature reviews Gastroenterology & hepatology, 16, 19-34. GHORBANI, A., FOROUZESH, M. & KAZEMIFAR, A. M. 2014. Variation in anatomical position of vermiform appendix among iranian population: an old issue which has not lost its importance. Anatomy research international, 2014. GOH, Y. P. S., HENDERSON, N. C., HEREDIA, J. E., RED EAGLE, A., ODEGAARD, J. I., LEHWALD, N., NGUYEN, K. D., SHEPPARD, D., MUKUNDAN, L. & LOCKSLEY, R. M. 2013. Eosinophils secrete IL-4 to facilitate liver regeneration. Proceedings of the National Academy of Sciences, 110, 9914-9919. GOODMAN, D. A., GOODMAN, C. B. & MONK, J. S. 1995. Use of the neutrophil: lymphocyte ratio in the diagnosis of appendicitis. The American surgeon, 61, 257-259. GREGORY, S., KUNTZ, K., SAINFORT, F. & KHARBANDA, A. 2016. Cost-effectiveness of integrating a clinical decision rule and staged imaging protocol for diagnosis of appendicitis. Value in Health, 19, 28-35. GUINANE, C. M., TADROUS, A., FOUHY, F., RYAN, C. A., DEMPSEY, E. M., MURPHY, B., ANDREWS, E., COTTER, P. D., STANTON, C. & ROSS, R. P. 2013. Microbial composition of human appendices from patients following appendectomy. MBio, 4, 10-1128. HAGHI, A. R., POURMOHAMMAD, P. & RABIEE, M. A. S. 2020. Accuracy of mean platelet volume (MPV) and red cell distribution width (RDW) for the diagnosis of acute appendicitis: Evaluation of possible new biomarkers. Advanced Journal of Emergency Medicine, 4. HEREDIA, J. E., MUKUNDAN, L., CHEN, F. M., MUELLER, A. A., DEO, R. C., LOCKSLEY, R. M., RANDO, T. A. & CHAWLA, A. 2013. Type 2 innate signals stimulate fibro/adipogenic progenitors to facilitate muscle regeneration. Cell, 153, 376-388. HUMES, D. J. & SIMPSON, J. 2006. Acute appendicitis. Bmj, 333, 530-534. IKEDA, M., ARAKAWA, S., KOBAYASHI, T., INADA, K.-I., KIRIYAMA, Y., SAKUMA, T., IMAEDA, Y., ISHIHARA, T., MIYOSHI, H. & YAMAMOTO, S. 2022. New histopathological evaluation method for eosinophilic gastrointestinal disorders using Giemsa and direct fast scarlet stains. IMAD WAJEH, A. S., ZUHAIR BASHIR, K. & LAITH NAIEF, H. 2010. Comparison between the diagnostic values of serum inflammatory markers, interleukin-6 and C-reactive protein in detection the severity of acute appendicitis. IQBAL, J., SAYANI, R., TAHIR, M. & MUSTAHSAN, S. M. 2018. Diagnostic efficiency of multidetector computed tomography in the evaluation of clinically equivocal cases of acute appendicitis with surgical correlation. Cureus, 10. IQBAL, T., AMANULLAH, A. & NAWAZ, R. 2012. Pattern and positions of vermiform appendix in people of Bannu district. Gomal Journal of Medical Sciences, 10. IURII, B., VAHTANG, G. & ALIN, B. 2018. Acute appendicitis. The Moldovan Medical Journal, 61, 28-37. JACKSON, D. J., AKUTHOTA, P. & ROUFOSSE, F. 2022. Eosinophils and eosinophilic immune dysfunction in health and disease. European Respiratory Review, 31. JACOBY, D. B., GLEICH, G. J. & FRYER, A. D. 1993. Human eosinophil major basic protein is an endogenous allosteric antagonist at the inhibitory muscarinic M2 receptor. The Journal of clinical investigation, 91, 1314-1318. JAFFE, B. M. & BERGER, D. H. 2005. The appendix. Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Pollock RE. Schwartz's Principle of Surgery. New York: McGraw-Hill, 1119-38. JAGDISH, P. & ASHOKA, R. K. 2018. Morphometry of Vermiform Appendix: A Human Cadaveric study. Journal of Dental and Medical Sciences, 17, 72-76. JAIN, M., KASETTY, S., SUDHEENDRA, U. S., TIJARE, M., KHAN, S. & DESAI, A. 2014. Assessment of tissue eosinophilia as a prognosticator in oral epithelial dysplasia and oral squamous cell carcinoma—an image analysis study. Pathology Research International, 2014. JONES, M. W., LOPEZ, R. A. & DEPPEN, J. G. 2021. Appendicitis. StatPearls [Internet]. StatPearls Publishing. JOSHI, P. S. & KAIJKAR, M. S. 2013. A histochemical study of tissue eosinophilia in oral squamous cell carcinoma using Congo red staining. Dental Research Journal, 10, 784. JUNG, S. K., RHEE, D. Y., LEE, W. J., WOO, S. H., SEOL, S. H., KIM, D. H. & CHOI, S. P. 2017. Neutrophil-to-lymphocyte count ratio is associated with perforated appendicitis in elderly patients of emergency department. Aging clinical and experimental research, 29, 529-536. JUNG, Y. 2015. Comparative analysis of dibutyric cAMP and butyric acid on the differentiation of human eosinophilic leukemia EoL-1 cells. Immune network, 15, 313-318. JUNQUEIRA, L. C. U. & CARNEIRO, J. 2005. Basic histology: text & atlas, McGraw-Hill Professional. KABIR, S. A., KABIR, S. I., SUN, R., JAFFERBHOY, S. & KARIM, A. 2017. How to diagnose an acutely inflamed appendix; a systematic review of the latest evidence. International Journal of Surgery, 40, 155-162. KAFLE, S. U., SINGH, M., KAFLE, N. & SINHA, A. 2020. Eosinophil Count Variation among Histopathological Features of Appendectomy Specimens at Birat Medical College Teaching Hospital. Birat Journal of Health Sciences, 5, 1104-1109. KANDA, A., YUN, Y., VAN BUI, D., NGUYEN, L. M., KOBAYASHI, Y., SUZUKI, K., MITANI, A., SAWADA, S., HAMADA, S. & ASAKO, M. 2021. The multiple functions and subpopulations of eosinophils in tissues under steady-state and pathological conditions. Allergology International, 70, 9-18. KAREEM, S. R. & KARIM, K. R. 2014. Is There a Relationship Between Histopathological Features of Acute Appendicitis and Preoperative Acute Inflammatory Markers? International Journal, 2, 967-973. KIM, D.-H., LEE, J. H., KIM, D., HWANG, S., KANG, K. & KOO, J. S. 2019. Acute suppurative appendicitis diagnosed by acute lower gastrointestinal hemorrhage. The Korean Journal of Gastroenterology, 73, 45-49. KIM, H.-J., ALONZO, E. S., DOROTHEE, G., POLLARD, J. W. & SANT'ANGELO, D. B. 2010. Selective depletion of eosinophils or neutrophils in mice impacts the efficiency of apoptotic cell clearance in the thymus. PloS one, 5, e11439. KIM, H. J. & JUNG, Y. 2020. The emerging role of eosinophils as multifunctional leukocytes in health and disease. Immune network, 20. KINOSHITA, Y., OOUCHI, S. & FUJISAWA, T. 2019. Eosinophilic gastrointestinal diseases-Pathogenesis, diagnosis, and treatment. Allergology International, 68, 420-429. KISERA, Y. V., STORCHAK, Y. G., GUTYJ, B. V., BOZHYK, L. Y., MAGRELO, N., SUS, Y., DASHKOVSKYY, O., PRYIMYCH, V. I., VUS, U. & KIT, L. 2019. Structural and functional features of the vermiform appendix at the tissue and cellular levels in rabbits after the introduction of immunobiological drugs. Ukrainian Journal of Ecology, 9, 217-226. KLION, A. D., ACKERMAN, S. J. & BOCHNER, B. S. 2020a. Contributions of eosinophils to human health and disease. Annual review of pathology, 15, 179. KLION, A. D., ACKERMAN, S. J. & BOCHNER, B. S. 