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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 665 Documents
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Effectiveness of early weight-bearing rehabilitation protocols on outcomes after surgical fixation of pelvic and acetabular fractures: A systematic review Muhammad A. Junaidi; Rizki F. Suskhan; Wilton W. Iskandar
Narra J Vol. 6 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i2.3122

Abstract

Optimal postoperative weight-bearing management following surgical fixation of pelvic and acetabular fractures remains incompletely defined. Prolonged restriction carries well-recognized risks of immobility-related morbidity, yet the safety and efficacy of early weight bearing (EWB) after screw-based constructs have not been rigorously synthesized. This review evaluates the available evidence on fixation stability, functional recovery, and complication rates following explicitly prescribed EWB protocols after surgical fixation of pelvic and acetabular fractures using screw-dominant or minimally invasive stabilization constructs. A systematic review was conducted in accordance with PRISMA 2020 guidelines. Eligible studies included adult patients who underwent screw-dominant or minimally invasive surgical fixation for pelvic or acetabular fractures and whose postoperative protocol explicitly prescribed EWB initiation within two weeks of surgery. Studies prescribing restricted or delayed weight bearing as the primary protocol were excluded. Methodological quality was appraised using the Methodological Index for Non-Randomized Studies (MINORS). Electronic databases (PubMed, Scopus, the Cochrane Library, and Google Scholar) were systematically searched as of December 2025. Six studies encompassing 297 patients met the final eligibility criteria. The evidence base consisted predominantly of retrospective case series, with one comparative cohort study identified. Across the included studies, catastrophic fixation failure was uncommon in carefully selected patients receiving EWB, and the included studies did not consistently demonstrate increased rates of loss of reduction. Functional recovery was generally favorable, and complication rates were low. Substantial heterogeneity across fracture morphology, fixation techniques, and EWB definitions precluded meta-analysis. Current literature on EWB following pelvic and acetabular fixation consists predominantly of low-level retrospective evidence subject to meaningful selection bias. While EWB appears feasible and catastrophic fixation failure was uncommon in these highly selected cohorts, the absence of high-quality comparative trials precludes confirmation of its widespread safety. EWB should currently be regarded as a feasibility concept applicable to carefully selected patients with stable fixation, rather than a routine recommendation. Prospective randomized trials are needed to establish definitive guidance.
Mediating effect of loneliness in association between smartphone use and depression among older adults in West Bengal, India: An analytical cross-sectional study Sembagamuthu Sembiah; Sunom M. Lepcha; Md AK. Gazi; Loknath Agasti; Madhu S. Nayak; Jagyabalya Sahu; Jishnu Dhali; Himanshu Choudhary; Koushik Mondal; Khushi Singhania
Narra J Vol. 6 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i2.3098

Abstract

Smartphone use among older adults is increasing and may influence mental well-being by improving social connection and reducing loneliness. This community-based analytical cross-sectional study assessed the association between smartphone use and depression among older adults and examined whether loneliness mediated this relationship. The study included adults aged 60 years and above from an urban community in Nadia district, West Bengal, India. Data on sociodemographic characteristics and smartphone use were collected using a pretested, semi-structured questionnaire. Depression was assessed using the Center for Epidemiologic Studies Depression Scale Revised-10 item version, while loneliness was assessed using the 8-item UCLA Loneliness Scale. Linear regression and mediation analyses were performed to evaluate the associations among smartphone use, loneliness, and depression. Overall, 153 participants (62.7%) used smartphones. Smartphone users had lower mean depression scores than non-users (14.15±4.96 vs 16.61±5.24) and lower mean loneliness scores (15.77±5.18 vs 17.90±5.23). Depression was observed in 83.7% of smartphone users and 92.3% of non-users, while loneliness was observed in 45.8% and 63.7%, respectively. Smartphone use was significantly associated with lower depression scores (B=-2.30; p<0.001) and lower loneliness scores (B=-2.12; p=0.002). Mediation analysis showed that loneliness partially mediated the association between smartphone use and depression, accounting for 60.7% of the total effect. These findings suggest that smartphone use may be associated with lower depressive symptoms among older adults, partly through reduced loneliness. Digital inclusion strategies that promote meaningful social connection may have potential value for public mental health interventions targeting elderly populations.
Nanoliposomal curcumin as a potential pro-apoptotic agent for cervical cancer: Evidence from Bcl-2 and Bax modulation in HeLa cells Subandi Subandi; Oktalia N. Aisyah; Bayu Lestari
Narra J Vol. 6 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i2.3126

