Narra J

Nutritional composition and action mechanism of Channa striata meat in wound healing: A systematic review

Riani Hapsari, Raymond Tjandrawinata — Thu, 30 Oct 2025 00:00:00 +0700

Wound healing is a complex biological process requiring adequate nutritional support, particularly proteins, amino acids, fatty acids, and essential minerals. Snakehead fish (Channa striata) has been traditionally consumed in Southeast Asia to accelerate recovery after surgery and childbirth. Emerging evidence suggests that its nutritional composition plays a pivotal role in tissue repair. The aim of this systematic review was to consolidate evidence on the nutritional composition of C. striata and elucidate its mechanisms of action in wound healing based on preclinical and clinical studies. A systematic search was conducted across PubMed, ScienceDirect, ProQuest, and Google Scholar for studies published between 2000 and 2023, following PRISMA 2020 guidelines. Eligible studies included biochemical analyses, in vitro and in vivo preclinical studies, and clinical trials assessing the wound-healing effects of C. striata. Data extraction covered nutrient composition, study design, wound-healing parameters, and mechanistic pathways. Out of 2898 identified studies, 22 of them met the inclusion criteria: ten biochemical composition studies, nine preclinical investigations, and four clinical trials. C. striata extract demonstrated high levels of albumin (0.76–10.73 g/100 g), essential and non-essential amino acids (notably glutamic acid, arginine, and glycine), fatty acids (palmitic, arachidonic, linoleic), and minerals such as zinc and copper. Preclinical models consistently showed enhanced fibroblast proliferation, epithelialization, tensile strength, and collagen deposition. Clinical studies in post-cesarean patients reported significant improvements in wound healing scores, uterine involution, pain reduction, and biomarker modulation (VEGF, IL-6, MMP-9). In conclusion, C. striata exhibits promising wound-healing potential attributable to its rich nutrient profile and multi-pathway mechanisms involving collagen synthesis, angiogenesis, and immunomodulation. However, the limited number of clinical trials underscores the need for larger, well-designed studies to confirm its translational efficacy in human wound care.

Biomolecules derived from salivary exosomes encapsulated in chitosan for bone regeneration in alveolar osteitis: A systematic review

Silvia Sulistiani, Endang W. Bachtiar, Boy M. Bachtiar — Mon, 20 Oct 2025 00:00:00 +0700

Alveolar osteitis (dry socket) is a common complication after tooth extraction that delays bone healing and causes significant pain. Conventional treatments are largely palliative and do not actively promote regeneration. Salivary exosomes, rich in bioactive molecules, and chitosan, a biocompatible and biodegradable polymer, might offer a promising combined approach for targeted bone regeneration. The aim of this systematic review was to systematically evaluate the regenerative potential of salivary exosomes encapsulated in chitosan for the treatment of alveolar osteitis. The systematic review was conducted following PRISMA guidelines and the PICO framework. Comprehensive searches were performed across PubMed, ScienceDirect, ProQuest, Cochrane Library, and Google Scholar for English-language articles published between 2021 and 2025. Eligible studies included in vitro, in vivo, and preclinical research assessing chitosan-encapsulated salivary exosomes for bone regeneration. Data were extracted on study design, interventions, outcome measures, and therapeutic effects. From 524 retrieved records, 10 full-text articles were assessed, and two met the eligibility criteria. Both studies demonstrated that chitosan encapsulation improved the stability and delivery efficiency of salivary exosomes. Outcomes included increased osteogenic gene expression (ALP, BMP-2, osteocalcin, RUNX2), enhanced angiogenesis, reduced inflammation, and histological evidence of accelerated bone regeneration compared with conventional treatment. In conclusion, current evidence suggests that salivary exosomes encapsulated in chitosan have strong therapeutic potential for alveolar osteitis by promoting osteogenesis, reducing inflammation, and enhancing bone healing. However, further preclinical validation and controlled human trials are required before clinical translation.

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

Wed, 17 Sep 2025 00:00:00 +0700

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.

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

Menang B. Tarigan, Rama M. Saragih, Kevin A. Tarigan, Franciscus Ginting — Wed, 17 Sep 2025 00:00:00 +0700

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.

