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MADE RATNA SARASWATI .
Bagian Ilmu Penyakit Dalam RSUP Sanglah, Fakultas Kedokteran Universitas Udayana
Biochemistry, Genetics & Molecular Biology Decision Sciences, Operations Research & Management Earth & Planetary Sciences Economics, Econometrics & Finance Environmental Science Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Public Health Social Sciences

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Glycated Albumin Sebagai Penanda Kontrol Glikemik Pada Penderita Diabetes Melitus Tipe 2 Ake, Anselmus; Saraswati, Made Ratna; Widiana, I Gde Raka
Jurnal Penyakit Dalam Udayana Vol 1 No 1 (2017): JPD Vol. 1 No.1 2017
Publisher : PAPDI BALI

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Abstract

Latar Belakang: Glycated albumin (GA) merupakan indeks kontrol glikemik yang relatif baru. GA mencerminkan statusglukosa darah yang lebih pendek dibandingkan HbA1C, yakni 2-4 minggu sebelumnya. Tujuan: untuk mengetahuiapakah GA dapat digunakan sebagai penanda kontrol glikemik pada penderita DM tipe 2 (DMT2) dengan mencarisensitivitas, spesifisitas, nilai duga positif (NDP), dan nilai duga negatif (NDN) dari GA. Metode: Penelitian inimerupakan uji diagnostik, studi potong lintang, dilaksanakan di RSUP Sanglah dari Desember 2015 hingga Februari2016 menggunakan sampel 59 pasien DMT2. Kontrol glikemik ditentukan dengan HbA1C, glukosa puasa dan glukosa2JPP (baku emas). Hasil: Didapatkan area under ROC curve GA adalah 0,9135 (91,35%). Didapatkan 5 cut off point GAdimana 2 cut off point menunjukkan kemampuan skrining GA yakni ≥18,7% dan ≥19%, 2 cut off point menunjukkankemampuan diagnostik GA yakni ≥21,4% dan 22,4%, dan 1 cut off point optimal yakni 20,4%. Hasil uji diagnostikdengan menggunakan tabel silang 2x2 pada masing-masing cut off point yaitu GA ≥18,7% sensitivitas 94,7%;spesifisitas 76,2%; NDP 87,8%; NDN 88,9%. GA ≥19% sensitivitas 89,5%; spesifisitas 81%; NDP 89,5%; NDN 81%. GA ≥20,4% sensitivitas 81,6%; spesifisitas 85,7%; NDP 91,2%; NDN 72%. GA ≥21,4% sensitivitas 76,3%; spesifisitas 90,5%;NDP 93,5%; NDN 67,9%. GA ≥22,4% sensitivitas 63,2%; spesifisitas 95,2%; NDP 96%; NDN 58,8%. Berdasarkan ujikorelasi, terdapat hubungan positif kuat antara GA dengan HbA1C, GA dengan glukosa puasa dan GA dengan glukosa2JPP. Kesimpulan: Pemeriksaan GA darah dapat digunakan sebagai modalitas diagnostik dalam menilai kontrolglikemik pada penderita DMT2.
Hubungan Obesitas Pada Orangtua Dengan Terjadinya Obesitas Pada Anak Remaja SMA Di Kota Denpasar, Provinsi Bali Gozali, Theodorus Onesiforus; Saraswati, Made Ratna
Jurnal Penyakit Dalam Udayana Vol 1 No 1 (2017): JPD Vol. 1 No.1 2017
Publisher : PAPDI BALI

