The association between blood glucose level and cognitive dysfunction among acute traumatic brain injury in Manado, Indonesia

Background: Traumatic brain injury (TBI) is a public health challenge. TBI contributes to chronic physical impairment and also disrupt mental and personality aspects. Cognitive dysfunction is influenced by multiple factors, including blood glucose level. The objective of the study was to analyze the association between blood glucose level and cognitive dysfunction among TBI patients.Methods: A hospital-based observational study was conducted with cross-sectional design for six months period. Population of research were all of TBI patients treated at the emergency unit. Eligible sample were obtained with total sampling technique. Dyslgycemia was defined as random blood glucose level outside the range of 80-200mg/dl; cognitive dysfunction was defined as MMSE score <26. Statistical analysis with SPSS version 17.0 was employed. Chi square test and odd ratio were executed, p value <0,05 were regarded as significant level.Results: Majority of the 124 patients was male (75.8%), in 21-30 age group (20.7%), mostly due to RTA, specifically from motorcycle-related accident. Most of the motorcyclist (56,5%) were not using helmet. Unconsciousness was in 65.8% sample. Seizure was found in 3.9% of total patients; almost half of patients had history of headache (40.8%). Vomit was found in 30.3% of patients. Vertigo or dizziness post-trauma was in 3.9% patients; almost one third of patients had history of alcohol consumption (30.3%). Majority (65.8%) were in GCS 13-15. Proportion of dysglycemia and cognitive dysfunction were 4.8% and 14.5% consecutively. Odd ratio analysis revealed that dysglycemic group have 3 times higher risk to develop cognitive dysfunction, but the association was statistically not significant.Conclusions: The association between random blood glucose level and cognitive dysfunction among acute traumatic brain injury was statistically not significant

Ageing and Weakening Social Cohesion among Stroke Patients in Manado

Background: Stroke is one of the major public health problem worldwide. Data from several hospital in Indonesia showed that stroke is the leading cause of mortality among adults in Indonesia. Stroke patients experience diminishing quality of life. This study aimed to determine the effect of ageing on weakening social cohesion among stroke patients in Manado. Subjects and Method: This was an analytic observational study with cross sectional design. This study was conducted in Manado, North Sulawesi. A sample of 42 ischemic stroke patients were selected for this study from several hospitals in Manado by stratified random sampling. The dependent variable was social cohesion. The independent variable was age. The sample patients were divided into 2 age groups: <60 years old (non-geriatric patients) and ≥ 60 years old (geriatric patients). The data were collected by questionnaire. Data on stroke diagnosis was obtained from the medical record. The data were analyzed using Odd Ratio and Chi Square. Results: Mean (SD) age of stroke patients was 57.6 years (12.0 years). Proportion of geriatric stroke patients (aged ≥ 60 years old) was 38.1%. Female patients were 57.1%. Patients with ≥ high school attainment or higher were 42.9%. Patients belonging to Minahasa ethnic was 76.2%. The proportion of poor social cohesion was 37.5% among geriatric patients and 11.5% among non-geriatric patients. Ageing was associated with poorer social cohesion (OR= 4.60; 95% CI=0.95 to 22.16; p= 0.046). Conclusion: Ageing is associated with poorer social cohesion among ischemic stroke patients. Keywords: ageing, social cohesion, stroke patient

