Journal of Pharmaceutical and Sciences

Relationship Between Delta Like Ligand 1 (DLL-1) Levels in Serum and Cerebrospinal Fluid (CSF) with The Severity of Tuberculosis Meningitis

Abdul Razak — 2026-05-03

Tuberculous meningitis (TBM) is an infection caused by Mycobacterium tuberculosis (M.tb) affecting the meninges, characterized by high morbidity rates. The prognosis of TBM is partially determined by clinical severity, classified according to the British Medical Research Council (BMRC) scale. Delta Like Ligand 1 (DLL-1) is a transmembrane protein that plays a role in the formation of lipid cells, which are essential for the survival, virulence, and defense of M.tb against the host immune system. DLL-1 expression can be induced by the stimulation of M.tb cell walls in response to the human immune system. This study aims to analyze the correlation between DLL-1 levels in the serum and cerebrospinal fluid (CSF) with the clinical severity of TBM patients. A cross-sectional study was conducted involving 30 TBM patients treated at M. Djamil Central General Hospital, Padang, from October 2025 to January 2026. Serum and CSF DLL-1 levels were measured using the enzyme-linked immunosorbent assay (ELISA) method, while TBM severity was assessed based on the BMRC criteria. Data analysis was performed using SPSS version 26.0 with a significance level of p < 0.05. The results of the analysis showed no significant difference in serum DLL-1 levels (p = 0.129) or CSS DLL-1 levels in relation to the severity of TBM (p = 0.097).

Nephroprotective Effectiveness Test of Coffee Fruit Extract (Coffea arabica L.) Against Histopathological Features and Inflammatory Markers in Gentamicin-Induced Mice

Anas Tasya Glori Br Ginting — 2026-05-04

Gentamicin is an aminoglycoside antibiotic widely used in the treatment of severe bacterial infections; however, its clinical application is limited due to nephrotoxic effects. Gentamicin-induced nephrotoxicity is closely associated with oxidative stress and inflammatory responses, which contribute to tubular damage and renal dysfunction. Coffee fruit (Coffea arabica L.) contains various bioactive compounds, including phenolics, flavonoids, and polyphenols, which exhibit antioxidant and anti-inflammatory activities and may provide renal protection. This study aimed to evaluate the nephroprotective effectiveness of coffee fruit extract against gentamicin-induced kidney injury in rats based on histopathological features and inflammatory markers. This experimental in vivo study used male Wistar rats divided into five groups: normal control, gentamicin control, and gentamicin combined with coffee fruit extract at doses of 100, 200, and 400 mg/kg body weight. Gentamicin was administered intraperitoneally to induce nephrotoxicity, while the extract was given orally for 14 days. Serum interleukin-6 (IL-6) levels were measured using enzyme-linked immunosorbent assay, and kidney tissues were examined histopathologically using hematoxylin–eosin staining. The results showed that gentamicin significantly increased serum IL-6 levels and caused moderate renal histopathological damage. Administration of coffee fruit extract significantly reduced IL-6 levels at doses of 200 and 400 mg/kg body weight (p<0.05) and improved renal histopathological features in a dose-dependent manner, with the highest dose showing the most pronounced protective effect. In conclusion, coffee fruit extract demonstrates nephroprotective potential against gentamicin-induced renal injury by reducing inflammatory responses and improving kidney histopathology.

Formulation and Antioxidant Activity of Old Coconut Water Syrup (Cocos nucifera L) and Red Fruit Extract (Pandanus conoideus L) Using the DPPH Method

Siti Mun Muhliza Ahmad — 2026-05-06

Background: Mature coconut water (Cocos nucifera L.) has the potential as a health drink but is often discarded as waste. Red fruit (Pandanus conoideus L.) is an endemic plant of Papua that is rich in antioxidants. The combination of both is expected to produce a beneficial herbal syrup preparation. Objective: To formulate a combination syrup of mature coconut water and red fruit extract and to determine its antioxidant activity using the DPPH method. Methods: Red fruit extract was obtained by maceration using 96% ethanol. Phytochemical screening was performed on both ingredients. The syrup was prepared with the addition of sugar, citric acid, vanilla, and CMC. Physical evaluation included organoleptic, homogeneity, pH, viscosity, and clarity tests. Antioxidant activity was tested using the DPPH method at a wavelength of 517 nm using a UV-Vis spectrophotometer. Results: Phytochemical screening showed that mature coconut water contains alkaloids, while red fruit extract contains flavonoids, tannins, saponins, and alkaloids. The syrup evaluation met SNI requirements: organoleptic (reddish-orange color, characteristic odor, sweet taste), homogeneous, pH 5–6, viscosity 250 mPa·s, and clear. The IC50 values of the syrup in three consecutive replicates were 550.34 μg/mL, 2282.3 μg/mL, and 2863.4 μg/mL, which are classified as weak antioxidant activity (IC50 > 200 ppm). Conclusion: The combination syrup of mature coconut water and red fruit extract exhibits weak antioxidant activity but meets the physical quality standards of the preparation. This preparation has the potential to be developed as a herbal health drink.

In Vitro Study : Antifungal Activity of Coffea canephora Peel and Leaf Extracts Against Candida albicans

Mastuti Widianingsih — 2026-05-06

Candida albicans is a major cause of invasive candidiasis with high morbidity and mortality rates, and it has shown increasing resistance to antifungal agents. The objective of this research to evaluate the antifungal activity of Coffea canephora peel and leaf extract against Candida albicans in vitro by determining the Minimum Inhibitory Concentration (MIC). Robusta coffee peel and leaves were extracted using maceration with 96% ethanol, followed by phytochemical screening and antifungal activity testing using the broth dilution method. Phytochemical screening revealed the presence of alkaloids, phenolic-tannins, flavonoids, saponins, and terpenoids, while steroid were not detected. Based on the antifungal activity test conducted separately, both extracts had the same MIC value at a concentration of 12,5%. Statistical analysis using One Way ANOVA demonstrated a significant difference among treatment groups (p<0,05). The antifungal activity of the extract is presumed to be associated with phenolic compounds, such as chlorogenic acid and caffeine, which may act through disruption of cell membrane integrity and inhibition of ergosterol synthesis. These finding suggest that Coffea canephora peel and leaf extract has the potential to be further developed as an antifungal agent, especially in topical formulations, but further toxicity tests and in vivo tests are required.