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Tujuan: Studi ini bertujuan melakukan pencarian prevalensi obesitas orangtua, anak, serta hubungan obesitas orangtua terhadap obesitas anak remaja sekolah menengah atas (SMA) di Denpasar tahun 2015. Metode: Penelitian observasional ini memiliki rancangan studi potong lintang dengan melakukan pengambilan data anak sekolah menengah atas dibeberapa sekolah di Denpasar. Secara acak dipilih sampel yang dapat mewakili Denpasar. Kuesioner dibagikan dan diminta untuk diisi oleh siswa-siswi. Dilanjutkan dengan pengukuran berat badan, tinggi badan, lingkar pinggang, maupun lingkar lengan atas. Pengukuran dilakukan pada siswa-siswi maupun kedua orangtuanya. Hasil: Dari 298, 188 (63,09%) yang dapat diambil menjadi data. Prevalensi obesitas orangtua 40,96% dan obesitas anak sekolah menengah atas 15,4%, di Denpasar tahun 2015. Analisis data menunjukkan bahwa terdapat hubungan antara status nutrisi atau gizi ibu ditinjau dari indeks massa tubuh dengan lingkar pinggang atau lingkar lengan atas terhadap status gizi anak sekolah menengah atas di Denpasar. Hubungan dari status gizi pada jumlah orangtua obesitas berdasarkan indeks massa tubuh dengan status gizi pada anak sekolah menengah atas di Denpasar pada 2015 juga ditemukan, nilai p < 0,05. Simpulan: Terdapat hubungan obesitas orangtua ditinjau dari indeks massa tubuh terhadap obesitas anak sekolah menengah atas di Denpasar pada tahun 2015. Adanya kelemahan di dalam penelitian membuat perlu dilakukannya penelitian lebih lanjut dengan topik ini, dengan sampel lebih besar dan memperhatikan faktor-faktor perancu penelitian.
Seorangwanitadengan penyakit trofoblas gestasionaldankrisis tiroid Mayura, I Gusti Ngurah; Saraswati, Made Ratna
Medicina Vol 47 No 3 (2016): September 2016
Publisher : Medicina

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Abstract

Penyakit trofoblas gestasional (PTG) merupakan sebuah kondisi yang terkait dengan adanya jaringan trofoblastikplasenta setelah fertilisasi normal atau abnormal yangspektrumnya dari mola hidatidosa sampai keganasan. Krisistiroid mencerminkan status ekstrim dari spektrum tirotoksikosis. Terjadinya PTG denganhipertiroid dapat menjadikrisis tiroid pasca-operasi atau kuretase. Subunit ? padahuman chorionic gonadotropin(hCG), mirip dengan subunit?luteinising hormone(LH) dandapat mengaktifkan reseptortyrotropin stimulating hormone(TSH)ketika diproduksidalam jumlahberlebihan dan menginduksi tirotoksikosis. Kasus adalah seorang wanita berusia 24 tahun datangdengan keluhan badan lemas, sesak napas, demam, dan batuk, denganriwayat mola hidatidosa. Pada pemeriksaan fisisdidapatkan takikardi, pireksia, dispne, ronki, dan massa abdominal. Dari toraks foto didapatkan gambaran metastasisparu dan infeksi paru, pada pemeriksaan penunjang didapatkan peningkatan penanda tumor, hipertiroid, danpeningkatan skor untuk krisis tiroid. Berdasarkan anamnesis, pemeriksaan fisis, dan pemeriksaan penunjangmendukung diagnosis PTG dengan metastasis paru, infeksi paru, dan krisis tiroid.[MEDICINA.2016;47(3):47-51].Gestasional trophoblastic disease (GTD) is a condition associated with the trophoblastic tissue of the placentaafter normal or abnormal fertilization, which the spectrum from hydatidiform mole to malignancy. Thyroid stormreflects the extreme state of thyrotoxicosis spectrum. The GTD with hyperthyroidism can be a thyroid storm postsurgeryorcurettage.The?subunitofhumanchorionicgonadotropin(hCG),similartothe?subunitofluteinisinghormone(LH) and can activate the receptor of tyrotropin stimulating hormone(TSH) receptor when producedexcessively and induced thyrotoxicosis. The case was a 24 year old women came with complaints of weakness,shortness of breath, fever, and cough, with a history of hydatidiform mole. On physical examination foundtachycardia, pyrexia, dyspnea, crackles, and abdominal mass. Obstained from thorax photo ilustration lung metastasisand pulmonary infection, from laboratorium found increase in tumor marker, hyperthyroidism, and increase score forthyroid storm. Base on history, physical examination, and laboratorium support the diagnosis of PTG with lungmetastasis, pulmonary infection, and thyroid storm. [MEDICINA.2016;47(3):47-51].
EUTHYROID SICK SYNDROME Rai Purnami, Ni Ketu; Ratna Saraswati, Made; Sustika, I Ketut
journal of internal medicine Vol. 10, No. 1 Januari 2009
Publisher : journal of internal medicine

