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Glow discharge is part of the phenomenon of plasma formation on the electrode side in contact with the electrolyte solution and begins with an electrolysis reaction with direct electric current. In this research, 0.02 M K2SO4 electrolyte was used, the anode in the form of tungsten and stainless steel for the cathode in a direct current plasma electrolysis reactor. The phenomenon of plasma formation is explained using a strong current and voltage characteristic curve. There are three plasma formation zones: the ohmic zone, the transition zone and the glow discharge plasma zone. Air injection affects the formation of glow discharge plasma and radicals. Without the injection of air, radicals formed only •OH, •H and •O with emission intensities of 20012 a.u, 10121 a.u and 10245 a.u. Air injection 0.8 L men-1 produced radicals •OH, •N, •N2*, •N2+, •H and •O with emission intensities of 30863a.u, 20139 a.u, 28540 a.u, 18023 a.u, 12547 a.u and 49800 a.u. Many radicals are generated when the plasma reaches stability. The plasma is dominated by H2O ionization, and the plasma is more stable if formed in the gas phase. Other results from this research at 0 L men-1, 0.2 L men-1, 0.4 L men-1 and 0.8 L men-1 stable plasma were formed at 675 V, 660 V, 650 V and 650 V. The plasma that can be seen from the bright light, the injection of air accelerates the formation of a gas envelope to reduce energy.

Pandemi, disrupsi, dan inflasi menjadi tantangan besar dalam sektor ekonomi di Indonesia saat ini. Disrupsi teknologi digital merupakan peluang yang bisa dimanfaatkan untuk pemulihan ekonomi. Sasaran dalam pengabdian ini adalah Desa Pucangan yang terletak di Kabupaten Sukoharjo, Jawa Tengah. Desa Pucangan memiliki beberapa penjual UMKM dimana desa tersebut menghasilkan limbah minyak jelantah yang cukup banyak. Jika limbah tersebut tidak diolah dengan benar maka akan mencemari lingkungan dan mengganggu kesehatan. Di desa tersebut belum ada pengolahan limbah minyak. Disisi lain, banyak masyarakat yang terdampak Covid 19 di desa tersebut sehingga kehilangan pekerjaan yang menjadi sumber penghasilan. Dalam pengabdian ini, diusulkan sosialisasi dan pelatihan mengolah limbah minyak jelantah menjadi lilin aromaterapi yang layak untuk dijual. Selain itu, masyarakat dilatih menggunakan teknologi website e-commerce untuk pemasaran yang diharapkan dapat memperluas area penjualan lilin tersebut. Dalam proses penjualan mengaplikasikan periklanan menggunakan Google Ads yang terintegrasi dengan website e-commerce yang dibuat. Tujuan dari pengabdian ini adalah membentuk/memberdayakan kelompok masyarakat di Desa Pucangan agar dapat mandiri secara ekonomi.

Turmeric (Curcuma longa L) is one of the many spices that grow on the Asian continent, especially Southeast and South Asia, which can be utilized to its full potential, especially the antioxidant compounds contained in curcuminoids. This study aims to determine the effect of different forms of turmeric, powder and fresh, on the extraction using the reflux extraction method and antioxidant activity using the DPPH method (2,2-Diphenyl-1-PicrylHydrazyl). The reflux extraction process was carried out using distilled water with three variations of sample forms, turmeric powder, fresh turmeric (grated turmeric and pieces of turmeric) with a solute/solvent ratio (w/v) (1:5). The viscous extract in the form of a paste was obtained after the distillation process and solvent evaporation. The best extracts and essential oils obtained were extracts from powdered turmeric samples with yields of 8.28 (% w/w) and essential oils of 0.44 g, which were clearer than the other two samples. The analysis showed that the sample of turmeric with the highest antioxidant activity was a sample of freshly grated turmeric with an IC50 value of 114.7 ppm with a moderate level of antioxidant activity. The cut turmeric sample has an IC50 value of 158.3 ppm, which is included in the weak antioxidant activity. The powdered turmeric sample has an IC50 value of 134.1 ppm with moderate strength.

Convection industries are always required to improve quality. The ABC convection industry faces several problems in the production process, such as waste product defects of up to 10%, waste over-processing, and transportation waste. This research aims to reduce the occurrence of waste in The ABC production process. The method used in this research is Lean Six Sigma and the DMAIC approach (define, measure, analyze, improve, and control), which have been proven to reduce waste. In the DMAIC stages, the fishbone diagram is used in the analysis stage to find the root of the problem, while the 5W+1H method is used in the improvement stage to provide recommendations for improvement. The improvements implemented include re-layout the sewing workstation, installing a partition on the sewing table, and adding tools such as material measuring stickers and grouping patterns based on models at the patterning and cutting workstations. The workstation space was moved to the same building to eliminate transportation waste. After the improvement, the sigma level calculation results showed an increase of 10%, from a sigma level of 3.5 to 3.9 sigma.

