ANALISA PENURUNAN DAYA PADA UNIT WHEEL LOADER KOMATSU WA470-3

Turbocharger merupakan suatu alat untuk menambah jumlah udara masuk ke dalam silinder dengan memanfaatkan energi gas buang hasil pembakaran untuk memutar kompresor yang digerakan turbin. Analisa ini bertujuan untuk mengetahui penyebab penurunan daya, mengetahui jenis kerusakan dan perbaikan pada wheel loader Komatsu WA470-3.. Prosedur pemeriksaan dilakukan dengan cara visual pada kondisi gas buang, kondisi fuel system, kondisi oli dan kondisi turbocharger. Selanjutnya dilakukan proses assembly pada bagian turbocharger untuk menganalisa jenis kerusakan dan faktor penyebab rusaknya turbocharger pada wheel loader. Hasil analisa kerusakan turbocharger terjadi pada shaft atau bearing. Jenis kerusakannya yaitu keausan yang terjadi pada shaft atau bearin. Langkah perbaikan yang dilakukan yaitu dengan mengganti turbocharger secara komplit

RETROSPECTIVE STUDY OF PREDICTORS FOR FOOT ULCERATION AMONG DIABETIC PATIENTS ATTENDING KUALA LANGAT HEALTH CENTRE FROM 1999 TO 2008

ABSTRACT Background : Foot ulcers and its complications are an important cause of morbidity and mortality in diabetes. The aim of this retrospective study is to determine the ulcer-free survival in diabetic foot and its relevant predictors in a cohort of diabetic patients in the primary health care setting. Methods : Data of newly diagnosed diabetics (n=1121) who received treatment in five health centers in the district of Kuala Langat, Selangor between 1 st January 1999 until the 30 th June 2008 were studied. Information was gathered by reviewing patient's medical records. All patients were followed until 31 st December 2008. The duration of ulcer-free survival was measured from the date of being diagnosed as diabetic until the development of the ulcer. Results : The total incidence of diabetic foot ulcer was 9.9% (n=111), with an average annual incidence of 1%. The total incidence of amputation was 1.2%. Conclusion : In conclusion, about 1% of primary care health center-based diabetic patients developed new ulcers each year. Renal profile and lipid profile can be used as a predictor to ulcer-free survival for diabetic foot ulcer in the primary health care setting. All patients must be given the appropriate duration of follow-up which should not exceed more than six months with emphasis on defaulter tracing to increase the number of patients free from diabetic foot ulcer

Interpretation of chronic pain clinical trial outcomes: IMMPACT recommended considerations

Interpreting randomized clinical trials (RCTs) is crucial to making decisions regarding the use of analgesic treatments in clinical practice. In this article, we report on an Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) consensus meeting organized by the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), the purpose of which was to recommend approaches that facilitate interpretation of analgesic RCTs. We review issues to consider when drawing conclusions from RCTs, as well as common methods for reporting RCT results and the limitations of each method. These issues include the type of trial, study design, statistical analysis methods, magnitude of the estimated beneficial and harmful effects and associated precision, availability of alternative treatments and their benefit-risk profile, clinical importance of the change from baseline both within and between groups, presentation of the outcome data, and the limitations of the approaches used

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P &lt; 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P &lt; 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Predictors of survival among end stage renal failure patients undergoing dialysis treatment in Pahang from 2000 TO 2004

Introduction : A retrospective cohort study was conducted among ESRD who received dialysis treatment (Haemodialysis and CAPD) in all government hospitals in the State of Pahang from 1st January 2000 to 31st December 2004. Objective : The aim of the study was to identify factors affecting the survival of patients undergoing dialysis in the state of Pahang. Methods : Survival time was measured from the date of dialysis until the subjects died, lost to follow up or until the end of the study period at 31st December 2004. Results : Diabetes mellitus was the major cause for ESRD (33%) out of 132 subjects eligible for the study. Seven (7.1%) and five (15.2%) deaths occurred among haemodialysis and CAPD patients respectively, but statistically of no difference between the two treatments (log-rank, p=0.093). Factors influencing the survival of haemodialysis patients were diabetes mellitus (p=0.014), albumin (p=0.0005), creatinine (p=0.020) and hemoglobin level (p=0.002), while age of treatment and diabetes mellitus affecting the survival of CAPD patient. Cox Proportional Hazard Regression showed that haemodialysis subjects with low albumin (HR 0.669 df 95% 0.513 - 0.873) and hemoglobin (HR 0.403 df 95% 0.225 - 0.720) level had lower survival rate but none for CAPD. Conclusion : Good nutritional status, higher hemoglobin level and prevention of diabetes mellitus are important for the survival of haemodialysis patient

Retrospective study of predictors for foot ulceration among diabetic patients attending Kuala Langat Health Centre from 1999 to 2008

Background : Foot ulcers and its complications are an important cause of morbidity and mortality in diabetes. The aim of this retrospective study is to determine the ulcer-free survival in diabetic foot and its relevant predictors in a cohort of diabetic patients in the primary health care setting. Methods : Data of newly diagnosed diabetics (n=1121) who received treatment in five health centers in the district of Kuala Langat, Selangor between 1st January 1999 until the 30th June 2008 were studied. Information was gathered by reviewing patient’s medical records. All patients were followed until 31st December 2008. The duration of ulcer-free survival was measured from the date of being diagnosed as diabetic until the development of the ulcer. Results : The total incidence of diabetic foot ulcer was 9.9% (n=111), with an average annual incidence of 1%. The total incidence of amputation was 1.2%. Mean age of being diagnosed having diabetic was 52+10.7 year old and mean age of being diagnosed having diabetic foot ulcer was 54.68+10.16 year old. The mean for overall ulcer-free survival was 99 months (95%CI:96-102). Male gender (LR=6.56; p=0.01), smokers (LR=3.94; p=0.04), low body mass index (LR=4.45; p=0.03), impaired renal function (LR=5.17; p=0.02) and long duration between follow-up (LR=25.10; p<0.0005) predicted the ulcer-free survival. However, with Cox’s Proportional Hazard Regression analysis factors independently associated to ulcer-free survival were impaired renal function (HR=1.65)(95%CI:1.09,2.46), poor lipid control (HR=2.36)(95%CI:1.03, 5.41) and duration of follow-up more than six months (HR=4.74)(95%CI:2.28,9.86). Other factors studied were not significant. Conclusion : In conclusion, about 1% of primary care health center-based diabetic patients developed new ulcers each year. Renal profile and lipid profile can be used as a predictor to ulcer-free survival for diabetic foot ulcer in the primary health care setting. All patients must be given the appropriate duration of follow-up which should not exceed more than six months with emphasis on defaulter tracing to increase the number of patients free from diabetic foot ulcer