Salt intake- related knowledge, attitudes, and practices among Jordanian adults

Tue, 02 Dec 2025 00:00:00 +0700

High salt consumption is a worldwide public health problem, and its magnitude varies considerably among different communities. This study aimed to assess Jordanian adults’ knowledge, attitudes, and practices related to salt intake and to examine how these domains differed between genders. A quantitative cross-sectional survey was conducted using a multi-stage sampling technique to select a representative sample from the population of Amman, Jordan. Data were collected through a structured, validated questionnaire administered by trained interviewers between November and December 2021. The findings indicate that the majority of participants (70.8%) did not know the maximum recommended daily salt intake and reported not reading food labels when purchasing food. Almost half of the participants (48.2%) reported always adding salt while cooking, and 14.6% reported always adding table salt after cooking. The most commonly reported practices to reduce salt intake included using spices other than salt while cooking (67.2%) and avoiding or reducing the consumption of salt-rich foods. Significant gender differences were observed in knowledge, attitudes, and practices (KAP) toward salt intake. Females demonstrated greater awareness of recommended salt intake and associated health risks, and were more likely to engage in practices aimed at reducing salt consumption, such as avoiding high-salt foods and using alternatives in cooking. In contrast, males were more likely to report misconceptions, limited use of food labels, and higher engagement in unhealthy practices such as daily smoking and lower awareness of low-salt alternatives. In conclusion, this study showed that Jordanian adults have relatively limited knowledge about salt intake, and their practices regarding salt consumption are inappropriate. Therefore, there is a need to adopt long-term strategies to reduce salt intake among the Jordanian population and mitigate its negative impacts on community health.

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

Fri, 01 Aug 2025 00:00:00 +0700

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.

Chronic exercise reduces astrocytic c-Fos and CCL2 via conditioned serum and cerebrospinal fluid

Wed, 01 Oct 2025 00:00:00 +0700

Inflammation, a critical immune response to infection and tissue damage, is mediated by pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α), which upregulate the expression of cellular proto-oncogene Fos (c-Fos) and chemokine ligand 2 (CCL2). Chronic exercise has been shown to exert systemic anti-inflammatory effects, yet its impact on astrocytic inflammatory signaling remains unclear. The aim of this study was to investigate whether chronic exercise modulates astrocytic expression of c-Fos and CCL2 through factors present in conditioned serum and cerebrospinal fluid (CSF). Male wistar rats were assigned to an exercise group (progressively increased swimming, five times per week for four weeks) or a sedentary control group. Conditioned serum and CSF were collected and applied to astrocyte cultures with or without TNF-α induction. After 120 minutes, c-Fos and CCL2 expression were quantified using western blot analysis. Conditioned serum and CSF from exercise rats significantly reduced TNF-α induced c-Fos and CCL2 expression compared with controls. These findings suggest that chronic exercise may attenuate neuroinflammatory responses by modulating astrocytic expression of c-Fos and CCL2. The parallel reductions observed in both serum and CSF indicate that exercise-induced circulating factors may possess anti-inflammatory properties within neural environments. This study provides preliminary in vitro evidence for mechanistic link between chronic exercise and reduced neuroinflammation, underscoring the need for in vivo validation and translational research to assess therapeutic potential.

SARS-CoV-2 lineages and naso-oropharyngeal bacterial communities in COVID-19 reinfection: A study in West Java, Indonesia

