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Andy Darma
Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Airlangga
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Proteksi Probiotik pada Mukosa Ileum Mencit yang Terpajan Lipopolisakarida Escherichia Coli Alpha Fardah Athiyyah; Ariani Setiawati; Andy Darma; Anang Endaryanto; I Ketut Sudiana; Reza Ranuh; Subijanto MS
MEDIA MEDIKA INDONESIANA 2012:MMI VOLUME 46 ISSUE 2 YEAR 2012
Publisher : MEDIA MEDIKA INDONESIANA

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (825.842 KB)

Abstract

Probiotic’s protection in ileal mucosa of mice after lipopolysaccaride Escherichia coliBackground: Gastrointestinal infection is one of the major causes of morbidity in children. Diarrhea is the common manifestation. Diarrheal prevention needs a balance mucosal immune system. Probiotic used in prevention of gastrointestinal infection needs to be considered. The aim of the study is to prove probiotic protection in ileal mucosa after lipopolysaccaride (LPS) Escherichia coli O55:B5 inoculation anatomically and immunologically.Method: Experimental study with male Balb/c, age 10-12 weeks, body weight 30-40g and randomized into treatment group and placebo group. Treatment group received mix probiotic for 14 days and on day 15 were inoculated by LPS Escherichia coli O55:B5, and day 16-21 were given mix probiotic again. Placebo group received LPS Escherichia coli O55:B5 on day 15. Mice necropsy were conducted at day 22. Immunohistochemistry examination used to look for amount expression cell for IL-2, IFN-γ, TNF-α, IL-4, IL-5,IL-6, IL-10 dan TGF-β in ileal mucosa. Scanning electron microscope was used to see ileal mucosal structure. Statistic analysis used in this study was multivariate analysis.Results: Sixteen Balb/c mices were randomized into 2 groups, each group consist 8 mices. There was significant difference on amount of cells expression IL-5 (p=0.022), IL-6 (p=0.05), and also on amount of cells expression TGF-β (p=0.036). On probiotic- LPS group, there was no Th1 domination but on the other hand, Treg became dominant. Th1 and Th2 response were still balance. Structural damages occurred in LPS group and did not occur in probiotic-LPS group.Conclusion: Probiotic protection in ileal Balb/c mice mucosa after LPS Escherichia coli O55:B5 inoculation is through anatomy and immunology changes.Keywords: Probiotic, LPS, Escherichia coli, protection, immunologyABSTRAKLatar belakang: Infeksi gastrointestinal dengan manifestasi tersering diare merupakan salah satu infeksi yang sering terjadi pada anak. Pencegahan diare memerlukan keseimbangan sistem imun mukosa yang baik. Penggunaan probiotik untuk pencegahan terhadap infeksi gastrointestinal perlu dipikirkan. Penelitian ini bertujuan untuk membuktikan proteksi probiotik pada ileum mencit yang terpajan lipopolisakarida (LPS) Escherichia coli O55:B5 secara anatomis dan imunologis.Metode: Uji eksperimental dengan menggunakan mencit Balb/c jantan berusia 10-12 minggu, berat badan 30-40g dan dirandomisasi menjadi kelompok perlakuan dan kelompok kontrol. Kelompok perlakuan mendapatkan mix probiotik selama 14 hari, hari ke-15 mendapatkan LPS Escherichia coli O55:B5 dan hari ke-16-21 kembali mendapatkan mix probiotik. Kelompok kontrol mendapatkan LPS Escherichia coli O55:B5 saja pada hari ke-15. Seluruh mencit dinekropsi pada hari ke-22. Pemeriksaan imunohistokimia untuk melihat ekspresi sel penghasil sitokin IL-2, IFN-, TNF-α, IL-4, IL-5, IL-6, IL-10 dan TGF-ß di jaringan ileum. Scanning microscope electron (SEM) untuk melihat struktur mukosa ileum. Analisis statistik yang digunakan adalah analisis multivariat.Hasil: Enam belas ekor mencit Balb/c terbagi menjadi dua kelompok, masing-masing 8 mencit. Pada kelompok probiotik-LPS didapatkan perbedaan bermakna dibandingkan dengan kelompok LPS pada jumlah penghasil sitokin IL-5 (p=0,022), IL-6 (p=0,050) dan jumlah sel penghasil sitokin TGF-β (p=0,036). Pada kelompok probiotik-LPS, dominasi respon Th1 tidak terlihat lagi dan menimbulkan dominasi Treg pada kelompok ini. Posisi Th1 dan Th2 masih dapat dipertahankan secara seimbang. Kerusakan struktur yang terjadi pada kelompok LPS tidak didapatkan pada kelompok Probiotik-LPS.Simpulan: Proteksi probiotik pada mukosa ileum yang terpajan LPS Escherichia coli terjadi secara anatomi dan imunologi.
Zinc Administration Affects Bronchial Mucosal NF-κB p105/p50, p-NF-κB p65, IL-8, and IL-1β of Zinc-deficient Rats Reza Gunadi Ranuh; Andy Darma; Alpha Fardah Athiyyah; Ergia Latifolia; Retno Asih Setyoningrum; Boerhan Hidajat; Siti Nurul Hidayati; Anang Endaryanto; Ferry Sandra; Subijanto Marto Sudarmo
The Indonesian Biomedical Journal Vol 12, No 3 (2020)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v12i3.1041