Dissolved oxygen is an important parameter in L. vannamei culture. The aim of this research is to determine of the oxygen levels produced by the paddle aerator in L. vannamei ponds. The research method used is a descriptive method by collecting research data using the causal expose-facto design which is analyzed by a dynamic modeling system. The results showed that water quality parameters were relatively stable during the shrimp culture periods. Based on dynamic modeling studies, the effectiveness of using the paddle aerator will decrease in the third week. According to modeling estimates of 1 HP paddle aerators produce dissolved oxygen levels was 0.5-8.0 mg/L. The oxygen solubility level from using the paddle aerator was lowest when the shrimp culture period reached 50 days and the highest solubility was 7.5 mg/L. The oxygen solubility rate in shrimp pond waters is also influenced by the temperature stability and other abiotic factors. Finally, the oxygen production rate in the paddle aerator oscillates dynamically throughout the shrimp culture cycle with estimated oxygen production rates ranging from 0.5-8 mg/L.

Hypertension is one of the most commonly encountered problems in primary health care and a major risk factor for other lethal diseases. Obesity, another arising problem in developing and developed countries, is another major risk factor for metabolic disease. However, studies about both diseases and their intercorrelation in rural areas are still limited. Therefore, we conducted this study to investigate the correlation between body mass index (BMI) and blood pressure in a rural area. This study was an observational, cross-sectional study performed in outpatients at Community Health Care of Ngronggot, a rural area in East Java for one month with inclusion criteria aged 18 years old, systole blood pressure (SBP) ≥140 and/or diastole blood pressure (DBP) ≥90, or a history of anti-hypertensive treatment. Information including age, gender, SBP, DBP, mean arterial pressure (MAP), body weight, and height was collected and calculated for its distribution and correlation using the Spearman rank-order correlation test. There were 201 subjects in this study, 65.7% of which were female, while 34.3% of which are male, and the median age was 59 years old. We also found that more than 60% of our participants were overweight and obese. The results of the Spearman test showed that BMI significantly correlated with SBP (p=0.029), DBP (p=0.016), and MAP (p=0.008). In conclusion, BMI had a positive correlation with blood pressure, and obesity was prevalent in our rural area population.

Abstract: Language learning strategies (LLSs) play an essential role in the process of English language learning. This study is aimed at investigating language-learning strategies employed by successful Indonesian EFL high school students. This study is of significance to provide a model of strategies practiced by successful EFL students who manage to develop good command of English regardless certain limitations and challenges they face. The results of this study show the students actively employ a combination of affective and cognitive-social learning strategies to develop their English skills. Keywords: language learning strategies, successful EFL learners, language learning, high school Abstrak: Strategi pembelajaran bahasa (LLS) memainkan peran penting dalam proses pembelajaran bahasa Inggris. Penelitian ini bertujuan untuk menyelidiki strategi pembelajaran bahasa yang digunakan oleh siswa EFL sekolah menengah atas di Indonesia yang berhasil. Studi ini sangat penting untuk memberikan model strategi yang dipraktikkan oleh siswa EFL yang berhasil yang berhasil mengembangkan penguasaan bahasa Inggris yang baik terlepas dari batasan dan tantangan tertentu yang mereka hadapi. Hasil penelitian ini menunjukkan siswa secara aktif menggunakan kombinasi strategi pembelajaran afektif dan kognitif-sosial untuk mengembangkan kemampuan bahasa Inggris mereka. Kata kunci: strategi pembelajaran bahasa, pebelajar bahasa Inggris EFL sukses, pembelajaran bahasa, siswa SMA

Perkembangan IPTEK saat ini secara langsung berdampak pada perubahan bentuk pengajaran dalam bidang Pendidikan. Guru dituntut untuk menguasai teknologi untuk menunjang proses pembelajarannya. Salah satu proses dalam pembelajaran yang dapat diimplementasikan dengan kemajuan teknologi adalah proses penilaian. Dalam proses penilaian dibutuhkan pola yang sistematis sehingga mempermudah proses penilaian. SD Tlogomas 2 Malang merupakan salah satu SD yang sudah menerapkan kurikulum 2013. Para guru sudah menerapkan pembelajaran tematik terpadu, dan mencoba mengaplikasikan media dalam kegiatan pembelajaran di kelas. Namun dalam melaksanakan penilaian hanya menggunakan perangkat instrument paper based test. Guru belum menggunakan penilaian secara online. Penelitian ini menggunakan model pengembangan O’ Malley dan Pierce yang disesuaikan dengan kebutuhan penelitian dengan lima tahapan meliputi: 1) menentukan tujuan pengembangan, 2) menyusun spesifikasi produk, 3) melakukan pengembangan, 4) uji coba, dan 5) revisi. Penelitian ini bertujuan untuk ini memfasilitasi siswa dalam meningkatkan kemampuan dan meningkatkan motivasi belajar siswa. Selain itu juga sebagai sarana untuk mempermudah guru dalam melakukan penilaian secara sistematis.