Abstract

Cervical cancer remains a major cause of cancer-related mortality, and treatment effectiveness is often limited by drug resistance and systemic toxicity. Curcumin has shown anticancer activity, but its clinical translation is constrained by poor solubility and low bioavailability. Nanoliposomal curcumin (Cur-NLPs) may improve intracellular delivery; however, its dose-dependent effect on apoptosis-related proteins in cervical cancer cells remains insufficiently defined. This study evaluated the dose-dependent modulation of Bcl-2 and Bax protein expression by Cur-NLPs in HeLa cells. HeLa cells were assigned to five groups: negative control, cisplatin 5 µg/mL as positive control, and Cur-NLPs at 100, 150, and 200 µg/mL. After 24 hours of treatment, Bcl-2 and Bax expression were assessed by immunofluorescence and quantified as corrected total cell fluorescence (CTCF). Data were analyzed using one-way ANOVA, Tukey HSD post hoc test, Pearson correlation, and linear regression. Significant between-group differences were observed for both Bcl-2 (F=8.99; p=0.002) and Bax (F=132.38; p<0.001). Cur-NLPs progressively reduced Bcl-2 expression and increased Bax expression, with the most pronounced effect observed at 200 µg/mL. Bcl-2 expression at 200 µg/mL and Bax expression at 150–200 µg/mL were significantly altered compared with the negative control, while the 200 µg/mL dose showed no significant difference from cisplatin for either marker. Cur-NLPs concentration showed a strong negative correlation with Bcl-2 expression (r=-0.847; p<0.001) and a strong positive correlation with Bax expression (r=0.942; p<0.001). Linear regression further confirmed dose-dependent effects, with Cur-NLPs concentration explaining 79.6% and 88.8% of the variance in Bcl-2 and Bax expression, respectively. These findings indicate that Cur-NLPs can shift the Bcl-2/Bax balance toward a pro-apoptotic profile in HeLa cells, supporting its potential as a curcumin-based nanodelivery strategy for cervical cancer. Further studies using functional apoptosis assays, additional cervical cancer cell lines, and in vivo models are needed to confirm its translational relevance.
Prevalence and factors associated with malnutrition among patients with pre-dialysis chronic kidney disease stages 3–5 Chantisa Arayangkoon; Wittawat Wattanasiriporn
Narra J Vol. 6 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i2.3128

Abstract

Malnutrition is a common and clinically significant complication in patients with chronic kidney disease (CKD), contributing to increased morbidity and mortality. However, evidence regarding its prevalence and associated factors in pre-dialysis CKD remains limited. The aim of this study was to determine the prevalence of malnutrition, compare its distribution across CKD stages, and identify factors associated with malnutrition in patients with pre-dialysis CKD stages 3–5. This cross-sectional study included patients with CKD stages 3–5 attending the nephrology clinic at Rajavithi Hospital, Thailand, between January and December 2025. Nutritional status was assessed using the Nutrition Alert Form (NAF). Demographic, clinical, dietary, and laboratory data were collected. Factors associated with malnutrition were analyzed using logistic regression. A total of 313 patients were included. The prevalence of malnutrition was 39.30%, including 34.50% moderate and 4.79% severe malnutrition. Independent factors associated with malnutrition included underweight (adjusted OR (aOR): 5.10; 95%CI: 1.26–20.68), severe obesity (aOR: 7.33; 95%CI: 2.53–21.22), history of stroke (aOR: 85.23; 95%CI: 19.23–377.70), weight loss within 4 weeks (aOR: 7.55; 95%CI: 2.92–19.51), increased weight within 4 weeks (aOR: 3.10; 95%CI: 1.19–8.07), reduced dietary intake (aOR: 46.42; 95%CI: 10.39–207.38), impaired food access (aOR: 10.63; 95%CI: 2.88–39.23), CKD stage 5 (aOR: 2.22; 95%CI: 1.14–4.31), higher serum creatinine (aOR: 1.86; 95%CI: 1.19–2.90), and lower lymphocyte percentage (aOR: 0.93; 95%CI: 0.89–0.97). Malnutrition was highly prevalent among patients with pre-dialysis CKD stages 3–5, and the findings suggest a possible U-shaped association between body habitus and malnutrition, with both underweight and severe obesity independently associated with increased nutritional risk. These findings support the importance of routine nutritional screening across all CKD stages regardless of BMI status and may help identify patients at increased nutritional risk.
Correlation between serum bone remodeling biomarkers and CTX-1 levels among patients with rheumatoid arthritis: A cross-sectional study at a provincial referral hospital in Indonesia Najirman Najirman; Eka Kurniawan; Herdian Herdian
Narra J Vol. 6 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i2.2831

