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THE DIFFERENCE IN TOTAL IMMUNOGLOBULIN E LEVELS AND EOSINOPHIL COUNTS AMONG ELDERLY INDIVIDUALS WITH AND WITHOUT ALLERGIC DISEASES Mulyana, Roza; Rio, Yugo Berri Putra; Raveinal, Raveinal; Martini, Rose Dinda; Harun, Harnavi; Asir, Taufik Rizkian; Fadrian, Fadrian; Murni, Arina Widya
Media Penelitian dan Pengembangan Kesehatan Vol. 35 No. 4 (2025): MEDIA PENELITIAN DAN PENGEMBANGAN KESEHATAN
Publisher : Poltekkes Kemenkes Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.34011/jmp2k.v35i4.3114

Abstract

Penyakit alergi dapat terjadi pada lansia dengan gejala yang dapat memburuk akibat adanya proses imunosenesens. Kadar IgE total dan jumlah eosinofil dapat digunakan sebagai pemeriksaan tambahan untuk penyakit alergi. Penelitian ini bertujuan untuk mengetahui perbedaan kadar IgE total dan jumlah eosinofil pada lansia dengan dan tanpa penyakit alergi. Penelitian observational analitik ini dilakukan pada lansia usia 60-80 tahun di RSUP DR. M. Djamil Padang selama Januari–Juni 2024. Sampel dikelompokkan menjadi kelompok lansia dengan penyakit alergi dan kelompok lansia tanpa penyakit alergi. Pengambilan sampel dilakukan secara consecutive sampling, melibatkan 52 partisipan (masing-masing 26 dengan dan tanpa penyakit alergi).  Kadar IgE total dan jumlah eosinofil diperiksa dengan menggunakan sampel darah vena. Analisis data menggunakan uji Mann-Whitney. Hasil penelitian menunjukkan median kadar IgE total pada kelompok alergi sebesar 1.741,1 kIU/L (minimum 517,7 kIU/L; maksimum 4843 kIU/L), sedangkan kelompok non-alergi 177,1 kIU/L (minimum 14 kIU/L; maksimum 800 kIU/L). Median jumlah eosinofil pada kelompok alergi sebesar 378 sel/µL (min: 100; maks: 950), sedangkan kelompok non-alergi 61,5 sel/µL (min: 17; maks: 189). Terdapat perbedaan signifikan kadar IgE total dan jumlah eosinofil antara lansia dengan dan tanpa penyakit alergi (p<0,001). Lansia yang mengalami Alergi menunjukkan kadar IgE  dan jumlah eosinofil lebih tinggi dibandingkan lansia yang tidak  alergi.  
STUDI KOMPARATIF GAYA HIDUP, STATUS ANEMIA DAN POLA MAKAN PADA PENDERITA PENYAKIT GINJAL KRONIS (PGK) Rusdi, Faza Yasira; Harun, Harnavi; Mufidah, Athasya Aulia; Alyu, Hanifa
Jurnal Kesehatan Medika Saintika Vol 16, No 2 (2025): Desember 2025
Publisher : Stikes Syedza Saintika Padang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30633/jkms.v16i2.30586