Virgin Coconut Oil (VCO) yang biasanya dikenal dengan minyak perawan atau minyak dara ini saat ini menjadi tren di kalangan masyarakat. Manfaat dari VCO yang baik untuk kesehatan tubuh menjadi acuan banyak orang untuk pola hidup sehat. Pemanfaatan buah kelapa sebagai bahan baku pembuatan VCO dan proses yang sederahan serta mudah menjadikan produk ini menjadi salah satu solusi bagi permasalahan masyarakat untuk peningkatan pendapatan. Latar belakang tersebut yang mendorong adanya kegiatan pengabdian masyarakat pelatihan pembuatan VCO dengan sasaran ibu PKK daerah Patemon Kecamatan Gunungpati Semarang. Pada proses pengabdian ini yang dilakukan anatra lain sosialisasi dan penjaringan peserta, presentasi materi pembuatan VCO, demonstrasi pembuatan VCO dan evaluasi kegiatan. Pada pelaksanaan pelatihan VCO diikuti oleh 20 orang ibu PKK yang terbagi menjadi 4 kelompok yang terdiri masing-masing 5 orang. Pelaksanaan sangat mendapat respon positif baik dari peserta maupun aparat desa. Hasil dari evaluasi kegiatan bahwasanya pada pelaksanaan pelatihan pembuatan VCO terdapat 1 orang yang kurang paham, 3 orang paham dan 16 orang paham sekali. Sedangkan untuk volume VCO yang dihasilkan pada tiap kelompok sebanyak 25 ml, 30 ml, 22.5 ml dan 27 ml. Kata kunci : kelapa, pelatihan, VCO

Perkembangan bioteknologi di bidang pangan semakin meningkat seiring kebutuhan bagi kesehatan tubuh. Salah satu bioteknologi pangan yang dapat dilakukan yaitu pembuatan nata de leri. Nata merupakan produk makanan yang berupa lapisan selulosa sebagai hasil fermentasi bakteri pembentuk nata, yaitu Acetobacter xylinum. Pelatihan nata de leri yang dilakukan di kelurahan banyumanik bertujuan memanfaatkan air sisa cucian beras menjadi hasil ekonomi yang dapat didiversifikasi menjadi nata. Air cucian beras yang biasa dikenal dengan leri tersebut biasanya langsung dibuang karena dianggap tidak memiliki nilai tambah, namun sebenarnya masih mengandung karbohidrat, protein, dan vitamin B. Pelatihan dilakukan menggunakan metode experimental learning. Pelatihan diawali dengan presentasi kemudian praktik secara langsung pembuatan nata de leri. Proses pembuatan terdiri dari persiapan bahan dan alat yang digunakan, pembibitan stater, pembuatan nata de leri dan uji organoleptic berupa uji warna, uji tingkat kemanisan dan uji tingkat kekenyalan. Hasil uji organoleptik yang diperoleh antara lain 16 peserta melihat warna nata de leri hasil fermentasi menarik karena berwarna putih, sedangkan 14 peserta berpendapat bahwa warna nata de leri tidak menarik karena warna yang dihasilkan putih pucat tidak putih transparan. Tingkat kemanisan dibagi menjadi dua opsi yaitu manis dan tawar. Semua peserta (30 orang) berpendapat bahwa nata de leri rasanya tawar, baru ada rasa setelah diberi essence atau perasa. Uji tingkat kekenyalan memperlihatkan, bahwa sebanyak 26 peserta menyatakan nata de leri kenyal dan 4 peserta menyatakan tidak kenyal. Kata kunci: acetobacter xylinum, leri, nata

Damage to coral reef ecosystems is a major problem on the islands of Gili Air and Gili Trawangan. This will have an impact on the presence of reef fish in the area. This study aims to look how much relation caused by associated between live coral cover and reef fish in Gili Air and Gili Trawangan island.. This research method using Line Intersept Transect (LIT), Underwater Visual Census and simple linear regression analysis to know the relation. The percentage of coral cover on Gili Air Island and Gili Trawangan Island on reef flats (1-5 m) is 11.75% and 11.67% respectively, on the reef slopes (6-10 m) the percentage is 50.4% and 48.9%. In addition we observed the existence of 11 families reef fish. The abundance of reef fish on Gili Air and Gili Trawangan islands on reefs flat with an average of 0,406 ind / m2 and 0,137 ind / m2, on the reef slope on average - respectively 0,434 ind / m2 and 0,274 ind / m2. The determinant value in Southern part of both island indicates a value close to +1 and in Northern part of both island indicates a value close to -1.

Background: There are still many patients newly diagnosed with HIV at an advanced stage in Indonesia. We aimed to identify factors associated with 1-year mortality among cytomegalovirus (CMV)-infected people living with HIV (PLHIV)., Methods: This retrospective cohort study was carried out at a tertiary-care hospital in Jakarta, Indonesia (January 2017 to December 2022). We included PLHIV with CMV end-organ disease (EOD) and CMV syndrome. The presence of CMV infection was confirmed by fulfilling one of the following criteria: (1) positive PCR from plasma, urine, cerebrospinal fluid, or other body fluids, or associated tissue for CMV EOD; (2) positive immunoglobulin M (IgM); or (3) consistent symptoms and signs of CMV retinitis., Results: Out of 1737 PLHIV, 147 (8.5%, 95% CI: 7.2 to 9.9%) were diagnosed with CMV infection. Forty (27.2%, 95% CI: 20.6 to 35.1%) patients died within 1 year of being diagnosed. Only anti-retroviral therapy (ART) defaulting (aHR 3.31, 95% CI: 1.12 to 9.73) was found to be significantly associated with 1-year mortality in multivariate analysis., Conclusion: Defaulted ART status is significantly associated with reduced 1-year survival after CMV infection diagnosis. Patients with low CD4 counts, especially those with <50 cells/μL, should be assessed for CMV infection, monitored, and treated accordingly., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: All authors have completed the ICMJE uniform disclosure form at https://www.icmje.org/disclosure-of-interest/and-declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work; no other relationships or activities that could appear to have influenced the submitted work.

