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Gram stain evaluation in dermatovenereology clinic and microbiology laboratories: case series Kusumadewi, Yolanda Pitra; Kholidah, Siti Nurhayati; Susetiati, Devi Artami; Nuryastuti, Titik
Journal of Clinical Microbiology and Infectious Diseases Vol. 5 No. 1 (2025): Available online : 1 June 2025
Publisher : Indonesian Society for Clinical Microbiology (Perhimpunan Dokter Spesialis Mikrobiologi Klinik Indonesia)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/jcmid.v5i1.59

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Introduction: The normal vaginal flora consists of aerobic and anaerobic bacteria; Lactobacillus sp. is the main microorganism in the vagina. In bacterial vaginosis, there is a decrease in Lactobacillus sp. and an increase in pathogenic bacteria. Direct gram staining of vaginal fluid is the standard microbiological method for diagnosing bacterial vaginosis. Gram staining allows us to distinguish between gram-positive and gram-negative bacteria based on differential staining with crystal violet iodine complex and safranin. This study aimed to evaluate and compare the gram stain results between the dermatovenereology clinic and microbiology laboratories. Case description: Direct gram staining of vaginal or cervical swabs was carried out on women aged 19 years, women aged 29 years, and women aged 40 years. The gram staining was carried out at the dermatovenereology clinic and microbiology laboratory with different results between the two locations. Conclusion: It is important to evaluate the process of taking vaginal fluid samples, making smears/slides, and gram staining so that the quality of the examination results is maintained
Ambroxol Therapy as an Antibiofilm Candidate in Diabetic Ulcer Patients Wahyuddin, Munifah; Sari, Ika Puspita; Asdie, Rizka Humardewayanti; Nuryastuti, Titik
Jurnal Mandala Pharmacon Indonesia Vol. 11 No. 1 (2025): Jurnal Mandala Pharmacon Indonesia
Publisher : Program Studi Farmasi Universitas Mandala Waluya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35311/jmpi.v11i1.791

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Patients with diabetic ulcers are susceptible to infection because the tissue in their extremities is constantly exposed to various pathogenic bacteria, so biofilm formation plays an important role in developing the disease. Based on previous studies, ambroxol can inhibit the formation of biofilm bacteria. The purpose of this study was to identify biofilm-forming bacteria, prove that ambroxol has the potential to inhibit and eradicate biofilms formed by bacteria in diabetic ulcers and analyse the potential of ambroxol in eradicating biofilms formed by bacteria in diabetic ulcer patients based on PEDIS and SEM scores. The method used was a 96-well microtiter plate assay (MtPA) with crystal violet and MTT staining techniques, a test using human samples with a quasi-experimental method with sampling carried out by nonprobability sampling. The samples used were diabetic ulcer patients with culture results forming biofilms. The results obtained identified 3 clinical isolates that formed biofilms with 100% Gram-negative bacteria, including two isolates of Pseudomonas aeruginosa and one isolate of Escherichia coli with the ability to form biofilms are moderate. Ambroxol effectively inhibits and eradicates 50% of biofilms formed by diabetic ulcer bacteria at a minimum concentration of 1 mg/ml. Based on the PEDIS score and SEM images of diabetic ulcer patients, there was a decrease in the PEDIS score in each patient, with an average score of 2. Several studies have demonstrated that combining Ambroxol with antimicrobials can synergistically enhance the antibiotic's efficacy against biofilms. The co-administration of Ambroxol with other antimicrobial agents represents a promising approach to improving antibiotic effectiveness. Nevertheless, careful consideration must be given to the concentration of Ambroxol used.
Treatment of the cytokine storm in COVID-19: review of clinical pharmacology Sapriati, Aisyah Nur; Rahmawati, Fita; Nuryastuti, Titik
JSFK (Jurnal Sains Farmasi & Klinis) Vol 10 No 2 (2023): J Sains Farm Klin 10(2), Agustus 2023
Publisher : Fakultas Farmasi Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/jsfk.10.2.162-183.2023

