Editor in Chief Harapan Harapan Medical Research Unit, School of Medicine Universitas Syiah Kuala, Indonesia Scopus ID : 55844857500 Co-Editor in Chief Kuldeep Dhama NAAS Associate, Principal Scientist ICAR-Indian Veterinary Research Institute, India Scopus ID : 6507396956 Abram L. Wagner School of Public Health University of Michigan, USA Scopus ID : 56178049300 Editorial Board Ruth Müller Department of Biomedical Sciences Institute of Tropical Medicine, Belgium Scopus ID : 25653255200 Herman Kosasih Indonesia Research Partnership on Infectious Disease INA-RESPOND, Indonesia Scopus ID : 6507043017 Mahir Gachabayov School of Medicine New York Medical College, USA Scopus ID : 56626010400 Santi Martini Faculty of Public Health Universitas Airlangga, Indonesia Scopus ID : 57162600900 Slobodan Janković Faculty of Medical Sciences University of Kragujevac, Serbia Scopus ID : 7101906319 Arief Budi Witarto Department of Biochemistry and Molecular Biology Indonesian Defense University, Indonesia Scopus ID : 6507004235 Morteza Arab-Zozani Social Determinants of Health Research Center Birjand University of Medical Sciences (BUMS), Iran Scopus ID : 57210284593 Dina Nur Anggraini Ningrum Department of Public Health Universitas Negeri Semarang, Indonesia Scopus ID : 57195329470 Talha Bin Emran Department of Pharmacy BGC Trust University Bangladesh, Bangladesh Scopus ID : 55325267100 Ferry Efendi Faculty of Nursing Universitas Airlangga, Indonesia Scopus ID : 55301269100 Raymond Pranata Department of Cardiology and Vascular Medicine Universitas Pelita Harapan, Indonesia Scopus ID : 57201973901 Tauseef Ahmad School of Public Health Zhejiang University, China Scopus ID : 57214283386 Lalu Muhammad Irham Department of Toxicology Universitas Ahmad Dahlan, Indonesia Scopus ID : 57195464918 Malik Sallam Department of Pathology, Microbiology and Forensic Medicine University of Jordan, Jordan Scopus ID : 58031424100 Muhammad Iqhrammullah Department of Public Health Universitas Muhammadiyah Aceh, Indonesia Scopus ID : 57208859701 Gholib Gholib Laboratory of Physiology Universitas Syiah Kuala, Indonesia Scopus ID : 57191609673 Seyi Samson Enitan Department of Medical Laboratory Science Babcock University, Nigeria Scopus ID : 56293344800 Adi Utarini Department of Health Policy and Management Universitas Gadjah Mada, Indonesia Scopus ID : 6507275614 Ayodhia P. Pasaribu Department of Child Health Universitas Sumatera Utara, Indonesia Scopus ID : 57217846705 Ricky I. Alfaray Faculty of Medicine Oita University, Japan Scopus ID : 57215962996 Trina E. Tallei Department of Biology Universitas Sam Ratulangi, Indonesia Scopus ID : 57193317686 Guilherme W. Wendt Department of Medical Sciences Universidade Estadual do Oeste do Paraná, Brazil Scopus ID : 36700764100 Henry Surendra Public Health Program Monash University, Australia Scopus ID : 57192694199 Eggi Arguni Department of Child Health Universitas Gadjah Mada, Indonesia Scopus ID : 8520598700 Managing Editor Rooh Ullah Pure Health Laboratory-Mafraq Hospital United Arab Emirates Diva R. Rizki Universitas Syiah Kuala Indonesia Language Editor Alice Michie The University of Western Australia Australia Nurjannah Nurjannah Universitas Syiah Kuala Indonesia Supporting Staff Muhammad Ainul Assistant Editor Aigia Syahraini Assistant Editor Irla Hanum Assistant Editor Baidillah Zulkifli Assistant Editor Iqbal Fahmi Production Team Irfan Fajri Production Team Ghina Tsurayya Production Team Alyauma Akmal Kalani Production Team Chosy Alvais Production Team Aulia Syarif Aziz Web Administrator
Determinants of intrauterine device use among reproductive-age women in a province implementing Islamic Sharia law in Indonesia: An application of the theory of planned behavior
The utilization of the intrauterine device (IUD) in Indonesia remains low at 3.9%, despite its high effectiveness (99.4%) and designation as a national family planning priority, suggesting the presence of psychosocial barriers influencing contraceptive behavior among women of reproductive age. This study aimed to analyze psychosocial factors influencing IUD use behavior based on the theory of planned behavior, including attitudes, subjective norms, perceived behavioral control, actual behavioral control, and intention, in Banda Aceh—the only province in Indonesia implementing holistic Sharia law. A quantitative cross-sectional study was conducted among women of reproductive age from six urban public health centers using cluster random sampling. Data were collected through face-to-face interviews using a structured TPB-based questionnaire validated for reliability. Statistical analyses included linear regression and binary logistic regression with a significance level set at p<0.05. A total of 442 women were included in the final analysis. Attitude toward IUD use, subjective norms, and perceived behavioral control were all significantly associated with intention to use an IUD, all had p<0.001. Attitudes toward IUD use (B=0.410; p<0.001; R²=0.213), subjective norms (B=0.552; p<0.001; R²=0.413), perceived behavioral control (B=0.273; p<0.001; R²=0.255), and actual behavioral control (B=0.273; p<0.001; R²=0.255) were all significantly associated with IUD use behavior. Intention to use an IUD emerged as the strongest predictor of IUD use behavior (B=0.780; p<0.001; R²=0.566). Intention to use an IUD emerged as the strongest predictor of IUD use behavior (B=0.78; p<0.001; R²=0.56). This study highlights that all intention was shaped by positive attitudes, strong subjective norms, and a high level of behavioral control. Efforts to increase IUD use should therefore focus on educational interventions, strengthening partner and social support, and improving the accessibility and quality of long-acting contraceptive services.
