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All Journal Majalah Kedokteran Bandung The Indonesian Biomedical Journal Indonesian Journal of Rheumatology eJournal Kedokteran Indonesia The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal)
Cleopas Martin Rumende
Division Of Pulmonology, Department Of Internal Medicine, Faculty Of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo General National Hospital
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Correlation of Forced Expiratory Volume in 1 Second Prediction with Mean Pulmonary Arterial Pressure Using Echocardiography in Stable Chronic Obstructive Pulmonary Disease Munadi, Munadi; Yamin, M.; Ujainah, Anna; Rumende, Cleopas Martin
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 4
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Validation of A2DS2 Score as Predictor of Pneumonia among Patients Hospitalized for Acute Ischemic Stroke Nababan, Toman; Pitoyo, Ceva Wicaksono; Harris, Salim; Rumende, Cleopas Martin
Jurnal Penyakit Dalam Indonesia Vol. 5, No. 3
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Introduction. Pneumonia is the leading cause of morbidity and mortality in acute ischemic stroke patients admitted to hospital. Thus required a valid scoring system which is easy to apply, to predict and stratify the risk of pneumonia in patients with acute ischemic stroke. This study aimed to assess the performance of calibration and discrimination of A2 DS2 score in predicting the incidence of pneumonia in patients with acute ischemic stroke. Methods. A retrospective cohort study was conducted among adult acute ischemic stroke patients who are hospitalized in Cipto Mangunkusumo Hospital, Jakarta. Age, atrial fibrillation, dysphagia, sex (male), and stroke severity (rated with National Institute of Health Stroke Scale/NIHSS) were obtained at the beginning of admission. The subjects were followed up for up to seven days after the onset of ischemic stroke to assess the outcome (pneumonia). Calibration properties of the A2 DS2 score were assessed by Hosmer-Lemeshow test and calibration plot. Discrimination properties of the A2 DS2 score were assessed by the area under the curve (AUC). Results. A total of 281 subjects were followed up. The incidence of pneumonia in acute ischemic stroke patients was observed in 118 patients (42%). Hosmer Lemeshow test of A2 DS2 score showed p = 0,222 and calibration plot showed r = 0,982. Discrimination of A2 DS2 score was shown by the AUC value of 0,885 (95% CI 0,845-0,924). Conclusion. The A2 DS2 score has a good calibration and discrimination performance in predicting the incidence of pneumonia in patients with acute ischemic stroke.
Peripheral Blood Count Characteristics, Neutrophil-Lymphocyte Ratio, and Platelet-Lymphocyte Ratio Pulmonary Tuberculosis Patients with Depression Shatri, Hamzah; Alexander, Reinaldo; Putranto, Rudi; Rumende, Cleopas Martin
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 2
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Introduction. Patients with pulmonary tuberculosis (TB) had an increased risk for depression up to 1.53 times from a large cohort study. Studies have found an increase in the neutrophil - lymphocyte ratio (NLR) in various mood disorders including depression, also the value of the platelet-lymphocyte ratio (PLR) associated with major depression accompanied by psychotic symptoms. This study aimed to describe the peripheral blood characteristics, NLR, and PLR in pulmonary TB patients with depression. Methods. A cross-sectional study of 106 non-multidrug-resistant pulmonary TB patients was done at outpatient department of Cipto Mangunkusumo General Hospital, Jakarta from August to October 2018. The diagnosis of depression was made by interview according to Diagnostic and Statistical Manual of Mental Disorder-V (DSM-V) criteria, and severity of depression is determined using Beck Depression Inventory-II (BDI-II). The laboratory tests were done to obtain complete peripheral blood results, NLR, and TLR. Parametric test was used for numeric variables with even distribution, and nonparametric test for variables with uneven distribution. Results. From 106 patients with non-multidrug-resistant pulmonary TB, the proportion of depression was 32%. White blood cell count (p=0.024), and absolute lymphocte count (p=0.004) is lower in depressed TB patients compared to nondepressed TB patients. There were no significant relationship between NLR and TLR and the severity of depression in depressed pulmonary TB patients (p>0.05). Conclusion. White blood cell count and absolute lymphocyte count are lower in depressed pulmonary TB patients. Meanwhile, RNL and PLR are higher in depressed pulmonary TB patients eventhough not statistically significant.
