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Narra X
Published by PT Narra Sains Indonesia
ISSN : -     EISSN : 29882990     DOI : DOI: https://doi.org/10.52225/narrax
Core Subject : Health, Science,
Biochemistry, Genetics & Molecular Biology Chemistry Immunology & microbiology Materials Science & Nanotechnology Medicine & Pharmacology Physics Public Health
Narra X is a multidisciplinary journal, published three times in a year (April, August, and December). The journal aims to act as a platform for rapid scientific communication while upholding the highest integrity. Articles are published in a form of Original articles, Short Report, Case Reports, Methods articles, Review articles, and Letters to the Editor. All submitted articles are subjected to peer-review prior to their publication. As a multidisciplinary journal, Narra X welcomes articles from any subject field, depending on the editorial capacity. At the moment, Narra X is handled by section editors in the following fields: Health and medicine Chemistry Biology Mathematics Physics Narra X is online only journal and all articles do not have page numbers; instead, they are given a unique article number.
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Articles 104 Documents
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Random forest-based QSAR modeling for predicting the potency of neprilysin inhibitors using Mordred molecular descriptors Nizam Albar; Derren DCH. Rampengan; Saiful Azhari; Mahmudi Mahmudi; Farrah Fahdhienie; Anggi Susilawati; Muhammad Habiburrahman
Narra X Vol. 4 No. 1 (2026): April 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narrax.v4i1.242

Abstract

Neprilysin (NEP) is a zinc-dependent metallopeptidase, considered a key therapeutic target in heart failure management. Efficient identification of potent NEP inhibitors remains a challenge in drug discovery. The aim of this study was to develop a quantitative structure–activity relationship (QSAR) model using 2D Mordred molecular descriptors and Random Forest algorithms to predict the inhibitory potency (pIC50) of drug candidates. A curated dataset of compounds with experimentally determined IC₅₀ values (in nM) against NEP was preprocessed and converted to pIC50. Mordred was used to calculate 2D molecular descriptors, and descriptors with missing values were excluded. The dataset was split into training, internal validation, and external test sets. A Random Forest regression model was trained using 500 estimators, and model performance was evaluated using R2, root mean square error (RMSE), mean absolute error (MAE), and concordance correlation coefficient (CCC), while a binary classification model was also constructed. Feature importance, residual analysis, and chemical space visualization were conducted to assess model interpretability and reliability. The regression model demonstrated moderate to strong predictive performance, with R2 of 0.286, RMSE of 0.949, MAE of 0.723, and CCC of 0.532 in the internal validation. External validation showed improved generalization, with R2=0.659, RMSE=0.858, MAE=0.630, and CCC=0.763. Binary classification revealed an accuracy of 0.953, precision of 1.000, recall of 0.943, and an F1-score of 0.971, indicating strong discriminative ability in classifying inhibitory versus non-inhibitory compounds. Top contributing descriptors included ATSC2p (feature importance=0.0505), GATS2p (0.0408), and SaasC (0.0317). Principal component analysis (PCA) and Williams plots confirmed that test compounds lie within the model’s applicability domain, with no major outliers in leverage or residual distribution. The developed Random Forest-based QSAR model demonstrates strong predictive power and interpretability for identifying NEP inhibitors. This study provides a valuable tool for virtual screening and highlights the relevance of 2D structural features in governing NEP inhibitory activity. It is the first dedicated QSAR analysis of neprilysin inhibition using Mordred descriptors with rigorous internal and external validation.
Technology-based contraceptive decision aids and the role of healthcare providers: A scoping review Syah R. Wisdayanti; Shinta Prawitasari
Narra X Vol. 4 No. 1 (2026): April 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narrax.v4i1.254

Abstract

Technology-based decision aids are increasingly integrated into contraceptive counseling to enhance informed decision-making and promote patient-centered care. However, evidence regarding their effectiveness on clinical outcomes and the evolving role of healthcare providers remains limited. The aim of this study was to map existing evidence on technology-based contraceptive decision aids and to examine the role of healthcare providers in supporting decision-making processes. The study was conducted in accordance with the PRISMA-ScR framework. A systematic search was performed across PubMed/MEDLINE, Cochrane Library, ProQuest, ScienceDirect, and Scopus for studies published between January 1, 2000, and March 1, 2025. Study selection and data extraction were performed independently by two reviewers, with discrepancies resolved through discussion. A total of five studies were included, encompassing web-based platforms, mobile applications, and tablet-based tools. The findings suggest that technology-based decision aids improve patient knowledge and satisfaction. However, the assisting technology does not improve contraceptive uptake and continuation rates. Across studies, healthcare providers remained essential in facilitating shared decision-making by contextualizing information, addressing patient concerns, and supporting individualized choices. In conclusion, current evidence suggests that the use of technology to support contraceptive decision-making improves subjective outcomes, but not clinical outcomes. Healthcare providers remain essential in complementing these tools, ensuring that decisions are informed and tailored to individual contexts. Further high-quality studies are needed to strengthen the evidence base and evaluate long-term effectiveness.
Effect of Mindfulness-Based Stress Reduction on burnout among nurses: A systematic review and meta-analysis of randomized controlled trials Ani Talia; Raniindra KS. Abidin; Oscar Jayanagara
Narra X Vol. 4 No. 1 (2026): April 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narrax.v4i1.259

