Rino A Gani
Department Of Internal Medicine, Faculty Of Medicine, Universitas Indonesia, Jakarta, Indonesia

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CD38+ Liver Stellate Cells in Chronic Hepatitis C Patients with Fibrosis Titos Ahimsa; Rino Alvani Gani; Ari Fahrial Syam; Suhendro - -
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 16, No 2 (2015): VOLUME 16, NUMBER 2, August 2015
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (211.526 KB) | DOI: 10.24871/162201586-91

Abstract

Background: Approximately 3% of the world population is infected with hepatitis C virus (HCV). Protein of hepatitis C virus modulates apoptosis and steatosis, liver cell injury, activates liver stellate cells and liver fibrosis. Hepatitis C virus infection will cause injury to the hepatocytes. This injury to the hepatocyte will activate liver stellate cells. Stellate cells have a huge role in the development of liver fibrosis. The objective of this study is to evaluate the difference of active CD38+ liver stellate cells in various degree of fibrosis as well as its relation with aspartate transaminase (AST), alanine transaminase (ALT), and quantitative amount of hepatitis c virus ribonucleic acid (HCV RNA) in chronic hepatitis C.Method: This study was a cross-sectional study performed in 32 patients with chronic hepatitis C who had undergone liver USG, did not suffer from hepatoma, had undergone liver biopsy. Paraffin block of patients’ liver tissue was further stained using Haematoxylin and Eosin technique to identify the Metavir degree which is categorized into mild-moderate or severe degree. Special staining is performed to evaluate liver stellate cells that were then counted in averagely in five fields of view.Results: In this study, we found significant difference in the amount of CD38+ stellate liver cells between severe and mild-moderate fibrosis (p 0.001), there was no association between CD38+ stellate liver cells with AST (p = 0.2) or ALT (p = 0.7), and there was association between CD38+ stellate liver cells with quantitative HCV RNA (r = -0.372).Conclusion: Total amount of CD38+ stellate liver cells in severe fibrosis was higher compared to the total amount of CD38+ liver stellate cells in mild-moderate fibrosis. There was no association between the value of AST, ALT, and quantitative HCV RNA with the number of CD38+ stellate liver cells.
Nucleoside/Nucleotide Analogues for the Treatment of Chronic Hepatitis B: A 3-Year Follow Up Study Sulaiman, Andri Sanityoso; Hasan, Irsan; Lesmana, Cosmas Rinaldi A; Jasirwan, Chyntia Olivia M; Nababan, Saut Horas H.; Kalista, Kemal Fariz; Aprilicia, Gita; Gani, Rino Alvani
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 3
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Introduction. Chronic hepatitis B (CHB) is endemic in Indonesia, where it is usually treated with pegylated interferon and nucleoside/nucleotide analogs (NA). The aim of this study was to determine the efficacy of treating CHB infection among Indonesian patients with NA (lamivudine, telbivudine, and tenofovir) for a 3-year period.Methods. We retrospectively reviewed the records of patients with CHB infection attending the Hepatology Clinic Cipto Mangunkusumo during 2010-2013 period. Subjects with inclusion criteria were all patients aged above 18 years treated with NA for at least three years. The degree of liver stiffness, hepatitis B virus deoxyribonucleic acid (HBV-DNA), alanine aminotransferase (ALT) levels, and hepatitis B antigen (HBeAg) were assessed before and after 3-years therapy.Results. A total of 62 subjects were included in the study. Forty-eight patients (77%) were treated with telbivudine, 9 (15%) with tenofovir, and 5 (8%) with lamivudine. At baseline prior to the onset of therapy, 52 patients (84%) had a positive HBeAg test, 15 patients (24%) had F3 liver disease (advance fibrosis), and 36 (58%) had liver cirrhosis using transient elastography. At the end of the 3 year study period, median of liver stiffness significantly decline from baseline (14.5 (3.3 – 59.3) kPa to 6.7 (3.3 – 37.2) kPa, p = 0.001), HBV DNA load significantly decline (1.31 x 107 (2.0x106 – 1.0x108) copies/mL to 0 (0 – 1.7 x 107) copies/mL, p = 0.001), alanine aminotransferase (ALT) levels significantly decline (58 (11– 404) U/L to 27 (8-291) U/L, p = 0.001). Nevertheless, there were five patients (8%) who still had F3 liver disease, and 20 patients (32.3%) had F4 liver disease, 21 (34%) had detectable HBV-DNA, 17 (27%) had not achieved ALT normalization. From 52 patients with positive HBeAg 140| Jurnal Penyakit Dalam Indonesia | Vol. 8, No. 3 | September 2021Andri S. Sulaiman, Irsan Hasan, C.R.A. Lesmana, Chyntia O.M. Jasirwan, Saut Horas H. Nababan, Kemal F. Kalista, Gita Aprilicia, Rino A. Ganibaseline, there were 20 patients (39%) who had seroconversion to negative HBeAg after three year period.Conclusion. NA therapy resulted in a reduction level of fibrosis in CHB induced liver disease.
