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All Journal Medical Journal of Indonesia The Indonesian Biomedical Journal Sari Pediatri Paediatrica Indonesiana Narra J Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal)

Mulyadi M. Djer

Department Of Child Health, Medical School, University Of Indonesia/Cipto Mangunkusumo Hospital, Jakarta

Author-ID : 254970

Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Comparison of minimal inhibitory and bactericidal capacity of oral penicillin V with benzathine penicillin G to Streptococcus beta--hemolyticus group A in children with rheumatic heart disease Burhanuddin Iskandar; Bambang Madiyono; Sudigdo Sastroasmoro; Sukman T. Putra; Mulyadi M. Djer; Anis Karuniawati
Paediatrica Indonesiana Vol 48 No 3 (2008): May 2008
Publisher : Indonesian Pediatric Society

Background Injection ofbenzatine penicillin G (BPG) every 28days is still the drug of choice for secondary prevention of rheu-matic heart disease (RHD). BPG sometimes poses problems dueto pain at the injection site, possible anaphylaxis, and is not alwaysavailable. Some centers choose oral penicillin over BPG.Objectives To compare minimal inhibitory capacity (MIC) andminimal bactericidal capacity (MBC) of oral penicillin V serumwith those of BPG among SGA infected RHD.Methods This was a clinical trial with crossover design study tocompare MIC of penicillin V and BPG. Outcome measures wereMIC and MBC. Statistical analysis was performed using pairedt-test and wilcoxon test.Result There were 32 subjects consisted of 17 males and 15females. The mean value of MIC and MBC serum of penicillinV were 0.031 and 0.125. The mean value of MIC and MBCserum of BPG3 were 0.094 and 0.031. Respectively the MICof penicillin V was similar to that of BPGy The mean value ofMIC and MBC of BPG4 were 0.125 and 0.250. Respectively theMIC of penicillin V was significantly higher than that of BPG 4.The MBC of penicillin V was significantly higher than that ofBPG 4. The MIC ofBPG 3 was similar to that ofBPG 4â€¢ The MBCof BPG 3 was similar to that of BPG 4.Conclusions The MIC of penicillin V was similar to that ofBPG 3,the MBC of oral penicillin V was higher than that ofBPG 3â€¢ TheMIC and MBC of penicillin V was higher than those of BPG 4.

Inhibiting ability of benzathine penicillin G towards group A Streptococcus Î² -hemolyticus in 21 and 28 days after a single intramuscular injection Bambang Madiyono; Mulyadi M Djer; Sudigdo Sastroasmoro; Amin Subandrio; Erni Erfan
Paediatrica Indonesiana Vol 43 No 4 (2003): July 2003
Publisher : Indonesian Pediatric Society

Background The effectiveness of a single intramuscularbenzathine penicillin G as a secondary prevention of acute rheu-matic fever after 28 days is still controversial. The latest studyshowed that serum penicillin concentration was below protectivelevel in 4 weeks after a single intramuscular injection.Objective This study was a preliminary study to compare the in-hibiting ability of benzathine penicillin G towards group A Strepto-coccus Î² -hemolyticus in 21 and 28 days after a single IM injectionby using Mueller-Hinton broth method.Methods The inhibiting ability was measured by the serum in-hibitory concentration and serum bactericidal concentration aftera single intramuscular injection of benzathine penicillin G 1.2 mil-lion units.Results The subjects were 28 patients, with mean age of 15.5years (SD 3.4). The numbers of male and female were equal. Meanserum inhibitory concentration in 21 days after a single injectionwas 926.4 (SD 3080.1) and after 28 days was 1540.9 (SD 4275.1),which was not significantly different (p=0.0662). Mean serum bac-tericidal concentration in 21 days after IM injection was 1579.6(SD 4265.7) and in 28 days was 2417 (SD 6849.4) and it was notstatistically different (p=0.2276).Conclusion This study concluded that there was no significantdifference in the inhibiting ability of benzathine penicillin G to-wards group A Streptococcus Î² -hemolyticus between 21 and 28days after a single intramuscular injection

