Pendahuluan: Spina bifida (SB) merupakan suatu kelainan kongenital sistem saraf pusat dengan prevalensi tertinggi dalam spektrum cacat tabung saraf (neural tube defect) akibat gangguan penutupan tulang belakang janin pada bulan pertama kehamilan. Laporan kasus: Dilaporkan dua kasus SB pada bayi laki-laki berusia dua hari dan tiga hari yang lahir prematur. Pada kedua pasien ditemukan massa di area lumbosakral disertai rembesan cairan serebrospinal (cerebro spinal fluid) serta kelainan kongenital multipel antara lain berupa congenital talipes equinovarus (CTEV) bilateral, hipospadia dan atresia ani. Kedua pasien menjalani pemeriksaan darah, ekokardiografi, CT scan tanpa kontras dan babygram. Hasil pemeriksaan darah menunjukkan peningkatan prothrombine time, thromboplastine time dan kalium. Hasil CT scan menunjukkan ventriculomegali dan edema otak. Echocardiography menunjukkan adanya PDA. Pasien menjalani kolostomi, repair spina bifida dan pemasangan ventriculoperitoneal (VP) shunt. Pembahasan: SB sering disertai dengan kelainan kongenital lain yang berasal dari lapisan neuroektoderm saat embriogenesis. Segera setelah bayi lahir perlu dilakukan pemeriksaan dan manajemen secara komprehensif dari tim multidisiplin terkait adanya bagian neural placode yang terbuka untuk mengetahui lokasi, ukuran, apakah ada kebocoran cairan serebrospinal serta kelainan kongenital lain yang menyertai.
Quality control is a part that must be taken into account by every company in a developing era like today. Pt. XYZ is a company that produces palm oil. Types of defects in the packaging in PT. XYZ includes uneven packaging prints, packaging not tightly closed, peeling brand glue. From the three packaging defects, an analysis was carried out using the FMEA and FTA methods so that the quality of the product was even better by providing proposed improvements at the stage that was considered a failure. The highest RPN value is in the defect of peeling brand glue, with an RPN value of 168, the number of defects in a period of 6 months is 3949 pcs. This is carried out by FTA analysis so that the cause is known to be the lack of rest hours for workers, stuffy rooms, the absence of comfortable facilities, and workers must complete their work quickly so that it requires very extra accuracy. The proposed improvements for peeling brand glue are to provide sufficient rest hours, provide special training to workers, change the layout of the room or add a room so that it is not stuffy, and facilitate a blower or fan that is sufficient for the glue to dry quickly.
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