Copyright (c) 2026 Dean R. Purnama, Tgk. Puspa Dewi, Rusnaidi Rusnaidi, Niken A. Utami, Rizka Aditya, Rachmad Suhanda https://creativecommons.org/licenses/by-nc/4.0
Relative validity of a self‑dietary assessment nutrition application compared with a 3‑day food record in non‑dialysis chronic kidney disease: A prospective study
Accurate and repeated dietary assessment is essential for nutritional management in chronic kidney disease (CKD); however, conventional methods, such as the 3-day food record, are burdensome for routine clinical use. Digital self-administered dietary assessment tools may offer a practical alternative; however, validation data in non-dialysis CKD, particularly among Asian populations, remain limited. This study aimed to evaluate the relative validity of a locally adapted digital self-dietary assessment application (Nutrirodcal) compared with a 3-day food record in patients with non-dialysis CKD. This prospective single-center study enrolled adults with non-dialysis CKD stages 3–5. Participants completed both a 3-day food record (reference method) and Nutrirodcal every 4 weeks for 12 weeks. Correlations between the two methods were assessed for energy, macronutrients, minerals, and fluid intake. Changes in nutritional status, biochemical parameters, and body composition were assessed as secondary outcomes. Twenty participants completed the study. At week 12, Nutrirodcal showed moderate-to-strong correlations with the 3-day food record for energy, protein, sodium, potassium, calcium, and phosphorus intake (Spearman r=0.50–0.65; all p<0.05). Correlations for fluid intake were weak at weeks 4 and 12 but reached a moderate and statistically significant level at week 8 (r=0.55, p=0.012). Over the study period, body mass index decreased significantly without deterioration in serum albumin or kidney function, while other biochemical and body composition parameters remained stable. Nutrirodcal demonstrated acceptable relative validity for assessing key nutrient intakes relevant to CKD management compared with a 3-day food record. This Thai-adapted digital tool may support repeated dietary monitoring and patient engagement in non-dialysis CKD care, although dietitian oversight remains essential, particularly for fluid intake assessment.
Copyright (c) 2026 Chantisa Arayangkoon, Patchanon Siriyong https://creativecommons.org/licenses/by-nc/4.0
Development of a novel multi-epitope peptide vaccine candidate against Mycobacterium tuberculosis using reverse vaccinology: A promising strategy for enhanced immunoprotection
Tuberculosis (TB) is a leading cause of death worldwide, caused by Mycobacterium tuberculosis (Mtb). The existing Bacillus Calmette-Guerin (BCG) vaccine has limitations, especially its reduced effectiveness in adults. This research focuses on developing a multi-epitope Mtb vaccine candidate through reverse vaccinology, aiming for a more effective and widely applicable solution. The study used the Vaxign2 pipeline to identify Mtb antigenic proteins, including PPE35, mpt83, mrsA, and rplK. Cytotoxic T cells (CTL), helper T cells (HTL), and B-cells, were predicted and selected based on their antigenicity, non-allergenicity, and non-toxicity. The chosen epitopes from these proteins, 4 CTL, 1 HTL, and 1 B cell epitope, were assembled into a multi-epitope vaccine construct, incorporating the adjuvant PADRE and linkers (EAAAK, AAY, and GPGPG). The vaccine candidate has a molecular weight of 10.68 kDa, with stability, hydrophilicity, and solubility confirmed. Its 3D structure was validated for quality and accuracy. Docking and molecular dynamics simulations with immune receptors TLR2 and TLR4 showed strong, stable interactions. The global population coverage of the vaccine candidate was reaching 98.19%. In silico cloning into the pET30a(+) vector in Escherichia coli BL21(DE3) was successful, with codon optimization (CAI: 0.98) and a GC content of 54.6%. Immunity simulations indicated enhanced activation of antigen-presenting cells, CTL, HTL, B cells, and antibody production. Overall, this study suggests vaccine candidate is a promising multi-epitope vaccine candidate, warranting further in vivo testing, including protein expression in E. coli.
