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All Journal Jurnal Kedokteran Brawijaya The Journal of Experimental Life Sciences (JELS) Research Journal of Life Science Berkala Kedokteran Indonesian Journal of Cardiology Heart Science Journal Budapest International Research and Critics Institute-Journal (BIRCI-Journal): Humanities and Social Sciences Journal of Nursing Science Update Indonesian Journal of Biomedicine and Clinical Sciences Brawijaya Journal of Urology
Mohammad Saifur Rohman
Department Of Cardiology And Vascular Medicine, Faculty Of Medicine, Universitas Brawijaya
Religion Agriculture, Biological Sciences & Forestry Arts Humanities Biochemistry, Genetics & Molecular Biology Economics, Econometrics & Finance Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health Social Sciences

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Time components contributing to door-to-balloon time of patients with ST-elevation myocardial infarction Setiawan, Dion; Anjarwani, Setyasih; Rohman, Mohammad Saifur
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.3

Abstract

Timely percutaneous coronary intervention (PCI) for patients experiencing ST-segment elevation myocardial infarction (STEMI) can greatly decrease mortality and morbidity. However, delays can hinder its effectiveness. The interval from hospital admission to reperfusion with PCI, known as door-to-balloon time (D2B), is closely linked to patient outcomes and is a key indicator of hospital quality. European guidelines suggest a D2B time of 90 minutes or less. Furthermore, some registries break down the D2B time into component times. These components include the time needed to identify a STEMI and activate the catheterization lab (door-to-activation time), the time for lab preparation and patient transport (activation-to-laboratory time), and the time from lab arrival to the initial use of devices to open the blocked artery (laboratory-to-balloon time). In Indonesia, factors such as population diversity, cultural beliefs, health literacy, and national insurance processes may affect D2B times. Understanding these components can help develop strategies to reduce delays. Understanding each component of D2B time and its contributing factors can aid physicians in developing effective strategies to reduce D2B delays.
The relationship between atrial myopathy with and without atrial fibrillation to cryptogenic stroke Kahadi, Cik; Rizal , Ardian; Rohman, Mohammad Saifur
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.9

Abstract

Background: Ischemic stroke is the second most common cause of mortality globally, with some cases classified as cryptogenic strokes (CS) where the cause is unknown. Traditionally, atrial fibrillation (AF) has been considered the primary cause of ischemic stroke, but recent clinical trials and the occurrence of CS have led to the concept of atrial myopathy (AM). AM not only serves as a substrate for AF, promoting thrombus formation, but also causes blood stasis in the atrium, resulting in stroke without AF. Objective: The relationship between AM with and without AF to CS incidences at Saiful Anwar Hospital, Malang was evaluated in this study. Methods: Retrospectively analyzed medical records of patients from January 2023 to December 2024. Univariate analysis for baseline characteristic, bivariate analysis with Chi square, t-test and Mann Whitney u-test and multivariate analysis for predictive model using logistic regression were used for determine the relationship among variable in this study. Result: 112 patients were included in this study. AM has a statistically significant (OR 31.762, 95% CI: 3.965-254.427, p=0.001) as a predictor of CS, but AF did not (OR: 1.666, 95% CI: 0.414-6.707, p=0.473). A better predictive value was achieved with CHA2DS2-VASC ≥2 combined with AM (OR 7.948, 95% CI: 2.628-24.034, p<0.001), compared with CHA2DS2-VASC ≥2 alone (OR 1.909, 95% CI: 0.651-5.598, p=0.239) or CHA2DS2-VASC ≥2 combined with AF and AM (OR 3.600, 95% CI: 0.985-13.159, p=0.050). Conclusion: Atrial myopathy with and without atrial fibrillation had association to increasing the risk of cryptogenic stroke. Combining AM with the CHA2DS2-VASC score can improve stroke cryptogenic risk prediction
Cardioprotective effects of colchicine: Targeting pyroptosis and inflammation in myocardial infarction Satrijo, Budi; Mohammad Saifur Rohman; Aulanni'am Aulanni'am; Hidayat Sujuti; Bayu Lestari; Rislan Faiz Muhammad
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.8