Abstract

Penyakit Ginjal Kronis (PGK) ditandai dengan penurunan kerja ginjal yang berlangsung secara progresif. Prevalensi dan tingkat kematian yang disebabkan oleh PGK mengalami peningkatan setiap tahun. Kejadian PGK yang meningkat dan perkembangan penyakit yang semakin cepat sering dikaitkan dengan berbagai faktor risiko gaya hidup dan pola makan. Studi ini bertujuan untuk melihat perbandingan gaya hidup, status anemia, dan pola makan antara kelompok pre-dialisis dan hemodialisis. Desain penelitian adalah cross-sectional yang melibatkan 27 penderita PGK pre-dialisis dan 50 penderita PGK hemodialisis di RSUP M. Djamil Padang. Data yang dikumpulkan adalah gaya hidup (kebiasaan merokok dan aktivitas fisik), status anemia, dan pola makan (kepatuhan diet asupan protein). Pengumpulan data pola makan dilakukan menggunakan kuesioner food recall. Data dianalisis menggunakan SPSS dengan uji chi-square dan fisher’s exact test dengan signifikansi p < 0.05. Sebagian besar subjek memiliki kebiasaan tidak merokok, aktivitas fisik yang ringan, anemia dan tidak patuh terhadap rekomendasi diet asupan protein. Tidak ada perbedaan kebiasaan merokok dan aktivitas antara kelompok pre-dialisis dan hemodialisis. Namun, terdapat perbedaan status anemia dan kepatuhan diet protein pada kedua kelompok. Intervensi dengan pendekatan holistic dapat diberikan dalam bentuk edukasi gizi terhadap gaya hidup dan peningkatan kepatuhan diet.
Management of Iodine Contrast Media Related Anaphylactic Shock following Renal Arteriography: A Rare Case Report Kino, Kino; Karmia, Rofila Dita; Harun, Harnavi
Sciences of Pharmacy Volume 5 Issue 1
Publisher : ETFLIN

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58920/sciphar0501429

Abstract

Background, anaphylactic shock (AS) caused by iodinated contrast media (ICM) is a rare but potentially life-threatening immediate hypersensitivity reaction. Despite widespread use of ICM in diagnostic imaging, data on ICM-related AS are limited, particularly in Indonesia. Early recognition and timely intervention are crucial to reduce morbidity and mortality. Case presentation, a 28-year-old female underwent renal arteriography with iodixanol. Within 5 minutes of contrast administration, she developed a generalized pruritic rash, dyspnea, vomiting, hypotension, and unstable cardiac parameters. Clinical presentation confirmed iodixanol-induced anaphylactic shock. Management, initial management included intramuscular epinephrine, rapid intravenous fluids, intravenous antihistamines and corticosteroids, and norepinephrine infusion. The patient’s hemodynamic status stabilized, and she was monitored in the CVCU for 48 hours. Outcome and conclusion, the patient recovered fully without complications. This case emphasizes the importance of rapid recognition and prompt pharmacologic intervention in ICM-induced anaphylaxis, while highlighting the value of thorough allergy documentation and preventive counseling.
OPTIMALISASI LAYANAN KESEHATAN IBU DAN ANAK MELALUI PROGRAM TANGGAP BENCANA HIDROMETEOROLOGI PADA MASYARAKAT TERDAMPAK BANJIR BANDANG DI KABUPATEN AGAM Rinita Amelia; Ira Suryanis; Dessy Abdullah; Yudha Endra Pratama; Harnavi Harun; Sari Setiarini; Afrah Diba Faisal
Nusantara Hasana Journal Vol. 5 No. 7 (2025): Nusantara Hasana Journal, December 2025
Publisher : Yayasan Nusantara Hasana Berdikari

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59003/nhj.v5i7.1807

Abstract

Hydrometeorological disasters such as flash floods significantly impact access to and quality of health services, particularly for vulnerable groups such as pregnant women, postpartum mothers, breastfeeding mothers, infants and toddlers. Agam Regency, West Sumatra, is one of the areas affected by flash floods, with the risk of disruption to maternal and child health services. This Community Service (PKM) activity aims to optimize maternal and child health services through a hydrometeorological disaster response program for communities affected by flash floods in Agam Regency. The activity uses a descriptive-participatory approach, implemented through preparation, implementation, monitoring, and evaluation. The activities include comprehensive midwifery services, health services, maternal and child health education, and basic psychosocial support. The results of the activity indicate that the PKM program can improve access to maternal and child health services and achieve a high level of participant satisfaction. This activity is considered beneficial and appropriate to the needs of disaster-affected communities. This program is expected to become a model of applicable and sustainable community service in supporting maternal and child health services in hydrometeorological disaster situations.
Korelasi Kadar Serum VEGF-A dengan Rasio Albumin-Kreatinin Urin pada Pasien Penyakit Ginjal Diabetik Syaiful, Hannie Q; Priyono, Drajad; Harun, Harnavi; Murni, Arina W; Hanif, Akmal M; Faheri, Eifel; Arnelis, Arnelis; Yoga, Vesri
Jurnal Penyakit Dalam Indonesia Vol. 12, No. 4
Publisher : UI Scholars Hub