Copyright (c) 2026 Nur AHM. Hasan, Husna Nugrahapraja, Ernawati A. Giri-Rachman https://creativecommons.org/licenses/by-nc/4.0
Knowledge, attitudes, and practices related to the intergenerational cycle of malnutrition among adolescent girls: A school-based cross-sectional study
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.
Copyright (c) 2026 Tirumalasetti L. Varshitha, Sarada Vadlamani, Chaitanya Gujjarlapudi, Manasa R. Venkata, Payala Vijayalakshmi https://creativecommons.org/licenses/by-nc/4.0
Multi-stakeholder perspectives on cervical cancer screening implementation in Indonesia: A qualitative study of cervical screening barriers in Banda Aceh
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.
Copyright (c) 2026 Febrina Yolanda, Tgk Puspa Dewi, Sarah I. Nainggolan, Munawar Munawar, Munizar Munizar, Rachmad Suhanda, Rusnaidi Rusnaidi https://creativecommons.org/licenses/by-nc/4.0
Chronic tonsillitis and its potential alternative treatment: Exploration of the antibacterial activity of ethanolic Mentha piperita leaf extract against bacterial isolates from patients
Chronic tonsillitis is commonly associated with persistent bacterial infection, predominantly involving Gram-positive organisms, and increasing antimicrobial resistance has encouraged exploration of alternative therapeutic agents derived from medicinal plants. Mint leaves (Mentha piperita) are known to contain bioactive compounds with potential antibacterial activity; however, their antibacterial efficacy against isolates specifically obtained from patients with chronic tonsillitis has not been clearly established. The aim of this study was to evaluate the antibacterial activity of ethanolic M. piperita leaf extract against bacterial isolates from patients with chronic tonsillitis. An experimental laboratory study was conducted using bacterial isolates from tonsillar core specimens. Antibacterial activity was assessed using the disk diffusion method at various extract concentrations, followed by determination of the minimum inhibitory concentration (MIC) by the microdilution method and the minimum bactericidal concentration (MBC) by subculture on plate count agar. Results showed that Gram-positive bacteria were the predominant isolates, with Staphylococcus aureus identified as the most frequent species, followed by Streptococcus agalactiae and Pseudomonas aeruginosa. The extract demonstrated greater inhibitory activity against Gram-positive bacteria, with the largest inhibition zone observed in Streptococcus agalactiae at 50% concentration (18.31 mm). In the microdilution assay, the lowest tested concentration (0.75%) inhibited bacterial growth in all tested species, and no colony growth was observed upon subculture, indicating bactericidal activity at this concentration. These findings suggest that ethanolic M. piperita leaf extract exhibits antibacterial activity, particularly against Gram-positive pathogens associated with chronic tonsillitis, and may represent a potential natural antimicrobial agent for further investigation.
Copyright (c) 2026 Puti G. Munirwan, Lily Setiani, Benny Kurnia, Novina Rahmawati, Azwar Ridwan https://creativecommons.org/licenses/by-nc/4.0
Development and diagnostic performance of a novel scoring system for predicting COVID-19 severity in a national referral hospital
Coronavirus disease 2019 (COVID-19) shows a wide spectrum of clinical manifestations, ranging from mild illness to severe and critical disease. Early identification of patients at risk of deterioration remains important for timely clinical decision-making. The aim of this study was to develop a novel scoring system for predicting COVID-19 severity in a national referral hospital. This prospective cohort study included patients with confirmed COVID-19 admitted to Dr. M. Djamil Hospital, Padang, Indonesia, from May to December 2021. Demographic, clinical, and laboratory data were collected, and disease severity was classified according to the World Health Organization criteria. Univariate analysis was performed to identify candidate variables, followed by multivariable logistic regression analysis to determine independent predictors of severity. A scoring system was then constructed based on the retained predictors, and its diagnostic performance was evaluated using receiver operating characteristic analysis and the Youden index. Five variables were independently associated with COVID-19 severity: white blood cell count (WBC) ≥10,000/mm3, absolute lymphocyte count (ALC) <1,500/mm3, platelet large cell ratio (PLCR) ≥30%, interleukin-6 (IL-6) ≥7 pg/mL, and D-dimer ≥500 ng/mL. These variables were incorporated into a scoring system with a maximum total score of 6. Using a cut-off score of 3.5, the model showed a sensitivity of 96.15% and a specificity of 79.03% for differentiating severe from non-severe COVID-19. This study highlights that a novel scoring system based on WBC, ALC, PLCR, IL-6, and D-dimer performed well in predicting COVID-19 severity and may support early risk stratification in hospitalized patients.
Copyright (c) 2026 Rikarni Rikarni, Najirman Najirman, Dwi Yulia, Ricvan D. Nindrea, Muhammad AP. Yudha, Amalina Amalina https://creativecommons.org/licenses/by-nc/4.0
Development and evaluation of a synthetic Cu-Zn-reinforced biphasic calcium phosphate scaffold for periodontal bone repair
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.
