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Double fatal consequences of distance metastasis in nasopharyngeal carcinoma after a completed chemoradiation in pregnancy: A case report Utami, Niken A.; Muknisa, Liza
Narra J Vol. 3 No. 3 (2023): December 2023
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v3i3.221

Distant metastasis in nasopharyngeal carcinoma (NPC) patients is one of the reasons for the decreased life expectancy with the most common metastasis spreads are to the bone, liver, and lung. Hepatoma is the most frequent liver malignancy and is one of the highest causes of cancer death worldwide and this can be as a result of NPC metastasis. The aim of this case report was to present a patient with hepatoma in pregnancy as a result of NPC metastasis. A 34-year-old pregnant female at 24–25 weeks of gestation presented with a chief complaint of heartburn and unbearable pain radiating to the back. Previous medical history reported that the patient had a liver enlargement. The patient was G4P2A1 with a single living intrauterine fetus and active fetal movements. The patient has a history of NPC and received a completed chemoradiation one month prior to hospital admission. Physical examination showed bilateral rales and palpable diffuse multiple nodule masses in the upper right abdominal quadrant. Laboratory examination revealed anemia, thrombocytopenia, negative hepatitis B surface antigen (HBsAg), and elevated liver markers. Abdominal ultrasonography results showed multiple diffuse nodules in the liver. The patient was diagnosed with a metastatic hepatoma based on the clinical and imaging findings. During hospitalization, the patient repeatedly experienced pleural effusion with suspicion metastases. A few days later, the fetal movements stopped and the ultrasonography indicated negative fetal heart rate. After experiencing respiratory distress for hours, the patient expired the day after. This case highlights that due to the potential adverse effects of chemotherapy and radiotherapy, the initiation of these therapies should be carefully decided to avoid adverse effects to mother and fetus.

Cortisol and pregnancy-related anxiety in relation to preeclampsia among third-trimester pregnant women: A case–control study from Aceh, Indonesia Hezron, Teuku M.; Dewi, Tgk. Puspa; Septivera, Yusra; Rajuddin, Rajuddin; Utami, Niken A.
Narra J Vol. 5 No. 3 (2025): December 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i3.2985

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.

Comparison of interleukin-6 and serum creatinine levels in preeclampsia and normal pregnancy patients: A cross-sectional study in Indonesia Dewi, Syerli R.; Yeni, Cut M.; Munizar, Munizar; Dewi, Tgk. Puspa; Utami, Niken A.; Rusnaidi, Rusnaidi
Narra J Vol. 6 No. 1 (2026): April 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i1.3016

Preeclampsia (PE) is a complication of pregnancy with high morbidity and mortality, characterized by endothelial dysfunction, systemic inflammation, and impaired renal function. Interleukin-6 (IL-6) and serum creatinine have potential as biomarkers for early detection of PE; however, data from Indonesia are limited. The aim of this study was to compare IL-6 and serum creatinine levels between pregnant women with PE and normotensive controls, as well as their diagnostic performance in identifying PE. A cross-sectional study involving pregnant women with PE and normotensive controls was conducted at Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. Serum IL-6 and creatinine levels were measured using the ECLIA method. Levels were compared using the Mann–Whitney test; diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis, and multivariable logistic regression was used to evaluate combined diagnostic contribution. A total of 68 pregnant women were included, comprising 34 patients with PE and 34 normotensive controls. Median IL-6 levels were significantly higher in the PE group (16.05 pg/mL) than in the control group (3.71 pg/mL). Receiver operating characteristic analysis demonstrated excellent diagnostic performance of IL-6, with an are under the curve (AUC) of 0.831 (95%CI: 0.734–0.929). At an optimal cutoff value of 5.52 pg/mL, IL-6 achieved a sensitivity of 73.53%, specificity of 76.47%, and diagnostic accuracy of 86.76%. Median serum creatinine levels were also significantly elevated in the PE group (0.56 mg/dL) compared with controls (0.44 mg/dL; p<0.001). The AUC for serum creatinine was 0.806 (95%CI: 0.700–0.912), indicating good diagnostic performance. At a cutoff value of 0.475 mg/dL, serum creatinine demonstrated a sensitivity of 70.59%, specificity of 73.53%, and accuracy of 72.06%. Multivariable logistic regression confirmed that IL-6 (B=0.123; p=0.005) and serum creatinine (B=9.306; p=0.023) were independently associated with PE, explaining 57.5% of PE variability (Nagelkerke R²=0.575). These findings indicate that serum IL-6 and creatinine are significantly associated with PE, and their combined assessment shows potential as a predictive biomarker with good diagnostic performance.

