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All Journal Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Jurnal Simetris Indonesian Journal of Cancer Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML) JURNAL ILMIAH MAKSITEK Abdi Masya Jurnal Abdikarya : Jurnal Karya Pengabdian Dosen dan Mahasiswa JKKI : Jurnal Kedokteran dan Kesehatan Indonesia Indonesian Journal of Cancer IJRETINA - International Journal of Retina
Teguh Triyono
Department Of Clinical Pathology, Faculty Of Medicine, Public Health, And Nursing, Universitas Gadjah Mada-Dr. Sardjito General Hospital, Yogyakarta, Indonesia
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THE DIFFERENCE LEVEL OF MYELOPEROXIDASE IN PLATELET CONCENTRATE BASED ON PREPARATION METHOD AND STORAGE DURATION Fuad Anshori; Teguh Triyono; Tri Ratnaningsih
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 25, No 3 (2019)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v25i3.1462

Abstract

The thrombocyte concentrate (TC) preparation process through its storage affects the platelets contained inside. The contaminating leukocytes in TC is an important factor implicated in storage lesion on TC during storage. Leukodepletion is a method to reduce contaminant leukocytes. Myeloperoxidase (MPO) is an enzyme produced by polymorphonuclear cells that have the potential to change structure and function of platelets when there is interaction between them during storage. The aim of this study is assessing the difference in myeloperoxidase level of TC based on its preparation method (leukodepleted and non-leukodepleted) and time storage. A cross-sectional observational study was conducted at the Blood Transfusion Services Unit, Dr. Sardjito hospital, Yogyakarta from April to December 2014. Thrombocyte Concentrate products was grouped based on storage time (≤ and >72 hours) and preparation method (leukodepleted and non-leukodepleted), their MPO was then measured. Mean difference in each group was analyzed using ANOVA test and post hoc test with statistical significance level of p < 0.05. There were 64 eligible subjects, consisted of 29 leukodepleted TCs and 35 non-leukodepleted TCs, based on their storage time, 31 TCs had ≤72 hours storage  time and the other 33 TCs > 72 hours. There were significantly lower median MPO level in ≤72 hours TCs than > 72 hours in non-leukodepleted TC group (13.23 ± 6.47 ng/mL vs 15.58 ± 7.82 ng/mL; p = 0.017). In TC group with more than 72 hours storage time, median MPO level in non-leukodepleted was significantly higher than leukodepleted TC (15.58 ± 7.82 ng/mL vs. 11.11 ± 3.97 ng/mL; p = 0,001). Myeloperoxidase level was lower in non-leukodepleted TC group with ≤ 72 hours than > 72 hours storage time. Furthermore, the MPO level was higher in leukodepleted TC than non-leukodepleted TC in > 72 hours storage time.
PLATELET LEUCOCYTE AGGREGATES ANALYSIS IN LEUCODEPLETED AND NON-LEUCODEPLETED PLATELET CONCENTRATES Teguh Triyono; Raehanul Bahraen
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 25, No 3 (2019)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v25i3.1458

Abstract

Activated platelet could initiate aggregation and linkage with nearby leucocytes to form Platelet-Leucocyte Aggregates (PLA). Leucodepletion procedure could remove leucocyte and separate it from the other blood components therefore minimalizing the probability of PLA formation. We analyze percentage difference of PLA in leucodepleted and non-leucodepleted platelet concentrate. Dual expression of CD41 and CD45 was determined by flowcytometry method representing the value of PLA, PLA percentage of each group was calculated and analyzed with statistical software SPSS 22. Mean percentage value of PLA in leucodepleted group was 63.05 ±19.86, meanwhile in non-leucodepleted group was 64.61 ±17.27. We found that the percentage of PLA in nonleucodepleted group is higher than leucodepleted although the difference is not statistically significant.
QUALITY OF STORED RED BLOOD Anak Agung Wiradewi Lestari; Teguh Triyono; Usi Sukorini
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 23, No 3 (2017)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v23i3.1209