Copyright (c) 2026 Devina Novelia, Theophani O. Cahyadi, Natasya MP. Sidharta, Mora Octavia, Evi UM. Situmorang, Daniel Edbert https://creativecommons.org/licenses/by-nc/4.0
Sexual and bowel function in women with obstetric anal sphincter injuries after perineoplasty and sphincterorrhaphy
Obstetric anal sphincter injury (OASIS) may lead to persistent sexual and bowel dysfunction, even after surgical repair. Evidence on the functional outcomes after sphincterorrhaphy and perineoplasty remains limited, particularly in Indonesia. The aim of this study was to analyze the associations of perineal muscle strength and anal sphincter tone with sexual and bowel function in women with OASIS after sphincterorrhaphy and perineoplasty. This cross-sectional study was conducted at Hasan Sadikin Hospital, Bandung, Indonesia. Women with anal incontinence secondary to OASIS or fecal incontinence secondary to rectovaginal fistula who had undergone sphincterorrhaphy and perineoplasty were evaluated at three months after surgery. Vaginal tone and anal tone were assessed using perineometry and anometry, respectively. Sexual and bowel function were measured using the Female Sexual Function Index (FSFI) and Fecal Incontinence and Constipation Questionnaire (FICQ). Correlations were analyzed using Pearson’s correlation test. Maternal age was significantly associated with vaginal tone, with a moderate negative correlation (r=-0.318; p=0.021). Both vaginal tone and anal tone were positively associated with sexual function, with weak but significant correlations with FSFI score (r=0.30; p=0.042 and r=0.30; p=0.036, respectively). In contrast, maternal age, fetal birth weight, vaginal tone, and anal tone were not significantly associated with bowel function as measured by FICQ score. In conclusion, among women with OASIS who underwent sphincterorrhaphy and perineoplasty, vaginal and anal tones were significantly associated with sexual function at three months after surgery, suggesting that pelvic floor recovery may contribute to better postoperative sexual function.
Copyright (c) 2026 Efriyan Imantika, Raden K. Praharsini, Raden MS. Sasotya, Eppy D. Ahmad, Muhammad R. Arev, Andi Rinaldi, Aria Prasetya https://creativecommons.org/licenses/by-nc/4.0
Challenges and strategies of implementing active case finding for tuberculosis: A qualitative study at a high-burden primary healthcare center, Yogyakarta, Indonesia
Tuberculosis (TB) remains a major public health problem in Indonesia, and strengthening active case finding (ACF) is essential to improve early detection and interrupt transmission in high-burden settings. This study aimed to analyze the implementation of TB ACF at Depok II Primary Health Center, Sleman, Indonesia, using the Donabedian framework consisting of input, process and output components, with a focus on implementation processes, challenges, and strategies from a health promotion perspective. A qualitative case study design was employed. Data were collected through in-depth interviews, field observations, and document reviews involving 14 informants, including primary health center staff, district health office representatives, community health cadres, TB patients, a community leader, and a representative from a non-governmental organization. Data were analyzed thematically using the Miles and Huberman framework with support from NVivo version 12. The findings showed that the input component was generally well established, supported by policy commitment, multidisciplinary human resources, adequate basic logistics, program financing, and strong multisectoral partnerships, although challenges remained in village-level budget execution, limited cadre incentives, and dependence on external diagnostic services such as mobile chest X-ray. The process component was generally effective, characterized by structured service delivery, adaptive outreach strategies, strong health education, and patient-centered implementation. However, variation in community responsiveness, internalized stigma, and referral delays remained important barriers. The outcome component was reflected not only in case detection, but also in improved community awareness, acceptance of diagnosis, treatment adherence, and recognition of TB symptoms. Overall, TB ACF at Depok II Primary Health Center was generally effective and supported by strong system readiness and community engagement; however, its sustainability requires strengthened financing, referral access, and health promotion capacity to address remaining operational, behavioral, and social challenges.
