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Narra J
Published by PT Narra Sains Indonesia
ISSN : -     EISSN : 28072618     DOI : https://doi.org/10.52225/narraj
Core Subject : Health, Science,
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health
Narra J is a multidisciplinary journal and it is published three times (April, August, December) a year. The objective is to promote articles on infection, public health, global health, tropical infection, one health and diseases in tropics. Narra J publishes original research work across all disciplines of medicine and allied sciences, related to infection, public health, global health, tropical infection, one health and diseases in tropics. The journal publishes Original articles, Short Report, Review articles, and Letters to the Editor. All articles published in Narra J are peer-reviewed and published online for immediate access and citation. Narra J publishes the primary research papers, review articles, short communications and letters on topics but not limited to: Public health Global health Infection Tropical diseases One health Biomedical sciences Epidemiology and clinical epidemiology Molecular biology Environmental health Microbiology Pharmacological sciences Diseases in tropics
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 565 Documents
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Analysis of specialist doctors' behavior towards SGLT2 inhibitors prescription in Indonesia: A qualitative study Cokro, Fonny; Sauriasari, Rani; Tahapary, Dicky L.; Setiawan, Heri; Martha, Evi
Narra J Vol. 5 No. 1 (2025): April 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i1.2089

Abstract

Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have a broad range of clinical indications and are recommended by various guidelines for the management of diabetes, heart failure, and chronic kidney disease. However, prescribing rates for these agents are suboptimal towards various intended indications in many countries, including Indonesia. The aim of this study was to analyze the prescribing practices of SGLT2is among endocrinologists, cardiologists, and nephrologists in Indonesia. A qualitative method was utilized to provide a comprehensive understanding of this phenomenon. Semi-structured online interviews were performed with 18 participants, comprising seven specialized doctors as primary informants; eight key informants representing pharmacies, governmental bodies, and pharmaceutical marketing representatives; and three patients as supplementary informants. Furthermore, closed observations of two specialist doctors were undertaken as an additional data collection method. Informants were recruited using criterion and snowball sampling methods. The Theoretical Domains Framework was used as an interview guide; all interviews were audio visual-recorded, transcribed verbatim, and subsequently analyzed for thematic content with NVivo version 12. Seven themes emerged concerning the prescribing behavior of SGLT2is: socioeconomic status, therapeutic rationality, utilization barriers, utilization optimization, the urge to prescribe, therapeutic expectations and targets, and aspects of the health system and ethical considerations. Most informants possessed favorable perspectives regarding using SGLT2is when prescribed appropriately, yet specific elements necessitate enhancement to refine therapeutic justification, including initiatives to incorporate SGLT2is into the national formulary.
Moringa oil-based nanocarrier system containing curcumin formulation as anti- breast cancer agent: Efficacy and safety study Widodo, Ferri; Anggadiredja, Kusnandar; Amalia, Riezki; Rachmawati, Heni
Narra J Vol. 5 No. 1 (2025): April 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i1.2101

Abstract

Current 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.
Predicting the risks of stroke, cardiovascular disease, and peripheral vascular disease among people with type 2 diabetes with artificial intelligence models: A systematic review and meta-analysis Nur, Aqsha; Tjandra, Sydney; Yumnanisha, Defin A.; Keane, Arnold; Bachtiar, Adang
Narra J Vol. 5 No. 1 (2025): April 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i1.2116

Abstract

Macrovascular complications, including stroke, cardiovascular disease (CVD), and peripheral vascular disease (PVD), significantly contribute to morbidity and mortality in individuals with type 2 diabetes mellitus (T2DM). The aim of this study was to evaluate the performance of artificial intelligence (AI) models in predicting these complications, emphasizing applicability in diverse healthcare settings. Following PRISMA guidelines, a systematic search of six databases was conducted, yielding 46 eligible studies with 184 AI models. Predictive performance was assessed using the area under the receiver operating characteristic curve (AUROC). Subgroup analyses examined model performance by outcome type, predictor data (lab-only, non-lab, mixed), and algorithm type. Heterogeneity was evaluated using I2 statistics, and sensitivity analyses addressed outliers and study biases. The pooled AUROC for all AI models was 0.753 (95%CI: 0.740–0.766; I2=99.99%). Models predicting PVD achieved the highest AUROC (0.794), followed by cerebrovascular diseases (0.770) and CVD (0.741). Gradient-boosting algorithms outperformed others (AUROC: 0.789). Models with lab-only predictors had superior performance (AUROC: 0.837) compared to mixed (0.759) and non-lab predictors (0.714). External validations reported reduced AUROC (0.725), underscoring limitations in generalizability. AI models show moderate predictive accuracy for T2DM macrovascular complications, with laboratory-based predictors being key to performance. However, the limited external validation and reliance on high-resource data restrict implementation in low-resource settings. Future efforts should focus on non-lab predictors, external validation, and context-appropriate AI solutions to enhance global applicability.
Effect of the modified Atkins diet on NLRP3, caspase-1, IL-1β, and IL-10 in patients with tetralogy of Fallot undergoing open-heart surgery: A randomized controlled trial Yanuarso, Piprim B.; Djer, Mulyadi M.; Hendarto, Aryono; Pudjiadi, Antonius H.; Rachmadi, Lisnawati; Wibowo, Heri; Advani, Najib; Murni, Indah K.; Kekalih, Aria; Sukardi, Rubiana; Dilawar, Ismail; Susanti, Dhama S.; Supriatna, Novianti
Narra J Vol. 5 No. 1 (2025): April 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i1.2138

