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All Journal MEDIA MEDIKA INDONESIANA Folia Medica Indonesiana The Indonesian Journal of Public Health Sari Pediatri Paediatrica Indonesiana Health Notions Qanun Medika - Medical Journal Faculty of Medicine Muhammadiyah Surabaya Syntax Literate: Jurnal Ilmiah Indonesia Jurnal Keperawatan Muhammadiyah Holistik Jurnal Kesehatan Manuju : Malahayati Nursing Journal Care : Jurnal Ilmiah Ilmu Kesehatan Jurnal Kesehatan Ibu dan Anak Jurnal SMART Kebidanan Golden Age: Jurnal Ilmiah Tumbuh Kembang Anak Usia Dini JUXTA: Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML) JURNAL KESEHATAN MERCUSUAR World Nutrition Journal Psychiatry Nursing Journal (Jurnal Keperawatan Jiwa) JOURNAL OF COMMUNITY MEDICINE AND PUBLIC HEALTH RESEARCH Indian Journal of Forensic Medicine & Toxicology INDONESIAN MIDWIFERY HEALTH AND SCIENCES JOURNAL PROFESSIONAL HEALTH JOURNAL Indonesian Journal on Medical Science (IJMS) MEDICINUS Jurnal Sosial dan Sains Journal of Public Health and Pharmacy Jurnal Vokasi Keperawatan (JVK)
Ahmad Suryawan
Departemen Ilmu Kesehatan Anak, Fakultas Kedokteran Universitas Airlangga, RSU Dr. Soetomo, Surabaya.
Humanities Astronomy Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Dentistry Education Environmental Science Health Professions Immunology & microbiology Law, Crime, Criminology & Criminal Justice Library & Information Science Medicine & Pharmacology Neuroscience Nursing Physics Public Health Social Sciences Other

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Peran Bifidobacterium dalam Perkembangan Otak dan Tumbuh Kembang Anak Ahmad Suryawan; Rini Sekartini
Sari Pediatri Vol 22, No 5 (2021)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp22.5.2021.325-30

Abstract

Pengetahuan tentang peran spesifik mikrobiota saluran cerna dalam perkembangan otak dan tumbuh kembang anak semakin menarik perhatian peneliti pada beberapa tahun terakhir. Hal tersebut disebabkan karena terakumulasinya bukti dari berbagai studi tentang komunikasi dua arah antara saluran cerna dan otak, yang digambarkan sebagai teori gut-brain axis. Salah satu mikrobiota yang mendapat perhatian khusus dalam hal ini adalah Bifidobacterium, yang berpotensi mempunyai peran khusus dalam perkembangan otak anak usia dini, Kolonisasi Bifidobacterium dalam saluran cerna paling dominan pada usia awal setelah lahir, yang terjadi paralel dengan periode kritis perkembangan sirkuit otak anak. Aplikasi klinis teori gut-brain axis lebih banyak terbukti pada studi eksperimental. Studi pada subyek anak mayoritas merupakan studi observasional dengan hasil yang tidak konsisten. Pemberian Bifidobacterium nampak menjanjikan sebagai regimen untuk terapi gejala gangguan tumbuh kembang. Namun bukti berbasis uji klinis masih sangat terbatas, dan menunjukkan hasil yang heterogen. Masih diperlukan bukti berbasis uji klinis acak-terkontrol yang dirancang dengan baik untuk memvalidasi efektivitas probiotik untuk terapi gangguan tumbuh kembang dalam hal identifikasi strain, dosis, dan waktu pengobatan yang sesuai dan standar. Peningkatan pemahaman tentang keilmuan gut-brain axis diharapkan membuka kemungkinan dimasa depan akan muncul terapi berbasis probiotik yang mempunyai efek terhadap berbagai kondisi otak dan tumbuh kembang anak
Evaluasi Penggunaan Metode Prechtl untuk Menilai Kualitas Gerakan Spontan Bayi Muda Sehat: Pengalaman RSU Dr. Soetomo Surabaya Ahmad Suryawan; Komang Ayu Witarini; Risa Etika; Fatimah Indarso; Irwanto Irwanto; Moersintowati B. Narendra; Sylviati M. Damanik
Sari Pediatri Vol 9, No 6 (2008)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (141.375 KB) | DOI: 10.14238/sp9.6.2008.363-9

