Background: Blacksmith is one of the small industries that is developing in Gubug Village, Tabanan Regency. One of the processes in manufacturing household utensils in the form of small knives, large knives, sickles, and machetes will be faced with a grinder. In this process, the worker holds a vibrating grinder weighing more than 1.5 kg. Working with heavy loads and being exposed to vibration for a long time is an additional burden that will cause musculoskeletal complaints, as well as diseases such as Raynaud's Syndrome, Tenosynovitis, and Carpal Tunnel Syndrome in workers. This study aimed to determine the effect of Sitting Grinding Modification on Reducing Complaints of Musculoskeletal Disorders (MSDs), Workload, and Increasing Work Productivity of Blacksmiths in Gubug Tabanan Village.

Methods: This research is an experimental study with treatment by subject design. The population is 40 people from 10 industries. Sample selection by simple random sampling with a table of random numbers. The minimum number of samples was calculated using the Colton formula to determine the sample size to be 16 people. Data processing and analysis: Descriptive test for subject condition data includes age, weight, height, and body mass index. Normality test was performed on the data; a) physical environment includes air temperature, humidity, and noise), b). musculoskeletal complaints; c) workload; and d) work productivity. Difference test for data on musculoskeletal complaints, workload, and work productivity using parametric statistical tests (different test paired samples t-test at significance level = 0.05) in treatment I and treatment II on data that is normally distributed, and if it is not normal, non-parametric statistical tests were performed (Wilcoxon's difference test at significance level = 0.05).

Results: The mean age of the subjects was 39.00±8.52 years, body weight was 65.31±6.7.57 kg, height was 164.69±4.40 cm and the body mass index was 23.94±2.05. kg/m². There is no difference in air temperature and humidity, there is a decrease in noise of 0.81%. There was a decrease in musculoskeletal complaints by 0.15%, a decrease in workload by 0.19%, an increase in productivity by 1.06%.

Conclusion: There is a significant decrease between musculoskeletal complaints, workload and noise before and after the use of the seated grinder (p<0.05), and there is a significant increase between work productivity before and after using modified sitting grinder.

Introduction: The condition of decreased muscle mass and function in people with type 2 diabetes mellitus (DMT2) will lead to a significant effect on the decline in quality of life. A commonly found manifestation of sarcopenia is the presence of a decrease in the strength of the hand grip. Other research showed a significant inverse relationship between the strength of the hand grip and DMT2. But to date, there are still few studies that assess the factors that cause a decrease in the strength of the hand grip in DMT2 patients. This study aims to evaluate risk factors that are related to the strength of the decrease in the strength of the hand grip in patients with DMT2.

Methods: Cross-sectional analytical research. The data was taken through interviews, physical examinations and data collection of laboratory examination results at the general polyclinic of the Tabanan Public Health Center II. The bivariate test used chi-square and the multivariate analysis with logistic regression was used in assessing the magnitude of influence between variables that have a meaningful relationship with HGS and looking for the magnitude of the adjusted odd ratio (AOR) value. 

Results: The study discovered a strong correlation between age (p=0.002), body mass index (p=0.002), and fasting blood sugar levels (p=0.001) and hand grip strength. In the multivariate analysis, it was found that the relationship of age more than 50 years to the decrease in hand grip strength was greater than high fasting blood sugar levels, while no significant relationship was found on excess nutritional status in this multivariate analysis (p=0.44).

Conclusion: Age, body mass index, and fasting blood sugar levels are the risk factors for decreased hand grip strength in type 2 diabetes mellitus patients.

Introduction: The existence of regulations using clothing made from traditional Balinese fabrics cloth called “endek” has caused the demand for woven fabrics to increase. One of the traditional woven fabric handicrafts starting to be recognized and favored by the public is the Cepuk and Rangrang woven fabric from island of Nusa Penida. Currently, liquid waste from weaving home industry activities has not been processed.  The purpose of the study was to measure the quality of liquid waste from the weaving home industry and compare it with the quality standards of liquid waste for businesses and or textile industry activities.

Method: This study was descriptive, conducted in Nusa Penida District, Klungkung Regency. The sample size was 25, taken by purposive sampling from nine craftsmen actively carrying out the production process with repetition three times. Measurement of liquid waste quality was carried out at the Laboratory of Panureksa Denpasar. The parameters examined are mandatory test parameters including physical parameters (temperature, TDS, TSS and color) and chemical parameters (total chromium, total ammonia, BOD_5, COD, sulfide, oil and fat). Data analysis was carried out by comparing the measurement results with the Liquid Waste Quality Standards for Textile Industry Businesses and Activities according to Bali Governor Regulation 16 of 2016.