Abstract

The cause of the COVID-19 pandemic can be attributed to the Acute Respiratory Syndrome Virus-2 (SARS-CoV-2). COVID-19 manifests with severe symptoms in the upper respiratory tract and can progress to a critical condition due to an acute hyperinflammatory response that triggers a cytokine storm. The cytokine storm refers to an excessive or impaired production of proinflammatory cytokines, resulting in immune dysregulation and uncontrolled inflammatory activity. To effectively address the hyperinflammatory state induced by SARS-CoV-2 infection, it is imperative to explore promising strategies aimed at overcoming the cytokine storm, such as the prompt initiation of anti-inflammatory therapy. Several classes of drugs can potentially prevent the deterioration of COVID-19 patients by mitigating immune system dysregulation and suppressing uncontrolled inflammatory responses. These drug classes encompass corticosteroids, chloroquine and hydroxychloroquine, inhibitors of interleukin-1 (IL-1), inhibitors of interleukin-6 (IL-6), inhibitors of tumor necrosis factor (TNF), and anti-inflammatory drugs. Additionally, tumor necrosis factor alpha (TNF-α) inhibitors, as well as inhibitors targeting the Janus kinase signaling pathway and activator of transcription (JAK/STAT), have exhibited efficacy in treating COVID-19. This efficacy is evident when considering the drug's mechanism of action and pharmacokinetics, while also taking into account the tolerable side effects associated with their usage
Badai Sitokin pada Covid-19: Ulasan Naratif: Cytokine Storm in Covid-19: Narative Review Sapriati, Aisyah Nur; Rahmawati, Fita; Nuryastuti, Titik
Jurnal Surya Medika (JSM) Vol. 10 No. 1 (2024): Jurnal Surya Medika (JSM)
Publisher : Institute for Research and Community Services Universitas Muhammadiyah Palangkaraya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33084/jsm.v10i1.7243

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SARS-Cov-2 adalah virus yang dapat menyebabkan terjadinya penyakit COVID-19 yang parah yang terkait dengan peningkatan produksi sitokin/kemokin proinflamasi. Badai sitokin adalah pelepasan sitokin proinflamasi yang berlebihan atau tidak terkendali yang menyebabkan kekacauan pada sistem kekebalan tubuh dan respon inflamasi yang tidak terkendali. Artikel ini dibuat dengan tujuan untuk memberikan pemahaman terkait badai sitokin, patofisiologi yang menyertainya, manifestasi klinis, pengukuran laboratorium, dan faktor-faktor yang memicu terjadinya badai sitokin. Badai sitokin pada COVID-19 ini menyebabkan terjadinya kegagalan multi-organ bahkan kematian. Faktor-faktor yang menyebabkan terjadinya badai sitokin pada pasien COVID-19 ini bukan saja disebabkan oleh adanya SARS-CoV-2 tetapi adanya factor pendukung lain seperti usia yang lebih tua, jenis kelamin laki-laki, golongan darah A serta adanya gangguan metabolisme pada pasien seperti peningkatan tekanan darah, obesitas maupun diabetes.
Effectiveness evaluation of antibiotic use in patients with Methicillin-resistant Staphylococcus aureus (MRSA) infection: a review As, Musdalifa; Ika Puspitasari; Nuryastuti, Titik
Indonesian Journal of Pharmacology and Therapy Vol 5 No 1 (2024)
Publisher : Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada and Indonesian Pharmacologist Association or Ikatan Farmakologi Indonesia (IKAFARI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ijpther.10771

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Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogen that become a public health problem due to its ability to be resistant to more than three classes of antibiotics. Evaluation of the effectiveness of antibiotic use in patients with MRSA is important to optimize antibiotic use and to control antibiotic resistance. This article review attempted to evaluate the effectiveness of antibiotics in patients with MRSA. This review explored the results of previous research from PubMed as a literature source and the PRISMA flow diagram as a protocol for the article selection process. Eight studies reviewed the evaluation of the effectiveness of antibiotic use in MRSA patients with various clinical conditions, such as uncomplicated wound infections, cellulitis and no wound, purulent drainage or abscess, cSSSI infections caused by MRSA, infections caused by MRSA bacteremia and nosocomial infections caused by MRSA. In conclusion, the effectiveness of antibiotics in patients with MRSA infection depends on the clinical condition of each patient. Therefore, the use of antibiotics is adjusted based on the type of infection and the efficacy of the antibiotics. Combination therapy is recommended for MRSA patients considering its life-threatening ability.
The hospital environment as an ecological driver of multidrug-resistant organisms: evidence from intensive isolation and operating rooms Widyasari, Domas Fitria; Daniwijaya, Edwin Widyanto; Purnomo, Galih Santo; Rahayu, Ayu; Nuryastuti, Titik
Berita Kedokteran Masyarakat Vol 42 No 01 (2026)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/bkm.v42i01.24745

