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Bioscientia Medicina : Journal of Biomedicine and Translational Research

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ISSN : - EISSN : 25980580 DOI : https://doi.org/10.37275/bsm

Core Subject : Health, Science,

Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience

This journal welcomes the submission of articles that offering a sensible transfer of basic research to applied clinical medicine. BioScientia Medicina covers the latest developments in various fields of biomedicine with special attention to : 1.Rhemumatology 2.Molecular aspect of Indonesia Traditional Herb 3.Cardiology and Cardiovascular diseases 4.Genetics 5.Immunology 6.Environmental health 7.Toxicology 8. Neurology 9. Pharmacology 10. Oncology 11. Other multidisciplinary studies related medicine. The views of experts on current advances in nanotechnology and molecular/cell biology will be also considered for publication as long as they have a direct clinical impact on human health.

Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)

Articles 1,165 Documents

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The Mosaic of Risk in Neonatal Asphyxia: A Systematic Review of Clinical, Placental, and Systemic Predictors Ni Made Suartiningsih; Romy Windiyanto
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.v9i8.1367

Background: Neonatal asphyxia, a critical failure of gas exchange during the perinatal period, remains a primary cause of neonatal mortality and long-term neurodevelopmental disability worldwide, including hypoxic-ischemic encephalopathy (HIE). Its etiology is a complex mosaic of interconnected factors. Understanding this intricate risk profile is essential for developing effective prevention and intervention strategies. The aim of this study is to systematically review and synthesize recent evidence (published 2019–2025) on the spectrum of maternal, fetal, intrapartum, placental, and systemic risk factors associated with neonatal asphyxia. Methods: This systematic review was conducted following the PRISMA guidelines. A comprehensive literature search was performed in PubMed, ScienceDirect, and Google Scholar for observational studies published between January 1st, 2019, and April 1st, 2025. Dual reviewers independently conducted study selection, data extraction, and risk of bias assessment using the Newcastle-Ottawa Scale (NOS). Due to significant clinical and methodological heterogeneity, a narrative synthesis was performed. Results: The search yielded 870 articles, from which 13 observational studies met the inclusion criteria. The synthesis of these studies revealed a consistent and powerful link between neonatal asphyxia and a wide array of predictors. Key factors included maternal comorbidities (hypertensive disorders), prenatal maternal psychological stress, intrapartum complications (prolonged labor, meconium-stained amniotic fluid), placental pathology (maternal vascular malperfusion, meconium-associated changes), fetal characteristics (low birth weight), and crucial systemic factors, such as maternal immigrant status and sociodemographic disparities. Predictive models developed in two of the included studies demonstrated good discriminative performance in identifying high-risk pregnancies, offering potential for clinical application. Conclusion: Neonatal asphyxia arises from a complex interplay of risk factors that span the entire perinatal continuum, from pre-conceptual maternal health and systemic inequities to acute intrapartum events. Effective mitigation requires a multi-pronged approach encompassing comprehensive antenatal care that addresses both physical and mental health, vigilant intrapartum monitoring, and systemic efforts to ensure equitable access to high-quality perinatal care. The integration of validated risk prediction tools into clinical practice holds significant promise for reducing the global burden of this devastating condition.

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

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.

The Impact of Intravascular Imaging (IVUS/OCT) Guidance on Preventing In-Stent Restenosis and Improving Long-Term Clinical Outcomes in Complex PCI: A Meta-Analysis Lian Lanrika Waidi Lubis; Taufik Indrajaya; Ferry Usnizar; Erwin Sukandi; Syamsu Indra
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.v9i8.1369

