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

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Predicting Mortality in Pulmonary Alveolar Proteinosis: A Meta-Analysis of Prognostic Factors Mohd Syahbani Nugraha; Rohani Lasmaria; Dewi Wijaya
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 3 (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.v9i3.1211

Abstract

Background: Pulmonary alveolar proteinosis (PAP) is a rare lung disease with a variable clinical course. This meta-analysis aimed to synthesize the available evidence on prognostic factors associated with mortality in patients with PAP. Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science databases for studies published from 2013 to 2024. Studies reporting prognostic factors associated with mortality in patients with PAP were included. Data on study characteristics, patient demographics, clinical variables, and outcomes were extracted. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for dichotomous outcomes, and hazard ratios (HRs) and 95% CIs were calculated for time-to-event outcomes. Random-effects meta-analysis was used to pool data, and heterogeneity was assessed using the I² statistic. Results: Six studies with a total of 1,375 PAP patients were included in the meta-analysis. The pooled analysis showed that several factors were significantly associated with increased mortality in PAP. These included older age (HR 1.45, 95% CI 1.02-1.9, p < 0.001), lower diffusing capacity for carbon monoxide (DLCO) % predicted (HR 0.87, 95% CI 0.65-0.98, p < 0.001), higher serum lactate dehydrogenase (LDH) levels (OR 2.50, 95% CI 1.80-3.47, p < 0.001), lower arterial oxygen tension (PaO2) (HR 0.89, 95% CI 0.78-0.98, p=0.002), and a diagnosis of secondary PAP (OR 3.85; 95% CI 2.19-5.56, p <0.001). Heterogeneity was moderate to high for most analyses. Conclusion: This meta-analysis identified several clinical and laboratory parameters associated with increased mortality in PAP. These factors could be used to identify high-risk patients who may benefit from closer monitoring and more aggressive treatment strategies. Further prospective studies are needed to validate these findings and to develop accurate predictive models for mortality in PAP.
Antibiotic Management in Bacterial Pneumonia: A Narrative Literature Review Herdika, Yusri; Rohani Lasmaria
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 3 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i3.934

Abstract

Pneumonia is an acute inflammation of the lung parenchyma caused by various types of microorganisms, such as bacteria, viruses, fungi, and parasites. The use of antibiotics is often faced with many types and inappropriate doses, and using antibiotics for too long can increase the risk of bacteria multidrug resistance (MDR). Therefore, the choice and dosage of antibiotics must be appropriate to reduce the rate of bacterial resistance. The increasing incidence of bacterial resistance is an indicator of failure in treating pneumonia because, apart from clinical improvement, optimal eradication of bacteria should also be the goal in every antibiotic administration. The aim of this literature review is to explain the basis for administering and selecting empiric antibiotics for pneumonia infections as well as appropriate antibiotic management and adequate especially in bacterial pneumonia, to provide a better prognosis.
Antibiotic Management in Bacterial Pneumonia: A Narrative Literature Review Herdika, Yusri; Rohani Lasmaria
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 3 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i3.934

Abstract

Pneumonia is an acute inflammation of the lung parenchyma caused by various types of microorganisms, such as bacteria, viruses, fungi, and parasites. The use of antibiotics is often faced with many types and inappropriate doses, and using antibiotics for too long can increase the risk of bacteria multidrug resistance (MDR). Therefore, the choice and dosage of antibiotics must be appropriate to reduce the rate of bacterial resistance. The increasing incidence of bacterial resistance is an indicator of failure in treating pneumonia because, apart from clinical improvement, optimal eradication of bacteria should also be the goal in every antibiotic administration. The aim of this literature review is to explain the basis for administering and selecting empiric antibiotics for pneumonia infections as well as appropriate antibiotic management and adequate especially in bacterial pneumonia, to provide a better prognosis.
Predicting Mortality in Pulmonary Alveolar Proteinosis: A Meta-Analysis of Prognostic Factors Mohd Syahbani Nugraha; Rohani Lasmaria; Dewi Wijaya
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 3 (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.v9i3.1211

Abstract

Background: Pulmonary alveolar proteinosis (PAP) is a rare lung disease with a variable clinical course. This meta-analysis aimed to synthesize the available evidence on prognostic factors associated with mortality in patients with PAP. Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science databases for studies published from 2013 to 2024. Studies reporting prognostic factors associated with mortality in patients with PAP were included. Data on study characteristics, patient demographics, clinical variables, and outcomes were extracted. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for dichotomous outcomes, and hazard ratios (HRs) and 95% CIs were calculated for time-to-event outcomes. Random-effects meta-analysis was used to pool data, and heterogeneity was assessed using the I² statistic. Results: Six studies with a total of 1,375 PAP patients were included in the meta-analysis. The pooled analysis showed that several factors were significantly associated with increased mortality in PAP. These included older age (HR 1.45, 95% CI 1.02-1.9, p < 0.001), lower diffusing capacity for carbon monoxide (DLCO) % predicted (HR 0.87, 95% CI 0.65-0.98, p < 0.001), higher serum lactate dehydrogenase (LDH) levels (OR 2.50, 95% CI 1.80-3.47, p < 0.001), lower arterial oxygen tension (PaO2) (HR 0.89, 95% CI 0.78-0.98, p=0.002), and a diagnosis of secondary PAP (OR 3.85; 95% CI 2.19-5.56, p <0.001). Heterogeneity was moderate to high for most analyses. Conclusion: This meta-analysis identified several clinical and laboratory parameters associated with increased mortality in PAP. These factors could be used to identify high-risk patients who may benefit from closer monitoring and more aggressive treatment strategies. Further prospective studies are needed to validate these findings and to develop accurate predictive models for mortality in PAP.
Efficacy and Safety of Adjunctive Corticosteroids in Non-HIV Pneumocystis jirovecii Pneumonia with Respiratory Failure: A Systematic Review and Meta-Analysis of Randomized and Observational Studies Reza Rahmadinata; Rohani Lasmaria
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (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.v10i2.1508