Abstract

Latar belakang. Penilaian kualitas gerakan spontan pada bayi dengan metode “General movements (GMs)”dari Prechtl mempunyai validitas tinggi untuk memprediksi risiko gangguan perkembangan anak. MetodeGMs masih relatif baru di Indonesia, sehingga dibutuhkan evaluasi aspek praktikalnya untuk dapatdiaplikasikan secara optimal.Tujuan. Mengetahui kondisi paling optimal untuk menilai kualitas gerakan spontan bayi muda sehatmenggunakan metode GMs dari Prechtl.Metode. Dilakukan rekaman video secara berurutan pada bayi yang memenuhi kriteria inklusi lahir sehat,cukup bulan, tanpa risiko, dan mendapat persetujuan tertulis dari orangtua, lahir di RSU Dr Soetomo-Surabaya pada kurun waktu Desember 2006-Januari 2007. Teknik perekaman dilakukan sesuai standarisasiPrechtl, dengan berbagai variasi waktu dan kondisi. Analisis video rekaman dilakukan secara persepsiGestalt oleh salah satu peneliti, yang sebelumnya telah mendapat kursus dan sertifikat metode GMs.Parameter aspek praktikal untuk evaluasi digolongkan: optimal dan tidak optimal.Hasil. Tidak didapatkan penolakan dari orang tua untuk seluruh 56 bayi yang memenuhi kriteria inklusi.Tiga (5,4%) video yang tidak dapat dianalisis karena faktor kesalahan teknis perekaman. Kualitas GMslebih optimal untuk dianalisis apabila perekaman dilakukan pada waktu siang hari dibandingkan waktupagi (p=0,026) atau malam (p=0,045), dan dilakukan 30 menit sebelum waktu minum, dibandingkan 30menit sesudahnya (p=0,032). Tingkat kesulitan analisis tidak berbeda bermakna apabila perekamandilakukan di tempat yang khusus dibandingkan dilakukan di boks (p=0,156) atau inkubator (p=0,466).Kesimpulan. Metode Prechtl dapat diterapkan dengan praktis dan optimal apabila pengambilan videodilakukan pada waktu siang hari dan 30 menit sebelum waktu minum. Tempat pengambilan rekamantidak mempengaruhi segi kepraktisannya
Perkembangan Otak dan Kognitif Anak: Peran Penting Sistem Imun pada Usia Dini Ahmad Suryawan; Anang Endaryanto
Sari Pediatri Vol 23, No 4 (2021)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp23.4.2021.279-84

Abstract

Perkembangan kognitif anak merupakan cerminan dari kompleksitas kerja sirkuit otak yang terbentuk sejak usia dini dan harus melewati periode kriitis pada tahun-tahun pertama awal kehidupan anak. Semakin kompleks sirkuit otak yang terbentuk, maka semakin besar kapasitas anak untuk belajar mengembangkan kemampuan kognitif. Saat ini berbagai studi mengkaitkan antara perkembangan otak dengan perkembangan sistem imun anak pada usia dini. Sistem imun selama ini lebih dikenal peranannya dalam sistem pertahanan tubuh untuk melawan organisme patogen, ternyata terbukti juga mempunyai peran khusus dalam proses perkembangan otak, baik dalam kondisi yang normal atau sehat, maupun pada kondisi patologis. Proses perkembangan otak dan sistem imun melibatkan berbagai sel dan molekul-molekul mediator yang sama, seperti protein dan sitokin. Keterkaitan perkembangan otak dan sistem imun terjadi secara dua arah dengan konsep mekanisme yang terprogram sejak usia dini, dimana aktivasi di usia dini akan berdampak jangka panjang terhadap kedua sistem tersebut. Berbagai studi saat ini juga membuktikan bahwa mikrobiota saluran cerna juga berperan khusus dalam sistem imun dan perkembangan otak. Memahami aktivasi sistem imun selama periode kritis perkembangan otak anak merupakan langkah yang strategis untuk dapat mengungkap patogenesis berbagai gangguan perkembangan, perilaku, dan kognitif pada anak dan juga terhadap berbagai cara dan metode terapi di masa depan.
Determinant Factors of Depression in Beta Major Thalassemia Children Ahmad Suryawan; Hapsari Widya Ningtiar; Irwanto Irwanto; I Dewa Gede Ugrasena
Folia Medica Indonesiana Vol. 57 No. 1 (2021): March
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (311.354 KB) | DOI: 10.20473/fmi.v57i1.13664

