Epstein-Barr virus (EBV) infections usually cause mild symptoms and resolves spontaneously, however the virus may cause severe complications such as neurological diseases, malignant diseases and myocarditis. Determining a diagnosis requires molecular, serological and imaging procedures. The therapeutic modalities for EBV-related severe organ damage including central nervous system manifestations are still uncertain. We report a 31-year-old man with lung tuberculosis with EBV meningoencephalitis presenting with prolonged fever and altered consciousness. Cranial imaging was consistent with meningoencephalitis characteristics. The diagnosis was made by EBV-DNA amplification in cerebrospinal fluid samples. In this case report, we aim to describe a meningoencephalitis caused by EBV in adult with underlying other organ infection.have antibodies to the virus [1,2]. Central nervous system (CNS) involvement in primary EBV infection in adults is rare, with less than 8% of cases found. EBV was found as a causative agent in 2 to 5% of viral encephalitis and meningitis cases [3].Involvement of EBV in CNS includes encephalitis, meningitis, cerebellitis, myelitis, plexitis and acute disseminated encephalomyelitis [2,[4][5][6]. This case report aims to describe a patient with lung tuberculosis showing symptoms and signs of meningoencephalitis caused by EBV. Case ReportA 31-year-old man was admitted to the emergency room with a history of unconsciousness since the day before admission. He previously had 6 days of fluctuating fever and headache. The patient had some behavioral changes since six days before admission such as deliriousness, incoherence and anxiousness. There were involuntary movements in both his hands. He was diagnosed with miliary type lung tuberculosis (TB) 3 months ago. He was given a regimen of antituberculosis drugs which he consumed for only two months before stopping for one month.On admission, he was sopor (Glasgow Coma Scale E2M5V2) and his vital signs recorded were blood pressure 110/70 mmHg, heart rate 70x/minute, respiratory rate 32x/minute, and temperature 37oC. There was crackles in right lung examination. In the neurologic examination there was nuchal rigidity, positive Kernig sign, hemiparesis in right extremities, and positive Babinski sign.Initial investigations including hematologic, liver function, renal function and random plasma glucose did not show any abnormalities, except for a decrease in serum sodium 123 mmol/L. Anti-HIV test was negative, with normal CD4 count, CD 8 count and CD4:CD8 ratio. Serology test for syphilis were normal. Blood culture was negative for bacteria.The chest X-ray revealed no abnormality at this admission. Contrast-enhanced CT scan conducted on admission was consistent with meningoencephalitis characteristics and hydrocephalus sign was noted. He was diagnosed with TB meningoencephalitis and lung tuberculosis with history incompliance to TB therapy. He was treated with ceftriaxone, the same antituberculosis drug regimen and dexamethasone therapy with tapering...

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THE DIFFERENCE OF BRAIN GYM AND POCO-POCO GYMNASTICS IMPROVING EXECUTIVE FUNCTION OF ELDERLY: EXPERIMENTAL STUDY IN PUSAT SANTUNAN KELUARGAABSTRACTIntroduction: The elderly have the risk of experiencing executive dysfunction due to structural and functional changes in neurons and synapses in the prefrontal cortex associated with aging. The brain gym and Poco-poco gymnastics can maintain and improve executive function so that productivity and quality of life of theelderlyremainoptimal.Aim: To find out the difference between the effect of brain gym and Poco-poco gymnastics on improving the executive function of elderly population in Pusat Santunan Keluarga (PUSAKA).Method: The study uses an experimental study with a nonequivalent control group design approach. Sixty elderly respondents were dividedinto the brain gym group (n=30) and the Poco-poco gymnastics group (n=30) in two different PUSAKAs. Each interventions are carried out three times a week for 30 minutes in four weeks. Analysis of the differences in the effect of brain gym and Poco-poco gymnastics on executive function of the elderly based on the mean difference in Oral Trail Making Test Form B (OTMT-B) using the Mann-Whitney test.Result: There was an improvement in the mean duration of completion of OTMT-B after the intervention in the brain gym group and Poco-poco gymnastics group with a significant p<0.05. The difference in mean difference between OTMT-B after the intervention in the Poco-poco gymnastics group was higher than the brain gym group.Discussion: The brain gym and Poco-poco gymnastics can improve the function of the elderly executive function. Improved executive function was more significant in the Poco-poco gymnastics group than the brain gym group.Keyword: Brain gym, elderly, executive function, Oral Trail Making Test Form-B, Poco-poco gymnasticsABSTRAKPendahuluan: Lansia berisiko mengalami gangguan fungsi eksekutif karena perubahan struktural dan fungsional pada neuron dan sinaps di korteks prefrontalis terkait penuaan. Senam otak dan senam Poco-poco dapat mempertahankan dan meningkatkan fungsi eksekutif sehingga produktivitas dan kualitas hidup lansia tetap optimal.Tujuan: Untuk mengetahui perbedaan pengaruh senam otak dan senam Poco-poco terhadap peningkatan fungsi eksekutif populasi lansia di Pusat Santunan Keluarga (PUSAKA).Metode: Penelitian menggunakan studi eksperimental dengan pendekatan nonequivalent control group design. Enam puluh lansia sebagai subyek terbagi dalam kelompok senam otak (n=30) dan kelompok senam Poco-poco (n=30) di­ dua PUSAKA. Masing-masing intervensi dilakukan sebanyak tiga kali seminggu selama 30 menit dalam empat minggu. Analisis perbedaan pengaruh senam otak dan senam Poco-poco terhadap fungsi eksekutif lansia berdasarkan selisih rerata Oral Trail Making Test Form B (OTMT-B) menggunakan uji Mann-Whitney.Hasil: Terdapat perbaikan durasi penyelesaian OTMT-B setelah intervensi senam otak dan senam Poco-poco dengan nilai kemaknaan p<0,05. Perbedaan selisih rerata durasi penyelesaian OTMT-B pada kelompok intervensi senam Poco-poco lebih tinggi dibandingkan kelompok senam otak.Diskusi: Intervensi senam otak dan senam Poco-poco dapat meningkatkan fungsi eksekutif populasi lansia. Peningkatan fungsi eksekutif lebih signifikan pada kelompok intervensi senam Poco-poco dibandingkan kelompok intervensi senam otak.Kata kunci: Fungsi eksekutif, lanjut usia, Oral Trail Making Test Form-B, senam otak, senam Poco-poco