Abstract

Telah diketahui bahwa selama penyimpanan, sel darah merah mengalami sejumlah perubahan yang mempengaruhi viabilitas dankemampuannya untuk membawa oksigen ke jaringan. Perubahan tersebut digolongkan menjadi perubahan biomekanik dan biokimia.Perubahan biomekanik yang terjadi adalah perubahan membran sel. Selama penyimpanan, sel darah merah mengalami perubahanmorfologi secara pesat, dari bikonkaf menjadi echinocytes dengan tonjolan dan akhirnya menjadi spheroechinocytes. Hilangnya kesatuansel darah merah tersebut menyebabkan pelepasan hemoglobin (hemolisis) dan pembentukan mikropartikel yang dapat menyebabkankomplikasi transfusi. Pelepasan hemoglobin (Hb) dan mikropartikel bebas menyebabkan peningkatan penggunaan Nitric Oxide (NO),sebuah molekul sinyal penting yang berperan dalam aliran darah dan dapat merangsang terjadinya inflamasi. Perubahan kimia lainnyayang dapat terjadi adalah penurunan glukosa dan penumpukan asam laktat, penurunan kalium, kepekatan adenosine triphosphate (ATP)dan 2,3-diphosphoglycerate (DPG). Tidak semua kerusakan sel akibat penyimpanan ini bersifat eryptotic. Penurunan kalium bersifatpasif (suhu yang dingin menyebabkan pompa pertukaran natrium/kalium menjadi tidak aktif). Penurunan DPG juga bersifat pasif,terkait dengan perubahan kekhasan enzim diphosphoglycerate mutase/diphosphoglyceratephosphatase dan penurunan pH. PenurunanNO terjadi karena larutnya NO bersama dengan Hb yang dilepaskan saat hemolisis. Hb plasma lebih cepat bereaksi dengan NO,dibandingkan dengan Hb dalam sel darah merah. Berkurangnya NO ini berperan dalam keadaan patologis yang terjadi sehubungandengan pemberian darah simpan termasuk dalam hal pengangkutan oksigen oleh Hb. Perubahan akibat penyimpanan ini reversibel bilasel darah merah tersebut ditransfusikan kembali ke dalam peredaran. Tolok ukur utama yang dikontrol secara rutin untuk penyimpananRBC adalah 0,8–1% hemolisis, 75% in-vivo survival dalam waktu 24 jam setelah transfusi, volume dan kadar hemoglobin sel darahmerah. Tolok ukur tersebut memang sangat berguna, namun, perubahan biokimia yang berhubungan dengan fungsi vaskular jugaharus dipertimbangkan. Perubahan yang terjadi selama penyimpanan tersebut akan reversibel melalui upaya peningkatan kualitaspenyimpanan, atau menambahkan larutan additive.
AUDIT SYSTEM FOR USAGE OF BLOOD PRODUCT IN SANGLAH GENERAL HOSPITAL DENPASAR BALI Kadek Mulyantari; Teguh Triyono; Usi Sukorini
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 25, No 3 (2019)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v25i3.1382

