ABSTRACT
BACKGROUND: Bullous pemphigoid (BP) is the most frequently encountered autoimmune blistering disorder, affecting mainly elderly population. The aim of the study was to assess the incidence of BP in Podlaskie Province (north-east Poland) in 1999-2012, socio-demographic characteristics and mortality of patients with BP. METHODS: The number of newly diagnosed (in two regional hospitals) cases of BP per million inhabitants of the province in consecutive years was calculated and analysis of age, sex, and residency of patients performed. RESULTS: A total of 122 cases of BP were diagnosed (in 52 males and 70 females). The average annual incidence was 7.38 ± 3.51 per million inhabitants: 5.70 ± 4.16 and 9.26 ± 4.40 in urban and rural areas, P < 0.05, respectively, and had an increasing trend over the period analyzed. Age of patients with BP was 74.18 ± 12.12. The incidence among men and women over 75 years of age was 86.67 ± 61.39 and 51.49 ± 41.44, P < 0.05, respectively. The 1-year mortality of patients was 32.35 and 18.42% (P < 0.05) in men and women, respectively. Overall mortality was 36.11%. CONCLUSIONS: The incidence of BP in Podlaskie Province is almost twice as high among residents of rural than urban areas, and in males than females in advanced age. The results suggest that the incidence of BP will be increasing in an aging society, as will its impact on the quality of life of the population.
Subject(s)
Pemphigoid, Bullous/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Cohort Studies , Female , Humans , Incidence , Male , Middle Aged , Pemphigoid, Bullous/mortality , Poland/epidemiology , Retrospective Studies , Time Factors , Young AdultABSTRACT
OBJECTIVES: A randomized controlled trial was conducted to clarify whether continuous regional arterial infusion (CRAI) of protease inhibitor and antibiotic could reduce mortality rate of severe acute pancreatitis (SAP). METHODS: Seventy-eight patients with SAP were included in the study. Thirty-nine patients were treated with CRAI, 31 patients completed the study; and another group of 39 patients was treated without CRAI therapy. Groups were well matched in clinical characteristics. The CRAI patients were treated continuously with nafamostat mesylate 240 mg/d and imipenem 1 g/d for 5 days via one of the arteries perfusing the pancreas. Later, imipenem was given intravenously (0.5 g every 8 hours) for 9 days. The non-CRAI patients received imipenem (0.5 g every 8 hours) intravenously for 14 days. Statistical analysis of the intention-to-treat (ITT) group was performed. RESULTS: Lack of septic complications was observed in 23 patients with CRAI therapy and 20 non-CRAI patients (not significant). The additional antibiotics were applied in 8 of CRAI patients and in 18 non-CRAI (ITT, P = 0.02). Mortality rate was 5.1% in CRAI and 23.1% in non-CRAI group (ITT, P = 0.02). Urgent surgical intervention was necessary in 10.3% CRAI patients and in 33.3% non-CRAI (ITT, P = 0.01). CONCLUSIONS: The results show that CRAI of protease inhibitor and antibiotic is effective in preventing complications and in reducing mortality rate in SAP.
Subject(s)
Guanidines/therapeutic use , Imipenem/therapeutic use , Pancreatitis/drug therapy , Acute Disease , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Benzamidines , Drug Administration Schedule , Drug Therapy, Combination , Female , Guanidines/administration & dosage , Humans , Imipenem/administration & dosage , Infusions, Intra-Arterial , Infusions, Intravenous , Male , Middle Aged , Pancreatitis/mortality , Pancreatitis/pathology , Protease Inhibitors/administration & dosage , Protease Inhibitors/therapeutic use , Severity of Illness Index , Survival Rate , Treatment OutcomeABSTRACT
BACKGROUND: Epidemiological studies on pemphigoid, the most frequent group of autoimmune bullous diseases, are rare. The aim was to evaluate the incidence of pemphigoid in the Podlaskie voivodship (northeastern Poland), the prevalence of concomitant diseases and their treatment, and the efficacy and side effects of pemphigoid therapy. MATERIAL/METHODS: The study included 23 female and 12 male consecutive in-patients of the Department of Dermatology and Venereology, Medical University of Bialystok , between January 2000 and June 2006. Their sociodemographic data, diseases, and treatment before and after pemphigoid onset were analyzed. Diagnosis was confirmed using direct and/or indirect immunological studies. RESULTS: The annual incidence of pemphigoid was 4.47/million. Sixty percent of the patients lived in rural areas. Their mean age at diagnosis was 68.99 years in women and 67.25 years in men; five female patients were under 53 years. All patients were treated for other diseases prior to pemphigoid onset and the diseases could have been drug-induced in >30% of cases. Two patients had malignancies prior to pemphigoid onset, and neoplasmas were diagnosed afterwards in three. Prednisolone was a successful treatment in >60% of patients. Infections and osteoporosis were observed in 34.3% during therapy; one patient had sudden gastric hemorrhage. Seven patients died within the first year. CONCLUSIONS: The results confirm that pemphigoid affects mainly elderly people, usually being treated for other disorders; the disease may be more frequent in rural areas. In an aging society, the disease is expected to become a more serious therapeutic challenge.