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Purpose: Multidrug-resistant organisms (MDROs) present a significant challenge for hospital infection control, with environmental surfaces acting as key reservoirs. This study sought to identify MDRO species, evaluate their biofilm-forming capacity, and quantify microbial bioburden in intensive care isolation and operating rooms. Methods: Environmental sampling was conducted in 16 rooms. Air and surface samples, including floors, walls, and bedside monitors, were collected using a microbiological air sampler and sterile swabs. Samples were cultured to determine total bioburden and detect MDROs, with bacterial identification performed using VITEK 2. Antimicrobial resistance was assessed using the Kirby-Bauer disc diffusion test, and bioburden levels were compared to national standards. Results: Forty-nine MDRO isolates were identified: 3 methicillin-resistant Staphylococcus aureus (MRSA, 6.12%), 19 methicillin-resistant coagulase-negative staphylococci (MRCONS, 38.78%), 24 carbapenem-resistant Acinetobacter spp. (CRA, 48.98%), and 3 extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (6.12%). Mean microbial bioburden remained within acceptable limits for air (57.44 CFU/m³), walls (70.63 CFU/100 cm²), and bedside monitors (22.63 CFU/100 cm²), but exceeded thresholds on floors (753.75 CFU/100 cm²). Biofilm-forming capacity varied: MRCONS (26.32% strong biofilm), CRA (8.33% strong biofilm), and ESBL-producing Enterobacterales (66.67% weak biofilm). Conclusion: MDROs were detected in all sampled rooms, with CRA as the predominant species. Floors exhibited microbial loads above acceptable standards, highlighting the necessity for improved cleaning protocols. Enhanced environmental infection control strategies are essential to reduce MDRO transmission in healthcare settings.
GAMICBANK: Pendekatan Inovatif dalam Pelestarian Isolat Mikroba Mulyani, Mulyani; Awaludin, Kamla; Rahayu, Ayu; Nuryastuti, Titik
Indonesian Journal of Laboratory Vol 9, No 1 (2026)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ijl.v9i1.112540