Abstract

Thalassemia is a chronic disease with long-term treatment that increases the potential for impact on physical, cognitive, and psychological conditions. About 80% of patients with major thalassemia have at least one psychiatric disorder, depression is one of the most frequently reported, especially in prepubertal and puberty periods. The aim of this study is to evaluate determinant factors of depression in beta mayor thalassemia children. This was a cross-sectional study on patients aged 9 to 17 years at hematology outpatient clinic in Dr. Soetomo General Hospital from September to Desember 2018. Level of depression determinded by Children Depression Inventory (CDI) questionnaire. The data were collected and analyzed using using the IBM SPSS Statistics version 21. It is statistically significant with p<0.05. Forty-five participants were included in this study, 15 participants with mild depression and 30 participants without depression. Gender (p=0.462), age of diagnosis (p=0.385), frequency of tranfussion (p=0.065), family history of depression (p=0,350), physical change (p=0.711), duration of illness (p=0.674) have no significant value as a determinant factor while complication (p=0.049) and serum cortisol level (p=0.037) had significant value as determinant factors of depression in Beta Major Thalassemia children. Mild depression is more common in thalassemia patients who experience complications and had high serum cortisol levels
Effectiveness of The Newborn Behavioral Observation (NBO) System in Improving Mother and Infant Interaction Siti Wahyu Windarti; Ahmad Suryawan
Folia Medica Indonesiana Vol. 57 No. 2 (2021): June
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (284.448 KB) | DOI: 10.20473/fmi.v57i2.21558

Abstract

The interaction of mother and infant is a fundamental basis for the development of the infant. It can also determine the success of the baby in the future. About 4 out of 10 infants experience problems interacting with their parents. The NBO system was created to sensitize parents on their infant’s competencies to help them understand their infant’s behavior, and promote positive interactions between parents and their new infant. This study aimed to evaluate the effectiveness of the NBO system to improve mother-infant interactions and find out the mothers’ knowledge about their infant’s behavior when participating in this observation. This study was a cross-sectional study consisting of all the newborns and their mothers admitted to the Dr. Soetomo General Academic Hospital Surabaya from May 2019 to January 2020 who met the inclusion criteria. Mothers and infants participated in the NBO within 1-3 days after delivering their infants and one month postpartum for the second NBO. The NBO was carried out with 35 mothers and infants. The mothers’ age was on average 28.5±5.98 years old, multiparous mothers accounted for 71.4%, most infants were male (65.7%), the median gestational age was 38 weeks with the median birth weight 2900 grams. The median score of mothers’ knowledge about their infants before the NBO session was 2 (1-6). After the session, these median scores increased to 7 (5–10) significantly (p<0.001). The NBO system was significant to strengthen mother-infant interaction and increased the mothers’ knowledge about their infants’ behavior.
Association between Sleep Disturbance with Weight-for-Height and Body Mass Index in Preschoolers Laili Nur Rosyidah; Ahmad Suryawan; Irfiansyah Irwadi
JUXTA: Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga Vol. 12 No. 1 (2021): Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga
Publisher : Faculty of Medicine Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/juxta.V12I12021.19-25