Clinical Profile of Cirrhotic Patient with Esophageal Varices WhoUndergone Band Ligation in Cipto Mangunkusumo Hospital Kalista, Kemal Fariz; Lesmana, Cosmas Rinaldi Adithya; Sulaiman, Andri Sanityoso; Gani, Rino Alvani; Hasan, Irsan
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 1
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Introduction. Liver cirrhosis (LC) is the end stage of chronic liver disease. One of the main complication caused by LC is esophageal varices (EV). Bleeding due to EV rupture is the main cause of mortality in patient with LC. EV band ligation can be used for primary or secondary prophylaxis to prevent bleeding. The purpose of this study was to know the clinical profile of LC patient with EV who underwent band ligation and who not underwent band ligation. Methods. A cross-sectional study was conducted in LC patients who underwent esophagogastroduodenoscopy (EGD) in Procedure Room Division of Hepatobiliary, Departement of Internal Medicine, Cipto Mangunkusumo Hospital from 2016 to 2017. Results. During January 2016-December 2017, a total of 313 patients underwent EGD. Most of them ( 73.2%) were male and predominantly > 60 years (34,2%). Most common LC etiology was hepatitis B (51.8%., There were 22% subjects with hepatocellular carcinoma (HCC). EV band ligations were done in 146 (46.7%) patients. In the ligation group, 56.2% patients were from outpatient clinic. The most common EGD indication (39%) was evaluation from previous ligation. Of 41.8% patients had Child-Turcotte-Pugh (CTP) class-A condition, 82.9% patients had MELD score < 15, 61.6% patients had large EV, 22.1% had red color sign (RCS) and 84,9% patients had portal hypertensive gastropathy. There were significant differences in CTP class, ascites, platelet, bilirubin, and albumin between ligation group compare to non-ligation group. Conclussion. Most of LC patients who underwent EV band ligation had CTP class-A, came from the outpatient clinic. The Jurnal Penyakit Dalam Indonesia | Vol. 6, No. 1 | Maret 2019 | 37 Profil Klinis Pasien Sirosis Hati dengan Varises Esofagus yang Menjalani Ligasi Varises Esofagus di Rumah Sakit Dr. Cipto Mangunkusumo main finding in EGD was large EV with portal hypertensive gastropathy. There were significant differences in liver functions between patient in ligation group compared to patient in non-ligation group.
