Narra J (Journal)
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Adherence to iron supplementation and associated factors among pregnant women in Cambodia: Insights from the 2021–2022 Demographic and Health Survey
Get PDFIron deficiency is the leading cause of anemia during pregnancy, a major public health concern in many developing countries. To mitigate anemia, iron supplementation for at least 90 days is recommended for pregnant women. The aim of this study was to evaluate adherence to iron supplementation during pregnancy and to identify its key determinants in Cambodia. A cross-sectional study was conducted using secondary data from the 2021–2022 Cambodia National Demographic and Health Survey. Key variables assessed included maternal age, education level, ethnicity, wealth index, number of pregnancies, age at first pregnancy, prenatal care provider, timing of the first antenatal care (ANC) visit, and frequency of ANC visits. Multivariate logistic regression was employed to evaluate associations between adherence and independent variables. A total of 4,475 women aged 15–49 years who had been pregnant in the past five years were included in the analysis, with 91.2% adhering to iron supplementation for at least 90 days. Multivariate logistic regression showed that those with primary and higher education had greater odds of adherence (odds ratio (OR)=1.38; 95%CI: 1.00–1.90; OR=3.07; 95%CI: 1.39–6.79, respectively) compared to women with no education. There was a positive relationship between education level and adherence. Women who attended four or more ANC visits were more likely to adhere (OR=2.93; 95%CI: 2.27–3.77), and those who initiated ANC in the first trimester had higher adherence compared to those who started later (OR=1.78; 95%CI: 1.35–2.36). This study highlights that education level, frequency, and timing of ANC visits significantly influenced adherence to iron supplementation. Strengthening maternal education and promoting early and regular ANC follow-up should be prioritized to improve adherence and prevent anemia during pregnancy
Enhanced delivery of anti-inflammatory therapeutics using pH-responsive histidine-modified poly-L-lysine on mesoporous silica nanoparticles
Get PDFMesoporous silica nanoparticles (MSNs) are effective platforms for drug delivery due to their high surface area, adjustable pore sizes, and biocompatibility. The aim of this study was to explore the application of histidine-modified poly-L-lysine (PLL-His) as a pH-responsive gatekeeper to control the release of an anti-inflammatory agent, celecoxib, from MSNs. MSNs were synthesized through a sol-gel process using cetyltrimethylammonium bromide (CTAB) as a template and were functionalized with amine groups using (3-aminopropyl)triethoxysilane (APTES). Drug loading was achieved via adsorption in ethanol. Subsequently, poly-L-lysine (PLL) and PLL-His were conjugated to the MSNs using 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDAC) and N-hydroxysuccinimide (NHS) to form MSN-NH2-Drug-PLL and MSN-NH2-Drug-PLL-His constructs. Characterization of these particles was conducted using Fourier-transform infrared (FT-IR) spectroscopy, Brunauer-Emmett-Teller (BET) analysis, and particle size analysis. Results showed that the particle size of MSN-NH2-drug-PLL and MSN-NH2-drug-PLL-His was 237.10±6.56 nm and 234.03±14.65 nm, respectively, indicating suitability for cellular uptake. BET analysis confirmed the increased surface area and pore volume after the removal of CTAB, demonstrating successful mesopore formation. Drug release tests were performed in simulated gastric (pH 1.2) and physiological (pH 7.4) conditions, showing that PLL-His-modified MSNs exhibited minimal release in acidic conditions and sustained release at physiological pH. The PLL-His effectively functioned as a pH-responsive gatekeeper, enhancing drug targeting and reducing premature release. This study highlights the potential of PLL-His-modified MSNs as a promising model for pH-sensitive, targeted drug delivery, with potential applications across various therapeutic areas requiring precise release profiles. This approach could significantly improve therapeutic outcomes and patient compliance, particularly in disease contexts where pH variability is a critical factor. Overall, the integration of PLL-His as a pH-responsive gatekeeper represents a significant advancement in the design of smart drug delivery systems
Mesenchymal stem cell-derived secretome accelerates third-degree burn wound healing: Effects on proliferation, angiogenesis, and fibrosis regulation