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Abstract

Subclinical thyroid dysfunction is a common clinical problem for which there are many controversial issues regardingscreening, evaluation and management. Subclinical hypothyroidism is defined as an elevated serum TSH level associated withnormal total or free T4 and T3 levels. Euthyroid sick syndrome (ESS) identifies abnormalities in thyroid function tests observedin patients with systemic nonthyroidal illnesses (NTIs) and those undergoing surgery or fasting. Abnormalities of thyroid functionin NTIs have been classified as 1). Low T3 syndrome, 2). Low T3-low T4 syndrome, 3). High T4 syndrome, and 4). Otherabnormalities. The condition is not considered to need treatment because there are no symptoms and the tests go back to normalwhen the stressful illness has passed. It has been reported a case of euthyroid sick syndrome of a 49 years old woman, whoÕssuffering from sistemic illness of space occupaying lession in thoracal VII-VIII (with histopathologycal findings: metastaticadeno carcinoma). We found low levels of T3 (0.49 nmol/L) and TSH (<0.05 uI/ml), but normal levels of T4 (96.91nmol/L). Inseverely ill patients, T4 decreases and both T4 and T3 are inversely correlated with mortality rate.
KORELASI ANTARA BRACHIAL-ANKLE PULSE WAVE VELOCITY DAN PROFIL LIPID PADA PASIEN DIABETES GERIATRIK Ratna Saraswati, Made; Suka Aryana, IGP; Astika, Nym; Kuswardani, Tuty; Suastika, K
journal of internal medicine Vol. 7, No. 2 Mei 2006
Publisher : journal of internal medicine

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Brachial-ankle pulse wave velocity (baPWV) is an indicator of limb arterial stiffness. Dislipidemia is a major risk factorof atherosclerosis and may worsen baPWV by increasing the blood viscosity. This study aims to know the correlation betweenbaPWV and the lipid profile in diabetic geriatric patients. Cross sectional analytic study has conducted in geriatric polyclinic,Sanglah hospital. Pulse wave velocity was measured using an automatic device (Fukuda VS 1000). Lipid profile were taken beforetest was done. Data was expressed in mean + SD, analyzed by t-test compare mean and Pearson correlation by using SPSS 11.0.There were 61 patients involved, 40 (65.6%) male and 21 (34.4%) female, age between 60-82 (mean 67.23 + 5.79) years old.Cholesterol total level, LDL-C, HDL-C, and triglyceride were vary among subject, range (means + SD) as 96-312 (198.7 + 42.3)mg/dL, 54-314 (133.2 + 40.4) mg/dL, 27-67 (45,5 + 9.0) mg/dL, and 51-438 (138.6 + 80.0) mg/dL, respectively. BaPWV on theright limbs were between 920-2260 (1605.4 + 228.5) cm/sec, on the left limbs were 870-2240 (1628.0 + 274.8) cm/sec, and meanright/left limbs baPWV were 895-2240 (1616.7 + 241.8) cm/sec. A significant correlation were found between triglyceride leveland the left baPWV (r = 0.3, p = 0.019), while no significant correlation were found on the right side and mean r/l. There weresignificant difference of left limb baPWV among high (>150 mg/dL) and normal triglyceride level group (<150 mg/dL, accordingATP-III). Brachial-ankle pulse wave velocity correlated positively with triglyceride level in diabetic geriatric patients.
DISFUNGSI SEKSUAL PADA WANITA PENDERITA DIABETES MELITUS TIPE 2 Ratna Saraswati, Made; Sanjaya Funistera, Surya
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Abstract