Determinants of intrauterine device use among reproductive-age women in a province implementing Islamic Sharia law in Indonesia: An application of the theory of planned behavior Purnama, Dean R.; Dewi, Tgk. Puspa; Rusnaidi, Rusnaidi; Utami, Niken A.; Aditya, Rizka; Suhanda, Rachmad
Narra J Vol. 6 No. 1 (2026): April 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i1.3025

The utilization of the intrauterine device (IUD) in Indonesia remains low at 3.9%, despite its high effectiveness (99.4%) and designation as a national family planning priority, suggesting the presence of psychosocial barriers influencing contraceptive behavior among women of reproductive age. This study aimed to analyze psychosocial factors influencing IUD use behavior based on the theory of planned behavior, including attitudes, subjective norms, perceived behavioral control, actual behavioral control, and intention, in Banda Aceh—the only province in Indonesia implementing holistic Sharia law. A quantitative cross-sectional study was conducted among women of reproductive age from six urban public health centers using cluster random sampling. Data were collected through face-to-face interviews using a structured TPB-based questionnaire validated for reliability. Statistical analyses included linear regression and binary logistic regression with a significance level set at p<0.05. A total of 442 women were included in the final analysis. Attitude toward IUD use, subjective norms, and perceived behavioral control were all significantly associated with intention to use an IUD, all had p<0.001. Attitudes toward IUD use (B=0.410; p<0.001; R²=0.213), subjective norms (B=0.552; p<0.001; R²=0.413), perceived behavioral control (B=0.273; p<0.001; R²=0.255), and actual behavioral control (B=0.273; p<0.001; R²=0.255) were all significantly associated with IUD use behavior. Intention to use an IUD emerged as the strongest predictor of IUD use behavior (B=0.780; p<0.001; R²=0.566). Intention to use an IUD emerged as the strongest predictor of IUD use behavior (B=0.78; p<0.001; R²=0.56). This study highlights that all intention was shaped by positive attitudes, strong subjective norms, and a high level of behavioral control. Efforts to increase IUD use should therefore focus on educational interventions, strengthening partner and social support, and improving the accessibility and quality of long-acting contraceptive services.

Cortisol and pregnancy-related anxiety in relation to preeclampsia among third-trimester pregnant women: A case–control study from Aceh, Indonesia Hezron, Teuku M.; Dewi, Tgk. Puspa; Septivera, Yusra; Rajuddin, Rajuddin; Utami, Niken A.
Narra J Vol. 5 No. 3 (2025): December 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i3.2985

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.

Comparison of interleukin-6 and serum creatinine levels in preeclampsia and normal pregnancy patients: A cross-sectional study in Indonesia Dewi, Syerli R.; Yeni, Cut M.; Munizar, Munizar; Dewi, Tgk. Puspa; Utami, Niken A.; Rusnaidi, Rusnaidi
Narra J Vol. 6 No. 1 (2026): April 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i1.3016

Preeclampsia (PE) is a complication of pregnancy with high morbidity and mortality, characterized by endothelial dysfunction, systemic inflammation, and impaired renal function. Interleukin-6 (IL-6) and serum creatinine have potential as biomarkers for early detection of PE; however, data from Indonesia are limited. The aim of this study was to compare IL-6 and serum creatinine levels between pregnant women with PE and normotensive controls, as well as their diagnostic performance in identifying PE. A cross-sectional study involving pregnant women with PE and normotensive controls was conducted at Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. Serum IL-6 and creatinine levels were measured using the ECLIA method. Levels were compared using the Mann–Whitney test; diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis, and multivariable logistic regression was used to evaluate combined diagnostic contribution. A total of 68 pregnant women were included, comprising 34 patients with PE and 34 normotensive controls. Median IL-6 levels were significantly higher in the PE group (16.05 pg/mL) than in the control group (3.71 pg/mL). Receiver operating characteristic analysis demonstrated excellent diagnostic performance of IL-6, with an are under the curve (AUC) of 0.831 (95%CI: 0.734–0.929). At an optimal cutoff value of 5.52 pg/mL, IL-6 achieved a sensitivity of 73.53%, specificity of 76.47%, and diagnostic accuracy of 86.76%. Median serum creatinine levels were also significantly elevated in the PE group (0.56 mg/dL) compared with controls (0.44 mg/dL; p<0.001). The AUC for serum creatinine was 0.806 (95%CI: 0.700–0.912), indicating good diagnostic performance. At a cutoff value of 0.475 mg/dL, serum creatinine demonstrated a sensitivity of 70.59%, specificity of 73.53%, and accuracy of 72.06%. Multivariable logistic regression confirmed that IL-6 (B=0.123; p=0.005) and serum creatinine (B=9.306; p=0.023) were independently associated with PE, explaining 57.5% of PE variability (Nagelkerke R²=0.575). These findings indicate that serum IL-6 and creatinine are significantly associated with PE, and their combined assessment shows potential as a predictive biomarker with good diagnostic performance.

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