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Cerelia Sugeng
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Hubungan Nilai Estimasi Laju Filtrasi Glomerulus dan Kadar Asam Urat Serum pada Subyek Penyakit Ginjal Kronik Non-Dialisis Moula, Jonathan; Moeis, Emma Sy.; Sugeng, Cerelia
e-CliniC Vol 5, No 2 (2017): Jurnal e-CliniC (eCl)
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v5i2.18583

Abstract

Abstract: Chronic kidney disease (CKD) is a global public health problem. The CKD Epidemiology Collaboration (CKD-EPI) equation is the most accurate result of GFR (eGFR) that has been evaluated in large varied populations and can be applied clinically in general. In CKD patient, uric acid excretion decreases linearly along the worsening renal function. This study was aimed to determine the relationship between serum uric acid level based on eLFGCKD-EPI value and eGFR CKD-EPI in non-dialysis CKD patients (male and female). This was an analytical study with a cross-sectional design using medical record data of CKD patients at Prof. Dr. R. D. Kandou Hospital from January to December 2016. There were 82 samples who met the inclusion criteria. The results showed that 45 of 54 males and 27 of 28 females with non-dialysis CKD had elevated serum uric acid levels. The correlation test between serum uric acid level and eLFG CKD-EPI value on males and females were P=0.0; r=-0.473 and P=0.0; r=-0,598 respectively. Conclusion: There was a significant negative relationship between serum uric acid level and eLFG CKD-EPI value in non-dialysis CKD patients for both sexes. Based on eLFGCKD-EPI value, most patients had elevated serum uric acid levels.Keywords: non-dialysis chronic kidney disease, serum uric acid, eLFG CKD-EPI Abstrak: Penyakit ginjal kronik (PGK) merupakan masalah kesehatan masyarakat global. Persamaan CKD-EPI (CKD Epidemiology Collaboration) adalah persamaan estimasi LFG (eLFG) yang paling akurat dan telah dievaluasi pada populasi beragam dalam jumlah besar dan dapat diterapkan pada penggunaan klinis secara umum. Pada pasien PGK, ekskresi asam urat menurun secara linier seiring dengan memburuknya fungsi ginjal. Penelitian ini bertujuan untuk mengetahui hubungan kadar asam urat serum berdasarkan nilai eLFGCKD-EPI dan nilai eLFG CKD-EPI pada PGK non-dialisis (PGK-ND) baik pada jenis kelamin laki-laki maupun perempuan. Jenis penelitian ialah analitik dengan desain potong lintang menggunakan data rekam medik pasien PGK di RSUP Prof. Dr. R. D. Kandou periode Januari-Desember 2016. Terdapat 82 sampel yang memenuhi kriteria inklusi. Hasil penelitian mendapatkan 45 dari 54 laki-laki dan 27 dari 28 perempuan dengan PGK-ND mengalami peningkatan kadar asam urat serum. Uji korelasi hubungan antara kadar asam urat serum dan nilai eLFGCKD-EPI pada jenis kelamin laki-laki dan perempuan masing-masing P=0,0; r=-0,473 dan P=0,0; r=-0,598. Simpulan: Terdapat hubungan negatif bermakna antara kadar asam urat serum dan nilai eLFGCKD-EPI pada kedua jenis kelamin. Pada sebagian besar pasien PGK-ND baik laki-laki mupun perempuan terdapat peningkatan kadar asam urat serum berdasarkan nilai eLFGCKD-EPI.Kata kunci: penyakit ginjal kronis non-dialisis, asam urat serum, eLFG CKD-EPI
HUBUNGAN DERAJAT KEPARAHAN SIROSIS HATI DAN NILAI LAJU GLOMERULUS PADA SIROSIS HATI Poluan, Pamela M.; Kawengian, Ventje; Sugeng, Cerelia
e-CliniC Vol 3, No 1 (2015): Jurnal e-CliniC (eCl)
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v3i1.7482