Abstract

Cardiopulmonary bypass in tetralogy of Fallot (TOF) corrective surgery induces hyperinflammation by activating NLRP3, caspase-1, and interleukin-1β (IL-1β), subsequently triggering an interleukin-10 (IL-10) response. Despite its known metabolic and anti-inflammatory effects, the impact of the modified Atkins diet (MAD) in pediatric cardiac surgery remains unexplored, with no studies on its use in TOF patients undergoing open-heart surgery. The aim of this study was to assess the effect of MAD on the expression of NLRP3, caspase-1, IL-1β, and IL-10, in TOF patients undergoing open-heart surgery. A double-arm, randomized-controlled trial was conducted with 44 TOF patients. The treatment group (n=22) received the MAD, a low-carbohydrate, high-fat regimen with unrestricted fat and protein intake for at least 14 days preoperatively, while the control group (n=22) followed a standard diet without carbohydrate restriction. Blood plasma and infundibulum heart tissues were collected for analysis. Whole blood samples were collected using a winged infusion needle before the intervention, an Abbocath infusion needle after 14 days of intervention, and a syringe without a needle connected to an arterial line in patients undergoing open-heart surgery at 6, 24, and 48 hours post-surgical correction. Infundibulum heart tissues were collected during the open-heart surgery. This study demonstrated significant differences in NLRP3 protein expression (p=0.015), caspase-1 protein expression (p=0.001), and IL-10 levels between before intervention and 6-, 24-, and 48-hours post-surgery in the MAD group compared to the control group. In contrast, no significant differences in IL-10 levels were observed in the control group between before intervention and 48 hours post-surgery (p=0.654). In conclusion, MAD may modulate perioperative inflammation in TOF patients undergoing open-heart surgery by downregulating NLRP3 and caspase-1 expression while sustaining IL-10 levels. Despite reduced NLRP3 and caspase-1 expression, unchanged IL-1β levels indicate alternative regulatory mechanisms.
Impact of lumbar support on pain reduction in low back pain patients: A systematic review and meta-analysis of randomized control trials Akbar, Muh. S; Syafar, Muhammad; Thamrin, Yahya; Aras , Djohan; Maidin, Alimin; Arsyad, Muhammad
Narra J Vol. 5 No. 1 (2025): April 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i1.2165

Abstract

Low back pain (LBP) is a global health concern, affecting millions and contributing significantly to disability and economic burden. Various non-pharmacological interventions, including lumbar support, have been explored for LBP management. However, its efficacy remains debated due to inconsistent findings. The aim of this study was to evaluate the impact of lumbar support on pain reduction in individuals with LBP and compare its effectiveness to alternative interventions. A systematic search was conducted across multiple databases (PubMed, ScienceDirect, Scopus, SpringerLink, Google Scholar, and ProQuest) for studies published up to 2023. Data from six search engines were searched using inclusion criteria based on the PICO framework. Search terms included low back pain, lumbar support, lumbar orthose and randomized controlled trial, combined using Boolean operators. Sixteen randomized controlled trials (RCTs) were included in the systematic review, with eight studies analyzed in the meta-analysis. Eligible studies focused on adults with non-specific LBP, assessing pain levels using the Visual Analog Scale (VAS). The meta-analysis was assessed using the standardized mean difference (SMD) in the Visual Analog Scale (VAS). The meta-analysis revealed a statistically significant pain reduction with lumbar support compared to other interventions (SMD: 1.33; 95%CI: -2.09–(-0.57)); p=0.0006), though with high heterogeneity (I²=97%). The findings indicated that lumbar support effectively reduces pain and improves health-related quality of life, particularly in physically demanding occupations or among individuals with severe pain. While efficacy may depend on specific conditions, lumbar support represents a viable non-pharmacological option for LBP management.
Antibiotic use patterns and factors associated with leukocyte decrease in COVID-19 patients with suspected secondary infections: A cross-sectional study in Indonesia Ginting, Pricella A.; Padmasawitri, Tjokorde IA.; Hanum, Nadia; Nurhayati, Raden D.; Soeroto, Arto Y.; Amalia, Lia
Narra J Vol. 5 No. 1 (2025): April 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i1.2170