Proporsi Infeksi Virus Hepatitis B Tersamar pada Pasien yang Terinfeksi Human Immunodeficiency Virus Bratanata, Joyce; Gani, Rino Alvani; Karjadi, Teguh Haryono
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 3
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Pendahuluan. Infeksi hati kronik merupakan penyebab penting morbiditas serta mortalitas di antara penderita HIV positif pada pemakaian highly active antiretroviral therapies (HAART). Penyakit hati kronik dapat terjadi mulai dari infeksi tersamar sampai karsinoma hepatoselular. Kejadian VHB tersamar sering ditemukan pada pasien dengan kondisi imunosupresi seperti HIV. Penelitian ini bertujuan untuk mengetahui besarnya proporsi hepatitis B tersamar, hitung CD4+, transmisi IVDU, proporsi hepatitis C dan proporsi anti-HBc yang positif pada koinfeksi hepatitis B tersamar pada pasien HIV/AIDS di RSCM. Metode. Studi potong-lintang dilakukan pada pasien HIV yang berobat di Pokdisus dan ruang rawat inap RSCM dengan pengambilan sampel secara consecutive. Kriteria inklusi adalah pasien HIV dengan hasil HBsAg negatif dan belum pernah mendapat terapi antiretroviral. Subjek dengan hasil HBsAg negatif dilanjutkan dengan pemeriksaan anti-HBc, anti-HCV dan HBV DNA dengan teknik double step (nested) polymerase chain reaction (PCR) secara kualitatif dengan sensitifitas mencapai 102 kopi genom per mililiter serum. Ekstraksi HBV DNA menggunakan High Pure Viral Nucleic Acid Kit ® (Roche Diagnostics). Primers yang digunakan pada nested PCR berasal dari HBV-DNA S gene. Amplifikasi nested PCR dilakukan sebanyak dua putaran. Hasil. Selama bulan Desember 2008 – Januari 2009 diperoleh 58 subjek HIV. Pada akhir penelitian didapatkan 57 pasien memenuhi kriteria inklusi (68,4% laki-laki, usia 26-35 tahun sebanyak 68,4%, penularan HIV/AIDS melalui penggunaan jarum suntik secara bersama-sama 42,1%, hubungan seks 36,8%, dan keduanya 21,1%) dilakukan evaluasi adanya hepatitis B tersamar. Proporsi anti-HBc positif pada penderita HIV sangat tinggi (91,2%). Proporsi hepatitis B tersamar didapatkan pada 5 dari 57 subjek (8,8%). Proporsi hepatitis B tersamar lebih banyak didapatkan pada subjek dengan hitung CD4+ < 200 sel/μL (80%), risiko penularan IVDU (60%) dan hasil anti-HBc positif (80%). Proporsi koinfeksi hepatitis C dengan hepatitis B tersamar relatif lebih sedikit yaitu 40%. Simpulan. Proporsi hepatitis B tersamar didapatkan 8,8%. Proporsi hepatitis B tersamar lebih banyak didapatkan pada subjek dengan hitung CD4+ < 200 sel/μL (80%), risiko penularan IVDU (60%) dan hasil anti-HBc positif (80%). Proporsi koinfeksi hepatitis C dengan hepatitis B tersamar relatif lebih sedikit yaitu 40%. Keterbatasan penelitian ini adalah sensitivitas dari metoda PCR yang digunakan untuk mendeteksi DNA VHB dan dilakukan hanya satu kali pada setiap subjek. Perlu dilakukan penelitian lebih lanjut dengan sensitivitas PCR yang lebih tinggi dan jumlah sampel yang memadai untuk menentukan karakteristik dan hubungan berbagai faktor dengan kejadian infeksi virus hepatitis B tersamar pada pasien HIV.
Faktor - Faktor yang Berhubungan dengan Kejadian Hepatitis C pada Pasangan Seksual Pasien Koinfeksi Human Immunodeficiency Virus dan Virus Hepatitis C Kurniawati, Sri Agustini; Karjadi, Teguh H.; Gani, Rino A.
