Narra J (Journal)
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Moringa oil-based nanocarrier system containing curcumin formulation as anti- breast cancer agent: Efficacy and safety study
Get PDFCurrent anti-breast cancer drugs have limited efficacy and often cause severe side effects, highlighting the need for bioactive agents that could overcome these limitations. Curcumin, a phenolic compound from Curcuma domestica, has antineoplastic activity but has low solubility in physiological media, while moringa oil is a key component of the oil-phase nanocarrier and also possesses anticancer properties. The aim of this study was to develop a moringa oil-based nanocarrier system containing curcumin and to analyze its anticancer effects on MDA-MB-231 cell lines, focusing on the underlying mechanisms involving B-cell lymphoma 2 (Bcl-2) and Bcl-2-associated X (Bax) proteins. Additionally, the study investigated the side effects of the nanocarrier system following acute administration in animals. The anticancer effects were evaluated in vitro using MDA-MB-231 cell lines, while the acute toxicity assessment was conducted in healthy female Wistar rats. The nanocarrier system was formulated using moringa oil, Cremophor RH40, and PEG 400. Its cytotoxicity against MDA-MB-231 cells was assessed using the 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) assay. DNA fragmentation, apoptosis, and the expression of Bax and Bcl-2 proteins were analyzed via terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assays, flow cytometry, and western blotting. Acute toxicity was further evaluated in female Wistar rats. The results demonstrated that the moringa oil-based nanocarrier system containing curcumin inhibited cell proliferation and induced apoptosis in MDA-MB-231 cells. Curcumin suppressed tumorigenesis by modulating Bcl-2 and Bax protein expression. Our data indicated that the combination of curcumin and moringa oil in a nanocarrier system had greater anticancer potential than either component alone. Moreover, administration of the nanocarrier system did not result in any clinically significant changes in body weight, behavior, or organ weight indicative of toxicological effects. No treatment-related histopathological abnormalities were observed at terminal necropsy. In conclusion, this novel combination of curcumin and moringa in nanocarrier system has better anticancer potential; nevertheless, further studies are needed to confirm this in cancer animal models
Medical cost inflation and its drivers in Indonesian employer-sponsored health insurance for retiree families
Get PDFRising life expectancy and changes in disease patterns have led to an increase in retiree medical costs. Understanding these trends is essential for ensuring the financial sustainability of retiree healthcare programs. The aim of this study was to analyze medical cost inflation and its drivers in Indonesia's employer-sponsored retiree health insurance program from 2020 to 2023. A retrospective cohort study using total sampling included 29,695 retirees, analyzing medical records and insurance claims to examine demographic transition, cost analysis and relative risk of cost drivers. The study found that the retiree population is aging, characterized by longer life expectancy and a growing proportion of individuals aged above 71 years. Medical cost inflation among retirees is higher compared to the general population, driven by aging, high-cost diseases, increased healthcare utilization, and rising treatment costs. Cardiovascular diseases, diabetes, and chronic kidney disease are major drivers of high medical costs. Inpatient care is the most significant cost component, with a cost risk 14.39 times higher than clinic visits. Medicine and medical treatment are leading cost contributors in the retired population. The rising cost of retiree healthcare necessitates sustainable financing strategies. The study highlights that medical cost inflation in retirees was higher than in the general population, driven by aging, high-cost diseases, increased utilization, and rising treatment costs. Strengthening preventive care, optimizing primary care, and diversifying funding sources are recommended to ensure long-term financial stability
Development of an inactivated viral transport medium for diagnostic testing in low-resource countries
Get PDFViral 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
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
Get PDFAcute 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
Outcome and safety comparison of low-molecular-weight heparin versus unfractionated heparin for bridging anticoagulation in individuals with mechanical heart valves undergoing non-cardiac surgery: A systematic review and meta-analysis
