Treatment Outcomes of Childhood Tuberculous Meningitis in a Real-World Retrospective Cohort, Bandung, Indonesia.

We retrospectively evaluated clinical features and outcomes in children treated for tuberculous meningitis (TBM) at Hasan Sadikin Hospital, Bandung, Indonesia, during 2011-2020. Among 283 patients, 153 (54.1%) were <5 years of age, and 226 (79.9%) had stage II or III TBM. Predictors of in-hospital death (n = 44 [15.5%]) were stage III TBM, hydrocephalus, male sex, low-income parents, seizures at admission, and lack of bacillus Calmette-Guérin vaccination. Predictors of postdischarge death (n = 18 [6.4%]) were hydrocephalus, tuberculoma, and lack of bacillus Calmette-Guérin vaccination. At treatment completion, 91 (32.1%) patients were documented to have survived, of whom 33 (36.3%) had severe neurologic sequelae and 118 (41.7%) had unknown outcomes. Predictors of severe neurologic sequelae were baseline temperature >38°C, stage III TBM, and baseline motor deficit. Despite treatment, childhood TBM in Indonesia causes substantial neurologic sequelae and death, highlighting the importance of improved early diagnosis, better tuberculosis prevention, and optimized TBM management strategies.

Changes in optic nerve sheath diameter and its correlation with degree of consciousness, pupil diameter, and light reflex in children with central nervous system infection after osmotherapy.

Background: High intracranial pressure (ICP) is one of the most common complications of central nervous system (CNS) infection. Failure to control high intracranial pressure results in brain herniation and death. One of the treatments for high ICP involves the administration of osmotherapy in the form of 3% NaCl or 20% mannitol with observation during administration. Observation of ICP during administration of osmotherapy is possible through measurement of optic nerve sheath diameter (ONSD), which could be correlated with degree of consciousness, pupil diameter, and light reflex. Previous studies have not correlated ONSD with degree of consciousness, pupil diameter, and light reflex during the administration of osmotherapy. Purpose: To provide insights of incorporating ONSD measurement as a form of non-invasive bedside method for ICP monitoring by correlating it with degree of consciousness, pupil diameter, and light reflex at several time points. Methods: This study is a prospective cohort study, performed at Dr. Hasan Sadikin General Central Hospital Bandung, Cibabat General Regional Hospital, and General Regional Hospital Bandung Kiwari on children aged 2-18 years with decreased consciousness and CNS infection, from June 2023. Inter-rater reliability was performed with a correlation coefficient of 0.90. Measurement of ONSD, degree of consciousness, pupil diameter, and light reflex simultaneously up to 48 h after initiation of osmotherapy to 30 patients. Correlational analyses were performed using Spearman's rank. Results: Observation for 48 h after administration of osmotherapy showed changes in ONSD. A significant positive correlation was found between ONSD and degree of consciousness (r = 0.621 for the right eye and r = 0.602 for the left eye, p < 0.001). A significant positive correlation was found between ONSD and light reflex (r = 0.801 for the right eye and r = 0.812 for the left eye, p < 0.001). No significant correlation was found with changes of pupil diameter (r = -0.136 for the right eye and r = -0.141 for the left eye, p > 0.05). Conclusion: A significant correlation was found between ONSD and degree of consciousness and light reflex in children aged 2-18 years with CNS infection during administration of osmotherapy.

The High Prevalence of Negative Hepatitis B Surface Antibody (Anti-HBs) among Pregnant Women in Bandung, Indonesia: A Community-Based Study.

BACKGROUND: Hepatitis B virus (HBV) infection is a disease that creates a high global burden by affecting approximately 3.5% of the total world population. The main transmission of this disease is from mother to child (MTCT). HBV vaccination program was already initiated in Indonesia in 1987. However, after three decades, the HBV infection prevalence stays stagnant. This study aimed to explore the seroprevalence of HBV markers and the attributable risk factors of pregnant women at risk of transmitting HBV to their offspring. METHOD: A cross-sectional study was conducted on pregnant women from primary midwifery and obstetric clinics across Bandung, Indonesia, to assess the HBsAg, anti-HBc, and anti-HBs serological markers. Questionnaire-based interviews were used to obtain the sociodemographic determinants. Logistic regression was applied to assess the association of each determinant factor to positive HBsAg or negative anti-HBs as a dependent variable, which was then reported as odds ratios (OR). RESULTS: A total of 196 subjects were recruited with 12/196 (6.1%) of them were positive HBsAg. After exclusions of those with positive HBsAg and anti-HBc, 24/175 (13.7%) women were isolated as positive anti-HBs, leaving 151/175 (86.3%) women with negative anti-HBs who were susceptible to HBV infection. Low body mass index (BMI) less than 18.5 kg/m2 was a risk factor for positive HBsAg with OR = 5.850 (95% CI 1.466-23.34), p = 0.012. Nevertheless, no significant determinant factor was associated with negative anti-HBs. CONCLUSION: Most pregnant women in Bandung, Indonesia, are susceptible to HBV infection, as marked by the negative anti-HBs status.