Abstract

Blood transfusion is one of very important therapy components. One indicator of the blood services quality in Sanglah  General Hospital Denpasar Bali Indonesia is achieving the target of unused blood order ≤ 10% per month. However, these targets have not been achieved. The number of unused blood orders reached 6,719 bags per year (600 bags per month or 21.5%). Unused blood orders is mostly from Department of Internal Medicine (40.9%), followed by Department of Surgical (35.6%),  Department of Obstetrics and Gynecology (15.5%) , and Department of Pediatrics (8%). The high number of unused blood orders can causes several problems such as the disorder of blood supply, inefficiency of pre-transfusion testing and decreased quality of blood product. Considering the consequences of high unused blood order, it is necessary to conduct a research on audit system for usage of blood product in Sanglah Hospital.The aim of study are to analyze the influence of audit system to reduce unused blood order and to decrease the number of C/T ratio. The study design was a pre and post test intervention study. The population in this study were all forming of blood requests in Sanglah Hospital. The sample is blood request form Department of Internal Medicine of the last two months. Intervention in this study was the development and dissemination of guidelines for usage of blood products, followed by concurrent audit and prospective audit of the sample.The study show there are decline of unused blood orders and C/T ratio before and after implementation of the audit system for usage of blood products. Reduction of unused blood order in Sanglah Hospital is 5.4%, and in the Department of Internal Medicine is 5.2%. The causes of unused blood orders were patient died, overestimation of blood order, transfusion delays because waiting for the schedule of hemodialysis, the patient has a fever, blood product has expired, and the occurrence of administration errors. Reduction of C/T ratio in Sanglah Hospital is 0,094 and in the Department of Internal Medicine is 0,072. Audit system for usage of blood products can reduce unused blood orders and decrease C/T ratio.
Faktor yang Memengaruhi Episode Transfusi Packed Red Cell (PRC) pada Anak dengan Keganasan DIAN A.P PURWANTO; SRI MULATSIH; TEGUH TRIYONO
Indonesian Journal of Cancer Vol 11, No 2 (2017): April - June
Publisher : National Cancer Center - Dharmais Cancer Hospital

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (439.562 KB) | DOI: 10.33371/ijoc.v11i2.501

Abstract

ABSTRACTPRC transfusion is an adjuvant therapy frequently used in children with malignancy. There are some factors affecting transfusion episodes. For rational use of PRC must consider these factors. Objective: To find factors affecting transfusion episodes in children with malignancy. This retrospective cohort study evaluated children with malignancy between January 1 and December 31, 2015 who were admitted to Sardjito hospital. Patients were receiving therapy dan PRC transfusion during the four months following cancer diagnosis. Those with incomplete data or renal failure were excluded. The influence of these factors were analyzed with Chi-square or Fisher’s exact and Kolmogorov-Smirnov when iligible, and the most influential factor were analyzed by logistic regression. Out of 123 subjects receiving a PRC transfusion, 56 (45,5%) subjects received a PRC transfusion more than one times episodes. Higher episodes of transfusion were observed for patients whose bleeding (RR 6.940 (95%CI 2.563 to 18.790). Lower episodes of transfusion were observed for patients receiving transfusion previously and hematological malignancies, but the result were not significant (RR 0,524 (IK95% 0,057 – 4,852) and 0,464 (IK 95% 0,140 – 1,540) respectively). Bleeding is factor affecting transfusion episodes of PRC in children with malignancy.ABSTRAKTransfusi PRC merupakan terapi adjuvant yang sering digunakan pada anak dengan keganasan. Terdapat beberapa faktor yang memengaruhi episode transfusi sehingga penggunaan PRC rasional harus mempertimbangkan faktor tersebut. Penelitian ini bertujuan mengetahui faktor yang memengaruhi episode transfusi PRC pada anak dengan keganasan. Penelitian kohort retrospektif pada anak (0 –18 tahun) yang dirawat di RSUP Dr. Sardjito dengan penyakit keganasan yang telah terdiagnosis selama empat bulan dan mendapat terapi serta transfusi PRC sejak 1 Januari – 31 Desember 2015. Register tidak lengkap atau dengan gagal ginjal dieksklusi. Pengaruh faktor– faktor tersebut dianalisis dengan uji Chi-square atau uji Fisher serta Kolmogorov-Smirnov bila tidak memenuhi syarat, dan faktor yang paling berpengaruh dianalisis dengan uji logistic regression. Dari 123 subjek, 56 subjek dengan episode transfusi PRC > 1 kali. Keganasan hematologi, riwayat transfusi, dan perdarahan memengaruhi episode transfusi PRC > 1 kali. Analisis multivariat didapatkan perdarahan memengaruhi episode transfusi PRC > 1 kali (RR 6,940 (IK95% 2,563 – 18,790), namun riwayat transfusi dan keganasan hematologi tidak bermakna dengan nilai RR secara berturut-turut 0,524 (IK95% 0,057 – 4,852) dan 0,464 (IK 95% 0,140 – 1,540). Penelitian ini menyimpulkan bahwa perdarahan merupakan faktor yang memengaruhi episode transfusi PRC pada anak dengan keganasan. 
AUDIT SYSTEM FOR USAGE OF BLOOD PRODUCT IN SANGLAH GENERAL HOSPITAL DENPASAR BALI Kadek Mulyantari; Teguh Triyono; Usi Sukorini
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 25 No. 3 (2019)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v25i3.1382