Ventricular function and dimensions in children with human immunodeficiency virus infection Rahmat B. Kuswiyanto; Mulyadi M. Djer; Arwin A. P. Akib; Sudigdo Sastroasmoro
Paediatrica Indonesiana Vol 51 No 3 (2011): May 2011
Publisher : Indonesian Pediatric Society

Background Prevalence of cardiac complications in children 'WithÂ human immunodeficiency virus (HIV) infection have increased,Â in association 'With the availability of antiretroviral (ARV) therapyÂ and the decrease of opportunistic infections. However, studies onÂ cardiac complications in HIV patients in the various HIV clinicalÂ and immunologic categories have been limited. Furthermore,Â cardiac complications in Indonesian HIVinfected children haveÂ never been reported.Objectives To detennine the prevalence of cardiac complicationsÂ in HIVinfected children and to compare ventricular function andÂ dimensions based on HIV clinical and immunologic categories.Â Methods A crossô€sectional study was done in the Department ofÂ Child Health, Cipto Mangunkusumo Hospital, Jakarta betweenÂ October and December 2009 on 7 4 HIVô€infected childrenÂ aged below 15 years. Children with severe chronic or acuteÂ systemic diseases were excluded. Investigations included physicalÂ examinations, 12ô€lead electrocardiography and echocardiographyto assess left ventricular dimension and ventricular function.Â Cardiac findings among children in different clinical andÂ immunological categories were compared.Results Five children showed left ventricular fractional shorteningÂ below 25% and 16 had right ventricular dysfunction. MeanÂ cardiac function and dimension were in the normal range. NoÂ differences in cardiac function and dimension, among the clinicalÂ HIV category groups (p>0.05) or immunologic suppression statusÂ groups (p>0.05) were observed.Conclusion In children 'With HIV infection, the prevalence of left ventricular dysfunction and right ventricular dysfunction was 7% andÂ 22%, respectively. No differences in cardiac function and dimensionÂ were found among the different HIV clinical and immunologicalÂ categories.

Stent implantation into ductus arteriosus: a new alternative of palliative treatment of duct-dependent pulmonary circulation Mulyadi M Djer; Bambang Madiyono; Sudigdo Sastroasmoro; Sukman T Putra; Ismet N Oesman; Najib Advani; Mazeni Alwi
Paediatrica Indonesiana Vol 44 No 1 (2004): January 2004
Publisher : Indonesian Pediatric Society

Background The technical aspects of ductal stenting have beenreported, but little is known about the fate of the duct after stentimplantation.Objectives To determine the effects of PDA stenting on the degreeof cyanosis, blood oxygen saturation, long-term patency of PDA,and the growth of pulmonary artery and its branches, in patientswith duct-dependent pulmonary circulation.Methods This was a case series study conducted at the Depart-ment of Pediatric Cardiology, Institut Jantung Negara (National HeartInstitute), Kuala Lumpur, Malaysia from November 1996 to Septem-ber 2001 on patients with duct-dependent pulmonary circulation whounderwent stent implantation. All patients were followed-up until oc-clusion or block occurred or until the end of follow-up time. The evalu-ation consisted of clinical manifestations, electrocardiography, chestx-ray, echocardiography, and cardiac catheterization.Results Stent was successfully implanted in 60 patients (84%),failed in 7 patients (10%) and contra indicated in 4 patients (6%).There was significant improvement on the degree of cyanosis afterstent implantation (p<0.0001). The blood oxygen saturation signifi-cantly increased from 74% (ranged 42-93; SD 12) before proce-dure, to 90% (ranged 62-100; SD 8) afterward (p<0.0001). The meanduration of follow-up time was 14.2 months (ranged 2.5-50.8; SD13) and the minimal patency of PDA was 11.2 months (ranged 1.1-47.7; SD 10.7) after implantation. At the end of follow-up, the stentswere widely patent in 33 patients (55%), stenotic in 15 patients (25%)and spontaneously occluded in 12 patients (20%). There was in-creased growth of pulmonary artery as measured by McGoon ratiofrom 1.23 (ranged 0.4-2.3; SD 0.4) to 1.81 (ranged 0.7-0.9; SD 0.57),and no distortion of pulmonary artery and its branches found.Conclusion Stent implantation into ductus arteriosus decreasedthe degree of cyanosis, increased blood oxygen saturation, main-tained long-term patency of ductus arteriosus, and promoted theincreased growth of pulmonary artery without distortion of pulmo-nary artery and its branches