Abstract

Burnout is highly prevalent among nurses, characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, and is associated with adverse impacts on mental health, professional performance, and quality of patient care. Mindfulness-Based Stress Reduction (MBSR) has been proposed as a potential intervention; however, evidence regarding its effectiveness across burnout dimensions remains inconsistent. The aim of this study was to systematically evaluate and quantify the effects of MBSR on burnout among nurses across the three Maslach Burnout Inventory (MBI) dimensions. A systematic search of PubMed, ScienceDirect, and the Cochrane Library was conducted up to October 2025. Eligible studies evaluated MBSR among nurses, with burnout outcomes measured using the MBI subscales: emotional exhaustion, depersonalization, and personal accomplishment. Meta-analyses were performed using inverse-variance random-effects model, with heterogeneity assessed using the I² statistic. Outcomes were categorized by follow-up duration: short-term (0–4 weeks), medium-term (>1–6 months), and long-term (>6 months). A total of seven RCTs were included in the meta-analysis. MBSR was associated with a significant reduction in emotional exhaustion overall (mean difference (MD): −5.80, 95% confidence interval (95%CI): −7.77 to −3.84; I²=26%), with the strongest effects observed in the short term (MD: −7.00), which attenuated in the medium term (MD: −5.03) and were not sustained at long-term follow-up. Depersonalization showed a modest overall reduction (MD: −2.71, 95%CI: −4.25 to −1.16), although heterogeneity was substantial (I²=70%) and effects were not maintained over time. No significant improvement was observed for personal accomplishment (MD: −0.53, 95%CI: −2.95 to 1.88; I²=88%). Risk of bias across studies was generally low to moderate, and no evidence of publication bias was identified. MBSR appears to provide short-term reductions in emotional exhaustion and may offer transient benefits for depersonalization; however, these effects diminish over time and no significant improvement is observed in personal accomplishment. These findings suggest that MBSR may function primarily as a short-term supportive intervention, and sustained reductions in burnout likely require integration with organizational strategies and ongoing support.
Association of reactive hyperglycemia, D-dimer, and asymmetric dimethylarginine (ADMA) with outcomes in acute ischemic stroke Imran Imran; Syahrul Syahrul; Nasrul Musadir
Narra X Vol. 4 No. 1 (2026): April 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narrax.v4i1.261

Abstract

Acute ischemic stroke is frequently accompanied by stress-related (reactive) hyperglycemia and may involve coagulation activation and endothelial dysfunction, reflected by D-dimer and asymmetric dimethylarginine (ADMA) levels, respectively. These factors may influence clinical outcomes. The aim of this study was to evaluate the associations of reactive hyperglycemia, D-dimer, and plasma ADMA with stroke outcomes in patients with acute ischemic stroke. A cross-sectional study was conducted among patients with acute ischemic stroke admitted to the neurology ward and stroke unit of Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia, between May and September 2024. Functional stroke outcome (FSO) was assessed using the Barthel Index, and disability stroke outcome (DSO) was assessed using the modified Rankin Scale (mRS). A total of 123 patients were included. The findings indicate that mean admission blood glucose was significantly higher in the improved FSO group than in the unchanged-worsened group (p=0.004), whereas mean blood glucose did not differ significantly across DSO categories (p=0.194). Mean D-dimer was significantly higher in the unchanged-worsened FSO group than in the improved group (538.6±249.4 vs 398.4±128.5 ng/mL; p<0.001). Across DSO categories, D-dimer showed a significant difference only between the no-disability and moderate-disability groups (p=0.044), without a consistent graded pattern. Mean ADMA levels were not significantly different between FSO groups (p=0.136), but it was statistically significant between DSO categories (slight vs moderate disability), p=0.045. The present analysis indicated that elevated D-dimer, dyslipidemia, heart disease, and GCS were significantly associated with FSO. Systolic blood pressure, diastolic blood pressure, reactive hyperglycemia, and hypertension were significantly associated with DSO severity. Overall, elevated D-dimer was more strongly associated with Barthel Index-based functional outcome, whereas reactive hyperglycemia was associated with mRS-based disability outcome.
In silico design of a multi-epitope rabies vaccine candidate incorporating African HLA diversity: A reverse vaccinology approach Moh R. Afnani; Nur F. Emilia; Efi Nurlaili; Anwar Rovik; Arif NM. Ansori; Arli A. Parikesit; Shrabonti Chatterjee; Joydeep Mahata; Athika Firdous; Sukma Sahadewa; Aswin R. Khairullah; I MDM. Adnyana; Maksim Rebezov; Abdugani Abdurasulov; Fara D. Durry; Rollando Rollando
Narra X Vol. 4 No. 1 (2026): April 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narrax.v4i1.263