Copyright (c) 2026 Hafizha U. Nafiu, Retna S. Padmawati, Bagas S. Bintoro https://creativecommons.org/licenses/by-nc/4.0
Neurocognitive consequences of occupational heavy metal exposure among electronic waste sorting workers in Thailand
Electronic waste sorting workers in Thailand are chronically exposed to heavy metals, including lead (Pb), cadmium (Cd), and nickel (Ni), in informal work settings characterized by limited use of personal protective equipment and suboptimal hygiene practices. This study aimed to evaluate the associations between heavy metal exposure, individual risk factors, and neuropsychological performance among workers. A cross-sectional study was conducted involving 76 exposed workers and 49 non-exposed controls. Data were collected using structured interviews, surface wipe sampling of workplace dust for Pb, Cd, and Ni, and blood metal measurements. Neuropsychological function was assessed using the Digit Span Forward Test (DSFT) and Digit Span Backward Test (DSBT). The mean ages of the exposed and non-exposed groups were 47.39±12.64 and 49.92±8.46 years, respectively. Surface dust concentrations of Pb, Cd, and Ni were significantly higher in the exposed group than in controls (all p<0.001). In contrast, blood metal concentrations did not differ between groups (Pb: 6.41±1.49 vs 6.41±1.62µg/dL, p=0.885; Cd: 0.97±0.39 vs 0.91±0.28µg/L, p=0.501; Ni: 2.60±0.48 vs 2.52±0.45µg/L, p=0.689). No significant difference was observed in DSFT scores between groups (p=0.912). However, DSBT scores differed significantly (p<0.001), with the exposed group scoring higher (2.23±0.55) than the non-exposed group (1.72±0.39). Among exposed workers, simple linear regression identified education (β=0.353, p=0.002), income (β=0.257, p=0.025), age (β=-0.236, p=0.041), and alcohol consumption (β=-0.231, p=0.044) as significant predictors of DSFT performance. However, DSBT scores differed significantly (p<0.001). Drinking alcohol, smoking, Pb in dust, and working area size were significant predictors of DSBT performance (p=0.020, 0.022, 0.013, and <0.001, respectively). These findings indicate that cognitive performance among Thai informal e-waste workers is more strongly influenced by socioeconomic factors and surface lead contamination than by blood metal levels. Interventions focusing on education, income support, and routine workplace surface cleaning, supported by surface-based environmental monitoring and community health volunteers, are critical for protecting cognitive health in this vulnerable population.
Copyright (c) 2026 Kornwika Harasarn, Practhaya Keawkaen, Anamai Thetkathuek https://creativecommons.org/licenses/by-nc/4.0
Patient experience, satisfaction, and adherence: Mediating roles of communication and outcome quality among geriatrics
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.
Copyright (c) 2026 Stepvia Stepvia, Juan AG. Silimalar, Oscar Jayanagara https://creativecommons.org/licenses/by-nc/4.0
Determinant of recovery, recurrence and recurrence-free interval of condyloma acuminata: A five-year cross-sectional data from a provincial referral hospital in Indonesia
Condyloma acuminata is a common sexually transmitted disease caused by human papillomavirus infection and is characterized by frequent recurrence despite available therapies. This study evaluated recovery, recurrence, and recurrence-free interval across therapeutic modalities among condyloma acuminata outpatients at Dr. Moewardi Regional General Hospital, Surakarta, Indonesia, from January 2020 to December 2024. Using a cross-sectional analysis of medical records, 132 eligible patients were included and analyzed with bivariate tests. Treatment modality was not significantly associated with recovery (p=0.157), although recovery was highest with trichloroacetic acid (71.2%), followed by excision (66.7%), combination therapy (trichloroacetic acid + cryotherapy) (64.7%), and cryotherapy alone (33.3%). In bivariate analysis, type of therapy (p=0.025) as well as type of condyloma (p<0.001), sexual orientation (p=0.019), and HIV status were associated with recurrence, with the highest recurrence observed after excision (42.4%) and the lowest after cryotherapy alone (11.1%). Mean recurrence-free interval varied across modalities (cryotherapy 8.00±0.00; trichloroacetic acid (TCA) 15.92±28.49; excision 18.93±13.64; combination therapy 27.50±36.67 weeks), with the longest interval observed in the combination group. However, statistical analysis revealed that only types of condyloma, sexual orientation, and HIV status were associated with the mean recurrence time. Overall, recovery and recurrence patterns differed descriptively across treatment modalities, with excision showing the highest recurrence and cryotherapy alone the lowest. Recurrence outcomes varied according to treatment modality; however, no significant association was observed between therapy type and recurrence-free interval.
Copyright (c) 2026 Prasetyadi Mawardi, Muhammad I. Maulana, Endra Y. Ellistasari, Pratiwi P. Primisawitri, Rina Purnamasari https://creativecommons.org/licenses/by-nc/4.0
Loving-kindness moderates the association between neuroticism and anxiety symptoms among Thai older adults
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.
Copyright (c) 2026 Moe P. Phyu, Justin DeMaranville, Peerasak Lerttrakarnnon, Danny Wedding, Nahathai Wongpakaran, Tinakon Wongpakaran https://creativecommons.org/licenses/by-nc/4.0
Enhancing neuromuscular recovery after sciatic nerve injury using stem cell therapy: Evidence from a preliminary preclinical study
Sciatic nerve injury results in motor dysfunction and muscle atrophy, with limited effective therapies. Umbilical cord–derived mesenchymal stem cells (UC-MSCs) may promote neuromuscular recovery, but their effects on functional and muscle recovery remain unclear. This study aimed to evaluate the effects of UC-MSC therapy on functional and muscle recovery in an animal model of sciatic nerve injury. An animal experimental study with a post-test-only control group was conducted using adult male Wistar rats. Rats were randomly allocated into three groups: sham operation, saline control with sciatic nerve injury, and UC-MSC treatment after sciatic nerve injury. UC-MSCs were administered at a dose of 1×10⁶ cells/kg body weight immediately after nerve injury. Functional recovery was assessed using the extensor postural thrust (EPT) test, and muscle recovery was evaluated using the gastrocnemius muscle index (GMI) post 35 days of observation. Data were analyzed using one-way ANOVA for EPT percentage recovery and Kruskal–Wallis tests for GMI values, followed by post-hoc analysis. Our data indicated there was no significant EPT percentage recovery among the study groups. In contrast, relative gastrocnemius muscle mass was significantly different across groups (p=0.012), with post-hoc analysis demonstrating a significantly higher GMI in the UC-MSC group compared to the saline control group (109.75% vs 81.68%, p=0.003), indicating improved preservation of gastrocnemius muscle mass following UC-MSC therapy. This study highlights that UC-MSC therapy significantly improved gastrocnemius muscle preservation after sciatic nerve injury but did not result in detectable functional motor recovery at the observation time point. These findings suggest that UC-MSCs might exert early structural benefits that may precede functional recovery.