Correlation between Proper Antibiotics Administration to Community Acquired Pneumonia Patients Based on Alur Gyssens with Clinical Response Rumende, Cleopas Martin; Chen, Lie Khie; Karuniawati, Anis; Bratanata, Joyce; Falasiva, Rezyta; Sitorus, Truly Panca; Susanto, Erwin Christian
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 2
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Introduction. The proper of antibiotics treatment will increase the improvement of the patient with community-acquired pneumonia (CAP) and also counteract antimicrobial resistance. Community-Acquired Pneumonia is commonly found in Indonesia with an incidence of 2.4%. This study aimed to determine the proper of antibiotic selection for CAP based on IDSA-ATS 2007 guidelines with Gyssens method and evaluate the relationship between the proper of antibiotic treatment with the clinical response of patients. Methods. A retrospective cohort study was conducted with secondary data from the previous study. Study was conducted in three hospitals in Jakarta, namely Cipto Mangunkusumo General Hospital, Budhi Asih Hospital, and Gatot Subroto Hospital between September 2016 and November 2017. Results. From 151 patients, the appropriate of the first antibiotic treatment, including category 0 and 1 was found in 38 patients (25.2%), while for inappropriate one (category II-V) was in 113 patients (74.8%) mainly due too short antibiotic treatment. For the second antibiotic given to 54 patients, appropriate treatment was found in 15 patients (9.9%). There was no correlation between the accuracy of both antibiotics treatment in CAP based on Gyssens method with clinical response of the patients (first antibiotic treatment: RR=0,970 (95% CI: 0,80 – 1,16), p=0,738; second antibiotic treatment: RR=1,194 (95% CI: 0,648 – 2,20), p=1,00). Conclusion. There was no correlation between the accuracy of antibiotics treatment in CAP based on Gyssens method with clinical response of the patients.
Correlation Between the Severity of Coronary Heart Disease andQT Dispersion in Patients with Obstructive Sleep Apnea Rasmijon, Rasmijon; Yamin, Muhammad; Hutauruk, Syahrial M.; Rumende, Cleopas Martin
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 1
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Introduction. Coronary heart disease (CHD) and obstructive sleep apnea (OSA) are common and complex clinical problems. Both have a high risk of sudden cardiac death (SCD). QT dispersion (QTd) in electrogram is a measure of heterogeneity of myocardial repolarization that can predict the occurrence of ventricular arrhythmias that cause SCD QTd is a predictor of ventricular arrhythmias and sudden cardiac death. So far, there is no publication about the severity relationship CHD with QTd in OSA patients in Indonesia. Methods. A cross-sectional study was conducted on twenty-nine CHD patients accompanied OSA in 2015 who had undergone coronary angiography and polysomnography against the QT dispersion by electrocardiography in Cipto Mangunkusumo Hospital, Jakarta. QTd obtained from maximum QTc difference with minimum QTc. The severity of CHD was assessed by the Gensini score obtained from the recording of coronary angiography in the cath lab. Results. The median value of Gensini score was 10 (range 1-112). Mean value of QTc max and QTc min were 459.76 ms (standard deviation [SD] 41.39 ms) and 386.72 ms (SD 31.61), respectively. Meanwhile, the median value of QTd was 56 ms (range 14-201 ms). The Spearman correlation test showed a weak positive correlation between Gensini score and QTd (r = 0.464; p value = 0.006). Conclusion. The severity of coronary heart disease by Gensini score is weakly correlated with QT dispersion.