Abstract

Rheumatoid arthritis (RA) is associated with accelerated bone loss, partly mediated by dysregulation of the receptor activator of nuclear factor-κB (RANK)/RANK ligand (RANKL)/osteoprotegerin (OPG) pathway, which regulates osteoclast activity. Carboxy-terminal cross-linked telopeptide of type I collagen (CTX-1) is a biochemical marker of bone resorption and may reflect increased skeletal turnover in RA. Although previous studies have evaluated RANKL, OPG, and the RANKL/OPG ratio in relation to bone mineral density, osteoporosis, and fracture risk, the correlations of circulating RANK, RANKL, and OPG with CTX-1 remain insufficiently characterized in patients with RA. The aim of this study was to evaluate the correlations of serum RANK, RANKL, and OPG levels with serum CTX-1 levels in patients with RA. An analytical cross-sectional study was conducted at a provincial referral hospital in Padang, Indonesia, from July to December 2024, during which patients with RA were recruited through consecutive sampling. Serum RANK, RANKL, OPG, and CTX-1 concentrations were measured using enzyme-linked immunosorbent assays. Correlations were assessed using Pearson’s correlation analysis. The mean age of the patients was 40.30±5.08 years. The mean serum concentrations of RANK, RANKL, OPG, and CTX-1 were 5.20±2.83, 6.55±3.14, 0.17±0.09, and 2.10±1.10 ng/mL, respectively. Serum RANK and RANKL levels showed very strong positive correlations with CTX-1 levels (r=0.928 and r=0.929, respectively; both p<0.001). Serum OPG levels also showed a strong positive correlation with CTX-1 levels (r=0.786; p<0.001). These findings suggest that circulating components of the RANK/RANKL/OPG pathway are associated with biochemical bone resorption in patients with RA. However, a larger longitudinal study incorporating disease activity, treatment exposure and bone mineral density is required to determine their clinical relevance.
Skin–mind connection in atopic dermatitis: Associations of disease severity with skin barrier function, stress, anxiety, and quality of life Fitria Fitria; Nanda Earlia; Zahrani Zahrani; Cynthia W. Asrizal; Zayyan Nafis; Zahwa Nabila
Narra J Vol. 6 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i2.3125

Abstract

Although skin barrier dysfunction and psychosocial impairment are well-recognized features of atopic dermatitis, its association remains incompletely understood. Evidence integrating objective measures of skin barrier function with stress, anxiety, quality of life, and disease severity is limited. Therefore, the aim of this study was to investigate the associations of disease severity with skin barrier function, psychological status, and quality of life, and in patients with atopic dermatitis. A hospital-based cross-sectional study was conducted at the Dermatology, Venereology, and Aesthetic Outpatient Clinic of Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia, in 2025. Adults aged ≥20 years with atopic dermatitis diagnosed according to the Hanifin–Rajka criteria were recruited consecutively. Disease severity was assessed using the Scoring Atopic Dermatitis (SCORAD) index. Skin barrier function was evaluated by measuring transepidermal water loss (TEWL) and stratum corneum hydration using a Tewameter and Corneometer, respectively. Anxiety, perceived stress, and quality of life were assessed using the Zung Self-Rating Anxiety Scale (SAS), Perceived Stress Scale (PSS), and Dermatology Life Quality Index (DLQI). Most patients were female (62.5%), and 68.8% had mild disease. Disease severity was not significantly associated with TEWL (p=0.923), skin hydration (p=0.208), SAS (p=0.560), PSS (p=0.841) or DLQI (p=0.621). Spearman's correlation analysis likewise demonstrated no significant correlation between disease severity and TEWL (r=-0.052, p=0.770), skin hydration (r=-0.136, p=0.450), SAS (r=−0.0150, p=0.930), PSS scores (r=–0.155, p=0.390) or DLQI (r=0.062. p=0.730). In conclusion, although greater skin barrier dysfunction and psychosocial burden tended to be observed in patients with moderate and severe atopic dermatitis, no significant associations were observed between disease severity and skin barrier function, anxiety, perceived stress or quality of life. The relatively small sample size and cross-sectional design may have limited the ability to detect significant associations.
Association and predictive performance of platelet-to-lymphocyte ratio and maternal serum ferritin level for preterm birth: A prospective cohort study Sofie D. Wahyudi; Cut M. Yeni; Niken A. Utami; Hasanuddin Hasanuddin; Yusra Septivera; Muhammad Yani
Narra J Vol. 6 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i2.3131

