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An outbreak of H1N1 infection was first declared by the World Health Organization in 2009 and confirmed in the post-pandemic phase in 2010. Amid the COVID-19 pandemic, we found a confirmed case of H1N1pdm09 in Bunda Women and Children Hospital Jakarta. A 13-year-old boy was referred to our hospital after four days of hospitalization due to worsening tachypnea following a productive cough and fever. The patient had severe dyspnea with inspiratory effort and oxygen desaturation to 80%, therefore admitted to our pediatric intensive care unit. On physical examination, the patient had increased work of breathing, looked irritable, had a respiratory rate of about 40x/minute with non-rebreathing mask support, and crackles were heard in both lungs. Chest X-ray showed right bronchopneumonia. There was a history of a generalized seizure for less than 1 minute, which stopped spontaneously in previous hospital care. The patient was diagnosed with mucopolysaccharidosis at age six years old and has never received enzyme replacement therapy. Laboratory results revealed thrombocytopenia, leukopenia, neutrophilia, monocytosis, high c-reactive protein and procalcitonin, and elevated liver enzymes. The investigation of etiology was performed using the respiratory panel test and showed a positive real-time polymerase chain reaction for H1N1pdm09 and Influenza A. The patient was given oxygen therapy with a high-flow nasal cannula with an oxygen fraction of 40% and a flow of 20 liters per minute, fluid maintenance while fasting, antibiotics, inhaled b-2 agonists, and a neuraminidase inhibitor (oseltamivir). The patient's clinical and laboratory markers improved on the third day of treatment, and he was discharged two days later. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) has been extensively researched, particularly with regard to COVID-19 vaccines. However, issues with logistics and availability might cause delays in vaccination programs. Thus, the efficacy and safety of half-dose heterologous mRNA should be explored. This was an open-label observational study to evaluate the immunogenicity and safety of half-dose mRNA-1273 as a booster vaccine among adults aged >18 years who underwent a complete primary SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) vaccination regimen with CoronaVac® and ChAdOx1-S. Adverse events (AEs), seropositivity rate, seroconversion, geometric mean titer (GMT) of SARS-CoV-2 antibodies, neutralizing antibodies, and T cells (CD4+ and CD8+) specific for SARS-CoV-2 were analyzed. Two hundred subjects were included in the final analysis, with 100 subjects in each priming vaccine group. Most of the AEs were mild, with systemic manifestations occurring between 1 and 7 days following vaccination. A significant difference was observed in the GMT and seropositivity rate following booster dose administration between the two groups. CD8+/CD3+, IFN (interferon)-producing CD8+, and TNF (tumor necrosis factor)-producing CD8+ cells showed significant increases in both groups. The administration of the half-dose mRNA-1273 booster is safe and effective in increasing protection against SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

Background. The ketogenic diet has recently been explored as a potential treatment approach for intractable epilepsy in children and has been applied in various parts of the world. The ketogenic diet is also effective for the treatment of mood disorders, especially for adolescent and young adults with epilepsy. The Modified Atkins Diet (MAD) is the less restrictive type of ketogenic diet with similar principles as the classic type. However, no study has been conducted to evaluate the use of MAD in children with severe epilepsy in Indonesia. This study aims to assess the effectiveness, tolerance, compliance, and the adverse effects of MAD in children with intractable epilepsy during a 6-month monitoring period. Methods. This is a pilot experimental study involving children aged 2–18 years old with intractable epilepsy at the Pediatric Neurology and the Pediatric Nutrition & Metabolic Diseases Clinics at the Dr. Cipto Mangunkusumo Hospital Jakarta between November 2021 and June 2022. Results. A total of 31 subjects met the inclusion criteria and received the MAD in the first month, followed by 13 (41.9%) subjects in the third month, and 9 (29%) subjects in the sixth month. The MAD reduced the seizure frequency by 50% (p = 0.144), 62% (p = 0.221), and 83.3% (p = 0.028) in the first, third, and sixth months, respectively. The most frequent adverse effects are vomiting and diarrhea. Noncompliance was observed in 18 (58.1%) subjects. A sample of the MAD food menu guidebook was developed to make it easier for parents to adhere to the diet. Conclusions. The MAD reduces the mean seizure frequency in children with intractable epilepsy in the first, third, and sixth months, with a statistical significance in the sixth month. A further randomized, controlled, and multicenter clinical trial with a larger sample size and longer observation period is required. This trial is registered with Protocol ID 20-10-1323. [ABSTRACT FROM AUTHOR]

Background Hand hygiene is essential in reducing healthcareassociated infections. Alcohol-based hand rub solutions have been reported to have superior antimicrobial efficacy on both bacteria and lipophilic viruses compared to washing with hand soap. In low- and middle-income countries, the cost of infection control poses a challenge. Our hospital produced an ethanol-based hand rub based on a WHO formulation to reduce the infection prevention costs. Objectives To identify the antimicrobial activity of a WHO ethanol-based hand rub solution against bacterial contamination on the hands of healthcare workers at the Department of Child Health, Dr. Cipto Mangunkusumo National Referral Hospital. Methods This cross-sectional study was performed on the hands of healthcare workers (physicians and nurses) working in the Department of Child Health, Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta. A total of 225 specimens from 75 subjects were obtained by collecting swabs on both hands before and after participants worked in the Department of Child Health, Dr. Cipto Mangunkusumo General Hospital. Bacterial culture tests were performed to identify Gram positive and Gram-negative bacteria. Bacteria were grouped into no-growth/Bacillus sp., Enterobacteriaceae, cocci, and non-fermenter groups. Results The use of our WHO ethanol-based hand rub solution, generally resulted in a statistically significant decrease in bacterial growth from 84 to 54.6%, before compared to after the hand rub was performed. In more detail, there was a 72.7% decrease in Enterobacteriaceae, a 71.4% decrease in non-fermenters, an 8.6% decrease in cocci and a 44.1% increase in the number of specimens showing no growth bacteria/Bacillus sp. Conclusion Our WHO ethanol-based hand rub has significant antimicrobial activity for common nosocomial pathogens (e.g., Staphylococcus aureus, P. aeruginosa, and K. pneumoniae). [ABSTRACT FROM AUTHOR]