Objective: Neuropsychiatric SLE (NPSLE) has a broad spectrum and to date, there is no gold-standard biomarker. The diagnosis relies on clinical assessment, supporting examinations and exclusion of other possible aetiologies. One method that can be used to establish NPSLE is to conduct a re-evaluation by involving several fields of medical science. This study aims to reassess SLE cases with neuropsychiatric (NP) manifestations through multidisciplinary re-evaluation and determine the final diagnosis of NPSLE or non-NPSLE., Methods: This retrospective cross-sectional study used medical record data from patients with SLE with NP manifestations. Inclusion criteria included patients diagnosed with SLE, who had clinical manifestations of NP and were >18 years old. Multidisciplinary re-evaluation was conducted and agreed upon the diagnosis of NPSLE or non-NPSLE., Results: We included 94 subjects with a total of 132 NP events consisting of 69 NPSLE and 63 non-NPSLE. After re-evaluating NPSLE events, 33.3% were still concluded to be NPSLE. Meanwhile, from the non-NPSLE group, 22.2% were then declared as NPSLE. There were no significant differences in demographic characteristics between the NPSLE and non-NPSLE groups. The proportion of NP events in both groups was almost the same except for cerebrovascular disease manifestations which were more common in the NPSLE group. Higher Mexican SLE Disease Activity Index scores with (p<0.001) or without NP (p=0.02) were observed in the NPSLE group compared with the non-NPSLE group, as well as higher proportion of active disease (p=0.03), higher anti-double-stranded DNA titres (p<0.001) and lower values of C3 (p=0.018) and C4 (p=0.001)., Conclusions: Multidisciplinary re-evaluation can be used as a method to confirm the diagnosis of NPSLE. There is a tendency for overdiagnosis of NPSLE when clinicians are faced with NP events in patients with SLE. Complete clinical and supporting data are needed to determine the final diagnosis of NPSLE., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Little is known about the etiology, clinical presentation, management, and outcome of central nervous system (CNS) infections in Indonesia, a country with a high burden of infectious diseases and a rising prevalence of HIV., Methods: We included adult patients with suspected CNS infections at two referral hospitals in a prospective cohort between April 2019 and December 2021. Clinical, laboratory, and radiological assessments were standardized. We recorded initial and final diagnoses, treatments, and outcomes during 6 months of follow-up., Results: Of 1051 patients screened, 793 were diagnosed with a CNS infection. Patients (median age 33 years, 62% male, 38% HIV-infected) presented a median of 14 days (IQR 7-30) after symptom onset, often with altered consciousness (63%), motor deficits (73%), and seizures (21%). Among HIV-uninfected patients, CNS tuberculosis (TB) was most common (60%), while viral (8%) and bacterial (4%) disease were uncommon. Among HIV-infected patients, cerebral toxoplasmosis (41%) was most common, followed by CNS TB (19%), neurosyphilis (15%), and cryptococcal meningitis (10%). A microbiologically confirmed diagnosis was achieved in 25% of cases, and initial diagnoses were revised in 46% of cases. In-hospital mortality was 30%, and at six months, 45% of patients had died, and 12% suffered from severe disability. Six-month mortality was associated with older age, HIV, and severe clinical, radiological and CSF markers at presentation., Conclusion: CNS infections in Indonesia are characterized by late presentation, severe disease, frequent HIV coinfection, low microbiological confirmation and high mortality. These findings highlight the need for earlier disease recognition, faster and more accurate diagnosis, and optimized treatment, coupled with wider efforts to improve the uptake of HIV services., (© 2024. The Author(s).)