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Introduction. Diabetic kidney disease (DKD) is a major microvascular complication of diabetes mellitus, characterized by persistent albuminuria and a progressive decline in glomerular filtration rate (GFR), making it a leading cause of chronic kidney disease (CKD) and end-stage renal disease. Vascular endothelial growth factor-A (VEGF-A) is implicated in the pathogenesis of DKD, being overexpressed in the kidneys and contributing to increased vascular permeability, inflammation, and fibrosis. Albuminuria, an early indicator of renal damage in DKD, is a strong predictor of CKD progression and cardiovascular events. The urine albumin-to-creatinine ratio (UACR) is the recommended test for detecting and monitoring albuminuria. This study aimed to investigate the correlation between serum VEGF-A levels and UACR in patients with DKD. Methods. This cross-sectional analytical observational study involving DKD patients at the Outpatient Clinic of Dr. M. Djamil General Hospital Padang from May to October 2024. Demographic and clinical data were collected. Blood samples were taken for serum VEGF-A measurement using ELISA, and morning spot urine samples were collected for UACR measurement using immunoturbidimetry. Correlation analysis was performed using the Spearman test. Ethical approval was obtained from the Health Research Ethics Committee of Dr. M. Djamil General Hospital Padang. Results. A total of 30 PGD patients were included in the study. The mean age was 61.9 years (SD 9.75), and 53.3% of the participants were male.The mean serum VEGF-A level in DKD patients was 131.34 (SD 83.9) pg/ml, and the mean UACR was 403.90 (SD 53.1) mg/g creatinine. There was a very strong positive correlation between serum VEGF-A levels and UACR (r = 0.993, p < 0.05). Conclusions. Serum VEGF-A levels are very strongly and positively correlated with UACR in DKD patients. Serum VEGF-A may serve as a potential marker for assessing DKD progression and risk of complications, as well as a potential therapeutic target.
The Uncoupling Phenomenon: Dissociation Between Albuminuria and Glomerular Filtration Rate in an Advanced Diabetic Kidney Disease Phenotype Naufal Fathi Ashari; Harnavi Harun; Russilawati; Dinda Aprilia; SM Rezvi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1521

Abstract

Background: The classical paradigm of diabetic kidney disease (DKD) assumes a synchronous, linear trajectory where increasing albuminuria predicts the decline of glomerular filtration rate (GFR). However, emerging epidemiology suggests these markers may dissociate in advanced disease stages, particularly under modern renoprotective pharmacotherapy. We aimed to investigate this uncoupling phenomenon by evaluating the correlation between urine albumin creatinine ratio (UACR) and estimated GFR (eGFR) in a specific cohort of advanced DKD patients in Indonesia. Methods: We conducted a cross-sectional analytic study from January to November 2025 at Dr. M. Djamil General Hospital Padang, a tertiary referral center. The study population comprised 30 patients with established DKD, predominantly in CKD Stages 3b and 4. The primary outcome was the Spearman rank correlation (r) between UACR and eGFR, reported with 95% Confidence Intervals (CI). An exploratory sub-analysis compared trends in patients receiving SGLT2 inhibitors (n=12) versus standard care (n=18). Results: The cohort was elderly (mean age 61.93 years) with critical renal reserve depletion (median eGFR 32.50 mL/min/1.73 m²). Median UACR was 403.90 mg/g, yet exhibited massive heterogeneity (IQR: 170.82–1779.27). Spearman analysis revealed a complete lack of linear correlation between albuminuria and filtration function (r = 0.041; 95% CI: -0.322 to 0.395; p = 0.830). While SGLT2 inhibitor users (n=12) demonstrated numerically lower median UACR than non-users (n=18), the dissociation from eGFR persisted in both subgroups. Conclusion: We demonstrate a distinct dissociation between albuminuria severity and filtration function in advanced DKD. This uncoupling suggests that in late-stage nephropathy, structural glomerulosclerosis and tubulointerstitial fibrosis progress independently of permeability changes. Consequently, albuminuria cannot serve as a sole surrogate for disease progression in this phenotype, supporting a dual-biomarker strategy where UACR and eGFR are monitored as independent risk factors.
The Uncoupling Phenomenon: Dissociation Between Albuminuria and Glomerular Filtration Rate in an Advanced Diabetic Kidney Disease Phenotype Naufal Fathi Ashari; Harnavi Harun; Russilawati; Dinda Aprilia; SM Rezvi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1521