Abstract

Background: Pneumocystis jirovecii pneumonia in HIV-negative immunocompromised patients carries a mortality rate significantly higher than in the HIV-positive population. While adjunctive corticosteroids are the standard of care for HIV-associated pneumonia to prevent Immune Reconstitution Inflammatory Syndrome, their efficacy in non-HIV patients remains controversial due to differing immunopathogenesis. This study evaluated the efficacy and safety of adjunctive corticosteroids in non-HIV patients with respiratory failure, specifically addressing the discordance between historical observational data and recent randomized evidence. Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines, searching databases from January 2014 to July 2025. We included randomized controlled trials and observational studies of non-HIV adults with pneumonia receiving adjunctive corticosteroids. To address methodological heterogeneity, we performed stratified analyses separating randomized trial data from observational cohorts and conducted sensitivity analyses to account for outliers. Risk of bias was assessed using Cochrane RoB-2 and the Newcastle-Ottawa Scale. Results: Ten studies comprising 2,900 patients were analyzed. The randomized trial demonstrated no statistically significant reduction in 28-day mortality with corticosteroids (21.5% vs 32.4%, p=0.069). In the observational arm, initial pooled analysis suggested benefit, but sensitivity analysis removing a large administrative database study shifted the result to null. Crucially, higher cumulative steroid doses were associated with increased 90-day mortality (Hazard Ratio 1.01 per 100mg equivalent; p<0.05) and a significantly increased risk of secondary infections and hyperglycemia. Subgroup analysis revealed no benefit for pulse-dose regimens over standard dosing. Conclusion: Unlike in HIV, adjunctive corticosteroids do not confer a consistent survival benefit in non-HIV Pneumocystis pneumonia and are associated with dose-dependent toxicity. The routine use of corticosteroids should be abandoned in favor of a cautious approach restricted to severe, early hypoxemia using standard rather than pulse doses.
Efficacy and Safety of Adjunctive Corticosteroids in Non-HIV Pneumocystis jirovecii Pneumonia with Respiratory Failure: A Systematic Review and Meta-Analysis of Randomized and Observational Studies Reza Rahmadinata; Rohani Lasmaria
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (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.v10i2.1508

Abstract

Background: Pneumocystis jirovecii pneumonia in HIV-negative immunocompromised patients carries a mortality rate significantly higher than in the HIV-positive population. While adjunctive corticosteroids are the standard of care for HIV-associated pneumonia to prevent Immune Reconstitution Inflammatory Syndrome, their efficacy in non-HIV patients remains controversial due to differing immunopathogenesis. This study evaluated the efficacy and safety of adjunctive corticosteroids in non-HIV patients with respiratory failure, specifically addressing the discordance between historical observational data and recent randomized evidence. Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines, searching databases from January 2014 to July 2025. We included randomized controlled trials and observational studies of non-HIV adults with pneumonia receiving adjunctive corticosteroids. To address methodological heterogeneity, we performed stratified analyses separating randomized trial data from observational cohorts and conducted sensitivity analyses to account for outliers. Risk of bias was assessed using Cochrane RoB-2 and the Newcastle-Ottawa Scale. Results: Ten studies comprising 2,900 patients were analyzed. The randomized trial demonstrated no statistically significant reduction in 28-day mortality with corticosteroids (21.5% vs 32.4%, p=0.069). In the observational arm, initial pooled analysis suggested benefit, but sensitivity analysis removing a large administrative database study shifted the result to null. Crucially, higher cumulative steroid doses were associated with increased 90-day mortality (Hazard Ratio 1.01 per 100mg equivalent; p<0.05) and a significantly increased risk of secondary infections and hyperglycemia. Subgroup analysis revealed no benefit for pulse-dose regimens over standard dosing. Conclusion: Unlike in HIV, adjunctive corticosteroids do not confer a consistent survival benefit in non-HIV Pneumocystis pneumonia and are associated with dose-dependent toxicity. The routine use of corticosteroids should be abandoned in favor of a cautious approach restricted to severe, early hypoxemia using standard rather than pulse doses.
Co-Authors Dewi Wijaya Herdika, Yusri Mohd Syahbani Nugraha Reza Rahmadinata