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 3
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Pendahuluan. Pencegahan transmisi hepatitis C pada pasangan seksual pasien koinfeksi HIV/HCV merupakan upaya penatalaksanaan hepatitis C. Namun demikian, belum ada data prevalensi hepatitis C dan faktor yang berhubungan dengan transmisi hepatitis C pada pasangan seksual pasien koinfeksi HIV/HCV di Indonesia, sehingga perlu dilakukan penelitian untuk memperoleh data tersebut. Penelitian ini bertujuan untuk mengetahui prevalensi hepatitis C dan faktor-faktor yang berhubungan dengan kejadian hepatitis C pada pasangan seksual pasien koinfeksi HIV/HCV. Metode. Studi potong lintang pada pasangan heteroseksual pasien koinfeksi HIV/HCV yang berobat di Pokdisus RSCM. Faktor yang diteliti meliputi penggunaan narkotika suntik, transfusi darah, status HIV, penggunaan kondom, jumlah hubungan seksual, jumlah pasangan seksual, tipe hubungan seksual dan hitung CD4+ pasien koinfeksi HIV/HCV. Pengambilan data dilakukan dengan wawancara secara terpisah dan pemeriksaan darah antiHCV total dan antiHIV. Analisis statistik dilakukan dengan uji chi-square dan Fisher dan regresi logistik menggunakan program SPSS. Hasil. Selama periode Mei-Agustus 2008, diperoleh 119 subyek penelitian pada rentang usia 19-39 tahun (median 26 tahun) dan 95,8% diantaranya berjenis kelamin perempuan. Didapatkan prevalensi hepatitis C sebesar 10,1%. Hasil analisis bivariat kelompok subyek nonpengguna narkotika suntik didapatkan status HIV reaktif dan hubungan seksual nonvaginal berhubungan dengan kejadian hepatitis C. Pada hasil analisis multivariat didapatkan hanya tipe hubungan nonvaginal yang berhubungan dengan kejadian hepatitis C (adjusted RP 8,051; IK95% 1,215-53,353). Simpulan. Prevalensi hepatitis C pada pasangan seksual pasien koinfeksi HIV/HCV sebesar 10,1%. Tipe hubungan nonvaginal dan status antiHIV positif dapat meningkatkan risiko terjadinya kejadian hepatitis C sebesar 8 kali. Dibutuhkan studi lanjutan dengan sampel yang lebih besar dan desain yang lebih baik untuk menentukan transmisi seksual hepatitis C.
Serokonversi Hepatitis C pada Pasien Hemodialisis di Rumah Sakit Cipto Mangunkusumo Widhani, Alvina; Lydia, Aida; Gani, Rino A; Setiati, Siti
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 1
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Pendahuluan. Pasien hemodialisis (HD) tergolong kelompok risiko tinggi terinfeksi virus hepatitis C. Penelitian mengenai serokonversi hepatitis C di RS Cipto Mangunkusumo belum pernah dilakukan. Agar transmisi hepatitis C dapat diturunkan, faktor risiko serokonversi hepatitis C penting diketahui. Penelitian ini bertujuan mengetahui proporsi dan faktor risiko serokonversi hepatitis C pada pasien yang menjalani HD di RS Cipto Mangunkusumo. Metode. Penelitian potong lintang terhadap pasien yang menjalani HD di RS Cipto Mangunkusumo pada bulan Juni-Juli 2011. Pemeriksaan anti-HCV menggunakan Roche Elecsys ECLIA, Analisis multivariat menggunakan regresi logistik. Hasil. Pada bulan Juni-Juli 2011 terdapat 135 pasien HD yang memenuhi kriteria inklusi dan eksklusi. Serokonversi mencapai 21,5%. Analisis bivariat menunjukkan hubungan yang bermakna antara lama dialisis (p=0,003) dan jenis kelamin pria (OR 2,43; 95%CI 0,99-5,98; p=0,048) dengan serokonversi hepatitis C. Pasien yang menjalani dialisis >42 bulan (sebelum pemrosesan ulang dialiser menggunakan mesin) lebih banyak yang mengalami serokonversi dibandingkan pasien yang menjalani dialisis ≤42 bulan. Terdapat dua variabel yang marginally statistically significant yaitu HBsAg negatif (p=0,07) dan menggunakan dialiser proses ulang (p=0,07). Pada analisis multivariat, didapatkan jenis kelamin pria (OR 2,91; 95%CI 1,14-7,48; p=0,03) dan lama dialisis (OR 1,02; 95%CI 1-1,03; p=0,007) berhubungan dengan serokonversi hepatitis C. Simpulan. Serokonversi hepatitis C pada pasien yang menjalani HD di RS Cipto Mangunkusumo mencapai 21,5%. Terdapat hubungan signifikan antara jenis kelamin pria dan lama dialisis dengan serokonversi hepatititis C.
Prevention of Hepatitis B Vertical Transmission: Focus on Antenatal Antiviral Administration Khumaedi, Anandhara Indriani; Gani, Rino Alvani; Hasan, Irsan
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 4
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Liver Function and Treatment Modalities are Predictors of Survival in Patients with Hepatocellular Carcinoma Hasan, Irsan; Loho, Imelda Maria; Lesmana, Cosmas Rinaldi; Gani, Rino A.
