Narra J

Relationship between serum CA125, prolactin and cortisol levels with disease stage and pain level in endometriosis patients

2025-11-11T15:19:15+07:00

Endometriosis affects approximately 10% of women of reproductive age and is characterized by the presence of endometrial tissue outside the uterine cavity. Diagnostic delays are common due to nonspecific symptoms and the absence of reliable biomarkers. Serum CA125, prolactin, and cortisol have been implicated in the pathophysiology of endometriosis through inflammatory, neuroendocrine, and stress-response mechanisms. However, their role as biomarkers in endometriosis remains poorly studied. This study aimed to investigate the relationships between serum CA125, prolactin, and cortisol levels with endometriosis staging and pain severity in endometriosis patients. A cross-sectional study was conducted at Dr. Zainoel Abidin General Hospital, Banda Aceh, Indonesia, involving women with laparoscopically confirmed endometriosis. Serum CA125, prolactin, and cortisol levels were measured using electrochemiluminescence immunoassay (ECLIA). Disease staging followed the American Society for Reproductive Medicine (ASRM) classification, and pain severity was assessed using the Numeric Rating Scale (NRS). Statistical analyses were performed using the Spearman correlation test. A total of 30 women with confirmed endometriosis were included in this study, with a mean age of 37.2 years. Endometriosis stages were distributed as stage II (20.0%), stage III (16.7%), and stage IV (63.3%), and the mean pain score was 5.60±1.48. Elevated serum biomarker levels were observed with CA125 of 72.65±55.39 U/mL, prolactin of 1456.77±1799.79 μIU/mL, and cortisol of 341.92±189.02 nmol/L. The serum CA125 level was positively correlated with endometriosis staging (r=0.580, p=0.001) but not with pain severity. Prolactin and cortisol had no significant correlations with disease stage or pain severity (all p>0.05). This study shows that serum CA125 levels are significantly correlated with endometriosis staging, supporting its potential as a biomarker of disease progression. Although prolactin and cortisol levels were elevated, their lack of association with clinical parameters suggests broader neuroendocrine dysregulation rather than direct markers of disease severity.

Predicting early in-hospital mortality in acute hemorrhagic stroke: Implications for improving stroke care and health outcomes in low-income settings

2025-11-10T09:15:29+07:00

Stroke is a leading cause of death and disability worldwide, and mortality in acute intracerebral hemorrhagic (ICH) stroke is influenced by many factors, and early identification of high-risk patients is crucial for guiding clinical management. This study aimed to evaluate the role of blood pressure, blood glucose level, and Glasgow coma scale (GCS) on admission as predictors of 10-day in-hospital mortality and to develop a predictive scoring system in patients with acute ICH stroke. A cross-sectional study was conducted at Dr. Zainoel Abidin Hospital, a provincial referral hospital in Banda Aceh, Indonesia, in 2025. Patients with acute ICH were consecutively recruited. Clinical parameters on admission, including systolic and diastolic blood pressure, random blood glucose level, and GCS, were recorded. Associations with 10-day mortality were assessed with a Chi-squared test, and a predictive scoring system was developed based on independent predictors. A total of 62 patients were included in this study. Higher systolic blood pressure (≥140 mmHg), diastolic blood pressure (≥90 mmHg) and GCS <9 on admission were significantly associated with 10-day mortality (p=0.031, p=0.023 and p<0.001, respectively). Multivariate analysis identified that GCS <9 was the only independent predictor. A predictive scoring system assigned 8 points for GCS <9, 5 points for systolic ≥140 mmHg, 4 points for diastolic ≥90 mmHg, and 1 point for random blood glucose ≥200 mg/dL, estimating patient-specific mortality risk, highest when all risk factors were present. This study indicates that GCS <9 and elevated blood pressure on hospital admission are key predictors of 10-day mortality in acute ICH. The developed scoring system may assist in early risk stratification and management, and further exploration of predictive models is warranted to optimize clinical outcomes.