Abstract

Antibiotics are frequently prescribed to coronavirus disease 2019 (COVID-19) patients, often without evidence of bacterial superinfection, increasing the risk of antibiotic resistance and posing a public health threat. The aim of this study was to evaluate antibiotic prescribing patterns in COVID-19 patients with suspected secondary infections and to assess the association between antibiotic use and clinical outcomes, particularly leukocyte count. The study analyzed 376 hospitalized COVID-19 patients from two hospitals in Bandung, Indonesia, between 2020 and 2022. All included patients were aged ≥17 years with confirmed COVID-19, leukocyte count >11,000 μg/L, and received antibiotic therapy. The Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) and drug utilization (DU) 90% were used to assess prescribing patterns. The patients’ demographic characteristics, clinical and culture results were also collected. Our data indicated that most patients received multiple antibiotics (>2), with prescribing patterns significantly associated with age, confirmed bacterial pathogen, length of hospital stay and having tuberculosis infection. The most frequently identified pathogens included Gram-positive bacteria Staphylococcus aureus, Staphylococcus haemolyticus and Gram-negative bacteria Klebsiella pneumoniae, Acinetobacter baumannii, and Escherichia coli. The most frequently prescribed antibiotics were azithromycin, levofloxacin, and ceftriaxone. No significant association was found between the number of antibiotics prescribed and clinical outcome (leukocyte normalization). Broad-spectrum antibiotics from the World Health Organization (WHO) AWaRe "Watch" category dominated the antibiotic prescriptions in the patients. While antibiotic selection was generally aligned with pathogen type and comorbidities, standardized guidelines remain crucial to optimizing antibiotic use, particularly in settings with limited pathogen testing.
Efficacy of N-acetylcysteine and motivational enhancement therapy for nicotine addiction: A randomized clinical trial Nasrun, Martina WS.; Ginting, Tribowo T.; Siste, Kristiana; Pandelaki, Jacub; Kekalih, Aria; Louisa, Melva; Susanto, Agus D.; Utami, Diah S.; Tarigan, Immanuel N.; Trishna, Alya R.; Halim, Kelvin
Narra J Vol. 5 No. 1 (2025): April 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i1.2178

Abstract

N-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.
Design of lipid nanoparticle (LNP) containing genetic material CRISPR/Cas9 for familial hypercholesterolemia Prasetia, I GNJA.; Kurniati, Neng F.; Riani, Catur; Mudhakir, Diky
Narra J Vol. 5 No. 1 (2025): April 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i1.2217

Abstract

Familial hypercholesterolemia is a genetic disorder caused by mutations in the low-density lipoprotein receptor gene (LDLR) and the current treatment still focuses on symptom management. The aim of this study was to develop a lipid nanoparticle (LNP)-based delivery system for the CRISPR/Cas9 component in correcting LDLR gene mutations. LNPs were prepared using an ultrasonic-solvent emulsification technique by varying the surfactant: oil ratio (SOR), homogenization speed and time, and sonication time. Next, the LNP surface was modified by adding DSPE-PEG2000-NH2 and polyethyleneimine. The next stage is to design the single guide RNA (sgRNA) and Donor DNA wildtype (Donor DNA wt). This genetic material was complexed with LNP and then transfected into Hepa1-6 LDLR mt cells, an in vitro representation of cells suffering from familial hypercholesterolemia. This optimization process produced LNPs with a particle size of 118.6±0.8 nm and a polydispersity index of 0.34±0.03. The LNP surface modification resulted in a zeta potential of +7.5 mV. A transmission electron microscope (TEM) analysis howed spherical morphology with size distribution following a regular pattern. LNP cell viability tests showed good biocompatibility at concentrations <15 mM with a half-maximal inhibitory concentration (IC50) value of 27.7 mM. The dominant cellular uptake mechanism of LNP was through the clathrin-mediated endocytosis (CME) pathway. The Hepa1-6 LDLR mt cell model was successfully produced with the transfecting agent Lipofectamine 3000 by homology-directed repair (HDR) mechanism. The LNP-genetic material complex with a ratio of sgRNA:Cas9:Donor DNA wt (1:1:0.04) showed an increase in LDLR gene expression of 3.3±0.2 times and LDLR protein levels reached 12.95±0.25 ng/mL on day 4 after transfection. The results of this study indicate that the developed LNP-based delivery system has the potential for gene therapy applications in familial hypercholesterolemia.
Dual anti-inflammatory and antimicrobial effects of stingless bee propolis on second-degree burns Manginstar, Christian O.; Tallei, Trina E.; Salaki, Christina L.; Niode, Nurdjannah J.; Jaya, Hendra K.
Narra J Vol. 5 No. 1 (2025): April 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i1.2359