Abstract

Rabies remains a neglected zoonotic disease with disproportionately high incidence and mortality across African regions, highlighting the need for improved and population-tailored preventive strategies. The aim of this study was to design and evaluate a multi-epitope rabies vaccine candidate targeting the rabies virus glycoprotein using a reverse vaccinology and immunoinformatics approach, with consideration of African human leukocyte antigen (HLA) allele diversity. A total of eleven cytotoxic T-lymphocyte (CTL), nine helper T-lymphocyte (HTL), and nine B-cell linear epitopes were predicted and subsequently filtered based on immunogenicity, interferon-gamma (IFN-γ) induction potential, antigenicity, allergenicity, and toxicity. The selected epitopes were assembled into a vaccine construct using appropriate adjuvants and immunostimulatory linkers. Population coverage analysis demonstrated a high theoretical coverage of 99.95% across five African subregions, underscoring the advantage of region-specific vaccine design. The final construct exhibited favorable physicochemical properties, including an instability index of 29.00 and a Grand Average of Hydropathy (GRAVY) score of -0.304, indicating stability and hydrophilicity. Structural validation showed 95.6% residues in favored regions of the Ramachandran plot, with an ERRAT score of 98.86 and a ProSA Z-score of -3.26. Molecular docking with toll-like receptor 4 (TLR4) revealed strong binding interactions, including 35 hydrogen bonds and ten salt bridges. Immune simulation predicted robust humoral and cellular responses with memory cell formation, while normal mode analysis supported structural stability and flexibility. Furthermore, the construct was successfully codon-optimized (codon adaptation index: 0.97; GC content: 51%) and in silico cloned into the pET-28a(+) vector, indicating potential for expression in Escherichia coli. These findings support the theoretical feasibility of a population-specific rabies vaccine candidate and warrant further experimental validation.
Effect of atorvastatin on frailty-related outcomes, body composition and biochemical markers in people living with HIV: A randomized, double-blind, placebo-controlled clinical trial Maryatun Hasan; Kurnia F. Jamil; Darmawi Darmawi; Maimun Syukri
Narra X Vol. 4 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narrax.v4i2.282

Abstract

Frailty is increasingly recognized among people living with human immunodeficiency virus (PLHIV) despite antiretroviral therapy (ART). Statins, including atorvastatin, have pleiotropic metabolic and anti-inflammatory effects that may influence frailty-related pathways, although their impact on frailty in PLHIV remains unclear. The aim of this study was to evaluate the effect of atorvastatin on frailty status, its components, body composition, and related laboratory parameters in PLHIV receiving ART. This randomized, double-blind, placebo-controlled clinical trial included PLHIV with frailty or pre-frailty status at baseline. Participants were assigned to receive atorvastatin 40 mg once daily or placebo for 12 weeks. The primary outcome was frailty incidence, assessed using Cardiovascular Health Study (CHS)-based criteria and the Frailty Index (FI), including combined CHS–FI frailty status and CHS-based frailty components. Secondary outcomes included body composition, total cholesterol, and serum myostatin levels. Statistical analyses were performed using unadjusted and adjusted models. After 12 weeks, FI scores improved significantly within both the placebo (p<0.001) and atorvastatin groups (p=0.009). Serum myostatin levels also decreased significantly within both groups (both p<0.001). However, no significant between-group differences were observed for changes in CHS-based fit status (p=0.201), FI-based fit status (p=0.194), combined CHS–FI fit status (p=0.153), FI score (p=0.292), unintentional weight loss (p=0.225), handgrip strength (p=0.785), exhaustion (p=0.227), gait speed (p=0.333), physical activity limitation (p=0.479), total cholesterol (p=0.586), or serum myostatin levels (p=0.310) in the fully adjusted model. Atorvastatin was significantly associated with reductions in body weight (p=0.029) and BMI (p=0.030), whereas no significant effects were observed on body fat, water mass, muscle mass, or bone mass in the fully adjusted model. In conclusion, atorvastatin did not improve frailty status, frailty-related components, total cholesterol, or serum myostatin levels compared with placebo in PLHIV receiving ART. Although reductions in body weight and BMI were observed, these changes were not accompanied by improvement in frailty outcomes. Future studies with larger sample sizes, longer follow-up periods, and more detailed assessments of physical activity, diet, ART regimens, and inflammatory markers are needed to clarify the role of atorvastatin in frailty-related outcomes among PLHIV.
Quality-adjusted assessment and determinants of midwife-delivered antenatal care performance in primary health services: Evidence from Indonesia Tilaili Ibrahim; Maimun Syukri; Hizir Sofyan; Nurjannah Nurjannah
Narra X Vol. 4 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narrax.v4i2.285