Abstract

BACKGROUND: Risk of acute respiratory infections in children less than 5 years of age is up to 95%. Zinc deficiency is one of the main risk factors. This study aimed to explore the effect of zinc on the bronchial mucosae inflammatory status expressed by nuclear factor (NF)-κB p105/p50, NF-κB p65, interleukin (IL)-8, and IL-1β.METHODS: Twenty-four Wistar rats were divided into 4 groups: normal zinc diet group without zinc supplementation (Z1), normal zinc diet group with zinc supplementation (Z2), zinc deficient diet group without zinc supplementation (Z3), and zinc deficient diet group with zinc supplementation (Z4). NF-κB p105/p50, p-NF-κB p65, IL-8, and IL-1β were measured by immunohistochemical staining.RESULTS: The inflammatory status of bronchial mucosae between Z1 and Z2 groups showed no difference (p=0.055). However, the inflammatory status of bronchial mucosae between Z3 and Z4 groups showed significant difference (p<0.01). Multivariate factorial design showed that zinc supplementation was beneficial when given to zinc deficient diet group with regard to decrease p-NF-κB p65, IL-8 and IL-1β levels (p<0.001) and increase dendritic cell (p=0.022).CONCLUSION: Zinc administration under conditions of zinc deficiency affects the inflammatory status, as shown by the decrease of p-NF-κB p65, IL-8 and IL-1β and the increase of NF-κB p105/p50.KEYWORDS: zinc, NF-κB, p105/p50, p65, IL-8, IL-1β, rat
Lactobacillus plantarum IS-20506 Probiotic Restores Galectin-4 and Myosin-1a Expressions in Duodenum, Jejunum and Ileum of Lipopolysaccharide-induced Rats Reza Gunadi Ranuh; Alpha Fardah Athiyyah; Andy Darma; Wibi Riawan; Ingrid Suryanti Surono; Ferry Sandra; Subijanto Marto Sudarmo
The Indonesian Biomedical Journal Vol 12, No 3 (2020)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v12i3.1098