Abstract

Propolis, a natural resinous product from stingless bees, is widely recognized for its anti-inflammatory and antimicrobial properties. However, its combined effects in addressing both inflammation and infection in second-degree burns have remained insufficiently explored. The study aimed to investigate the dual role of propolis in modulating inflammation and preventing bacterial infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa in a second-degree burn model. Propolis was collected from stingless bees in Gowa, South Sulawesi, Indonesia, and extracted using methanol. Second-degree burns were induced in male Rattus norvegicus, which were then divided into three groups: one treated with propolis, another silver sulfadiazine (positive control), and third with NaCl (negative control). After seven days of treatment, the expression of tumor necrosis factor-alpha (TNF-α) and vascular endothelial growth factor (VEGF) proteins in wound samples was analyzed using immunohistochemistry. The antimicrobial activity of the propolis extract was assessed using the disc diffusion assay, followed by minimum inhibitory concentration (MIC) testing. Network pharmacology analysis was also conducted to assess the anti-inflammatory activity of propolis. Results showed that propolis significantly reduced TNF-α expression and increased VEGF expression, which might enhance VEGF-mediated angiogenesis, leading to improved wound healing compared to controls. The antimicrobial tests demonstrated strong activity against MRSA and P. aeruginosa, with inhibition zones correlating with higher extract concentrations. The MIC value of the propolis extract was 198.66 µg/µL against MRSA and 212.06 µg/µL against P. aeruginosa. Network pharmacology analysis revealed key proteins, including Jun proto-oncogene (JUN), estrogen receptor 1 (ESR1), signal transducer and activator of transcription 3 (STAT3), and proto-oncogene tyrosine-protein kinase Src (SRC), involved in the regulation of TNF-α and VEGF, further supporting the synergistic effects of propolis. This study demonstrates that stingless bee propolis effectively promotes tissue regeneration and prevents infection in second-degree burns, highlighting its potential as an alternative to conventional treatments for wound care.
Chinese generative AI models (DeepSeek and Qwen) rival ChatGPT-4 in ophthalmology queries with excellent performance in Arabic and English Sallam, Malik; Alasfoor, Israa M.; W. Khalid, Shahad; Al-Mulla, Rand I.; Al-Farajat, Amwaj; M. Mijwil, Maad; Zahrawi, Reem; Sallam, Mohammed; Egger, Jan; Al-Adwan, Ahmad S.
Narra J Vol. 5 No. 1 (2025): April 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i1.2371

Abstract

The rapid evolution of generative artificial intelligence (genAI) has ushered in a new era of digital medical consultations, with patients turning to AI-driven tools for guidance. The emergence of Chinese-developed genAI models such as DeepSeek-R1 and Qwen-2.5 presented a challenge to the dominance of OpenAI’s ChatGPT. The aim of this study was to benchmark the performance of Chinese genAI models against ChatGPT-4o and to assess disparities in performance across English and Arabic. Following the METRICS checklist for genAI evaluation, Qwen-2.5, DeepSeek-R1, and ChatGPT-4o were assessed for completeness, accuracy, and relevance using the CLEAR tool in common patient ophthalmology queries. In English, Qwen-2.5 demonstrated the highest overall performance (CLEAR score: 4.43±0.28), outperforming both DeepSeek-R1 (4.31±0.43) and ChatGPT-4o (4.14±0.41), with p=0.002. A similar hierarchy emerged in Arabic, with Qwen-2.5 again leading (4.40±0.29), followed by DeepSeek-R1 (4.20±0.49) and ChatGPT-4o (4.14±0.41), with p=0.007. Each tested genAI model exhibited near-identical performance across the two languages, with ChatGPT-4o demonstrating the most balanced linguistic capabilities (p=0.957), while Qwen-2.5 and DeepSeek-R1 showed a marginal superiority for English. An in-depth examination of genAI performance across key CLEAR components revealed that Qwen-2.5 consistently excelled in content completeness, factual accuracy, and relevance in both English and Arabic, setting a new benchmark for genAI in medical inquiries. Despite minor linguistic disparities, all three models exhibited robust multilingual capabilities, challenging the long-held assumption that genAI is inherently biased toward English. These findings highlight the evolving nature of AI-driven medical assistance, with Chinese genAI models being able to rival or even surpass ChatGPT-4o in ophthalmology-related queries.

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