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.

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.

Background: Colorectal carcinoma is the world's third most common type of cancer. The incidence in India is around 7/100,000. From GLOBOCAN data, the incidence of colorectal cancer in Indonesia is 17.2 per 100,000 adult population, with a mortality of 8.4% of all cancer cases. Several parameters were related to the risk of colorectal carcinoma. This study aims to evaluate the association of age, gender, tumor site, and smoking habit with histopathologic types of colorectal carcinoma patients in Wahidin Sudirohusodo Hospital, Makassar, Indonesia.

Methods: The retrospective cross-sectional study was conducted among 158 cases of colorectal carcinoma using a descriptive categorical sampling technique at Wahidin Sudirohusodo Hospital, Makassar, Indonesia, from January-March 2022. The variables assessed in this study were age, gender, tumor site, smoking habit, and histopathologic types of colorectal carcinoma. Data were analyzed using SPSS version 22 for Windows.

Results: There were 158 cases of colorectal carcinoma. According to age, most patients were 45-60 years old (41.1%), while 18-44 years and over 60 years had almost the same proportion. In this study, most of the tumors were found in the distal part, namely the rectum (30.4%), rectosigmoid (18.4%) and sigmoid (17.1%). Most of the subjects were smokers (78.5%). Meanwhile, according to the histological type, 85.4% were adenocarcinomas, followed by mucinous adenocarcinomas (13.3%) and signet ring cell types (1.3%). There is no significant relationship between age, gender, tumor location, and smoking habits with the histopathological type of colorectal carcinoma (p>0.05).

Conclusion: There is no significant relationship between age, gender, tumor location, and smoking habits with the histopathological type of colorectal carcinoma.

Background: Research related to the implementation of the referral system still needs to be conducted in more depth because there are still problems and obstacles in the implementation of the referral system along with the development of the health service system in recent years. This study aims to determine the development of research on referral system implementation in health services from 2013 to 2022.

Methods: This research category is qualitative with a literature study. This research uses the Scopus search engine to search for journals related to the implementation of the referral system from 2013 to 2022, with keywords "implementation" AND "referral system" with subject area restrictions related to referral system in health care, the document type is an article and English language. This research also uses VOSviewer and R-Studio for data mapping and analysis.

Results: From this research, 222 English-language articles were selected. Research publications are increasing in 2020, 2021, and 2022. Fondazione IRCSS Istituto Nazionale Dei Tumori Sn and Tabriz University of Medical Sciences contributed the most publications in this study. The journal BMC Health Services Research published the most articles on referral system implementation; Petersen, I. Rashidian, A., and Putoto, G. were the top authors on this research topic. The word human was found 196 times, the female was found 177 times, and the patient referral was found 139 times. From the VOSviewer visualization analysis, topics such as disease case groups (neoplasms, Human Immunodeficiency Virus), digitalization of health services (electronic health records, telemedicine, telehealth), and related developing countries such as Ethiopia and India, and underdeveloped countries such as Tanzania still have excellent opportunities for future research.

Conclusion: This research is dominated by developed countries, so research in developing countries needs to be reproduced and developed. Data sources from the Web of Science are recommended for future research.

Introduction: Spinal cord trauma can cause partial or total damage to the brain's and spinal cord's connection. The effects of spinal cord injury will affect motor function even if there is a severe injury, and in a longer duration, it will cause death. Medulla spinalis retraction can cause clinical abnormalities, especially in motor function.

Methods: This study consisted of three groups of male Wistar rats (Rattus norvegicus). Each group was subjected to 15%, 25% and 37.5% retractions for 1 minute, 3 minutes and 5 minutes, respectively. After that, an assessment was carried out with the footprint test and forced swim test. Data were analyzed with Fisher's exact test.

Results: This study had 27 samples of male Wistar rats which were divided into 3 groups. In the 15%, 25% and 37.5% retractions treatment with a duration of 3 minutes and 5 minutes, all samples died. Retraction of 15% of the diameter of the medulla spinalis in 1 minute does not cause motor function disorders. Statistically, there is no significant difference in the degree of medulla spinalis retraction and motor function on the footprint test and forced swim test (p = 0.102).