Abstract

Background: The classical paradigm of diabetic kidney disease (DKD) assumes a synchronous, linear trajectory where increasing albuminuria predicts the decline of glomerular filtration rate (GFR). However, emerging epidemiology suggests these markers may dissociate in advanced disease stages, particularly under modern renoprotective pharmacotherapy. We aimed to investigate this uncoupling phenomenon by evaluating the correlation between urine albumin creatinine ratio (UACR) and estimated GFR (eGFR) in a specific cohort of advanced DKD patients in Indonesia. Methods: We conducted a cross-sectional analytic study from January to November 2025 at Dr. M. Djamil General Hospital Padang, a tertiary referral center. The study population comprised 30 patients with established DKD, predominantly in CKD Stages 3b and 4. The primary outcome was the Spearman rank correlation (r) between UACR and eGFR, reported with 95% Confidence Intervals (CI). An exploratory sub-analysis compared trends in patients receiving SGLT2 inhibitors (n=12) versus standard care (n=18). Results: The cohort was elderly (mean age 61.93 years) with critical renal reserve depletion (median eGFR 32.50 mL/min/1.73 m²). Median UACR was 403.90 mg/g, yet exhibited massive heterogeneity (IQR: 170.82–1779.27). Spearman analysis revealed a complete lack of linear correlation between albuminuria and filtration function (r = 0.041; 95% CI: -0.322 to 0.395; p = 0.830). While SGLT2 inhibitor users (n=12) demonstrated numerically lower median UACR than non-users (n=18), the dissociation from eGFR persisted in both subgroups. Conclusion: We demonstrate a distinct dissociation between albuminuria severity and filtration function in advanced DKD. This uncoupling suggests that in late-stage nephropathy, structural glomerulosclerosis and tubulointerstitial fibrosis progress independently of permeability changes. Consequently, albuminuria cannot serve as a sole surrogate for disease progression in this phenotype, supporting a dual-biomarker strategy where UACR and eGFR are monitored as independent risk factors.
Associated Factors with Erectile Dysfunction in Hemodialysis Patients at Dr. Reksodiwiryo Hospital Padang Vidiansyah, Achmad; Putra, Mindy Pasuma; Veronike, Evelin; Harun, Harnavi
Indonesian Journal of Kidney and Hypertension Vol 2 No 3 (2025): Volume 2 No. 3, December 2025
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32867/inakidney.v2i3.218

Abstract

Background: Erectile dysfunction (ED) is a common condition affecting a significant number of men worldwide, with its prevalence particularly high among patients with chronic kidney disease (CKD). Objective: This study aims to investigate the association between ED and CKD in patients undergoing hemodialysis. Methods: This study used a survey approach, designed with cross-sectional involving 24 male patients undergoing hemodialysis at the hospital from January to July 2024. Data were gathered using the IIEF-5 questionnaire as well as patient records. The severity of ED was classified based on IIEF-5 scores, and data analysis was conducted using SPSS. Results: Most respondents (58.3%) were under 60 years old, with 58.3% having hemoglobin levels below 10 g/dL and 79.2% with a KT/V ratio under 1.8. ED prevalence was high at 95.8%, with severe ED affecting 54.2%. A significant correlation existed between KT/V and ED severity p<0.05, while hemoglobin levels showed no significant association p>0.05. The high prevalence of ED in CKD patients undergoing hemodialysis highlights the importance of regular screening and early intervention. The study indicates that sufficient hemodialysis, as measured by the Kt/V ratio, could be essential in reducing the severity of ED in this group. However, hemoglobin levels did not show a significant connection to ED severity, which contrasts with certain earlier research findings. Conclusion: Erectile dysfunction is common among CKD patients undergoing hemodialysis, with insufficient dialysis being a key contributing factor. This highlights the need to maintain adequate dialysis to reduce the severity of ED in these individuals.
Diagnostic Value of Proenkephalin A 119 – 159 Serum in Early Detection of Sepsis Associated Acute Kidney Injury Wahyudi, Adefri; Priyono, Drajad; Harun, Harnavi; Viotra, Deka; Najirman, Najirman; Kurniati, Roza; Simajuntak, Rohayat Bilmahdi; Murni, Arina Widya
Indonesian Journal of Kidney and Hypertension Vol 3 No 1 (2026): Vol 3 No 1 (2026): Volume 3 No. 1, April 2026
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32867/inakidney.v3i1.239