Quality of Simplicia and Composition of Barangan Banana Peel (M. acuminata Colla) as Preventive Dental Material with Different Drying Methods

Astrid Yudhit — 2026-05-09

Background: The drying process in the preparation of herbal material affects the quality, chemical compound content, and mineral composition of herbal ingredients. Barangan banana peel (Musa acuminata Colla) has potential as a preventive dental agent due to its phytochemical and mineral content. Objective: This study aimed to analyze the simplicia quality (moisture content and total ash content) as well as the chemical compound and mineral composition of Barangan banana peel dried using two different methods. Methods: This was a qualitative analytical study. Cleaned and chopped Barangan banana peels were divided into two groups: oven-dried (OD; 60°C for 12 hours) and freeze-dried (FD; -65°C for 4 hours followed by 48 hours of freeze drying). The simplicia was ground using a ball mill (500 rpm for 6 hours). Moisture content was determined using the toluene method, while total ash content was measured by heating at 800°C. Identification of chemical compounds and minerals was performed using GC-MS and XRF, respectively. Results: Moisture content of the OD group was 9.23% and of the FD group was 7.11%; total ash content was 10.83% and 10.60%, respectively. Both met the standards of the Indonesian Herbal Pharmacopoeia (moisture content <10%, total ash content <15%). GC-MS identification revealed that the FD group exhibited a greater variety of chemical compounds (12 components) compared to the OD group (7 components). The highest mineral content in both groups was potassium (K), with magnesium (Mg) being higher in the OD group (15.32%) than in the FD group (9.95%). Conclusion: The drying method affects the quality and composition of Barangan banana peel. Freeze drying resulted in lower moisture content and greater phytochemical diversity, whereas oven drying tended to preserve higher mineral content for certain elements. The simplicia of Barangan banana peel from both methods has potential to be developed as a preventive dental material.

Concentration and Urbach Energy of ZnO Nanoparticles Synthesized Using Tween 80 Encapsulant

Horasdia Saragih — 2026-05-10

Excessive exposure to ultraviolet (UV) radiation can cause skin damage, necessitating the development of effective and transparent sunscreen materials. ZnO nanoparticles are a promising candidate; however, they often suffer from agglomeration, which degrades their optical performance. This study aims to investigate the effect of varying concentrations of Tween 80 as an encapsulating agent on the optical and structural characteristics of ZnO nanoparticles. The nanoparticles were synthesized using a rotor–stator homogenization method with Tween 80 concentrations ranging from 2 to 5 mL (each dissolved in 50 mL of ethanol), followed by characterization using UV–Vis spectroscopy. The results indicate that increasing the concentration of Tween 80 enhances the concentration of ZnO nanoparticles without significantly altering the average particle size (~2.44 nm), resulting in a monodisperse system. Urbach energy analysis reveals that crystal order improves up to an optimum at 4 mL of Tween 80, followed by a slight decrease at higher concentrations. Optically, all samples exhibit strong absorption in the UV region and high transmittance in the visible range (95–100%). These findings demonstrate that the synthesized ZnO nanoparticles have strong potential as a sunscreen. It is concluded that Tween 80 plays a crucial role in controlling the growth, crystal structure, and optical properties of ZnO nanoparticles, with the optimum concentration yielding the best performance.

Sedative Activity of Ethanol Extract of Tali Kuning (Anamirta cocculus (L.) Wight & Arn.) Stem Against Male Mice (Mus musculus)

Wiwit Ayu Fitrianti — 2026-05-10

Mental health is a state of well-being that includes where individuals recognize their personal potential, enabling them to manage life's pressures and be able to work productively. Treatment of mental health disorders usually involves the use of sedative drugs such as benzodiazepines, barbiturates, and several other drugs. This study aims to evaluate the sedative activity of the ethanol extract of tali kuning (A. cocculus (L.) Wight & Arn.) stem in male mice as an alternative therapy requiring sedative effects. The study was conducted using a quantitative experimental approach with a pretest–posttest control group design and the rotarod method. The experimental animals were divided into five groups: positive control, negative control, and three extract dose groups treated with the ethanol extract of tali kuning stem at 19.25 mg/kgBW, 38.5 mg/kgBW, and 77 mg/kgBW. The results indicated that the ethanol extract of tali kuning stem at all three doses produced sedative activity, as validated by a paired sample t‑test that revealed significant differences condition between pre‑ and post‑treatment measurements. The ethanol extract of tali kuning stem at doses of 19.25 mg/kgBW, 38.5 mg/kgBW, and 77 mg/kgBW demonstrated sedative activity, although statistical comparison with the positive control showed variable results depending on dose and observation time.

Effect of Adjunctive Collagen Gel Therapy on Salivary Matrix Metalloproteinase-8 Levels in Gingivitis Following Scaling and Root Planing

Haria Fitri — 2026-05-11

Gingivitis is a reversible inflammatory condition of the gingival tissue without attachment loss, primarily caused by plaque accumulation, which can trigger an immune response. Matrix metalloproteinase-8 (MMP-8) is an enzyme that contributes to collagen degradation. Scaling and root planing (SRP) is the standard therapy; however, it may induce a transient inflammatory response and result in suboptimal tissue regeneration, thereby necessitating adjunctive therapy. This study aimed to evaluate the effect of adjunctive collagen gel therapy on salivary matrix metalloproteinase-8 levels in gingivitis. This experimental study employed a pre- and post-test control group design involving 50 subjects divided into five groups: healthy control, gingivitis treated with SRP, and gingivitis treated with SRP combined with 1%, 2%, and 4% collagen gel. Salivary MMP-8 levels were measured to assess the inflammatory response. Statistical analysis revealed that collagen gel at concentrations of 1% and 2% had a significant effect on MMP-8 levels. In conclusion, Collagen gel at 1% and 2% concentrations significantly modulated salivary MMP-8 levels, suggesting a potential role in the tissue remodeling phase following SRP.

Nephroprotective Effect of Butterfly Pea Flower (Clitoria ternatea L.) Extract in a Rat Model of Nephrotoxicity: Biochemical, Histopathological, Antioxidant, and Cytokine, Analyses

Asyrun Alkhairi Lubis — 2026-05-12

Background: Butterfly pea flower (Clitoria ternatea L.) is rich in antioxidants and bioactive compounds that may protect the kidney from nephrotoxic injury. Objective: This study aimed to evaluate the nephroprotective effect of ethanolic extract of butterfly pea flower in gentamicin-induced rats. Methods: This in vivo experimental study used 30 male Wistar rats divided into five groups: normal control, negative control, and three treatment groups receiving butterfly pea flower extract at doses of 100, 200, and 400 mg/kgBW. The extract was administered orally, while gentamicin 100 mg/kgBW was given intraperitoneally. Parameters observed included BUN, urea, IL-6, TNF-α, renal morphology, kidney weight, and histopathology. Results: Gentamicin increased BUN, urea, IL-6, and TNF-α levels and caused histopathological damage and morphological changes in the kidney. Administration of butterfly pea flower extract reduced inflammatory response, improved histopathology, and restored renal morphology and kidney weight toward normal. The best histopathological improvement was observed at 200 mg/kgBW, whereas the strongest anti-inflammatory effect was found at 400 mg/kgBW. Conclusion: Ethanolic extract of butterfly pea flower has potential as a nephroprotective agent against gentamicin-induced nephrotoxicity.

