Implementasi Audit Operasional Pada PT. Tunggal Djaja Indah Di Waru Sidoarjo

Sales become part of corporaate activity that has much support. Success corporate are supported also by it’s good internal control. Effectivity and efficiency became the most important things at operational scope in order to reach the goal. Therefore, operational audit are needed in a corporate to evaluate any operational activity, especially at sales departement. Research on operational audit aims to analyze implementation of operational audit on sales departement at PT Tunggal Djaja Indah. The research are using two X variable and one Y variable, they are Operational Audit (X1), sales (X2) and Effectivity (Y). It is also using SOP Checklist of sales activity and operational audit which is contains 30 times sales activity observation and once operational audit. As the result of research, it can be described that operational audit of sales departement at PT Tunggal Djaja Indah has already according to SOP (Standart Operating Procedure). It is very useful to raise sales effectivity

Application of α-lipoic acid beyond peripheral diabetic polyneuropathy (A report of 3 cases)

Background: In Germany, lipoic acid is registered with the indication of “peripheral diabetic polyneuropathy”. This report intends to demonstrate therapeutic activity beyond this indication. In Indonesia, the substance is not registered for therapy.Methods: Three patients (two of them in Germany and one in Indonesia) with pathoneurological symptoms different from peripheral diabetic polyneuropathy were treated with α-lipoic acid: i) post-borelliosis infl ammation with arthritic and paraesthetic symptoms, ii) post-operative (mamma carcinoma) and post-chemotherapeutic sensoric and motoric neural deficits occurring in parallel with additional radiation therapy, and iii) post-traumatic (cerebral) and postoperative (brain surgery) cardiovascular and pulmonary crisis with broad pathoneurological (sensoric and motoric, visual, auditory) deficits and dysarthria.Results: All three patients improved in close correlation with the onset and continuation of lipoic acid intake, whereas other therapeutic measures did not appear very successful. It cannot be ruled out that the other therapeutic regimens applied interacted with lipoic acid in a supporting additive or synergistic manner, because three cases as reported here do not allow for such conclusion; however, separately, or with interaction, lipoic acid helped the patients to recover from their pathoneurological symptoms in the meaning of the traditional medical term “restitutio ad integrum”.Conclusion: In the three cases in this study, lipoic acid was effective in therapy of pathoneurological symptoms different from peripheral diabetic neuropathy. Further confirmative studies are suggeted. (Med J Indones 2011; 20:143-8)Keywords: α-Lipoic acid, cancer therapy, cerebral trauma, infection, inflammation, neuropathy</p

A Dumbbell-shaped hypoglossal schwannoma managed by a combination of open surgery and endoscopic assistance

Background: Hypoglossal schwannoma is a rare benign tumor that comprises about 5% of all intracranial schwannoma. Surgical management for hypoglossal schwannoma is still evolving along with our understanding of neuroanatomy and surgical equipment improvement, especially endoscopy. The far lateral transcondylar approach is commonly used for hypoglossal schwannomas. This traditional approach requires great effort and is considered a lengthy procedure. The use of endoscopy gives an additional advantage to microscopic surgery in managing this tumor, making surgery less complicated and faster. Combining the microscope and endoscope is an effective way to operate in small corridors. Case: In a stepwise fashion, we present a case of a 53-year-old female with hypoglossal schwannoma, which was successfully resected using a retrosigmoid transcondylar approach with endoscopic assistance. Conclusion: A retrosigmoid transcondylar approach with endoscopic assistance is an excellent option in surgical management for hypoglossal schwannoma. Both microscopic and endoscopic approaches will be gaining more usefulness in managing skull base tumors and should be used collaboratively

Luaran Nilai Fungsional Kasus Tumor Primer Spinal Intradura Ekstramedula Pascaoperatif di RSUPN Dr. Cipto Mangunkusumo 2014-2016