2020b. Contributions of eosinophils to human health and disease. Annual Review of Pathology: Mechanisms of Disease, 15, 179-209. KOLUR, A., PATIL, A. M., AGARWAL, V., YENDIGIRI, S. & SAJJANAR, B. B. 2014. The significance of mast cells and eosinophils counts in surgically resected appendix. Journal of interdisciplinary Histopathology, 2, 150-153. KOOIJ, I. A., SAHAMI, S., MEIJER, S. L., BUSKENS, C. J. & TE VELDE, A. A. 2016. The immunology of the vermiform appendix: a review of the literature. Clinical & Experimental Immunology, 186, 1-9. KOTAGAL, M., RICHARDS, M. K., CHAPMAN, T., FINCH, L., MCCANN, B., ORMAZABAL, A., RUSH, R. J., GOLDIN, A. B., SAFE, T. & CAMPAIGN, S. 2015. Improving ultrasound quality to reduce computed tomography use in pediatric appendicitis: the Safe and Sound campaign. The American Journal of Surgery, 209, 896-900. KUHLMANN, W. D. 2018. Romanowsky-Giemsa staining. MVZ für Laboratoriumsmedizin Koblenz-Mittelrhein Viktoriastrasse, 39, 56068. KUZAN, B. N., KUZAN, T. Y. & ERGELEN, R. 2019. A new parameter in the diagnosis of acute appendicitis: Ileocolic artery and vein diameter measurements. LACY, P. 2017. Eosinophil cytokines in allergy. Cytokine Effector Functions in Tissues. Elsevier. LAVINE, K. J. 2020. Eosinophils confer protection following myocardial infarction. American College of Cardiology Foundation Washington DC. LEE, G.-E. & BAE, K.-E. Imaging of appendiceal disease; beyond acute appendicitis. 2018. European Congress of Radiology-ECR 2018. LEE, J. J., JACOBSEN, E. A., MCGARRY, M. P., SCHLEIMER, R. P. & LEE, N. A. 2010. Eosinophils in health and disease: the LIAR hypothesis. Clinical & Experimental Allergy, 40, 563-575. LEE, J. Y. & KIM, N. 2015. Diagnosis of Helicobacter pylori by invasive test: histology. Annals of translational medicine, 3. LEE, S. L., KU, Y. M., CHOI, B. G. & BYUN, J. Y. 2014. In vivo location of the vermiform appendix in multidetector CT. Journal of the Korean Society of Radiology, 70, 283-289. LEVIN, M. D. 2019. Pathogenesis of acute appendicitis: review. Gastroenterology & Hepatology: Open Access, 10, 279-285. LI, N. & HUA, J. 2017. Immune cells in liver regeneration. Oncotarget, 8, 3628. LIAO, W., LONG, H., CHANG, C. C.-C. & LU, Q. 2016. The eosinophil in health and disease: from bench to bedside and back. Clinical Reviews in Allergy & Immunology, 50, 125-139. LIN, J., ZHANG, P., LI, Y., ZHENG, J., ZHONG, X., ZHANG, W., NIE, L. & ZHANG, B. 2005. The comparison of HE staining and giemsa staining in detection of eosinophilic granulocytes in conjunctiva scroping. Yan ke xue bao= Eye science, 21, 79-81. LOKTIONOV, A. 2019. Eosinophils in the gastrointestinal tract and their role in the pathogenesis of major colorectal disorders. World journal of gastroenterology, 25, 3503. LOMBARDI, C., BERTI, A. & COTTINI, M. 2022. The emerging roles of eosinophils: implications for the targeted treatment of eosinophilic-associated inflammatory conditions. Current research in immunology, 3, 42-53. LONG, H., LIAO, W., WANG, L. & LU, Q. 2016. A player and coordinator: the versatile roles of eosinophils in the immune system. Transfusion Medicine and Hemotherapy, 43, 96-108. MAGAKI, S., HOJAT, S. A., WEI, B., SO, A. & YONG, W. H. 2019. An introduction to the performance of immunohistochemistry. Biobanking: Methods and Protocols, 289-298. MAGHSOUDI, L. H., SOLTANIAN, A., SHIRZADI, A., ALIZADEH-KASHANI, R. & AHMADINEJAD, M. 2021. Biomarker of urinary 5-HIAA as a valuable predictor of acute appendicitis. Practical Laboratory Medicine, 23, e00198. MANDEVILLE, K., MONUTEAUX, M., POTTKER, T. & BULLOCH, B. 2015. Effects of timing to diagnosis and appendectomy in pediatric appendicitis. Pediatric Emergency Care, 31, 753-758. MARICHAL, T., MESNIL, C. & BUREAU, F. 2017. Homeostatic eosinophils: characteristics and functions. Frontiers in medicine, 4, 101. MCALPINE, J. C. & BANCROFT, J. D. 1964. A histological study of hyaline deposits in laryngeal, aural, and nasal polyps and their differentiation from amyloid. Journal of Clinical Pathology, 17, 213-219. MCBRIEN, C. N. & MENZIES-GOW, A. 2017. The biology of eosinophils and their role in asthma. Frontiers in medicine, 4, 93. MCQUILKEN, S. A. 2021. The mouth, stomach and intestines. Anaesthesia & Intensive Care Medicine, 22, 330-335. MEINZER, A., ALKATOUT, I., KREBS, T. F., BAASTRUP, J., REISCHIG, K., MEIKSANS, R. & BERGHOLZ, R. 2020. Advances and trends in pediatric minimally invasive surgery. Journal of clinical medicine, 9, 3999. MEKAKAS, A., NAGORNI, E.-A. & TABLARIDIS, T. 2022. Complicated appendicitis: A surgical controversy concerning risk factors, diagnostic algorithm and therapeutic management. Doubts, Problems and Certainties about Acute Appendicitis, 10. MELO, R. C. N. & WELLER, P. F. 2018. Contemporary understanding of the secretory granules in human eosinophils. Journal of leukocyte biology, 104, 85-93. MEMON, Z. A., IRFAN, S., FATIMA, K., IQBAL, M. S. & SAMI, W. 2013. Acute appendicitis: diagnostic accuracy of Alvarado scoring system. Asian journal of surgery, 36, 144-149. MESNIL, C., RAULIER, S., PAULISSEN, G., XIAO, X., BIRRELL, M. A., PIROTTIN, D., JANSS, T., STARKL, P., RAMERY, E. & HENKET, M. 2016. Lung-resident eosinophils represent a distinct regulatory eosinophil subset. The Journal of clinical investigation, 126, 3279-3295. MEYERHOLZ, D. K., GRIFFIN, M. A., CASTILOW, E. M. & VARGA, S. M. 2009. Comparison of histochemical methods for murine eosinophil detection in an RSV vaccine-enhanced inflammation model. Toxicologic pathology, 37, 249-255. MICHALINOS, A., MORIS, D. & VERNADAKIS, S. 2014. Amyand's hernia: a review. The American Journal of Surgery, 207, 989-995. MISHRA, A., HOGAN, S. P., LEE, J. J., FOSTER, P. S. & ROTHENBERG, M. E. 1999. Fundamental signals that regulate eosinophil homing to the gastrointestinal tract. The Journal of clinical investigation, 103, 1719-1727. MOHAMED, A. & BHAT, N. 2010. Acute appendicitis dilemma of diagnosis and management. Internet J Surg, 23, 1528-8242. MOHAMMADI, S., HEDJAZI, A., SAJJADIAN, M., RAHMANI, M., MOHAMMADI, M. & MOGHADAM, M. D. 2017. Morphological variations of the vermiform appendix in Iranian cadavers: a study from developing countries. Folia morphologica, 76, 695-701. MORIS, D., PAULSON, E. K. & PAPPAS, T. N. 2021. Diagnosis and management of acute appendicitis in adults: a review. JAMA, 326, 2299-2311. MOSTBECK, G., ADAM, E. J., NIELSEN, M. B., CLAUDON, M., CLEVERT, D., NICOLAU, C., NYHSEN, C. & OWENS, C. M. 2016. How to diagnose acute appendicitis: ultrasound first. Insights into imaging, 7, 255-263. MOWLA, G. 2021. A Histopathological Study of