Evaluating serum cyclooxygenase-2 and vascular endothelial growth factor as biomarkers for endometriosis severity in reproductive-age women

2025-11-11T15:25:12+07:00

Endometriosis affects approximately 10–15% of reproductive-age women and up to 70% of those with chronic pelvic pain, with diagnosis typically relying on invasive laparoscopy with histopathological confirmation. Cyclooxygenase-2 (COX-2) and vascular endothelial growth factor (VEGF) are central mediators of the inflammatory and angiogenic pathways underpinning endometriosis pathogenesis, making them promising candidates for non-invasive biomarkers. This study aimed to analyze the correlation between serum COX-2 and VEGF concentrations and endometriosis severity to evaluate their potential utility as non-invasive biomarkers. A cross-sectional study was conducted among women with confirmed endometriosis at Dr. Zainoel Abidin General Hospital in Banda Aceh, Indonesia, in 2025. Peripheral blood samples were collected preoperatively, and serum COX-2 and VEGF concentrations were quantified using ELISA. Endometriosis severity was classified according to the American Society for Reproductive Medicine staging system. Correlation analyses were performed to assess associations between biomarker levels and disease stage, and diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis to determine the area under the curve (AUC) values, optimal cut-off points, sensitivity, and specificity. Twenty-eight patients were included, with the mean COX-2 and VEGF levels being 1.16±1.28 ng/mL and 266.50±72.91 pg/mL, respectively. VEGF demonstrated a strong and statistically significant correlation with endometriosis staging (r=0.744, p<0.001), while COX-2 showed a limited correlation that did not reach statistical significance (r=0.367, p=0.055). The ROC analysis further highlighted VEGF’s superior diagnostic performance, with an AUC of 0.975 (95%CI: 0.926–1.000, p<0.001) compared with COX-2 (AUC 0.734; 95%CI: 0.518–0.950, p=0.057). The optimal VEGF threshold of 221 pg/mL yielded 90% sensitivity and 100% specificity, whereas the COX-2 threshold of 0.675 ng/mL provided 80% sensitivity and 62.5% specificity. These findings indicate that VEGF is a highly promising non-invasive biomarker for assessing endometriosis severity and may support the development of improved diagnostic approaches for endometriosis management.

Associations of VEGF and CA125 with disease stage and pain among women with endometriosis: A cross-sectional study in Indonesia

2025-12-16T12:48:29+07:00

Endometriosis is a chronic gynecological disease characterized by the presence of endometrial tissue outside the uterine cavity, affecting approximately 10% of women of reproductive age. Vascular endothelial growth factor (VEGF) and cancer antigen 125 (CA125) have been proposed as potential biomarkers in endometriosis; however, evidence regarding their association with disease stage and pain severity remains limited, particularly in the Indonesian population. The aim of this study was to evaluate the relationship between peritoneal fluid VEGF and serum CA125 levels with endometriosis stage and pain severity. A cross-sectional study was conducted involving patients with surgically and histopathologically confirmed endometriosis who underwent laparoscopy or laparotomy at Dr. Zainoel Abidin Hospital, Banda Aceh, between February and July 2025. Peritoneal fluid VEGF and serum CA125 levels were measured using enzyme-linked immunosorbent assay and chemiluminescence immunoassay, respectively. Endometriosis stage was classified according to the revised American Society for Reproductive Medicine (rASRM) criteria, and pain severity was assessed using the Numeric Rating Scale. Statistical analyses included Spearman’s correlation and receiver operating characteristic (ROC) curve analysis. Our data suggested no significant correlation between VEGF levels and endometriosis stage (r=0.042; p=0.813). Peritoneal fluid VEGF levels showed a moderate positive correlation with pain severity (r=0.505; p<0.05), and ROC analysis identified an optimal cut-off value of 39.45 pg/mL, with a sensitivity of 73.68% and specificity of 73.33% for distinguishing severe pain from mild-to-moderate pain. Serum CA125 levels demonstrated a significant positive correlation with endometriosis stage (r=0.422; p=0.013), and ROC analysis yielded an optimal cut-off value of 32.45 U/mL, with a sensitivity of 86.95% and a specificity of 63.64% for distinguishing stage IV endometriosis from lower stages. No significant correlation was observed between CA125 levels and pain severity (r=0.186; p=0.292). This study represents the first report from Indonesia to simultaneously evaluate peritoneal fluid VEGF and serum CA125 in relation to endometriosis stage and pain severity. This study highlights that CA125 is primarily associated with endometriosis stage, whereas VEGF is more closely related to pain severity, supporting their complementary roles in endometriosis assessment.