Perbedaan Pola Sirkadian Tekanan Darah pada Pasien Penyakit Ginjal Kronik Pra dan PascaTransplantasi Ginjal Di RSCM Tambunan, Marihot; Susalit, Endang; Dharmeizar, Dharmeizar; Rumende, Cleopas Martin
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 4
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Pendahuluan: Meningkatnya tekanan darah (TD) 24 jam dan nondipper merupakan faktor risiko morbiditas dan mortalitas kardiovaskular. Prevalensi hipertensi dan nondipper pada Penyakit Ginjal Kronik Stadium 5 dalam Terapi Dialisis (PGK 5D) masih sangat tinggi. Transplantasi ginjal akan memperbaiki TD dan nondipper. Namun demikian, satu bulan pasca transplantasi ginjal, kebutuhan dosis obat imunosupresan masih cukup tinggi yang dapat mengakibatkan hambatan penurunan TD. Perlu dilakukan studi untuk mengetahui seberapa dini perubahan pola sikardian, sehingga dapat dijadikan pertimbangan penatalaksanaan hipertensi yang lebih tepat pada pasien PGK 5D pra dan pasca transplantasi ginjal. Metode: Studi Pre experimental dengan before and after design dilakukan pada 15 pasien PGK 5D/ Pra Transplantasi Ginjal berusia 18–60 tahun di Rumah Sakit dr. Cipto Mangunkusumo (RSCM) Jakarta pada Oktober-Desember 2014. Dilakukan pengumpulan urin 24 jam, pemeriksaan LFG dan pengukuran TD 24 jam dengan 24 hrs ABPM pada pra dan satu bulan pasca transplantasi ginjal. Hasil: Terdapat 12 subjek nondipper dan 3 subjek dipper pada pasien PGK Pra Transplantasi Ginjal. Satu bulan pasca transplantasi ginjal, seluruh subjek (15 orang) memperlihatkan keadaan nondipper. Uji McNemar tidak dapat dilakukan karena seluruh subjek PGK satu bulan pasca transplantasi ginjal nondipper (homogen). Penurunan rerata TD sistolik 24 jam pasien PGK satu bulan pasca transplantasi ginjal tidak bermakna (p >0,05), namun demikian penurunan rerata TD diastolik 24 jam bermakna (p <0,05). Simpulan: Berdasarkan hasil studi, dapat disimpulkan bahwa belum terdapat perbaikan nondipper pada pasien satu bulan Pasca Transplantasi Ginjal.
Pengaruh Penggunaan Antibiotika Terhadap Lama Hari Sakit dan Lama Kehilangan Hari Kerja pada Pasien Infeksi Pernapasan Akut Bagian Atas pada Pelayanan Kesehatan Primer Gunawan, Gunawan; Suwarto, Suhendro; Rumende, Cleopas Martin; Harimurti, Kuntjoro
Jurnal Penyakit Dalam Indonesia Vol. 1, No. 1
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Pendahuluan: Prevalensi infeksi saluran pernapasan bagian atas akut (ISPA) di komunitas masih tinggi dan menyebabkan morbiditas dan penurunan kualitas hidup masyarakat secara luas. Etiologi tersering dari infeksi pernapasan akut di luar negeri adalah virus, selain itu terdapat etiologi bakteri yang memerlukan terapi antibiotika yang spesifik. Penggunaan antibiotika untuk infeksi pernapasan akut berlebihan, dan hal ini menyebabkan peningkatan resistensi bakteri terhadap antibiotika. Penelitian ini bertujuan untuk mengetahui pola etiologi infeksi pernapasan akut, kesesuaian pemberian antibiotika dan perbedaan rerata lama sakit dan lama kehilangan hari kerja. Metode: Penelitian ini merupakan penelitian observasional analitik dengan pengambilan data secara potong lintang dan kohort prospektif dengan sampel yang diambil secara berurutan dari pasien ISPA yang berobat ke Puskesmas Kecamatan Pulogadung, Jakarta Timur dan KDK “Kayu Putih” serta “Kiara” pada bulan Agustus hingga Desember 2011. Pada 100 pasien ISPA yang berobat dilakukan pemeriksaan kultur resistensi bakteri dan uji antigen influenza melalui swab tenggorok dan nasofaring, dan pemeriksaan darah perifer rutin. Perbedaan lama hari sakit dan lama kehilangan hari kerja dianalisa menggunakan uji beda dua median Mann Whitney karena data berdistribusi bukan normal. Hasil: Hasil kultur bakteri positif pada 34% pasien ISPA, hasil uji antigen influenza positif untuk influenza A pada 3% pasien, dan 63 % pasien belum diketahui penyebabnya. Hasil kultur bakteri terbanyak berturut-turut adalah Klebsiella pneumonia (47,1%), Streptococcus pyogenes (14,7%) dan Staphylococcus aureus (14,7%). Jenis antibiotika terbanyak yang mengalami resistensi adalah ampicillin (20 isolat), tetracycline (8 isolat), benzylpenicillin (4 isolat), amoxicillin/clavulanic acid (3 isolat). Kesesuaian pemberian antibiotika dengan hasil kultur bakteri ditemukan pada 56 pasien ISPA (56%). Median lama hari sakit pada kelompok pasien ISPA yang mendapatkan pengobatan antibiotika tidak berbeda dibandingkan dengan