the Appendix after Surgical Resection. Sch J App Med Sci, 3, 381-384. MWACHAKA, P., EL-BUSAIDY, H., SINKEET, S. & OGENG’O, J. 2014. Variations in the position and length of the vermiform appendix in a black kenyan population. International Scholarly Research Notices, 2014. NARCI, H., TURK, E., KARAGULLE, E., TOGAN, T. & KARABULUT, K. 2013. The role of mean platelet volume in the diagnosis of acute appendicitis: a retrospective case-controlled study. Iranian Red Crescent Medical Journal, 15. O.AHMED, H. 2006. role of ultrasound in diagnosis of acute appendicitis. Journal of Zankoy Sulaimani, 9, 107-114. OGOBUIRO, I., GONZALES, J. & TUMA, F. 2021. Physiology, Gastrointestinal. StatPearls [Internet]. StatPearls Publishing. OGUNTOLA, A. S., ADEOTI, M. L. & OYEMOLADE, T. A. 2010. Appendicitis: Trends in incidence, age, sex, and seasonal variations in South-Western Nigeria. Annals of African medicine, 9. OHENE-YEBOAH, M. & ABANTANGA, F. A. 2009. Incidence of acute appendicitis in Kumasi, Ghana. West African journal of medicine, 28. ÖZTURK, A., KORKMAZ, M., ATALAY, T., KARAKÖSE, Y., FARUK AKINCI, Ö. & BOZER, M. 2017. The role of doctors and patients in appendicitis perforation. The American Surgeon, 83, 390-393. PANAGIOTOPOULOU, I. G., PARASHAR, D., LIN, R., ANTONOWICZ, S., WELLS, A. D., BAJWA, F. M. & KRIJGSMAN, B. 2013. The diagnostic value of white cell count, C-reactive protein and bilirubin in acute appendicitis and its complications. The Annals of the Royal College of Surgeons of England, 95, 215-221. PATEL, S. & NAIK, A. 2016. Study of the length of vermiform appendix. Indian Journal of Basic and Applied Medical Research, 5, 256-260. PAUL, U. K., NAUSHABA, H., ALAM, M. J., BEGUM, T., RAHMAN, A. & AKHTER, J. 2011. Length of vermiform appendix: a postmortem study. Bangladesh Journal of Anatomy, 9, 10-12. QUIRCE, S., COSíO, B. G., ESPAñA, A., BLANCO, R., MULLOL, J., SANTANDER, C. & DEL POZO, V. 2023. Management of eosinophil-associated inflammatory diseases: the importance of a multidisciplinary approach. Frontiers in immunology, 14, 1192284. RADENKOVIĆ, G., PETROVIĆ, V., NEDIN-RANKOVIĆ, G., DENČIĆ, T., ŽIVKOVIĆ, V. & JOCIĆ, M. 2021. CD11C immunopositive cells in the human fetal vermiform appendix. Vojnosanitetski pregled, 78, 882-886. RAHMAN, M. M., KHALIL, M., KHALIL, M., JAHAN, M. K., SHAFIQUAZZAMAN, M. & PARVIN, B. 2008. Mass of the Vermiform Appendix in Bangladeshi People. Journal of Bangladesh Society of Physiologist, 3, 8-12. RAMIREZ, G. A., YACOUB, M.-R., RIPA, M., MANNINA, D., CARIDDI, A., SAPORITI, N., CICERI, F., CASTAGNA, A., COLOMBO, G. & DAGNA, L. 2018. Eosinophils from physiology to disease: a comprehensive review. BioMed research international, 2018. RAMRAO, L. Y., GAJBHIYE, V., VAIDYA, V. P., AKTHER, M. J. & PADMAWAR, M. 2020. Role of c Reactive Protein in Acute Appendicitis: A Cross-Sectional Study. International Journal of Current Research and Review, 12, 66-69. RAWOLLE, T., REISMANN, M., MINDERJAHN, M. I., BASSIR, C., HAUPTMANN, K., ROTHE, K. & REISMANN, J. 2019. Sonographic differentiation of complicated from uncomplicated appendicitis. The British journal of radiology, 92, 20190102. RIBEIRO, A. M., ROMERO, I., PEREIRA, C. C., SOARES, F., GONCALVES, Á., COSTA, S. & DA SILVA, J. B. 2022. Inflammatory parameters as predictive factors for complicated