Abstract

Although maternal inflammation is increasingly recognized in the pathogenesis of preterm birth, evidence regarding the combined predictive value of platelet-to-lymphocyte ratio (PLR) and maternal serum ferritin levels remains scarce. The aim of this study was to evaluate the association and predictive performance of PLR and maternal serum ferritin levels, two readily available inflammatory biomarkers, with the incidence of preterm birth. A prospective cohort study was conducted. Pregnant women with singleton pregnancies between 28 and 36 weeks 6 days of gestation were consecutively recruited and followed until delivery. PLR was calculated from absolute platelet and lymphocyte counts obtained from complete blood count analysis, while maternal serum ferritin levels were measured using electrochemiluminescence immunoassay. The present study found that higher PLR (odds ratio (OR): 1.013; 95%CI: 1.002–1.025; p=0.025) and maternal serum ferritin levels (OR: 1.016; 95%CI: 1.002–1.031; p=0.029) were significantly associated with the incidence of preterm birth. In multivariable analysis, PLR ≥134.4 (adjusted OR: 3.701; 95%CI: 1.186–11.548; p=0.024) and maternal serum ferritin levels ≥29.3 ng/mL (adjusted OR: 4.513; 95%CI: 1.351–15.075; p=0.014) remained independently associated with preterm birth. Receiver operating characteristic analysis demonstrated very modest discriminatory performance for both PLR (area under the curve (AUC): 0.632, p=0.076) and maternal serum ferritin levels (AUC: 0.645, p=0.052), with optimal cut-off values of 134.4 and 29.3 ng/mL, respectively. These findings support the contribution of maternal inflammatory processes to the development of preterm birth and suggest that PLR and maternal serum ferritin levels may provide complementary information for risk assessment. However, the modest predictive performance observed indicates that these biomarkers are unlikely to be sufficient as standalone screening tools and should be interpreted alongside established clinical predictors.
Diagnostic performance of hematological inflammatory biomarkers for assessing endometriosis severity and pelvic pain severity Mala Hayati; Rusnaidi Rusnaidi; Ima Indirayani; Hasanuddin Hasanuddin; Dewi K. Rusly; Muhammad Yani
Narra J Vol. 6 No. 3 (2026): December 2026 (In Press)
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i3.3130

Abstract

Endometriosis is a chronic inflammatory disease frequently associated with pelvic pain and infertility. Since systemic inflammation may reflect disease activity, hematological inflammatory biomarkers obtained from routine blood tests have been proposed as non-invasive indicators of endometriosis severity. The aim of this study was to evaluate the association of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and monocyte-to-lymphocyte ratio (MLR) with endometriosis severity and pelvic pain severity, as well as to assess their diagnostic performance. A cross-sectional study was conducted at Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia, among women with histopathologically confirmed endometriosis. Endometriosis severity was classified intraoperatively according to the revised American Society for Reproductive Medicine (rASRM) staging system. Pelvic pain severity was assessed preoperatively using the Numeric Rating Scale (NRS). Hematological inflammatory biomarkers were calculated from preoperative complete blood count results. The associations and diagnostic performance of the biomarkers in relation to endometriosis severity and pelvic pain severity were evaluated using correlation analysis and receiver operating characteristic (ROC) curve analysis. Our data indicated that NLR (r=0.460; p<0.001), SII (r=0.439; p=0.001), and MLR (r=0.391; p=0.003) had significant positive correlations with endometriosis severity, whereas PLR demonstrated a borderline correlation (r=0.261; p=0.050). ROC analysis showed good diagnostic performance for NLR (AUC=0.784; p=0.005), SII (AUC=0.777; p=0.006), and MLR (AUC=0.783; p=0.005), while PLR was not statistically significant (AUC=0.679; p=0.078). NLR (r=0.295; p=0.026) and SII (r=0.275; p=0.038) showed weak but significant positive correlations with pelvic pain severity, whereas PLR and MLR had no significant association. None of the biomarkers demonstrated significant diagnostic performance for pelvic pain severity. NLR, SII, and MLR may serve as accessible and inexpensive adjunctive indicators of endometriosis severity, particularly in resource-limited settings; however, their utility for assessing pelvic pain severity appears limited.
Association and discriminative performance of TNF-α and CA125 for disease severity and pain severity in endometriosis patients Rauzatul Jannah; Rusnaidi Rusnaidi; Hasanuddin Hasanuddin; Cut Meurah Yeni; Dewi Karlina Rusly; Muhammad Yani
Narra J Vol. 6 No. 3 (2026): December 2026 (In Press)
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i3.3132