Background: Chronic headache is a 'silent' neuropsychiatric systemic lupus erythematosus symptom with heterogeneous prevalence, potentially reaching 54.4%. It may reduce quality of life by increasing the likelihood of depression and sleep disturbance. While pharmacotherapy remains the first-line treatment, the current management is still challenging and needs other non-invasive modalities. An effective, tolerable and disease-specific treatment modality including transcranial direct current stimulation (tDCS) is considered to reduce the frequency of chronic headaches, including in SLE. Until recently, there was no standard protocol for tDCS in treating headaches., Methods and Analysis: SHADE is a single-centre randomised double-blind multiarm sham-controlled trial for adults with clinically stable SLE, chronic headaches and without history of traumatic brain injury, brain infection, stroke or brain tumour. Random allocation is conducted to 88 subjects into 3 treatment groups (administration at primary motor, primary sensory and dorsolateral prefrontal cortex) and control group in 1:1:1:1 ratio. The primary endpoint is reduced number of headache days after adjunctive tDCS. The secondary endpoints are reduced headache intensity, increased quality of life, increased sleep quality, decreased depression and reduced analgesics use. The outcome is measured monthly until 3-month postintervention using headache diary, 36-Item Short Form Survey, Chronic Headache Quality of Life Questionnaire, Pittsburgh Sleep Quality Index and Mini International Neuropsychiatry Interview version 10 (MINI ICD 10). Intention-to-treat analysis will be performed to determine the best tDCS electrode placement., Ethics and Dissemination: Ethical approval had been obtained from the local Institutional Review Board of Faculty of Medicine Universitas Indonesia. Results will be published through scientific relevant peer-reviewed journals., Trial Registration Number: NCT05613582., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Cerebrovascular complications could occur in 15-57 % of patients with tuberculous meningitis (TBM). It is crucial to rapidly identify TBM patients who are at risk for stroke. This study aimed to find predictors of stroke in patients with TBM., Methods: This systematic review and meta-analysis were done using literature searches through online databases up to April 30th, 2022. Three independent authors performed literature screening, data extraction, and critical appraisal of the studies. Eight studies involving 1535 samples were included., Results: We analyzed data regarding demographic, comorbidity, clinical presentation, radiologic, and laboratory parameters. Overall, clinical presentation that showed outcome difference was found in patients with findings of vomiting (OR = 2.71, 95 % CI: 1.30-5.63), cranial nerve deficit (OR = 4.10, 95 % CI: 1.83-9.21), focal deficit (OR = 5.56, 95 % CI: 2.24-13.79), and altered consciousness (OR = 1.90, 95 % CI: 1.24-2.92). Some comorbidities showed significant differences such as diabetes mellitus (OR = 2.58, 95 % CI: 1.51-4.41), hypertension (OR = 5.73, 95 % CI: 3.36-9.77), ischemic heart disease (OR = 2.18, 95 % CI: 1.02-4.63), and smoking (OR = 2.65, 95 % CI: 1.22-5.77). Two radiological changes shown to have significantly higher proportions are hydrocephalus (OR = 2.50, 95 % CI: 1.74-3.58) and meningeal enhancements (OR = 3.99, 95 % CI: 1.73-9.20)., Conclusion: Our analysis indicated that clinical presentations of vomiting, cranial nerve deficit, focal deficit, altered consciousness; comorbidity of diabetes mellitus, hypertension, smoking history, ischemic heart disease; and radiological findings of meningeal enhancement and hydrocephalus showed significant association with stroke incidence in tuberculous meningitis., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Adjunctive glucocorticoids are widely used to treat human immunodeficiency virus (HIV)-associated tuberculous meningitis despite limited data supporting their safety and efficacy., Methods: We conducted a double-blind, randomized, placebo-controlled trial involving HIV-positive adults (≥18 years of age) with tuberculous meningitis in Vietnam and Indonesia. Participants were randomly assigned to receive a 6-to-8-week tapering course of either dexamethasone or placebo in addition to 12 months of antituberculosis chemotherapy. The primary end point was death from any cause during the 12 months after randomization., Results: A total of 520 adults were randomly assigned to receive either dexamethasone (263 participants) or placebo (257 participants). The median age was 36 years; 255 of 520 participants (49.0%) had never received antiretroviral therapy, and 251 of 484 participants (51.9%) with available data had a baseline CD4 count of 50 cells per cubic millimeter or less. Six participants withdrew from the trial, and five were lost to follow-up. During the 12 months of follow-up, death occurred in 116 of 263 participants (44.1%) in the dexamethasone group and in 126 of 257 participants (49.0%) in the placebo group (hazard ratio, 0.85; 95% confidence interval, 0.66 to 1.10; P = 0.22). Prespecified analyses did not reveal a subgroup that clearly benefited from dexamethasone. The incidence of secondary end-point events, including cases of immune reconstitution inflammatory syndrome during the first 6 months, was similar in the two trial groups. The numbers of participants with at least one serious adverse event were similar in the dexamethasone group (192 of 263 participants [73.0%]) and the placebo group (194 of 257 participants [75.5%]) (P = 0.52)., Conclusions: Among HIV-positive adults with tuberculous meningitis, adjunctive dexamethasone, as compared with placebo, did not confer a benefit with respect to survival or any secondary end point. (Funded by the Wellcome Trust; ACT HIV ClinicalTrials.gov number, NCT03092817.)., (Copyright © 2023 Massachusetts Medical Society.)

