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

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Idiopathic Pulmonary Fibrosis: A Narrative Literature Review Febrina, Nidya; Dewi Wijaya
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 8 (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.v8i8.1052

Abstract

Idiopathic pulmonary fibrosis is a chronic progressive interstitial lung disease (ILD) with unknown causes. Male gender, age > 60 years, history of smoking with symptoms of dry cough and progressive chronic shortness of breath are typical clinical findings in this patient. The diagnosis is made based on a combination of radiological findings in the form of a pattern consistent with usual interstitial pneumonia (UIP) and/or histopathology with the exclusion of other causes of ILD. Treatment includes pharmacological and non-pharmacological therapy in the form of pulmonary rehabilitation, psychosocial support, and lung transplantation. Anti-fibrosis pharmacological therapy, namely nintedanib and pirfenidone, has been proven to slow the progression of pulmonary fibrosis and reduce mortality. The relatively low average survival rate of 3-4 years after the diagnosis is made makes this disease have a poor prognosis and requires adequate identification and treatment in order to reduce morbidity, mortality and improve the quality of life of sufferers.
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.
Predictive Value of Circulating Pro-Fibrotic Cytokines for Progression in Idiopathic Pulmonary Fibrosis and Progressive Pulmonary Fibrosis (PPF): A Systematic Review and Meta-Analysis Yolanda Julia Perel Putri; Indi Esha; Dewi Wijaya
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (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.v9i8.1368

Abstract

Background: The clinical trajectory of patients with idiopathic pulmonary fibrosis (IPF) and the broader phenotype of progressive pulmonary fibrosis (PPF) is highly variable. Current prognostic models lack precision, highlighting an urgent need for reliable biomarkers. Circulating pro-fibrotic cytokines are implicated in fibrogenesis, but their individual predictive utility for disease progression remains debated. This systematic review and meta-analysis were conducted to synthesize the available evidence and quantify the predictive value of key circulating pro-fibrotic cytokines for disease progression in patients with IPF and PPF. Methods: A systematic literature search was performed in PubMed, Embase, and Scopus databases for studies published between January 1st, 2014, and December 31st, 2024. We included longitudinal cohort studies that evaluated the association between baseline circulating levels of Transforming Growth Factor-beta 1 (TGF-β1), Chemokine Ligand 18 (CCL18), or Interleukin-6 (IL-6) and a composite endpoint of disease progression (all-cause mortality, lung transplantation, or a significant decline in Forced Vital Capacity [FVC]). Hazard Ratios (HRs) and their 95% Confidence Intervals (CIs) were extracted. A random-effects model was used to pool the data. Heterogeneity was assessed using the I² statistic, and publication bias was evaluated with funnel plots and Egger’s test. Results: The search yielded 1,842 citations, from which seven studies comprising a total of 1,158 patients met the inclusion criteria. Elevated baseline levels of all three cytokines were significantly associated with an increased risk of disease progression. The pooled HR for TGF-β1 (4 studies, 650 patients) was 2.15 (95% CI: 1.55-2.98, p < 0.001), with moderate heterogeneity (I² = 55%). For CCL18 (5 studies, 812 patients), the pooled HR was 1.98 (95% CI: 1.41-2.78, p < 0.001), with substantial heterogeneity (I² = 68%). For IL-6 (3 studies, 515 patients), the pooled HR was 2.41 (95% CI: 1.78-3.26, p < 0.001), with low heterogeneity (I² = 21%). Subgroup analysis suggested a consistent predictive effect across both IPF and non-IPF PPF cohorts. Conclusion: This meta-analysis provides robust evidence that elevated circulating levels of TGF-β1, CCL18, and IL-6 are potent and independent predictors of disease progression in patients with IPF and PPF. These biomarkers hold significant promise for enhancing patient risk stratification, improving prognostic accuracy, and guiding personalized therapeutic decisions in clinical practice.
Predictive Value of Circulating Pro-Fibrotic Cytokines for Progression in Idiopathic Pulmonary Fibrosis and Progressive Pulmonary Fibrosis (PPF): A Systematic Review and Meta-Analysis Yolanda Julia Perel Putri; Indi Esha; Dewi Wijaya
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (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.v9i8.1368