Background: Percutaneous coronary intervention (PCI) in patients with complex coronary artery disease is associated with a higher risk of adverse events, including in-stent restenosis (ISR). Intravascular imaging, using either intravascular ultrasound (IVUS) or optical coherence tomography (OCT), has been proposed to optimize stent implantation and improve outcomes, but its definitive role requires comprehensive evidence synthesis. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). Major electronic databases (PubMed, EMBASE, Cochrane CENTRAL) were searched from January 2014 to May 2025 for RCTs comparing intravascular imaging-guided PCI with angiography-guided PCI in patients undergoing complex procedures. The primary efficacy endpoint was Major Adverse Cardiovascular Events (MACE), a composite of cardiac death, target-vessel myocardial infarction, and clinically-driven target lesion revascularization. The key secondary endpoint was angiographic ISR. A random-effects model was used to calculate pooled Risk Ratios (RRs) and 95% Confidence Intervals (CIs). Results: Seven RCTs, enrolling a total of 9,150 patients, met the inclusion criteria. The median follow-up was 24 months. Intravascular imaging guidance was associated with a significant reduction in the risk of MACE (RR: 0.66; 95% CI: 0.55-0.79; p<0.0001) compared to angiography guidance, with moderate heterogeneity (I²=52%). The risk of angiographic ISR was also significantly lower in the imaging-guided group (RR: 0.49; 95% CI: 0.38-0.63; p<0.0001). Furthermore, imaging guidance led to a significant reduction in cardiac death (RR: 0.55; 95% CI: 0.38-0.80) and clinically-driven target lesion revascularization (RR: 0.54; 95% CI: 0.42-0.69). Conclusion: This meta-analysis provides definitive evidence that the use of intravascular imaging (IVUS or OCT) to guide complex PCI significantly reduces the incidence of long-term major adverse cardiovascular events and in-stent restenosis. These findings support the routine adoption of intravascular imaging as the standard of care to optimize outcomes in this high-risk patient population.

Successful Use of Epidural Anesthesia Following Guideline-Based Anticoagulation Bridging for Hip Surgery in a Patient with Acute Pulmonary Embolism: A Case Report Ayudya Tarita Alda; Paramita Putri Hapsari; RTH Supraptomo
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.v9i8.1370

Background: The perioperative management of patients with acute pulmonary embolism (PE) requiring major surgery presents a formidable clinical challenge. Therapeutic anticoagulation, essential for treating PE, is a significant relative contraindication for neuraxial anesthesia due to the risk of spinal hematoma. General anesthesia, however, carries a high risk of hemodynamic collapse in patients with compromised cardiopulmonary reserves. This report describes the successful application of a multidisciplinary, guideline-adherent strategy to manage this complex clinical scenario. Case presentation: A 56-year-old, obese female (BMI 30 kg/m²) with an extensive history of cardiovascular disease—including hypertensive heart disease, prior myocardial infarction, and an aortic dissection repaired via EVAR—presented with a post-traumatic left hip dislocation. Her presentation was critically complicated by an acute massive pulmonary embolism, diagnosed via echocardiography, which revealed large thrombi in the pulmonary arteries, and confirmed with a chest X-ray showing a Westermark sign. The patient required an open reduction and repair of the hip. A collaborative, multidisciplinary plan was formulated to enable the use of epidural anesthesia. Her anticoagulation with rivaroxaban was stopped five days preoperatively and bridged with a therapeutic infusion of unfractionated heparin (UFH). The UFH was discontinued six hours before the procedure, and surgery proceeded only after confirming normalization of coagulation parameters (INR < 1.5). Epidural anesthesia was successfully administered, providing excellent hemodynamic stability throughout the surgery. The patient was monitored in a cardiac intensive care unit postoperatively, with no neurological or bleeding complications. Conclusion: This case demonstrates that epidural anesthesia is a viable and potentially superior option for high-risk patients with acute PE, provided that a meticulous, guideline-concordant anticoagulation bridging strategy is implemented. Successful outcomes in such complex cases are predicated on rigorous multidisciplinary planning, patient selection, and vigilant postoperative monitoring. This approach validates current safety guidelines rather than challenging them, showcasing their utility in enabling advanced anesthetic care.

Pancreas-Sparing Mucosectomy for a Complex Gastric Duplication Cyst: A Case Report Filza Rifqi Aufa Aslam; Ismar Ibrahim; Tubagus Odih Rhomdani Wahid; Andrea Valentino; Salamullah; Indrajaya
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (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.v9i9.1371