Abstract

ABSTRAK. Pelestarian isolat mikroba sangat penting untuk penelitian, diagnostik, dan bioteknologi. Metode konvensional seperti stok gliserol atau liofilisasi efektif namun seringkali mahal dan rentan terhadap risiko kontaminasi. Strategi alternatif penyimpanan berbasis butiran, memungkinkan pengambilan mikroorganisme yang masih hidup dengan mudah sambil meminimalkan siklus pembekuan-pencairan berulang. Studi ini bertujuan untuk mengevaluasi kinerja awal sistem GAMICBANK, metode penyimpanan mikroba berbasis butiran menggunakan butiran mikrobank plastik yang dimasukkan dalam larutan susu skim atau Skim Milk–Tryptone–Glucose–Glycerol (STGG), untuk menyimpan bakteri dan ragi pada suhu –80 °C. Isolat Gram-positif, Gram-negatif, dan ragi yang representatif (Staphylococcus aureus, Streptococcus spp., Listeria monocytogenes, Salmonella typhi, Shigella flexneri, Escherichia coli, Neisseria gonorrhoeae, Chromobacterium violaceum, dan Candida albicans) disimpan dalam butiran dengan susu skim atau STGG. Butiran tersebut diambil kembali setelah 1 dan 3 bulan, ditanam pada media selektif, dan dievaluasi pertumbuhan koloni dan viabilitasnya. Setelah 1 bulan, semua isolat tetap memiliki viabilitas yang sangat baik di kedua media. Pada 3 bulan, sebagian besar spesies tetap sangat viabel (>99%) di kedua media. Namun, Listeria monocytogenes dan Neisseria gonorrhoeae menunjukkan penurunan viabilitas yang signifikan dalam susu skim (30%) tetapi tetap stabil dalam STGG (99%). Demikian pula, Candida albicans menunjukkan penurunan viabilitas dalam susu skim (50%) tetapi mempertahankan 99% kelangsungan hidup dalam STGG. Sistem bead GAMICBANK secara efektif melestarikan mikroorganisme yang tangguh dan sensitif pada suhu –80 °C. STGG memberikan perlindungan beku yang lebih unggul dibandingkan susu skim, terutama untuk bakteri sensitif dan ragi. Kesimpulannya bahwa sistem GAMICBANK dapat dijadikan sebagai metode alternatif untuk penyimpanan isolat bakteri dan ragi.ABSTRACK.The preservation of microbial isolates is crucial for research, diagnostics, and biotechnology. Conventional methods, such as glycerol stocks or lyophilization, are effective but frequently expensive and susceptible to contamination risks. An alternative strategy, bead-based storage, facilitates the easy retrieval of viable microorganisms while minimizing repeated freeze-thaw cycles. This study aims to evaluate the initial performance of the GAMICBANK system, a bead-based microbial storage method utilizing plastic microbank beads submerged in either skim milk or Skim Milk–Tryptone–Glucose–Glycerol (STGG) solutions, for the cryopreservation of bacteria and yeast at –80 °C. Representative Gram-positive, Gram-negative, and yeast isolates (Staphylococcus aureus, Streptococcus spp., Listeria monocytogenes, Salmonella typhi, Shigella flexneri, Escherichia coli, Neisseria gonorrhoeae, Chromobacterium violaceum, and Candida albicans) were preserved in beads using either skim milk or STGG. The beads were retrieved after 1 and 3 months of storage, cultured on selective media, and evaluated for colony growth and viability. After 1 month, all isolates maintained excellent viability in both preservation media. At 3 months, the majority of the species remained highly viable (>99%) in both media. However, Listeria monocytogenes and Neisseria gonorrhoeae exhibited a significant decline in viability when stored in skim milk (30%) but remained stable in STGG (99%). Similarly, Candida albicans demonstrated a reduction in viability in skim milk (50%) while maintaining a 99% survival rate in STGG. The GAMICBANK bead system effectively preserves both robust and sensitive microorganisms at –80 °C. STGG provides superior cryoprotection compared to skim milk, particularly for sensitive bacteria and yeast. In conclusion, the GAMICBANK system serves as a viable alternative method for the preservation of bacterial and yeast isolates. 
Hubungan Antara Rasionalitas Pemberian Antibiotik Profilaksis Dengan Kejadian Infeksi Luka Operasi Pada Pasien Bedah DI RSA UGM Aron Saputra Thie; Ika Puspitasari; Titik Nuryastuti
Majalah Farmaseutik Vol 22, No 2 (2026)
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/farmaseutik.v22i2.106960

