Narra J

Development of an inactivated viral transport medium for diagnostic testing in low-resource countries

Silmi Rahmani — 2025-08-01

Viral transport medium (VTM) is crucial for retaining clinical specimens, such as the virus or its genetic material from the mucus of respiratory tract of coronavirus disease 2019 (COVID-19) suspected patients. However, the locally produced VTM in Indonesia lacks the ability to inactivate the virus, risking the safety of diagnostic personnel. The aim of this study was to formulate inactive VTM (iVTM) incorporating chaotropic agents like guanidine salt, along with anionic detergents, chelators, buffers, and surfactants, to inactivate the virus while maintaining RNA integrity. Viral RNA stability in iVTM (pH 4 and pH 6) was evaluated for 30 days at 4°C and 25–28°C. In vitro inactivation test was performed on SARS-CoV-2 isolate (variant B1). The stability test revealed that storing the clinical specimens in iVTM at pH 6 maintained severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) detectability by qPCR for up to 30 days at cold and room temperatures. Stability assessments conducted over a 4-month period (at 25–28°C) on iVTM with a pH of 6 revealed clear appearance, consistent pH stability, no alteration in the solution color, and no indications of bacterial or fungal contamination. Results from an in vitro inactivation assay demonstrated that iVTM pH 6 eliminated SARS-CoV-2 infectivity within just five minutes of contact. These findings suggest that iVTM pH 6 offers a safer and cost-effective alternative for handling and transportation of clinical specimens.

Factors associated with the incidence of young-onset colorectal cancer: A cross-sectional study

Natallina Sianturi — 2025-08-19

The factors associated with the incidence of young-onset colorectal cancer (YO-CRC) remain uncertain and are continuously being studied. The aim of this study was to investigate the factors associated with the incidence of young-onset colorectal cancer. This cross-sectional study examined multiple factors (demographic status, medical comorbidities, smoking, alcohol intake, nighttime sleep duration, family history of cancer, sedentary behavior, daily consumption of fried foods, fast food, and processed meat) among 171 patients from two cancer referral hospitals in Jakarta, Indonesia. Logistic regression analysis revealed that the low-income group had a higher risk of YO-CRC compared to high-income group (p=0.004). Those with comorbid diseases such as inflammatory bowel disease, diabetes, or high cholesterol were more likely to develop YO-CRC compared to those without these conditions (p=0.002). Frequent consumption of processed meat (vs seldom) (p=0.003) and fried food (vs no consumption) (p=0.001) were associated with higher risk. Those with high sedentary behavior (vs low) (p=0.021) also had higher risk of YO-CRC. Notably, nighttime sleep emerged as the strongest predictor (odds ratio (OR): 10.462). These findings underscore the need for targeted public health interventions promoting adequate sleep, healthy diets, and active lifestyles, particularly among Indonesian youth and low-income groups. Further studies are recommended to investigate these associations in larger and more diverse populations across Indonesia.

Development of decellularized mouse auricular scaffolds using sodium dodecyl sulfate immersion-agitation for microtia tissue engineering

Putu KD. Jaya — 2025-08-01

Effective treatment strategies for microtia remain limited due to the side effects and shortcomings associated with current therapeutic approaches. Tissue engineering, particularly the development of biological scaffolds, has emerged as a promising alternative. However, research on auricular scaffold fabrication in murine models using sodium dodecyl sulfate (SDS) and the immersion–agitation decellularization technique remains scarce. The aim of this study was to evaluate the effects of varying SDS concentrations on the decellularization efficiency and extracellular matrix (ECM) preservation of murine auricular tissue for scaffold development. Auricular tissues from mice (n=4) were immersed in Erlenmeyer flasks containing 0.1%, 0.5%, or 1% SDS and subjected to continuous agitation until the tissues became macroscopically translucent. Qualitative assessments included macroscopic appearance and microscopic evaluation using hematoxylin–eosin and Masson's trichrome staining. Quantitative analysis involved counting residual nuclei, while semiquantitative analysis of ECM area fractions was performed using ImageJ software. Statistical comparisons were conducted using one-way analysis of variance (ANOVA), with significance defined as p<0.05. The results demonstrated that the decellularized scaffolds exhibited macroscopic translucency, significantly reduced nuclear content (p=0.001), and preserved ECM integrity (p=0.012). Among the tested concentrations, 0.5% SDS provided the optimal balance between effective decellularization and ECM preservation. These findings support the potential application of murine auricular scaffolds decellularized with 0.5% SDS via the immersion–agitation method for future microtia tissue engineering.