Abstract

Myocardial infarction (MI) is a significant contributor to global morbidity and mortality. The outcome of MI is associated with the inflammatory response triggered by ischemic or necrotic cells. Pyroptosis is a type of programmed cell death that can exacerbate cardiac injury following MI. This study reviewed the potential therapeutic effects of colchicine in regulating cardiac pyroptosis in response to MI. Primarily, colchicine inhibits tubulin polymerization and microtubule formation, disrupting inflammasome advancement and the subsequent secretion of various pro-inflammatory mediators. In particular, colchicine disrupts the NLRP3 inflammasome assembly process by blocking ASC recruitment into the complex, suggesting its potential to mitigate the inflammatory response related to cardiac pyroptosis. Additionally, colchicine binds to P2X7 receptors, reducing ATP-induced microtubule and pore formation, which attenuates reactive oxygen species and IL-1β production. A clinical trial involving colchicine showed positive outcomes in lowering the occurrence of major cardiovascular events in individuals with coronary artery disease (CAD). Nonetheless, additional studies are required to ascertain the ideal dosage, timing, and long-term effects of colchicine in the infarcted myocardium before it can be routinely recommended for post-MI treatment. In conclusion, colchicine's modulation of the inflammatory response and inhibition of pyroptosis highlight its potential as a cardioprotective agent for MI management.
Predicting lesion complexity in premature coronary artery disease: The utility of clinical risk scores Firdaus, Achmad Jauhar; Mohammad Saifur Rohman; Budi Satrijo; Cholid Tri Tjahjono; Anna Fuji Rahimah
Heart Science Journal Vol. 6 No. 3 (2025): Advancements in Cardiac Imaging : Unlocking New Perspectives on the Heart Visua
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.03.12

Abstract

Background: Premature coronary artery disease (PCAD) has been recognized as a significant global health issue, with its prevalence increasing due to earlier exposure to various risk factors. Emerging evidence suggests that PCAD may be as aggressive, if not more so, than in older populations. The clinical implications and angiographic characteristics for more aggressive management strategies remain poorly explored. Objectives: This study aims to develop and validate a clinical scoring system in predicting lesion complexity in patients with PCAD. Methods: A retrospective cohort study was conducted on 645 patients who underwent invasive coronary angiography (ICA) from January 2023 to December 2024 in Dr. Saiful Anwar General Hospital, East Java, Indonesia. Patients were divided into developmental (n = 322) and validation (n = 323) groups. Clinical information was gathered from medical records, including risk factors and angiographic results. Predictors of complex CAD (SYNTAX ≥ 33) were identified by multiple logistic regression analysis. A clinical scoring system was developed and validated. Results: This study found complex CAD in 252 (39.1%) of all PCAD patients. Smoking (OR 2.3; p 0.006), dyslipidemia (OR 2.8; p < 0.001), diabetes mellitus (OR 3.9; p < 0.001), history of previous myocardial infarction (OR 6.5; p < 0.001), and family history of CAD (OR 5.7; p < 0.001) were independent predictors of complex CAD. A clinical scoring system was developed with a cut-off score ≥ 4 predicting complex CAD, with an area under the curve (AUC) value of 0.836 (95% CI 0.791-0.880), sensitivity of 71.3%, and specificity of 85.0%. Conclusion: The PCAD population continues to represent a high-risk group of concern. While the short-term prognosis is optimistic, the long-term outlook for this cohort is less promising due to the high recurrence rate and prolonged complications, especially in individuals with complicated CAD, leading to impaired quality of life
Cardiovascular side effects and toxicity of lithium usage in adults: A systematic review of case reports and observational studies Rahmi, Koyuki Atifa; Khotimah, Husnul; Rohman, Mohammad Saifur
Heart Science Journal Vol. 6 No. 4 (2025): The Pursuit of Precision: Navigating Risks, Refining Diagnosis, and Securing Lo
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.04.7