Abstract

Infeksi luka operasi (ILO) dapat memberikan efek yang signifikan terhadap kualitas hidup pasien. Penggunaan antibiotik profilaksis dapat menurunkan kejadian ILO. Penelitian ini bertujuan untuk mengetahui jumlah penggunaan antibiotik profilaksis yang rasional, mengetahui jumlah kejadian ILO, mengidentifikasi faktor risiko yang berpengaruh terhadap ILO dan mengetahui hubungan rasionalitas antibiotik profilaksis pada pasien bedah dengan kejadian ILO di RSA UGM. Penelitian ini merupakan penelitian dengan rancangan kohort retrospektif. Populasi dan sampel dalam penelitian ini adalah seluruh pasien yang menjalani tindakan pembedahan dan mendapatkan antibiotik profilaksis di RSA UGM selama bulan Januari sampai dengan Desember 2023. Terdapat 156 pasien yang menjalani tindakan bedah dan masuk dalam kriteria inklusi pada penelitian ini. Rasionalitas penggunaan antibiotik profilaksis berdasarkan metode Gyssens (kategori 0) pada penelitian ini sebesar 39,7% (62 pasien) dan angka kejadian ILO pada penelitian ini sebesar 5,1% (8 dari total 156 pasien). Tidak terdapat hubungan yang signifikan antara ketidakrasionalan penggunaan antibiotik profilaksis dengan kejadian ILO (P=1,000). Terdapat hubungan yang signifikan antara lama rawat inap post operasi, Intraoperative Blood Loss, dan waktu pemberian antibiotik dengan kejadian ILO berdasarkan analisis bivariat. Analisis multivariat menunjukkan bahwa lama rawat inap post operasi memiliki hubungan yang bermakna dengan angka kejadian ILO. Individu dengan lama rawat inap post operasi lebih dari 3 hari memiliki risiko 0,167 lebih tinggi untuk mengalami ILO (OR 0,167; CI 95% 0,036-0,765; p = 0,021).
Correlation between ciprofloxacin and levofloxacin susceptibility in beta-lactam- and carbapenem-resistant Escherichia coli isolated from UTI patients in Yogyakarta Aman, Abu Tholib; Nuryastuti, Titik; Rizmattu, Kezhiki Diaz Martha; Riyelly, Zelfia; Mahanani, Nabeilla Shouma; Putri, Natasya Salsabila; Kuncorojati, R. Alif; Aman, Alia Hanifa; Mawarti, Yuli
JKKI : Jurnal Kedokteran dan Kesehatan Indonesia JKKI, Vol 17, No 2, (2026)
Publisher : Faculty of Medicine, Universitas Islam Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20885/JKKI.Vol17.Iss2.art7

