Objectives To report a neonate with clinical findings consistent with thanatophoric dysplasia (TD). Only a few cases of this rare and lethal skeletal disorder have been reported in South-East Asia. Case presentation A 37-year-old Asian female, fourth gravida at 39 weeks, presented to our hospital for an elective cesarean section due to polyhydramnios, frank breech and gestational hypertension. The father was a 42-year-old Asian male. There was no history of rashes, fever, alcohol intake, substance drug abuse, smoking habit or radiation exposure. Ultrasound (US) of 34-weeks’ gestation found a baby with frontal bossing, prominent temporal lobe, clover-skull and low nasal bridge. The thoracic diameter was smaller than the abdominal diameter. Short limbs without bowing were noted in femur and humeral bones. The patient delivered a baby boy, 4115 g, APGAR scores were 5 and 7 at 1 and 5 min. The baby had a dysmorphic face, frontal bossing, low nasal bridge, low-set ears and short neck. The thorax was narrow and abdomen was protuberant. The upper and lower proximal limbs appeared short. A chest X-ray revealed short, curved ribs and opacification of both lungs. He had respiratory distress shortly after birth and had persistent severe respiratory distress despite adequate mechanical ventilation. On the third day, he had cardiac arrest; resuscitation was not done due to family request. The baby was declared deceased due to cardiopulmonary failure related to his congenital anomaly. Conclusions Ultrasonography could readily indicate TD prenatally. The pregnancy can continue up to late third trimester without miscarriage. Most of the neonates die in utero; those who survive are dependent on ventilator.

PERANCANGAN SISTEM ENTERPRISE RESOURCEPLANNING MODUL SALES PADA DISTRIBUTOR BERASUD MANISDANA MARSETIYA UTAMA*, DAN FERRY YULIANTOJurusan Teknik Industri, Fakultas Teknik, Universitas Muhammadiyah MalangJl. Raya Tlogomas 246, Malang, Jawa Timur 65144Email: fund.1986@gmail.comABSTRAKUD Manis adalah distributor beras di Kabupaten Lamongan.Permasalahan pada UD Manisadalah belum adanya sistem informasi untuk menampilkan stock barang di gudang dan titipan barangdari pelanggan meskipun perusahaan telah menggunakan aplikasi data base MS Access. Perusahaanmemerlukan sistem informasi untuk menampilkan stock dan mengintegrasikan antar departemen.Tahapan perancangan sistem Enterprise Resources Planning (ERP) modul sales terdapat 3 tahapan yaitupengumpulan data, perancangan proses dan uji coba, serta evaluasi. Hasil perancangan sistem ERPmodul sales dengan menggunakan Adempiere memiliki urutan proses sales order, shipment, invoice, danpayment. Hasil uji coba perancangan sistem ERP Adempiere menunjukkan bagian gudang dan sales dapatmelakukan pengecekan stock aktual barang di gudang lebih cepat dan akurat.Kata kunci: enterprise resource planning, modul penjualan, pelangganABSTRACTUD Manis is a rice distributor in Lamongan. The problem faced by UD Manis is having no informationsystem for notifying stock in warehouse and customer order although company has used MS Access database.Company requires information system for notifying stock and integrating across department. There are3 major steps in module sales in Enterprise Resource Planning (ERP) which are data collection, processplanning and testing, & evaluation. The result of ERP system design particularly for module sales byusing software package “Adempiere” has process sequence as sales order, shipment, invoice, and payment.Testing result of ERP system design using Adempiere shows that warehouse and sales department couldcheck actual stock in warehouse more agile and accurate.Key words: enterprise resource planning, module sales, customer

Diagnosis of bacterial meningitis in children is difficult. Both bacterial and aseptic meningitis have identical clinical presentation. Cerebrospinal fluid (CSF) analysis and microbacterial culture are modalities to help physician distinguishing between both of them. However, lumbar puncture procedure to gain CSF sample could not always be done due to contraindications or clinically unstable condition. Blood Neutrophil Lymphocyte Ratio (NLR) examination has a potential biomarker to differentiate causes of meningitis when CSF sample cannot be obtained, especially in the early phase of disease. This study's objective is to determine whether the NLR value can be used as a predictor of bacterial meningitis in children. The research design was cross-sectional. Data was taken retrospectively by reviewing medical records at Sanglah Hospital, Denpasar for the period January 2017 to December 2020. Data taken were age, sex, leukocyte, neutrophils, lymphocytes count and cerebrospinal fluid culture. Analysis of NLR in conjunction with bacterial and aseptic meningitis was carried out. During the study period, a total of 100 data samples were obtained, 58 subjects were male and 42 female subjects. Non-bacterial meningitis and aseptic meningitis were found in 62 cases, while bacterial meningitis with positive CSF culture results was found in 38 cases. ROC curve analysis showed the optimal cut-off value for NLR was 5.64 which resulted in a sensitivity of 0.84 and a specificity of 0.51. The Area Under the Curve (AUC) value for the NLR was 0.67 (CI95% 0.56-0.78, p=0,003) with positive and negative predictive values being 0.41 (0.28-0.54) and 0.63 (0.56-0.7), respectively. NLR ≥5.64 can be used as one of the predictors for diagnosing bacterial meningitis in children.

Myasthenia gravis is a chronic autoimmune disease of neuromuscular blockade, characterized by rapid fatigability of striated muscle. Estimated incidence has been reported at 1/200,000 to 1/1,000,000 worldwide, but its incidence in Indonesia is not clearly recorded. We report a rare case of juvenile ocular myasthenia gravis which is considered rare in child population. The objective of this case report is to describe the proper assessment of its clinical presentation. Patient is an eleven years old boy who had ptosis and opthalmoplegia on both sides for three weeks duration. Its complaint was exaggerated with sustained gaze on daily activities. Ptosis was triggered quickly after being induced by fixated upgaze without blinking and improved after ice pack was put on his eyelids for five minutes. However, his vision was preserved and no slurred speech, dysphagia or limb weakness on physical examination. Neostigmine test showed positive result and rapid nerve stimulation test also revealed withsignificant decrement on the affected eyelid muscles. No thymoma was seen on chest CT scan and thyroid function test was also normal. Hence the diagnosis was made and pyridostigmine was started for its medication. This report present a rare case of juvenile ocular myasthenia gravis. Early recognizing by some diagnostic modalities confirms its diagnosis so that treatment could be started to control the muscle weariness and improving patient's quality of life.