Abstract

Abstract: Liver cirrhosis is often associated with impaired renal function. This can be due to disturbances of hemodynamic and neurohormonal systems and increased activity of the sympathetic nervous system. This will lead to a decrease in glomerular filtration rate (GFR). This study aimed to find out the connection of the liver cirrhosis degree and GFR values in liver cirrhosis subjects. This study was a cross-sectional design. Samples were 30 liver cirrhosis cases’ medical records at BLU Prof. Dr R.D Kandou Hospital Manado in the period of October 2013 to October 2014.The medical record data included age, gender, values of albumin, bilirubin, and creatinine, Child’s score, and the GFR values by using CKD-EPI formula. The corrrelation of the liver cirrhosis degrees and GFR values was tested by using the Spearman correlation test. The results showed that there was a negative, not significant correlation between class B Child’s score and GFR (r = -0.231, p = 0.618); a positive, not significant correlation between class C Child’s score and GFR (r = 0.188, p = 0.428), and btween Child’s score and GFR (r = 0.118, p = 0.533)Conclusion: There was no significant correlation between the liver cirrhosis degree (Child’s score) and GFR values.Keywords: liver cirhhosis, Child’s score, GFRAbstrak: Sirosis hati sering disertai gangguan fungsi ginjal. Hal tersebut dapat disebabkan adanya gangguan sistem hemodinamik dan neurohormonal, serta peningkatan aktivitas sistem saraf simpatis. Gangguan ini akan memicu penurunan laju filtrasi glomerulus (LFG). Penelitian ini bertujuan untuk melihat hubungan derajat keparahan sirosis hati dengan nilai laju filtrasi glomerulus pada subyek sirosis hati. Penelitian ini menggunakan desain potong lintang. Sampel peneltian ini berjumlah 30 rekam medik subyek sirosis hati yang tercatat di BLU RSUP Prof. Dr. R.D. Kandou Manado periode Oktober 2013 sampai Oktober 2014. Data rekam medik tersebut mencakup umur, jenis kelamin, nilai albumin, bilirubin, kreatinin, skor Child, dan nilai LFG menggunakan formula CKD-EPI. Hubungan derajat keparahan Child dengan LFGdiuji dengan uji korelasi Spearman. Hasil uji korelasi Spearman menunjukkan bahwa terdapat hubungan negatif dan tidak signifikan antara skor Child kelas B dengan LFG (r = -0,231, p = 0,618), hubungan positif dan tidak signifikan antara skor Child kelas Cdengan LFG (r = 0,188, p = 0,428), serta skor Child dengan LFG (r = 0,118, p = 0,533). Simpulan: Tidak terdapat hubungan signifikan antara derajat keparahan sirosis hati (Skor Child) dengan nilai LFG.Kata kunci: sirosis hati, skor Child, LFG
Gambaran status besi pada pasien penyakit ginjal kronik stadium 5 dengan anemia yang menjalani hemodialisis reguler Silaban, Bryan J.; Sugeng, Cerelia; Waleleng, Bradley J.
e-CliniC Vol 4, No 2 (2016): Jurnal e-CliniC (eCl)
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.4.2.2016.14372