Intravenous paracetamol and patent ductus arteriosus closure in preterm infants Rizky Adriansyah; Nikmah S. Idris; Mulyadi M. Djer; Sukman T. Putra; Rinawati Rohsiswatmo
Paediatrica Indonesiana Vol 57 No 4 (2017): July 2017
Publisher : Indonesian Pediatric Society

Background Indomethacin and ibuprofen are the drugs of choice for closure of patent ductus arteriosus (PDA) in preterm infants. However, intravenous preparations are of limited availability in Indonesia. Circumstantial evidence has shown that intravenous paracetamol may be an alternative therapy for PDA closure in premature infants.Objective To evaluate the effect of intravenous paracetamol on PDA closure in preterm infants.Methods A before-and-after study was conducted between May and August 2014 in Cipto Mangunkusumo General Hospital, Jakarta in preterm infants with hemodynamically significant PDAs, as established by echocardiography using the following criteria: duct diameter >1.4 mm/kg, left atrium to aorta ratio >1.4, and mean velocity in the left pulmonary artery >0.42 m/s or mean diastolic velocity in the left pulmonary artery >0.2 m/s. Subjects, aged 2 and 7 days, received intravenous paracetamol (15 mg/kg every six hours) for 3 days. Paired T-test was used to compare pre-intervention PDA diameter to those assessed at 24 hours after the intervention and at 14 days of life.Results Twenty-nine subjects had a mean gestational age of 30.8 weeks and mean birth weight of 1,347 grams. Nineteen (65.5%) patients had closed PDAs at the day 14 evaluation, 1 experienced PDA reopening, and 9 had failed PDA closure. No liver toxicity was identified. Mean duct diameters before, 24 hours after the intervention, and at 14 days of life were 3.0, 0.9, and 0.6 mm, respectively (P<0.0001).Conclusion Intravenous paracetamol seems to be reasonably effective for PDA closure in preterm infants.

Heated, humidified high-flow nasal cannula vs. nasal CPAP in infants with moderate respiratory distress Adhi Teguh Perma Iskandar; Risma Kerina Kaban; Mulyadi M Djer
Paediatrica Indonesiana Vol 59 No 6 (2019): November 2019
Publisher : Indonesian Pediatric Society

Background Respiratory distress is the most common cause of morbidity in premature babies in the delivery room. Nasal continuous positive airway pressure (nCPAP) is widely used as the preferred modality of treatment, although it may cause nasal trauma. Heated, humidified high-flow nasal (HHHFN) cannula is an alternative oxygen therapy, yet the safety and efficacy has not been widely studied. Objective To compare the safety and efficacy of HHHFN and nCPAP in premature babies with gestational age > 28 to < 35 weeks and moderate respiratory distress. Methods We conducted a randomized, non-inferiority, clinical trial using HHHFN vs. nCPAP as a treatment for moderate respiratory distress within 72 hours after they had been used. The efficacy endpoints were treatment failure, length of device use, length of Kangaroo Mother Care (KMC), and full enteral feeding time. Safety assessment included pain score, nasal trauma, and systemic complications. Results No differences were found in terms of incidence of endotracheal intubation within < 72 hours of HHHFN (20%) compared to nCPAP (18%) (P=0.799). However, there was a significant difference in moderate nasal trauma in nCPAP (14%) compared to HHHFN (0%)(P=0.006). There were no significant differences of blood gas analysis results, full enteral feeding time, length of KMC, length of device use, and rate of complications (bronchopulmonary dysplasia/BPD, intraventricular hemorrhage/IVH, patent ductus arteriosus/PDA, necrotizing enterocolitis/NEC and late onset neonatal sepsis/LONS) between the nCPAP and HHHFN groups. Conclusion The HHHFN is not inferior to nCPAP in terms of the safety and efficacy as primary non-invasive therapy in premature babies of gestational age > 28 to < 35 weeks with moderate respiratory distress . Compared to nCPAP, HHHFN induced lower nasal trauma.