Formulation of Antibacterial Gel Preparation from Robusta Coffee Bean Extract (Coffea Canephora L.) as a treatment for Diabetes Wounds

Jesika Nopa Yanti Br. Nainggolan — 2026-05-12

Diabetic wounds are chronic wounds that are susceptible to bacterial infection and therefore require optimal therapy. Robusta coffee beans (Coffea Canephora L.) are known to contain various active compounds, including polyphenols, alkaloids, and flavonoids, which have antibacterial potential. This study aimed to develop a gel preparation based on Robusta coffee bean extract and to assess its antibacterial activity against Staphylococcus epidermidis and its physical properties. The extract was obtained through a maceration process using 96% ethanol and then formulated into three concentration variations: F1 (30%), F2 (50%), and F3 (75%). The tests included phytochemical screening, organoleptic evaluation, homogeneity, pH, spreadability, and antibacterial activity testing using the disc diffusion method. The screening results indicated the presence of flavonoids, alkaloids, tannins, and terpenoids in the extract. All gel formulations had good physical properties, with a pH ranging from 5.42 to 6.33 and a spreadability of 5.0 to 6.7 cm. Antibacterial activity increased with increasing extract concentration, indicated by the inhibition zone diameters of 11.98 mm (F1), 17.76 mm (F2), and 18.49 mm (F3), respectively. Thus, the Robusta coffee bean extract gel preparation meets the topical physical requirements and has the potential to be used as an alternative therapy for diabetic wounds.

In Vivo Study of Nephroprotective Effect of Ethanol Extract of Yellow Rope (Anamirta cocculus (L.) Wight & Arn.) on Serum Creatinine Profile of Mice

Dian Nur Khofifah — 2026-05-13

Background: Nephrotoxicity due to the use of drugs such as gentamicin can cause kidney damage characterized by increased creatinine levels. The use of medicinal plants as nephroprotective agents is a potential alternative; one such plant is yellow rope stem (Anamirta cocculus (L.) Wight & Arn.), known to contain antioxidant compounds. Objective: This study aims to assess the nephroprotective activity of yellow rope stem ethanol extract and determine the optimal dose for reducing gentamicin-induced increases in creatinine levels in mice. Method: The study was conducted experimentally with a pre-test and post-test design using the maceration method with 70% ethanol solvent. Mice were divided into six groups, namely negative control, positive control (vitamin E), healthy control, and three treatment groups with varying extract doses. Creatinine levels were measured using the Jaffe method with a UV-Vis spectrophotometer. Results: The results showed that the yellow rope stem ethanol extract at a dose of 77 mg/kgBW was able to reduce creatinine levels significantly (p<0.05), while lower doses did not show a significant difference. Conclusion: Ethanol extract of yellow rope stems has nephroprotective activity at an optimal dose of 77 mg/kgBW, thus having the potential to be developed as a herbal agent to protect kidney function.

Physicochemical and Antioxidant Activity Evaluation of Yellow Rope (Anamirta cocculus (L.) Wight & Arn.) Stem Extract Isotonic Drink

Nadziatul Khasanah — 2026-05-14

as having potential as a natural antioxidant agent. One potential way to utilize this plant is by innovating it into an isotonic drink product. Objective: This study aimed to evaluate the physicochemical properties and antioxidant activity of an isotonic drink formulated with yellow rope stem extract. Methods: he extraction process was conducted using the maceration method with 70% ethanol as the solvent. The isotonic drink was developed into three formulas, which were then tested for their physicochemical properties and antioxidant activity using the DPPH method. Results: The results indicated that the best formula was FII, with an overall hedonic score of 4,6 (neutral). All three formulas showed identical pH values (4,0) and Total Soluble Solids (TSS) of 7%, while the total acidity decreased progressively: FI (1,024%), FII (0,896%), and FIII (0,704%). The isotonic drinks from yellow rope stem extract for formulas FI, FII, and FIII produced IC₅₀ values of 35,61, 46,56, and 57,69 μg/mL, respectively. Based on these data, FI and FII were identified as having very strong antioxidant intensity, while the FIII showed activity classified in the strong category. Conclusion:.The test results demonstrate that the isotonic drink made from yellow rope stem extract exhibits antioxidant potential with intensity levels ranging from strong to very strong.

Analysis of Albumin Levels and Protein Profile of Toman Fish (Channa Micropeltes) from South Kalimantan

Nia Kusumadewi — 2026-05-14

Toman fish (Channa micropeltes) is a freshwater fish widely found in Kalimantan and known for its high nutritional value, particularly its albumin and omega-3 fatty acid content. However, studies regarding the metabolite profile and albumin levels of this species are still limited compared with other snakehead fish species. This study aimed to analyze the protein profile and determine the albumin levels of toman fish collected from three regions in South Kalimantan, namely Barito Kuala, Banjarmasin, and Banjarbaru. Albumin extraction was carried out using the Ultrasonic-Assisted Extraction (UAE) method. Qualitative characterization of protein functional groups was performed using ATR-FTIR spectroscopy in the range of 4000–400 cm⁻¹, while quantitative determination of albumin levels was conducted using UV–Vis spectrophotometry at a wavelength of 642 nm with bromocresol green (BCG) reagent. The results showed that the highest albumin level was obtained from Banjarmasin samples (0.560 ± 0.0343 %w/w), followed by Barito Kuala (0.542 ± 0.0416 %w/w), whereas the lowest level was observed in Banjarbaru samples (0.431 ± 0.0261 %w/w). ATR-FTIR analysis confirmed the presence of albumin in all samples through the identification of characteristic amide I (~1650 cm⁻¹) and amide II (~1550 cm⁻¹) absorption bands. Statistical analysis indicated that differences in albumin levels among sampling locations were not statistically significant (p > 0.05), although numerical variations were observed and may be associated with environmental and habitat conditions. Overall, the combination of UV–Vis spectrophotometry and ATR-FTIR proved effective for the characterization and determination of albumin in Channa micropeltes.

Antioxidant Activity and Characteristics of Body Lotion with Different Concentrations of Jeruju Leaf Extract (Acanthus ilicifolius)

Almaida Mulya — 2026-05-14

This study aimed to determine the effect of different concentrations of Acanthus ilicifolius leaf extract on antioxidant activity and physical characteristics of body lotion. The formulations were prepared with extract concentrations of 0, 2, 4, and 6 g. Antioxidant activity was tested using the DPPH method, while physical evaluations included pH, homogeneity, emulsion type, organoleptic properties, and skin moisture. The results showed that increasing extract concentration increased antioxidant activity, with the highest inhibition value found in P3 (76.19%). All formulations were homogeneous and had oil-in-water emulsion type. The pH values ranged from 6.92 to 7.93 and were within acceptable limits. Organoleptic test showed decreased panelist preference at higher extract concentrations. Moisture test showed no signific ant difference, but all formulations increased skin hydration.

Formulation of Transdermal Patch Nanoemulgel of Dadap Serep Leaves (Erythrina subumbrans (Hassk.) Merr.) and Sand Ginger (Kaempferia galanga L.) as Candidate Herbal Lactagogum Based on Usadha

Ni Luh Gde Mona Monika — 2026-05-14

Traditional Usadha-based herbal lactagogues, such as Erythrina subumbrans and Kaempferia galanga, are used by lactating mothers; however, their delivery in practical, standardized forms is limited. This study aimed to formulate a nanoemulgel transdermal patch containing E. subumbrans extract and K. galanga extract, evaluate its physicochemical properties, and assess its safety for skin irritation as a potential herbal lactagogue. Extracts of E. subumbrans and K. galanga were added to the nanoemulsion base. The nanoemulsions were incorporated into HPMC/PVP-based transdermal patch matrices by solvent casting. The resulting patches were evaluated for physicochemical properties and tested for skin irritation. Phytochemical screening confirmed the presence of flavonoids, tannins, triterpenoids, saponins, and alkaloids in both extracts. The total flavonoid contents were 47.44 mg QE/g for E. subumbrans and 36.79 mg QE/g for K. galanga. The nanoemulsion exhibited greater than 90% transmittance, mean droplet size of 7.79 nm, and polydispersity index (PDI) of 0.193. The patches met acceptable physical criteria, including a thickness of 0.20 mm, weight variation with %CV less than 10%, and folding endurance over 300. pH values ranged from 6.00 to 6.58. In a human patch test, no erythema or edema was observed; only mild pruritus (mean = 0.2) was reported in two participants. The formulated nanoemulgel transdermal patches demonstrated favorable physicochemical properties and were non-irritating. These patches show potential as a herbal lactagogue delivery system; further studies on lactation efficacy and long-term stability are recommended.