Abstract

Abstract: Chronic kidney disease (CKD) is a pathological condition with a variety of etiology, resulting in progressively decreased renal function which is often ended with kidney failure. Chronic kidney disease has a global prevalence of 800 per million of population and the incidence of end-stage renal disease ranges from 150 to 200 per million of population. Complications often occur at the end-stage renal disease inter alia anemia with a rate of 80-90%. This study was aimed to obtain the profile of stage-5 CKD patients with anemia and regular hemodialysis was performed on them. This was a descriptive-retrospective study using data of medical records at Prof. Dr. R. D. Kandou General Hospital from January 2015 to October 2016. There were six observed variables as follows: age, gender, serum iron (SI), total iron binding capacity (TIBC), transferrin saturation, and ferritin. The results showed that of the 48 CKD patients with anemia, there were 24 males and 24 females. The majority were aged 60-69 years (33%) and had normal SI level in 30 patients (67%); decreased TIBC in 35 patients (75%); normal transferrin saturation in 26 patients (54%); and increased ferritin level in 38 patients (81%). Conclusion: Majority of the patients were 60-69 years old and had normal level of SI, decreased TIBC, normal transferrin saturation, and increased levels of ferritin. There was no difference in case number of both sexes.Keywords: serum iron, total iron binding capacity, transferrin saturation, ferritin Abstrak: Penyakit Ginjal Kronik (PGK) adalah suatu keadaan patologis dengan etiologi yang beragam, terjadi penurunan fungsi ginjal secara progresif, dan biasanya berakhir dengan gagal ginjal. Penyakit ginjal kronik merupakan salah satu masalah kesehatan di dunia dengan prevalensi 800 per juta populasi dan insidensi end-stage renal disease (ESRD) 150-200 per juta populasi di dunia. Komplikasi sering terjadi pada PGK stadium akhir antara lain anemia dengan persentase mencapai 80-90%. Penelitian ini bertujuan untuk mendapatkan profil pasien PGK stadium 5 dengan anemia dan menjalani hemodialisis reglular. Jenis penelitian ialah deskriptif-retrospektif menggunakan data sekunder dari catatan rekam medik periode Januari 2015 – Oktober 2016 di RSUP Prof. Dr. R. D. Kandou Manado dengan enam variabel penelitian, yaitu usia, jenis kelamin, serum iron (SI), total iron binding capacity (TIBC), saturasi transferin, dan feritin. Dari 48 data rekam medik pasien yang memenuhi kriteria inklusi ditemukan bahwa mayoritas pasien berumur 60-69 tahun (33%), laki-laki maupun perempuan berjumlah sama, mayoritas pasien memiliki kadar SI normal berjumlah 30 pasien (67%), kadar TIBC menurun berjumlah 35 pasien (75%), saturasi transferin normal berjumlah 26 pasien (54%), dan kadar feritin meningkat berjumlah 38 pasien (81%). Simpulan: Mayoritas pasien PGK stadium 5 yang menjalani hemodialisis reguler berusia 60-69 tahun, laki-laki dan perempuan berjumlah sama, serta memiliki kadar SI normal, penurunan TIBC, saturasi transferin normal, dan peningkatan kadar feritin. Kata kunci: serum iron, total iron binding capacity, saturasi transferin, feritin
HUBUNGAN KADAR GULA DARAH TIDAK TERKONTROL DAN LAMA MENDERITA DIABETES MELITUS DENGANFUNGSI KOGNITIF PADA SUBYEK DIABETES MELITUS TIPE 2 Meloh, Monica L.; Pandelaki, Karel; Sugeng, Cerelia
e-CliniC Vol 3, No 1 (2015): Jurnal e-CliniC (eCl)
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.3.1.2015.6837