Neutrophil-to-lymphocyte ratio as a predictor of low cardiac output syndrome after open heart surgery in children with congenital heart disease Laila, Dewi S.; Perdana, Andri; Permatasari, Ruth K.; Kadim, Muzal; Advani, Najib; Supriyatno, Bambang; Chozie, Novie A.; Djer, Mulyadi M.
Narra J Vol. 4 No. 2 (2024): August 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i2.736

Neutrophil-to-lymphocyte ratio (NLR) as a predictor in determining low cardiac output syndrome (LCOS) has not been widely reported. The aim of this study was to explore the role of pre-surgery, 0-, 4-, and 8-hour post-surgery NLR as predictors of LCOS incidence after open heart surgery in children with congenital heart disease (CHD). This study used a prognostic test with a prospective cohort design and was conducted from December 2020 until June 2021 at the cardiac intensive care unit (CICU) of Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. The subject consisted of children aged one month to 18 years who underwent open heart surgery using a cardiopulmonary bypass (CPB) machine. A receiver operating characteristic curve was applied to identify the predictive performance of NLR for poor outcomes (LCOS incidence). Out of 90 patients included in the study, 25 (27.8%) of them developed LCOS between 3 to 53 hours post-surgery. All NLR values (pre-surgery and 0-, 4-, and 8-hours post-surgery) were associated with the incidence of LCOS. Pre-surgery NLR (cut-off value ≥0.88) had a fair predictive value (area under curve (AUC) 70; 95%CI: 57–83) for predicting LCOS incidence with sensitivity and specificity of 64% and 64.62%, respectively. NLR 0-hour post-surgery (cut-off value ≥4.73) had a good predictive value (AUC 81; 95%CI: 69–94) for predicting LCOS incidence, with 80% sensitivity and 80% specificity. NLR 4- and 8-hours post-surgery had very good predictive values (AUC 97%; 95%CI: 92–100 and 98; 95%CI: 94–100, respectively), with cut-off values ≥6.19 and ≥6.78, had the same 92% sensitivity and the same 96% sensitivity. The presence of LCOS was associated with mortality (odds ratio of 5.11 with 95%CI: 3.09–8.46). This study highlights that pre-surgery, 0-, 4-, and 8-hours post-surgery NLR can be predictors of LCOS after open heart surgery in children with CHD.

Effect of the modified Atkins diet on NLRP3, caspase-1, IL-1β, and IL-10 in patients with tetralogy of Fallot undergoing open-heart surgery: A randomized controlled trial Yanuarso, Piprim B.; Djer, Mulyadi M.; Hendarto, Aryono; Pudjiadi, Antonius H.; Rachmadi, Lisnawati; Wibowo, Heri; Advani, Najib; Murni, Indah K.; Kekalih, Aria; Sukardi, Rubiana; Dilawar, Ismail; Susanti, Dhama S.; Supriatna, Novianti
Narra J Vol. 5 No. 1 (2025): April 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i1.2138

Cardiopulmonary bypass in tetralogy of Fallot (TOF) corrective surgery induces hyperinflammation by activating NLRP3, caspase-1, and interleukin-1β (IL-1β), subsequently triggering an interleukin-10 (IL-10) response. Despite its known metabolic and anti-inflammatory effects, the impact of the modified Atkins diet (MAD) in pediatric cardiac surgery remains unexplored, with no studies on its use in TOF patients undergoing open-heart surgery. The aim of this study was to assess the effect of MAD on the expression of NLRP3, caspase-1, IL-1β, and IL-10, in TOF patients undergoing open-heart surgery. A double-arm, randomized-controlled trial was conducted with 44 TOF patients. The treatment group (n=22) received the MAD, a low-carbohydrate, high-fat regimen with unrestricted fat and protein intake for at least 14 days preoperatively, while the control group (n=22) followed a standard diet without carbohydrate restriction. Blood plasma and infundibulum heart tissues were collected for analysis. Whole blood samples were collected using a winged infusion needle before the intervention, an Abbocath infusion needle after 14 days of intervention, and a syringe without a needle connected to an arterial line in patients undergoing open-heart surgery at 6, 24, and 48 hours post-surgical correction. Infundibulum heart tissues were collected during the open-heart surgery. This study demonstrated significant differences in NLRP3 protein expression (p=0.015), caspase-1 protein expression (p=0.001), and IL-10 levels between before intervention and 6-, 24-, and 48-hours post-surgery in the MAD group compared to the control group. In contrast, no significant differences in IL-10 levels were observed in the control group between before intervention and 48 hours post-surgery (p=0.654). In conclusion, MAD may modulate perioperative inflammation in TOF patients undergoing open-heart surgery by downregulating NLRP3 and caspase-1 expression while sustaining IL-10 levels. Despite reduced NLRP3 and caspase-1 expression, unchanged IL-1β levels indicate alternative regulatory mechanisms.