Fri, 17 Oct 2025 00:00:00 +0700

Continuous emergence of new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants may influence viral transmission dynamics and alter interactions with the respiratory microbiota, potentially increasing the risks of reinfection. This study investigated cases of coronavirus disease 2019 (COVID-19) reinfection in West Java, Indonesia, with the aim of identifying the SARS-CoV-2 variants involved, characterizing their genomic mutations, and profiling the nasal and oropharyngeal microbiota associated with reinfection. Naso-oropharyngeal swab samples were collected from 42 COVID-19 reinfection cases and nine new infection cases. Whole genome sequencing was performed using Oxford Nanopore Technologies (ONT) MinION Mk1C and variant analysis was conducted using ARTIC workflow. Nexstrain and PANGOLIN were used to determine the lineages. Phylogenetic trees were constructed using IQ-tree and FigTree. Key mutations were identified by Cov-GLUE. Additionally, 16s rRNA amplicon sequencing was conducted on nine samples from each group to analyze bacterial communities using EPI2ME and MicrobiomeAnalyst. All identified SARS-CoV-2 strains in this study were Delta variant (B.1.617.2), predominantly lineage AY.23 (n=46, 90%), followed by AY.24 (n=3) and AY.109 (n=2). No differences in SARS-CoV-2 lineages were observed between reinfection and new infection cases. Unique hotspot mutations found only in COVID-19 reinfections included NSP3, V220A, S_T676I, ORF7a_V82A, and ORF7a_TI20I. Bacterial community analysis revealed no significant diversity differences (alpha and beta) between the two groups. While the most dominant phylum remained Terrabacteria in both groups, Streptococcus was dominant in COVID-19 reinfections, whereas Prevotella was dominant in new infection cases. Notably, Haemophilus parainfluenzae, Fusobacterium periodonticum, Fusobacterium nucleatum, and Leptotrichia buccalis had significant increases in reinfection cases. Despite the similarity in SARS-CoV-2 lineages causing both COVID-19 reinfection and new infection cases, the presence of distinct key mutations and bacterial species suggest their potential as biomarkers within this group.

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

Putu KD. Jaya, Anak AAAP. Dewi, Asri Lestarini, Ni PD. Witari, Luh G. Evayanti — Fri, 01 Aug 2025 00:00:00 +0700

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.

Association between the CYP24A1 rs2762939 polymorphism and vascular calcification in Indonesian patients with chronic kidney disease on hemodialysis

Wendy Wendy, Riri A. Muzasti, Radar R. Tarigan — Thu, 16 Oct 2025 00:00:00 +0700

Vitamin D plays a key role in mineral metabolism, and its dysregulation contributes to vascular calcification, a major complication of chronic kidney disease–mineral and bone disorder (CKD–MBD) in patients undergoing hemodialysis with CKD. The CYP24A1 gene encodes 24-hydroxylase, the enzyme responsible for degrading active vitamin D metabolites and its polymorphisms, particularly rs2762939, have been linked to variability in vitamin D status and coronary artery calcification. The aim of this study was to assess the association between the rs2762939 polymorphism of CYP24A1 and vascular calcification in Indonesian patients with CKD undergoing maintenance hemodialysis. A case–control study was conducted in 92 hemodialysis patients, including 46 with vascular calcification and 46 without. Genotyping of the rs2762939 polymorphism was carried out using PCR–RFLP, and the amplified products were separated by electrophoresis on 4% agarose gel. The frequency of vascular calcification was found to be significantly higher in patients with diabetes mellitus than in the control group (19 (82.6%) vs 4 (17.4%)), whereas in non-diabetic patients the frequency of vascular calcification was lower compared with controls (27 (39.1%) vs 42 (60.9%)). A statistically significant association between CKD etiology and vascular calcification was observed (p=0.001). The prevalence of vascular calcification was lower among carriers of the mutant C allele (45%) compared with the G allele (51.4%), although this difference was not statistically significant (OR=0.77; 95%CI: 0.38–1.56; p=0.592). The rs2762939 polymorphism of the CYP24A1 gene was not significantly associated with vascular calcification in Indonesian patients with CKD undergoing maintenance hemodialysis. Further studies with larger, ethnically diverse cohorts and integration of vitamin D status are needed to clarify the genetic contribution of CYP24A1 and related pathways to vascular calcification.