Tumor spinal primer memiliki morbiditas dan disabilitas yang tinggi. Profil demografi dan luaran nilai fungsional penderita tumor primer spinal intradural ekstramedular 60% dari seluruh tumor spinal primer sehingga penting dinilai karena dapat dijadikan parameter keberhasilan operasi dan dapat digunakan dalam memberikan informasi kepada pasien dan keluarga sebelum operasi. Studi retrospektif deskriptif analitik ini menggunakan data rekam medis penderita tumor spinal intradural ekstramedular yang baru menjalani operasi pertama kali di RSUPN dr. Cipto Mangunkusumo tahun 2014 &ndash; 2016. Skor luaran fungsional Medical Outcome Study 36-item Short-form Health Survey (SF-36) pra dan pasca-operasi dievaluasi dan dibandingkan menggunakan uji korelasi Friedman. Rerata usia subjek adalah 46,3 tahun (min-maks 15-71 tahun), dengan 31% penderita berusia 50-60 tahun, 69% penderita perempuan, dan rerata lama awitan keluhan hingga operasi adalah 7,79 bulan. Sebanyak 65% menderita Schwannoma dan 34,5% meningioma. Dibandingkan dengan skor pra-operasi, skor pasca-operasi kuesioner SF-36 memperlihatkan peningkatan bermakna pada kedelapan aspek kuesioner. Nilai fungsional SF-36 penderita tumor primer spinal intradural ekstramedular menunjukkan perbaikan bermakna pada masa 1 tahun pasca-operasi. Kata kunci: Tumor primer spinal, intradura ekstramedula, SF -36. &nbsp; Evaluation of Functional Outcome of Primary Extramedullar Intradura Spine Tumor Operated in Dr. Cipto Mangunkusumo General Hospital, 2014&ndash;2016 &nbsp; Abstract &nbsp; Spinal tumor is one of the neural disorders that contributes to high number of morbidities disabilities. Demographic profile and functional outcome of primary intradural extramedullary spinal tumor patient is important to be evaluated for the purpose of providing holistic information for patients and their family prior to surgery, as well as measuring surgical results. This analytical descriptive retrospective study utilized medical record of primary intradural extramedullary spinal tumor patient who underwent first surgery in dr. Cipto Mangunkusumo General Hospital from 2014-2016. Pre- and postsurgical Medical Outcome Study 36-item Short-form Health Survey (SF-36) functional score were evaluated and compared using Friedman correlation test. The mean age of study participants is 46,3 years old (min-max: 15-71 years old), with 31% participants included in the age group of 50-60 years old, 69% participants were female, and the mean of onset-to-surgery time is 7,79 months. The dominant histopathological finding was Schwannoma (65%). Compared to the pre-surgical score, post-surgical SF-36 showed significant improvements in all eight aspects of the questionnaire. SF-36 functional score of primary intradural extramedullary spinal tumor patient presented significant improvement in 1 year after surgery. Keywords: Primary spinal tumor, intradural extramedullar, SF-36

New Predictor of In-Hospital Mortality of The Surgically Treated Haemorrhagic Stroke: Subanalysis

At present there are no specific limits on the level of inflammatory markers which can be used as a boundary between excessive or non-inflammatory responses. We investigate the leukocytes count at hospital admission of spontaneous intracerebral haemorrhage patients to be proposed as a boundary between excessive inflammation and not excessive. This is a subanalysis from the study of the neuroprotective effect of tigecycline on brain injury due to spontaneous intracerebral haemorrhage supratentorial who underwent evacuation of the hematoma. Leukocytosis defined as a leukocyte count &ge; 11.000 cells/mL. The primary outcome was inhospital mortality and the secondary outcome was length of hospital stay (LOS). Statistical analysis conducted by chi-square or Fisher&rsquo;s exact test and logistic regression. Seventy patients were included. Approximately 79% of the patients had leucocytosis. Leucocytosis was not associated with inhospital mortality or LOS of 15 days or longer. However, a leucocyte count of 20,000 mm3 or higher was associated with in-hospital mortality (odds ratio, 9.09; 95% confidence interval, 1.97 to 42.06; P = 0.005). A leucocyte count of 20,000/mm3 or higher can be proposed as a boundary of the excessive inflammation on spontaneous intracerebral haemorrhage.&nbsp;Prediktor Baru Kematian di Rumah Sakit untuk Pasien Stroke Hemoragik yang Dilakukan Operasi: Hasil Subanalisis&nbsp;Saat ini belum ada penanda khusus untuk menilai suatu respons inflamasi yang berlebihan atau tidak. Penelitian ini bermaksud mengungkap jumlah leukosit tertentu sebagai penanda inflamasi yang berlebihan pada pasien perdarahan otak spontan yang dilakukan operasi evakuasi hematoma intracranial. Penelitian Ini adalah subanalisis dari studi efek neuroprotektif tigecycline pada cedera otak akibat perdarahan intraserebral spontan yang menjalani evakuasi hematoma. Leukositosis didefinisikan sebagai jumlah leukosit &ge; 11.000 sel / mL. Luaran utamanya adalah kematian di rumah sakit dan luaran sekundernya adalah lama perawatan di rumah sakit (LOS= length of stay). Analisis statistik dilakukan dengan chi-square atau uji eksak Fisher dan regresi logistik. Hasil: 70 pasien dilibatkan. Sekitar 79% dari pasien memiliki leukositosis. Leucocytosis tidak berhubungan dengan kematian di rumah sakit atau LOS 15 hari atau lebih. Namun, jumlah leukosit 20.000 mm3 atau lebih tinggi berhubungan dengan kematian di rumah sakit (rasio odds, 9,09; interval kepercayaan 95%, 1,97 hingga 42,06; P = 0,005). Jumlah leukosit 20.000 / mm3 atau lebih tinggi dapat diusulkan sebagai batas peradangan berlebihan pada perdarahan intraserebral spontan.&nbsp

In retrospective, the gentle learning curve of unilateral laminectomy promotes favorable clinical outcomes

Background: The learning curve in implementing a new surgical procedure is often time-consuming and potentially comes with the additional risk of injury associated with an unusual surgical procedure, which may harm the patient. Aim: Evaluate intraoperative burden and neurologic recovery of spinal tumor resection following unilateral laminectomy procedures. Methods: Medical records of patients undergoing surgery for intradural spinal tumors from January 2015 to June 2020 were retrospectively reviewed. Preoperative and postoperative data were collected from medical records and interviews. The intraoperative burden was assessed by duration of surgery, estimated intraoperative blood loss (EIBL), and postoperative leukocyte count. Short-term and long-term outcomes were recorded. Data analysis was performed using descriptive statistics and Fisher's exact test. The neurological recovery rate is calculated by the Hirabayashi method, where a 75–100% score indicates an excellent neurological recovery. Results: Twenty-six records were included in this study. The mean duration of surgery was 180 (120–540) minutes, the mean EIBL was 175 (50 – 1,200) mL, and mean increase in postoperative leukocyte count was 5,670 (2,210 – 13,250) cells/mL, and the mean LOS was 6.5 (4 – 42) days. In 20 of 26 (76.9%) patients, gross total resection was achieved. An excellent neurological recovery rate was achieved in 81% of patients. Conclusion: Unilateral laminectomy procedures are adaptable without additional disadvantages, resulting in satisfactory clinical results

Status Koagulasi Pasien Cedera Kepala Sedang Berdasarkan Tromboelastografi dan Hemostasis Konvensional

&nbsp;Pasien cedera kepala paling banyak di RSUPN dr. Cipto Mangunkusumo (RSCM), Jakarta adalah cedera kepala sedang (CKS) dan kelainan koagulasi dapat memperburuk luaran pasien cedera kepala. Untuk mengetahui status koagulasi dan luaran pada pasien CKS di RSCM dilakukan studi kohort prospektif pada bulan Oktober 2019 &ndash; Januari 2020 dengan subjek 20 pasien CKS. Dilakukan pemeriksaan hemostasis konvensional (trombosit, PT, APTT) dan viskoelastisitas darah menggunakan tromboelastografi (TEG). Dari pemeriksaan konvensional didapatkan gangguan koagulasi pada 5% pasien sedangkan dari pemeriksaan TEG diperoleh 60% subjek dengan gangguan koagulasi (55% hiperkoagulasi dan 5% hipokoagulasi). Median lama rawat inap adalah 7 (3-27) hari dan tidak didapatkan mortalitas. Tidak didapatkan perbedaan bermakna antara pemeriksaan hemostasis konvensional dengan TEG (uji Fisher, p&gt;0,999) serta antara status TEG dengan lama rawat inap (Uji Mann-Whitney, p=0,243). Dari parameter TEG (R time, K time, alpha angle, dan MA) tidak didapatkan perbedaan bermakna dengan lama rawat (uji Mann Whitney dan korelasi Spearman). Terdapat perbedaan bermakna antara parameter TEG, yaitu R time (p&lt;0,001) dan alpha angle (p=0,028) dengan hasil CT scan. Disimpulkan, hiperkoagulasi merupakan kelainan koagulasi yang paling sering pada pasien CKS. &nbsp; Coagulation Status of Patients with Moderate Traumatic Brain Injury Based on Thromboelastography and Conventional Haemostasis Test &nbsp; It is known that the majority of traumatic brain injury (TBI) patients in Cipto Mangunkusumo Hospital, Jakarta (RSCM) are comprised of moderate TBI. This prospective cohort study was done in RSCM to evaluate the coagulation status profile of 20 patients with moderate TBI using conventional hemostatic test (platelet count, PT, APTT) and blood viscoelasticity using thromboelastography (TEG) from October 2019 &ndash; January 2020. From conventional test, coagulopathy were detected in 5% patients, while from the TEG, coagulopathy were detected in 60% patients (55% hypercoagulopathy and 5% hypocoagulopathy). The outcome of the patients were evaluate using length of stay (LOS) which is 7 days (3-27 days) and mortality (no mortality found in this study). From statistical analysis, the conventional test result and TEG test are not significantly correlated (p&gt;0.999). Thromboelastography test result are not significantly correlated with LOS (p=0.243). From each parameter of TEG (R time, K time, alpha angle, and MA) are not correlated with LOS (Mann Whitney test and Spearman&rsquo;s correlation test). We found that 2 parameters of TEG, R time (p&lt;0,001) and alpha angle (p=0,028) are significantly correlated with CT scan. In conclusion, hypercoagulopathy is the most coagulation abnormality that occurred in moderate TBI. &nbsp;&nbsp