Antimicrobial resistance and empirical antibiotic use in diabetic foot infections: A retrospective study from Indonesia

Menang B. Tarigan — 2025-09-17

Diabetic foot infection (DFI) represents a major complication of diabetes mellitus with significant morbidity, frequently leading to amputation if not optimally managed. The aim of this study was to analyze clinical, microbiological, and antibiotic susceptibility data from patients with type 2 diabetes who presented with foot infections in Indonesia. The retrospective study, conducted at St. Elisabeth Hospital in North Sumatra, Indonesia, predominantly comprised male farmers with a mean diabetes duration of 8.6 years, most of whom exhibited advanced ulcer severity (64.5% at Wagner grade III). Surgical debridement was performed in 79.0% cases, and amputation in 21.0% of cases. Laboratory investigations revealed poor glycemic control (mean HbA1c 10.12%) and biochemical markers indicative of systemic inflammation and renal impairment. Microbial cultures identified a predominance of Gram-negative bacteria (58.1%), primarily Klebsiella pneumoniae, Proteus mirabilis, and Escherichia coli, whereas Gram-positive isolates (41.9%) were dominated by Staphylococcus aureus, including methicillin-resistant strains. Empirical outpatient and inpatient antibiotic regimens commonly included amoxicillin, ciprofloxacin, metronidazole, and ceftriaxone; however, in vitro susceptibility testing demonstrated limited efficacy of β-lactams such as ampicillin and amoxicillin (<10% sensitivity). In contrast, linezolid, amikacin, vancomycin, carbapenems, and fosfomycin exhibited superior activity against the isolated pathogens. These findings emphasize the critical need for empirical antibiotic guidelines tailored to local microbial ecology and resistance profiles, integrated with early surgical management, stringent glycemic control, and multidisciplinary care. This comprehensive approach is essential to reduce the risk of amputation and improve clinical outcomes in tropical, resource-limited settings.

Biopsychosocial determinants of anxiety and depression among working mothers in China: A public mental health perspective

Jia Jiao — 2025-08-01

Working mothers often face dual demands from work and parenting, increasing their risk for anxiety and depression. However, the prevalence and contributing factors among Chinese working mothers remain underexplored. The aim of this study was to examine the prevalence and biopsychosocial determinants of anxiety and depression in this population. A cross-sectional survey was conducted between October 17 and November 21, 2024 through WeChat online among 330 working mothers aged 30–45 years old using validated instruments, including the Outcome Inventory-21 (OI-21), Parental Stress Scale (PSS), Experiences in Close Relationships-revised (ECR-R-10), Inner Strength-based Inventory (I-SBI), and the Multidimensional Scale of Perceived Social Support (MSPSS). Sociodemographic, socioeconomic and biological factors, including age, marital status, annual income, and physical disease, were also collected through a self-administered general information questionnaire. Data were analyzed using t-test, analysis of variance, Pearson’s correlation, and hierarchical linear regression. This study found the prevalence was 26.1% for anxiety symptoms and 38.2% for depression symptoms in this group based on the screening tools. Anxiety was significantly associated with both biological (e.g., hormonal changes, family psychiatric history) and psychological factors (e.g., attachment anxiety, parental stress). At the same time, depressive symptoms were primarily predicted by psychological and lifestyle-related factors (e.g., smoking, alcohol use). Notably, inner strength was a protective factor across both conditions. The findings highlight the importance of early detection and integrative care strategies for addressing mental health concerns in working mothers. Incorporating psychological screening, lifestyle assessment, and resilience-building interventions into workplace and community-based healthcare services may improve work-family balance outcomes in this population.