Get PDFIn patients with mechanical heart valves, low-molecular-weight heparin (LMWH) and unfractionated heparin are commonly used as bridging anticoagulation therapies to reduce the risk of thromboembolic events and major adverse cardiac events; however, the efficacy and safety of these therapies remain debatable. The aim of this study was to compare the safety and outcomes of LMWH and unfractionated heparin in patients with mechanical heart valve replacement undergoing non-cardiac surgery. This systematic literature review was conducted from January to June 2023, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to search for related studies through PubMed, ScienceDirect, and Cochrane Library. Categorical variables were analyzed using a Mantel-Haenszel random-effects model, with relative risk (RR) as the effect size. Higgins I2 was used to measure the heterogeneity and publication bias was assessed through funnel plots. Out of 814 potential studies, six studies (one randomized control trial and five prospective studies) were included. The analysis revealed no significant differences in thromboembolic event or valvular thrombosis (RR: 0.61; 95%CI: 0.36–1.04; p=0.07; ꭓ2=1.96; I2=0%), all-cause mortality (RR: 0.73; 95%CI: 0.40–1.35; p=0.32; ꭓ2=0.97; I2=0%), major bleeding (RR: 0.81; 95%CI: 0.53–1.23; p=0.33; ꭓ2=4.14; I2=0%), minor bleeding (RR: 1.18; 95%CI: 0.86–1.62; p=0.31; ꭓ2=4.50; I2=11%), and thrombocytopenia (RR: 0.56; 95%CI: 0.20–1.59; p=0.27; ꭓ2=0.85; I2=0%). The study highlights that LMWH and unfractionated heparin did not differ significantly when used as bridging anticoagulant therapy for non-cardiac surgery in mechanical heart valve patients
Improving Indonesian nurse performance on nursing care documentation: A mixed-methods study of a culturally tailored hybrid roleplay intervention
Get PDFNursing documentation is critical for ensuring quality patient care and effective communication among healthcare professionals. However, in low- and middle-income countries (LMICs), documentation practices often fall short due to resource limitations and cultural barriers. This mixed-methods study evaluated a culturally adapted roleplay-based intervention to improve nursing documentation quality among Indonesian nurses. Guided by Kolb's Experiential Learning Theory, this intervention focused on experiential, reflective, and technology-enhanced components to enhance nursing documentation practices. Using a quasi-experimental design, 132 nurses from three public hospitals in Jakarta were assigned to either the treatment or control group. The intervention integrated conventional roleplay, digital simulation, and reflective practice. Quantitative data were collected at baseline, post-intervention, and at a 12-week follow-up, measuring documentation quality, self-efficacy, and cognitive load. Additionally, qualitative data were gathered through semi-structured interviews with 15 experimental group participants. Results showed significant improvements in documentation quality (Cohen’s d=1.28 at T1; d=1.14 at T2), self-efficacy (d=0.99 at T1; d=0.85 at T2), and reductions in cognitive load (d=-0.84 at T1; d=-0.72 at T2), indicating significant and sustained improvements at the 12-week follow-up. Qualitative findings highlighted increased confidence, realism of the scenarios, integration of digital skills, and cultural considerations in documentation practices. Participants' hierarchical structure orientation moderated the effectiveness of the intervention. In conclusion, this study provides evidence that hybrid roleplay interventions can enhance nursing documentation practices in low- and middle-income countries, with a focus on culturally tailored healthcare education
Exploring the potential effects of Lactococcus lactis D4 on the proliferation, apoptosis, and inflammatory responses in colorectal cancer cells
Get PDFLactococcus lactis D4 is a probiotic produced through the fermentation of buffalo milk in bamboo, namely "dadih", a traditional food from West Sumatera, Indonesia. To the best of our knowledge, no specific research has investigated the effects of L. lactis D4, derived from dadih extraction, on colorectal cancer or its potential clinical applications. Therefore, the aim of this study was to evaluate the potential of L. lactis D4 from dadih to inhibit colorectal cancer growth in rat models, with a focus on its effects on cell proliferation, apoptosis, and inflammatory responses. An in vivo study was conducted using 37 male Sprague-Dawley rats, allocated into five groups: (1) control (no treatment), (2) dysplasia (induced with 1,2-dimethylhydrazine until dysplasia developed), (3) dysplasia + L. lactis D4 (induced with 1,2-dimethylhydrazine, then treated with L. lactis D4 after dysplasia confirmation), (4) cancer (induced with 1,2-dimethylhydrazine until cancer was confirmed), and (5) cancer + L. lactis D4 (induced with 1,2-dimethylhydrazine until cancer was confirmed, then treated with L. lactis D4 for 15 days). The effects of L. lactis D4 on cancer progression were assessed through immunohistochemical analysis of cell proliferation (cyclin D1, Bcl-2), apoptosis (p53, caspase-3), and inflammation (nuclear factor-κB (NF-κB) and cyclooxygenase-2 (COX-2)). This study found that L. lactis D4 treatment reduced adenocarcinoma and dysplasia severity in colorectal cancer models through significant reduction in cyclin D1, Bcl-2, NF-κB, and COX-2 expression observed across all groups (p<0.01), although changes in dysplasia and cancer subgroups were not statistically significant (p>0.05). No statistically significant change was noted in p53 expression (p=0.518), whereas caspase-3 expression varied significantly across groups (p=0.010). In conclusion, L. lactis D4 reduces the expression of cyclin D1, Bcl-2, NF-κB, and COX-2 proteins, offering insights into its potential to modulating proliferation and inflammation in colorectal cancer growth
Designing the CORI score for COVID-19 diagnosis in parallel with deep learning-based imaging models