Copyright (c) 2026 Cut R. Firlana, Dessy R. Emril, Dedy Syahrizal, Cynthia R. Sartika, Nova D. Lestari, Yopie A. Habibie https://creativecommons.org/licenses/by-nc/4.0
Prevalence of malnutrition in patients with acute coronary syndrome undergoing coronary angiography in Thailand: A retrospective observational study
Malnutrition is an important prognostic factor in patients with acute coronary syndrome (ACS), but it remains under-recognized in routine practice, particularly in Thailand, where local data are limited, and no population-specific nutritional screening tool has been validated. The Prognostic Nutritional Index (PNI) and Nutritional Risk Index (NRI) have been associated with mortality and major adverse cardiovascular events (MACEs) in patients with ACS, but their clinical usefulness in Thai patients remains unclear. This study aimed to determine the prevalence of malnutrition among patients with ACS undergoing coronary angiography (CAG) at Rajavithi Hospital, Bangkok, Thailand, and to assess the clinical usefulness of PNI and NRI in this setting. The secondary objective was to evaluate 1-year all-cause mortality and the occurrence of MACEs according to nutritional status. This study included 244 adult patients with ACS who were admitted between January 2023 and December 2024, underwent CAG, and completed a 1-year follow-up. Nutritional status was assessed using PNI and NRI, and categorized as severe, moderate, or no malnutrition. The primary outcome was 1-year all-cause mortality, while the secondary outcome was MACEs, defined as a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal ischemic stroke, hospitalization for heart failure, and hospitalization for unstable angina. Associations between nutritional status and outcomes were examined using logistic regression. According to PNI, 43.8% of patients were malnourished, including 27.0% with severe malnutrition and 16.8% with moderate malnutrition. In contrast, NRI classified 99.6% of patients as severely malnourished. The 1-year all-cause mortality rate was 28.3%, and the MACE rate was 28.7%. Based on PNI, severe and moderate malnutrition were associated with higher mortality than no malnutrition (62.1% and 31.7% vs 10.9%, respectively). Severe malnutrition was associated with 13.34-fold higher odds of death (odds ratio (OR) 13.34; 95%CI: 6.41–27.71), while moderate malnutrition was associated with 3.78-fold higher odds (OR 3.78; 95%CI: 1.61–8.82). Severe and moderate malnutrition were also associated with higher odds of MACEs (OR 2.65; 95%CI: 1.38–5.06 and OR 2.89; 95%CI: 1.36–6.11, respectively). Malnutrition was common among Thai patients with ACS undergoing CAG and was strongly associated with adverse 1-year outcomes. Compared with NRI, PNI provided more clinically meaningful stratification in this cohort. Although formal comparative performance analyses were not performed, PNI may be a practical tool for nutritional risk assessment in routine ACS care.
Copyright (c) 2026 Wittawat Wattanasiriporn, Methat Sunawin, Chantisa Arayangkoon https://creativecommons.org/licenses/by-nc/4.0
Delayed percentage attenuation ratio (DPAR) on multiphase CT as a quantitative predictor of early response in hepatocellular carcinoma
Hepatocellular carcinoma (HCC) remains a major cause of cancer-related mortality, and transarterial chemoembolization (TACE) is the standard therapy for intermediate-stage disease. However, response to TACE is variable, and reliable quantitative imaging biomarkers are needed to support early treatment decision-making. This study aimed to evaluate the predictive value of the delayed percentage attenuation ratio (DPAR) measured from pre-TACE multiphasic computed tomography (CT) in forecasting early therapeutic response. A retrospective cross-sectional study was conducted involving patients with a definitive diagnosis of HCC who underwent their first TACE session and had complete multiphasic CT imaging before and after treatment. Quantitative washout parameters, delayed percentage attenuation ratio (DPAR), absolute washout (WOAbs), and relative washout (WORel) were measured using standardized region of interest (ROI) placement by three radiologists. Treatment response was assessed four to six weeks post-TACE based on modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria and classified into responders and non-responders. Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis, and interobserver reliability was assessed using intraclass correlation coefficient (ICC) and Cohen’s κ. A total of 49 HCC patients were included and analyzed. Responders demonstrated significantly higher DPAR values compared with non-responders (median 134.5 vs 113.0; p<0.001). DPAR showed the strongest discriminative performance with an area under the curve (AUC) of 0.898, outperforming WOAbs (AUC 0.689) and WORel (AUC 0.704). The optimal DPAR threshold of ≥120.5 provided 84.4% sensitivity and 88.2% specificity to predict early post-TACE treatment response. Interobserver reliability was excellent for all washout parameters (ICC 0.98–0.99), and agreement for mRECIST classification was also excellent (κ=0.867). In conclusion, pre-TACE DPAR is a robust and reproducible quantitative imaging biomarker that accurately predicts early response to TACE in HCC. A threshold value of ≥120.5 may assist in treatment planning and patient selection in routine clinical practice.