Knowledge, Attitude, and Practice Among Long and Short-Term Contraception Methods Users in a Rural Area of Indonesia

Hani Sri Fitriani — 2026-05-14

The use of long-acting contraceptive methods (LACMs) in Indonesia remains relatively low despite government efforts to increase their adoption to reduce maternal and child mortality. This study aims to examine differences in knowledge, attitudes, and practices (KAP) between LACM users and non-LACM users, as well as to identify factors influencing contraceptive method selection among women of reproductive age in a rural area of Indonesia. A cross-sectional design was employed involving 394 respondents selected through Cluster Random Sampling, all of whom completed validated and reliable questionnaires. Data were analyzed descriptively. The Mann–Whitney test was used to compare KAP between LACM and non-LACM users. Chi-square tests and logistic regression analysis were conducted to identify factors associated with contraceptive method selection. The results showed significant differences between the two groups. LACM users demonstrated higher levels of knowledge, more positive attitudes, and better contraceptive practices compared with non-LACM users. Factors associated with LACM use included high knowledge (OR = 2.415; p = 0.001), education above primary school level (OR = 7.03; p = 0.003), exposure to print media (OR = 28.331; p = 0.000), and obtaining contraceptives from community health centers (OR = 6.6; p = 0.009). In conclusion, short-acting contraceptive users exhibited lower knowledge, attitudes, and practices than LACM users. Therefore, individuals with low KAP levels should be prioritized in reproductive health education and promotion programs.

The Evaluation of Skin Irritation Potential of a Butterfly Pea (Clitoria ternatea) Extract Sunscreen Spray Using the Patch Test Method

Nyoman Rudi Kusuma — 2026-05-16

Background: Butterfly pea flower (Clitoria ternatea) contains high levels of anthocyanins with potent antioxidant activity, making it a promising natural ingredient for sunscreen formulations. However, the skin safety of sunscreen spray containing this extract must be evaluated before cosmetic application. Objective: This study aimed to evaluate the skin irritation potential of sunscreen spray formulations containing butterfly pea flower extract using the patch test method. Methods: A patch test was conducted on 15 male Wistar rats. The test materials included sunscreen spray formulations with butterfly pea flower extract at concentrations of 1% (F1), 2% (F2), and 3% (F3). A base formulation without extract (F0) served as a negative control, and sodium lauryl sulfate served as a positive control. Erythema and edema scores were observed at 24, 48, and 72 hours after application. Results: The mean erythema and edema scores for formulations F1, F2, and F3 were 0.0 ± 0, indicating no signs of skin irritation in all tested groups. The positive control group showed slight erythema (score 2.33 ± 0.5), confirming the validity of the test method. Conclusion: Sunscreen spray formulations containing butterfly pea flower extract at concentrations of 1%, 2%, and 3% did not induce skin irritation in male Wistar rats under the patch test conditions. These findings support the potential of butterfly pea flower extract as a safe natural ingredient for sunscreen products.

Evaluation of Antidiabetic Activity of Breadfruit Leaf Infusion (Artocarpus altilis) in Male White Mice (Mus musculus) Induced with Alloxan

Kanne Dachi — 2026-05-20

Diabetes mellitus is a degenerative disease and has become a national as well as international health problem. An unhealthy lifestyle is a primary trigger for the onset of diabetes. Synthetic antidiabetic drugs are one therapeutic option, but their side effects lead patients to switch to natural remedies, such as using breadfruit leaves (Artocarpus altilis) by consuming their decoction. Therefore, this study aims to investigate the potential of breadfruit leaves as an antidiabetic agent in vivo. This experimental research used mice as the test animals. Identification of the plant and test animals was conducted. Subsequently, simplicia powder from the breadfruit leaves was produced and its secondary metabolites were identified. Test preparations, including alloxan suspension, metformin suspension, Na-CMC suspension, and breadfruit leaf infusion, were then prepared. Five treatment groups were established, each consisting of 3 mice. The mice were induced with diabetes, and their blood glucose levels were checked over 15 days, with the data analyzed statistically. The results confirmed the validity of the breadfruit plant and the mice. The identification of secondary metabolites showed positive results for alkaloids, flavonoids, glycosides, tannins, and saponins. The 15% breadfruit leaf infusion significantly reduced blood glucose levels (p < 0.05), and its effect was not significantly different from metformin. This indicates that the 15% concentration demonstrated the most potent antidiabetic effect among the three concentrations tested. However, the interpretation of these results is limited by the small sample size in this preliminary study. In conclusion, the 15% breadfruit leaf infusion has the potential to be developed as a herbal antidiabetic agent.

Analysis of Knowledge and Medication Adherence among Type 2 Diabetes Mellitus Patients at Kedungmundu Public Health Center, Semarang City

Rizky Budi Santoso — 2026-05-21

Type 2 Diabetes Mellitus is a chronic disease caused by metabolic disorders characterized by hyperglycemia due to impaired insulin secretion or action. Long-term management is required to prevent complications, making patient adherence to treatment essential. Patients’ knowledge of their disease significantly influences their attitudes and behaviors in undergoing therapy. This study aims to examine the relationship between knowledge levels and medication adherence among patients with Type 2 Diabetes Mellitus at Kedungmundu Public Health Center, Semarang. This research employed an analytical observational design with a cross-sectional approach conducted from March to June 2025. A total of 225 respondents were selected randomly using a simple random sampling method. The instruments used were the DKQ-24 questionnaire to assess knowledge and the Proportional Measurement of Adherence (ProMAS) questionnaire to evaluate medication adherence. Data were analyzed using Spearman's rank correlation test. The results showed that most respondents had a high level of knowledge (60.0%) and a high level of adherence (49.8%). Statistical analysis using the Spearman test revealed a significant relationship between knowledge and medication adherence (r = 0.536, p < 0.001). The higher the patients’ knowledge level, the higher their adherence to treatment. In conclusion, patients’ knowledge plays a crucial role in enhancing medication adherence among individuals with Type 2 Diabetes Mellitus. Therefore, structured health education should be emphasized as an effective strategy to improve disease management and patient outcomes.