Abstract

Introduction: Hormonal changes affecting a child's growth occur in deep sleep phase of preschoolers. Nowadays, obesity is still a world health problem. In 2014, Indonesia had three growth problems, one of them was overweight in preschoolers. This study aimed to analyze the association between sleep disturbance with weight-for-height and body mass index (BMI) in preschoolers. Methods: This was a cross-sectional study by analyzing the tendency with boxplot charts and the association was measured by Mann-Whitney test and independent t-test. Data of 86 preschoolers aged 3-5 years old were obtained from three kindergartens in Kalijudan, Surabaya from March to September 2018. Z-score values and the categories of weight-for-height Z-score (WHZ) and BMI-for-age Z-score (BAZ) refer to WHO Standards 2006 and sleep disturbances were measured by sleep disturbance scale for children (SDSC) questionnaire. Results: 65.12% of preschoolers had sleep disturbance and 66.28% of them had normal WHZ and BAZ. The average WHZ and BAZ value in preschoolers who had sleep disturbance (M = -0.2730; -0.2207) were higher than preschoolers who had no sleep disturbance (M = -0.6083; -0, 5920). Results from Mann-Whitney test showed the same significance value between WHZ and BAZ, p = 0.226. Independent t-test showed a significance value of p = 0.524 and p = 0.490, meaning that there was no statistically significant association. Conclusion: There was no statistically significant association between sleep disturbance with WHZ and BAZ in preschoolers aged 3-5 years old, however descriptively, the values of WHZ and BAZ in the group of preschoolers who had sleep disturbance tended to be higher. 
Assessment of the quality of general movements in newborn infants: a tool to predict developmental disorders at an early age Ahmad Suryawan; Bambang Permono; Komang Ayu Witarini; Risa Etika; Fatimah lndarso; Moersintowarti B. Narendra
Paediatrica Indonesiana Vol 48 No 5 (2008): September 2008
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (126.968 KB) | DOI: 10.14238/pi48.5.2008.292-8

Abstract

Background Nowadays, quality assessment of general movements(GMs) in infants can be used as a tool to predict developmentaloutcome. Until now, there is no published study in this field inIndonesia.Objectives The aim of this study was to evaluate the quality ofGMs of newborn infants.Methods A prospective study was done at neonatal ward, Dr.Soetomo Hospital in Surabaya, between December 2006 andJanuary 2007. A single supine position video recording of newbornsat GMs preterm and writhing age was made using Precthl's method.Infants were chosen consecutively among singletons above 28week gestational age. The quality of GMs was assessed by meansof Gestalt perception by one of the authors, who had been trainedand certified in GMs. GMs were classified into: normal-optimal,normal-suboptimal, mildly-abnormal, and definitely-abnormal.Correlation tests were used to assess the relationship betweenperinatal conditions and the quality of GMs.Results 106 videos were recorded, and 100 were assessedcompletely. Abnormal GMs were found in both 35 pretermage (normal-optimal 2.9%; normal-suboptimal 28.6%; mildly-abnormal45. 7o/o; definitely-abnormal22.9o/o) and 65 writhing age(3.1 o/o; 41.5%; 41.5%; 13.8%, respectively) (P=0.285). There wasa weak negative correlation between birth weight and the qualityofGMs (r=-0.20, P=0.044).Conclusions The quality ofGMs in Indonesian newborn infants inour study was predominantly abnormal, which puts these infantsat high risk for later developmental disorders. The lower theinfants'birth weight, the more likely for abnormal GMs.
Long term follow-up of multidrug resistant tuberculosis in a pubertal child Andri Kurnia Wahyudhi; Retno Asih Setyoningrum; Ahmad Suryawan
Paediatrica Indonesiana Vol 58 No 4 (2018): July 2018
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1020.653 KB) | DOI: 10.14238/pi58.4.2018.198-204