Get PDFMesenchymal stem cell-derived secretome (MSC-derived secretome) has shown promise in regenerative medicine; however, research specifically evaluating its efficacy in third-degree burn wounds remains scarce. The aim of this study was to investigate the effects of MSC-derived secretome on cellular proliferation, angiogenesis, myofibroblast activity, and collagen synthesis in a third-degree burn wound model. A total of 20 Wistar rats were randomly assigned to four groups: a healthy control group, a negative control group with untreated third-degree burn wounds, and two treatment groups receiving MSC-derived secretome at doses of 100 µL and 200 µL for 14 days. The wound healing was assessed 14 days post-treatment. Proliferating cell nuclear antigen (PCNA) protein expression was quantified via Western blot to assess cell proliferation; vascular endothelial growth factor (VEGF) gene expression was analyzed using quantitative reverse transcription polymerase chain reaction (qRT-PCR) to examine angiogenesis; alpha-smooth muscle actin (α-SMA) expression was assessed through immunohistochemistry to evaluate myofibroblast activity; and collagen density was measured using Masson's trichrome staining to determine tissue remodeling. Our data indicated that MSC-derived secretome treatment significantly enhanced multiple aspects of the healing process in a dose-dependent manner. PCNA expression increased by 2.8-fold in the 200 µL MSC-derived secretome group compared to the negative control (p<0.05). VEGF gene expression was upregulated by 2.14-fold in the 200 µL secretome group compared to the negative control (p<0.05). α-SMA protein expression increased by 12.67% in the 200 µL secretome group, while collagen density demonstrated the most pronounced improvement at the 200 µL dose, reaching an increase of 81.26% (p<0.05). In conclusion, MSC-derived secretome significantly accelerates burn wound healing by promoting cell proliferation, enhancing angiogenesis, and increasing collagen synthesis while modulating myofibroblast activity. This highlights the potential of MSC-derived secretome as a therapeutic option for optimizing burn wound repair and reducing fibrotic complications
DOCA and L-NAME hydrochloride: Their impact on T regulatory cells, macrophage activity, and pro- and anti-inflammatory cytokine profiles in pre-eclampsia animal model
Get PDFDeoxycorticosterone acetate (DOCA) and N-nitro-L-arginine methyl ester (L-NAME) hydrochloride have been well-reported as pre-eclampsia inducers due to their ability to mimic hypertension, endothelial dysfunction, and inflammatory response. However, no study has compared the two inducers in developing a mice model of preeclampsia characterized by proinflammatory and anti-inflammatory parameters. The aim of this study was to investigate the efficacy of DOCA and L-NAME hydrochloride in inducing pre-eclampsia in pregnant mice, focusing on the expression of regulatory T cells (Tregs), macrophages, anti-inflammatory cytokines TGF-β, and pro-inflammatory cytokines (IL-6 and IL-1β). Twenty-seven female BALB/c mice were grouped into three groups (n=9): healthy pregnant mice (NP), pregnant mice induced with DOCA (PD), and pregnant mice induced with L-NAME hydrochloride (PL). L-NAME hydrochloride was orally given to the pregnant mice at 4.464 mg/30 g body weight (BW) every day after five days of gestation. DOCA was injected subcutaneously in 0.1 mL of corn oil at 0.74 mg/30 g BW before mating and 0.38 mg/30 g BW once a week until dissection. Drinking water for PD and PL groups was replaced with 0.9% saline. On day 16 of pregnancy, the lymphocytes were isolated from the spleen to determine the profile of Tregs, macrophages, TGF-β, IL-6, and IL-1β using flow cytometry analysis. The results showed that administering L-NAME hydrochloride in pregnant mice exhibited a significant increase in the relative number of IL-1β and macrophages compared to DOCA (p<0.05). L-NAME hydrochloride significantly reduced the production of TGF-β compared to DOCA (p<0.05). Both DOCA and L-NAME hydrochloride could decrease Tregs and IL-6 levels. This study also found that L-NAME hydrochloride was more effective in inducing pre-eclampsia in pregnant BALB/c mice than DOCA indicated by the highest increase in pro-inflammatory cytokines and macrophage activity and a low anti-inflammatory cytokine. The present study provides a foundation for understanding the pathophysiological mechanisms of preeclampsia in the inflammatory pathway; however, further exploration of other mechanisms, markers, and target proteins can deepen insights into its development
Healing the healers: Unlocking psychological well-being through meaningful work and quality of work life
Get PDFHealthcare workers in developing countries, such as Indonesia, experience significant psychological stress due to heavy workloads, limited resources, and systemic inefficiencies, all of which negatively impact their psychological well-being (PWB). The aim of this study was to investigate the direct and indirect effects of quality of work life (QWL) on PWB, with meaningful work (MW) as a mediating variable. A cross-sectional survey was conducted with 285 healthcare professionals from various healthcare facilities, including specialists, general practitioners, and nurses. Data were collected using validated scales to assess QWL, MW, and PWB. Pearson correlation analysis was employed to examine relationships among variables, while mediation analysis tested direct and indirect effects. The results indicate that QWL positively influences PWB both directly (β=0.22, p<0.001) and indirectly through MW (β=0.13, p<0.001). Furthermore, MW was found to be a strong mediator (β=0.61, p<0.001), underscoring its critical role in enhancing purpose and resilience. Specialists reported the highest QWL and PWB, whereas nurses exhibited the lowest levels, highlighting occupational disparities. These findings suggest that enhancing the QWL and fostering MW can significantly improve healthcare professionals' PWB. Accordingly, organizations should prioritize strategies that promote MW and improve work-life conditions to support mental well-being and job satisfaction