Nephroprotective Effect of Cherry Leaf Extract on Rat Model of Nephrotoxicity: Biochemical, Histopathological, Antioxidant, and Cytokine Analysis

Asyrun Alkhairi Lubis — 2026-05-25

Background: Gentamicin-induced nephrotoxicity is closely associated with oxidative stress and inflammation that lead to renal damage. Natural compounds with antioxidant and anti-inflammatory properties are potential nephroprotective agents. Muntingia calabura L. leaves are rich in bioactive compounds such as flavonoids and polyphenols. Objective: This study aimed to evaluate the nephroprotective effect of Muntingia calabura L. leaf ethanol extract in a gentamicin-induced rat model. Methods: Male Wistar rats were divided into five groups: normal control, negative control (gentamicin), and treatment groups receiving extract doses of 100, 200, and 400 mg/kgBW. Renal function, inflammatory cytokines, antioxidant activity, and histopathological changes were evaluated. Results: The extract demonstrated dose-dependent nephroprotective activity, with the 400 mg/kgBW dose showing the most optimal effect in improving renal function, reducing inflammatory responses, and preserving kidney histological structure. Conclusion: Muntingia calabura L. leaf extract exhibits nephroprotective potential through antioxidant and anti-inflammatory mechanisms, supporting its development as a natural therapeutic candidate.

Comparison of the Antibacterial Effectiveness of Peppermint Leaf (Mentha piperita L.) Extract and Hand Soap Gel Preparation Against Staphylococcus aureus Causing Skin Infections

Candrika Candrika — 2026-05-27

Background: Peppermint leaves (Mentha piperita L.) contain various secondary metabolites, including flavonoids, alkaloids, tannins, and steroids, which exhibit antibacterial activity. The development of peppermint extract into a hand soap gel requires evaluation of its physical stability and antibacterial effectiveness. Aim: This study aimed to formulate a hand soap gel from peppermint leaf ethanol extract and evaluate its physical characteristics, stability, and antibacterial activity against Staphylococcus aureus. Methods: Peppermint leaves were extracted by maceration using 70% ethanol. Hand soap gel formulations containing 3%, 6%, and 9% extract concentrations were prepared and evaluated through organoleptic, homogeneity, spreadability, foam height, pH, viscosity, and stability tests under different storage temperatures. Antibacterial activity was determined against Staphylococcus aureus using the agar diffusion method. Results: The ethanol extract demonstrated antibacterial activity with a maximum inhibition zone of 17.1 mm at 50% concentration. All hand soap gel formulations showed good physical characteristics and stability under various storage temperatures. The antibacterial activity of the formulations increased with extract concentration, producing inhibition zones ranging from 20.8 to 21.1 mm, categorized as very strong activity. Statistical analysis using one-way ANOVA showed significant differences among treatment groups (p < 0.05). Conclusion: Peppermint leaf ethanol extract can be successfully formulated into a stable hand soap gel preparation with very strong antibacterial activity against Staphylococcus aureus.

Phytochemical Screening and Antibacterial Activity Test of the Ethanolic Extract of Jeluak (Microcos tomentosa (L.)) Leaves Against Escherichia coli and Staphylococcus aureus

Toni Andareas Sitompul — 2026-05-28

Background: Bacterial infections caused by Staphylococcus aureus and Escherichia coli remain major public health problems. Resistance to conventional antibiotics has driven the search for alternative antibacterial agents from natural sources. Jeluak leaves (Microcos tomentosa L.) have been traditionally used as an antimicrobial, yet scientific evidence regarding their antibacterial activity is limited. Objective: This study aimed to perform phytochemical screening and evaluate the antibacterial activity of the ethanolic extract of Jeluak leaves against E. coli and S. aureus. Methods: This was an experimental laboratory study. Extraction was carried out by maceration using 96% ethanol. Phytochemical screening included tests for alkaloids, flavonoids, tannins, saponins, steroids, and glycosides. Antibacterial activity was tested using the disc diffusion method on Mueller Hinton Agar at extract concentrations of 10%, 30%, 50%, and 70%. Chloramphenicol and DMSO were used as positive and negative controls, respectively. Inhibition zone diameters were measured after 24 hours of incubation at 37°C. Results: Phytochemical screening revealed the presence of alkaloids, flavonoids, tannins, saponins, steroids, and glycosides. The extract produced inhibition zones against E. coli of 6.3 mm, 9.3 mm, 12.2 mm, and 13.61 mm, and against S. aureus of 7.51 mm, 10.7 mm, 12.7 mm, and 14.28 mm, respectively. According to CLSI 2020 criteria, the 70% concentration was categorized as intermediate, while concentrations of 10–50% were resistant. The positive control was sensitive against both bacteria. Conclusion: The ethanolic extract of Jeluak leaves (Microcos tomentosa L.) possesses antibacterial activity against E. coli and S. aureus, with higher effectiveness against S. aureus than E. coli. Secondary metabolites such as flavonoids, tannins, and alkaloids are suggested to contribute to the antibacterial mechanism

Determination of Total Phenolic Content and Evaluation of Antioxidant Activity of Ethanolic Extract of Celery Herb (Apium graveolens L.) Using the DPPH Method

Wiranda Gultom — 2026-05-29

Introduction: Celery (Apium graveolens L.) is a herbal plant that has long been used in traditional medicine. This plant contains various bioactive compounds such as flavonoids, tannins, and phenolic compounds that play important roles as natural antioxidants. The DPPH method is commonly used to evaluate the ability of antioxidant compounds to scavenge stable DPPH free radicals, resulting in a color change from purple to yellow as the radical concentration decreases. Objective: This study aimed to determine the total phenolic content and antioxidant activity of ethanol extract of celery (Apium graveolens L.) using the DPPH method. Methods: This study employed a laboratory experimental design with a quantitative descriptive approach. The research was conducted from May to December 2025 at the UNPRI Laboratory and USU Laboratory. Results: The quality parameter evaluation of ethanol extract of celery (Apium graveolens L.) showed a moisture content of 5.9%. The total ash content was 15.6%, while the acid-insoluble ash content was 2.19%. The water-soluble extractive value and ethanol-soluble extractive value were 17.49% and 7.37%, respectively. The average total phenolic content obtained was 102.104 ± 0.3032 mgGAE/g extract, indicating that the ethanol extract of celery contains relatively high phenolic compounds. The linear regression equation obtained was y = 0.0083x + 0.0052 with a coefficient of determination (R²) of 0.9894. The R² value close to 1 indicates a very strong linear relationship between gallic acid concentration and absorbance, suggesting that the calibration curve met the validity requirements for total phenolic determination. Conclusion: Based on the results of this study, the ethanol extract of celery (Apium graveolens L.) exhibited an IC₅₀ value of 21.023 µg/mL, which is categorized as a very strong antioxidant. Although the IC₅₀ value was higher than that of quercetin, the antioxidant activity of the extract was still considered very good for a crude plant extract.

Evaluation of Microencapsulation Formulation of Ethanolic Extract of Noni Leaves (Morinda citrifolia L.)