Abstract

Blood transfusion is one of very important therapy components. One indicator of the blood services quality in Sanglah  General Hospital Denpasar Bali Indonesia is achieving the target of unused blood order ≤ 10% per month. However, these targets have not been achieved. The number of unused blood orders reached 6,719 bags per year (600 bags per month or 21.5%). Unused blood orders is mostly from Department of Internal Medicine (40.9%), followed by Department of Surgical (35.6%),  Department of Obstetrics and Gynecology (15.5%) , and Department of Pediatrics (8%). The high number of unused blood orders can causes several problems such as the disorder of blood supply, inefficiency of pre-transfusion testing and decreased quality of blood product. Considering the consequences of high unused blood order, it is necessary to conduct a research on audit system for usage of blood product in Sanglah Hospital.The aim of study are to analyze the influence of audit system to reduce unused blood order and to decrease the number of C/T ratio. The study design was a pre and post test intervention study. The population in this study were all forming of blood requests in Sanglah Hospital. The sample is blood request form Department of Internal Medicine of the last two months. Intervention in this study was the development and dissemination of guidelines for usage of blood products, followed by concurrent audit and prospective audit of the sample.The study show there are decline of unused blood orders and C/T ratio before and after implementation of the audit system for usage of blood products. Reduction of unused blood order in Sanglah Hospital is 5.4%, and in the Department of Internal Medicine is 5.2%. The causes of unused blood orders were patient died, overestimation of blood order, transfusion delays because waiting for the schedule of hemodialysis, the patient has a fever, blood product has expired, and the occurrence of administration errors. Reduction of C/T ratio in Sanglah Hospital is 0,094 and in the Department of Internal Medicine is 0,072. Audit system for usage of blood products can reduce unused blood orders and decrease C/T ratio.
PLATELET LEUCOCYTE AGGREGATES ANALYSIS IN LEUCODEPLETED AND NON-LEUCODEPLETED PLATELET CONCENTRATES Teguh Triyono; Raehanul Bahraen
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 25 No. 3 (2019)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v25i3.1458

Abstract

Activated platelet could initiate aggregation and linkage with nearby leucocytes to form Platelet-Leucocyte Aggregates (PLA). Leucodepletion procedure could remove leucocyte and separate it from the other blood components therefore minimalizing the probability of PLA formation. We analyze percentage difference of PLA in leucodepleted and non-leucodepleted platelet concentrate. Dual expression of CD41 and CD45 was determined by flowcytometry method representing the value of PLA, PLA percentage of each group was calculated and analyzed with statistical software SPSS 22. Mean percentage value of PLA in leucodepleted group was 63.05 ±19.86, meanwhile in non-leucodepleted group was 64.61 ±17.27. We found that the percentage of PLA in nonleucodepleted group is higher than leucodepleted although the difference is not statistically significant.
THE DIFFERENCE LEVEL OF MYELOPEROXIDASE IN PLATELET CONCENTRATE BASED ON PREPARATION METHOD AND STORAGE DURATION Fuad Anshori; Teguh Triyono; Tri Ratnaningsih
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 25 No. 3 (2019)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v25i3.1462