Efficacy of N-acetylcysteine and motivational enhancement therapy for nicotine addiction: A randomized clinical trial
Get PDFN-acetylcysteine (NAC) is known to enhance neuroplasticity and help reduce smoking addiction by modulating brain metabolites. The use of magnetic resonance spectroscopy (MRS) in smokers receiving NAC as an adjuvant to motivational enhancement therapy (MET) represents a novel approach to understanding how this combination therapy influences brain chemistry. By utilizing MRS, the effectiveness of NAC can be quantitatively assessed by analyzing changes in smoking-affected brain metabolites. The aim of this study was to evaluate the efficacy of NAC combined with MET for nicotine addiction, using MRS to assess neurochemical alterations associated with treatment response. A stratified, randomized, parallel-group clinical trial was conducted, comparing NAC and MET combination to MET only among smokers. The study analyzed the effectiveness of NAC by evaluating glutamate-glutamine (Glx) to creatine ratio (Glx/creatine ratio) and N-acetylaspartate (NAA) to creatine ratio (NAA/creatine ratio) in the nucleus accumbens, bilateral cerebellum, medial prefrontal cortex, ventromedial prefrontal cortex, and bilateral precuneus. Our data indicated that the Glx/creatine ratios for the intervention versus control groups were as follows: nucleus accumbens (0.68 vs 0.43), bilateral cerebellum (0.68 vs 0.43), left medial prefrontal cortex (1.11 vs 0.82), ventromedial prefrontal cortex (0.32 vs 0.86), and bilateral precuneus (0.75 vs 0.58). The NAA/creatine ratios for the intervention versus control groups were as follows: nucleus accumbens (3.55 vs 8.35), bilateral cerebellum (7.82 vs 4.02), left medial prefrontal cortex (5.47 vs 5.20), ventromedial prefrontal cortex (3.55 vs 7.46), and bilateral precuneus (4.73 vs 4.00). Our analysis indicated that the Glx/creatine ratio was higher in the intervention group than in the control group in the medial prefrontal cortex (p=0.02), while the NAA/creatine ratio was higher in the intervention group than in the control group in the bilateral cerebellum (p<0.001). The reported side effects were mild to moderate discomfort and well-tolerated across both groups. These findings highlight the potential of NAC and MET combination in promoting neuroplasticity and supporting nicotine addiction treatment
Enhancing the quality of tuberculosis care in a high-prevalence area of West Java, Indonesia: A comparative study between public and private hospitals
Get PDFDespite 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
Development of decellularized mouse auricular scaffolds using sodium dodecyl sulfate immersion-agitation for microtia tissue engineering
Get PDFEffective 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
Outcomes of first-generation versus second-generation drug-eluting stents in calcified coronary lesions: A meta-analysis
Get PDFThe choice between first-generation drug-eluting stents (DES) and second-generation DES in managing calcified coronary lesions remains a topic of debate. The aim of this study was to compare outcomes between first-generation DES and second-generation DES in patients with calcified coronary lesions. This meta-analysis study was conducted from October to November 2024. The databases used were Embase, Scopus, and PubMed. Relevant articles were collated, and data regarding outcomes in patients with calcified coronary lesions treated with first-generation and second-generation DES were included to calculate the pooled effect size. The statistical analysis was performed using the Mantel-Haenszel method. Six articles were included in the study. The results indicated that calcified coronary lesions treated with first-generation DES were associated with increased risks of all-cause mortality (Odd ratios (OR): 1.23; 95% confidence interval (95%CI): 1.05–1.45; p-Egger= 0.9346; p-Heterogeneity: 0.9720; p=0.0120), myocardial infarction (OR: 1.48; 95%CI: 1.22–1.80; p-Egger: 0.6472; p-Heterogeneity: 0.5890; p<0.0001); and target lesion revascularization (TLR) (OR: 1.47; 95%CI: 1.24–1.74; p-Egger: 0.9982; p-Heterogeneity: 0.5950; p<0.0001), in comparison with second-generation DES. In contrast, when comparing first- and second-generation DES in terms of cardiac death and major adverse cardiovascular events, a similar risk was depicted. This study compared the outcomes of first-generation and second-generation DES in the management of patients with calcified coronary lesions, which may serve as a reference for selecting DES in the patient population
Human strongyloidiasis in rural villages of South Kalimantan, Indonesia: A case series
Get PDFStrongyloidiasis, 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