Abstract

BACKGROUND: Galectin-4 and Myosin-1a are important proteins for normal intestinal brush border structure and composition. Damage of these proteins by inflammation may alter digestion, absorption and barrier function. Probiotic has been widely known in maintaining gut health. However, the molecular mechanism of Lactobacillus plantarum IS-2056 probiotic in repairing intestinal brush border is not well defined. Therefore, current study was conducted by investigating the Galectin-4 and Myosin-1a expressions in a rodent model.METHODS: Male Wistar rats were induced with/without lipopolysaccharide (LPS) and treated with/without L. plantarum IS-2056 probiotic. On the seventh day, duodenum, jejunum, and ileum were collected and analyzed with western blot and immunohistochemistry for Galectin-4 and Myosin-1a expressions.RESULTS: Rats administrated with L. plantarum IS-2056 probiotic showed significant increase of Galectin-4 and Myosin-1a expressions in duodenum, jejunum, and ileum compared to the control group (p<0.05). While in control group, Galectin-4 level tended to increase in more distal of intestinal segment and Myosin-1a level tended to decrease in more distal intestinal segment.CONCLUSION: L. plantarum IS-20506 probiotic may facilitate the repairment of damaged intestinal brush border as demonstrated by significant restoration of Galectin-4 and Myosin-1a expressions in duodenum, jejunum, and ileum of LPS-induced rats.KEYWORDS: Lactobacillus plantarum, IS-20506, probiotic, galectin-4, myosin-1a, duodenum, jejunum, ileum
Zinc Supplementation Effect on the Bronchial Cilia Length, the Number of Cilia, and the Number of Intact Bronchial Cell in Zinc Deficiency Rats Andy Darma; Alpha Fardah Athiyyah; Reza Gunadi Ranuh; Wiweka Merbawani; Retno Asih Setyoningrum; Boerhan Hidajat; Siti Nurul Hidayati; Anang Endaryanto; Subijanto Marto Sudarmo
The Indonesian Biomedical Journal Vol 12, No 1 (2020)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v12i1.998

Abstract

BACKGROUND: Airway epithelium is the first line of defense against a variety of exposures. Inflammatory processes, hyperresponsiveness and zinc deficiency cause epithelial damage. Zinc is involved in apoptosis and microtubule formation. However, its role in the integrity of bronchial mucosa and cilia is unclear.METHODS: To assess the effect of zinc on the integrity of the bronchial epithelium, 24 male Rattus norvegicus strain Wistar rats were randomized into four experimental groups: normal zinc diet group without zinc supplementation, normal zinc diet group with 60 ppm zinc supplementation, zinc deficient diet group without zinc supplementation, and zinc deficient diet group with 120 ppm zinc supplementation. Bronchial mucosal integrity was measured with the number of epithelial cells, and the number and length of cilia.RESULTS: Number of cell in normal zinc diet group was 8.8±1.82, while it was only 8.1±1.08 in zinc deficient diet group (p<0.001). Number of cilia per cell was 4.6±1.08 in normal zinc diet group, compared to 4.0±0.79 in zinc deficient diet group (p<0.001). Ciliary length also differ by 7.68±0.66 μm in normal zinc diet group and only 5.16±0.91 μm in zinc deficient diet group (p<0.001).CONCLUSION: Zinc supplementation of the normal zinc diet group affected the length of bronchial cilia. Zinc supplementation of the zinc deficient diet group affected the integrity of the bronchial epithelium, which was shown by the number and length of cilia, and the number of epithelial cells.KEYWORDS: zinc, bronchial epithelial integrity, cilia length, number of cilia, epithelial cell 
THE CLINICAL EPIDEMIOLOGY OF NOROVIRUS INFECTION IN CHILDREN WITH DIARRHEA AT REGIONAL PUBLIC HOSPITAL DR.SOETOMO Alpha Fardah Athiyyah; Sofia Wardhani; Andy Darma; Reza Gunadi Ranuh; Dadik Raharjo; Toshiro Shirakawa; Subijanto Marto Sudarmo
Jurnal Berkala Epidemiologi Vol. 8 No. 3 (2020): Jurnal Berkala Epidemiologi (Periodic Epidemiology Journal)
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jbe.V8I32020.200-207