Abstract

BACKGROUND: Lithium is a first-line treatment for Bipolar Affective Disorder, but it has a narrow therapeutic range and has been shown to have cardiovascular side effects. This study aimed to compile the cases of lithium-induced cardiovascular abnormalities and the pathological mechanisms behind those effects. OBJECTIVES: To conduct a systematic review of case reports in adult patients who experienced cardiovascular side effects of lithium in the last 11 years. METHODS: The PRISMA method was followed to search PubMed, Wiley Online Library, ResearchGate, Springer, Semantic Scholar, and Google Scholar databases for articles from January 2013 to June 2024 using combinations of 'lithium,' 'cardiac,' 'cardiovascular,' 'side effect,' 'patient,' and 'case.' Case reports and observational studies concerning lithium use were identified for cardiovascular side effects. RESULTS: Reported cardiovascular side effects of lithium included ECG abnormalities (N=31), myocarditis (N=1), cardiomyopathies (N=4), cardiac tamponade (N=1), thrombosis (N=1), and pulmonary hypertension (N=1). Lithium causes cardiovascular abnormalities via sodium channel blockage, interference with cardiac pacemaker cells, increased serum catecholamines and serotonin, disruption of thyroid gland functions, and induction of nephrogenic diabetes insipidus, leading to hemodynamic imbalance. CONCLUSION: Lithium precipitates cardiac side effects and toxicity through direct interference with the cardiac conduction system, disruption of metabolic hormones, and multi-organ interactions.
Ventricular Tachycardia Storm Management in Acute Cardiac Care: Prompt response to life-threatening conditions Lestari, Puspa; Anjarwani, Setyasih; Rohman, Mohammad Saifur; Rizal, Ardian
Heart Science Journal Vol. 4 No. 1 (2023): Optimizing Outcome in Acute Cardiac Care
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.01.7

Abstract

Background: Ventricular Tachycardia (VT) storm or electrical storm (ES) is defined as cardiac electrical instability and refers to the occurrence of three or more ventricular tachyarrhythmias (VT and or ventricular fibrillation (VF)) in a 24-hour period, or VT recurring soon (within five minutes) after termination of another VT episode, or sustained or no sustained VT with total ectopic beats greater than sinus beats in a 24-hour period. The frequency of VT storms varies on population. When ICDs are implanted for primary prevention (4 percent), it is lower than when they are implanted for secondary prevention (20 percent).Case Summary: We presented patient with Ventricular Tachycardia (VT) storm. A 63-year old woman was admitted to emergency room with chief complaint frequent episodes of palpitation. She was found to have monomorphic VT with unstable hemodynamic. Then she got cardioversion 100 Joule, continued with lidocaine drip and VT reverted to sinus rhythm. Patient admitted to cardiovascular care unit, but she had VT refractory. She got complete revascularization for coronary artery before, but the episodic of VT still occurred with cardiogenic shock (CS) and pulmonary edema. She got cardioversion, amiodarone iv and inotropes, then observed this patient at CVCU. After the condition stable, this patient was discharged and planned for ICD insertion at the next admission.Discussion: We discuss the various available treatment options for VT storm and practical challenges faced in management of hemodynamically unstable VT storm. Initial management involves identifying and correcting the underlying ischemia, electrolyte imbalances, or other inciting factors.
Idiopathic Pulmonary Arterial Hypertension Newly Diagnosed in Pregnancy with Anemia and Threatened Preterm Labor Harumsari, Stefani; Rahardjo, Bambang; Prasetyorini, Nugrahanti; Dwijayasa, Pande Made; Yogibuana, Valerinna; Rohman, Mohammad Saifur
Heart Science Journal Vol. 3 No. 4 (2022): Prevention, Screening dan Rehabilitation : The Back Bone of Quality Care Improv
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2022.003.04.7