Abstract

Abstract: Diabetes Mellitus (DM) type 2 is one of the chronic disease which related to the increased risk of cognitive decline. Uncontrolled blood glucose levels and duration of DM affect the pathophysiology of the occurrence of cognitive function disruption to DM type 2 subject. Uncontrolled blood glucose levels is HbA1c levels > 7% and cognitive function measured by using Mini Mental State Examination (MMSE). The objective of this research is to find out the relation between an uncontrolled blood glucose levels and duration of DM to cognitive function from DM type 2 subject. Methods: This research is descriptive analytic with cross sectional approach. The sampling technique used was consecutive sampling. Result: The discoveries from all the 36 samples are a mean age of 55.2; length of sustaining DM 9.0; HbA1c 9.9; and MMSE score 24.7. Pearson correlation test results obtained the relation of HbA1c with MMSE score (p=0,215 ; r=-0,212) and the relation of the duration of sustaining DM with MMSE score (p=0,237 ; r=-0,202). Conclusion: There is a negative connection between uncontrolled blood sugar level and the duration of sustaining DM with cognitive function but statistically both of them are not significant to the DM type 2 subject.Keywords: diabetes mellitus, HbA1c, length of sustaining DM, cognitive function.Abstrak: Diabetes Melitus (DM) tipe 2 adalah salah satu penyakit kronis yang berhubungan dengan peningkatan risiko penurunan kognitif. Kadar gula darah yang tidak terkontrol dan lama menderita DM, mempengaruhi patofisiologi terjadinya gangguan fungsi kognitif pada subyek DM tipe 2. Kadar gula darah yang tidak terkontrol adalah kadar HbA1c >7% dan fungsi kognitif diukur berdasarkan Mini Mental State Examination (MMSE). Tujuan penelitian ini untuk mengetahui hubungan kadar gula darah yang tidak terkontrol dan lama menderita DM dengan fungsi kognitif subyek DM tipe 2. Metode: Penelitian ini bersifat deskriptif analitik dengan pendekatan cross sectional. Teknik pengambilan sampel yang digunakan yaitu consecutive sampling. Hasil: Dari 36 sampel didapatkan rerata usia 55,2; lama menderita DM 9,0; HbA1c 9,9; dan skor MMSE 24,7. Hasil uji korelasi pearson didapatkan hubungan HbA1c dengan skor MMSE (p=0,215; r=-0,212) dan hubungan lama menderita DM dengan skor MMSE (p=0,237;r=-0,202). Simpulan: Terdapat hubungan negatif antara kadar gula darah tidak terkontrol dengan fungsi kognitif dan terdapat hubungan negatif antara lama menderita DM dengan fungsi kognitif namun secara statistik keduanya tidak bermakna pada subyek DM tipe 2.Kata kunci: diabetes melitus, HbA1c, lama menderita DM, fungsi kognitif.
Profil Pasien Tuberkulosis Paru dengan Penyakit Ginjal Kronik yang Dirawat di RSUP Prof. Dr. R. D. Kandou Manado Periode Oktober 2017 – Oktober 2018 Putranto, Michael; Wongkar, Maarthen C. P.; Sugeng, Cerelia
e-CliniC Vol 6, No 2 (2018): Jurnal e-CliniC (eCl)
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.6.2.2018.22113

Abstract

Abstract: Patients with chronic kidney disease (CKD) have increased risk of tuberculosis compared to patients with normal renal function. This is due to impaired cell-mediated immunity, imunosupressive medication, HIV infection, and diabetes mellitus (DM). Uremia is also associated with immunodeficiency in CKD patients due to functional abnormality of neutrophils, reduced T and B cell function, and impaired monocyte and monocyte-derived dendritic cell function. This study was aimed to obtain the profile of TB patients associated with CKD at Prof. Dr. R. D. Kandou Hospital Manado This was a descriptive retrospective study using medical record data of CKD patients with TB co-infection within one-year. The results showed that of 1369 CKD patients, 32 patients had coinfection with TB (2.34%). The majority of patients were males (81%); 62.5% were in the age range of 46-65 years old. Most of them worked as agricultural farmer (28%). Forty-four percent of the patients had CKD stage 5; 11 of them did not undergo dialysis. Most CKD patients were caused by NSAID nephropathy (65%). Conclusion: The majority of TB patients associated with CKD were males, aged 45-65 years, and worked as farmers. The major cause of CKD was NSAID nephropathy. Most patients suffered from CKD stage 5, some did not undergo dialysis.Keywords: chronic kidney disease, lung tuberculosis Abstrak: Pasien dengan penyakit ginjal kronik (PGK) mempunyai peningkatan risiko tuberkulosis (TB) dibanding pasien dengan fungsi ginjal yang normal. Hal ini terkait dengan penurunan cell-mediated immunity, pengobatan imunosupresif, koinfeksi human immune-deficiency virus (HIV), dan diabetes melitus (DM). Uremia juga berhungan dengan imuno-defisiensi pada PGK yang disebabkan oleh abnormalitas fungsional dari neutrofil, penurunan fungsi sel T dan B dan terganggunya fungsi monosit dan sel dendritik turunan monosit. Penelitian ini bertujuan untuk mendapatkan profil pasien TB paru disertai PGK yang dirawat di RSUP Prof. dr. R. D. Kandou Manado periode Oktober 2017-Oktober 2018. Jenis penelitian ialah deskriptif retroskpektif menggunakan data rekam medik pasien PGK dengan koinfeksi TB paru selama satu tahun. Hasil penelitian mendapatkan 1369 pasien PGK; 32 pasien dengan koinfeksi TB paru (2,34%). Mayoritas pasien berjenis kelamin laki-laki (81%), berada pada rentang usia 46-65 tahun (62,5%), dan bekerja sebagai petani (28%). Sebesar 44% dari pasien dengan PGK derajat 5; 11 diantaranya non-dialisis. Paling banyak disebabkan oleh nefropati OAINS (65%). Simpulan: Mayoritas pasien PGK di RSUP Prof. Dr. R. D. Kandou Manado berjenis kelamin laki-laki, berusia 45-65 tahun, dan bekerja sebagai petani. Penyakit penyebab PGK-nya terbanyak ialah nefropati OAINS. Mayoritas pasien PGK dengan derajat 5, sebagian di antaranya non dialisis.Kata kunci: penyakit ginjal kronik, tuberkulosis paru
Profil pasien perdarahan saluran cerna bagian atas yang dirawat di RSUP Prof. Dr. R. D Kandou Manado periode 2013 – 2015 Effendi, Junaidi; Waleleng, Bradley J.; Sugeng, Cerelia
e-CliniC Vol 4, No 2 (2016): Jurnal e-CliniC (eCl)
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v4i2.13041