Background: Gastric duplication (GD) is a rare congenital anomaly, representing 2–9% of all gastrointestinal duplications. These embryologic abnormalities are typically managed by complete surgical resection due to the risk of complications, including malignancy. However, this standard approach becomes perilous when the duplication cyst is intimately adherent to vital organs. We present a case where a large gastric duplication cyst was inseparable from the pancreas, necessitating a deviation from standard management. Case presentation: An 8-month-old female infant presented with a four-month history of non-bilious vomiting and progressive abdominal distension. A palpable, cystic, 8x5 cm mass was identified in the left upper abdomen. Abdominal ultrasound revealed a loculated, septated cystic lesion, and a barium study demonstrated a significant filling defect on the greater curvature of the stomach. Initial management was delayed as the family sought alternative medicine. Surgical exploration revealed a large gastric duplication cyst arising from the greater curvature, which was found to be densely adherent to the body and tail of the pancreas. To avoid catastrophic pancreatic injury, a complete resection was abandoned in favor of a pancreas-sparing mucosectomy. The entire mucosal lining of the duplication was excised, and the shared muscular wall was preserved and repaired. Postoperatively, the patient had a transient ileus but recovered well, with complete resolution of symptoms. At an 11-day follow-up, she was thriving, feeding well, and had gained significant weight. Histopathology confirmed a benign gastric duplication cyst. Conclusion: This case highlights that for complex gastric duplication cysts where resection would endanger vital structures, complete mucosal excision is a safe, effective, and organ-preserving surgical alternative. This technique successfully mitigates the risks of both the untreated anomaly and iatrogenic surgical complications, underscoring the importance of surgical judgment and adaptability in managing rare congenital anomalies.

Navigating a Therapeutic Triad: A Case of Pulmonary Tuberculosis Complicated by Drug-Induced Liver Injury and Prediabetes Yuni Kartika; Irvan Medison; Dessy Mizarti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (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.v9i9.1372

Background: The management of pulmonary tuberculosis (TB) is frequently complicated by adverse drug reactions, with drug-induced liver injury (DILI) being one of the most severe. The clinical challenge is significantly amplified in patients with underlying metabolic disorders such as prediabetes, which can impair immune responses and affect treatment outcomes. This report details the complex management of a geriatric patient presenting with this therapeutic triad. Case presentation: A 67-year-old male with newly diagnosed, drug-sensitive pulmonary tuberculosis developed severe hepatotoxicity ten days after initiating standard first-line anti-tuberculosis therapy. Clinical presentation included jaundice, nausea, and vomiting, with laboratory findings showing a severe hepatocellular injury pattern (SGOT 204 U/L, SGPT 126 U/L) and hyperbilirubinemia (Total Bilirubin 2.6 mg/dL). Concurrently, he was diagnosed with prediabetes (HbA1c 5.9%) and was suffering from severe malnutrition (BMI 15.6 kg/m²). The offending drugs were immediately withdrawn, and supportive therapy was initiated. Following normalization of liver function, a modified anti-tuberculosis regimen was cautiously reintroduced using a stepwise re-challenge protocol that entirely omitted pyrazinamide. Conclusion: The patient was successfully managed with a modified nine-month regimen of isoniazid, rifampicin, and ethambutol, achieving clinical and biochemical stability without recurrence of liver injury. This case highlights that a meticulous, stepwise approach—involving prompt drug withdrawal, supportive care, and a tailored re-challenge protocol—can lead to successful TB treatment outcomes without recurrence of DILI, even in a patient with multiple converging high-risk factors.

Head-to-Head Comparison of Urinary Hydroxyproline and Serum CTX-I in Monitoring Antiresorptive Therapy for Osteoporosis: A Network Meta-Analysis Jonggara Octaviandra Siahaan; Eka Kurniawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (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.v9i9.1373