Abstract

Background: Escherichia coli (E. coli) is a major cause of urinary tract infection (UTI). The emerging resistance of E. coli against beta-lactams and or carbapenem lead to the increased use of fluoroquinolone (ciprofloxacin or levofloxacin) in clinical practice. Data of E. coli susceptibility, particularly regarding the extended-spectrum beta lactamase (ESBL) expression and carbapenem or fluoroquinolone resistance can be important for clinical treatment.Objectives: This study aimed to describe the susceptibility profile of ESBL producing E. coli isolates, as well as their resistance against carbapenem and fluoroquinolone. In addition, the use of ciprofloxacin in predicting levofloxacin against the E. coli isolates was analyzed.Methods: A retrospective analytic study was conducted on 135 laboratory records of E. coli isolated from urine culture of adult patients at FMPHN UGM (2007-2022). Proportion of ESBL phenotype, as well as carbapenem, ciprofloxacin and levofloxacin resistance were calculated and augmented by kappa score and plots matrix analysis.Results: The ESBL producer E. coli as well as their resistances to carbapenem and ciprofloxacin were observed in 71(53.78%) of the 132 isolates, 23(17.04%), and 82(60.74%) of the 135 isolates respectively. Among 108 E. coli isolates which tested against both ciprofloxacin and levofloxacin, phenotypic ESBL resistances to carbapenem, ciprofloxacin and levofloxacin were identified in 56(52.33%), 21(19.44%), 80(74.07%), and 60(55.55%) respectively. The kappa score (κ=0.6222) and plots matrix showed the moderate agreement of ciprofloxacin to predict levofloxacin susceptibility against E. coli isolates.Conclusion: The E. coli resistances against beta-lactams, carbapenem, ciprofloxacin and levofloxacin were alarming. In addition, both ciprofloxacin and levofloxacin are needed to be regularly tested because ciprofloxacin susceptibility results cannot accurately predict levofloxacin susceptibility.
Co-Authors . Mursiti Abu Tholib Aman Ade Christanti Putri Sidabutar Afdina Melya Ganes Febiyanti Aisyah Nur Sapriati Altaufik Ngani Amaia, Devika N. Amalia Setyati Aman, Alia Hanifa Aminy, Sayyidah A. Andi Ameilia Sari Riandika Anggraeni, Nuniek Annisa Aulia Savitri Annisa Somaningtyas Anton Pratama Apriyanto, Muchammad Arief Nurrochmad Aron Saputra Thie As, Musdalifa Atikana, Akhirta Atthobari Avanilla Fany Septyasari Awaludin, Kamla Ayu Rahayu Bastiaan P. Krom, Bastiaan Bastian P. Krom Cicilia Widhi Astuti Cindy Elvionita Daniwijaya, Edwin Widyanto Daru Estiningsih Dessy Kurnia Sari Devi Artami Susetiati Dewi Purbaningsih Dhannia Fitratiara Diah Susanti Diyan Ajeng Rossetyowati Djoko Wahyono Djoko Wahyono Domas Fitria Widyasari Dwi Utami Anjarwati Dwikisworo Setyowireni Edwin W. Daniwijaya Eggi Arguni Elya Antariksana Bachmida Emi Rusdiyati Endang Estriningsih Ervina Damayanti Estiningsih, Daru Estriningsih, Endang Firdhani Satia Primasari Fita Rahmawati Fita Rahmawati Galang Ridha Allatief Hakim, Mohamad Saifudin Hamzah, Hasyrul Hananun Zharfa Hanifah Handi Virawan Hardyanto Soebono Henk J. Busscher Henk J. Busscher, Henk J. Henny C. van der Mei Henny C. van der Mei, Henny C. Hera Nirwati Ika Puspita Sari Ika Puspita Sari IKA PUSPITA SARI Ika Puspita Sari Ika Puspita Sari Ika Puspita Sari Ika Puspita Sari Ika Puspitasari Ika Puspitasari Ika Puspitasari Ika Puspitasari Ika Puspitasari Ilma Tazkiya Iman Iman Ishak SKM., MPH IWAN DWIPRAHASTO Kholidah, Siti Nurhayati Kris Kurniawan Kuncorojati, R. Alif Kuwat Triyana LINDA SUKMARINI Linda, Vitia Ajeng Nur Lucky Herawati Luthvia Annisa Mahanani, Nabeilla Shouma Marselinus Edwin Widyanto Daniwijaya Maulidia, Faiqoh Nur Maulidiah, Rizka Mawarti, Yuli Meilia Nhadia Amalia Mubasysyir Hasanbasri Mujahidah, Mujahidah Mukhriani, Mukhriani Mulyani Mulyani Mursiti, Mustofa, Handry Darussalam, Titik Nuryastuti, Mursiti, Mustofa Mustofa Nanang Munif Yasin Ni Luh Putu Vidya Paramita Niken Puspitasari Ning Rintiswati Nunung Yuniarti Nunung Yuniarti Nurkhalika, Rachmi Nurpagino, Bombong Prameshwara, Almarissa Ajeng Praseno Praseno Pratama, Anton Prawarni, Vidyadhari Puspa Prayoga, Muhammad Bagas Pujilestari, Dwi Purnomo, Galih Santo PUSPITA LISDIYANTI Putri, Natasya Salsabila Qonita Imma Irfani Rachma Dewi Isnaini Putri Rahmawati, Fita Rakhmat Ari Wibowo Rebriarina Hapsari Retno Wahyuningrum Rina Triasih Ritmaleni, Ritmaleni Riyelly, Zelfia Rizal Fauzi Rizka Humardewayanti Asdie Rizka Humardewayanti Asdie Rizmattu, Kezhiki Diaz Martha Rizqi Nurul Khasanah Roel Kuijer Roel Kuijer, Roel SAMUEL BUDI Sapriati, Aisyah Nur Setiawati, Setiawati SHANTI RATNAKOMALA Subagus Wahyuono Supriyati Susi Iravati Sylvia Utami Tunjung Pratiwi Takushi Kaneko Tatang Irianti Tina Amnah Ningsih Titi Ira Pangestuti Tri Murti Andayani Tri Murti Andayani Tri Wibawa Triana Hertiani Tristina Devi Azzahra Untari, Febriana Vera Olfiana Wahyuddin, Munifah Wihda Yanuar Wihda Yanuar Yanuar, Wihda Yeli Trimayanti Yolanda Pitra Kusumadewi Yusrizal Djam’an Saleh ZULLIES IKAWATI