Copyright (c) 2026 Yana Supriatna, Rifki Bachtiar, Muhammad Y. Makkaraeng, Arif Budiman https://creativecommons.org/licenses/by-nc/4.0
Associations of VEGF and CA125 with disease stage and pain among women with endometriosis: A cross-sectional study in Indonesia
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.
Copyright (c) 2026 Akmal Sujudi, Rusnaidi Rusnaidi, Rajuddin Rajuddin, Yusra Septivera https://creativecommons.org/licenses/by-nc/4.0
Predicting early in-hospital mortality in acute hemorrhagic stroke: Implications for improving stroke care and health outcomes in low-income settings
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.
Copyright (c) 2026 Shefina P. Harnold, Syahrul Syahrul, Imran Imran, Nasrul Musadir, Muhammad Yani https://creativecommons.org/licenses/by-nc/4.0
Relationship between serum CA125, prolactin and cortisol levels with disease stage and pain level in endometriosis patients
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.
Copyright (c) 2026 Teuku A. Fasha, Rajuddin Rajuddin, Tgk. Puspa Dewi, Rusnaidi Rusnaidi, Munizar Munizar https://creativecommons.org/licenses/by-nc/4.0
Evaluating serum cyclooxygenase-2 and vascular endothelial growth factor as biomarkers for endometriosis severity in reproductive-age women
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.
Copyright (c) 2026 Aga Aslam, Rajuddin Rajuddin, Munizar Munizar, Rusnaidi Rusnaidi, Hasanuddin Hasanuddin https://creativecommons.org/licenses/by-nc/4.0
Comparison of interleukin-6 and serum creatinine levels in preeclampsia and normal pregnancy patients: A cross-sectional study in Indonesia
Preeclampsia (PE) is a complication of pregnancy with high morbidity and mortality, characterized by endothelial dysfunction, systemic inflammation, and impaired renal function. Interleukin-6 (IL-6) and serum creatinine have potential as biomarkers for early detection of PE; however, data from Indonesia are limited. The aim of this study was to compare IL-6 and serum creatinine levels between pregnant women with PE and normotensive controls, as well as their diagnostic performance in identifying PE. A cross-sectional study involving pregnant women with PE and normotensive controls was conducted at Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. Serum IL-6 and creatinine levels were measured using the ECLIA method. Levels were compared using the Mann–Whitney test; diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis, and multivariable logistic regression was used to evaluate combined diagnostic contribution. A total of 68 pregnant women were included, comprising 34 patients with PE and 34 normotensive controls. Median IL-6 levels were significantly higher in the PE group (16.05 pg/mL) than in the control group (3.71 pg/mL). Receiver operating characteristic analysis demonstrated excellent diagnostic performance of IL-6, with an are under the curve (AUC) of 0.831 (95%CI: 0.734–0.929). At an optimal cutoff value of 5.52 pg/mL, IL-6 achieved a sensitivity of 73.53%, specificity of 76.47%, and diagnostic accuracy of 86.76%. Median serum creatinine levels were also significantly elevated in the PE group (0.56 mg/dL) compared with controls (0.44 mg/dL; p<0.001). The AUC for serum creatinine was 0.806 (95%CI: 0.700–0.912), indicating good diagnostic performance. At a cutoff value of 0.475 mg/dL, serum creatinine demonstrated a sensitivity of 70.59%, specificity of 73.53%, and accuracy of 72.06%. Multivariable logistic regression confirmed that IL-6 (B=0.123; p=0.005) and serum creatinine (B=9.306; p=0.023) were independently associated with PE, explaining 57.5% of PE variability (Nagelkerke R²=0.575). These findings indicate that serum IL-6 and creatinine are significantly associated with PE, and their combined assessment shows potential as a predictive biomarker with good diagnostic performance.
