Narra J (Journal)
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Fecal ingestion rate based on worker activity patterns during stool handling in a ruminant farm
Full text linkFarm workers who handle livestock stools face an increased risk of infection by pathogenic bacteria, such as Escherichia coli O157 and Salmonella spp., leading to millions of severe health issues and thousands of fatalities annually. The aim of this study was to assess the impact of these pathogens by measuring their concentrations, determining rates of unintentional fecal consumption, and conducting a quantitative assessment of microbial risk. An integrated farm in Sukabumi City, Indonesia, was examined for E. coli O157 and Salmonella spp. in livestock stools. Additionally, the study monitored the rate of incidental fecal ingestion among farm workers. Stool samples were collected (n= 40) from ruminants and analyzed following ISO 16649-1:2018, ISO 9308-1:2014, and ISO 6579-1:2017/Amd.1:2020. The study tracked worker’s behavior daily to determine the contact time. The fecal ingestion rate was calculated by multiplying the estimated stool weight ingested by the contact time workers spent cleaning livestock stools in the barn each day. Microbial analysis revealed that the highest concentration of E. coli O157 in beef cattle stools was 2.49 log10 CFU/g. The study determined mean fecal ingestion rates during the dry season (8.64 mg/day) and rainy season (6.84 mg/day). Results from the quantitative microbial risk assessment showed that stool from beef cattle posed a higher risk of E. coli O157 infection compared to other ruminants, with an estimated disease burden of 9.8 × 10-3 pppy. This study represents the first comprehensive quantitative evaluation of fecal ingestion by farm workers during animal husbandry. The findings underscore the need for improved worker safety measures, such as enhanced sanitation practices and protective equipment, to mitigate the risks of handling livestock stools
Factors associated with the incidence of young-onset colorectal cancer: A cross-sectional study
Full text linkThe 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
Comparative effectiveness of microsurgery and endoscopic surgery in lumbar disc herniation: A systematic review and meta-analysis
Full text linkLumbar disc herniation, a common degenerative disc disease, adversely affects quality of life and often necessitates surgical intervention. Microsurgery and endoscopic surgery have emerged as alternatives to traditional open surgery, offering reduced pain and shorter recovery times. The aim of this study was to compare the outcomes of microsurgery and endoscopic surgery for lumbar disc herniation, evaluating effectiveness, safety, and patient-reported outcomes. A systematic search was conducted across six databases (EBSCOhost, OVID, ScienceDirect, Scopus, PubMed, and Cochrane) using terms related to lumbar disc herniation, spine injury, minimally invasive biportal endoscopic spine surgery, and conventional microscopic discectomy. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS), and a random-effects meta-analysis calculated mean differences (MD) and 95% confidence intervals (CI). Among the 267 studies screened, two studies met the inclusion criteria for a meta-analysis assessing the functional outcomes and safety of microsurgery and endoscopic surgery in patients with spinal disorders. The meta-analysis indicated that patients who received microscopic surgery had no significant difference in terms of operation time (MD: 3.48; 95%CI: -14.74 –21.70; p=0.71; I²=90%), postoperative drainage (MD: 16.28; 95%CI: -2.33–34.89; p=0.09; I²=47%), postoperative length of stay (MD: -1.26; 95%CI: -2.52–0.00; p=0.05; I²=77%), and postoperative C-reactive protein (CRP) levels (MD: -13.49; 95%CI: -36.85–9.87; p=0.26; I²= 97%) compared to those treated with endoscopic surgery. In conclusion, microscopic surgery and endoscopic surgery yield similar outcomes in terms of operation time, postoperative drainage, postoperative length of stay, and postoperative CRP levels. Therefore, the choice of techniques should be guided by patient-specific factors, surgeon expertise, and the facilities available at the healthcare center
Cerebral artery stenosis and neurological outcomes after anticoagulant and antiplatelet therapy in acute ischemic stroke: A digital subtraction angiography-based study in Indonesia
Full text linkAcute 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
Community-based intervention in mosquito control strategy: A systematic review
Full text linkAs part of the World Health Organization’s One Health Initiative, vector-borne disease control requires multidisciplinary and community involvement. This review examined community-based mosquito control intervention methods, their efficacy, and limitations. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, data were extracted from four medical databases: PubMed, Clinical Key, ProQuest, and ScienceDirect, covering the period from 2014 to 2023. The search used the keywords "community intervention," "vector control," and "mosquito." Filters were applied for full text, primary sources, scholarly journals, and publications within the last ten years (2014–2023). Studies without community intervention components were excluded. The initial search retrieved 1,035 articles, and 32 full-text articles were selected and assessed for eligibility, with 15 papers included in the final analysis. The included studies focused on arbovirus or malaria vectors and used randomized controlled trials (RCTs), pre- and post-intervention surveys, community-based implementation surveys, or qualitative research designs. Commonly applied interventions included community-driven vector population control and community education. Overall, the studies reported improvements in outcome measures such as entomological indices, community knowledge and practices, costs, and disease incidence or prevalence. However, some studies reported challenges with community perception and acceptance. In conclusion, this review consistently demonstrated a positive impact of community interventions on managing mosquito control