Result: The results showed an average temperature of 27.48^o C, TDS levels of 6,095.20 mg/L, TSS 1,090.76 mg/L and color 2,216.56 TCU scale.  The chemical parameters showed average levels of total chromium 2.3912 mg/L, total ammonia 1.6068 mg/L, BOD₅ 675.84 mg/L, COD 1,286.72 mg/L, Sulfide 0.2395 mg/L, oil and fat 1,340 mg/L. Based on Bali Governor Regulation No. 16 of 2016, the parameters of temperature, total ammonia, Sulfide, Oil and Fat meet the quality standard requirements. While the parameters of TDS, TSS, color, total chrome, BOD and COD do not meet the quality standard requirements because it exceed the maximum allowable levels.

Conclusion:  It is recommended that weaving craftsmen carry out liquid waste treatment before disposal in the environment.

Introduction: Sarcopenia is a multifactorial condition characterized by progressive and comprehensive mass loss accompanied by skeletal muscle strength or function. It can be triggered by physical inactivity, hormonal changes, energy, protein intake, oxidative stress and inflammatory processes. The state of inactivity underlying sarcopenia is related to follistatin levels.

Methods: an analytical cross-sectional study conducted in Posyandu or Elderly Associations in Denpasar City with subjects aged ≥60 years old started from January 2021 to September 2021. The data collected were anthropometric measurements, muscle mass, grip strength, walking speed and serum follistatin levels. Sarcopenia was diagnosed based on the AWGS criteria. Bivariate analysis was performed using the Mann-Whitney analysis to determine the difference in the mean of the independent variables and the Spearman's test to determine the relationship between sarcopenia and follistatin levels. 

Results: 75 subjects were selected, and 15 (20%) subjects were diagnosed with sarcopenia. The results of the Spearman correlation test of upper arm circumference, waist circumference, calf circumference, SMI, walking speed, hand grip strength and follistatin levels only found a significant negative relationship between waist circumference and follistatin levels r= -0,309, p= 0,016. No differences in mean follistatin levels with sarcopenia and non-sarcopenia group p= 0,516. There was no significant relationship between follistatin levels and sarcopenia p= 0,615.  

Conclusion: There is no correlation between follistatin levels and sarcopenia in the elderly. However, follistatin is inversely correlated with waist circumference.

Background: An anterior cruciate ligament reconstruction (ACLR) phase I is critical for the patient to improve knee pain and range of motion (ROM), knee functions, and prevent excessive inflammation and muscle atrophy. This study aims to evaluate the physiotherapy interventions to improve the pain, ROM, muscle atrophy, and knee function following ACLR phase I.

Case Description: In July 2022, a 22-year-old female basketball athlete injured her right knee while running-pivoting movement during practice. The patient received ACLR on September 22, 2022, following an MRI and physiotherapy examinations. On October 14, 2022, the patient began receiving three times physiotherapy programs weekly. Until November 11, 2022, she complained of having trouble bending and straightening her knee. Although there was no increment in leg muscle circumference of 20 cm above the right patella (RP), there were increments in muscle circumferences of 1.3 cm at 10 cm above the RP, 1.1 cm at 5 cm above the RP, 1.2 cm at 10 cm below the RP, and 1.5 cm at 20 cm below the RP. After three times interventions, we found changes 5^o of knee flexion, 2 points of tenderness VAS, 5-28 points of KOOS score, and 10 points of Lysholm’s score.

Conclusion: The physiotherapy interventions improved the pain, ROM, leg muscle circumference, and knee function in the ACLR phase I patient. This case report study could be a reference for further experimental study.

Background: Type 2 diabetes mellitus (T2DM) is an independent factor in increasing the risk of heart failure in the absence of coronary heart disease and hypertension. Global longitudinal strain (GLS) as the gold standard in determining subclinical left ventricular (LV) systolic dysfunction is not available on all echocardiographic tools and requires good-quality images. Mitral annular plane systolic excursion (MAPSE) and mitral annular peak systolic velocity (Sm) are simpler, faster, and widely available method that can determine left ventricular systolic dysfunction regardless of image quality.

Methods: This study involved 72 asymptomatic T2DM patients, divided into two groups, patients with subclinical left ventricular systolic dysfunction (GLS >-18%) and normal systolic function (GLS ≤-18%). GLS was obtained from the mean of 18 left ventricular segments on the apical 4-chamber, 3-chamber and 2-chamber images. MAPSE was obtained on the septal and lateral sides of the mitral annulus using M-mode on apical 4-chamber view, while Sm was obtained using tissue doppler imaging (TDI).