Abstract

Indonesia continues to face a high maternal mortality rate despite improvements in maternal health service coverage. Antenatal care (ANC) performance is commonly evaluated using service coverage indicators, such as first antenatal visit (K1) and fourth antenatal visit (K4). However, these indicators do not fully capture the quality of care delivered during ANC contacts. The aim of this study was to assess ANC implementation based on the Indonesian Ministry of Health 10T Standard (10T), develop quality-adjusted performance indicators integrating coverage and service quality, and identify factors associated with midwife performance in primary health services. A cross-sectional study was conducted among village midwives in Banda Aceh, Indonesia. ANC quality was assessed using 37 indicators derived from the 10T Standard, while midwife performance was evaluated using conventional coverage indicators and newly modified quality-adjusted indicators, namely modified K1 (K1mod) and modified K4 (K4mod). Individual, organizational, and psychological determinants of performance were analyzed using structural equation modeling (SEM). The results indicated that conventional ANC coverage was high, with mean K1 and K4 values of 99.61% and 91.51%, respectively. However, after adjustment for 10T implementation, performance declined substantially to 84.89% for K1mod and 77.94% for K4mod, indicating that coverage-based indicators overestimated actual performance. Implementation of the 10T Standard varied across components: medical identity recording (95.4±5.7%), medical examination (90.6±8.1%), and intervention (87.6±10.7%) were relatively well implemented, whereas some components, such as counseling or health education and nutritional assessment, were less consistently performed. Key gaps were observed in nutritional assessment. SEM showed acceptable model fit (RMSEA=0.038; GFI=0.971; AGFI=0.939; TLI=0.964; CFI=0.981). Organizational factors had the strongest direct effect on midwife performance (β=0.361, p<0.001) and ANC quality (β=0.310, p<0.001), followed by individual and psychological factors. ANC quality also had a significant direct effect on midwife performance (β=0.388, p<0.001) and mediated the effects of individual, organizational, and psychological factors. These findings indicate that high ANC coverage does not necessarily reflect high-quality service delivery. Quality-adjusted indicators provide a more comprehensive measure of midwife performance, and strengthening organizational support, particularly resources, leadership, and incentives, is essential to improve ANC quality and performance in primary health services.
Culture-based breast milk and infant gut microbiota profiles among stunted infants: A case-control study from Indonesia Aslinar Aslinar; Herlina Dimiati; Nur Indrawati; Sofia Sofia
Narra X Vol. 4 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narrax.v4i2.294

Abstract

Stunting remains a major public health problem in Indonesia. Early-life microbiota may contribute to infant growth through their roles in microbial colonization, immune maturation, intestinal function, and nutrient utilization, but evidence from high-stunting settings in Indonesia remains limited. The aim of this study was to compare culture-based breast milk and infant fecal microbiota profiles between stunted and normal infants in Aceh, Indonesia, and to examine their associations with maternal, postnatal, environmental, and socioeconomic factors. A total of 54 breastfed infants aged 6–11 months were included, consisting of 27 stunted and 27 normal infants matched by age and sex. Breast milk and fecal samples were analyzed using culture-based microbiological methods for bacterial identification and colony-forming unit counts. In breast milk, Streptococcus sp. and Staphylococcus sp. were the predominant bacteria, with higher detection frequencies among mothers of stunted infants. In fecal samples, Escherichia coli was the most frequently detected bacterium in both groups, while Staphylococcus aureus and Clostridium innocuum were significantly more common among stunted infants. Breast milk bacterial colony counts were significantly higher in the stunted group, whereas fecal colony counts were numerically higher but not statistically significant. Poor household sanitation was more frequent among stunted infants. Exploratory analyses among stunted infants showed that maternal height was associated with Anaerococcus prevotii, while maternal education was associated with selected fecal bacteria, including Salmonella choleraesuis, Proteus mirabilis, and Eggerthella lenta. These findings suggest culture-detectable differences in breast milk and infant fecal microbiota between stunted and normal infants. Given the small sample size, confirmation using longitudinal and sequencing-based studies is warranted.
Association of BDNF Val66Met polymorphism with clinical severity, cognitive function, and treatment response in schizophrenia Juwita Saragih; Irwan Saputra; Marty Mawarpury; Endang M. Rahayuningsih
Narra X Vol. 4 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narrax.v4i2.300