Navigating the intersection of COVID-19 and lower extremity acute limb ischemia: A retrospective cohort study of clinical characteristics and outcomes at Dr. Cipto Mangunkusumo Hospital

Akhmadu Muradi — 2025-08-01

Acute limb ischemia (ALI), a critical condition threatening limb viability and patient survival, has demonstrated an increased incidence during the COVID-19 pandemic, primarily due to virus-associated thrombotic complications. The pandemic has also led to delays in the diagnosis and treatment of non-COVID conditions, including ALI. The aim of this study was to evaluate the clinical characteristics and outcomes of ALI patients treated at Dr. Cipto Mangunkusumo Hospital between 2018 and 2022, comparing outcomes before and during the COVID-19 pandemic. Patients were categorized into two cohorts: pre-pandemic (n=28) and pandemic (n=53), with March 2020 marking the onset of the pandemic period. Treatment outcomes—revascularization success, re-intervention, and mortality—were assessed using multivariate logistic regression. Among the 81 patients, 34.6% were treated before the pandemic and 65.4% during the pandemic. Revascularization success was significantly higher during the pandemic (relative risk (RR): 2.46; 95% confidence interval (CI): 1.16–5.24; p=0.013), whereas no significant differences were observed in re-intervention or mortality rates (both with p>0.05). A prior history of COVID-19 was not significantly associated with revascularization outcome (p=0.933). The use of fluoroscopic guidance was significantly associated with improved revascularization success (RR: 36.58; 95%CI: 6.54–204.6; p=0.001). Rutherford classification was a significant predictor of re-intervention success (p=0.022), while the presence of dyslipidemia and cardiovascular disease were independently associated with mortality (RR: 0.08–0.76, p=0.0o5, and RR: 2.24–25.18, p=0.001, respectively). In conclusion, fluoroscopy appears to enhance revascularization outcomes in the treatment of ALI. Comorbidities such cardiovascular disease, and COVID-19 history should be taken into account when managing patients with ALI.

Enhancing the quality of tuberculosis care in a high-prevalence area of West Java, Indonesia: A comparative study between public and private hospitals

Inaz K. Dewi — 2025-08-14

Despite the World Health Organization’s (WHO) ambitious goal of eradicating tuberculosis (TB) by 2035, the three key indicators of the End TB Strategy remain unmet. Improving the quality of care is essential to achieving better health outcomes in Indonesia, where both public and private hospitals play a pivotal role in strengthening TB services. The aim of this study was to evaluate the quality of TB care in public and private hospitals in Karawang Regency, a district with the fifth highest TB prevalence in West Java, Indonesia. A mixed-methods approach was employed, using an evaluation framework that integrated the High-Quality Health System (HQHS) model and the Quality of Tuberculosis Service Assessment (QTSA) tool. Quantitative data were collected using a modified QTSA questionnaire administered to patients, while qualitative primary data were obtained through in-depth interviews with stakeholders and healthcare providers. Secondary qualitative data were sourced from patient visit records and TB control reports. The findings indicated that low treatment success rates were associated with increased patient loss to follow-up, inadequate evaluation, patient mortality, and dissatisfaction, which were largely driven by deficiencies in foundational elements and suboptimal treatment processes, including budgeting, policy dissemination, and the functioning of internal and external networks. Positive patient experiences and access to follow-up care significantly influenced patient satisfaction. Strengthening the foundational components of the TB health system and adopting a sustainable, integrated treatment approach are critical to improving treatment success rates, clinical outcomes, and patient satisfaction.

Phytochemical profiling and enzyme inhibitory activity of Sterculia populifolia DC stem bark extract and fractions against elastase and tyrosinase