Effects of lung recruitment maneuver using mechanical ventilator in preterm infant microcirculation: a clinical trial Iskandar, Adhi Teguh Perma; Djer, Mulyadi Muhammad; Supriyatno, Bambang; Kaban, Risma Kerina; Kautsar, Ahmad; Rahmadhany, Anisa; Sutjipto, Fiolita Indranita; Suhendro; Advani, Najib; Santoso, Dewi Irawati Soeria; Prihartono, Joedo; Yuniati, Tetty
Medical Journal of Indonesia Vol. 34 No. 1 (2025): March
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.oa.247472

BACKGROUND Preterm infants often require continuous positive airway pressure due to immature respiratory tracts. Bronchopulmonary dysplasia (BPD) manifests as prolonged oxygen dependence until 28 days of age and is classified into mild, moderate, or severe forms. The lung recruitment maneuver (LRM) aims to reopen collapsed alveoli, enhancing oxygenation during mechanical ventilation using the assist control volume guarantee mode (MV-AC/VG). This study aimed to evaluate the impact of LRM on alveolar and endothelial injuries, neonatal microcirculation, and its relation to BPD reduction or mortality in preterm infants. METHODS This study was conducted from March 2021 to April 2022 at Cipto Mangunkusumo and Bunda Menteng Hospitals, Jakarta. The participants are <32 weeks infants with severe respiratory distress syndrome requiring MV-AC/VG, divided into LRM and control groups (n = 55 each). The alveolar injury was assessed using plasma surfactant protein-D (SP-D), endothelial injury by flow cytometry for endothelial microparticles (CD-31⁺/CD-42-), and neonatal microcirculation via transcutaneous-artery CO2 gap (TcPCO₂-PaCO₂) and transcutaneous O2 index (TcPO₂/PaO₂) measurements at 1 and 72 hours post-ventilation. RESULTS LRM did not negatively affect preterm infants (24–32 weeks) undergoing invasive mechanical ventilation. At 72 hours, no significant differences were observed in alveolar (SP-D) and endothelial injury (CD-31+/CD-42-), nor in BPD reduction or mortality by 36 weeks. CONCLUSIONS LRM is a beneficial intervention for enhancing respiratory support and microcirculation in preterm infants. Among survivors, LRM reduced the time to achieve the lowest FiO2 (60.0 versus 435.0 hours, p<0.0001), shortened respiratory support duration (25.0 versus 36.83 days, p = 0.044), and improved TcO2 index (1.00 versus 1.00, p = 0.009).

Evaluation of myocardial injury from use of aortic cross-clamp and cardiopulmonary bypass duration in patients undergoing tetralogy of Fallot corrective surgery Wardoyo, Suprayitno; Djer, Mulyadi M.; Busro, Pribadi Wiranda
Paediatrica Indonesiana Vol. 65 No. 2 (2025): March 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.2.2025.147-55