Background: Bone turnover markers (BTMs) are essential for monitoring the efficacy of antiresorptive therapies in osteoporosis. While serum C-terminal telopeptide of type I collagen (s-CTX-I) is the recommended reference marker for bone resorption, the utility of the classic marker, urinary hydroxyproline (u-HYP), in the modern therapeutic era remains debated. This study aimed to provide the first network meta-analysis (NMA) to compare the responsiveness of u-HYP and s-CTX-I to antiresorptive treatments. Methods: We conducted a systematic review and NMA of randomized controlled trials (RCTs) published between January 2015 and December 2024. We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for RCTs of antiresorptive therapies (alendronate, denosumab, risedronate) in postmenopausal women with osteoporosis that reported changes in s-CTX-I or u-HYP at 3-6 months. A Bayesian random-effects NMA was performed to calculate the standardized mean difference (SMD) and rank the responsiveness of each marker. Results: Seven RCTs involving 3,451 patients met the inclusion criteria. The evidence network was well-connected for both markers. Antiresorptive therapies induced a significantly greater reduction in s-CTX-I levels compared to u-HYP. For instance, the effect of denosumab versus placebo was substantially larger when measured by s-CTX-I (SMD: -1.88; 95% Credible Interval [CrI]: -2.25 to -1.51) than by u-HYP (SMD: -0.95; 95% CrI: -1.22 to -0.68). Surface Under the Cumulative Ranking (SUCRA) analysis confirmed that s-CTX-I had a 98.2% probability of being the more responsive marker, compared to 1.8% for u-HYP. Heterogeneity was manageable, and no significant inconsistency was detected between direct and indirect evidence. Conclusion: This network meta-analysis provides robust, synthesized evidence that serum CTX-I demonstrates a markedly superior dynamic response to antiresorptive therapy compared to urinary hydroxyproline. These findings reinforce the position of s-CTX-I as the preferred biomarker for monitoring treatment efficacy in clinical practice.

Harnessing Nature's Adjuvant: A Systematic Review and Meta Analysis of Phyllanthus niruri's Immunomodulatory and Chemosensitizing Mechanisms in Colorectal Cancer Adhi Setradian Anto Maria; Albertus Ari Adrianto; Awal Prasetyo
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (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.v9i9.1374

Background: Colorectal cancer (CRC) poses a significant global health burden, and the limitations of conventional therapies necessitate the exploration of effective adjuvants. Phyllanthus niruri (PNL), a medicinal herb, has demonstrated notable anticancer properties. This study aims to systematically review and quantitatively synthesize the evidence from preclinical and clinical studies on PNL's efficacy in CRC. Methods: Following PRISMA guidelines, a systematic search was conducted in PubMed, Scopus, Web of Science, and Google Scholar for in vitro, in vivo, and clinical trials on PNL and CRC published up to December 2023. Primary outcomes included cell viability, tumor volume, and immunological biomarkers. Data were extracted for meta-analysis, calculating standardized mean differences (SMD) with 95% confidence intervals (CI) using a random-effects model to account for heterogeneity, which was assessed using the I² statistic. Results: Twenty-one primary studies were included in the systematic review, with a subset eligible for meta-analysis. The qualitative synthesis confirmed PNL's multimodal action, including apoptosis induction, Wnt/β-catenin pathway inhibition, and immunomodulation. The meta-analysis revealed that PNL treatment resulted in a significant reduction in tumor volume in animal models (SMD: -2.54; 95% CI: -3.87 to -1.21; p < 0.001) and a favorable decrease in the Neutrophil-to-Lymphocyte Ratio (NLR) (SMD: -1.89; 95% CI: -2.78 to -1.01; p < 0.001). Significant heterogeneity was observed across studies. Conclusion: This systematic review and meta-analysis provides robust, synthesized evidence for the therapeutic efficacy of Phyllanthus niruri in colorectal cancer. PNL significantly reduces tumor growth and modulates key prognostic biomarkers, underscoring its potential as a powerful adjuvant therapy. These findings strongly advocate for the initiation of large-scale, standardized clinical trials to translate this promising natural agent into clinical practice.

Opioid Rotation vs. Dose Titration in Refractory Cancer Pain: A Meta-Analysis of Efficacy and Adverse Events Arina Widya Murni; Dian Arfan As Bahri; Widya Deli Satuti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (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.v9i9.1375