Abstract

The brain-derived neurotrophic factor gene (BDNF) Val66Met polymorphism has been implicated in neuroplasticity, cognitive performance, and variability in antipsychotic treatment response. However, evidence from Indonesian populations, particularly among individuals with schizophrenia from Aceh, remains limited. The aim of this study was to assess the association of BDNF Val66Met polymorphism with clinical symptom severity and cognitive function and to determine its association with clinical and cognitive outcomes after antipsychotic treatment. A prospective cohort study was conducted among Acehnese individuals with schizophrenia. Genotyping was performed using polymerase chain reaction–restriction fragment length polymorphism. Clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS), and cognitive function was assessed using the Montreal Cognitive Assessment–Indonesian version (MoCA-INA) at Day 0, Day 14, and Day 42 post-therapy. Genotype–outcome associations were examined using genotype comparisons and genetic models. A total of 207 individuals with schizophrenia were analyzed. The Val/Met genotype was the most frequent genotype (52.2%), followed by Val/Val (28.0%) and Met/Met (19.8%). Baseline PANSS total score was significantly different across all genetic models, with the lowest symptom severity observed in the Val/Val group. In the dominant model, Met-allele carriers had higher PANSS total scores than Val/Val individuals (p<0.001). Baseline cognitive function also differed significantly, with Met-allele carriers showing lower MoCA-INA scores than Val/Val individuals (p<0.001). Clinical symptom improvement was consistently greater in Val/Val individuals, whereas Met-allele carriage was associated with smaller PANSS reductions at Day 14 and Day 42. For cognitive outcomes, Val/Val participants showed the greatest early improvement, while Met-allele carriers demonstrated slower initial recovery followed by later gains, resulting in more comparable cognitive improvement by Day 42 in some models. In conclusion, BDNF Val66Met polymorphism was significantly associated with clinical symptom severity, cognitive function, and treatment-related improvement among Acehnese individuals with schizophrenia. The Val/Val genotype was associated with a more favorable clinical and cognitive profile and stronger early clinical and cognitive response. These findings support the potential relevance of BDNF Val66Met as a population-specific biomarker for clinical stratification in schizophrenia, although further studies with longer follow-up and biological validation are warranted.
Gene therapy for rare diseases marks a new era in precision medicine: Insights from clinical trials Suprianto Suprianto; Yunita Messe; Raehan AH. Hamzah; Rose CMH. Ortega-Kindica; Dian A. Umaroh; Yusril IF. Wijaya; Suryani Musa; Ian I. Fidhatami; Ahmad Ikhsanudin; Nurnisa Hamid
Narra X Vol. 4 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narrax.v4i2.276

Abstract

Gene therapy represents an important advance in the treatment of rare diseases, offering precise and transformative therapeutic strategies. As many rare diseases are associated with well-defined genetic variants, they represent ideal candidates for targeted genetic interventions. The substantial unmet medical need associated with rare diseases has driven growing interest in gene therapy, with more than 300 clinical trials reported to date. The aim of this study was to evaluate the current evidence on gene therapy for rare diseases by examining therapeutic strategies, target diseases, clinical progress, clinical outcomes, and emerging research trends. Several approved therapies, including those for hemophilia B, spinal muscular atrophy, metachromatic leukodystrophy, and Wiskott–Aldrich syndrome, have demonstrated the clinical potential of gene therapy. Clinical evidence suggests that gene-based therapies in the management of rare diseases can achieve sustained functional benefits, reduce disease-related complications, and lessen dependence on long-term replacement or supportive treatments. However, challenges in ethical considerations, regulatory requirements, manufacturing complexity, treatment costs, and limited patient access remain. Continued clinical evaluation is essential to further establish long-term safety and effectiveness. Advances in gene therapy technologies and clinical applications continue to expand therapeutic opportunities for rare diseases while supporting the broader development of precision medicine.

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