appendicitis: A retrospective cohort study. Annals of Medicine and Surgery, 74, 103266. RODRIGO-MUñOZ, J. M., GIL-MARTíNEZ, M., SASTRE, B. & DEL POZO, V. 2021. Emerging evidence for pleiotropism of eosinophils. International Journal of Molecular Sciences, 22, 7075. ROTHROCK, S. G. & PAGANE, J. 2000. Acute appendicitis in children: emergency department diagnosis and management. Annals of emergency medicine, 36, 39-51. RUD, B., VEJBORG, T. S., RAPPEPORT, E. D., REITSMA, J. B. & WILLE‐JøRGENSEN, P. 2019. Computed tomography for diagnosis of acute appendicitis in adults. Cochrane Database of Systematic Reviews. SAHAMI, S., KOOIJ, I. A., MEIJER, S. L., VAN DEN BRINK, G. R., BUSKENS, C. J. & TE VELDE, A. A. 2016. The link between the appendix and ulcerative colitis: clinical relevance and potential immunological mechanisms. Official journal of the American College of Gastroenterology| ACG, 111, 163-169. SALIH, M., MEHDI, A. J. & ABDULLAH, S. 2020. Human Vermiform Appendix Of Different Age Groups. Egyptian Academic Journal of Biological Sciences, D. Histology & Histochemistry, 12, 15-20. SAMOSZUK, M. 1997. Eosinophils and human cancer. Histology and histopathology. SARLA, G. S. 2019. Epidemiology of acute appendicitis. J. Clin. Med. Res. SARTELLI, M., BAIOCCHI, G. L., DI SAVERIO, S., FERRARA, F., LABRICCIOSA, F. M., ANSALONI, L., COCCOLINI, F., VIJAYAN, D., ABBAS, A. & ABONGWA, H. K. 2018. Prospective observational study on acute appendicitis worldwide (POSAW). World Journal of Emergency Surgery, 13, 1-10. SASTRE, B., RODRIGO-MUñOZ, J. M., GARCIA-SANCHEZ, D. A., CAñAS, J. A. & DEL POZO, V. 2018. Eosinophils: Old Players in a New Game. Journal of investigational allergology & clinical immunology, 28, 289-304. SAXENA, D., TANDON, M. & GEDAM, B. 2015. Role of mean platelet volume (MPV) in diagnosis of acute appendicitis. Int J Biomed Res, 6, 235-7. SAZHIN, A. V., PETUKHOV, V. A., NECHAY, T. V., IVAKHOV, G. B., STRADYMOV, E. A. & AKPEROV, A. I. 2021. Microbiological and immunological aspects of pathogenesis of acute appendicitis. Novosti khirurgii, 29, 221-223. SCHNYDER, B., LUGLI, S., FENG, N., ETTER, H., LUTZ, R. A., RYFFEL, B., SUGAMURA, K., WUNDERLI-ALLENSPACH, H. & MOSER, R. 1996. Interleukin-4 (IL-4) and IL-13 bind to a shared heterodimeric complex on endothelial cells mediating vascular cell adhesion molecule-1 induction in the absence of the common gamma chain. SEARLE, A. R., ISMAIL, K. A., MACGREGOR, D. & HUTSON, J. M. 2013. Changes in the length and diameter of the normal appendix throughout childhood. Journal of pediatric surgery, 48, 1535-1539. SENGUL, S., GULER, Y., CALIS, H. & KARABULUT, Z. 2020. The role of serum laboratory biomarkers for complicated and uncomplicated appendicitis in adolescents. J Coll Physicians Surg Pak, 30, 420-424. SHAHMORADI, M. K., ZAREI, F., BEIRANVAND, M. & HOSSEINNIA, Z. 2021. A retrospective descriptive study based on etiology of appendicitis among patients undergoing appendectomy. International Journal of Surgery Open, 31, 100326. SHEN, Z.