Faleria Destiani Hulu — 2026-05-29

Background: Noni leaves (Morinda citrifolia L.) contain bioactive compounds that are easily degraded by environmental factors, thus requiring a delivery system that protects their stability. Microencapsulation is a technique of coating active compounds with a polymer matrix to enhance stability and delivery effectiveness. Objective: This study aimed to evaluate the microencapsulation formulation of ethanolic extract of noni leaves and to determine the extract concentration that produces the most optimal microencapsulation characteristics. Methods: The study was conducted experimentally. The extract was obtained by maceration using 70% ethanol. Microencapsulation was formulated based on sodium alginate with CaCl₂ as a crosslinking agent and chitosan as a coating material. Three formulas were prepared: blank (F0), 2 g extract (F1), and 4 g extract (F2). Evaluations included morphology (SEM), particle size (PSA), moisture content, floating ability, and physical stability over 14 days at room temperature. Results: Microencapsulation was successfully formed with spherical morphology, dominant particle size in the nanoscale (0.04757 µm), moisture content below 5% (F0: 1.5%; F1: 2.4%; F2: 2.3%), floating ability up to 8 hours, and no organoleptic changes during storage. The formulation with 4 g extract (F2) showed the most optimal characteristics compared to other formulas. Conclusion: The microencapsulation method based on sodium alginate, CaCl₂, and chitosan is effective for encapsulating the ethanolic extract of noni leaves. The extract concentration of 4 g produced microencapsulation with the best physical stability, low moisture content, nanoscale particle size, and optimal floating ability.

Indonesia The Effect of Structured Booklet-Based Education on Medication Adherence, Quality of Life, and Random Blood Glucose Levels in Patients with Type 2 Diabetes Mellitus at Primary Health Centers in Tasikmalaya City, Jawa Barat, Indonesia

Listya Permatasari — 2026-05-29

This study aimed to analyze the effect of structured booklet-based education on medication adherence, quality of life, and random blood glucose levels in patients with type 2 diabetes mellitus at primary health care centers in Tasikmalaya City. This research employed a quasi-experimental design with a pretest–posttest control group approach. A total of 72 respondents were divided into an intervention group (n=36) and a control group (n=36). Medication adherence was assessed using the Morisky Green Levine Scale (MGLS), quality of life was measured using the Diabetes Quality of Life–Brief Clinical Inventory (DQoL-BCI), and clinical outcomes were evaluated using random blood glucose levels. The results showed that the intervention group experienced a significant improvement in medication adherence (p<0.001) and a significant reduction in random blood glucose levels (p<0.001). Quality of life also improved significantly within the intervention group (p<0.001); however, the difference in posttest quality of life between groups was not statistically significant (p=0.317). The improvement in quality of life observed in both groups may have been influenced by routine primary health care services, repeated attention during the study (Hawthorne effect), as well as support from health cadres or the surrounding environment that was not specifically measured. ANCOVA analysis demonstrated that after controlling for confounding variables, structured booklet-based education had a significant effect on medication adherence (p<0.001) and random blood glucose levels (p=0.048), but not on quality of life (p=0.055). In conclusion, structured booklet-based education was effective in improving medication adherence and reducing random blood glucose levels, but it did not show a statistically significant effect on quality of life in patients with type 2 diabetes mellitus.

Review of Potential Activities of Sambiloto Herbs, Meniran Herbs, and Kumis Kucing Leaves in the Management of Diabetic Neuropathy: A Narrative Review

Anita Purnama Sari — 2026-05-03

Diabetic neuropathy is one of the most common microvascular complications among patients with diabetes mellitus, characterized by damage to peripheral nerves due to persistently high blood sugar levels, excessive oxidation and inflammation. Conventional treatments are often not effective enough in comprehensively addressing this problem, so strategies using medicinal plants are emerging as promising options. This study aims to review the potential pharmacological activities of three medicinal plants, namely sambiloto (Andrographis paniculata), meniran (Phyllanthus niruri), and cat's whisker (Orthosiphon aristatus), in the treatment of diabetic neuropathy. This study was conducted using the Narrative Review method with a literature search of two databases PubMed and ScienceDirect with an interval of publication years 2016-2026. A total of 16 articles were selected. The three types of plants showed significant pharmacological properties, including as antioxidants, anti-inflammatory, hypoglycemic, and neuroprotective. Sambiloto functions through andrographolide compounds that inhibit the NF-κB pathway and increase Nrf2 antioxidant activity. Meniran has an effect in lowering blood glucose levels and increasing the performance of antioxidant enzymes. Cat whisker plays a role in glucose control, kidney care, and inflammation in the system. The results of this study are expected to provide an overview of additional therapies in overcoming diabetic neuropathy through the workings of Sambiloto, meniran, and cat's whiskers have complementary potential. The combination of these three plants offers a diverse approach, but further research is needed to assess synergistic effects, safety, and the most appropriate formulation as a modern herbal treatment.

The Integrating Precision Genomic Strategies and Islamic Ethical Perspectives in Stunting Prevention: Focus on the Growth Hormone-IGF-1 Pathway

Hifdzil Qur’ani — 2026-05-03

Stunting remains one of the major chronic nutritional problems in Indonesia. The national prevalence of stunting has decreased from 37.2% in 2013 to 19.8% in 2024; however, this figure is still above the World Health Organization threshold (<20%) and has not yet reached the national target of 14%. The interaction of nutritional, environmental, and genetic factors influences stunting. Genetic variations within the Growth Hormone–Insulin-like Growth Factor One pathway play a significant role in regulating linear growth in children; disruptions in this pathway can increase vulnerability to stunting. In addition, the majority of Indonesia's population adheres to Islam, making religious values a strategic potential for strengthening health interventions. This review article examines the integration of scientific approaches, focusing on genetics and Islamic values, in stunting prevention by highlighting polymorphisms in the IGF1, IGF1R, and GHR genes and their relevance to the principles of maqāsid al-sharī‘ah, particularly hifz al-nasl (protection of lineage). The analysis is conducted using a descriptive-analytical approach based on recent scientific literature and Islamic references, including the Qur’an, prophetic traditions, and scholarly exegesis. The findings indicate a strong alignment between scientific approaches and Islamic teachings, including the importance of adequate nutrition during pregnancy, exclusive breastfeeding, consumption of lawful, nutritious food, genetic screening efforts consistent with the values of divine decree, and vitamin D supplementation to support Insulin-like Growth Factor One levels. This integration has the potential to enhance community acceptance of stunting-prevention programs, strengthen moral and spiritual motivation, and support the achievement of national stunting-reduction targets. Thus, an approach that combines precise genomics and Islamic values may serve as a contextual and sustainable strategy in shaping a generation that is healthy, intelligent, and spiritually resilient.