Exploring the potential of Holothuria atra extract in modulating fasting triglyceride index and obesity: In silico, in vitro and in vivo studies

Thu, 18 Sep 2025 00:00:00 +0700

Obesity remains a major global health challenge and is strongly associated with metabolic disorders, particularly cardiovascular disease. This has fueled growing interest in natural interventions that regulate lipid metabolism as potential strategies to mitigate associated risks. Among these, Holothuria atra has emerged as a candidate due to its diverse bioactive compounds, though its mechanisms of action and therapeutic efficacy remain inadequately characterized. The aim of this study was to evaluate the combined effects of H. atra extract (HAE) and exercise on metabolic regulation, with the goal of determining whether their synergistic use enhances obesity management by targeting multiple metabolic pathways. Specimens of H. atra were collected from Tablolong Beach, Indonesia, and ethanol extracts were prepared. An in-silico analysis was performed to assess drug-likeness, quantitative structure-activity relationship (QSAR) properties, and network pharmacology. In vitro test using human umbilical cord-derived mesenchymal stem cells (hUC-MSCs) underwent adipogenic differentiation with or without HAE treatment. This study used male Sprague-Dawley rats that were fed either a control or high-fat diet and further subdivided into groups receiving extract supplementation, swimming exercise, or a combination of both for six weeks. Liquid chromatography-mass spectrometry (LC-MS) analysis identified 6-gingerol and sarcostin as principal bioactive compounds, both of which fulfilled drug-likeness criteria. In silico analyses implicated peroxisome proliferator-activated receptor gamma (PPAR-γ) signaling as a major molecular target. In vitro tests found that HAE attenuated adipogenic differentiation of hUC-MSCs. Both HAE and exercise significantly reduced triglycerides, glucose, and the triglyceride–glucose index in rats fed a high-fat diet. The combination of HAE and exercise produced the greatest improvements, with significant reductions in glucose (p<0.01) , triglycerides (p<0.001), and the triglyceride–glucose index (p<0.001) compared to the high-fat diet control group. Collectively, these findings suggest that HAE, particularly when combined with regular exercise, improves lipid metabolism and may serve as a promising complementary strategy for obesity management.

Integrated analysis of dengue transmission risk and insecticide resistance in Aedes aegypti from Vichada, Colombia

Wed, 19 Nov 2025 00:00:00 +0700

Dengue is the primary arbovirus transmitted by Aedes aegypti mosquitoes. Effective management of dengue demands a multidisciplinary approach. The aim of this study was to conduct an integrated analysis of dengue transmission, focusing on its vector mosquitoes, to establish a baseline for dengue control and prevention in an endemic region of Colombia. The study was conducted from 2015 to 2018 across four municipalities in the Vichada department near the Venezuelan border. Five complementary approaches were employed: (1) determining the natural infection rate and circulation of various dengue virus serotypes in mosquitoes; (2) evaluating the insecticide susceptibility status and examining mosquito genotypes for three knockdown (kdr) mutations linked to insecticide resistance; (3) performing a phylogenetic analysis to identify the lineage of Ae. aegypti; (4) creating risk maps for dengue transmission based on predictive models in two municipalities in the department; and (5) empowering the community. Molecular analysis using RT-PCR indicated dengue virus infections in all municipalities of the Vichada department. Eleven positive pools for serotypes DENV-1, DENV-2, DENV-3, and DENV-4 were detected. The highest minimum infection rate (MIR) was found in Cumaribo, followed by La Primavera, which showed the greatest diversity of dengue virus serotypes. Mosquitoes from all three populations showed susceptibility to malathion and lambda-cyhalothrin pyrethroid, except for mosquitoes from Puerto Carreño, which presented moderate resistance to lambda-cyhalothrin (resistance ratio of 8). Importantly, all mosquitoes had the F1534C mutation, while the V1016I and V419L mutations were found at lower frequencies. Risk classification maps for Puerto Carreño and La Primavera showed neighborhoods with high risk, indicating potential hotspots for intervention and vector control. This study established a necessary baseline for the ongoing monitoring and improvement of the early warning system for all municipalities in the Vichada department. The integrative approach employed in this study highlights the importance of incorporating these methodologies into dengue epidemiological surveillance in endemic regions.

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

Wed, 17 Sep 2025 00:00:00 +0700

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.