tanpa pengobatan antibiotika (4 hari dengan 3,5 hari; p=0,054). Median lama kehilangan hari kerja pada kelompok pasien ISPA yang mendapatkan pengobatan antibiotika tidak berbeda dibandingkan dengan tanpa pengobatan antibiotika (1 hari dengan 1 hari; p=0,629). Simpulan: Penyebab infeksi saluran pernapasan akut bagian atas pada penelitian ini adalah bakteri sebanyak 34% dengan bakteri Gram negatif terbanyak adalah Klebsiella pneumonia dengan antibiotika yang sensitif dengan antibiotika golongan Penicillin beta laktamase dan golongan aminoglikosida serta makrolid, virus influenza A sebanyak 3% dan etiologi yang belum diketahui sebanyak 63%. Proporsi kesesuaian penggunaan antibiotika di Puskesmas Kecamatan Pulogadung dan Klinik Kedokteran Keluarga Kayu Putih serta Kiara sebesar 56%. Pemberian antibiotika tidak memberikan perbedaan lama hari sakit dan lama kehilangan hari kerja.
Modifikasi Skor TIMI sebagai Model Prediksi Mortalitas 30 Hari Pasien STEMI Muda Mansur, M. Tasrif; Yamin, Muhammad; Rusdi, Lusiani; Abdullah, Murdani; Karim, Birry; Rumende, Cleopas Martin; Marbun, Maruhum Bonar H.; Shatri, Hamzah
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 4
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Introduction. Cardiovascular disease is a leading cause of death worldwide. Three-quarters of these deaths occur in lowand middle-income countries among individuals in their productive years. ST-segment elevation myocardial infarction (STEMI) is a dangerous manifestation of coronary artery disease (CAD) and can lead to sudden death. Smoking and a family history of early CAD are major risk factors for STEMI cases. However, their role in any risk stratification system for patients has not been clearly established. The most widely used score in assessing the prognosis of STEMI patients is the TIMI score, but its accuracy in the young patient population is still unknown. The objectives of this study were to determine the proportion of mortality in young STEMI patients at RSCM, validate the TIMI score in young patients, and develop a risk stratification system for young STEMI patients. Methods. This research is a retrospective cohort study using medical record data from the Dr. Cipto Mangunkusumo National General Hospital (RSCM) on patients aged ≤50 years who were treated for ST-elevation myocardial infarction (STEMI) from 2018 to 2022. Univariate analysis was conducted to obtain subject characteristics and the 30-day mortality proportion of young STEMI patients. Bivariate Cox regression analysis was performed to examine the relationship between smoking and a family history of early coronary artery disease (CAD) with 30-day mortality. The TIMI score was validated in the study subjects of young patients. Multivariate analysis was conducted to obtain a new prediction model, and the model’s discriminatory performance was assessed using the area under the ROC curve (AUC), and model calibration was modified using the Hosmer-Lemeshow test. Results. A total of 164 study subjects were included. There were 107 patients (65.2%) with a smoking risk factor, while 39 patients (23.9%) had a family history of early CAD. The proportion of 30-day mortality among young patients was 7.9% (13 individuals). Statistical analysis showed that there was no correlation between 30-day mortality in young STEMI patients and a history of smoking (HR 0.0441 (95% CI 0.148-1.312)) or a family history of early CAD (HR 0.567 (95% CI 0.126- 2.559)). The TIMI score showed good predictive ability for 30-day mortality in young STEMI patients, with an AUC value of 0.836 (95% CI 0.717- 0.956). The combination of the TIMI score with the smoking history variable demonstrated good discriminatory performance in predicting 30-day mortality among young STEMI patients, with an AUC value of 0.875. However, when comparing the AUC values between the TIMI score and the TIMI score with the addition of the smoking history factor, no significant increase in accuracy was observed (p-value=0.215). Conclusions. The TIMI score demonstrates good discrimination and calibration in predicting 30-day mortality among young STEMI patients. The TIMI score, when combined with the smoking history factor, shows improved discriminatory performance and calibration in predicting 30-day mortality among young STEMI patients compared to the pure TIMI score but does not significantly enhance the accuracy.