Conclusion: The medulla spinalis retraction of less than 15% with a duration of less than 1 minute will not cause motor function impairment. If more than 15% retraction with more than 1 minute will cause motor function impairment and death, this relationship is not statistically significant.

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 prevalence of improvement clean water services for urban areas yearly shows an increase of 40% to 50% in largest and 20%-30% in district. In other words, the level of water pollution is increasing. Alleviating poverty and unsafe water takes a strategic approach. Double pot diffuser method as a simple clean water treatment tool to improve water quality

Aims: The objective of this study is analysing the double pot diffuser method as a simple clean water treatment tool to improve water quality

Method and result: The data was collected two times (before- after) in control and double pot diffuser as an experiment. Statistical analysis, including univariate and bivariate analysis, was done using SPSS 23. A normality test was carried out, and the Mann-Whitney method was used to asses the difference in results between the experiment and control. The non-parametric test results showed that in the experimental group there was a difference between the results of the examination of biological parameters of the water (E.coli, coliform) and turbidity parameters, before and after the experiment  with p-value 0.001. In the control group, the results revealed no difference between the results of the examination of water biological parameters and water turbidity before and after the experiment.

Conclusion: Double pot diffuser is recommended to residents because it has been proven to improve the water quality in gumleng. Draining and cleaning gumleng once a week is also recommended to prevent sedimentation from dissolving and re-polluting the water.

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: ROT criteria are often used for cleft lip repair, however its use is still often debated. The aim of this review is to summarize the relationship of the various criteria that make up the rule of ten (ROT) with complications after cleft lip repair.

Method: We conducted systematic search of the literatures based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PICO criteria. Our inclusion criteria were:1) pediatric patients with cleft lip or cleft lip and palatum who underwent repair or surgery; 2) Patients were assessed pre-operatively with ROT criteria; 3) Articles in English; 4) Full original articles; 5) Publication year of 2012 to 2022. Evaluation of each article was done by checklist Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).

Results: From all articles in the publication year of 2012 to 2022, we reviewed three studies. The three studies involved 1,637 patients as the sample. All three studies evaluated the relationship between use of ROT criteria and cleft lip postoperative complications. Most patients are diagnosed as cleft lip with a cleft palate, not just a cleft lip. Several complications were found associated with post-cleft lip operation. It was found that cleft lip with palate was more prone to postoperative complications than cleft lip alone. The three studies agree that hemoglobin; leukocytes and age as part of the ROT criteria have no significant relationship with the incidence of complications after cleft lip repair, while one study found that body weight independently could significantly reduce the risk of postoperative complications.

Conclusion: ROT criteria are not related with the complication post-cleft lip repair since the advancement in operating safety. ROT is not completely reliable in perioperative setting in recent days. Complications post-cleft lip repair is more related to the degree of deformity.

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.

Background: Soil-transmitted helminths are widespread and grow well in countries with tropical and subtropical climates. It is one of the predispositions to anemia for pregnant women during pregnancy. This condition has long-term adverse effects on mothers and their children, causing the need for serious discussion and treatment. 

Methods: This systematic review uses pre-existing research by collecting data from valid sources such as Pubmed, Google Scholar, and NCBI, using the inclusion and exclusion criteria that have been determined. 

Results: Based on the vast amount of research that has previously been conducted, it was found that there is a close relationship involving the soil-transmitted helminth infection and various types of worms infecting pregnant women, which causes anemia. Pregnant women need nutrients and increased blood volume during pregnancy. However, the infection interferes with the absorption of micronutrients in the gastrointestinal tract, resulting in impaired nutrient transport between the woman and her unborn child. 

Conclusion: Soil-transmitted helminth infection is a predisposing factor for anemia in pregnant women and has long-term adverse effects for both mother and child.

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.