Comparison of Antioxidant Activity of Flavonoid Compounds From (Moringa Oleifera L.) Leaf Extract Using Uv-Vis Spectrophotometry Method

Puteri Rahma Maharani — 2026-05-06

The bioactive compounds found in moringa leaves (Moringa oleifera L.) can function as natural antioxidants to protect cells from damaging free radicals. The purpose of this study is to ascertain the antioxidant activity of moringa leaves according to the type of solvent, analyze the relationship between antioxidant capacity and concentration of active compounds, and determine the best solvent. Extraction was carried out using ethanol, methanol, and aquades solvents, followed by testing antioxidant activity using UV-Vis spectrophotometry method on DPPH radicals. The content of phenols, flavonoids, and tannins in the extract was measured to understand their contribution to antioxidant activity Based on the results of the study, the extract containing ethanol solvent showed the most powerful antioxidant activity, with an IC50 value of 103.98 ppm. In conclusion, the type of solvent has a significant effect on the antioxidant activity of moringa leaves, with ethanol solvents being the most effective option. This research strengthens the potential of moringa leaves as a natural source of antioxidants that can be utilized for applications in the pharmaceutical and health fields, although further research is needed to optimize extraction techniques and the development of moringa oleifera leaf-based product

The Effect of Menopause on the Cardiovascular System

Guadelupe Maria Melisa Wiriadinata — 2026-05-08

Menopause is the permanent cessation of menstruation for 12 consecutive months without any underlying pathological cause. This occurs due to ovarian follicular atresia, which leads to the cessation of estrogen production. The menopausal transition begins 5 to 10 years before menstruation ceases. During menopause, estrogen levels decline, leading to biological changes in the body, such as an increase in total cholesterol, low-density lipoproteins (LDL), triglycerides, and apolipoprotein B, as well as a decrease in high-density lipoprotein (HDL), an increase in visceral fat, and the development of metabolic syndrome. Various characteristics of menopause have been evaluated in relation to cardiovascular disease (CVD) risk, including age at menopause onset, type and stage of menopause, endogenous estradiol levels, and menopause-related symptoms. These factors have been found to be associated with CVD risk, with the highest risk occurring in women with ovarian failure and relatively early menopause. Women with early menopause (aged 40–44 years) have a hazard ratio of 1.55 (95% CI: 1.38–1.73) for coronary artery disease events compared to women with menopause at age 50–54 years. Women with premature ovarian failure tend to have a shorter life expectancy compared to those who experience late menopause, primarily due to an increased risk of cardiovascular disease.

The Impact of Telemedicine on Patient Satisfaction Levels in Several Developed and Developing Countries: A Systematic Review

Salsabilla Dyah Puspitasari — 2026-05-08

Telemedicine is a telecommunication technology in healthcare that has expanded rapidly, especially during COVID-19. Its implementation varies between developed and developing countries, raising questions about its impact on patient satisfaction and the factors influencing it. This study aims to evaluate the impact of telemedicine on patient satisfaction across developed and developing countries and to identify key factors influencing satisfaction to inform improvements in telemedicine delivery models. The systematic review was conducted using PubMed, Scopus, and Web of Science databases. The search utilized keywords related to telemedicine and patient satisfaction. The inclusion criteria focused on peer-reviewed articles published between 2020 and 2025, resulting in 14 studies (seven from developed countries and seven from developing countries) being analyzed. Data were extracted and synthesized following the PRISMA guidelines. The analysis identified 14 eligible studies. The findings indicate that telemedicine generally has a positive impact on patient satisfaction, with high satisfaction levels reported across various settings. For example, studies from Sweden and India reported that approximately 78-93% of patients expressed satisfaction or willingness to reuse the telemedicine service. However, several challenges were identified, particularly in developing countries such as Indonesia and the Philippines, including service costs, limited digital infrastructure, and low technological literacy

Rosemary (Rosmarinus officinalis) Phytochemicals as Prevention of Collagen Degradation and Wrinkle Formation: a Literature Review

Nyoman Ledy Trisna Parimartha — 2026-05-08

of the most visible manifestations. Aging disrupt the balance between collagen synthesis and degradation, leading to fragmentation of collagen fibers and loss of skin elasticity. Natural phytochemicals have gained increasing attention as potential agents for preventing or delaying skin aging due to their antioxidant and anti-inflammatory properties. Rosemary (Rosmarinus officinalis) contains a variety of bioactive compounds with potential dermatological benefits. Major phytochemicals identified in rosemary include phenolic acids such as rosmarinic acid, diterpenes such as carnosic acid and carnosol, as well as flavonoids and volatile terpenoids. These compounds have demonstrated strong antioxidant activity and the ability to modulate molecular pathways associated with skin aging. Evidence from in vitro studies suggests that rosemary phytochemicals can reduce reactive oxygen species (ROS) production, suppress inflammatory signaling pathways, and inhibit the expression of MMPs involved in collagen degradation. Emerging clinical evidence, particularly from oral supplementation studies, also suggests improvements in skin elasticity, wrinkle depth, and oxidative stress biomarkers, supporting the translational potential of rosemary phytochemicals in human skin. Available evidence supports the potential application of rosemary-derived compounds in dermatological and cosmeceutical formulations aimed at preventing collagen degradation and wrinkle formation. This literature review summarizes current evidence on the phytochemical composition of rosemary and the molecular mechanisms through which its bioactive compounds may contribute to the prevention of skin aging.

Advanced Drug Delivery Systems: Nano-Formulation Challenges of Poorly Water-Soluble Phytochemicals

Juliana Palungan — 2026-05-08

The poor water solubility and low oral bioavailability of various phytochemical compounds (BCS Classes II and IV) continue to be major obstacles in the development of modern therapeutics, despite their remarkable therapeutic potential. This narrative review critically evaluates the use of nanoscale drug delivery systems to overcome the biopharmaceutical limitations of hydrophobic phytochemicals and pinpoints key challenges in clinical translation and industrial-scale production. The review provides a comprehensive analysis of the latest literature on the effectiveness of nanotechnology-based physicochemical modifications, including solid lipid nanoparticles (SLNs), nanostructured lipid carriers (NLCs), nanosuspensions, polymeric micelles, liposomes, and phytosomes. The review's results indicate that nano-carrier engineering significantly enhances solubility, avoids first-pass metabolic degradation, and enables targeted delivery. Specifically, nanoformulations have proven effective at penetrating the dense matrix of the tumor microenvironment (TME) in cancer therapy, crossing the blood-brain barrier (BBB) in neurodegenerative diseases, and protecting drugs from stomach acid in infectious and metabolic conditions. However, the transition toward commercialization is hindered by issues of long-term physicochemical stability (e.g., lipid polymorphic transitions) and challenges in standardizing botanical raw materials. These issues affect the reproducibility of large-scale production, ultimately delaying the availability of these promising therapies to patients in need. In conclusion, while nanoformulations offer transformative solutions for overcoming phytochemical biological barriers, standardizing protocols, innovating green synthesis, and fostering interdisciplinary collaboration are essential for overcoming scalability barriers and preparing these innovations for clinical application.

Determinants of Medication Adherence Behavior among Productive-Age Hypertensive Patients in Primary Care: A Scoping Review

Kusniawati Kusniawati — 2026-05-15

Background: Hypertension is a major global health problem and a leading risk factor for cardiovascular disease. Although effective antihypertensive medications are widely available, poor medication adherence remains a significant challenge in achieving optimal blood pressure control, particularly among productive-age patients. Objective: This scoping review aimed to identify and synthesize evidence on the determinants of medication adherence among productive-age hypertensive patients (aged 18–59 years) in primary care settings. Methods: The review followed the Joanna Briggs Institute (JBI) framework and the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. A comprehensive literature search was conducted in PubMed, Scopus, ScienceDirect, and Google Scholar for articles published between 2016 and 2026. Studies involving productive-age participants (18–59 years) that examined determinants of adherence to antihypertensive medication were included. Results: A total of 14 studies met the inclusion criteria. The findings revealed that medication adherence among productive-age hypertensive patients was influenced by multiple factors, including sociodemographic characteristics (age, education, economic status), self-efficacy, health literacy, treatment-related factors (regimen complexity, side effects), healthcare system support (effective communication, counseling), social support, and digital health interventions (mobile applications, electronic reminders). Conclusion: Medication adherence among productive-age hypertensive patients is a multidimensional behavior. Comprehensive, integrated strategies are required, including patient education, enhancing self-efficacy and health literacy, simplifying treatment regimens, strengthening communication with healthcare providers, and using technology-based interventions to improve long-term adherence and blood pressure control.

