Streptococcus suis is a zoonotic pathogen that can infect humans, especially meningitis. S. suis meningitis has been commonly diagnosed in Bali, which is associated with the consumption of raw pork. We reported case of S. suis meningitis that could have occurred due to the ingestion of undercooked pork during a traditional ceremony, which also involved two more patients with similar symptoms. A 62-year-old male was brought to the emergency unit because of decreased consciousness (Glasgow coma scale 14/15) in the last 8 hours before admission. He also had a headache, high fever, and stiff neck. Examination of cerebrospinal fluid revealed the presence of S. suis infection and was confirmed by polymerase chain reaction. The patient was administered ceftriaxone and showed a clinical improvement on the third day without any hearing problem.

Sleep is a crucial lifestyle component that improves general health. The effect of diet and consumption of certain foods has been reported to have a significant effect on sleep patterns and sleep quality. Many supplements were used to help promote healthy sleep. However, the connection between some food factors and sleep is rather complicated. The nutritional components change depending on the food habits and the digestive and metabolic processes of each person. Several studies and systematic reviews reported potential benefit of specific nutrients and their role in sleep including: high-fiber and low-sugar carbohydrates, protein, fatty acids, several vitamins such as vitamins D, C, and B and electrolyte especially magnesium. Others were reported could disrupted sleep such as caffeine, alcohol and excess sugar. This article discussed nutrients that are potential to play a role in sleep quality, their mechanisms, and food recommendation that can be made to help improve sleep quality and sleep wellness. Keywords: Diet, sleep-promoting food, sleep quality

Migraine is a neurological condition that is the third highest cause of disability in the population under 50 years old. The Increasing incidence of migraine will affect the quality of life and increase the financial burden on the patient. Vitamin D is one of the supplementation agents that is thought to be associated with headaches and has anti-inflammatory and antioxidant effects. There is an increasing prevalence of vitamin D deficiency in migraine patients but there is no consensus regarding the provision of vitamin D supplementation as a complementary therapy in migraine. This article aims to explain the role of vitamin D in the mechanism of headache, especially migraine, and vitamin D supplementation therapy as a complementary therapy in migraine. Vitamin D is thought to play a role in the pathogenesis of headache through several mechanisms, namely as an anti-inflammatory effect, regulates the immune system, reduces nitric oxide (NO) levels, suppresses prostaglandin synthesis, and is associated with changes in several neurotransmitters such as glutamine, noradrenaline, dopamine, and serotonin. Several studies have reported that vitamin D supplementation in patients with migraine can improve the frequency of headache attacks. Most migraine patients can experience vitamin D deficiency. Vitamin D supplementation is also thought to reduce the frequency of headache attacks in migraine patients. However, further research is still needed to confirm these results.

Background: The human microbiome is a community of microorganisms that live in symbiosis with humans. This relationship between humans and the microbiome affects the physiology of health and disease, but not many studies have evaluated the condition of the digestive microbiome in neurology critical condition patients and its changes. This study aims to describe the microbiome characteristics of neurological patients in the intensive care unit. Methods: We conducted a systematic literature review of the relationship between the microbiome and neurology patients admitted to the intensive care unit by searching MEDLINE/PubMed, the Cochrane Database for Systematic Reviews, and Google Scholar for articles in English published through 13 June 2022. Results: There is a change in the normal flora pattern in neurological patients who are treated in the intensive care unit. The decrease in the number of colonies occurred in commensal flora bacteria and an increase in pathogenic bacteria such as Enterobacteriaceae. Discussion: The overgrowth of opportunistic pathogens suggests dysbiosis in patients with neurocritical conditions. This is thought to be correlated with the gut-brain axis relationship. This dysbiosis evaluation can be used to provide targeted microbiome therapy and to assess the risk of clinical deterioration and death in neurologic patients in intensive care. Conclusion: This study reported a significant difference between the composition of the gut microbiota in neurology patients in intensive care and the healthy population. The magnitude of this dysbiosis increases during hospitalization in the intensive care unit and has an impact on patient outcomes. Intestinal microbiota analysis is expected to provide an overview of targeted microbial therapy and predict future patient outcomes. Keywords: Neurocritical patients, intensive care, microbiome

Latar belakang: Infeksi Streptoccocus suis merupakan zoonosis yang terdistribusi global terutama di Asia. Infeksi yang berhubungan dengan babi ini menyebabkan meningitis dan berbagai gejala klinis. Kasus: Tercatat dua kasus infeksi S.suis dengan manifestasi meningitis bakteri akut dan artritis. Kedua pasien mengalami demam, nyeri kepala, dan kaku kuduk. Diagnosis definitif infeksi S. suis tegak berdasarkan kultur cairan serebrospinalis (CSS). Kultur cairan sendi negatif. Pasien diterapi dengan seftriakson sesuai uji kultur sensitivitas CSS dan deksametason sebagai adjuvan. Satu pasien sembuh sempurna sedangkan yang lainnya mengalami komplikasi tuli sensorineural bilateral. Diskusi: Manifestasi klinis dan penunjang pada kedua pasien mendukung infeksi S.suis sebagai etiologi meningitis dan artritis. Tidak adanya perkembangan bakteri S.suis pada kultur cairan sendi kedua pasien dapat disebabkan oleh pemberian antibiotik sebelum dilakukan kultur. Oleh karena itu, infeksi S.suis sebagai etiologi artritis septik pada pasien belum dapat disingkirkan. Simpulan: Infeksi S.suis merupakan infeksi hematogen sistemik yang menimbulkan berbagai gejala klinis. Kata Kunci: Infeksi S.suis, Meningitis Bakteri Akut, Artritis Septik