-J. & MALTER, J. S. 2015. Determinants of eosinophil survival and apoptotic cell death. Apoptosis, 20, 224-234. SHIMIZU, T., ISHIZUKA, M. & KUBOTA, K. 2016. A lower neutrophil to lymphocyte ratio is closely associated with catarrhal appendicitis versus severe appendicitis. Surgery today, 46, 84-89. SHOGILEV, D. J., DUUS, N., ODOM, S. R. & SHAPIRO, N. I. 2014. Diagnosing appendicitis: evidence-based review of the diagnostic approach in 2014. Western Journal of Emergency Medicine, 15, 859. SINGH, D., BAFADHEL, M., BRIGHTLING, C. E., SCIURBA, F. C., CURTIS, J. L., MARTINEZ, F. J., PASQUALE, C. B., MERRILL, D. D., METZDORF, N., PETRUZZELLI, S. J. A. J. O. R. & MEDICINE, C. C. 2020. Blood eosinophil counts in clinical trials for chronic obstructive pulmonary disease. 202, 660-671. SIPPOLA, S., HAIJANEN, J., VIINIKAINEN, L., GRöNROOS, J., PAAJANEN, H., RAUTIO, T., NORDSTRöM, P., AARNIO, M., RANTANEN, T. & HURME, S. 2020a. Quality of life and patient satisfaction at 7-year follow-up of antibiotic therapy vs appendectomy for uncomplicated acute appendicitis: a secondary analysis of a randomized clinical trial. JAMA surgery, 155, 283-289. SIPPOLA, S., VIRTANEN, J., TAMMILEHTO, V., GRöNROOS, J., HURME, S., NIINIVIITA, H., LIETZEN, E. & SALMINEN, P. 2020b. The accuracy of low-dose computed tomography protocol in patients with suspected acute appendicitis: the OPTICAP study. Annals of surgery, 271, 332-338. SNYDER, M. J., GUTHRIE, M. & CAGLE JR, S. D. 2018. Acute appendicitis: efficient diagnosis and management. American family physician, 98, 25-33. SONG, Y., YIN, J., CHANG, H., ZHOU, Q., PENG, H., JI, W. & SONG, Q. 2018. Comparison of four staining methods for detecting eosinophils in nasal polyps. Scientific reports, 8, 17718. STANDRING, S. 2019. The anatomy of the large intestine. Lower Gastrointestinal Tract Surgery: Vol. 1, Laparoscopic procedures. Springer. STRANDMARK, J., RAUSCH, S. & HARTMANN, S. 2016. Eosinophils in homeostasis and their contrasting roles during inflammation and helminth infections. Critical Reviews™ in Immunology, 36. SUGAWARA, R., LEE, E.-J., JANG, M. S., JEUN, E.-J., HONG, C.-P., KIM, J.-H., PARK, A., YUN, C. H., HONG, S.-W. & KIM, Y.-M. 2016. Small intestinal eosinophils regulate Th17 cells by producing IL-1 receptor antagonist. Journal of Experimental Medicine, 213, 555-567. References SUJATHA, R., SHAFIUDDIN, R., KULKARNI, M. V. & MANJUNATHA, Y. 2022. Tumour Associated Tissue Eosinophilia in Oral Squamous Cell Carcinoma by Special Histochemical Analysis of Tissue Eosinophilia using Congo Red Staining. TANRIKULU, C. S., TANRIKULU, Y., SABUNCUOGLU, M. Z., KARAMERCAN, M. A., AKKAPULU, N. & COSKUN, F. 2014. Mean platelet volume and red cell distribution width as a diagnostic marker in acute appendicitis. Iranian Red Crescent Medical Journal, 16. TARTAR, T., BAKAL, Ü., SARAC, M., AYDIN, S. & KAZEZ, A. 2020. Diagnostic value of laboratory results in children with acute appendicitis. Turkish Journal of Biochemistry, 45, 553-558. TAYFUR, M. & BALCI, M. G. 2019. Pathological changes in appendectomy specimens including the role of parasites: A retrospective study of 2400 cases of acute appendicitis. Niger J Clin Pract, 22, 270-5. TENG, T. Z. J., THONG, X. R., LAU, K. Y., BALASUBRAMANIAM, S. & SHELAT, V. G. 2021. Acute appendicitis–advances and controversies. World Journal of Gastrointestinal Surgery, 13, 1293. TEOULE, P., DE LAFFOLIE, J., ROLLE, U. & REISSFELDER, C. 2020. Acute appendicitis in childhood and adulthood: an everyday clinical challenge. Deutsches Ärzteblatt international, 117, 764. THOMPSON, C. A., DELAFOREST, A. & BATTLE, M. A. 2018. Patterning the gastrointestinal epithelium to confer regional-specific functions. Developmental biology, 435, 97-108. THROSBY, M., HERBELIN, A., PLÉAU, J.