Patient experience, satisfaction, and adherence: Mediating roles of communication and outcome quality among geriatrics

2025-12-13T10:40:24+07:00

Treatment adherence among geriatric population remains a challenge due to multimorbidity, polypharmacy, and communication barriers. Although patient experience and satisfaction are major predictors of treatment adherence, the mediating pathways involving communication and perceived outcome quality, patients' perceptions of the effectiveness of treatment, including symptom relief, functional improvement, and overall quality of life, have not been explored, particularly in healthcare systems of developing countries. This study aimed to examine the effects of patient experience and satisfaction on treatment adherence, with service communication and perceived outcome quality serving as mediating variables. A cross-sectional study was conducted at the Geriatric Outpatient Clinic of RSUPN Dr. Cipto Mangunkusumo Hospital between June and September 2025. A total of 221 geriatric patients aged ≥60 years completed validated questionnaires on five constructs using six-point Likert scales. Data were analyzed using Partial Least Squares Structural Equation Modeling, with model validity and reliability confirmed through average variance extracted, composite reliability, and variance inflation factor indicators. Patient experience (β=0.260, p<0.001) and satisfaction (β=0.158, p<0.001) significantly improved adherence. Service communication (β=0.352, p<0.001) and outcome quality (β=0.249, p<0.001) partially mediated these effects, explaining 74% of adherence variance (R²=0.740). Communication showed stronger mediation, underscoring the importance of empathy, clarity, responsiveness, and shared decision-making in fostering adherence. Enhancing patient experience and satisfaction through effective communication, collaborative care, and perceived positive outcomes may strengthen adherence and optimize service quality in geriatrics, particularly in resource-limited health systems.

Loving-kindness moderates the association between neuroticism and anxiety symptoms among Thai older adults

2025-12-09T12:37:24+07:00

The global population is experiencing rapid aging, and the mental health needs of older adults have become an urgent public health concern, with anxiety levels becoming increasingly prevalent among older adults. In Thailand, stress and anxiety among older adults are anticipated to double in the next decade. Neuroticism, characterized by emotional instability and an impulse for negative feelings, is a significant psychological characteristic associated with anxiety. Older adults with higher neuroticism have heightened sensitivity to stress and frequently struggle with emotional regulation, hence increasing their vulnerability to anxiety and other mental health disorders. Loving-kindness, a core Buddhist principle, has been shown to benefit mental health by reducing stress, anxiety, and depression, primarily in Western or short-term settings. However, there is limited research assessing its role among older adults in Buddhist cultural contexts, such as Thailand. This study investigated whether loving-kindness moderated the relationship between neuroticism and anxiety symptoms among 232 Thai adults aged 60 and above, using secondary data collected between December 2019 and September 2022. Measures included the Neuroticism Inventory, Core Symptom Index for anxiety, and the Inner Strength-Based Inventory for loving-kindness. Multiple regression analysis evaluated potential moderating effects. The results revealed that anxiety had a positive correlation with neuroticism and a negative correlation with loving-kindness and education; nevertheless, an unexpected pattern occurred in the moderation analysis. Loving-kindness specifically enhanced the correlation between neuroticism and anxiety at high levels, rather than mitigating it. Older adults exhibiting higher levels of neuroticism and loving-kindness reported increased anxiety symptoms. Education was identified as a protective factor, exhibiting a negative correlation with anxiety. Loving-kindness did not mitigate the effect of high neuroticism on anxiety in Thai older adults. Rather, it intensified this correlation, indicating that robust prosocial characteristics lacking sufficient emotional regulation may exacerbate stressful emotions. These findings contradict prevailing theories regarding the universal advantages of loving-kindness and underscore the necessity for therapies that incorporate loving-kindness with emotional regulation and self-care in older adults.

Knowledge, attitudes, and practices related to the intergenerational cycle of malnutrition among adolescent girls: A school-based cross-sectional study

2025-11-19T10:26:14+07:00

The intergenerational cycle of malnutrition contributes to adverse health outcomes across generations, with adolescence representing a key period for prevention. This study aimed to assess adolescent girls' knowledge, attitudes, and practices regarding the intergenerational cycle of malnutrition and to identify associated socio-demographic factors. A school-based cross-sectional study was conducted among adolescent girls in Visakhapatnam Urban, India, using a multistage probability sampling technique with probability proportional to size. Nine of 18 government secondary schools were randomly selected, followed by proportional selection of students from grades 8–10. Data were collected using a predesigned, pretested, semi-structured questionnaire. Multivariate logistic regression analysis was performed to examine factors associated with knowledge, attitude, and practice scores. A total of 316 adolescent girls were included, and 50.3%, 62.7%, and 52.5% of participants had knowledge, attitude, and practice scores above the median, respectively. Multivariate analyses found that parental education and employment status were associated with knowledge and attitude scores. A total of 316 adolescent girls were included; 50.3%, 62.7%, and 52.5% had knowledge, attitude, and practice scores above the median, respectively. Maternal education was strongly associated with good knowledge (aOR 8.84; 95%CI: 4.65–16.78; p<0.001) and favorable attitudes (aOR 1.67; 95%CI: 1.11–2.52; p=0.013), while paternal education was also associated with knowledge (aOR 2.10; 95%CI: 1.16–3.83; p=0.014) and attitude (aOR 1.49; 95%CI: 1.00–2.21; p=0.048). Only family type was significantly associated with practices (aOR 0.62; 95%CI: 0.39–0.99; p=0.047). Although adolescent girls demonstrated basic nutritional awareness, their understanding of malnutrition as a life-course and intergenerational issue remained limited. Strengthening school-based nutrition education with an explicit life-course perspective may improve informed dietary choices and support public health strategies to interrupt the intergenerational cycle of malnutrition.

