Bullous pemphigoid in 65 years old female: a case report

Introduction: Bullous pemphigoid is an autoimmune disorder. The incidence of bullous pemphigoid has increased over time, current understanding regarding treatment and complication is an important issue considering the disease often occur in elderly resulting in high rates of morbidity to the patients. Aim of ^current case report is to describe the clinical relevance regarding symptom and treatment of bullous pemphigoid.

Case presentation: A 65 years old female patient, came with chief complaints of bullae in abdominal region with itching and burning sensation in the ruptured bullae. Over time bullae spread in lower and upper extremity. Patient was admitted for four days with therapy intravenous steroids, oral antihistamine, and potent topical steroids. Patient was discharged from hospital in well condition.

Conclusion: Bullous pemphigoid is an inflammatory autoimmune skin disease and usually result in good prognosis with adequate management.

Keywords: autoimmune, bullous, pemphigoid, skin, disease.

Positive correlation between psoriasis vulgaris severity degree with HbA1C level

Introduction: Psoriasis is a skin abnormality based on chronic inflammation immune mediated. Inflammatory mediator roles (Th-1, TNF-α, IL-6,IL-7, IL-8, IL-17, and IL-23) in its pathogenesis proven to inhibit insulin receptor and glucose uptake from fat tissue and causing insulin resistance, then blood glucose level increased. Mean blood glucose level within 3 months can be represented by HbA1c (glycosylated haemoglobin) level. HbA1c is a bond between glucose and hemoglobin.           

Objective: The aim of this study is to understanding correlation between psoriasis vulgaris severity degree with HbA1c.

Material and methods: This study is using cross sectional method. HbA1c level examination done by drawing venous blood, then analyzed with chromatography method. Samples were selected by using inclusion and exclusion criteria and consecutive sampling method.

Result: Study result shows subject consist of total 51 subjects consists of 33 subjects with psoriasis vulgaris (22 males and 11 females with youngest age of 15 and oldest age of 65 years old), and 18 subjects without psoriasis vulgaris. Psoriasis vulgaris severity degree measured with Psoriasis Area Severity Index (PASI), then grouped to 3 categories: mild PASI score <6, moderate PASI score  6 – 12, and severe PASI score> 12. Mostly  (15 subjects) including mild category. HbA1c level on this study subjects resulted minimum level of 4.6%, maximum 12.1 %, and median 5.4%.  Based on Perkeni consensus, normal HbA1c level is <5,7%, prediabetes 5,7-6,4%, and diabetes >6,5%. HbA1c level of psoriasis vulgaris subjects are higher than non psoriasis vulgaris subjects significantly (p=0,019). Psoriasis vulgaris causing increase of HbA1c level with Prevalence Ratio (PR) 6,55. Thus, Psoriasis vulgaris subjects have increased risk 6,5 times to increase HbA1c level compared with non psoriasis vulgaris subjects. Correlation between severity degree and HbA1c level found in positive course significantly with moderate strength of correlation (Spearman correlation; r = 0.580, p<0,001).

Bacterial vaginosis as a risk factor of preterm premature rupture of membrane (PPROM)

Introduction: The pathogenesis of PPROM is complex and not fully understood. Recent studies showed that such role of genital tract infection as bacterial vaginosis in the pathogenesis of PPROM turned out to be present. They produce lipase enzymes in which they can form compounds with the fibrous tissue of amniotic membrane resulting in increased risk of rupture of the membrane.

Objective This study aims to prove that bacterial vaginosis is a risk factor for preterm premature rupture of membrane.

Material and methods: This research used case control method. Sampling was using the consecutive sampling method and had fulfilled inclusion and exclusion criteria with age-based matching, then vaginal swab sampling was conducted, painted with gram staining in the Dermalotogy and Venereology Laboratory of Sanglah Hospital, and Nugent score.

Result: Total of 76 pregnant women with 24-36 weeks of gestation were investigated, 38 mothers with PPROM and 38 mothers with normal pregnancy. Average score of Nugent at preterm PROM was 7.18 and in normal pregnancy was 2.37. Bacterial vaginosis risking for PPROM 7 times (OR= 7.0, 95% CI= 1.21-17.68, p= 0.001).

Conclusion: Bacterial vaginosis as a risk factor for the occurrence of PPROM.