Group A rotaviruses (RVAs) are the leading cause of acute gastroenteritis, which is often associated with severe symptoms in children under 5 years old. Genetic reassortments and interspecies transmission commonly occur, resulting in a great diversity of RVA circulating in the world. The aim of this study is to determine the prevalence and distribution of RVA genotypes among children in Indonesia over the years 2016–2018 across representative areas of the country. Stool samples were collected from 202 pediatric patients with acute gastroenteritis in three regions of Indonesia (West Nusa Tenggara, South Sumatra, and West Papua) in 2016–2018. Rotavirus G and P genotypes were determined by reverse transcription PCR (RT-PCR) and direct sequencing analysis. The prevalences of RVA in South Sumatra (55.4%) and West Papua (54.0%) were significantly higher than that in East Java (31.7%) as determined in our previous study. The prevalence in West Nusa Tenggara (42.6%) was the lowest among three regions, but higher than that in East Java. Interestingly, equine-like G3 rotavirus strains were found as predominant strains in South Sumatra in 2016 and in West Papua in 2017–2018. Moreover, the equine-like G3 strains in South Sumatra detected in 2016 were completely replaced by human G1 and G2 in 2018. In conclusion, RVA infection in South Sumatra and West Papua was highly endemic. Equine-like G3 strains were also spread to South Sumatra (West Indonesia) and West Papua (East Indonesia), as well as Java Island. Dynamic change in rotavirus genotypes from equine-like G3 to human genotypes was also observed. Continuous monitoring may be warranted in isolated areas in Indonesia.

Tumor Necrosis Factor Alpha (TNF-α) is a pro-inflammatory cytokine that plays a crucial role in COVID-19 disease progression. N-acetylcysteine (NAC) works throughout several GSH-mediated mechanisms and is known to eliminate oxidative stress in acute respiratory distress syndrome (ARDS) in COVID-19. This study aims to analyze the effect of the N-Acetylcysteine as Adjuvant Therapy to reduce TNF-α levels and Increase SpO2/FiO2 ratio in Improving hypoxemia in COVID-19 Patients. This is a quasi-experimental, non-equivalent control group design study. There were 91 subjects selected using non-random sampling, which consisted of 75 patients in the NAC group and 16 patients in the control group. The TNF-α level was measured using the ELISA method, and SpO2/FiO2 ratio was calculated on day 1 (on admission) and day eight after NAC 5000mg/ 72 hours was given. Statistical analysis was conducted using Wilcoxon and Mann-Whitney U Test. There is a significant decrease in TNF-α level in the treatment group (median 1.49±5.22) (p=0.016) compared with the control group (median 1.64±1.99) (p=0.005). The Median SpO2/FiO2 ratio on day 1 is 163.70±69.64 in the control group and 121.49±40.41 in the treatment group (p=0.005). The Median SpO2/FiO2 ratio on day 8 is 249.69±132.26 in the control group and 151.29±59.18 in the treatment group (p=0.001). There is a positive correlation between serum TNF-α level and SpO2/FiO2 ratio after administration of adjuvant therapy NAC (r=0.240, p=0.038). There is a positive correlation and significant decrease of serum TNF-α and SpO2/FiO2 ratio after adjuvant NAC therapy, which improves hypoxemia in COVID-19 patients.

Mediastinal lymphohemangioma is a very rare, benign, congenital malformation. Mediastinal lymphohemangioma originates from local proliferation of lymphatic vessels. This disorder is accountable for 4.5% among all mediastinal tumors. Most lymphohemangiomas are found in the neck and axillary region among children, whereas only 1% are found in the mediastinum and tend to occur in individuals aged over 20 years old. A proper understanding is needed to be able to make a diagnosis and perform effective management of mediastinal lymphohemangiomaIn this case report, a woman with a diagnosis of mediastinal lymphohemangioma, established through a multidisciplinary approach covering the fields of pulmonology, thoracic and cardiovascular surgery, radiology, and anatomical pathology.