Abstract

Endometriosis is a chronic inflammatory disease frequently associated with pelvic pain and disease progression. Tumor necrosis factor-alpha (TNF-α) and cancer antigen 125 (CA125) have been proposed as potential biomarkers reflecting inflammatory activity and disease burden. However, evidence remains limited on whether these biomarkers are associated with both anatomical disease severity and pain severity, particularly among patients with histopathologically confirmed endometriosis. The aim of this study was to evaluate the associations and discriminative performance of TNF-α and CA125 in relation to endometriosis severity and pain severity. A cross-sectional study was conducted at Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia, from October 2025 to January 2026, in which women with histopathologically confirmed endometriosis were included. Disease severity was classified intraoperatively using the revised American Society for Reproductive Medicine (rASRM) system. Pain severity was assessed using the Numeric Rating Scale (NRS). Peritoneal fluid TNF-α was measured using enzyme-linked immunosorbent assay (ELISA), and serum CA125 was measured using electrochemiluminescence immunoassay (ECLIA). Associations were analyzed using Spearman correlation, and discriminative ability was assessed using receiver operating characteristic (ROC) curve analysis. CA125 showed a significant positive correlation with rASRM stage (r=0.401; p=0.005) and TNF-α showed no significant correlation (r=0.068; p=0.649). ROC analysis demonstrated that CA125 had good discriminative ability for disease severity (AUC=0.808; p<0.001) with an optimal cut-off value of 32 U/mL. For pain severity, both CA125 (r=0.344; p=0.018) and TNF-α (r=0.338; p=0.020) had weak but significant positive correlations with NRS scores. ROC analysis indicated fair discriminative ability of CA125 (AUC=0.700; p=0.010) and TNF-α (AUC=0.674; p=0.031) for severe pain, with optimal cut-off values of 50.85 U/mL and 0.023 pg/mL, respectively. These findings highlight that CA125 is more consistently associated with endometriosis severity than TNF-α, while both biomarkers show limited ability to discriminate pain severity.
Prevalence, co-occurrence patterns, and factors associated with multiple sexually transmitted infections among men living with HIV in Indonesia: A cross-sectional study in Surakarta Labitta P. Aquaira; Elsita Lisnawati; Endra Y. Ellistasari; Nugrohoaji Dharmawan; Adniana Nareswari
Narra J Vol. 6 No. 3 (2026): December 2026 (In Press)
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i3.3093

Abstract

Men living with human immunodeficiency virus (HIV) may experience a substantial burden of sexually transmitted infections (STIs), including concurrent infections. The aim of this study was to determine the prevalence and co-occurrence patterns of multiple STIs and identify factors associated with their occurrence among male patients living with HIV. A retrospective cross-sectional study was conducted using medical records of 70 male patients living with HIV who were diagnosed with at least one active STI at Dr. Moewardi Regional General Hospital, Surakarta, Indonesia, between January 2019 and December 2023. Demographic characteristics, sexual orientation, number of sexual partners, and STI diagnoses were analyzed using bivariate analysis and multivariable binary logistic regression. Multiple STIs were identified in 18.6% of participants. Condyloma acuminata was the most frequently documented single STI (50.0%), while condyloma acuminata with syphilis was the predominant multiple-STI combination (14.3%). In the bivariate analysis, sexual orientation (p=0.005) and number of sexual partners (p=0.003) were significantly associated with multiple STIs, whereas age and education level were not. After adjustment, having more than one sexual partner remained significantly associated with multiple STIs (OR=6.93; 95%CI: 1.20–39.95; p=0.030), while sexual orientation was not significantly associated in the overall multivariable model (p=0.165). These findings support comprehensive STI screening and careful assessment of sexual behavior among men living with HIV, particularly those reporting multiple sexual partners.

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