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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Bioscientia Medicina : Journal of Biomedicine and Translational Research
Azhar Arrosyid
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Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience

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A Retrospective Analysis of Clinical Characteristics and Neutrophil-to-Lymphocyte Ratio in Hospitalized Indonesian Patients with Pemphigus Vulgaris and Bullous Pemphigoid: A Single-Center Experience Azhar Arrosyid; Nurrachmat Mulianto
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 11 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i11.1445

Abstract

Background: Comprehensive clinical-epidemiological data on severe autoimmune bullous diseases (ABDs) from Southeast Asian populations are notably scarce. Pemphigus vulgaris (PV) and bullous pemphigoid (BP) are the most common ABDs, and understanding their presentation in diverse ethnic and geographic contexts is crucial for global health equity. This study’s primary aim was to characterize a cohort of hospitalized ABD patients in Central Java, Indonesia, and to secondarily explore the behavior of the neutrophil-to-lymphocyte ratio (NLR) as an inflammatory marker within this real-world clinical setting. Methods: A retrospective, cross-sectional study was conducted at a tertiary referral hospital in Surakarta, Indonesia. The study included all patients admitted with a final diagnosis of PV or BP between January 2019 and December 2023. Comprehensive data on demographics, documented comorbidities, duration of hospitalization, and admission hematological parameters were extracted from medical records. Clinical characteristics were compared, and the non-parametric Mann-Whitney U test was used to analyze the difference in NLR. A post-hoc power analysis was performed to contextualize the hematological findings. Results: This study provides a detailed clinical profile of 30 hospitalized ABD patients. The PV cohort (n=17) was characterized by a younger age of onset (mean age 54.29 ± 14.83 years) and a strong female predominance (70.6%). In contrast, the BP cohort (n=13) was older (mean age 63.08 ± 22.01 years) with a balanced gender distribution. A key finding was that patients with PV had a significantly longer duration of hospitalization than those with BP (13.24 vs. 10.15 days, p < 0.05). The mean NLR was descriptively higher in BP (10.56 ± 7.22) than in PV (9.43 ± 6.14), but this difference was not statistically significant (p = 0.770), a finding consistent with the study’s critically low statistical power of 9.8%. Conclusion: This study presents a valuable clinical and epidemiological snapshot of hospitalized patients with PV and BP in an underrepresented Indonesian population, highlighting a significantly greater clinical burden for PV as quantified by length of stay. The exploratory analysis of the NLR was inconclusive and should not be interpreted as definitive evidence against its utility. Instead, it serves as a powerful illustration of how the effects of low statistical power and overwhelming, unmeasured confounding from disease severity and corticosteroid treatment present profound challenges to the validation of non-specific biomarkers in complex, real-world clinical scenarios.
A Retrospective Analysis of Clinical Characteristics and Neutrophil-to-Lymphocyte Ratio in Hospitalized Indonesian Patients with Pemphigus Vulgaris and Bullous Pemphigoid: A Single-Center Experience Azhar Arrosyid; Nurrachmat Mulianto
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 11 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i11.1445

Abstract

Background: Comprehensive clinical-epidemiological data on severe autoimmune bullous diseases (ABDs) from Southeast Asian populations are notably scarce. Pemphigus vulgaris (PV) and bullous pemphigoid (BP) are the most common ABDs, and understanding their presentation in diverse ethnic and geographic contexts is crucial for global health equity. This study’s primary aim was to characterize a cohort of hospitalized ABD patients in Central Java, Indonesia, and to secondarily explore the behavior of the neutrophil-to-lymphocyte ratio (NLR) as an inflammatory marker within this real-world clinical setting. Methods: A retrospective, cross-sectional study was conducted at a tertiary referral hospital in Surakarta, Indonesia. The study included all patients admitted with a final diagnosis of PV or BP between January 2019 and December 2023. Comprehensive data on demographics, documented comorbidities, duration of hospitalization, and admission hematological parameters were extracted from medical records. Clinical characteristics were compared, and the non-parametric Mann-Whitney U test was used to analyze the difference in NLR. A post-hoc power analysis was performed to contextualize the hematological findings. Results: This study provides a detailed clinical profile of 30 hospitalized ABD patients. The PV cohort (n=17) was characterized by a younger age of onset (mean age 54.29 ± 14.83 years) and a strong female predominance (70.6%). In contrast, the BP cohort (n=13) was older (mean age 63.08 ± 22.01 years) with a balanced gender distribution. A key finding was that patients with PV had a significantly longer duration of hospitalization than those with BP (13.24 vs. 10.15 days, p < 0.05). The mean NLR was descriptively higher in BP (10.56 ± 7.22) than in PV (9.43 ± 6.14), but this difference was not statistically significant (p = 0.770), a finding consistent with the study’s critically low statistical power of 9.8%. Conclusion: This study presents a valuable clinical and epidemiological snapshot of hospitalized patients with PV and BP in an underrepresented Indonesian population, highlighting a significantly greater clinical burden for PV as quantified by length of stay. The exploratory analysis of the NLR was inconclusive and should not be interpreted as definitive evidence against its utility. Instead, it serves as a powerful illustration of how the effects of low statistical power and overwhelming, unmeasured confounding from disease severity and corticosteroid treatment present profound challenges to the validation of non-specific biomarkers in complex, real-world clinical scenarios.
Single-Dose Intralesional Bacillus Calmette-Guérin (BCG) Immunotherapy Induces Complete and Sustained Remission of Recalcitrant Anogenital Condylomata: A Mechanistic Case Series Azhar Arrosyid; Prasetyadi Mawardi; Endra Yustin Ellistasari; Ammarilis Murastami
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1472