Abstract

Background: Pulmonary hypertension (PH) is a rare cardiovascular disorder that leads to right heart failure (RHF). Although most PH occurs secondary to congenital heart disease (CHD), PH can occur primarily due to pulmonary arterial vasculature abnormalities, known as Idiopathic pulmonary arterial hypertension (IPAH). In addition, the physiologic changes during pregnancy can potentially lead to worsening PAH and confer a poor prognosis. Therefore, when the mother refuses termination, a multidisciplinary team should manage the pregnancy and delivery to improve maternal and fetal outcomes.Objectives: This case report aimed to describe the importance of early diagnosis and treatment in PAH.Case reports: We reported a case of a 24-year-old woman with idiopathic pulmonary arterial hypertension (IPAH) that was newly diagnosed at 25 weeks of pregnancy and previously misdiagnosed with patent ductus arteriosus (PDA). This pregnancy was complicated with anemia and threatened preterm labor. Sildenafil was used as a vasodilator to reduce the symptoms of PAH. Unfortunately, the pregnancy was terminated at 29 weeks because of PPROM after considering giving lung maturation and neuroprotectant to the fetus. The patient was discharged without complication, but the baby died after eight days of intensive care due to HMD II, which led to respiratory failure.Conclusion: PAH in pregnancy is a life-threatening condition if untreated. Continuous treatments can help control the symptoms and avoid further complications for both mother and baby.
Atrial Fibrillation Development Risk Associated with Metabolic Syndrome Alfata, Fandy Hazzy; Rizal, Ardian; Rohman, Mohammad Saifur; Rahimah, Anna Fuji
Heart Science Journal Vol. 4 No. 3 (2023): The Essensial Role of the Metabolic Syndrome in the Development of Cardiovascul
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.03.2

Abstract

Even in the absence of antecedent myocardial infarction or congestive heart failure, atrial fibrillation (AF) is the most frequent arrhythmia seen in daily practice. There are several important predisposing factors for the initiationof AF, including growing older, being a man, being female, having high blood pressure, and having cardiac and noncardiac illnesses. Metabolic syndrome (MS) contributes to the progression of AF through its impact on the atrial substrate. MS involves metabolic risk factors that increase the likelihood of atherosclerotic cardiovascular disease and type 2 diabetes. Insulin resistance plays a significant role in MS pathophysiology, leading to glucose and lipid metabolism dysregulation, increased inflammation, and neurohormonal activation. These processes contribute to the development of hypertension, a major risk factor for AF. Atrial remodeling, including electrical and structural changes, is a common substrate for AF, and MS components further contribute to this remodeling.Hypertension, a key feature of MS, is associated with structural, contractile, and electrical remodeling in the atria, increasing the risk of AF. The renin-angiotensin-aldosterone system, implicated in hypertension regulation, alsoinfluences the pathophysiology of AF through fibrosis, ion channel alterations, oxidative stress, and inflammation. Understanding the intricate interplay between MS and AF can provide insights into therapeutic strategies for managing these conditions and reducing cardiovascular risks.
Effect Of Combination Decafeinated Green Tea and Green Coffee In Reducing Cholesterol Levels In Patients With Metabolic Syndrome Alfata, Fandy Hazzy; Rohman, Mohammad Saifur; Astiawati, Tri; Tjahjono, Cholid Tri; Martini, Heny
Heart Science Journal Vol. 4 No. 3 (2023): The Essensial Role of the Metabolic Syndrome in the Development of Cardiovascul
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.03.4