Female Sexual Dysfunction (FSD) has received less attention from doctors, beside very rare complained from patients.This is a contrast situation compare to male with diabetes, for example in general, erectile dysfunction is a common problemreported and decrease patient?s quality of life. A cross sectional study has done, enrolling 97 type 2 diabetes female at outpatientclinic Sanglah Hospital Denpasar. FSD was assessed using FSFI (the female sexual function index) with 19 items of questions.Based on the score of the answer, FSD cathegorized into four categories, including desire disorders, arousal disorder, orgasmicdisorder, and sexual pain disorder. In this study, mean age was 58.8 years (SD 8.9), age range between 34 ? 80 years; and meanduration of diabetes was 8.6 years (SD 8.0), range between 0 ? 30 years. Sexual function index of type 2 diabetes female werelow, arousal domain was the lowest score: 2.13 or 35.5% of maximum 6 score of this domain. Other domains also have low scoreunder 50%, including desire, lubrication, orgasm, and pain: 41.83%, 42.0%, 39.5%, 48.5%, respectively. Only satisfaction hasmore than 50%. There was significant association between each domain. Significant and strong negative association were foundbetween all domain and total score with age, followed by duration of diabetes, and number of children. While obesity, glycemiccontrol, lipid profile were not associated with female sexual function index in type 2 diabetes.
SEORANG PENDERITA HIPOKALSEMIA BERAT OLEH KARENA HIPOPARATIROIDISME DIDAPAT Dharmawan Harjanto, David; Ratna Saraswati, Made; Suastika, Ketut
journal of internal medicine Vol. 9, No. 2 Mei 2008
Publisher : journal of internal medicine

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Abstract

Albeit rare, hypocalcemia might present an acute severe symptom as hypocalcemic seizure, which is documented in ourpatients. Failure in its diagnosis and management will lead to significant morbidity and mortality. Establishing the PTH status,anorganic-phosphate and magnesium level will enable investigation on possible etiology of hypocalcemia. The overall incidenceof post thyroidectomy hypoparathyroidism and hypocalcemia is about 0.5-3 % worldwide. The pathophysiology are multifactorial,it is not simply the glands extirpations, as well as its multiple risk factors although operator technique skill is still theprominent one. We have presented a case of 24 year old female with an acute generalized seizure (hypocalcemic seizure) andprolonged corrected QT interval due to a severe hypocalcemia secondary to hypoparathyroidism from a total thyroidectomy,accompanied by acquired hyperthyroidism and a cerebral cortex calcification. Clinical symptoms and total calcium were improvedafter intravenous calcium gluconate, followed by oral calcium and calcitriol administrations. However, the ideal therapyfor hypoparathyroidism is still the hormone substitution, either by auto/xeno-transplantations or injections, pending further studies.PTH level determinations immediately or several hours after surgery and thus oral calcium supplementations might predictand reduce the incidence of post thyroidectomy hypocalcemia and hypoparathyroidism.
Hubungan status sosial ekonomi keluarga dengan kegemukan pada remaja SMA di Denpasar Anak Agung Gede Ari Nanda Bhaswara; Made Ratna Saraswati
E-Jurnal Medika Udayana Vol 7 No 3 (2018): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

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Obesity (overweight and obesity) is a global problem that is associated with various metabolic diseases. The prevalence of obesity worldwide has increased annually. Thus the prevention of risk factors of obesity needs to be done, and adolescence is a time that is right for prevent the obesity in the future. The aim of this study was to determine the relationship between socioeconomic status of families with obesity in adolescents high school in Denpasar. The design of this research is the analysis of cross-sectional study of 233 high school students in Denpasar. Respondents filled out a questionnaire about the socio-economic status and confounding variable and measurement of BMI through a calculation of height and weight. Socioeconomic status families, confounding variable and BMI were analyzed with Chi-square test statistic. The Univariate results obtained 27.5 % of respondents are overweight , with a frequency of male by 35.06 % ; and female respondents reached 23.72 %. The bivariate analysis results obtained significant relationship (p = 0.025; OR = 2:00; 95% CI = 1.084 to 3.695). Besides breakfast habits and BMI had a significant relationship (p = 0.000; OR = 3.097; 95% CI = 1.674 to 5.732). The next test performed multivariate binary logistic regression method obtained only breakfast habits which have a significant relationship to obesity in adolescents (p = 0.000) whereas socioeconomic status did not (p=0.052). This study shows an association between socioeconomic status and obesity in adolescents in Denpasar. In addition there are breakfast habits variables that more influence to obesity compared with socioeconomic status. Keywords: Obesity, Overweight, BMI, Social-Economic, Adolescents.
HUBUNGAN JUMLAH LIMFOSIT TOTAL DENGAN STATUS NUTRISI PADA PASIEN DIABETES MELITUS TIPE 2 RAWAT INAP DI RUMAH SAKIT UMUM PUSAT SANGLAH DENPASAR TAHUN 2014 ¬Ni Putu Ade Tiwi Tyastarini Tyastarini; Made Ratna Saraswati
E-Jurnal Medika Udayana Vol 6 No 8 (2017): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