Background: Cellular metabolism is critical for the host immune function against pathogens, and metabolomic analysis may help understand the characteristic immunopathology of tuberculosis. We performed targeted metabolomic analyses in a large cohort of patients with tuberculous meningitis (TBM), the most severe manifestation of tuberculosis, focusing on tryptophan metabolism., Methods: We studied 1069 Indonesian and Vietnamese adults with TBM (26.6% HIV-positive), 54 non-infectious controls, 50 with bacterial meningitis, and 60 with cryptococcal meningitis. Tryptophan and downstream metabolites were measured in cerebrospinal fluid (CSF) and plasma using targeted liquid chromatography-mass spectrometry. Individual metabolite levels were associated with survival, clinical parameters, CSF bacterial load and 92 CSF inflammatory proteins., Results: CSF tryptophan was associated with 60-day mortality from TBM (hazard ratio [HR] = 1.16, 95% confidence interval [CI] = 1.10-1.24, for each doubling in CSF tryptophan) both in HIV-negative and -positive patients. CSF tryptophan concentrations did not correlate with CSF bacterial load nor CSF inflammation but were negatively correlated with CSF interferon-gamma concentrations. Unlike tryptophan, CSF concentrations of an intercorrelating cluster of downstream kynurenine metabolites did not predict mortality. These CSF kynurenine metabolites did however correlate with CSF inflammation and markers of blood-CSF leakage, and plasma kynurenine predicted death (HR 1.54, 95% CI = 1.22-1.93). These findings were mostly specific for TBM, although high CSF tryptophan was also associated with mortality from cryptococcal meningitis., Conclusions: TBM patients with a high baseline CSF tryptophan or high systemic (plasma) kynurenine are at increased risk of death. These findings may reveal new targets for host-directed therapy., Funding: This study was supported by National Institutes of Health (R01AI145781) and the Wellcome Trust (110179/Z/15/Z and 206724/Z/17/Z)., Competing Interests: EA, JA, LN, SD, DV, HH, KB, BA, RE, TT, JD, DH, TC, NB, AG, RR, VK, RH, DI, KM, VK, CC, Rv, GT, Av, NT No competing interests declared, MN has received consulting fees from Scientific Board TTxD and is a scientific founder of TTxD, Lemba and BioTRIP. The author has no other competing interests to declare, (© 2023, Ardiansyah et al.)

Background: Despite a considerable number of articles regarding neurological manifestations associated with severe acute respiratory syndrome coronavirus 2 infection, reports on transverse myelitis and encephalitis are scarce., Case Presentation: We report a 35-year-old Asian Arab female presenting with longitudinally extensive transverse myelitis within 3 weeks after being diagnosed with mild coronavirus disease 2019 infection. Administration of high-dose methylprednisolone led to significant clinical improvement. However, 2 days after discharge, the patient was readmitted with encephalitis manifestations, consisting of fever and loss of consciousness, along with deterioration in myelitis symptoms. Severe acute respiratory syndrome coronavirus 2 antibody was detected in cerebrospinal fluid, but DNA of severe acute respiratory syndrome coronavirus 2 was not found. Clinical recovery was achieved after the administration of intravenous immunoglobulin., Conclusion: Longitudinally extensive transverse myelitis can be a neurological manifestation of coronavirus disease 2019 and can be followed by encephalomyelitis episodes. High-dose steroids and intravenous immunoglobulin as an immunomodulator are possible effective treatment options., (© 2022. The Author(s).)

Chikungunya virus (CHIKV) is recognized but rarely considered as a cause of central nervous system infection in endemic areas. A total of 244 patients with acute meningoencephalitis in Indonesia were retrospectively tested to identify whether any CHIKV infection was associated with neurological manifestations, especially in provinces known for CHIKV endemicity. Cerebrospinal fluid (CSF) and blood specimens were tested using CHIKV-specific real-time reverse transcription polymerase chain reaction and IgM ELISA, alongside a panel of neurotropic viruses. We report four cases of suspected or confirmed CHIKV-associated neurological disease, including CHIKV RNA detection in CSF of one patient and in acute serum of another, and CHIKV IgM in CSF of three patients and in serum of a fourth. In conclusion, CHIKV should be considered as a cause of neurologic disease in endemic areas and especially during outbreaks, in addition to the more common arboviral diseases such as dengue and Japanese encephalitis viruses.

Tuberculoma of medulla oblongata is a rare manifestation of central nervous system tuberculosis (CNS TB), which may manifest as intractable singultus as the initial symptom. It is almost impossible to obtain definite diagnosis through biopsy consider its location. Immediate thorough diagnostic workup is needed, and empirical treatment should be started. We report a case of medulla oblongata tuberculoma in an HIV-negative 38-year-old man with intractable singultus as one of the early symptoms. He was treated empirically with anti-tuberculosis therapy and his symptoms subsided within 2 weeks., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Multiple sclerosis (MS) is an autoimmune disease characterized by inflammation and demyelination of the central nervous system which often involves the optic nerve even though only 20% of the patients experience optic neuritis (ON)., Objective: This study aims to compare the retinal structure and optic nerve function between patients with MS and healthy controls (HCs), evaluate optic nerve alterations in MS over 1-year follow-up, and analyze its correlations with disease duration, number of relapses, degree of disability, and different subtypes., Methods: This is a prospective cohort study involving 58 eyes of MS patients. Optic nerve function was evaluated with best-corrected visual acuity (BCVA), contrast sensitivity, and P100 latency, while the retinal structure was evaluated from the GCIPL and RNFL thickness measured with optical coherence tomography (OCT) and fundus photography., Results: The MS group had lower BCVA ( p =0.001), contrast sensitivity ( p < 0.001), mean GCIPL thickness ( p < 0.001), and mean RNFL thickness ( p < 0.001) than HC. At 6 and 12 months of observations, GCIPL and RNFL (nasal quadrant) of MS patients decreased significantly ( p =0.007 and p =0.004, respectively). Disease duration and the number of relapses correlated with delayed P100 latency ( r  = -0.61, p < 0.001 and r  = -0.46, p =0.02). GCIPL and RNFL in the SPMS subtype were thinner than in RRMS., Conclusions: The retinal structure and optic nerve function of MS patients are worse than those of normal individuals. GCIPL and RNFL thinning occurs at 6 and 12 months but do not correlate with disease duration, the number of relapses, and degree of disability., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2021 Riwanti Estiasari et al.)