Results: The study included 72 asymptomatic T2DM patients, 34 samples (47.2%) were found with subclinical LV systolic dysfunction. According to receiver operating characteristic (ROC) curve analysis, lateral TDI Sm had the highest area under the curve (AUC), it was 0.85, followed by average TDI Sm was 0.83 and average MAPSE was 0.81. The cut-off value of average TDI Sm <7.425 cm/s had the best sensitivity and specificity, 82.4% and 81.6%, while cut-off value of average MAPSE <13.4 mm had sensitivity of 76.5% and specificity of 73.7%.

Conclusion: TDI Sm had better accuracy than MAPSE in determining subclinical LV systolic dysfunction in T2DM patients. However, both of them can be used as alternative diagnostic methods of GLS.

Introduction: Injury to the anterior cruciate ligament (ACL) was prevalent among sports, with a female predominance. If not treated properly, ACL deficiency knee can cause significant morbidity and long-term impairment. The most often utilized reconstructive methods in modern clinical practice were conventional and all-inside treatments. This study compared all-inside and conventional ACL reconstruction methods through systematic review and meta-analysis.

Method: The searching protocol was carried out using several databases, such as PubMed, ScienceDirect, and Google Scholar, to identify relevant topics in May 2022. This study used the Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 (PRISMA) guidelines.

Result: There were 17 studies included in this systematic review and meta-analysis. All of the reviewed studies were written in English. Most of the included studies were carried out in Europe. Theafollowaup duration range from 3amonthsato 4ayears. The total participants were 2329 patients with ACL reconstructions. There was a significant difference between groups in the overall analysis, with the all-inside technique having higher Lysholm score outcomes than the conventional technique (MD = 1.87; 95% CI = 0.41–3.33; p < 0.05)

Conclusion: All-inside technique has higher Lysohlm score outcome than the conventional technique. There is no significant difference in pain and IKDC score between both groups.

Steven-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe drug allergic reactions characterized by skin and mucosal membrane detachments. Most of the literature focuses only on the skin and ocular mucosal damage, but more severe and life-threatening mucosal damage may actually occur in the respiratory tract. This airway involvement may cause an acute complication, e.g. acute respiratory failure, and chronic complications, e.g. bronchiolitis organizing pneumonia, bronchiectasis, and restrictive bronchiolitis. The presence of airway involvement in SJS/TEN requires a more detailed examination, ranging from examination of the ear, nose, and throat (ENT), to fiberoptic bronchoscopy done by a skilled clinician to determine the presence of bronchial epithelial detachment. A higher percentage of skin and mucosal detachment is associated with a greater need for mechanical ventilation. Male sex, age, low serum bicarbonate, high serum urea, and higher amount of infiltrate on chest X-rays are also associated with a higher risk for mechanical ventilation in patients with SJS/TEN. The general indications for intubation and mechanical ventilation in patients with SJS/TEN are respiratory failures, inability to clear the airway, shock, neurologic disorder, and uncontrollable pain. More specific indications for intubation and mechanical ventilation are oral involvement with an initial total body surface area (TBSA) during hospital admission was ≥70%, or progression of TBSA ≥15% in the first 3 days of hospitalization, or neurological disorders, or documented airway involvement based on direct laryngoscopy examination.

Introduction: Neglected achilles tendon rupture is generally defined as a rupture with a delay of more than 4 weeks prior to diagnosis or treatment. Difficulties in management make it one of the challenging problems in orthopedic practice. They have a greater tendency to develop complications and slightly poorer functional outcomes than patients with an acute rupture.

Method: This case report features a case of 30 years old female with 3 months of neglected achilles tendon rupture after landing in the wrong position while playing badminton. The patient complains of continuous pain and inability to move her ankle downward, making walking difficult. On physical examination and CT imaging, we found achiles tendon rupture with significant gap and calf muscle atrophy. The patient was then managed operatively by debridement and tendon repair with flexor halucis longus tendon transfer.

Result: Follow up 3 months post-operative, found a difference in calf muscle circumference in both legs. At the same time, there is still an improvement in active ROM ankle plantarflexion and positive single heel raise test on the affected side. The functional outcome measured by ATRS obtained 80 points, and AOFAS ankle-hindfoot scales with a value of 91 points.

Discussion: With several advantages, FHL tendon transfer is the currently used technique for neglected cases of achiles tendon rupture. Despite long immobilization will induce other complications. Good operative techniques and accelerated rehabilitation are still recommended to gain good functional outcomes for the patient.