Scoping Review: Factors Contributing to the Success of Community-Based Interventions in Improving Animal Protein Intake among Children Aged 6–23 Months (Studies in Low-Income and Middle-Income Countries)

Fathimah Asri Fadhilah Aulia — 2026-05-27

Purpose: The intake of animal protein among children aged 6–23 months in low-income and middle-income countries remains far below WHO recommendations. This scoping review aims to map community health worker–based interventions in improving animal protein intake during complementary feeding. Methods: Through a systematic search of the Scopus, PubMed, and EBSCOhost databases, 12 studies from various low-income and middle-income countries were analyzed using the Joanna Briggs Institute appraisal tool. Twelve studies from Africa, Asia, and Latin America met the inclusion criteria. All studies reported improvements in maternal knowledge related to animal-source protein (ranging from 19% to 37%) and positive changes in complementary feeding practices, including increased consumption of animal-source foods and improved dietary diversity. Several studies also demonstrated favorable impacts on child nutritional status, with reductions in stunting of up to 8.1%. Five main intervention strategies were identified: face-to-face nutrition education, community-based behavior change communication, home visits, combined lipid-based supplementation, and practical learning approaches. Ten enabling factors were consistently reported, particularly adequate CHW training, strong health system support, high CHW motivation, family involvement, and availability of local animal-source foods. Conversely, nine major barriers were identified, most notably household economic constraints, which were reported across all studies. Conclusion: Community-based interventions led by community health workers are effective in improving animal-source protein intake and complementary feeding practices among children under two years of age in LMICs. Program success depends on the interaction between well-trained and supported CHWs, enabling household and community environments, and broader socioeconomic conditions. Addressing structural barriers, especially household economic limitations, is essential to sustain and scale up effective interventions.

Global Cost Comparison of Hemodialysis and Peritoneal Dialysis in End-Stage Kidney Disease: A Systematic Review Across Country Income Levels

Affifatu Annisa — 2026-05-27

The increasing prevalence of end-stage renal disease poses an economic challenge to healthcare systems worldwide. Hemodialysis and peritoneal dialysis are currently the most commonly used renal replacement therapy modalities, but their costs vary across components and economic contexts. This systematic review aims to compare the costs of hemodialysis and peritoneal dialysis across countries, considering income levels and economic perspectives. A systematic literature search was conducted using EBSCO, ProQuest, PubMed, Scopus, and SpringerLink databases, with studies conducted between 2015 and 2025. Studies reporting cost analyses of hemodialysis and/or peritoneal dialysis were included. The selection process followed PRISMA guidelines, and the methodology was assessed using the CHEERS 2022 checklist. A total of 33 studies were included for discussion across low- to high-income levels. Economically, peritoneal dialysis was found to be more cost-effective than hemodialysis in most of these studies. The difference in cost structure is attributed to direct medical costs, which constitute the largest component of costs. Hemodialysis treatment is more expensive due to the costs of dialysis machines, service facilities, labor, and infrastructure, as well as lost productivity and indirect medical costs. Advantages of peritoneal dialysis include lower transportation costs, reduced productivity loss, and accessibility to low- and middle-income countries. Several studies have also shown that peritoneal dialysis yields quality-adjusted life years (QALYs) comparable to hemodialysis. This systematic review concludes that peritoneal dialysis can be cost-effective in most high-income countries. It should be considered a treatment modality of choice to improve efficiency, control long-term costs, and support health insurance management.

Economic Burden of Kidney Transplantation as Renal Replacement Therapy in End-Stage Chronic Kidney Disease Patients: A Systematic Review

Qurrata Akyuni — 2026-05-27

End-stage renal disease (ESRD) imposes a substantial economic burden on healthcare systems worldwide, extending well beyond its clinical implications. This burden is predominantly attributable to the requirements of renal replacement therapy (RRT), with kidney transplantation representing one of the most cost-intensive components of ESRD management. The complexity and continuity of long-term care needs further amplify the financial pressure on health systems globally. This systematic review was undertaken to identify and evaluate the economic burden associated with chronic kidney disease (CKD) across various RRT modalities, namely hemodialysis, peritoneal dialysis, and kidney transplantation, within diverse healthcare contexts. A systematic literature search was conducted in Scopus, PubMed, SpringerLink, and ProQuest, encompassing English-language observational studies and economic evaluations published between 2015 and 2025 that reported direct medical costs, non-medical costs, productivity losses, and related economic indicators. A total of 15 studies from multiple countries were analyzed, revealing a broadly consistent pattern of findings. Healthcare expenditures were found to escalate markedly with advancing CKD stage and the initiation of RRT. Multiple economic evaluation frameworks were employed, including disease burden analysis, cost-benefit analysis, comparative cost analysis, and cost-utility analysis. Hemodialysis incurred the highest annual costs, followed by peritoneal dialysis. While kidney transplantation requires a greater upfront investment, it has considerably lower long-term annual costs than continuous dialysis. The review ultimately affirms that kidney transplantation constitutes a more economically efficient therapeutic strategy for ESRD management, with meaningful potential to alleviate the broader global economic burden associated with this condition.

Impact of Educational Attainment, Illness Perception, Service Quality, and Accessibility on the Utilization of Internal Medicine Outpatient Services: A Scoping Review

Lita Susanti — 2026-05-27

Background: Outpatient healthcare utilization, particularly in internal medicine, plays a crucial role in early diagnosis, continuity of care, and clinical outcomes. However, disparities in the utilization of these services remain a challenge due to multiple interrelated determinants. Objective: This scoping review aimed to map and synthesize the evidence regarding the influence of educational attainment, illness perception, service quality, and accessibility on the utilization of internal medicine outpatient services. Methods: The review followed the Arksey and O'Malley framework and was reported in accordance with the PRISMA-ScR guidelines. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar for studies published between 2016 and 2026. A total of 16 studies met the inclusion criteria and were analyzed. Results: Most included studies employed quantitative cross-sectional designs, while several used qualitative and mixed-methods approaches. Educational attainment was reported as a significant determinant in 12 studies (71%), accessibility in 14 studies (82%), illness perception in 8 studies (47%), and service quality in 6 studies (35%). A combination of individual, psychological, service-related, and structural factors influenced outpatient service utilization. Educational attainment and accessibility were the most frequently reported determinants, whereas illness perception and service quality played roles in shaping healthcare-seeking behavior and continuity of care. Heterogeneity in study design, measurement approaches, and healthcare system contexts was a major limitation. Conclusion: Outpatient internal medicine service utilization is multidimensional and requires integrated strategies, including enhancing health literacy, strengthening patient-centered service quality, and reducing financial and geographical barriers, to achieve more equitable and effective healthcare delivery.