Status Koagulasi Pasien Cedera Kepala Sedang Berdasarkan Tromboelastografi dan Hemostasis Konvensional

&nbsp;Pasien cedera kepala paling banyak di RSUPN dr. Cipto Mangunkusumo (RSCM), Jakarta adalah cedera kepala sedang (CKS) dan kelainan koagulasi dapat memperburuk luaran pasien cedera kepala. Untuk mengetahui status koagulasi dan luaran pada pasien CKS di RSCM dilakukan studi kohort prospektif pada bulan Oktober 2019 &ndash; Januari 2020 dengan subjek 20 pasien CKS. Dilakukan pemeriksaan hemostasis konvensional (trombosit, PT, APTT) dan viskoelastisitas darah menggunakan tromboelastografi (TEG). Dari pemeriksaan konvensional didapatkan gangguan koagulasi pada 5% pasien sedangkan dari pemeriksaan TEG diperoleh 60% subjek dengan gangguan koagulasi (55% hiperkoagulasi dan 5% hipokoagulasi). Median lama rawat inap adalah 7 (3-27) hari dan tidak didapatkan mortalitas. Tidak didapatkan perbedaan bermakna antara pemeriksaan hemostasis konvensional dengan TEG (uji Fisher, p&gt;0,999) serta antara status TEG dengan lama rawat inap (Uji Mann-Whitney, p=0,243). Dari parameter TEG (R time, K time, alpha angle, dan MA) tidak didapatkan perbedaan bermakna dengan lama rawat (uji Mann Whitney dan korelasi Spearman). Terdapat perbedaan bermakna antara parameter TEG, yaitu R time (p&lt;0,001) dan alpha angle (p=0,028) dengan hasil CT scan. Disimpulkan, hiperkoagulasi merupakan kelainan koagulasi yang paling sering pada pasien CKS. &nbsp; Coagulation Status of Patients with Moderate Traumatic Brain Injury Based on Thromboelastography and Conventional Haemostasis Test &nbsp; It is known that the majority of traumatic brain injury (TBI) patients in Cipto Mangunkusumo Hospital, Jakarta (RSCM) are comprised of moderate TBI. This prospective cohort study was done in RSCM to evaluate the coagulation status profile of 20 patients with moderate TBI using conventional hemostatic test (platelet count, PT, APTT) and blood viscoelasticity using thromboelastography (TEG) from October 2019 &ndash; January 2020. From conventional test, coagulopathy were detected in 5% patients, while from the TEG, coagulopathy were detected in 60% patients (55% hypercoagulopathy and 5% hypocoagulopathy). The outcome of the patients were evaluate using length of stay (LOS) which is 7 days (3-27 days) and mortality (no mortality found in this study). From statistical analysis, the conventional test result and TEG test are not significantly correlated (p&gt;0.999). Thromboelastography test result are not significantly correlated with LOS (p=0.243). From each parameter of TEG (R time, K time, alpha angle, and MA) are not correlated with LOS (Mann Whitney test and Spearman&rsquo;s correlation test). We found that 2 parameters of TEG, R time (p&lt;0,001) and alpha angle (p=0,028) are significantly correlated with CT scan. In conclusion, hypercoagulopathy is the most coagulation abnormality that occurred in moderate TBI. &nbsp;&nbsp