Abstract

The thrombocyte concentrate (TC) preparation process through its storage affects the platelets contained inside. The contaminating leukocytes in TC is an important factor implicated in storage lesion on TC during storage. Leukodepletion is a method to reduce contaminant leukocytes. Myeloperoxidase (MPO) is an enzyme produced by polymorphonuclear cells that have the potential to change structure and function of platelets when there is interaction between them during storage. The aim of this study is assessing the difference in myeloperoxidase level of TC based on its preparation method (leukodepleted and non-leukodepleted) and time storage. A cross-sectional observational study was conducted at the Blood Transfusion Services Unit, Dr. Sardjito hospital, Yogyakarta from April to December 2014. Thrombocyte Concentrate products was grouped based on storage time (≤ and >72 hours) and preparation method (leukodepleted and non-leukodepleted), their MPO was then measured. Mean difference in each group was analyzed using ANOVA test and post hoc test with statistical significance level of p < 0.05. There were 64 eligible subjects, consisted of 29 leukodepleted TCs and 35 non-leukodepleted TCs, based on their storage time, 31 TCs had ≤72 hours storage  time and the other 33 TCs > 72 hours. There were significantly lower median MPO level in ≤72 hours TCs than > 72 hours in non-leukodepleted TC group (13.23 ± 6.47 ng/mL vs 15.58 ± 7.82 ng/mL; p = 0.017). In TC group with more than 72 hours storage time, median MPO level in non-leukodepleted was significantly higher than leukodepleted TC (15.58 ± 7.82 ng/mL vs. 11.11 ± 3.97 ng/mL; p = 0,001). Myeloperoxidase level was lower in non-leukodepleted TC group with ≤ 72 hours than > 72 hours storage time. Furthermore, the MPO level was higher in leukodepleted TC than non-leukodepleted TC in > 72 hours storage time.
EVALUASI PENETAPAN NILAI KRITIS PARAMETER HEMATOLOGI DI INSTALASI LABORATORIUM KLINIK RSUD WATES PRITA MURANI NUGRAHETI; TEGUH TRIYONO
JURNAL ILMIAH MAKSITEK Vol 8 No 2 (2023): JURNAL ILMIAH MAKSITEK
Publisher : LP2MTBM MAKARIOZ

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

Abstract

Timely and accurate reporting critical value of laboratory examination helps support decision making, improves patient safety, and promotes successful therapy. A very extensive or very exclusive list of critical values has the potential to cause problems. This study is aimed to evaluate the determination of critical values, especially hematological parameters, in the Clinical Laboratory Installation of RSUD Wates. This study is a descriptive study of laboratory examination data for hematological parameters at RSUD Wates on January-June 2021. The proportion of critical values is calculated according to the cut off determined by the Clinical Laboratory of RSUD Wates. The cut off of critical values for the Laboratory of RSUP Dr. Sardjito was used as a comparison. The difference in proportion between the two groups was analyzed using the Chi Square test with p<0.05 is statistically significant. The most examination data was leukocyte count (7903 or 25.1%) and the examination with the most critical values is hematocrit (363 or 4.59%). There is a statistically difference in the number of critical values on the parameters of hematocrit, platelet count, leukocyte count and APTT, between the use of the cut off critical value of the clinical laboratory of RSUD Wates compared to the laboratory of RSUP Dr. Sardjito (p<0.01). The different two cut offs has the potential to increase the workload of laboratory staff and more time in reporting critical values. The cut off of critical values at the Clinical Laboratory of RSUD Wates should be reviewed, revised and updated regularly.
DIFFERENCES OF APOLIPOPROTEIN A1 AND APOLIPOPROTEIN B LEVELS IN TYPE 2 DIABETES MELLITUS (T2DM) PATIENTS WITH DIABETIC RETINOPATHY AND WITHOUT DIABETIC RETINOPATHY shabrina hanifah; Angela Nurini Agni; Indra Tri Mahayana; Suhardjo Suhardjo; Teguh Triyono
International Journal of Retina Vol 4 No 2 (2021): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2021.vol004.iss002.153