Multi-stakeholder perspectives on cervical cancer screening implementation in Indonesia: A qualitative study of cervical screening barriers in Banda Aceh

2025-12-28T07:09:50+07:00

Indonesia is committed to the WHO's cervical cancer elimination strategy through the National Action Plan (RAN) 2023–2030, targeting 75% screening coverage by 2030. However, current rates remain critically low at 7.02%. This study explores multi-stakeholder perspectives to identify implementation barriers and facilitators for policy enhancement. A qualitative descriptive case study was conducted in Banda Aceh (July-August 2025) involving 25 stakeholders: City Health Office Head, 11 puskesmas heads, 11 VIA coordinators and 2 community organization representatives. Thematic analysis using NVivo v.16 identified key implementation factors. Five major themes emerged: (1) Knowledge gaps—screening perceived necessary only when symptomatic despite available information; (2) Access paradox—excellent geographic access and flexibility undermined by limited examination rooms, insufficient midwives, and psychosocial barriers (shame, fear, lack of spousal support); (3) Financial sustainability—free services threatened by complex BPJS claims and low reimbursement affecting logistics; (4) Service quality variation—dependent on cross-sector collaboration and staff competency, with uneven training and limited cryotherapy (only 2 centers); and (5) Communication challenges—inconsistent digital media use necessitates face-to-face counseling and cadres, though reach remains limited. Implementation faces psychological barriers, capacity limitations, and uneven digital adoption despite strong infrastructure. Priority policy recommendations include: (1) HPV DNA self-sampling to overcome privacy barriers; (2) simplified BPJS claims with adequate reimbursement; (3) systematic competency-building and cryotherapy expansion; and (4) culturally-adapted education integrating local language and religious leaders. These evidence-based enhancements could accelerate Indonesia's RAN 2030 elimination targets.

Development and evaluation of a synthetic Cu-Zn-reinforced biphasic calcium phosphate scaffold for periodontal bone repair

2026-01-08T15:44:39+07:00

Periodontal bone defects require bone grafting materials that provide structural stability, biocompatibility, and reliable biological performance. Synthetic alloplastic scaffolds composed of biphasic calcium phosphate, integrating hydroxyapatite (HAp) and β-tricalcium phosphate (β-TCP), offer a promising alternative to other graft materials. Polycaprolactone provides flexibility and support for pore formation, while copper (Cu) and zinc (Zn) ions contribute to their antimicrobial and osteogenic benefits. This study aimed to investigate the physicochemical, morphological, mechanical, and biological properties of a synthetic HAp40/β-TCP60 alloplastic scaffold reinforced with polycaprolactone and to compare them with those of a commercial xenograft. The scaffold was fabricated using a freeze-drying method with dimethylformamide, and characterization included Fourier-transform infrared spectroscopy (FTIR) and X-ray diffraction (XRD) for chemical and crystalline confirmation, Archimedes principle for porosity, light microscopy, and scanning electron microscopy (SEM) for morphological assessment, compressive testing, blood adhesion, as well as water and blood absorption analysis. FTIR and XRD verified the successful incorporation of polycaprolactone and the formation of a well-ordered biphasic calcium phosphate structure. Light microscopy showed that the synthetic scaffold had smaller macropore dimensions (324±49 µm) than the control (1410±541 µm), while SEM demonstrated markedly higher microporosity (8.184±2.581 µm) compared to the control (0.287±0.091 µm). Water absorption was lower in the synthetic scaffold (174.7%) than in the control (1172.5%), whereas blood absorption was comparable (300% vs 316.6%). The synthesized scaffold also exhibited superior blood adhesion, as evidenced by the absence of turbidity after agitation. Mechanical testing revealed that the control had superior compressive and yield strengths (0.980 MPa and 0.537 MPa, respectively) compared to the synthesized scaffold (0.287 MPa and 0.126 MPa, respectively). In conclusion, the synthetic HAp40/β-TCP60 scaffold exhibited properties within optimal ranges, highlighting its potential as a promising synthetic alloplastic material for clinical bone regeneration.