Abstract

Background: Green tea and green coffee are natural ingredients that improve cholesterol levels. Combining the two in experimental animal studies provides more significant benefits when compared to single administration in reducing cholesterol levels.Objective: This study aimed to determine the effect of decaffeinated green tea and green coffee as adjuvant treatments in reducing blood cholesterol levels.Methods: This randomized controlled trial included 90 metabolic syndrome patients determined according to the IDF criteria for Asian people aged 50–70. All subjects received atorvastatin 20 mg and were divided into three groups. Participants in Group 1 received decaffeinated green tea and green coffee 2.5 grams twice daily, Group 2 received 5 grams daily, and Group 3 received a placebo. The total cholesterol, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), and triglyceride levels were measured at the beginning and the end of the study.Results: At 90 days, after administration of the extract of decaffeinated green tea and green coffee, we found that the concentration of total cholesterol in Group 1 and Group 2 was significantly reduced compared to the placebo (-50 ± 6.1 vs. -62.8 ± 5.9 vs. -22.5 ± 5.8 mg/dL; p= <0.05). But there was no significant difference in reduction of total cholesterol levels between the first and second groups. The other parameters also decreased, but not significantly compared to the placebo group.Conclusion: Administration of a combination of decaffeinated green tea extract and green coffee as an adjunctive therapy can reduce the average total  cholesterol, LDL, HDL, and triglyceride levels more than placebo, but only total cholesterol has a significant difference compared to other cholesterol  components.
Early Management of Shock Condition in STEMI Patient Nugraha, Yudha Tria; Anjarwani, Setyasih; Satrijo, Budi; Rohman, Mohammad Saifur
Heart Science Journal Vol. 4 No. 3 (2023): The Essensial Role of the Metabolic Syndrome in the Development of Cardiovascul
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.03.9