Epidemiology and management of acute coronary syndrome in remote and resource-limited settings: Insights from a rural Indonesian hospital

Tue, 25 Nov 2025 00:00:00 +0700

Acute coronary syndrome (ACS) remains a major global health and economic burden. In Indonesia, North Kalimantan reports the highest prevalence of heart disease (2.2%), exceeding the national average of 1.5%. Nunukan, the province’s northernmost and predominantly archipelagic region, is served by a single general hospital, reflecting the healthcare challenges faced by many rural Indonesian areas. This study aimed to provide epidemiological insights into ACS cases in this region to inform improved management strategies in similar resource-limited settings. A retrospective cross-sectional study was conducted among ACS patients admitted to Nunukan Regency General Hospital, Nunukan, Indonesia, between January 1 and August 31, 2023. Data on demographics, risk factors, clinical presentation, vital signs, diagnostic findings, treatments, and outcomes were collected from paper-based medical records. Of the 241 patients admitted, 4.56% were diagnosed with ST-elevation myocardial infarction (STEMI), 35.68% with very high-risk non-ST-elevation ACS (VHR NSTE-ACS), and 59.75% with non-very high-risk NSTE-ACS (NVHR NSTE-ACS). The mean age was 55.4±12.26 years, with a predominance of males (51.5%) and obesity (35.7%). The median number of risk factors was 2 (IQR: 1–2.5), with hypertension being the most prevalent (72.6%). Late presentation was common, and only 36.4% of STEMI patients received fibrinolytic therapy. The overall in-hospital mortality rate was 3.3%, and the median length of stay was 6 days (IQR: 5–7). ACS patients in Nunukan exhibited distinct clinical and demographic profiles, characterized by younger age, obesity, multiple risk factors, and delayed presentation. These findings highlight the urgent need to strengthen cardiovascular care capacity and early intervention strategies in remote and resource-limited regions of Indonesia.

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

Fri, 01 Aug 2025 00:00:00 +0700

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.

Role of adult attachment and spiritual attachment on meaning in life among religious minorities in Thailand: Insights for mental health promotion

Tue, 11 Nov 2025 00:00:00 +0700

Attachment theory suggests that secure relationships are foundational to meaning in life, but less is known about the role of spiritual attachment, especially among religious minorities. This study examined whether attachment to God mediates the relationship between insecure human attachment and the presence of meaning in life among Thai Protestant Christians. A cross-sectional survey was conducted with Thai Protestant Christians, assessing insecure human attachment (avoidant and anxious), attachment to God, and the presence of meaning in life using validated self-report measures. Mediation analysis was used to test the indirect effect of insecure attachment on meaning via attachment to God. The results showed that attachment to God fully mediated the negative relationship between insecure human attachment and the presence of meaning in life. Participants with higher insecure attachment reported lower meaning in life, but those with a secure attachment to God did not display this deficit. Attachment to God serves as a central psychological resource, a positive figure for humans, and enhances meaning in life, particularly in the minority context of Thai Protestant Christians. These findings highlight the importance of spiritual interventions for individuals experiencing relational or social marginalization.

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, Farizah M. Hairi, Helen Andriani — Thu, 14 Aug 2025 00:00:00 +0700

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.

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

Natallina Sianturi, Debie Dahlia, Chiyar Edison — Tue, 19 Aug 2025 00:00:00 +0700

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.

Cortisol and pregnancy-related anxiety in relation to preeclampsia among third-trimester pregnant women: A case–control study from Aceh, Indonesia

Thu, 11 Dec 2025 00:00:00 +0700

Despite extensive research, the interplay between hormonal stress markers and pregnancy-specific anxiety in the pathogenesis of preeclampsia remains insufficiently understood. This study aimed to analyze the simultaneous relationships between serum cortisol levels, pregnancy-related anxiety, and the occurrence of preeclampsia among third-trimester pregnant women. A case–control study was conducted at three hospitals in Banda Aceh, Indonesia, involving third-trimester pregnant women. Serum cortisol concentrations were measured using an immunoassay, and anxiety levels were assessed with the validated Pregnancy Related Anxiety Questionnaire (PRAQ). Preeclampsia diagnosis followed standard clinical and laboratory criteria. Associations between cortisol levels (categorized into high and normal) and PRAQ scores (classified as high and low–moderate) with preeclampsia were evaluated using the Chi-squared test, and crude odds ratios (OR) with 95% confidence intervals (95%CI). The Spearman’s correlation was used to determine the correlation between cortisol levels and PRAG scores. A total of 66 pregnant women were included in the final analysis (33 with preeclampsia and 33 with normal pregnancy). Women with high serum cortisol levels had a markedly greater likelihood of developing preeclampsia compared with those with normal cortisol levels (odds ratio (OR)=34.00; 95% confidence interval (95%CI): 4.93–234.46). Similarly, women with high pregnancy-related anxiety exhibited a significantly elevated risk of preeclampsia (OR=16.71; 95%CI: 4.95–56.39). No significant correlation was observed between cortisol levels and PRAQ scores in both groups (preeclampsia: r=-0.041, p=0.821; normal pregnancy: r=0.278, p=0.117). In conclusion, elevated serum cortisol and high pregnancy-related anxiety are independently associated with preeclampsia, although not directly correlated with each other. These findings highlight the potential of dual screening for cortisol and pregnancy-specific anxiety as an innovative approach for early identification of women at high risk of preeclampsia.