Abstract

Background: Sepsis asscociated acute kidney injury (SA-AKI) is common condition that found in sepsis. Due to the lack of creatinine serum, this condition possibly makes therapy delayed. Proenkephalin A 119-159 (PENK) is a breakdown product of the prohormone proenkephalin A which freely filtered at the glomerulus. In other hand, this prohormone and its receptor predominantly expressed in proximal Tubular Epythelial Cells (pTEC) of kidney. Elevated serum PENK levels are an indicator of AKI. However, previous studies have shown varies results. Objectives: This study aims to determine early detection biomarkers for the presence of AKI in sepsis. Methods: This diagnostic test was conducted at Dr. M. Djamil General Hospital Padang in sepsis patients. The diagnosis of AKI was established based on the 2012 KDIGO criteria. Results: The study involved 98 sepsis patients, 58.16% (n=57) of them experienced AKI. Serum creatinine levels at admission and within 48 hours of hospitalization were 1.0 (IQR 0.8–1.5) mg/dl and 1.6 (IQR 0.9–2.1) mg/dl, respectively. A serum PENK level ≥82.6 pmol/L at admission had sensitivity of 98.6%, specificity of 95.1%, positive predictive value of 96.1%, negative predictive value of 97.5%, and accuracy of 96.9% in early detection of AKI in sepsis. Conclusion: Serum PENK level has excellent diagnostic value in early detection of AKI in sepsis.
Comparative Prognostic Value of Podocyturia Versus Microalbuminuria in Predicting Diabetic Nephropathy Progression: A Meta-Analysis Bayu Arief Hartanto; Deka Viotra; Harnavi Harun; Drajad Priyono
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 5 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i5.1578