Comparison of PD-L1, CTR-1, VEGF, and p53 expression in sensitive and resistant epithelial ovarian cancer (EOC) patients to platinum-based chemotherapy
Full text linkThe current standard treatment for ovarian cancer is a combination of cytoreductive surgery and platinum-based chemotherapy; however, many patients develop resistance, leading to a high recurrence rate. The aim of this study was to analyze the expression of PD-L1, CTR-1, VEGF, and p53 in epithelial ovarian cancer (EOC) patients, comparing those sensitive and resistant to platinum-based chemotherapy. A cross-sectional study was conducted among EOC patients who underwent surgery and platinum-based chemotherapy between 2020 and 2023 at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, with evaluations performed six months post-chemotherapy. The expression of PD-L1, CTR-1, VEGF, and p53 were measured using immunohistochemistry (IHC) and compared between chemotherapy-sensitive and resistant patients. A total of 65 patients were included: 31 resistant and 34 sensitive cases. The results showed higher PD-L1 expression in the resistant group compared to the sensitive group (mean combined positive score (CPS) of 0.46±0.29 vs 0.17±0.09, p<0.001). The CTR-1 expression was lower in the resistant group (immunoreactive score 2.90±1.30) compared to the sensitive group (immunoreactive score 6.82±2.68) with p<0.001. VEGF and p53 expression were also higher in the resistant group (6.68±2.59 vs 2.76±1.10 and 64.68±13.54% vs 30.15±13.06%, respectively) compared to the sensitive group, with both having p<0.001. The study suggests that increased expression of PD-L1, VEGF, and p53 and decreased CTR-1 expression are associated with platinum-based chemotherapy resistance among EOC patients. Therefore, these biomarkers might have the potential for predicting treatment responses and understanding resistance mechanisms
Assessing health-related quality of life in schizophrenia patients using EQ-5D-5L index: Insights from patients and caregivers
Full text linkSchizophrenia is a prevalent mental health disorder often marked by relapses, significantly affecting the health-related quality of life (HRQoL) of both patients and their families. The aim of this study was to compare the EuroQol 5-Dimension 5-level (EQ-5D-5L) responses of schizophrenia patients and their caregivers. Using an observational cross-sectional design, HRQoL was assessed among schizophrenia patients and their family caregivers recruited from a provincial referral hospital. Sociodemographic (age, sex, education, marital status, income) and clinical variables (diagnosis, treatment duration, comorbidities) were analyzed alongside HRQoL using structured interviews, medical record reviews, and the EQ-5D-5L instrument (self-report by patients and proxy-reported by family caregivers). Statistical analyses included chi-square tests for associations, Wilcoxon tests for patient-family caregiver comparisons, and multivariate modeling of HRQoL determinants. A total of 526 participants (263 patients and 263 accompanying family caregivers) were included. Significant differences were observed between patients and family caregivers in two domains: pain/discomfort and anxiety/depression. Also, the agreement between patients' and family caregivers’ reports showed good results. A substantial agreement was observed between patient-reported and family caregiver-assessed HRQoL, as indicated by a Cohen’s Kappa value of 0.8. This result suggests a strong level of consistency between the two assessments, supporting the potential use of family caregivers as reliable proxies for evaluating patient HRQoL when self-reports are unavailable or unreliable. In the self-care domain, mobility, and daily activities, patient and caregiver assessments show high agreement. In conclusion, the closeness between patients and caregivers significantly influences patients' HRQoL, providing critical insights for evaluating treatment effectiveness in schizophrenia cases. While discrepancies exist between patient and caregiver assessments, these interactions are particularly impactful in subjective domains like pain/discomfort and anxiety/depression, but not for other domains that are visible
Effect of Nigella sativa seed extract on estradiol, FSH levels, and vaginal maturity index in menopausal women: A randomized controlled trial