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Abstract

WHO has predicted that deaths from diabetes will be doubled from 2005 to 2030. According to the WHO, patients with DM in Indonesia will increase from 8.4 million in 2000 to 21.3 million in 2030. According to some data in 2011 showed total diabetes patients in Sanglah Hospital, Bali as many as 974 people. This study uses a cross-sectional study to determine the relationship between Total Lymphocyte Count (TLC) with nutritional status in patients with type 2 diabetes mellitus hospitalizations in Sanglah Hospital. When the study is over 12 months in 2014 which will be held in the Inpatient internal medicine faculty medicine of udayana university / Sanglah Hospital. In this study, 98 samples that meet the inclusion and exclusion criteria. The sample consisted of 55 male (56.1%) and 43 women (43.9%). The average age of the sample was 56 years with a standard deviation of 9.9. The average HbA1C of patients was 9.23% with 16 data that has not known the results of the tests. 11 patients (11.2%) had good glycemic control (HbA1C <6.5%) and 71 patients (72.4%) had poor glycemic control (HbA1c ? 6.5%). Of all the samples studied, a total of 91 patients (92.9%) who experienced various complications whereas only 7 patients (7.1%) is DM patients without complications. From the Post-Hoc test was obtained was not significant when seen differences in the number of lymphocytes among the five complications with the group that there are no complications. When analyzed further to determine the mean difference by looking at the results of the analysis of Post Hoc to three groups of nutritional status, the data showed that the group's nutritional status well with the medium, p <0.001, CI 95% not covered numbers 0 and between groups of nutrients well with bad p <0.001, CI 95% not covered zeros. Thus, the difference TLC significantly different between both groups of nutrients with moderate or good with the bad. Keywords: Diabetes mellitus (DM), Total Lymphocyte Count (TLC), nutrients.
HUBUNGAN ANTARA KENDALI GLIKEMIK DENGAN PROFIL LIPID PADA PENDERITA DIABETES MELITUS TIPE 2 Rheza Priyadi; Made Ratna Saraswati
E-Jurnal Medika Udayana vol 3 no 12(2014):e-jurnal medika udayana
Publisher : Universitas Udayana

