There is two-way communication between the gut and the brain. The condition of the quality and quantity of microbiota in the gut greatly affects the communication process or commonly known as the microbiota-gut-brain axis. Acute ischemic stroke can affect the quality and quantity of microbiota in the gut, which leads to intestinal dysbiosis. Thus, it might produce an inflammatory response that can change immune homeostatic. This can lead to poor clinical outcomes and neurologic function and an increase in mortality. Dysbiosis is a condition where there are qualitative and quantitative changes in the composition, distribution, and metabolic activity of intestinal microbiota which have a detrimental effect on human health, in other words, there is a decrease in the number of probiotic bacteria in the gut, which provide health benefits. The conditions for a good probiotic are that the probiotics have to be kept alive in the digestive tract to obtain health benefits. The approach taken to keep these bacteria alive is the use of prebiotics. Prebiotics are components of food that cannot be digested by the digestive tract enzymatically. Thus, they are fermented by microbiota in the large intestine to produce metabolites, one of which is short-chain fatty acids (SCFA) as a product of fermentation. SCFA (Short Chain Fatty Acid) or short-chain fatty acids play a neuroprotective role, synthesizing neurotransmitters and modulating the immune system. Therefore, this review explains how stroke affects the quantity and quality of microbiota in the gut in the communication process of the microbiota-gut-brain axis and the role of prebiotics in improving dysbiosis. Hence, it can provide better post-stroke clinical outcomes.

Background: The brain releases biochemical substrates, such as S100β protein, into circulation in response to ischemic conditions as a sign of damage in nerve cells and disruption of the blood-brain barrier’s integrity. Thrombolytic therapy has led to the development of many neuroprotective therapies such as protein, phosphatidylcholine, phosphatidylserine, and inulin, which can be added to food products. Protein, phospholipids, and inulin, have a neuroprotective impact on nerve cells in the brain and blood-brain barrier.Objective: To prove the effect of protein, phosphatidylcholine, phosphatidylserine, and inulin on S100β levels and clinical outcomes in patients with acute ischemic stroke.Materials and Methods: This study was done in a single-blind RCT. Eighteen ischemic stroke patients were randomly divided into nine subjects for the intervention group and nine subjects for the control group. The Control group received 250 ml conventional formula milk (11.8 g protein) 3 times/day. The intervention group received 250 mL commercial milk 3 rimes/day which contained 15 g protein with 128 mg phosphatidylcholine, 32 mg phosphatidylserine, and 3 g inulin. All of the groups were given hospital-standard therapy for ischemic stroke. S100β levels were measured at pre and post-intervention.Results: Pre and post S100β levels in intervention and the control group did not show any statistically difference (p = 0.777 and p = 0.096), but there was a trend of decreasing  levels of S100β in the intervention group (-24.6 + 252.0 pg/mL) versus control group (135.8 + 216.2 pg/mL).Conclusions: The addition of protein, phosphatidylcholine, phosphatidylserine, and inulin did not have a significant effect on S100β levels.

Anemia is a medical condition in which the hemoglobin level less than normal. Normal Hb levels in adolescent girls are >12 g/dl. Anemia in adolescent girls is still relatively high. Impact of anemia can be caused the body to become thin and drastically lose weight, shortness, constant illness, and anemia. This literature review identified factors that are consistently associated with the incidence of anemia in adolescent girls. This research method is a literature review by collecting various databases from Pubmed, Science Direct, Proquest, and Google Scholar. The selection of articles were limited from 2014-2019 and 20 articles were found. Factors that are consistently associated with the incidence of anemia in adolescents girls include the level of knowledge of girl adolescents regarding anemia, iron intake, nutritional status and the duration of menstruation, BMI, category of residence (rural/urban), dietary habits, and infections such as malaria. It is necessary to provide continuous blood supplement tablets to young women from the government and schools so that they can meet their nutritional needs and further research is expected to be able to use different research designs such as case control and cohorts in order to prove a stronger causal relationship, this is because there have been quite a number of studies related to risk factors for the incidence of anemia in adolescent girls.