Abstract

Background: Acute myocardial infarction is one of the emerging cardiovascular events worldwide. Infarcts of the inferior wall were present between one-third and half of the patients with RV involvement. The worse outcome was strongly associated with cardiogenic shock, and 7% of cases were caused by RV failure.Objective: This study aimed to describe the diagnosis and management of cardiogenic shock in STEMICase presentation: A male in his 40s was brought to our hospital 12 hours after the onset of persistent epigastric pain. He had a history of hypertension and a family history of diabetes Mellitus. Diagnostic procedures included blood tests, ECG, X-rays, coronary angiogram, and echocardiography. He underwent PCI to implant DES in his proximal RCA, which had 100% occlusion. The patient was admitted to the intensive cardiovascular care unit for 30 hours and died due to various complications.Conclusion: Current case was very complicated and seriously life-threatening. After acute myocardial infarction, Important problems kept coming up one after the other, and they all affected each other. Patients with cardiogenic shock must be found quickly and treated quickly and aggressively.
Co-Authors Achmad Rudijanto Adhika Prastya Wikananda Adi, Andi Wahjono Aditha Satria Maulana Ahsan Ahsan Ainan, Shafa Akbar, Naufal Zulfikar Alfata, Fandy Hazzy Anditri Weningtyas Anita Surya Santoso Anjarwani, Setyasih Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Annisa Hasanah Ardhani Galih Prakoso Ardhino, Ardhino Ardian Rizal Ardian Rizal Ardian Rizal Arief Wibisono Arif Wicaksono Arina Madjidi Ashari, Yordan Wicaksono Astiawati, Tri Aulanni'am Aulanni'am Ayu Asri Devi Ayu Asri Devi Adityawati Aziz, Indra Jabbar Bagus H Kuncahyo Bahar, Mokhamad Aswin Bambang Kusbandono Bambang Rahardjo Bayu Aji Bayu Lestari Budi Satrijo Budi Satrijo Budi Satrijo Caesario, Fahreza Cholid Tri Tjahjono Cholid Tri Tjahjono Cholid Tri Tjahjono Candra Chomsy, Indah Nur Citra Tarannita Dadang Hendrawan Dea Arie Kurniawan Dedy Irawan Dhani, Fauzan Kurniawan Dian Nugrahenny Dian Nugrahenny Djanggan Sargowo Djanggan Sargowo Djanggan Sargowo Djanggan Sargowo Djanggan Sargowo Djanggan Sargowo Djanggan Sargowo Dwi Adi Nugroho Dwi Adi Nugroho Dwi Adi Nugroho Dwi Sarbini Dwigustiningrum, Nur Kaputrin Efris Kartika Sari, Efris Kartika Endah Kusuma Rastini Evit Ruspiono Fahmi Rusnanta Fahmy Rusnanta Fahmy Rusnanta Fajar, Jonny Karunia Fandy Hazzy Alfatta Faris Wahyu Nugroho Filano, Marco Firdaus, Achmad Jauhar Firdaus, Dylan Hanny Fitranti Suciati Laitupa Ghazyarda Aqilah Setya H Hendarto Harumsari, Stefani Haryati, Lina Hendrawati Hendrawati Heny Martini Hidayat Sujuti Hikmawan Wahyu Sulistomo Hose, Victor Alvianoes Guterez Husnul Khotimah Ika Setyo Rini Ikhwan Handirosiyanto Imelda Krisnasari Imelda Krisnasari Indra Prasetya Indra Prasetya Indra Prasetya Inggita Kusumastuty Irma Kamelia Pratiwi Kahadi, Cik Karolina, Wella Krishna Ari Nugraha Kuhn, Corinna Maria Kurnianingsih, Novi KURNIAWAN, ARY Laitupa, Fitranti Suciati Laukkanen, Noora Julia Lenny Kartika Lestari, Puspa Liemena Harold Adrian Lowry Yunita Lukitasari, Mifetika Martini, Heny Maulidiyatun Nuril Faizah Mifetika Lukitasari Mifetika Lukitasari Mifetika Lukitasari Mifetika Lukitasari Millisani, Hayla Iqda Mohammad Aris Widodo Muchammad Dzikrul Haq Karimullah Muhamad Bayu Aji Muhammad Rizki Fadlan Muhammad Rizki Fadlan Muhammad Rizki Fadlan Nashi Widodo Nashi Widodo Noverike, Nikhen Novi Kurnianingsih Novi Kurnianingsih Novi Kurnianingsih Nugraha, Krishna Ari Nugraha, Yudha Tria Nugrahanti Prasetyorini Nugroho, Ira Vori Nur Ida Panca Nugraheini Nur Ida Panca Nugrahini Nur Permatasari Oktafin Srywati Pamuna Olivia Handayani Olivia Handayani Pamuna, Oktafin Srywati Pande Made Dwijayasa Pawik Supriadi Pawik Supriadi Purbaningroom, Dian Laila Putri Annisa Kamila Putri Annisa Kamila Putri, Valerinna Yogibuana Swastika Rahimah, Anna Fuji Rahma, Oktivani Adelathifa Rahmi, Koyuki Atifa Ratih Kusuma Wardani Ratna Pancasari Ratna Pancasari Renny Suwarniaty Rislan Faiz Muhammad Riswati, Harnanik Puji Riza, Mochamad Faishal Rizal , Ardian Rizal, Ardian Rochmawati, Icmi Dian Rohman, Ibrahim Abdur Sakti, Pradhika Perdana Salvatore Di Somma Sasmojo Widito Satrijo, Budi Seprian Widasmara Setiawan, Dion Setyasih Anjarwani Setyasih Anjarwani Setyowati, Danti Utami Suprayoga, Imam Mi'raj Suryanto Taufieq Ridlo Makhmud Taufiq Nur Budaya Teguh Aryanugraha Teguh Wahyu Sardjono Titi A W Tonny Adriyanto Veny Kurniawati Veny Kurniawati Wella Karolina Widito, Sasmojo Widodo Nashi Widodo Widodo Wikananda, Adhika Prastya Wira Kimahesa Anggoro Wira Kimahesa Anggoro Wiwit Nurwidyaningtyas, Wiwit Yoga Waranugraha Yoga Waranugraha Yoga Waranugraha Yogibuana, Valerinna Yoseph Budi Utomo Yusuf Arifin Zhao, Zihan