Abstract

Background: Norovirus has become a major cause of severe outbreaks of gastroenteritis since the discovery of the rotavirus vaccine, with the main symptom being diarrhea. Until now, research on the epidemiological analysis of norovirus has not been carried out at Regional Public Hospital (RSUD) Dr. Soetomo, Surabaya. Purpose: This study aims to provide clinical epidemiology data and an analysis of norovirus infections in children with diarrhea at Regional Public Hospital (RSUD) Dr. Soetomo, Surabaya, Indonesia, including the prevalence of norovirus infection in each age group and sex, its clinical appearance, and its seasonal variation. Methods: A cross-sectional study was conducted in children aged 1–60 months hospitalized for diarrhea in RSUD Dr. Soetomo between April 2013 and March 2014. Identification of the virus in the stool was done by norovirus enzyme immunoassay Quick NaviTM Noro2. The proportion, age, sex, clinical symptoms, and patterns of the norovirus seasonal data were calculated. Results: Norovirus was detected in 64 samples (19%) of the 340 stool samples, with a mean patient age of 11.75 months; it was mostly found in patients less than 24 months of age (95%), and 64% were male. The monthly pattern of norovirus infection was mostly found in November, followed by May and April. The clinical symptoms were fever (72%), vomiting (66%), bloating (59%), abdominal cramps (34%), perianal inflammation (27%), abdominal distension (16%), and seizures (8%). Conclusion: The prevalence of norovirus was found to be high in patients with diarrhea aged 1–60 months hospitalized in RSUD Dr. Soetomo, with a proportion of 19%. Further research is needed to determine the severity of norovirus infection.
Clinical Characteristic of Bloody Diarrhea in Under- Five Pediatric Inpatients Steven Christian Susianto; Alpha Fardah Athiyyah; Anak Agung Putri Nadia Paramitha; Eko Budi Koendhori; Khadijah Rizky Sumitro; Andy Darma; Reza Gunadi Ranuh; Subijanto Marto Sudarmo
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 1 No. 1 (2022): APGHN Vol. 1 No. 1 May 2022
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (325.457 KB) | DOI: 10.58427/apghn.1.1.2022.9-16

Abstract

Background: Diarrhea is the most common cause of death in under-five children. Bloody diarrhea comprises around 10% of all cases of diarrhea and may lead to severe complications until death. This study examined the characteristics of bloody diarrhea in children under five years old in Dr. Soetomo General Hospital Surabaya from 2013 to 2017. Material and Methods: A retrospective, cross-sectional study was conducted using secondary data from Dr. Soetomo General Hospital's inpatients with bloody diarrhea from 2013 to 2017. Gender, age, nutritional status, clinical symptoms, degree of dehydration, and laboratory results were assessed, and the data were presented in percentage (%) Results: Fifty-six samples were included in this study. The main demographics were male (58,9%), aged 7-24 months (44,6%), and normal nutritional status (66,1%). Meanwhile, the most notable manifestations were stool mucous (55,3%), mild to moderate degree of dehydration (60,7%), and leukocytosis (62%). Eleven patients (39,2%) had temperatures ≥380C. Leukocytes were positive in 93.7% of the stools. Furthermore, amoeba was found in 46,8% of samples. The serum electrolyte result showed hyponatremia (18%) and hypokalaemia (15%). Conclusion: The primary demographics of bloody diarrhea in under-five children admitted to Dr. Soetomo General Hospital were males, 7-24 months of age, and with normal nutritional status. The most frequent manifestations were mucous in stool, mild to moderate dehydration, leucocytosis, as well as positive leucocytes and amoeba in the stool.
Clinical Profile of Constipation in Children Under 5 Years of Age in Dr. Soetomo General Academic Hospital, Indonesia Steven Christian Susianto; Vina Lidya Setjaputra; Alpha Fardah Athiyyah; Khadijah Rizky Sumitro; Andy Darma; Reza Gunadi Ranuh; Subijanto Marto Sudarmo
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 1 No. 3 (2022): APGHN Vol. 1 No. 3 November 2022
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (196.798 KB) | DOI: 10.58427/apghn.1.3.2022.8-14