Abstract

Abstract: Upper gastrointestinal bleeding (UGIB) is the loss of blood in the lumen of gastrointestinal tract, from the eosophagus to the ligament of Treitz in the duodenum with hematemesis and melena as the symptoms. The causes of UGIB are divided into variceal and nonvariceal bleeding such as peptic ulcer, erosive gastritis, eosophagitis, Malory Weiss syndrome, and tumor. This study aimed to obtain the profile of upper gastrointestinal bleeding at Prof. Dr. R. D. Kandou Hospital Manado period 2013 to 2015. This study was conducted in November-December 2015. This was a descriptive retrospective study using medical records from the patients registered in Prof. Dr. R. D. Kandou Hospital Manado from 2013 to 2015. The results showed that there were 139 cases of UGB, consisted of 87 males (63%) and 52 females (37%). Of the 139 cases, peptic ulcer and variceal eosophagus were the most common causes of UGB; peptic ulcer in 105 cases (67%) and variceal esophagus in 34 cases (24%). The most frequent age group was 56-65 years old with 43 cases (31%), and the most rare cases were at 15-25 years old with 6 cases (6%). Conclusion: Among UGB cases at Prof. Dr. R. D. Kandou Hospital Manado from 2013 to 2015, the highest percentages were male gender, age group 56-65 years, and peptic ulcer as the most common cause. Keywords: UGB, variceal esophagus, peptic ulcer Abstrak: Perdarahan saluran cerna bagian atas (SCBA) adalah kehilangan darah dalam lumen saluran cerna dimana saja, mulai dari esofagus sampai dengan duodenum di daerah ligamentum Treitz dengan gejala hematemesis dan melena. Penyebab perdarahan SCBA terbagi atas pecahnya varises esofagus dan non-varises seperti tukak peptik, gastritis erosif, esofagitis, sindrom Mallory Weis, tumor, dll. Tujuan dari penelitian ini adalah untuk mengetahui profil pasien perdarahan saluran cerna bagian atas yang di rawat di RSUP Prof. dr. R. D Kandou Manado periode 2013-2015. Penelitian dilaksanakan pada bulan November-Desember 2015. Jenis penelitian ini deskriptif retrospektif dengan mengambil data rekam medik penderita perdarahan SCBA yang dirawat di RSUP Prof. Dr. R. D Kandou Manado periode 2013-2015. Hasil penelitian memperlihatkan terdapat 139 kasus perdarahan SCBA terdiri dari 87 pasien laki-laki (63%) dan 52 pasien perempuan (37%). Dari 139 kasus tersebut hanya ditemukan dua penyebab kasus perdarahan SCBA, yaitu ulkus peptikum pada 105 kasus (76%) dan varises esofagus pada 34 kasus (24%). Berdasarkan usia, tertinggi pada golongan usia 56-65 tahun sebanyak 43 kasus (31%) dan terendah pada golongan usia 15-25 tahun sebanyak 6 kasus (6%). Simpulan: Pada penelitian ini yang tersering ditemukan ialah ulkus peptik sebagai penyebab perdarahan SCBA, kelompok usia 56-65 tahun, dan pada jenis kelamin laki-laki.Kata kunci: varises esofagus, tukak peptik
Pneumonia Covid-19 dengan Gangguan Ginjal Akut Wahab, Rivaldy; Poli, Efata; Sugeng, Cerelia
e-CliniC Vol 9, No 1 (2021): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.9.1.2021.32303