Copyright (c) 2026 Syerli R. Dewi, Cut M. Yeni, Munizar Munizar, Tgk. Puspa Dewi, Niken A. Utami, Rusnaidi Rusnaidi https://creativecommons.org/licenses/by-nc/4.0
Biomarkers for diagnosis, disease progression, and therapeutic response in psoriasis vulgaris: A mini-review
Psoriasis vulgaris is a chronic immune-mediated inflammatory disease with substantial clinical, psychosocial, and public health impact. Despite advances in therapeutic options, disease management continues to rely predominantly on clinical assessment, which remains limited in its ability to detect early disease, quantify subclinical inflammation, monitor disease progression, and anticipate long-term outcomes. These limitations are further compounded by marked interindividual heterogeneity in disease course, systemic inflammatory burden, comorbidity risk, and treatment response. Although a growing body of research has identified numerous candidate biomarkers related to genetic susceptibility, epidermal pathology, immune activation, and systemic inflammation, their clinical relevance and integration into routine practice remain unclear. A comprehensive synthesis that bridges molecular biomarkers with clinically meaningful applications is therefore needed. This review critically examines the current landscape of biomarkers in psoriasis vulgaris and explores their potential roles in diagnosis, assessment of disease progression, and prediction of therapeutic response. This review discusses genetic biomarkers associated with disease susceptibility and immune pathway regulation, tissue-associated biomarkers reflecting epidermal dysfunction and local inflammatory activity, and soluble biomarkers indicative of systemic inflammation and metabolic dysregulation. By organizing existing evidence across these biomarker domains, this review seeks to highlight conceptual frameworks, unresolved challenges, and future directions for biomarker-informed psoriasis management.
Copyright (c) 2026 Sarah Q. Edwar, Yudo Irawan, Windy K. Budianti, Endi Novianto, Eyleny M. Fitri https://creativecommons.org/licenses/by-nc/4.0
Reality of implementation, barriers, and local-based innovations of stunting reduction programs in Papua region, Indonesia: A systematic review
Stunting remains a major public health problem in Indonesia, with a disproportionate burden in Papua, where many districts are classified as 3T regions (frontier, outermost, and least-developed areas) characterized by limited infrastructure, restricted access to services, and distinct socio-cultural challenges. The aim of this study was to comprehensively examine the implementation of stunting reduction programs in Papua’s 3T regions, including program delivery, barriers, and local innovations, through a systematic review. Articles were identified through searches of five major databases and grey literature and were selected using the PRISMA framework. Eligible studies reported on program implementation, barriers, risk factors, and/or strategies related to stunting reduction in Papua. A total of 45 studies met the inclusion criteria and were synthesized using a thematic narrative approach. The review indicated that stunting reduction efforts in Papua have included both nutrition-specific and nutrition-sensitive interventions, supported by the establishment of acceleration teams, the use of integrated health service posts (Posyandu), supplementary feeding, micronutrient supplementation, and the 1,000 days of life initiative. However, program effectiveness is constrained by geographical isolation, health workforce shortages, weak cross-sectoral coordination, and a persistent gap between national policy design and local implementation capacity. Frequently reported risk factors included suboptimal caregiving practices, inadequate dietary intake, recurrent infections, poor sanitation, poverty, and a double burden borne by women, all of which impede program success. Conversely, locally grounded strategies—such as local food-based interventions, strengthening cadres and traditional leaders, community education, and pentahelix collaboration—emerged as more contextually appropriate and community-accepted approaches. Overall, these findings underscore the need to adapt policies to local conditions, strengthen convergence governance, and expand long-term evaluative research to improve the effectiveness and sustainability of stunting interventions in Papua’s 3T regions.
Copyright (c) 2026 Rida Mustasmara, Tita Hariyanti, Ni LPH. Mastuti https://creativecommons.org/licenses/by-nc/4.0
Oxidative stress as a converging mechanism of aging and neurodegeneration: From molecular pathways to therapeutic targets
Aging is the primary risk factor for major neurodegenerative disorders, yet the precise molecular links between biological aging and progressive neuronal loss remain complex. Oxidative stress, defined as an imbalance between the production of reactive oxygen species (ROS) and antioxidant defenses, has emerged as a central converging mechanism driving both processes. This review aims to synthesize current evidence demonstrating how chronic redox imbalance drives cellular senescence and neuronal vulnerability through mitochondrial dysfunction, lipid peroxidation, and oxidative protein damage. These insights underscore how sustained oxidative insults promote the misfolding and aggregation of disease-defining proteins, including amyloid-beta in Alzheimer’s disease and α-synuclein in Parkinson’s disease, thereby amplifying neuroinflammation, synaptic dysfunction, and bioenergetic failure. Furthermore, antioxidant-based therapeutic strategies are critically reassessed, highlighting a paradigm shift from non-specific radical scavenging toward targeted modulation of endogenous defense systems, particularly NRF2 signaling and mitochondria-directed antioxidants. By integrating molecular mechanisms with translational perspectives, this review integrates molecular, cellular, and translational evidence to explain how oxidative stress links biological aging to neurodegenerative disorders such as Alzheimer’s and Parkinson’s diseases.
Copyright (c) 2026 Meutia A. Faradilla, Karina S. Anastasya, Deasyka Yastani, Yohana Yohana, Endrico X. Tungka, Suweino Suweino https://creativecommons.org/licenses/by-nc/4.0