Spleen and Liver Stiffness as Noninvasive Predictors of Varices in HBV Cirrhosis Siahaan, Billy Stinggo; Kurniawan, Juferdy; Simadibrata, Marcellus; Rizka, Aulia; Sanityoso, Andri; Rumende, Cleopas Martin; Rachman, Andhika; Shatri, Hamzah
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 24, No 2 (2023): VOLUME 24, NUMBER 2, August, 2023
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2422023137-142

Abstract

Background: Esophageal varices (EV) are the most frequent complication of portal hypertension in patients with liver cirrhosis. Due to many reasons, esophagogastroduodenoscopy remains impractical for routine surveillance in everyday practice. Hence, ongoing studies into reliable non-invasive test for predicting EV are still important.Methods: A total of 71 patients with liver cirrhosis due to hepatitis B who underwent endoscopy, spleen stiffness measurement (SSM), and liver stiffness measurement (LSM) between January and April 2023 were enrolled in this study. Diagnostic applicability was assessed using the area under the receiver-operator curve (AUC) to measure and compare the performance of each measurement and combination for predicting EV, as well as to obtain the corresponding optimal prediction value.Results: This study included 71 patients with liver cirrhosis. Among them, 74.6% (53 patients) were classified as Child-Pugh A, 22.5% (16 patients) as Child-Pugh B, and 2.8% (2 patients) as Child-Pugh C. The prevalence of esophageal varices (EV) within the cohort was 71.8%. This study showed that SSM with a cut-off of 38.8 kPa had AUC 0.867 (95% CI: 0.774–0.960) (sensitivity 78.4%, specificity 80%), and LSM with a cut-off of 10.55 kPa had AUC 0.822 (95% CI: 0.701–0.943) (sensitivity 88.2%, specificity 65%).Conclusion: Spleen and liver stiffness measurements demonstrate good performance in predicting EV in patients with liver cirrhosis caused by hepatitis B.
Hubungan Abnormalitas Ekokardiografi terhadap Mortalitas Pasien Terkonfirmasi COVID-19 Derajat Berat dan Kritis di RSUPN Dr. Cipto Mangunkusumo Santoso, Fidiaji Hiltono; Alwi, Idrus; Nasution, Sally A.; Rumende, Cleopas Martin
Jurnal Penyakit Dalam Indonesia
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Introduction. The mortality rate of COVID-19 patients in Indonesia is high with manifestations of cardiac complications. Echocardiographic evaluation can help identify cardiac functional and structural disorders associated with patient mortality. Therefore, this study aims to determine the relationship between echocardiographic abnormalities and mortality in severe and critical COVID-19 patients. Methods. A retrospective cohort study was conducted using medical record data of severe and critical COVID-19 patients at Dr. Cipto Mangunkusumo Hospital Jakarta during March 2020 to April 2021. Subjects were selected using total sampling. Descriptive analysis was performed, presenting descriptive tables, and bivariate analysis was conducted using the chi-square test. Results. Of the total 83 patients, 30 (36.1%) were classified as severe and 53 (63.9%) as critical. Most of the subjects were male, with 21 (70%) in the severe group and 33 (62.2%) in the critical group, with a median age of 55.5 (23-95) years for the severe group and 59 (23-83) years for the critical group. A total of 48 patients (57.8%) in this study died. The most common functional abnormality found on echocardiography was mPAP in 51 or 68%, and the most structural disturbance was left ventricular concentric remodelling in 48 or 58%. The chi-square analysis results of echocardiographic variables namely TAPSE with RR = 7.292, Right Ventricular Systolic Pressure (RVSP) 10.208, mean Pulmonary Artery Pressure (mPAP) 1.440, Pulmonary Acceleration Time (PAT) 2.357, and Right Atrial Pressure (RAP) 3.403 had a significant relationship with mortality. Meanwhile, LVEF, E/e’ and CO have no significant relationship. Based on the multivariate analysis, variables independently associated with mortality were RVSP and RAP. Conclusion. Echocardiographic abnormalities associated with mortality in severe and critical COVID-19 patients were TAPSE, RVSP, mPAP, PAT and RAP estimation.