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 3
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Introduction. Hepatocellular carcinoma (HCC) is a major health problem in Indonesia because most patients are diagnosed in late stages when curative treatment is no longer possible. The aim of this study is to evaluate one-year survival rate, prognostic factors, and treatment modalities of patients with hepatocellular carcinoma. Methods. A retrospective analysis was done in patients with HCC who were admitted to Cipto Mangunkusumo General Hospital (CMGH) between January 2013 and March 2014. Clinical parameters and treatment modalities were evaluated. Patients outcome at one-year of follow-up were recorded from medical records or patients were contacted by phone call. Survival curve was produced using Kaplan-Meier method and a multivariate analysis was conducted using Cox proportional hazards model. Results. A total of 114 patients were included in this study. Incidence of mortality was 57% and one-year survival rate was 29.4% with median survival as long as 135 days (approximately 4.5 months). According to the BCLC staging system, patients who were diagnosed as early, intermediate, late, and terminal stages were 2 (1.8%), 48 (42.1%), 32 (28.1%), and 32 (28.1%), respectively. Poor liver function (Child-Pugh C class) was diagnosed in 26.3% of patients. Only two patients were diagnosed during surveillance process. Proportion of patients treated with curative/palliative modalities and best supportive care were 34.2% and 65.8%, respectively. In multivariate analysis, Child-Pugh classification and treatment modalities were significant prognostic factors with p-value of <0,001 for both factors. Conclusion. Liver function and treatment modalities are predictors of survival in patients with HCC.
Comparison of Renal Safety of Tenofovir and Telbivudine in Chronic Hepatitis B Patients: A Real World Study in Indonesia Gani, Rino Alvani
Jurnal Penyakit Dalam Indonesia Vol. 5, No. 3
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Introduction. Tenofovir disoproxil fumarate (tenofovir) and telbivudine are two available nucleos(t)ide analogue (NA) for the treatment of chronic hepatitis B (CHB) patients. Tenofovir has been known as a nephrotoxic agent in HIV patients, but still controversy in CHB patients. On the other hand, telbivudine had a renal protective effect and increased estimated glomerular filtration rate (eGFR). This studi aimed to address the renal safety of tenofovir and telbivudine in Indonesian patients. Method. A retrospective cohort study design was conducted in CHB patients who prescribed with tenofovir or telbivudine from January 2013 to December 2016. Patients who hade baseline eGFR
A Cohort Retrospective Study of Framingham Score and ECG Abnormality among Coal Mining Workers Anandita, Faizal Ablansah; Firdaus, Isman; Gani, Rino Alvani; Werdhani, Retno Asti; Mansyur, Muchtaruddin
Occupational and Environmental Medicine Journal of Indonesia Vol. 1, No. 1
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Introduction. ECG is widely used for detecting cardiovascular disease in coal mine worker’s medical check-up. As the study has proven, coal mine workers have a double cardiovascular risk from their workplace hazard and their own medical risks as individuals. An early detection and risk assessment method is needed to predict ECG abnormalities in the future. This study will analyze the relationship between ECG abnormality and Framingham Risk Score on coal mine workers’. Methods. We examine ECG result from medical check-up of male coal worker during 2018 and 2021. Using Minnesota Code, we determine ECG abnormality categories in the 2021 result, then compare it with coal handling type worker and Framingham Score in 2018 as the main medical factor. Results. Among 755 male coal workers with normal ECG in 2018, 158 (20,9%) were found with ECG abnormalities in 2021. Cohort’s multivariate study shows that type of coal worker is considered a determinant, but Framingham risk score still has the highest influence (p multivariate