Background Much remains unknown about the myocardial injury caused by aortic cross-clamp and cardiopulmonary bypass durations in children undergoing open-heart surgery, especially children with cyanotic congenital heart disease. To assess this injury, specific biomarkers can provide valuable insights. Troponin I (TnI) is known to be a specific marker of heart damage, while serum lactate serves as an indicator of tissue hypoperfusion and ischemic events. Additionally, malondialdehyde (MDA) is recognized as a marker of oxidative stress resulting from CPB machine usage. Objective To investigate the association of aortic cross clamp and CPB durations on myocardial injury and oxidative stress in children undergoing TOF corrective surgery. Methods We conducted this prospective study which included 29 patients diagnosed with TOF and who underwent corrective surgery. Troponin I and MDA levels were measured before surgery, 1 hour after surgery, and 8 hours after surgery. Lactate levels were measured in arterial blood specimens taken before surgery, as well as 1 hour, 6 hours, 12 hours, and 24 hours after surgery. Results Twenty-nine patients were included in this study and divided into groups based on aortic cross-clamp duration: shorter (<38 minutes) or longer (≥38 minutes), as well as based on CPB duration: shorter (<75 minutes) or longer (≥75 minutes), according to the median. Wilcoxon test indicated For the <38 min clamp duration group, there was only a significant increase in TnI at 1 hour compared to pre-op (P=0.048). However, there were no significant different in TnI, MDA, or lactate levels at any time point between the two CPB or cross-clamp groups.

Co-Authors Adhi Teguh Perma Iskandar Agus Firmansyah Amin Subandrio Angelina Angelina Anis Karuniawati Antonius H. Pudjiadi Aria Kekalih Arwin A. P. Akib Aryono Hendarto Asri C. Adisasmita Audrey Audrey Badriul Hegar Bambang Madiyono Bambang Madiyono Bambang Madiyono Bambang Mardiyono Bambang Supriyatno Burhanuddin Iskandar Chozie, Novie A. Damayanti R. Sjarif Damayanti R. Syarif Darmawan B. Setyanto Desy Dewi Saraswati Dilawar, Ismail Djajadiman Gatot Emilda Osmardin Erni Erfan, Erni Fajar Subroto Heri Wibowo Herlina Dimiati Heru Samudro Hikari A. Sjakti Idrus Alwi Ika P Wijaya, Ika P Imral Chair Irawan Mangunatmadja Iskandar, Adhi Teguh Perma Ismet N Oesman Joedo Prihartono Johanes Edy Siswanto, Johanes Edy Jusuf Rachmat Jusuf Rachmat Kautsar, Ahmad Laila, Dewi S. Liku Satriani Lily Rundjan Lisnawati Rachmadi Mardjanis Said Maswin Masyhur Mazdar Helmy Mazeni Alwi Melva Louisa Mila Maidarti Mochammading Mochammading Mochammading Mochammading Murni, Indah K. Muzal Kadim Nafrialdi Nafrialdi Najib Advan Najib Advani Najib Advani Najib Advani Najib Advani Nia Kurniati Nikmah S Idris, Nikmah S Nikmah S. Idris Nikmah Salamia Idris NP Veny Kartika Yantie Nurhakiki, Syifa Nusarintowati Ramadhina Perdana, Andri Permatasari, Ruth K. Piprim B Yanuarso Piprim B. Yanuarso, Piprim B. Piprim Basarah Yanuarso Pribadi Wiranda Busro Pustika Amalia Putri, Dyanti Prima Rahmadhany, Anisa Rahmat B Kuswiyanto Rahmat B. Kuswiyanto Renno Hidayat Rinawati Rohsiswatmo Risma Kerina Kaban Risma Kerina Kaban Risma Kerina Kaban, Risma Kerina Rizky Adriansyah Rosary Rosary Rubiana Sukardi Rubiana Sukardi Rubiana Sukardi, Rubiana Safanta, Nurzalia Sake Juli Martina Santoso, Dewi Irawati Soeria Setyanto, Darmawan Budi Shirley L. Anggriawan Sudigdo Sastroasmoro Sudigdo Sastroasmoro Sudigdo Sastroasmoro Sudigdo Sastroasmoro Sudigdo Sastroasmoro Sudung O Pardede, Sudung O Sudung O. Pardede Suhendro Sukman T Putra Sukman T Putra Sukman T. Putra Sukman T. Putra Sukman T. Putra Sukman Tulus Putra Sukman Tulus Putra, Sukman Tulus Supriatna, Novianti Susanti, Dhama S. Sutjipto, Fiolita Indranita Swanty Chunnaedy Syarif Rohimi Talib, Suprohaita Rusdi Taufiqurahman, Khobir Abdul Karim Tetty Yuniati Wardoyo, Suprayitno

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