Abstract

Introduction Apolipoprotein A1 are antiatherogenic in blood serum and have an anti-inflammatory while Apolipoprotein B describes a protein structure that is potentially atherogenic.. Meanwhile, the inflammatory process plays a role in the diabetic retinopathy process. The aim of this study was to determine whether there were differences in the levels of apolipoprotein A1 and B in diabetic retinopathy patients and without diabetic retinopathy. Methods: This study used a cross sectional design. The subjects of this study were type 2 diabetes mellitus patients with diabetic retinopathy and without diabetic retinopathy at Dr. Sardjito General Hospital from July to September 2020. Subjects consisted of 32 patients in the group with diabetic retinopathy and 31 patients without diabetic retinopathy. The levels of apolipoprotein A1 and apolipoprotein B were analyzed using independent T test. The factors affecting apolipoprotein A1 and apolipoprotein B were analyzed using multiple regression tests. Result: There were no significant differences (p> 0.05) in age, gender, duration of diabetes, HDL, triglycerides, HbA1c, BMI, physical activity, and smoking history. The mean apolipoprotein A1 level in the diabetic retinopathy group was 1.46 ± 0.177 mg / dL higher than the non-diabetic retinopathy group, namely 1.44 ± 0.27 mg / dL (p = 0.699). The mean level of apolipoprotein B in the diabetic retinopathy group was 1.26 ± 0.289 mg / dl higher than the non-diabetic retinopathy group 1.01 ± 0.26 mg / dL (p = 0.001). The mean LDL levels were 162.5 ± 48.38 mmol / L in the diabetic retinopathy group and 127 ± 38.45 mmol / L in the group without diabetic retinopathy (p = 0.012). Conclusion: Apolipoprotein B levels were found to be higher in the group with diabetic retinopathy than in the group without diabetic retinopathy and there was a significant difference between the two assumed due to an atherogenic process in the diabetic retinopathy group. Further research is needed to assess the causal relationship between elevated levels of Apo B and the incidence of diabetic retinopathy by calculating the ratio of apolipoprotein B to apolipoprotein A1. Keywords: Apolipoprotein A1, Apolipoprotein B, Diabetic Retinopathy
Co-Authors Abdul Salam Sofro Aditya Wicaksana Akbar, Hammar Ilham Akhmad Fathoni, Akhmad Anak Agung Wiradewi Lestari Andri Christianalusi Angela Nurini Agni Bambang Margono Budi Mulyono Budi Mulyono Caesar Haryo Bimoseno Chamim, Moch. David Dwi Putera DIAN A.P PURWANTO Eko Surojo Endang Yuniastuti Fridawati, Veronica Fuad Anshori Hans Vrielink Harsito, Catur Indra Tri Mahayana Jarir At Thobari Johan Kurnianda Jonliberti Purba Kaslam, Surawijaya Bakhtiar Mardiah Suci Hardianti Neti Nurani Ni Kadek Mulyantari Nurul Muhayat Pramudi, Ganjar PRITA MURANI NUGRAHETI PURWANTO, DIAN A.P Raehanul Bahraen shabrina hanifah Singgih Dwi Prasetyo Sri Mulatsih Sri Mulatsih Sri Mulatsih Suhardjo Suhardjo Sukmaji Indro Cahyono, Sukmaji Indro Surawijaya Bakhtiar Kaslam Sutaryo Sutaryo Syahru Agung Setiawan Tri Ratnaningsih Triyono Triyono Triyono Ubaidillah Ubaidillah Umi Solekhah Intansari Usi Sukorini Veronica Fridawati Wijang Wisnu Raharjo Zainal Arifin