Abstract

Background: Childhood constipation is still common among children under 5 years of age. This study was conducted to determine the clinical profile of childhood constipation under 5 years of age at dr. Soetomo General Hospital, Indonesia. Methods: This retrospective cross-sectional study was performed by reviewing medical record of constipated children under 5 years of age at dr. Soetomo General Hospital Surabaya from January to December 2021. Data regarding age, gender, living place, body anthropometric (weight, height and nutritional status), sign and symptoms, and physical examination were collected for each patient. Nutritional status was determined by using WHO 2006 growth chart. We also assessed the presence of concomitant disease among those children and presented the data on the table. Results: A total of 35 subjects with constipation were included in this study. Mean (±SD) for age, body weight, length/height of these subjects were 27.09±17.71 months, 10.93±6.11 kg, 82.34±18.52 cm, respectively, with the male and female ratio of 1,67: 1. Around 18.2% of subjects presented with wasted, 18.2% with severely wasted, and 18.2% with severely stunted. Hardened stool (80%) was the most prevalent symptom, followed by straining (37.1%) and fecal impaction (22.9%). The most common concomitant diseases of childhood constipation were Hirschsprung’s disease (17.1%), congenital heart disease (11.4%), and hypothyroidism (11.4%). Conclusion: The results of this study showed that boys had a higher prevalence of constipation in children under 5 years of age, with the most prevalent clinical features being hardened stool, straining, and fecal impaction. Meanwhile, Hirschsprung’s disease, hypothyroidism, and congenital heart disease were the most concomitant disease.
Effect on Video Conference’s Education in Mandangin’s Community Health Center’s Healthcare Knowledge about Acute Diarrhea in Children Alpha Fardah Athiyyah; Andy Darma; Dwiyanti Puspitasari; Khadijah Rizky Sumitro; Ni Nyoman Metriani Nesa; Steven Christian Susianto; Muhammad Faizi; Reza Gunadi Ranuh; Subijanto Marto Sudarmo
Asian Journal of Health Research Vol. 2 No. 1 (2023): Volume 2 No 1 (April) 2023
Publisher : Ikatan Dokter Indonesia Wilayah Jawa Timur

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55561/ajhr.v2i1.61

Abstract

Introduction: The involvement and ability of health workers in Mandangin Island in early managing acute diarrhea in children to reduce infant mortality due to diarrhea are very important. This study aimed to determine the effect of community development Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital Surabaya in a seminar on Early Management of Acute Diarrhea in Children using video conference to educate health care workers (HCWs) at the Mandangin Community Health Center. Material and Methods: This cross-sectional study was designed on 20 HCWs at the Mandangin community health center. Subjects were evaluated for demographic data (gender, age, occupation, last education), and the knowledge was assessed using a pre-test before the seminar was given. We used questionnaire about acute diarrhea containing 10 questions with maximum score 100. The seminar was given through video conferences with form classical lecturer and a case study on acute diarrhea, and subjects attended the seminar in Community Health Center’s Hall. We assessed knowledge after the seminar using the same questionnaire with randomization in question and answer and compared the pre-and post-test using the Wilcoxon Rank sum test. Results: Most of the subjects were midwifery, with a mean age of 32.4 ± 5.75 years old, 45% with D-3 last education and 80% were female. There was a significant difference between pre-and post-test in acute diarrhea in children (47.89±20.7 vs 64.74±22.94) (p=0.008). Conclusion: Video conference education effectively increased health care workers' knowledge about acute diarrhea in children
UPAYA PENGUATAN PENGETAHUAN MASYARAKAT MENGENAI PENYAKIT GANGGUAN SALURAN CERNA FUNGSIONAL PADA ANAK DI PULAU MANDANGIN, KABUPATEN SAMPANG Subijanto Marto Sudarmo; Alpha Fardah Athiyyah; Andy Darma; Dwiyanti Puspitasari; Khadijah Rizky Sumitro; Ni Nyoman Metriani Nesa; Steven Christian Susianto; Muhammad Faizi; Reza Gunadi Ranuh
Jurnal Abdi Insani Vol 10 No 3 (2023): Jurnal Abdi Insani
Publisher : Universitas Mataram