Background: Tuberculous meningitis (TBM), the most severe form of tuberculosis (TB), results in death or neurological disability in >50%, despite World Health Organisation recommended therapy. Current TBM regimen dosages are based on data from pulmonary TB alone. Evidence from recent phase II pharmacokinetic studies suggests that high dose rifampicin (R) administered intravenously or orally enhances central nervous system penetration and may reduce TBM associated mortality. We hypothesize that, among persons with TBM, high dose oral rifampicin (35 mg/kg) for 8 weeks will improve survival compared to standard of care (10 mg/kg), without excess adverse events. Protocol: We will perform a parallel group, randomised, placebo-controlled, double blind, phase III multicentre clinical trial comparing high dose oral rifampicin to standard of care. The trial will be conducted across five clinical sites in Uganda, South Africa and Indonesia. Participants are HIV-positive or negative adults with clinically suspected TBM, who will be randomised (1:1) to one of two arms: 35 mg/kg oral rifampicin daily for 8 weeks (in combination with standard dose isoniazid [H], pyrazinamide [Z] and ethambutol [E]) or standard of care (oral HRZE, containing 10 mg/kg/day rifampicin). The primary end-point is 6-month survival. Secondary end points are: i) 12-month survival ii) functional and neurocognitive outcomes and iii) safety and tolerability. Tertiary outcomes are: i) pharmacokinetic outcomes and ii) cost-effectiveness of the intervention. We will enrol 500 participants over 2.5 years, with follow-up continuing until 12 months post-enrolment. Discussion: Our best TBM treatment still results in unacceptably high mortality and morbidity. Strong evidence supports the increased cerebrospinal fluid penetration of high dose rifampicin, however conclusive evidence regarding survival benefit is lacking. This study will answer the important question of whether high dose oral rifampicin conveys a survival benefit in TBM in HIV-positive and -negative individuals from Africa and Asia. Trial registration: ISRCTN15668391 (17/06/2019)., Competing Interests: No competing interests were disclosed., (Copyright: © 2020 Marais S et al.)

Background: Tuberculous meningitis (TBM), the most severe form of tuberculosis (TB), results in death or neurological disability in >50%, despite World Health Organisation recommended therapy. Current TBM regimen dosages are based on data from pulmonary TB alone. Evidence from recent phase II pharmacokinetic studies suggests that high dose rifampicin (R) administered intravenously or orally enhances central nervous system penetration and may reduce TBM associated mortality. We hypothesize that, among persons with TBM, high dose oral rifampicin (35 mg/kg) for 8 weeks will improve survival compared to standard of care (10 mg/kg), without excess adverse events. Protocol: We will perform a parallel group, randomised, placebo-controlled, double blind, phase III multicentre clinical trial comparing high dose oral rifampicin to standard of care. The trial will be conducted across five clinical sites in Uganda, South Africa and Indonesia. Participants are HIV-positive or negative adults with clinically suspected TBM, who will be randomised (1:1) to one of two arms: 35 mg/kg oral rifampicin daily for 8 weeks (in combination with standard dose isoniazid [H], pyrazinamide [Z] and ethambutol [E]) or standard of care (oral HRZE, containing 10 mg/kg/day rifampicin). The primary end-point is 6-month survival. Secondary end points are: i) 12-month survival ii) functional and neurocognitive outcomes and iii) safety and tolerability. Tertiary outcomes are: i) pharmacokinetic outcomes and ii) cost-effectiveness of the intervention. We will enrol 500 participants over 2.5 years, with follow-up continuing until 12 months post-enrolment. Discussion: Our best TBM treatment still results in unacceptably high mortality and morbidity. Strong evidence supports the increased cerebrospinal fluid penetration of high dose rifampicin, however conclusive evidence regarding survival benefit is lacking. This study will answer the important question of whether high dose oral rifampicin conveys a survival benefit in TBM in HIV-positive and -negative individuals from Africa and Asia. Trial registration: ISRCTN15668391 (17/06/2019)., Competing Interests: No competing interests were disclosed., (Copyright: © 2019 Marais S et al.)

Background: Quality of life assessment of patients with multiple sclerosis (MS) is not routinely performed in Indonesia due to the unavailability of the validated Indonesian version of a specific instrument. The objective of this study was to transculturally adapt and validate the Indonesian version of the MSQOL-54 (MSQOL-54 INA) questionnaire., Methods: The transcultural adaptation was conducted by performing a standardized forward-backward method. Psychometric analysis was performed by assessing the reliability (Cronbach α), internal validation (item internal consistency and item discriminant validity), and external validation by measuring the correlation with a clinical factor such as EDSS and other demographic factors., Results: Reliability test with Cronbach α showed good internal consistency (> 0.7) at each component, except for health perception (0.665) and social function (0.433). Construct validity using computation of correlation coefficient showed internal consistency in accordance with the original MSQOL-54 standard dimension, except for energy and role limitation due to emotional problems components. External validation with EDSS showed negative correlation on almost all components, except for sexual function, but both composite scores were statistically significant., Conclusion: MSQOL-54 INA questionnaire has good internal reliability and is proven to be valid and well-accepted by Indonesian MS patients. Therefore, it can be used by Indonesian clinicians for more comprehensive MS management.