Full text linkNigella sativa seed extract has been shown to have a significant effect on endometrial thickness and vaginal cytology in ovariectomized animal models, suggesting potential benefits for managing menopausal symptoms. However, to the best of the author’s knowledge, no human studies have been done to support these conclusions. The aim of this study was to investigate the effects of N. sativa seed extract on estradiol, follicle-stimulating hormone (FSH), and the vaginal maturity index (VMI) in postmenopausal women. A single-blinded, randomized placebo-controlled experiment was carried out at Haji Adam Malik Hospital, Medan, Indonesia, with 50 eligible postmenopausal women patients randomized into three groups. Group 1 received a placebo, while groups 2 and 3 were given N. sativa seed extract at 910 mg/day and 1,365 mg/day, respectively. All participants were blinded to the treatment they received. The study used Shad Nigella Plus, an Indonesian herbal medicine containing 455 mg of N. sativa seed extract per capsule. Before the treatments, estradiol levels, FSH levels, and VMI were measured at baseline and remeasured after eight weeks of treatment. Two participants in the intervention group withdrew due to nausea, a reported side effect of N. sativa seed extract consumption. Both treatment groups showed significant increases in estradiol levels (p=0.01 and p=0.001) and VMI (p=0.004 and p=0.001) after eight weeks of daily N. sativa seed extract administration compared to the placebo group. However, no significant differences were found between the two doses in estradiol levels and VMI (p=0.12 and p=0.673, respectively). Moreover, FSH levels showed no significant difference throughout both interventions (p=0.53 and p=0.96, respectively). In conclusion, twice-daily N. sativa seed extract at 910 mg/day or 1,365 mg/day for eight weeks significantly increased estradiol levels and VMI in menopausal women but had no significant effect on FSH levels. These findings support the potential role of N. sativa seed extract as a natural treatment for menopausal symptoms
Identifying the attributes of adherence to tuberculosis treatment in Indonesia: A Delphi study
Full text linkAdherence to tuberculosis (TB) treatment is essential for achieving successful health outcomes. Establishing a consensus among healthcare professionals regarding the definition and key attributes of adherence to TB treatment is essential. The aim of this study was to explore the perspectives of experts and patients on the attributes of adherence to TB treatment. A total of 20 TB specialists and 10 pulmonary TB patients from various regions in Indonesia participated in a three-round Delphi study designed to categorize and validate these attributes. In the first round, participants were interviewed to gather qualitative insights. In the second and third rounds, experts assessed the level of agreement on identified attributes using a five-point Likert scale. The strength of consensus was measured using the interquartile range (IQR), following the best practices outlined in the Conducting and REporting DElphi Studies (CREDES) guidelines. The experts achieved a substantial consensus, with over 85% agreement on the identified attributes. The findings indicated that adherence to TB treatment encompasses the ability of pulmonary TB patients to follow agreed-upon recommendations, including both medication adherence and lifestyle modifications. These lifestyle changes include improved nutritional care, smoking cessation, abstaining from alcohol, stress management, improved physical activity, better sleep, and rest quality, and preventive behaviors related to TB. In conclusion, the findings enhanced the understanding of adherence to TB treatment by highlighting its multifaceted nature. The consensus emphasized that adherence extends beyond medication-taking behaviors to include essential lifestyle changes, underscoring the comprehensive approach needed to support TB patients effectively
Effectiveness and safety of thoracic segmental spinal anesthesia for breast surgery: A systematic review and meta-analysis
Full text linkGeneral anesthesia is the standard approach for thoracic and abdominal procedures; however, it has notable limitations, particularly in high-risk patients. Regional anesthesia techniques, such as thoracic segmental spinal anesthesia, have gained popularity due to their potential to reduce these associated risks. The aim of this study was to assess the effectiveness and safety of thoracic segmental spinal anesthesia in breast cancer surgery using systematic review and meta-analysis. This study adhered to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines, conducting a comprehensive literature search across ScienceDirect, Cochrane Library, and PubMed databases up to July 4, 2024. The inclusion criteria focused on studies that provided specific information on the effectiveness (postoperative pain reduction) and safety (incidence of adverse events and complications) of thoracic segmental spinal anesthesia, as well as satisfaction among patients and surgeons. Out of 4,060 articles, six studies were included for qualitative assessment, with four further analyzed quantitatively. Meta-analysis findings indicated that thoracic segmental spinal anesthesia provided significantly better pain control at 12 hours postoperatively (SMD: -1.25; 95%CI: -1.54 to -0.96; p<0.0001), although no significant difference was noted at 0 hours (SMD: -1.07; 95%CI: -2.33 to 0.18; p=0.09). Thoracic segmental spinal anesthesia was associated with a lower incidence of postoperative vomiting (RR: 0.46; 95%CI: 0.22–0.95; p=0.04), but it presented a higher risk of hypotension (RR: 2.57; 95%CI: 1.41–4.71; p=0.002). Importantly, no anesthesia-related mortalities were reported. The technique resulted in higher satisfaction levels among both patients (SMD: 0.63; 95%CI: 0.33–0.92; p<0.0001) and surgeons (SMD: 0.81; 95%CI: 0.51–1.11; p<0.0001) compared to general anesthesia. The study highlights that thoracic segmental spinal anesthesia is a safe and effective alternative to general anesthesia for breast cancer surgery, offering superior postoperative pain control, enhanced patient and surgeon satisfaction, and a reduced incidence of postoperative vomiting