Get PDFThe coronavirus disease 2019 (COVID-19) pandemic has triggered a global health crisis and placed unprecedented strain on healthcare systems, particularly in resource-limited settings where access to RT-PCR testing is often restricted. Alternative diagnostic strategies are therefore critical. Chest X-rays, when integrated with artificial intelligence (AI), offers a promising approach for COVID-19 detection. The aim of this study was to develop an AI-assisted diagnostic model that combines chest X-ray images and clinical data to generate a COVID-19 Risk Index (CORI) Score and to implement a deep learning model based on ResNet architecture. Between April 2020 and July 2021, a multicenter cohort study was conducted across three hospitals in Jakarta, Indonesia, involving 367 participants categorized into three groups: 100 COVID-19 positive, 100 with non-COVID-19 pneumonia, and 100 healthy individuals. Clinical parameters (e.g., fever, cough, oxygen saturation) and laboratory findings (e.g., D-dimer and C-reactive protein levels) were collected alongside chest X-ray images. Both the CORI Score and the ResNet model were trained using this integrated dataset. During internal validation, the ResNet model achieved 91% accuracy, 94% sensitivity, and 92% specificity. In external validation, it correctly identified 82 of 100 COVID-19 cases. The combined use of imaging, clinical, and laboratory data yielded an area under the ROC curve of 0.98 and a sensitivity exceeding 95%. The CORI Score demonstrated strong diagnostic performance, with 96.6% accuracy, 98% sensitivity, 95.4% specificity, a 99.5% negative predictive value, and a 91.1% positive predictive value. Despite limitations—including retrospective data collection, inter-hospital variability, and limited external validation—the ResNet-based AI model and the CORI Score show substantial promise as diagnostic tools for COVID-19, with performance comparable to that of experienced thoracic radiologists in Indonesia
Challenges in maritime evacuation during pre-hospital emergency anesthesia on a remote island in Indonesia: A case report
Get PDFPreeclampsia and eclampsia remain significant contributors to maternal and perinatal mortality. Managing these conditions is particularly challenging in remote areas in many islands of Indonesia, where access to medical care is severely limited. The aim of this study was to analyze the pre-hospital anesthetic management of an eclampsia patient during maritime evacuation to a higher-level facility, highlighting the complexities of medical transport in resource-limited settings. A 38-year-old multiparous woman from a remote village on Pagerungan Island, Indonesia, at 37 weeks of gestation, presented with tonic-clonic seizures consistent with eclampsia. The absence of antenatal care necessitated urgent intervention. Upon presentation, the patient had a Glasgow Coma Scale (GCS) score of 5, tachycardia, and irregular breathing, requiring rapid-sequence intubation and magnesium sulfate administration. Given the geographic constraints, the patient was evacuated by sea under challenging conditions. Despite significant waves, a multidisciplinary team successfully performed an emergency cesarean section onboard, delivering a male infant who required neonatal resuscitation. Postoperatively, both mother and neonate were transferred to a higher-level facility. However, engine failure extended the journey to 18 hours, leading to depletion of oxygen and essential medications, necessitating critical decision-making. This case underscores the significant challenges of emergency eclampsia management in remote settings, particularly during maritime evacuation. Effective stabilization, anesthesia, monitoring, and timely transport are crucial. This case highlights the need for optimized evacuation protocols and increased healthcare resource allocation to enhance maternal and neonatal outcomes in maritime and other resource-limited settings
Efficacy of rotavirus vaccines in Indonesia: A review of genotype distribution and impact
Get PDFRotavirus remains the leading cause of diarrhea among children under five years of age, with an incidence of 31.1–90.9% in Indonesia. Initially, a rotavirus vaccination program was introduced in several provinces of Indonesia in 2022, which would be conducted nationally. This review provides information on the rotavirus genotype distribution in Indonesia, efficacy and effectiveness data of the rotavirus vaccine, and an update on the status of rotavirus vaccine implementation worldwide. The results show a varied distribution of G and P genotypes from 1978 to 2018, with G1–G3, G9, P[4], P[6], and P[8] as the prevalent genotypes, followed by a small proportion of G4, P[9], P[10], and P[11]. Three rotavirus vaccines, which are prequalified by the World Health Organization (WHO) and available in Indonesia, showed an efficacy of 17.6–76.9% in high-mortality countries. The Indonesian government procured ROTAVAC with a G9P[11] genotype for the national immunization program, which showed 31.3–69.1% protective efficacy against severe gastroenteritis caused by other strains. This review suggested that the decision to choose the rotavirus vaccine for the national program should take into account the country’s prevalent circulating genotype and the vaccine’s efficacy against severe diarrhea. The use of a pentavalent rotavirus vaccine with high efficacy in high-mortality countries can be regarded as the prime choice for the program. Another alternative is the rotavirus vaccine, which showed efficacy data in multiple high-mortality countries. In addition, regular surveillance of the rotavirus genotypes and the clinical manifestations of diarrhea are necessary to design vaccination strategies in Indonesia