In conjunction with the third regional Southeast Asian (SEA) therapeutic plasma exchange (TPE) conference in Kuala Lumpur, Malaysia, 25 clinicians and researchers from SEA and South Asian countries attended the inaugural strategy meeting for the establishment of a regional TPE consortium for neurological disorders. The primary objective was to establish regional collaboration to improve delivery of TPE services in SEA. A pre-meeting survey was conducted to gather insights on disease spectrum, contextual practice challenges, and the need for a regional TPE consensus. Challenges identified include limited healthcare funding in support of diagnostic workup, TPE therapy, as well as development of clinical infrastructure and expertise capacity building. There was favorable interest in developing a working plan contextualized to this region. Strategies to overcome challenges were discussed. This included the need for a comprehensive referral system and network of regional TPE centers suited to local needs, supported by innovative TPE delivery programs., (© 2019 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.)

Introduction: Multiple Sclerosis (MS) can affect cognitive function that might interfere with quality of life. Processing speed and memory are the most common area of cognitive impairment. Cognitive evaluation in daily practice is often difficult to be performed since it needs neuropsychological expert and is time-consuming. Brief International Cognitive Assessment for MS (BICAMS) is valid and practical for cognitive evaluation. This study aims to validate BICAMS in Indonesian MS patients and healthy controls (HC) and to analyse the effect of cognitive impairment on quality of life., Methods: BICAMS, which composes Symbol Digits Modalities Test (SDMT), California Verbal Learning Test-Second Edition (CVLT-II), and Brief Visuospatial Memory Test-Revised (BVMT-R), was translated and cross-culturally adapted to Indonesian from the original BICAMS and then administered to 40 Indonesian MS patients and 66 HC matched by sex, age, and education. Test-retest reliability was performed on 16-MS patients and 42 HC. Quality of life was measured using Multiple Sclerosis Quality of Life (MSQOL-54) instrument., Results: The SDMT, CVLT-II, and BVMT-R score in MS patients were significantly lower than those in HC (effect size, r: 0.61, 0.36, and 0.47, respectively). Test-retest reliability for all tests was satisfactory with correlation coefficient for SDMT, CVLT-II, and BVMT-R in MS subjects 0.86, 0.81, and 0.83, respectively. Using 5th percentile of HC score as cut-off, 15% MS subjects had impairment in one test, 27.5% in two tests, and 40% in three tests. BICAMS was moderately correlated with EDSS but was not correlated with disease duration and relapse rate. SDMT score correlated with physical function and physical and mental role limitation., Conclusion: BICAMS is valid and reliable for assessing cognitive function of Indonesia MS patients.

Neuromyelitis Optic (NMO) is an inflammatory disorder involving central nervous system which often co-exists with other autoimmune diseases such as Sjögren's syndrome (SS). NMO manifestation could precede or follow SS, but the role of anti-SSA in the pathogenesis of NMO remains unclear. We present a case of NMO with anti-AQP4 anti-SSA antibody positive. A-44-year-old female presented with right side weakness. The symptoms began with numbness that improved spontaneously. She also complained pain and dry sensations on her eyes. Schirmer test on her left eye, antinuclear antibody (ANA) and anti-SSA antibody were positive. Cervical MRI revealed intramedullary lesion on T2-weighted-image at C2-C5 level. She was diagnosed as NMO with positive anti-AQP4 and probable SS. She received 1g methylprednisolone for 5 days proceeded with mycophenolic acid. One-year observation showed clinical improvement. Systemic autoantibodies must substansially be evaluated in NMO. Comprehensive diagnosis and providing appropriate immuno-suppressant might prevent further disability and relapse., Competing Interests: Conflict of interest: the authors declare no potential conflict of interest.

Background: Little detailed knowledge is available regarding the etiology and outcome of CNS infection, particularly in HIV-infected individuals, in low-resource settings., Methods: From January 2015 to April 2016, we prospectively included all adults with suspected CNS infection in a referral hospital in Jakarta, Indonesia. Systematic screening included HIV testing, CSF examination, and neuroimaging., Results: A total of 274 patients with suspected CNS infection (median age 26 years) presented after a median of 14 days with headache (77%), fever (78%), seizures (27%), or loss of consciousness (71%). HIV coinfection was common (54%), mostly newly diagnosed (30%) and advanced (median CD4 cell count 30/µL). Diagnosis was established in 167 participants (65%), including definite tuberculous meningitis (TBM) (n = 44), probable TBM (n = 48), cerebral toxoplasmosis (n = 48), cryptococcal meningitis (n = 14), herpes simplex virus/varicella-zoster virus/cytomegalovirus encephalitis (n = 10), cerebral lymphoma (n = 1), neurosyphilis (n = 1), and mucormycosis (n = 1). In-hospital mortality was 32%; 6-month mortality was 57%. The remaining survivors had either moderate or severe disability (36%) according to Glasgow Outcome Scale., Conclusion: In this setting, patients with CNS infections present late with severe disease and often associated with advanced HIV infection. Tuberculosis, toxoplasmosis, and cryptococcosis are common. High mortality and long-term morbidity underline the need for service improvements and further study.