Abstract

Increasing awareness of the rising global rates of multidrug-resistant tuberculosis (MDR-TB) has led to a concerted international effort to confront this disease. Nonetheless, despite cure rates >80% in some programs, MDR-TB patients tend to have chronic disease and require prolonged therapy.1-3 Little is known about the long-term results and follow-up of patients with MDR-TB, include the recurrence rate and chronic disability in patients who have recovered from TB.4 There are many side effects and adverse reactions to drugs can occur during MDR-TB treatment. These could be physical and or psychological, as well as reversible or irreversible. Treatment of MDR-TB requires a combination regimen, consists of second and third-line anti-tuberculosis drugs which more toxic than first-line drugs. Additionally, MDR-TB treatment requires a long duration of treatment (18-24 months) and causes discomfort in the patient.5 In a cohort of 60 patients treated for MDR-TB, the most common side effects included gastritis (100%), dermatological disorders (43%), and peripheral neuropathy (16.7).6 While in a cohort of 75 patients, the incidence of depression, anxiety, and psychosis for MDR-TB treatments was 13.3%, 12.0%, and 12.0%, respectively.7 Aggressive and effective management are needed so the patient can tolerate the treatment and remain adhere the treatment.8 Long-term follow-up is required for the rehabilitation of disorders due to psychosocial sequelae. As such, psychosocial support can be benefit pediatric MDR-TB patients. Here, we present a case report on a two-year follow-up of a pubertal child with MDR-TB, focusing on medical aspects and her development.
Faktor Yang Mempengaruhi Risiko Gangguan Perilaku Anak Dengan Human Immunodeficiency Virus Laili Primasari; Ahmad Suryawan; Dominicus Husada
Jurnal Keperawatan Muhammadiyah 2019: EDISI KHUSUS
Publisher : UNIVERSITAS MUHAMMADIYAH SURABAYA

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (405.61 KB) | DOI: 10.30651/jkm.v4i2.2349

Abstract

The number of child HIV patients in Indonesia in 2016 was 1,185 children. In pediatric and adolescent patients with perinatal HIV, the risk of psychological disorders can arise as a direct and indirect result of HIV infection. The direct effect is derived from HIV infection itself and the indirect consequences are caused by things related to HIV status. These problems include emotional, behavioral, cognitive and psychosocial disorders. At present a child's development check is carried out if a problem is suspected and there are no regular inspections. This includes examining the risk of behavioral disorders for children with HIV. Knowing the risk of behavioral disorders in children with HIV aged 6-18 years. The research respondents were outpatients at Poli UPIPI RSUD Dr Soetomo. Patients and guardians who were present were given an explanation and were asked to fill out informed consent as a sign of agreement to become respondents. All patients and guardians who came and met the criteria were taken as research respondents. This research was conducted by filling out a questionnaire regarding risk factors and research instruments. The instrument used was GPPH to assess the risk of behavioral disorders. Statistical analysis with logistic regression showed that the risk factors for hospitalization history (P = 0.031) and parental completeness (P = 0.011) were associated with risk of behavioral disorders. Children who have been hospitalized in the hospital have a possibility of 22,337 times greater risk of behavioral disorders. And children who don't have parents have a 40.586 times greater risk of behavioral disorders. There was a risk of behavioral disorders in children with HIV aged 6-17 years who do not have parents or had been hospitalized.
Increased Insulin Like Growth Factor-1 and Antropometri in Premature Infants with Breast Milk I Dewa Ayu Agung Sridharaswari; Mira Irmawati; Ahmad Suryawan; Irwanto idris; Endang Retnowati
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 26, No 1 (2019)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v26i1.1399