Abstract

Background: Diabetic nephropathy represents the primary etiology of end-stage renal disease globally. Historically, clinical practice relied upon microalbuminuria as the definitive non-invasive biomarker for early detection. However, advanced histopathological evidence establishes that severe structural degradation of the glomerular filtration barrier, specifically the visceral epithelial cells known as podocytes, occurs significantly earlier than the clinical manifestation of microalbuminuria. Podocyturia, defined as the urinary excretion of intact podocytes and podocyte-specific proteins or messenger RNA, emerged as a direct indicator of active glomerular injury. This meta-analysis investigated the comparative prognostic value of podocyturia versus microalbuminuria in predicting the longitudinal progression of diabetic nephropathy. Methods: A systematic literature search was executed to identify comparative clinical studies evaluating both podocyturia and microalbuminuria in diabetic cohorts. Seven essential manuscripts met rigorous inclusion criteria. Following peer-review recommendations, statistical pooling was strictly stratified by study design. Data extraction focused on prognostic effect sizes in longitudinal cohorts and diagnostic effect sizes in cross-sectional cohorts. Statistical synthesis utilized DerSimonian-Laird random-effects models to calculate pooled Standardized Mean Differences and 95% confidence intervals. Results: Synthesized data demonstrated podocyturia possessed a significantly superior prognostic value compared to microalbuminuria. In longitudinal cohorts, the pooled Standardized Mean Difference for podocyturia predicting progression was 1.95 (95% CI: 1.50 to 2.40, p < 0.001), whereas microalbuminuria was 0.58 (95% CI: 0.25 to 0.91, p = 0.04). Cross-sectional data similarly demonstrated massive podocyte biomarker elevation in strictly normoalbuminuric patients. Conclusion: Podocyturia represents a substantially more accurate, sensitive, and temporally earlier prognostic biomarker for diabetic nephropathy progression than microalbuminuria. Incorporating podocyte-specific urinary quantification into routine clinical practice could fundamentally alter early therapeutic intervention strategies, shifting the focus toward arresting primary podocyte detachment.
Co-Authors -, Sari Setiarini Abdul Alim Rahimi Abdul Alim Rahimi Ade Asyari Ade Sukma Ade Teti Vani Afdhol Falah Afrah Diba Faisal Ajat Sudrajat Akmal M Hanif Alexander Kam Alexander Kam Alexander Kam Alvarino Alvarino Alyu, Hanifa Amelia, Rinita Anandia Putriyuni Andikha Putra Annesa Fadella Arief Rinaldy Arina Widya Murni Arnelis Arnelis Asir, Taufik Rizkian Athif Abyaz Khalil Putra ayu pathya Bayu Arief Hartanto Dasman, Hardisman Deddy Canceria Suka Rahmatsyah Deka Viotra Deka Viotra Dela Hangri Jalmas Dessy Abdullah Dewi, Amelia Fitria Dian Puspita Diana Melida Dinda Aprilia Dional Setiawan Drajad Priyono Drajad Priyono Drajad Priyono Eryati Darwin Evelin Veronike Evelin Veronike Fadrian, Fadrian Faheri, Eifel Fauzar Fauzar Fauzar Fauzar Fauzar, Fauzar Febrianti Ika Kurnia Finny Fitry Yani Genta Pradana gina ariani Hannie Qalbina Syaiful Hardisman Dasman Husna Yetti Ilmiawati Ilmiawati, Ilmiawati Indra, Syarif Indrapriyatna, Ahmad Syafruddin Ira Suryanis Irena Fathin Amelia Jalmas, Dela Hangri Jersivindo Ranazeri Jersivindo Ranazeri Kam Alexander Kam, Alexander Karmia, Rofila Dita Khairat AS Khairil Faiz Amir Kino Kino Miftah Irramah Mufidah, Athasya Aulia Murni, Arina W Nadia Purnama D Najirman, Najirman Naufal Fathi Ashari Nur Indrawaty Lipoeto Pratama, Yudha Endra Priyono, Drajad Putra, Mindy Pasuma Putri Lisna Radias Zasra Radias Zasra Rangga Lunesia Rapida Saragih RAVEINAL RAVEINAL Restu Susanti Rezki Sadeli Rini Yulia Rinita Amelia Rinita Amelia Rivai, Muhammad Iqbal Rizkianto Imannual Rose Dinda Martini Roslaini Roslaini Roza Kurniati Roza Kurniati Roza Kurniati Roza Kurniati Roza Mulyana Ruhsyahadati Ruhsyahadati Ruhsyahadati, Ruhsyahadati Rusdi, Faza Yasira Russilawati Selfi Renita Rusjdi Siana, Yusti Simajuntak, Rohayat Bilmahdi Sjaaf Fidiariani SM Rezvi Sofiani, Dinda Putri Sri Puji Rahayuningsih Suchitra, Avit Syaiful Azmi Syaiful Azmi Syaiful Azmi Syaiful Azmi Syaiful, Hannie Q Veronike, Evelin Vesri Yoga Vidiansyah, Achmad Wahyudi, Adefri Yanuar Surya Saputra Poedjijo Yerizal Karani Yudha E. Pratama Yudha Endra Pratama Yugo Berri Putra Rio Yuliarni Syafrita Yulistia Asmi Yusti Siana Zaki Mahmudi Dasril Zaki Mahmudi Dasril Zaki Mahmudi Dasril