Co-Authors -, Arles - -, Suhendro - -, Suhendro - A. D. Handayu A.A. Ketut Agung Cahyawan W Abdul Aziz Rani Adang Sabarudin Adityo Susilo, Adityo Agus Sudiro Waspodo Agus Waspodo Ahimsa, Titos Ahimsa, Titos Aida Lydia Alexander Michael Joseph Saudale Ali Sulaiman Ali Sulaiman Alvina Widhani, Alvina Amanda Trixie Hardigaloeh Anandhara Indriani Khumaedi Anandhara Indriani Khumaedi, Anandhara Indriani Anandita, Faizal Ablansah Andi Utama ANDI UTAMA Andri Sanityoso Andri Sanityoso Andri Sanityoso Sulaiman Aprilicia, Gita Ari Fahrial Syam Arles - - Baiq Kirana DN Mandasari Bambang Sutopo Banjarnahor, Riri Oktavani Begawan Bestari Bhanu S Kumar C Martin Rumende C Martin Rumende C Rinaldi A Lesmana Christopher F. Jaya Chudahman Manan Chudahman Manan Chyntia Olivia M. Jasirwan Chyntia Olivia Maurine Chyntia Olivia Maurine Jasirwan, Chyntia Olivia Maurine Cleopas Martin Rumende Daldiyono Daldiyono Daldiyono Daldiyono Devy Serevina Dewi Sumaryani Soemarko Diah Iskandriati DIAH ISKANDRIATI Dyah Ratna Budiani E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Edy Rizal Wahyudi Ening Krisnuhoni Epistel Pangujian Simatupang Erni Erfan, Erni Evy Yunihastuti Fera Ibrahim FX Pridady Griscalia Christine H. M.S. Noer H.M. Sjaifoellah Noer Hanif, Muhammad Yusuf Hardigaloeh, Amanda Trixie Heriawan Soejono Ichwan Baihaki Ignatius R Tenggara, Ignatius R Ihsanil Husna Ika Prasetya Wijaya Ikhwan Rinaldi Imelda Maria Loho Imelda Maria Loho, Imelda Maria Indra Marki Indra Marki Indra, Suwito Irsan Hasan Irsan Hasan Irsan Hasan Isman Firdaus Jacobus Albertus Jasirwan, Chyntia Olivia M Jenny Bashiruddin Joyce Bratanata Joyce Bratanata, Joyce Juferdy Kurniawan Julius R Samban Kaka Renaldi Kemal F Calista Kemal Fariz Kalista Kemal Fariz Kalista Kemal Fariz Kalista Kemal Fariz Kalista, Kemal Fariz Kuntjoro Harimurti L. A. Lesmana Laurentius A Lesmana Laurentius A Lesmana, Laurentius A Laurentius Lesmana Laurentius Lesmana Lianda Siregar Lianda Siregar Lies Luthariana Loli J Simanjuntak Lutfie Lutfie, Lutfie Marcellus Simadibrata K Marcellus Simandibrata Marsen Isbayuputra Maryati Surya Matthew Billy Maulana Suryamin Maulana Suryamin, Maulana Mesanti, Oska Muchtaruddin Mansyur Muhammad Sjaifoellah Noer Muhammad Yusuf Hanif Murdani Abdullah Nababan, Saut Horas Hatoguan Nafrialdi Nafrialdi Nanang Sukmana Nanang Sukmana Nurjati Chairani Siregar Nurul Akbar Nurul Akbar Oliver Emmanuel Yausep Oska Mesanti Prasna Pramita Pratiwi, Amalia Nur Profitasari Kusumaningrum Radhian Amandito Raksheeth Agarwal Ralph Girson Ralph Girson Gunarsa Ratu Ratih Kusumayanti Reny Mulatsih Retno Asti Werdhani Rika Bur Sabarinah Prasetyo Sabarudin, Adang Saut HH Nababan Seruni Tyas Khairunissa Silmi Mariya Siti Boedina Kresno Siti Setiati Sjaifoellah Noer Soemarno Soemarno Soemarno Soemarno Sri Agustini Kurniawati Sri Agustini Kurniawati, Sri Agustini Suhendro - - Suhendro Suhendro Suhendro Suhendro Suhendro Suhendro Sulaeman, Andri Sanityoso Susan Tai Suwito Indra Suzanna Immanuel Syahrizal Syarif Teguh H Karjadi Teguh H Karjadi, Teguh H Teguh H. Karjadi, Teguh H. Teguh Haryono Karjadi Teguh Haryono Karjadi, Teguh Haryono Teressa, Maria Titos Ahimsa Toar J.M. Lalisang Unggul Budihusodo Vera Yuwono Vito Filbert Jayalie, Vito Filbert Wirasmi Marwoto Wirasmi Marwoto Yustar Mulyadi Zubairi Djoerban Zubairi Djoerban