Abstract

Abstract: SARS-CoV-2 infection causes various symptoms, including mild, moderate, severe, and critical symptoms. Severe SARS-CoV-2 infection can cause pneumonia, acute respiratory syndrome, kidney failure, and even death. This study was aimed to evaluate patients with COVID-19 pneumonia associated with acute kidney injury (AKI). This was a literature review study using three databases, namely PubMed, ClinicalKey, and Google Scholar. The keywords used were acute kidney injury AND pneumonia AND COVID-19. The results showed 10 selected literatures based on inclusion and exclusion criteria. All literatures stated that males dominated the study samples (52.4-73%). The risk factors of AKI in COVID-19 pneumonia were co-morbidities which were predominantly hypertension, diabetes mellitus, COPD, cardiovascular diseases, and respiratory diseases, as well as nephrotoxic drugs. AKI was the complication of pneumonia COVID-19. The mortality rate was higher among pneumonia COVID-19 patients with AKI compared to pneumonia COVID-19 patients without AKI. In conclusion, AKI is the complication of COVID-19 pneumonia. Nephrotoxic drugs and co-morbidities are the risk factors of AKI in COVID-19 pneumonia.  The mortality rate is higher in patients with AKI compared to those without AKI.Keywords: acute kidney injury, pneumonia COVID-19, coronavirus disease 2019  Abstrak: Infeksi SARS-CoV-2 menimbulkan berbagai gejala baik yang ringan, sedang, berat        hingga kritis. Infeksi SARS-CoV-2 yang berat dapat menyebabkan pneumonia, sindrom pernapasan akut, gagal ginjal, bahkan kematian. Penelitian ini bertujuan untuk mengetahui gambaran pneumonia COVID-19 dengan gangguan ginjal akut (GGA). Jenis penelitian ialah literature review dengan pencarian data menggunakan tiga database yaitu PubMed, ClinicalKey, dan Google Scholar. Kata kunci yang digunakan ialah acute kidney injury AND pneumonia AND COVID-19. Hasil penelitian mendapatkan 10 literatur berdasarkan kriteria inklusi dan eksklusi. Pada semua literatur didapatkan jenis kelamin laki-laki yang mendominasi sampel penelitian (52,4-73%). Riwayat penyakit didominasi oleh hipertensi, diabetes melitus, PPOK, penyakit kardiovaskuler, dan penyakit pernapasan. GGA merupakan komplikasi pada pneumonia COVID-19. Pasien pneumonia COVID-19 dengan gangguan ginjal akut memiliki angka kematian yang lebih tinggi dibandingkan dengan pasien pneumonia COVID-19 tanpa gangguan ginjal akut di rumah sakit. Faktor risiko gangguan ginjal akut pada pneumonia COVID-19, antara lain: penggunaan obat yang bersifat nefrotoksik, memiliki komorbid (usia tua, diabetes mellitus, penyakit kardiovaskular, penyakit ginjal kronis, dll). Sinpulan penelitian ini ialah GGA merupakan komplikasi pada pneumonia COVID-19. Penggunaan obat yang bersifat nefrotoksik dan adanya komorbid merupakan faktor risiko terjadinya GGA pada pasien pneumonia COVID-19. Angka kematian lebih tinggi terdapat pada pasien pneumonia COVID-19 dengan GGA dibandingkan dengan yang tanpa GGA.kata kunci: gangguan ginjal akut, pneumonia COVID-19, coronavirus disease 2019
Co-Authors Bradley J. Waleleng Emma Sy. Moeis Junaidi Effendi, Junaidi Karel Pandelaki Monica L. Meloh Moula, Jonathan Pamela M. Poluan Poli, Efata Putranto, Michael Silaban, Bryan J. Ventje Kawengian Wahab, Rivaldy Wongkar, Maarthen C. P.