Co-Authors A Harahap A Harahap, A A.A. Ketut Agung Cahyawan W Adang Sabarudin Ade Dharmawan Adi Surya Komala, Adi Surya Aditya Wardhana Afifah Is Agasjtya Wisjnu Wardhana Aida Lydia Alexander Michael Joseph Saudale Alexander, Reinaldo Andhika Rachman Andri Sanityoso Andri Sanityoso Andri Sanityoso Sulaiman Anis Karuniawati Anna Ujainah, Anna Ari Fahrial Syam Arif Mansjoer Asrul Harsal, Asrul Aulia Rizka, Aulia Bambang Setiyohadi Bambang Setiyohadi Birry Karim C Rinaldi A Lesmana Ceva W. Pitoyo Daniel Martin Simadibrata Delly Chipta Lestari Dharmeizar Dharmeizar Dono Antono E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Em Yunir, Em Endang Susalit Erni Juwita Nelwan, Erni Juwita Estie Puspitasari, Estie Evy Yunihastuti Fahmi Razi Darkuthni Falasiva, Rezyta Fitri Imelda, Fitri Griskalia Christine Gunawan Gunawan Gunawan Gunawan Hadi, Edward J Harry Isbagio Harry Isbagio Hutauruk, Syahrial M. Idrus Alwi Ignatius Bima Prasetya, Ignatius Bima Ika Prasetya Wijaya Ikhwan Rinaldi Iris Rengganis Irsan Hasan Islamadina, Balqis Joyce Bratanata, Joyce Juferdy Kurniawan Kemal Fariz Kalista, Kemal Fariz Khie Chen Kumalawati, July Kuntjoro Harimurti Leonard Nainggolan Lugyanti Sukrisman Lusiani Lusiani Lusiani Rusdi, Lusiani M Yamin M. Yamin Mansur, M. Tasrif Marcellus Simadibrata Marcellus Simadibrata Marcellus Simadibrata Marihot Tambunan, Marihot Maruhum B.H. Marbun Mochamad Pasha Muhammad Yamin Munadi Munadi Murdani Abdullah Murdani Abdullah Murdani Abdullah Nababan, Toman Noorwati Sutandyo Nury Nusdwinuringtyas Parlindungan Siregar Pasha, Mochamad Pratiwi Pujilestari Sudarmono Rahmad Mulyadi Rasmijon, Rasmijon Ratih Tri Kusuma Dewi, Ratih Tri Kusuma Retno Wahyuningsih Rino Alvani Gani Rino Alvani Gani Rino Alvani Gani RR. Ella Evrita Hestiandari Rudi Putranto Rustam, Musfardi Sabarudin, Adang Salim Harris, Salim Sally A. Nasution Sally Aman Nasution Sally Aman Nasution, Sally Aman Salman Paris Harahap, Salman Paris Santoso, Fidiaji Hiltono Saputri, Imelda N Sasongko, Raditya Siahaan, Billy Stinggo Sitorus, Truly Panca Soroy Lardo Suhendro Suwarto, Suhendro Susanto, Erwin Christian Tanjung, Gloria Telly Kamelia Veronica, Raja Merlinda Wardhana, Agasjtya Wisjnu Widayat Djoko Santoso, Widayat Djoko Willy Brodus Uwan, Willy Brodus Wismandari Wisnu Zuljasri Albar Zuljasri Albar