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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Bioscientia Medicina : Journal of Biomedicine and Translational Research
Avino Mulana Fikri
Department of Internal Medicine, Faculty of Medicine, Universitas Andalas/Dr. M. Djamil General Hospital, Padang, Indonesia
Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience

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Evans Syndrome in a Forty-Four Years Old Male Patient: A Case Report Rudy Afriant; Avino Mulana Fikri; Alexander Kam
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 7 No. 4 (2023): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v7i4.805

Abstract

Background: Evans syndrome (ES) is an autoimmune disease characterized by the presence of autoimmune hemolytic anemia (AIHA) and idiopathic thrombocytopenic purpura (ITP), together with unknown causes. ES disease is the least common, diagnosed in only 0.8% - 3.7% of all patients with AIHA or ITP. This study aimed to describe Evans syndrome in a 44-year-old male patient. Case presentation: A 44-year-old male patient was reported with complaints of weakness and fatigue, red spots, a history of bleeding gums, a history of bleeding from the nose, and a history of red urination. A routine blood examination revealed mild anemia, reticulocytosis, and thrombocytopenia, and the peripheral blood showed polychromatic erythrocytes. Other laboratory examinations revealed an increase in LDH. The results of a positive Comb’s test and antibody screening examination showed the impression of warm-type AIHA. The diagnosis of Evans syndrome in this patient was confirmed by the presence of AIHA and ITP, which co-occur and are primarily due to unknown causes. Conclusion: ES is a rare disorder and a diagnosis of exclusion. The diagnosis of ES was established by the presence of signs and symptoms of AIHA and ITP accompanied by a positive direct antiglobulin test with no other etiology found.
Evans Syndrome in a Forty-Four Years Old Male Patient: A Case Report Rudy Afriant; Avino Mulana Fikri; Alexander Kam
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 7 No. 4 (2023): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v7i4.805

Abstract

Background: Evans syndrome (ES) is an autoimmune disease characterized by the presence of autoimmune hemolytic anemia (AIHA) and idiopathic thrombocytopenic purpura (ITP), together with unknown causes. ES disease is the least common, diagnosed in only 0.8% - 3.7% of all patients with AIHA or ITP. This study aimed to describe Evans syndrome in a 44-year-old male patient. Case presentation: A 44-year-old male patient was reported with complaints of weakness and fatigue, red spots, a history of bleeding gums, a history of bleeding from the nose, and a history of red urination. A routine blood examination revealed mild anemia, reticulocytosis, and thrombocytopenia, and the peripheral blood showed polychromatic erythrocytes. Other laboratory examinations revealed an increase in LDH. The results of a positive Comb’s test and antibody screening examination showed the impression of warm-type AIHA. The diagnosis of Evans syndrome in this patient was confirmed by the presence of AIHA and ITP, which co-occur and are primarily due to unknown causes. Conclusion: ES is a rare disorder and a diagnosis of exclusion. The diagnosis of ES was established by the presence of signs and symptoms of AIHA and ITP accompanied by a positive direct antiglobulin test with no other etiology found.
Outcomes of Surgical Resection versus Medical Management in Chronic Pulmonary Aspergillosis: A Systematic Review and Meta-Analysis of Comparative Cohorts Avino Mulana Fikri; Fauzar; Roza Kurniati
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i3.1540

Abstract

Background: Chronic pulmonary aspergillosis (CPA) is a progressive and debilitating fungal infection that complicates structural lung diseases, particularly in patients with a history of treated tuberculosis. The therapeutic strategy remains a subject of intense debate, polarized between surgical resection, which offers a potential definitive cure but carries significant operative risks, and long-term azole therapy, which is suppressive but prone to drug resistance and high relapse rates. This study aimed to systematically evaluate survival outcomes and recurrence risks between these two modalities, specifically addressing the clinical heterogeneity between simple aspergilloma (SA) and chronic cavitary pulmonary aspergillosis (CCPA). Methods: We conducted a systematic review and meta-analysis of six pivotal retrospective cohort studies published between 2013 and 2022, representing the modern era of thoracic surgery. Databases including PubMed, Scopus, and Embase were searched for comparative studies reporting overall survival (OS) and recurrence rates. Data were pooled using a random-effects model to account for clinical heterogeneity. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS), with specific adjustments for allocation bias and confounding factors. Results: The meta-analysis integrated data from 268 patients. Surgical resection was associated with a significant reduction in all-cause mortality compared to medical therapy (Pooled Hazard Ratio [HR] 0.12; 95% CI 0.04–0.35). In stratified analysis, recurrence rates were 2.7% for simple aspergilloma versus 10.3% for CCPA in surgical arms, contrasting sharply with relapse rates of 36–50% in medical arms upon drug cessation. An analysis of adjuvant antifungal therapy in a subset of patients showed no statistical benefit in completely resected simple aspergilloma. Postoperative complications occurred in 24.5% of surgical cases, primarily consisting of prolonged air leaks. Conclusion: Surgical resection offers superior recurrence-free survival in selected candidates with localized disease compared to medical therapy. While effectively curative for simple aspergilloma, surgery in CCPA acts as a cytoreductive measure with a persisting recurrence risk, necessitating a multimodal approach. Medical therapy remains the mainstay for patients with bilateral disease or poor pulmonary reserve, but requires indefinite duration to prevent relapse.
Outcomes of Surgical Resection versus Medical Management in Chronic Pulmonary Aspergillosis: A Systematic Review and Meta-Analysis of Comparative Cohorts Avino Mulana Fikri; Fauzar; Roza Kurniati
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i3.1540

Abstract

Background: Chronic pulmonary aspergillosis (CPA) is a progressive and debilitating fungal infection that complicates structural lung diseases, particularly in patients with a history of treated tuberculosis. The therapeutic strategy remains a subject of intense debate, polarized between surgical resection, which offers a potential definitive cure but carries significant operative risks, and long-term azole therapy, which is suppressive but prone to drug resistance and high relapse rates. This study aimed to systematically evaluate survival outcomes and recurrence risks between these two modalities, specifically addressing the clinical heterogeneity between simple aspergilloma (SA) and chronic cavitary pulmonary aspergillosis (CCPA). Methods: We conducted a systematic review and meta-analysis of six pivotal retrospective cohort studies published between 2013 and 2022, representing the modern era of thoracic surgery. Databases including PubMed, Scopus, and Embase were searched for comparative studies reporting overall survival (OS) and recurrence rates. Data were pooled using a random-effects model to account for clinical heterogeneity. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS), with specific adjustments for allocation bias and confounding factors. Results: The meta-analysis integrated data from 268 patients. Surgical resection was associated with a significant reduction in all-cause mortality compared to medical therapy (Pooled Hazard Ratio [HR] 0.12; 95% CI 0.04–0.35). In stratified analysis, recurrence rates were 2.7% for simple aspergilloma versus 10.3% for CCPA in surgical arms, contrasting sharply with relapse rates of 36–50% in medical arms upon drug cessation. An analysis of adjuvant antifungal therapy in a subset of patients showed no statistical benefit in completely resected simple aspergilloma. Postoperative complications occurred in 24.5% of surgical cases, primarily consisting of prolonged air leaks. Conclusion: Surgical resection offers superior recurrence-free survival in selected candidates with localized disease compared to medical therapy. While effectively curative for simple aspergilloma, surgery in CCPA acts as a cytoreductive measure with a persisting recurrence risk, necessitating a multimodal approach. Medical therapy remains the mainstay for patients with bilateral disease or poor pulmonary reserve, but requires indefinite duration to prevent relapse.
Co-Authors Alexander Kam Fauzar Roza Kurniati Rudy Afriant