-M. & DARDENNE, M. 2000. CD11c+ eosinophils in the murine thymus: developmental regulation and recruitment upon MHC class I-restricted thymocyte deletion. The Journal of Immunology, 165, 1965-1975. TREUTING, P. M., ARENDS, M. J. & DINTZIS, S. M. 2018. Lower gastrointestinal tract. Comparative Anatomy and Histology. Elsevier. TULIC, M. K., SLY, P. D., ANDREWS, D., CROOK, M., DAVOINE, F., ODEMUYIWA, S. O., CHARLES, A., HODDER, M. L., PRESCOTT, S. L. & HOLT, P. G. 2009. Thymic indoleamine 2, 3-dioxygenase-positive eosinophils in young children: potential role in maturation of the naive immune system. The American journal of pathology, 175, 2043-2052. TULLAVARDHANA, T., SANGUANLOSIT, S. & CHARTKITCHAREON, A. 2021. Role of platelet indices as a biomarker for the diagnosis of acute appendicitis and as a predictor of complicated appendicitis: A meta-analysis. Annals of Medicine and Surgery, 66, 102448. UEKI, S., OHTA, N., TAKEDA, M., KONNO, Y. & HIROKAWA, M. 2017. Eosinophilic otitis media: the aftermath of eosinophil extracellular trap cell death. Current allergy and asthma reports, 17, 1-7. ULUKENT, S. C., SARICI, I. S. & ULUTAS, K. T. 2016. All CBC parameters in diagnosis of acute appendicitis. Int J Clin Exp Med, 9, 11871-11876. VIRMANI, S., PRABHU, P. S., SUNDEEP, P. T. & KUMAR, V. 2018. Role of laboratory markers in predicting severity of acute appendicitis. African Journal of Paediatric Surgery: AJPS, 15, 1. VISWANTHAN, V., SHAH, N. J. & SHAH, N. 2017. Therapeutic Impact of Computerized Tomography Scan in Acute Appendicitis. Int J Res Med, 5, 114-21. VITETTA, L., CHEN, J. & CLARKE, S. 2019. The vermiform appendix: an immunological organ sustaining a microbiome inoculum. Clinical Science, 133, 1-8. WELLER, P. F. & SPENCER, L. A. 2017. Functions of tissue-resident eosinophils. Nature Reviews Immunology, 17, 746-760. WILLIAMS, N. S., BULSTRODE, C. J. K. & O’CONNELL, P. R. 2008. Short practice of surgery. Bailey and Love. WILLIAMS, R. A. & MYERS, P. 1994. Pathology of the Appendix, Chapman & Hall Medical. WITHERS, A. S., GRIEVE, A. & LOVELAND, J. A. 2019. Correlation of white cell count and CRP in acute appendicitis in paediatric patients. South African Journal of Surgery, 57, 9-13. YAEGER, A. A., CHENG, P. M., TATISHCHEV, S. & WHANG, G. 2018. Acute eosinophilic appendicitis: a radiologic-pathologic correlation. Clinical Imaging, 51, 337-340. YAKUPOVA, E. I., BOBYLEVA, L. G., VIKHLYANTSEV, I. M. & BOBYLEV, A. G. 2019. Congo Red and amyloids: history and relationship. Bioscience reports, 39, BSR20181415. ZHANG, P. L. & QU, Z. 2022. Increased eosinophils in the muscularis propria of appendix may indicate early symptomatic appendicitis. ZHU, X. & ZIMMERMANN, N. 2022. Detection of Eosinophils in Tissue Sections by Immunohistochemistry. Asthma: Methods and Protocols. Springer
Subjects:	Q Science > QD Chemistry
Divisions:	Faculty of Science and Health > Department of Biology > M.Sc. Thesis
Depositing User:	Mr. Rebwar Mohammed Jarjis
Date Deposited:	15 Jan 2024 06:38
Last Modified:	15 Jan 2024 06:38
URI:	http://eprints.koyauniversity.org/id/eprint/455

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