Nur Khairi — 2025-09-17

The demand for natural ingredients in cosmetic and medical applications is steadily increasing, particularly for anti-aging and skin-lightening products. Sterculia populifolia DC, a member of the Sterculia genus, is known to contain diverse bioactive compounds such as flavonoids, phenolics, and terpenoids, which may offer pharmacological benefits. The aim of this study was to evaluate the anti-aging potential of S. populifolia stem bark extract and its solvent-partitioned fractions through enzyme inhibition assays coupled with phytochemical profiling. The stem bark was extracted using 96% ethanol via maceration, followed by sequential liquid-liquid partitioning with n-hexane, ethyl acetate, n-butanol, and water. Phytochemical constituents were characterized using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The inhibitory activities of the extract and fractions against tyrosinase and elastase enzymes were evaluated using spectrophotometric assays, with kojic acid and quercetin as positive controls, respectively. IC₅₀ values were calculated to quantify enzyme inhibition potency. LC-MS/MS analysis revealed key bioactive compounds, including 4-[(E)-(3,5-diamino-1H-pyrazol-4-yl)diazenyl]phenol, isofraxidin, and (22E)-ergosta-4,6,8(14),22-tetraen-3-one. Among the tested samples, the ethanol extract exhibited the most potent activity, with an IC₅₀ of 93.35 µg/mL for elastase inhibition and 133.15 µg/mL for tyrosinase inhibition—classified as strong and moderate activity, respectively. Collectively, these findings demonstrate that S. populifolia stem bark extract possesses promising anti-aging and depigmenting properties, supporting its potential development as a natural bioactive ingredient in cosmetic and skincare formulations.

Death contemplation and mental well-being in elderly Thai Buddhist meditation practitioners

Alla Glushich — 2025-09-17

Depression is prevalent among older adults in Southeast Asia, with fear of death as a key contributing factor. In Thailand, Buddhist death contemplation practices promote acceptance of mortality and may support mental well-being. However, their impact on mental health among elderly Thai Buddhist meditation practitioners remains underexplored. The aim of this study was to examine the interrelationships among death contemplation practice, positive death attitudes, and key psychological outcomes: well-being, depression, and gratitude among elderly Thai Buddhist meditation practitioners. A cross-sectional study design was employed, and data were collected from elderly Thai Buddhist meditation practitioners in Northern Thailand. Participants completed validated instruments assessing death attitudes (Morana Questionnaire; MoQ), death contemplation practice (Modified Meditation Evaluation Questionnaire; MMEQ), well-being (WHO-5-T), depression (Outcome Inventory-21), and gratitude (Gratitude Inventory-6). Descriptive statistics, Pearson correlations, and analysis of covariance (ANCOVA) were used to examine associations among variables and differences across levels of death contemplation practice. A total of 332 elderly participants (mean age=68.12 years; 66% female) were included. Death contemplation practice showed a significant negative association with depression (p=0.011) but not with well-being (p=0.116) or gratitude (p=0.226) after controlling for covariates. Positive death attitudes were independently associated with lower levels of depression (p<0.001), as well as higher levels of well-being (p<0.001) and gratitude (p<0.001), remaining a significant predictor across all outcomes. The association between contemplation and depression weakened when positive attitudes were included in the model, suggesting a mediating effect. These findings underscore the central role of positive death attitudes, cultivated through contemplative practice, in supporting mental health among elderly Thai Buddhist meditation practitioners. Integrating such practices into interventions may offer culturally appropriate strategies for enhancing well-being in aging Buddhist populations.

Human strongyloidiasis in rural villages of South Kalimantan, Indonesia: A case series

Priska PP. Kristi — 2025-08-01

Strongyloidiasis, caused by the nematode Strongyloides stercoralis, can lead to severe complications, including hyperinfection syndrome and disseminated disease, particularly in immunocompromised individuals. However, data on its epidemiology and clinical significance in Indonesia remain scarce and outdated. The aim of this study was to investigate the presence of S. stercoralis, identify potential sources of infection, and explore associated risk factors. A case series of strongyloidiasis was identified during a soil-transmitted helminth survey conducted in two villages in Banjar District, South Kalimantan, Indonesia, between May and July 2024. S. stercoralis larvae were detected in four individuals out of 224 fecal samples (1.8%) using the Baermann funnel method, with confirmation via quantitative polymerase chain reaction (qPCR). All infected individuals were female farmers who reported nonspecific clinical symptoms. Subsequent environmental sampling revealed viable S. stercoralis larvae in soil from one of the villages. The detection of asymptomatic, infected individuals suggests that humans serve as reservoirs for ongoing transmission. In the context of open defecation practices, sustained transmission is likely unless targeted interventions are implemented. Urgent actions are needed, including community education and the provision of basic sanitation infrastructure such as latrines and access to clean water. These interventions are especially critical given that ivermectin—the first-line treatment for strongyloidiasis—is not currently available in Indonesia.