Neutrophil-to-lymphocyte ratio and stenosis severity in ischemic stroke: Digital subtraction angiography evaluation and implications for inflammation-based risk stratification in the Indonesian population

Aidil Fiqri, Nasrul Musadir, Imran Imran, Desiana Desiana, Sri Hastuti — Fri, 28 Nov 2025 00:00:00 +0700

Neutrophil-to-lymphocyte ratio (NLR), an accessible biomarker derived from routine blood counts, has been associated with stroke severity and outcomes. However, its association with angiographically confirmed stenosis has not been fully established. The aim of this study was to investigate the correlation and association between the NLR and the severity of intracranial arterial stenosis assessed by digital subtraction angiography (DSA). An observational analytic study with a cross-sectional design was conducted. Patients with acute ischemic stroke who underwent DSA were included using a total sampling method. Eligible patients were aged >18 years, had ischemic stroke onset <14 days, and had no prior thrombolysis, endovascular treatment, or surgery for cerebral stenosis. Those with infection, hematological disorders, malignancy, or immunosuppression were excluded. NLR was calculated from complete blood count results at admission, while stenosis severity was quantified using the Warfarin–Aspirin Symptomatic Intracranial Disease (WASID) method. A total of 44 ischemic stroke patients who underwent DSA were included. Pearson correlation test revealed a strong positive correlation between NLR and the severity of intracranial arterial stenosis (r=0.671; p<0.001). In subgroup analysis, NLR showed a strong positive correlation with stenosis severity in the cerebral arteries (r=0.707; p<0.001), but not in the carotid arteries (r=0.434; p=0.182). One-way ANOVA revealed significant differences in NLR across stenosis severity groups (p<0.0001), with higher NLR in moderate and severe stenosis compared with mild stenosis (p=0.017 and p=0.0003, respectively). These findings suggest that NLR reflects the inflammatory burden contributing to vascular narrowing and may serve as a simple and widely available biomarker for identifying ischemic stroke patients with a higher burden of intracranial arterial stenosis, particularly in settings where access to advanced imaging is limited.

Cerebral artery stenosis and neurological outcomes after anticoagulant and antiplatelet therapy in acute ischemic stroke: A digital subtraction angiography-based study in Indonesia

Nasrul Musadir, Syahrul Syahrul, Imran Imran, Aidil Fiqri, Dini R. Danial — Fri, 03 Oct 2025 00:00:00 +0700

Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality, with cerebral artery stenosis serving as an important prognostic factor. While revascularization therapies benefit selected patients, most rely on pharmacological strategies. However, evidence regarding the effect of sequential anticoagulant–antiplatelet therapy on vascular stenosis and neurological outcomes remains limited. The aim of this study was to evaluate changes in cerebral artery stenosis, assessed using digital subtraction angiography (DSA), and neurological deficits, assessed by the National Institutes of Health Stroke Scale (NIHSS), in patients with first-onset AIS treated with anticoagulant and antiplatelet therapy. A prospective cohort study was conducted involving 35 patients who received low-molecular-weight heparin or warfarin for seven days, followed by 90 days of oral antiplatelet therapy (aspirin or clopidogrel). Sixteen patients consented to repeat DSA at 90 days. Among these, the median stenosis decreased from 44.5% (30–90%) to 44.0% (20–90%) (p=0.003). In the full cohort (n=35), the median NIHSS improved from 10 (5–17) at baseline to 9 (2–14) at 90 days (p<0.001). Correlation analysis demonstrated a positive but non-significant association between stenosis reduction and NIHSS improvement (r=0.474, p=0.064). These findings suggest that sequential anticoagulant–antiplatelet therapy in first-onset AIS was associated with a modest but statistically significant reduction in arterial stenosis and meaningful improvement in neurological function. Although vascular and clinical outcomes were not significantly correlated, the observed trend highlights the importance of structured pharmacological therapy and the potential role of serial vascular imaging in follow-up care.