Abstract

Background: The clinical trajectory of patients with idiopathic pulmonary fibrosis (IPF) and the broader phenotype of progressive pulmonary fibrosis (PPF) is highly variable. Current prognostic models lack precision, highlighting an urgent need for reliable biomarkers. Circulating pro-fibrotic cytokines are implicated in fibrogenesis, but their individual predictive utility for disease progression remains debated. This systematic review and meta-analysis were conducted to synthesize the available evidence and quantify the predictive value of key circulating pro-fibrotic cytokines for disease progression in patients with IPF and PPF. Methods: A systematic literature search was performed in PubMed, Embase, and Scopus databases for studies published between January 1st, 2014, and December 31st, 2024. We included longitudinal cohort studies that evaluated the association between baseline circulating levels of Transforming Growth Factor-beta 1 (TGF-β1), Chemokine Ligand 18 (CCL18), or Interleukin-6 (IL-6) and a composite endpoint of disease progression (all-cause mortality, lung transplantation, or a significant decline in Forced Vital Capacity [FVC]). Hazard Ratios (HRs) and their 95% Confidence Intervals (CIs) were extracted. A random-effects model was used to pool the data. Heterogeneity was assessed using the I² statistic, and publication bias was evaluated with funnel plots and Egger’s test. Results: The search yielded 1,842 citations, from which seven studies comprising a total of 1,158 patients met the inclusion criteria. Elevated baseline levels of all three cytokines were significantly associated with an increased risk of disease progression. The pooled HR for TGF-β1 (4 studies, 650 patients) was 2.15 (95% CI: 1.55-2.98, p < 0.001), with moderate heterogeneity (I² = 55%). For CCL18 (5 studies, 812 patients), the pooled HR was 1.98 (95% CI: 1.41-2.78, p < 0.001), with substantial heterogeneity (I² = 68%). For IL-6 (3 studies, 515 patients), the pooled HR was 2.41 (95% CI: 1.78-3.26, p < 0.001), with low heterogeneity (I² = 21%). Subgroup analysis suggested a consistent predictive effect across both IPF and non-IPF PPF cohorts. Conclusion: This meta-analysis provides robust evidence that elevated circulating levels of TGF-β1, CCL18, and IL-6 are potent and independent predictors of disease progression in patients with IPF and PPF. These biomarkers hold significant promise for enhancing patient risk stratification, improving prognostic accuracy, and guiding personalized therapeutic decisions in clinical practice.
Corticosteroids, Azole Antifungals, and Biologic Agents for the Management of Allergic Bronchopulmonary Aspergillosis: A Systematic Review and Network Meta-Analysis Rezki Permata Sari; Dewi Wijaya
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (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.v9i10.1399

Abstract

Background: The management of allergic bronchopulmonary aspergillosis (ABPA) requires control of complex type 2 inflammation and reduction of fungal burden. The comparative efficacy of the primary therapeutic classes—corticosteroids, azole antifungals, and biologics—is not well established through direct evidence. This network meta-analysis was conducted to determine the optimal hierarchical treatment strategy for ABPA. Methods: A systematic review of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials was performed for randomized controlled trials (RCTs) published from January 2015 to July 2025. We included RCTs in patients with ABPA comparing oral corticosteroids (OCS) alone to OCS plus itraconazole or OCS plus a biologic agent (omalizumab, mepolizumab, benralizumab). The primary outcome was a composite therapeutic response (≥25% IgE reduction plus clinical stability). A Bayesian random-effects network meta-analysis was performed, with results presented as odds ratios (OR) and 95% credible intervals (CrI). Results: Seven RCTs enrolling 988 patients were included, forming a star-shaped evidence network anchored by a common placebo comparator. All active add-on therapies were superior to OCS alone for the primary outcome. Based on probabilistic rankings (SUCRA), OCS plus mepolizumab was most likely to be the most effective treatment (OR vs. OCS alone: 5.12; 95% CrI, 2.89-9.15; SUCRA: 94.5%), followed by OCS plus benralizumab (OR: 4.65; 95% CrI, 2.15-8.98; SUCRA: 87.2%), OCS plus omalizumab (OR: 3.88; 95% CrI, 2.10-7.15; SUCRA: 75.1%), and OCS plus itraconazole (OR: 2.54; 95% CrI, 1.55-4.17; SUCRA: 43.2%). Biologic agents demonstrated the greatest reduction in exacerbation rates. Conclusion: In patients with ABPA, combination therapy is superior to OCS monotherapy. This analysis provides compelling indirect evidence that biologic agents, particularly IL-5 inhibitors, represent the most effective therapeutic class for achieving disease control. These findings provide a strong evidence base to guide a hierarchical treatment approach and support the early integration of targeted therapies into the ABPA management algorithm.
Corticosteroids, Azole Antifungals, and Biologic Agents for the Management of Allergic Bronchopulmonary Aspergillosis: A Systematic Review and Network Meta-Analysis Rezki Permata Sari; Dewi Wijaya
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (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.v9i10.1399