Abstract

Background: Anogenital condylomata acuminata caused by Human Papillomavirus (HPV) presents a significant therapeutic challenge due to high recurrence rates after conventional cytodestructive therapies. Intralesional immunotherapy aims to induce a host-mediated immune response, offering a promising alternative. This report investigates the efficacy, safety, and immunological rationale of a novel, single-dose Bacillus Calmette-Guérin (BCG) protocol in an immunologically primed population. Methods: In this prospective case series, three immunocompetent patients with extensive, therapy-refractory anogenital condylomata were enrolled. Following a standardized protocol, each patient received a single, calculated intralesional injection of BCG vaccine into the largest index lesion. The primary outcome was complete clinical and dermoscopic clearance. Patients were evaluated at regular intervals for efficacy and safety over a 12-month follow-up period. Result: All three patients achieved complete clinical and dermoscopic clearance of both the injected and distant, untreated lesions within a rapid timeframe of 6 to 10 weeks. The treatment was well-tolerated, with adverse events limited to anticipated and transient local inflammatory reactions. No recurrences were documented in any patient during the 12-month follow-up period. Conclusion: Single-dose intralesional BCG immunotherapy appears to be a highly effective, durable, and safe therapeutic strategy for recalcitrant anogenital condylomata. The observed pan-lesional clearance strongly suggests the induction of a systemic, cell-mediated anti-HPV immune response. These compelling preliminary findings provide a strong rationale for validation through larger, randomized controlled trials.
Single-Dose Intralesional Bacillus Calmette-Guérin (BCG) Immunotherapy Induces Complete and Sustained Remission of Recalcitrant Anogenital Condylomata: A Mechanistic Case Series Azhar Arrosyid; Prasetyadi Mawardi; Endra Yustin Ellistasari; Ammarilis Murastami
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1472

Abstract

Background: Anogenital condylomata acuminata caused by Human Papillomavirus (HPV) presents a significant therapeutic challenge due to high recurrence rates after conventional cytodestructive therapies. Intralesional immunotherapy aims to induce a host-mediated immune response, offering a promising alternative. This report investigates the efficacy, safety, and immunological rationale of a novel, single-dose Bacillus Calmette-Guérin (BCG) protocol in an immunologically primed population. Methods: In this prospective case series, three immunocompetent patients with extensive, therapy-refractory anogenital condylomata were enrolled. Following a standardized protocol, each patient received a single, calculated intralesional injection of BCG vaccine into the largest index lesion. The primary outcome was complete clinical and dermoscopic clearance. Patients were evaluated at regular intervals for efficacy and safety over a 12-month follow-up period. Result: All three patients achieved complete clinical and dermoscopic clearance of both the injected and distant, untreated lesions within a rapid timeframe of 6 to 10 weeks. The treatment was well-tolerated, with adverse events limited to anticipated and transient local inflammatory reactions. No recurrences were documented in any patient during the 12-month follow-up period. Conclusion: Single-dose intralesional BCG immunotherapy appears to be a highly effective, durable, and safe therapeutic strategy for recalcitrant anogenital condylomata. The observed pan-lesional clearance strongly suggests the induction of a systemic, cell-mediated anti-HPV immune response. These compelling preliminary findings provide a strong rationale for validation through larger, randomized controlled trials.
Co-Authors Ammarilis Murastami Endra Yustin Ellistasari Nurrachmat Mulianto Prasetyadi Mawardi