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.29303/abdiinsani.v10i3.803

Abstract

Functional gastrointestinal disorders are problems that are often experienced by children, especially in isolated areas. Mandangin Island is among the secluded islands located in Sampang district.. The Department of Child Health, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital held a community development that aimed to increase public knowledge about functional gastrointestinal disorders in children on Mandangin Island, Sampang District. The community service was conducted using a hybrid seminar approach, where speakers participated remotely via Zoom while the local community gathered at the Village Hall on Mandangin Island.. The speakers explained the definition, important signs and symptoms, early management of Functional Gastrointestinal Disorders. All subjects who took part in community service activities were evaluated for knowledge based on pre- and post-tests, each of which consisted of 5 questions with maximum score 100. Subject’s knowledge was considered good if the score was ≥ 60. Based on our data, there were 29 people who participated in community development with the most working as fishermen and entrepreneurs. We found that 69% of the subjects had an increase in the pre-test score. At the time the pre-test was distributed, only 10.4% had good knowledge scores, while in the post-test there were 51.7% who had good knowledge. We also succeeded in making 3 health cadres caring in childhood functional gastrointestinal disorders. Community development in the form of health education for functional gastrointestinal disorders in children using video conference (ZOOM) on Mandangin Island could increase public knowledge and this activity can be implemented on other islands.
COMMUNITY DEVELOPMENT INFLUENCE ON PUBLIC'S KNOWLEDGE IN MANDANGIN ISLAND ABOUT ACUTE DIARRHEA AND FUNCTIONAL CONSTIPATION IN CHILDREN Ranuh, Reza Gunadi; Susianto, Steven Christian; Athiyyah, Alpha Fardah; Darma, Andy; Puspitasari, Dwiyanti; Sumitro, Khadijah Rizky; Nesa, Ni Nyoman Metriani; Faizi, Muhammad; Sudarmo, Subijanto Marto
Journal of Community Medicine and Public Health Research Vol. 3 No. 2 (2022): Journal of Community Medicine and Public Health Research
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (267.519 KB) | DOI: 10.20473/jcmphr.v3i2.34285

Abstract

In children, acute diarrhea and functional constipation (FC) are still more prevalent in Indonesia, especially in isolated islands, and need comprehensive management. This study aimed to determine the effect of community development from the Department of Child Health Faculty of Medicine, Universitas Airlangga, Surabaya, on Mandangin Island's public knowledge about acute diarrhea and functional constipation in children. This cross-sectional study was conducted on 29 subjects from Mandangin Island, Sampang, Indonesia on 17th February 2022. Subjects were given education and dissemination as community development by pediatricians via hybrid and could ask questions and discuss at the end of the presentation. The subject's knowledge was measured using a pre-and post-test questionnaire about children's acute diarrhea and functional constipation. Each questionnaire (diarrhea and functional constipation) consisted of 5 questions, with a minimum score of 0 and the maximum score of 100. The subject's knowledge was compared before and after the webinar using Paired T-Test and p<0,05 was measured as significant. We assessed the subject's age, gender, occupation, and last education. There was a significant increase in public knowledge about diarrhea (26,9±18,7; 55,1±24,3; p=0.000) and functional constipation pre-and post-webinar (24,8±18,2; 48,3±24,2; p=0.000). These findings support the importance of community development with education about acute diarrhea and functional constipation in children.
Co-Authors Alpha Fardah Athiyyah Ana Bilah, Aisah Nur Anak Agung Putri Nadia Paramitha Anang Endaryanto Ariani Setiawati Dadik Rahardjo, Dadik Dadik Raharjo Dwiyanti Puspitasari, Dwiyanti Eko Budi Koendhori, Eko Budi Ergia Latifolia Ferry Sandra Fitria, Anisa Lailatul Hidajat, Boerhan I Gusti Made Reza Gunadi Ranuh Ingrid Suryanti Surono Juniastuti Juniastuti Khadijah Rizky Sumitro Khadijah Rizky Sumitro Khadijah Rizky Sumitro Khadijah Rizky Sumitro Laura Navika Yamani Maharani, Aussie Tahta Muhammad Faizi Muhammad Faizi, Muhammad Nesa, Ni Nyoman Metriani Ni Nyoman Metriani Nesa Ni Nyoman Metriani Nesa PA, Deanty Ayu PA, Deanty Ayu Raharjo, Dadik Retno Asih Setyoningrum Reza Gunadi Ranuh Reza Gunadi Ranuh Reza Gunadi Ranuh Reza Ranuh S.Pd. M Kes I Ketut Sudiana . Shirakawa, Toshiro Shirakawa, Toshiro SITI NURUL HIDAYATI Sofia Wardhani Steven Christian Susianto Steven Christian Susianto Steven Christian Susianto Steven Christian Susianto Subijanto Marto Sudarmo Subijanto MS Sudarmo, Subijanto Marto Sudarmo, Subijanto Marto Sumitro, Khadijah Rizky Susianto, Steven Christian Toshiro Shirakawa Vina Lidya Setjaputra Wibi Riawan Wiweka Merbawani Zayyin Dinana