Abstract

Background: The management of allergic bronchopulmonary aspergillosis (ABPA) requires control of complex type 2 inflammation and reduction of fungal burden. The comparative efficacy of the primary therapeutic classes—corticosteroids, azole antifungals, and biologics—is not well established through direct evidence. This network meta-analysis was conducted to determine the optimal hierarchical treatment strategy for ABPA. Methods: A systematic review of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials was performed for randomized controlled trials (RCTs) published from January 2015 to July 2025. We included RCTs in patients with ABPA comparing oral corticosteroids (OCS) alone to OCS plus itraconazole or OCS plus a biologic agent (omalizumab, mepolizumab, benralizumab). The primary outcome was a composite therapeutic response (≥25% IgE reduction plus clinical stability). A Bayesian random-effects network meta-analysis was performed, with results presented as odds ratios (OR) and 95% credible intervals (CrI). Results: Seven RCTs enrolling 988 patients were included, forming a star-shaped evidence network anchored by a common placebo comparator. All active add-on therapies were superior to OCS alone for the primary outcome. Based on probabilistic rankings (SUCRA), OCS plus mepolizumab was most likely to be the most effective treatment (OR vs. OCS alone: 5.12; 95% CrI, 2.89-9.15; SUCRA: 94.5%), followed by OCS plus benralizumab (OR: 4.65; 95% CrI, 2.15-8.98; SUCRA: 87.2%), OCS plus omalizumab (OR: 3.88; 95% CrI, 2.10-7.15; SUCRA: 75.1%), and OCS plus itraconazole (OR: 2.54; 95% CrI, 1.55-4.17; SUCRA: 43.2%). Biologic agents demonstrated the greatest reduction in exacerbation rates. Conclusion: In patients with ABPA, combination therapy is superior to OCS monotherapy. This analysis provides compelling indirect evidence that biologic agents, particularly IL-5 inhibitors, represent the most effective therapeutic class for achieving disease control. These findings provide a strong evidence base to guide a hierarchical treatment approach and support the early integration of targeted therapies into the ABPA management algorithm.
Idiopathic Pulmonary Fibrosis: A Narrative Literature Review Febrina, Nidya; Dewi Wijaya
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 8 (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.v8i8.1052

Abstract

Idiopathic pulmonary fibrosis is a chronic progressive interstitial lung disease (ILD) with unknown causes. Male gender, age > 60 years, history of smoking with symptoms of dry cough and progressive chronic shortness of breath are typical clinical findings in this patient. The diagnosis is made based on a combination of radiological findings in the form of a pattern consistent with usual interstitial pneumonia (UIP) and/or histopathology with the exclusion of other causes of ILD. Treatment includes pharmacological and non-pharmacological therapy in the form of pulmonary rehabilitation, psychosocial support, and lung transplantation. Anti-fibrosis pharmacological therapy, namely nintedanib and pirfenidone, has been proven to slow the progression of pulmonary fibrosis and reduce mortality. The relatively low average survival rate of 3-4 years after the diagnosis is made makes this disease have a poor prognosis and requires adequate identification and treatment in order to reduce morbidity, mortality and improve the quality of life of sufferers.
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.
Co-Authors Febrina, Nidya Indi Esha Mohd Syahbani Nugraha Rezki Permata Sari Rohani Lasmaria Yolanda Julia Perel Putri