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Abstract

Penyebab terbanyak morbiditas dan mortalitas pada pasien diabetes melitus tipe 2 (DM tipe 2) adalah penyakit kardiovaskuler. Banyak faktor risiko yang terlibat dalam kejadian PJK pada pasien DM tipe 2, salah satunya adalah profil lipid. Berdasarkan penelitian sebelumnya ditemukan bahwa kondisi hiperglikemik memiliki efek langsung dan tidak langsung terhadap kondisi pembuluh darah. Efek tidak langsung kondisi hiperglikemik diperkirakan melalui pengaruhnya terhadap profil lipid. Penelitian ini ingin mengetahui hubungan antara kendali glikemik dengan profil lipid. Sampel diambil dari rekam medis yang memenuhi kriteria inklusi dan eksklusi. Pada penelitian ini dipakai 77 sampel yang terdiri dari  42 pria (54,5%) dan 35 wanita (45,5%). Usia rata-rata sampel adalah 54 tahun dengan tujuh data yang belum diketahui usianya. Rata-rata HbA1c pasien adalah 10,194%. 16 pasien (20,8%) memiliki kontrol glikemik yang baik (HbA1c <7 %), sedangkan 61 (79,2%) pasien memiliki kontrol glikemik yang buruk (HbA1c ?7 %). 26 pasien (33,8%) mengalami peningkatan kadar trigliserida (?150 mg/dl). 60 pasien (77,9%) mengalami penurunan kadar HDL (<40 mg/dl). Penelitian ini menggunakan rancangan penelitian analisa potong lintang. Sampel diambil dari pasien-pasien rawat jalan dengan diagnosis DM tipe 2 yang memeriksakan dirinya di RSUP Sanglah Denpasar periode Juli 2010 sampai Mei 2012. Analisis statistik yang digunakan adalah korelasi spearman satu arah. Berdasarkan hasil uji analitik korelatif satu arah terdapat hubungan yang bermakna antara kendali glikemik dengan kadar trigliserida darah dan antara kadar trigliserida dengan kadar HDL. Korelasi antara kendali glikemik dengan kadar trigliserida darah menunjukkan korelasi yang lemah dengan nilai korelasi 0,342 (p < 0,005; 95% CI).  Korelasi antara antara kadar trigliserida dengan kadar HDL menunjukkan korelasi lemah dengan kadar HDL, dengan nilai korelasi - 0,310 (p < 0,005; 95% CI). Korelasi antara antara kadar trigliserida dengan kadar kolesterol menunjukkan korelasi sedang, dengan nilai korelasi  0,415 (p < 0,005; 95% CI). Dapat disimpulkan bahwa kendali glikemik memiliki korelasi dengan kadar trigliserida, serta memiliki hubungan secara tidak langsung dengan kadar HDL dan kadar kolesterol melalui hubungannya dengan kadar trigliserida melalui korelasi yang bermakna antara kadar trigliserida dengan kadar kadar HDL dan kadar kolesterol.  
Co-Authors A.A Sagung Ika Nuriska A.A.Gde Budhiarta Agus Santosa Ake, Anselmus Anak Agung Gde Budhiarta Anak Agung Gde Budhiarta Anak Agung Gede Ari Nanda Bhaswara Anak Agung Gede Budhiarta Anak Agung Gede Mahaindra Putra Andika Budiartha, Putu Gede Azizah, Norma Nur Azizah Bondan Winarno Budhiarta, Anak Agung Gde Budi Ratna Aryani David Dharmawan Harjanto Devinta, Made Ratih Santi Dewa Ayu Sri Agung Suandewi Dewi, Putu Feby Miswari Dumilah Ayuningtyas Eti Kurniaty Gede Agung Widya Iswara Gede Andrewartha Gozali, Theodorus Onesiforus Herawati Sudoyo I Gde Raka Widiana I Gde Suranaya Pandit I Gusti Ayu Sri Mahendra Dewi I Gusti Ngurah Kade Mahardika I Gusti Putu Suka Aryana I Ketut Suastika I Ketut Sustika I Made Ady Wirawan I Made Bagiada I Made Pande Dwipayana I Made Siswadi Semadi I Made Siswadi Semadi I Made Siswadi Semadi I Made Yoga Prabawa I Wayan Eka Satriawibawa I Wayan Hartadi Noor I Wayan Losen Adnyana I Wayan Putu Sutirta Yasa I Wayan Sudhana I Wayan Sumardika I. K. Suastika Ida Bagus Aditya Nugraha Ida Bagus Yorky Brahmantya Isabella Soerjanto Putri K Suastika Kadek Dina Puspitasari Kartadinata, Sarah Levina Ketut Suega Komang Agus Wira Nugraha Laksmi, Putu Pradnyasanti Made Ayu Devi Pita Loka Made Yogi Krisnanda Malik, Safarina G. Marisye Christantia Mayura, I Gusti Ngurah Mochtar, Fransiska Muhammad Aris Sugiharso Ni Ketut Rai Purnami Ni Luh Made Novi Ratnasari Ni Luh Putri Kresnasari Ni Made Sintia Anggia Sari Nym Astika Nyoman Arya Shridewi Abhigamika Oktavianthi, Suksma Pande Ayu Naya Kasih Permatananda Parastan, Rovie Hikari Prichilia Sarah Permadi R. Prawira Bayu Putra Dewa Ratih Pradnyandari Pemayun Rena, Ni Made Renny Anggreni Rheza Priyadi Rooseno, Ratna Rayeni Natasha Rusditha, Sarah - S., Hantono Safarina G. Malik Savitri, Putu Dian Hermawati Sari Sukma Oktavianthi Surya Sanjaya Funistera Susy Purnawati Tuty Kuswardani Wan Muhamad Syafiq Wardana, Rr. Cattleya Allayka Wimpie I Pangkahila Wira Gotera ¬Ni Putu Ade Tiwi Tyastarini Tyastarini