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

Fri, 01 Aug 2025 00:00:00 +0700

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.

Comparison of anti-SARS-CoV-2 IgG seropositivity among vaccinated, unvaccinated, and COVID-19 survivor individuals: A cross-sectional study in Palembang, Indonesia

Thu, 25 Sep 2025 00:00:00 +0700

Measurement of anti–severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) antibody levels provides evidence of prior infection or vaccination. Persistent vaccine hesitancy underscores the importance of robust, evidence-based data to inform policy decisions. The aim of this study was to compare anti-SARS-CoV-2 IgG seropositivity among vaccinated individuals, unvaccinated individuals, and coronavirus disease 2019 (COVID-19) survivors in the community during the pandemic. In this cross-sectional study, 517 participants were enrolled, including 167 vaccinated individuals, 97 COVID-19 survivors, and 253 unvaccinated individuals, selected through multistage cluster sampling of 40 clusters. Anti-SARS-CoV-2 IgG seropositivity was defined as ≥50 AU/mL. Multivariable logistic regression was performed to evaluate associations between group type and seropositivity, adjusting for demographic factors, COVID-19 symptoms, hypertension, and body mass index (BMI). Vaccinated individuals demonstrated significantly higher odds of seropositivity compared with unvaccinated participants (odds ratio (OR)=5.60; 95% confidence interval (CI): 2.36–13.27). Covariates independently associated with seropositivity (p<0.05) included the presence of COVID-19 symptoms, hypertension, and BMI. Vaccination was strongly associated with increased anti-SARS-CoV-2 IgG seropositivity in the community, independent of clinical and demographic factors. These findings support ongoing vaccination campaigns and highlight the relevance of comorbidities and symptomatic history in shaping humoral immune responses.

Emergency management of recurrent ovarian ectopic pregnancy in a hemodynamically unstable patient: A case report

Rendy Singgih, Skmarina H. Larose, Meilyana MI. Kwary, Helmina Helmina — Tue, 30 Sep 2025 00:00:00 +0700

Recurrent ectopic pregnancy is defined as the occurrence of more than one extrauterine implantation of a fertilized ovum. Ectopic pregnancy arises when a fertilized egg fails to implant within the endometrial cavity and instead attaches to an alternative site such as the fallopian tube, ovary, or peritoneal cavity. In this report, a rare case of recurrent ovarian ectopic pregnancy in a 31-year-old patient at six weeks’ gestation is presented. The aim of this study was to highlight the clinical presentation, diagnostic challenges, and management considerations associated with recurrent ovarian ectopic pregnancy. The patient was admitted to the emergency maternal unit with severe abdominal pain. A previous history of ectopic pregnancy raised the suspicion of recurrence. The diagnosis of ectopic pregnancy was established, and the patient underwent emergency exploratory laparotomy. During the procedure, the gestational sac was identified on the surface of the right ovary. Postoperatively, the patient required blood transfusion and supportive management, and was discharged in stable condition after several days of hospitalization. Ovarian ectopic pregnancy is an uncommon but serious condition. Early diagnosis, ideally with high-resolution ultrasonography, is essential to prevent life-threatening complications such as rupture, massive intra-abdominal hemorrhage, hemorrhagic shock, and maternal mortality. This case highlights the importance for clinicians of recognizing the possibility of recurrence in patients with a prior history of ectopic pregnancy and ensuring vigilant follow-up and timely intervention.

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

Fri, 01 Aug 2025 00:00:00 +0700

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.