Background: The management of refractory cancer pain represents a formidable clinical challenge at the intersection of oncology and palliative medicine. When patients with advanced malignancy fail to achieve adequate analgesia or develop intolerable adverse effects from their opioid regimen, clinicians are faced with a crucial decision: to escalate the dose of the current opioid (dose titration) or to switch to a different opioid agent (opioid rotation). The optimal strategy remains a subject of intense debate and variable practice. This meta-analysis was conducted to rigorously compare the efficacy and safety of these two common interventions. Methods: A systematic and comprehensive search was performed in the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases for randomized controlled trials (RCTs) published between January 2015 and December 2024. We included studies that directly compared opioid rotation with dose titration in adult palliative care patients diagnosed with refractory cancer pain. The primary efficacy outcome was the change in pain intensity, analyzed using the Standardized Mean Difference (SMD) to accommodate pain scales such as the Numerical Rating Scale (NRS) and Visual Analogue Scale (VAS). Primary safety outcomes were the incidence of severe neurotoxicity and severe constipation. Data were pooled using a random-effects model, and results were expressed as SMD for the continuous pain outcome and Risk Ratio (RR) for dichotomous adverse events, with corresponding 95% confidence intervals (CI). Results: Seven RCTs, encompassing a total of 962 patients, met the stringent inclusion criteria. The pooled analysis revealed that the strategy of opioid rotation resulted in a statistically significant and clinically substantial greater reduction in pain intensity compared to continued dose titration (SMD -0.65, 95% CI [-0.88, -0.42], p<0.00001; I²=81%). Furthermore, the risk of developing severe neurotoxicity, including delirium and myoclonus, was significantly lower in the rotation group (RR 0.62, 95% CI [0.45, 0.85], p=0.003; I²=18%). There was no statistically significant difference in the incidence of severe constipation between the two intervention groups (RR 0.90, 95% CI [0.71, 1.14], p=0.38; I²=24%). Conclusion: In patients with refractory cancer pain, the strategy of opioid rotation provided superior analgesia and was associated with a markedly lower risk of severe neurotoxicity when compared to the continued dose titration of the same opioid. These findings provide strong, high-level evidence to support the use of opioid rotation as a primary and proactive strategy for managing uncontrolled pain or dose-limiting side effects in the palliative care population.

Efficacy and Safety of Bullectomy versus Conservative Management in Patients with Symptomatic Vanishing Lung Syndrome: A Systematic Review and Meta-Analysis of Respiratory Outcomes Raisya Farah Monica; Oea Khairsyaf; Dessy Mizarti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (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.v9i9.1376

Background: Vanishing lung syndrome (VLS), a severe form of giant bullous emphysema, causes debilitating dyspnea by compressing functional lung. A critical evidence gap exists regarding the optimal management strategy, forcing a contentious choice between surgical bullectomy and conservative care. This study provides the first meta-analytic synthesis comparing these two approaches. Methods: Following PRISMA guidelines, we systematically searched PubMed, Embase, Scopus, and Web of Science for comparative studies (2015-2024) evaluating bullectomy versus conservative management in symptomatic VLS. Primary outcomes were changes in Forced Expiratory Volume in one second (FEV1), St. George's Respiratory Questionnaire (SGRQ) scores, and major complications. Data were pooled using a random-effects model, and bias was assessed with the ROBINS-I tool. Results: Six non-randomized studies involving 488 patients were included. The overall risk of bias was moderate to serious. Compared to conservative care, bullectomy was associated with a substantial improvement in FEV1 (Mean Difference: 0.48 L; 95% CI: 0.35 to 0.61) and a profound improvement in quality of life (SGRQ MD: -15.55; 95% CI: -20.21 to -10.89). However, this efficacy was counterbalanced by a nearly six-fold increase in the risk of major complications (Risk Ratio: 5.82; 95% CI: 2.98 to 11.37). Conclusion: Our synthesis suggests that for carefully selected patients, bullectomy offers superior physiological and quality-of-life outcomes over conservative management, but at the cost of significantly higher perioperative risk. These findings, derived from low-quality evidence, underscore the critical need for a highly individualized, multidisciplinary approach to patient selection and a thorough shared decision-making process.

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Contact Name Rachmat Hidayat

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Editorial Address Jl. Sirna Raga no 99, 8 Ilir, Ilir Timur 3, Palembang

Location Kota palembang, Sumatera selatan INDONESIA

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Contact Name
Rachmat Hidayat

Contact Email
dr.rachmat.hidayat@gmail.com

Phone
+6281949581088

Journal Mail Official
editor.bioscmed@gmail.com

Editorial Address
Jl. Sirna Raga no 99, 8 Ilir, Ilir Timur 3, Palembang

Location
Kota palembang,

Sumatera selatan

INDONESIA