Abstract

Massage stimulation has consistently led to greater anthropometric in preterm infant by increasing IGF-1 in which plays an important role in promoting growth by stimulating cell growth, multiplication and inhibiting apoptosis. This research to analyze the effect of massage stimulation on IGF-1 and anthropometric in breastfeeding preterm infant. A randomized control trial was conducted on preterm infant with gestational age less than 37 weeks between February – May 2018 in nursery Dr. Soetomo Hospital. Fifty infants in nursery was randomly assigned to massage stimulation or control group. Massage stimulation consisted for three, 15 minutes periods per day for 10 days. Insulin Growth Factor -1 serum was examined on day 1 and 10. Data were analyzed by statistical software using t-test and spearman correlation. The average increase of IGF -1  in massage group was 4.8 (SD 4.41) and 3.1 (SD 3.57) in control group. The average increase of body weight was 252.2 (SD 208.55) in massage group, and 137.9 (SD 69.78) in control group. The average increase of body length was 2 (0.68) in massage group, and 1.1 (0.33) in control group. The average increase of head circumference was 1.5 (SD 0.82) in massage group, and 0.9 (0.28) in control group. The positive correlation between the mean increase of IGF-1 and body length was 0.347. The conclusion was IGF-1 and anthropometric  increase in both groups, but the massage group has a significantly higher mean. An increase in IGF-1 correlates with increase in body length.
Co-Authors Afiliany, Amelia Anang Endaryanto Andri Kurnia Wahyudhi Anggrahini, Simplicia Maria Arinaa Manasika Farida Ariyanto Harsono Atika Atika Aulia Septyani, Reta Azwin Mengindra Putera Badriul Hegar Bambang Permono Budi Utomo Budi Utomo BUDI UTOMO Darto Saharso Desi Fitriani Dewi Astasari Diah Retno Sari Dian Dwi Sari Dian Fitria Kurniawati Dinda Anes Tunjungsari Dinda Chandra Yuliantari Dominicus Husada Eka Marta Puspita Rini Elok Widjianingsih Endang Retnowati Erfi Prafiantini Fardana, Nur Ainy Fatimah Indarso Fatimah Indarso Fatimah lndarso Febriyana, Nining Felisita Maritza Abidanovanty Firinda, Seif Fitri Erna Erfiany Hapsari Widya Ningtiar Hari Basuki Notobroto Helen Lucky Maharani Hendy Hendarto I Dewa Ayu Agung Sridharaswari I Dewa Gede Ugrasena I Gusti Ayu Indah Ardani I gusti Lanang Sidhiarta Ichromy, Ulfi Rifki Irene Irene Irwadi, Irfiansyah IRWANTO Irwanto Irwanto Irwanto Irwanto Irwanto, Irwanto Isha Akastia Ivon Diah Wittiarika Jonathan, Elizabeth Beatrice Juniastuti Juniastuti Katharina Laurentia Monika Nago Adja Ketut Dewi Kumara Wati Komang Ayu Witarini Kurniasari, Anggun Febry Laili Nur Rosyidah Laili Primasari Lilik Djuari Linda Dewanti Linda Dewanti Lisa Pangemanan Lolita Lestari Maramis, Margarita M. Mira Irmawati Moersintowarti B Narendra Moersintowarti B. Narendra Moersintowarti BN Moersintowati B. Narendra Muhammad Faizi Neni Asmawati Putri Ningrum, Astika Gita Ninuk Dwi Ariningtyas Nur Rochmah Nyilo Purnami Pingkan Fredelia Lontoh Pudji Lestari Putri, Oky Arnanda Antonia Rahma Furi Sagita Rahmadhanti, Diah Caesaria Garindra Reta Aulia Septyani Retno Asih Setyoningrum Rika Hapsari Rini Sekartini Risa Etika, Risa Rize Budi Amalia Romdhoni Romdhoni Romdhoni, Achmad Chusnu Rusli, Vinia Sensusiati, Anggraini Dwi Setiawati, Yunias Shalma Alya Fadilla Shella Permata Sari Siti Nurul Fajariyah Siti Wahyu Windarti Sri Utami Sugeng, Santoso Sulistiawati Sulistiawati Sulistiawati, S Sylviati M. Damanik Tutfah Razzak Fitriari Wahyul Anis Widati Fatmaningrum Widya Tresna Kusuma Woro Setia Ningtyas Yusigania, Dinna Yvan Vandenplas Zahrah Hikmah, Zahrah Zakiudin Munasir Zamrotu Iva Purwanti Zamrotu Iva Purwanti