BackgroundTraumatic brain injury (TBI) is a common healthcare problem related to disability. An easy-to-use trauma scoring system informs physicians about the severity of trauma and helps to decide the course of management. The purpose of this study is to use the combination of both physiological and anatomical assessment tools that predict the outcome and develop a new modified prognostic scoring system in TBIs.Patients and methodsA total of 181 subjects admitted to the emergency department (ED) of Sanglah General Hospital were documented for both Marshall CT scan classification score (MCTC) and Revised Trauma Score (RTS) upon admission. Glasgow Outcome Scale (GOS) was then documented at six months after brain injury. A new Modified Revised Trauma–Marshall score (m-RTS) was developed using statistical analytic methods.ResultsThe total sample enrolled for this study was 181 patients. The mean RTS upon admission was 10.2±1.2. Of the 181 subjects, 110 (60.8%) were found to have favorable GOS (GOS score >3). Best Youden’s index results were obtained with any of the RTS of ≤10 with area under receiver operating characteristic (ROC) curve of 0.2542 and with risk ratio of 2.9 (95% CI=1.98−4.28; P=0.001); and Marshall score ≤2 with area under ROC curve of 0.2249 with risk ratio of 3.9 (95% CI=2.52−5.89; P=0.001). The RTS–Marshall combination has higher sensitivity with risk ratio of 4.5 (CI 95%=2.55−8.0; P=0.001) for screening tools of unfavorable outcome. The Pearson’s correlation between RTS and Marshall classification is 0.464 (P<0.001).ConclusionCombination of physiological and anatomical score improves the prognostic of outcome in moderate and severe TBI patients, formulated in this accurate, simple, applicable and reliable m-RTS prognostic score model.

Pediatric reconstruction of the cranial defect is a challenging task, the standard reconstruction method has been bone grafting. The reconstruction of complex facial defects should satisfy both aesthetic and functional requirements. In the case of large defects, the use of craniofacial prostheses using autogenous bone is the material of choice because of its potential for revascularization and its osteoconductive properties. A 3-year-old patient has facial disfgurement as result from bone defciency following anterior skull base tumour resection. To minimize the associated functional and cosmetic problems, a number  of reconstructive options are available to the surgeon including the use of autogenous and alloplastic implants. A computed tomography (CT) 3-dimensional reconstruction scan showed a large craniofacial defect as residual radical skull base tumour resection. A transcranial approach by a neurosurgeon and plastic surgery was performed to reconstruct the defect using autologous rib bone graft. Six months after the reconstruction surgery, a defect of the craniofacial was narrowing without cranial nerve defcits.Complex reconstructions of extensive defects in craniofacial area can be achieved using autologous bone grafts. They yield reasonable functional and aesthetic outcomes and noticeably improves the qualityof life.

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Intraventricular extension of intracerebral hemorrhage (IVH) is an poor independent outcome predictor in spontaneous intracerebral hemorrhage (ICH). IVH volume important in prediction of outcome and management; however, it is hard to measure routinely. Large IVH volume and increased number of affected ventricles have been associated with worse prognosis. Easy-to-use ICH scoring systems inform physicians of the severity and help to decide the course of management. ICH scoring system used to translate the severity into a score, allows quantification of severity, to predict outcome and clinical research. Graeb score can estimate the probability of survival in IVH volume. Purpose of this study is to combine original ICH score and Graeb score, to predict outcome in patients spontaneous ICH and determined the combination would improve the prediction.This prospective observational study of 88 patients who demonstrated spontaneous ICH with and without IVH on initial brain computed tomography (CT) were enrolled at Sanglah General Hospital Denpasar throughout 2017. Independent mortality or good outcome evaluation disability using modified Rankin Scale (mRS) at 30 days. Combination ICH-Graeb score was created by adding Graeb Score into original ICH. Mortality rate was 53.4%, and 34% has good outcome. Statistical result in terms of predictive power ICH score for in-hospital unfavourable outcome with cutoff point ³3 {Area Under Curve (AUC): 0.7546} risk ratio 1.8 (Confidence Interval/CI 95%: 1.29-2.67; p=0.0002). While predictive power Graeb score for in-hospital unfavourable outcome with cutoff point ³1 (AUC: 0.6365) risk ratio 1.7 (Confidence Interval/CI 95%: 1.11-2.61; p=0.0034). Combined ICH and Graeb score risk ratio 1.9 (Confidence Interval/CI 95%: 1.16-3.14; p=0.0012). The combination ICH-Graeb score better tools for prediction of unfavourable outcome. Combination of ICH and Graeb score improves the prediction of outcome in spontaneous ICH. Provides as accurate, simple, applicable and reliable screening tools.

When a person becomes an adult, then in fact he has become a person who is independent of himself. So the consequence of being an adult is, to live life with the sweat. Therefore, preparation is needed to become an independent life, one of which is to have survival skills, namely doing business. This service activity is carried out as a concern for the life of the surrounding community, especially teenagers, to provide information and expertise that can be useful for their lives in the future. This service activity contains learning activities, training and entrepreneurial practice, thus helping teenagers understand the basic concepts of establishing a business. This activity was carried out in Pamulang District (South Tangerang), and the participants in the activity were teenagers in the Reni Jaya housing estate. The activity was carried out for three days, with an agenda of learning theory, learning practice, and sharing experiences from business actors. Obviously, this activity creates enthusiasm for entrepreneurship, this can be seen in the enthusiasm of the participants in participating in activities, asking lots of questions, and being careful in participating in activities. In addition, this activity can increase the knowledge, knowledge, and interest of young people in establishing a business as a way to live their lives in the future.