HUBUNGAN ANTARA KADAR GULA DARAH SEWAKTU DENGAN DISFUNGSI EKSEKUSI PADA CEDERA KEPALA

Pendahuluan: Cedera Kepala merupakan masalah kesehatan masyarakat global, sebagian besar disebabkan oleh kecelakaan lalu lintas. Mayoritas penelitian cedera kepala berfokus pada keluaran motorik, komplikasi dan kematian. Masih sedikit informasi mengenai disfungsi eksekutif dalam hubungan dengan kadar glukosa darah pada kasus cedera kepala. Penelitian ini bertujuan untuk menganalisis hubungan antara kadar glukosa darah sewaktu dengan kejadian disfungsi eksekutif pada pasien cedera kepala akut. Metode: Penelitian di disain potong lintang berbasis rumah sakit yang dilakukan selama 6 bulan di instalasi gawat darurat (IGD) RSUP Prof. R. D. Kandou. Populasi penelitian adalah seluruh pasien cedera kepala/CK yang dirawat pada fase akut. Sampel penelitian didapatkan sebanyak 76 orang setelah memenuhi kriteria penyertaan. Disglikemia bila kadar GDS dibawah 80 mg/dl (hipoglikemia) atau diatas 200 mg/dl (hiperglikemia). Disfungsi eksekutif jika didapatkan nilai diluar normal pada tes TMT-A dan B. Dilakukan analisis data univariat dan bivariat. Hubungan antar variabel dianalisis dengan uji chi square dan analisis odd ratio menggunakan perangkat lunak SPSS. Batas kemaknaan ditetapkan jika p<0,05. Hasil: Mayoritas cedera kepala terjadi pada laki-laki (80,3%). Usia dibawah 21 tahun merupakan segmen yang terbanyak (31,6%). Onset sampai 3 jam sejak kejadian saat tiba di RS sebesar 38,2%. Gejala penurunan kesadaran sebesar 65,8%. Sebagian besar kasus tergolong cedera kepala ringan (65,8%). Proporsi kejadian disglikemia adalah 3,9%. Proporsi gangguan fungsi eksekutif adalah sebesar 28,9%. Pada kelompok disglikemia didapatkan proporsi disfungsi eksekutif sebesar 33,3%, sedangkan pada non-disglikemia sebesar 28,8%. Pada uji statistik didapatkan OR 1,23 (95% CI 0,10 – 14,39), p=0,86. Simpulan: Tidak didapatkan hubungan bermakna antara kadar glukosa darah sewaktu dengan kejadian disfungsi eksekutif pada cedera kepala akut.Kata kunci: Kadar Glukosa Darah, Disfungsi Eksekutif, Cedera KepalaABSTRACTIntroduction: Head injury is a global public health problem, commonly due to traffic accidents. Researches on head injury are mostly focused on motoric outcome, complication and mortality. There is lack of study about executive dysfunction among the victims, especially in relationship to blood glucose level. The objective of this study was to analyze the association between random blood glucose level and executive dysfunction in acute head trauma. Method: This was a hospital-based cross-sectional study for a-six-months period of research at local provincial tertiary hospital. Study population were head injury patients admitted to hospital in acute phase. We recruited consecutively 76 samples based on specific inclusion criteria. Dysglycemia was defined as random blood glucose was below 80 mg/dl (hypoglycemia) or above 200 mg/dl (hyperglycemia). Executive dysfunction was defined as abnormal score on TMT-A and B. We applied Chi square with Odd Ratio (OR) analysis to reach statistical conclusion. P-value less than 0,05 were significant. Result: Most of the patients were male (80,3%). Majority of cases were in group age of less than 21 years old (31,6%). Almost half of the patients (38,2%) were reach hospital within 3 hours after the accident. Most of them with unconsciousness as chief complaint (65,8%). Mild head injury were 65,8% of all cases. We found proportion of dysglycemia was 3,9%. Executive dysfunction was 28,9%. Among dysglycemic patients, we found the proportion of executive dysfunction was 33,3%, while in non-dysglycemia group executive dysfunction was 28,8%. In statistical analysis, we found OR 1,23 (95% CI 0,10 – 14,39), p = 0,86. Conclusion: There was no significant association between blood glucose level and executive dysfunction among head injury due to traffic accidents.Keywords: Executive Dysfunction, Dysglycemia, Glucose Level, Head Traum

Analisis Segmentasi, Targeting Dan Positioning Pembiayaan Mobil Pada PT. Adira Dinamika Multifinance Tbk Cabang Manado

Persaingan yang semakin ketat saat ini, menuntut adanya keunggulan bersaing yang harus dimiliki oleh setiap Perusahaan, dan membutuhkan strategi pemasaran yang tepat. Jumlah pesaing yang semakin banyak membuat konsumen memiliki alternatif pilihan yang banyak untuk mendapatkan produk yang sesuai dengan harapannya. Untuk memenangkan persaingan tidak hanya sebatas menyusun bauran pemasaran sebagai taktik namun lebih dari itu juga untuk menyusun strategi segmenting, targeting marketing, dan positioning yang diinginkan oleh Perusahaan. Tujuan penelitian ini yaitu: 1) untuk mengetahui segmentasi pembiayaan mobil pada PT. Adira Dinamika Multifinance Tbk Cabang Manado 2, berdasarkan segmentasi demografi dan segmentasi perilaku dan manfaat, 2) untuk mengetahui targeting pembiayaan mobil pada PT. Adira Dinamika Multifinance Tbk Cabang Manado 2, dan 3) untuk mengetahui positioning pembiayaan mobil pada PT. Adira Dinamika Multifinance Tbk Cabang Manado 2. Responden dalam penelitian ini sebanyak 100 responden dengan metode pengambilan sampel yang digunakan adalah sampling purposive, yaitu teknik penentuan sampel berdasarkan pertimbangan tertentu. Alat analisis yang digunakan adalah analisis cluster dan analisis multidimensional scalling. Hasil penelitian menggunakan analisis cluster yaitu K-Means Cluster, terbentuk 3 segmen berdasarkan segmentasi demografi, perilaku dan manfaat. Hasil analisis multidimensional scalling, menunjukkan PT. CIMB Niaga Auto Finance merupakan pesaing terdekat dari PT. Adira Dinamika Multifinance Tbk Cabang Manado 2. Kata kunci: segmentasi, targeting, positioning, pembiayaa

Laju Tumbuh Umbi Tanaman Kentang Varietas Granola dan Supejohn di Dataran Medium dengan Pemulsaan

ABSTRACTResearch on growth rate of two cultivars of potato c.v. Granola and Supejohn at medium altitude using mulching methods was conducted at Paslaten village, Subdistrict of West Langowan, District of Minahasa, North Sulawesi. Research location was at medium altitude of 750 m above sea level. The objectives of this research were to determine growth rate of potato tuber grown at medium altitude and the most suitable mulch. The research was arranged in a randomized complete block design with two treatments and three replications. The first factor was potato cultivars (Granola and Supejohn) and second factor was mulching methods (no mulch, straw mulch and black silver plastic). Research result showed that straw mulch treatment increased growth rate of Granola and Supejohn cultivars 0.87 g plant-1 day-1 and 0.73 g plant-1 day-1, respectively while black silver plastic treatment only increased the growth rate of Granola and Supejohn cultivars 0.70 g plant-1 day-1and 0.59 g plant-1 day-1, respectively. The highest tuber dry weight was achieved by straw mulch. The best treatment was Granola grown in straw mulch. The lowest growth rate occurred at the mulch treatment which were 0.49 g plant-1 day-1 for Granola cultivar and 0.47 g plant-1 day-1 for Supejohn cultivar.Keywords: black silver plastic mulch, dry weight, growth rate, potato, straw mulch    ABSTRAKPenelitian tentang laju tumbuh tanaman kentang dengan 2 (dua) varietas yaitu Granola dan Supejohn di dataran medium dengan menggunakan mulsa dilakukan di Desa Paslaten, Kecamatan Langowan Barat, Kabupaten Minahasa Provinsi Sulawesi Utara. Lokasi penelitian berada di dataran medium dengan elevasi 750 m di atas permukaan laut. Penelitian bertujuan untuk mendapatkan besarnya laju tumbuh umbi tanaman kentang yang dikembangkan di dataran medium dan jenis mulsa yang paling sesuai. Penelitian menggunakan rancangan acak kelompok dengan 2 (dua) faktor dan 3 (tiga) ulangan yaitu faktor I tanaman kentang (varietas Granola dan Supejohn) dan faktor II yaitu perlakuan mulsa (tanpa mulsa, mulsa jerami dan mulsa plastik hitam perak). Hasil penelitian menunjukkan bahwa perlakuan mulsa jerami meningkatkan laju tumbuh umbi pada varietas Granola sebesar 0.87 g tanaman-1 hari-1 dan varietas Supejohn sebesar 0.73 g tanaman-1 hari-1. Perlakuan mulsa plastik hitam perak meningkatkan laju tumbuh umbi pada varietas Granola sebesar 0.70 g tanaman-1 hari-1 dan varietas Supejohn 0.59 g tanaman-1 hari-1. Bobot kering umbi tertinggi dicapai oleh mulsa jerami. Perlakuan terbaik ialah varietas Granola yang diberi mulsa jerami. Laju pertumbuhan terendah terdapat pada perlakuan tanpa mulsa sebesar 0.49 g-1 hari-1 untuk kultivar Granola dan 0.47 g-1 hari-1 untuk Supejohn.Kata kunci: bobot kering, kentang, laju tumbuh, mulsa jerami, mulsa plastik hitam pera

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Variation in postoperative outcomes of patients with intracranial tumors: insights from a prospective international cohort study during the COVID-19 pandemic

Background: This study assessed the international variation in surgical neuro-oncology practice and 30-day outcomes of patients who had surgery for an intracranial tumor during the COVID-19 pandemic. Methods: We prospectively included adults aged ≥18 years who underwent surgery for a malignant or benign intracranial tumor across 55 international hospitals from 26 countries. Each participating hospital recorded cases for 3 consecutive months from the start of the pandemic. We categorized patients’ location by World Bank income groups (high [HIC], upper-middle [UMIC], and low- and lower-middle [LLMIC]). Main outcomes were a change from routine management, SARS-CoV-2 infection, and 30-day mortality. We used a Bayesian multilevel logistic regression stratified by hospitals and adjusted for key confounders to estimate the association between income groups and mortality. Results: Among 1016 patients, the number of patients in each income group was 765 (75.3%) in HIC, 142 (14.0%) in UMIC, and 109 (10.7%) in LLMIC. The management of 200 (19.8%) patients changed from usual care, most commonly delayed surgery. Within 30 days after surgery, 14 (1.4%) patients had a COVID-19 diagnosis and 39 (3.8%) patients died. In the multivariable model, LLMIC was associated with increased mortality (odds ratio 2.83, 95% credible interval 1.37–5.74) compared to HIC. Conclusions: The first wave of the pandemic had a significant impact on surgical decision-making. While the incidence of SARS-CoV-2 infection within 30 days after surgery was low, there was a disparity in mortality between countries and this warrants further examination to identify any modifiable factors

Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study.

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay