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Pengaruh pemberian diet rendah karbohidrat tinggi lemak terhadap penurunan CO2 darah dan perbaikan respirasi pada pasien penyakit paru obstruktif kronik di Rumah Sakit Immanuel Bandung Ruth R Wijaya; I Dewa Putu Pramantara; Susetyowati Susetyowati
Jurnal Gizi Klinik Indonesia Vol 2, No 2 (2005): November
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, FK-KMK UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ijcn.17403

Abstract

Background: Lung diseases are one of the main health problems in Indonesia. Among the lung diseases, Chronic Obstructive Pulmonary Disease (COPD) is the 7th leading causes of death in Indonesia. The prevalence COPD tends to increase due to increasing smoking habit, industrialization, air pollution, and more elderly people. Diet regulation for COPD patients were mainly for energy consumption, and accurate proportion of carbohydrate and fat. Excessive carbohydrate intake will increase blood CO2.Objective: To evaluate the influence of low carbohydrate and high fat diet on the decrease of CO2 concentration and improving respiration in acute exacerbation of COPD.Methods: This is an experiment study, with pre and posttest design. The subjects were COPD patients who hospitalized due to acute exacerbation. The subjects must be conscious, no left heart failure, no coronary heart disease, no acute respiratory failure that need ventilator and  hospitalized for minimum 7 days and could take oral diet.Results: Women, younger, and no smoking COPD patients had decreased blood CO2 offer low carbohydrate high fatty diet. All patients with this diet experience had improvement in their respiratory symptoms.Conclusion: Low carbohydrate high fat diet decreases blood CO2 in new acute exacerbation of COPD patients, no smoking women and younger patients. However, this diet improved respiratory symptoms for all patients who receive it.
Perbedaan PaCO2 darah pada pasien kritis yang mendapat diet makanan enteral komersial dengan diet makanan enteral kombinasi di rumah sakit Dr. Sardjito Yogyakarta M Jaelani; Untung Widodo; Susetyowati Susetyowati
Jurnal Gizi Klinik Indonesia Vol 2, No 3 (2006): Maret
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, FK-KMK UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (168.853 KB) | DOI: 10.22146/ijcn.17430

Abstract

Background: Malnutrition often occurs in a critical patient caused by various things such as decreasing function of gastrointestinal tract, high process of catabolism and homeostatie destruction. Other problem that may occur when nutrition is given with high total calories could be dangerous because it could cause hiperglikemia, the production improvement of CO blood and worsen the homeostasis destruction.Objective: To find out the difference of PaCO blood in critical patients who obtain commercial enteral food diet or combined enteral food diet.Methods: This was an experimental study using randomized controlled trial with pretest-posttest control group design. The subjects were critical patients who were given care in the intensive installation Dr. Sardjito hospital Yogyakarta who met the criteria: adult patient, using ventilator and receiving enteral food diet.Results: There was no difference between PaCO blood in critical patient who obtained commercial enteral diet and com- bined enteral food diet. There was a change difference of PaCO with <80% from total energy (p=0.03) and there was a different on change of PaCO in carbohydrate intake between criteria >55% compared with <55% from energy total (p=0.03).Conclusion: The improvement of PaCO was not caused by the type of enteral formula given, cause of the high intake of energy and carbohydrate.
Hubungan pola makan dengan sindroma metabolik pada karyawan PT.Unocal oil company di offshore Balikpapan Propinsi Kalimantan Timur Sri Sudarminingsih; Wiryatun Lestariana; Susetyowati Susetyowati
Jurnal Gizi Klinik Indonesia Vol 4, No 2 (2007): November
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, FK-KMK UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ijcn.17476

Abstract

Background: Prevalence of metabolic syndrome has significantly increased in both developed and developing countries. Criteria of metabolic syndrome includes: body mass index of > 27, and male waist circumference of > 102 cm which could be followed by fasting blood glucose level of >110 mg/dl. Other symptoms are blood pressure and triglyceride (of > 130/85 mm Hg and > 150 mg/dl respectively) and decrease in high density lipoprotein to < 40 mg/dl.Objective: This research was aimed to explore the extent to which food habit relates with metabolic syndrome among offshore workers employed by Unocal Oil Company Ltd. Located in Balikpapan.Method: The study which was an observational-analytical was then carried out using case-control design, with comparison 1:1 (matched case control). Nutrients intake measured using the 3 x 24 hours recall method. Chi squares, t- test, odd ratios, and logistic regressions were performed to determine statistical significant among variables.Result: The study showed that energy intake > 110% recommended daily allowance (RDA) between case and control group was significantly different (OR= 7.7; 95% CI= 3.1-18.8). This was also true for the case of total carbohydrate > 60%, (OR= 3.98, 95% CI= 1.6-9.8), refined carbohydrate > 5% (OR= 7.4; 95% CI= 2.9-18.7), total protein > 20% (OR= 3.2; 95% CI= 1.2-8.4), and fat > 20% (OR= 5.04; 95% CI= 1.578-16.1). Logistic regressions were performed to determine statistical significant among variables candidate and the result showed it was significant for refined carbohydrate, energy intake and old work in offshore (p<0.05).Conclusion: This study indicate that nutrient intake was higher than of RDA, it was closely related to the incidence of metabolic syndrome: refined carbohydrate, energy intake and old offshore workers employed (p < 0.05).
Hubungan kadar serum albumin dengan kejadian morbiditas dan mortalitas pada pasien penyakit ginjal kronik dengan hemodialisis di RS Dr. Sardjito Yogyakarta La Banudi; Ahmad Husain Asdie; Susetyowati Susetyowati
Jurnal Gizi Klinik Indonesia Vol 3, No 2 (2006): November
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, FK-KMK UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ijcn.17491

Abstract

Background: Chronic kidney disease is a characterized by decreasing kidney function with creatine clearance test <15 mL/minute. At such condition toxic in the body accumulates so that dialysis is needed to eliminate it. Blood albumin serum level may indicate nutrition status and is closely related to morbidity and mortality of hemodialysis patients.Objective: To find out association between albumin serum level and occurrence of morbidity and mortality among patients of chronic kidney disease with hemodialysis.Method: The study was observational with prospective cohort design. It was conducted at Dialysis Installation of Dr. Sardjito Hospital from August 2004 to December 2005. Population were all patients of hemodialysis. Samples were purposively taken using inclusion criteria with as many as 44 minimal samples. Dependent variables were morbidity and mortality. Independent variables  were albumin serum level, age and long time hemodialysis. Data analysis was done in phases, univariable, and then bivariable.Results: There was association between albumin serum level and morbidity at observation I (p=0.021), observation II (p=0.036), and observation III (p=0.012) which indicated that p<0.05. There was also association between albumin serum level and mortality at observation I (p=0.011), observation II, III and IV (p=0.000) which indicated that p<0.05.Conclusion: There was association between albumin serum level and morbidity and mortality of chronic kidney disease patients with hemodialysis.
Asupan natrium dan kalium berhubungan dengan frekuensi kekambuhan sindrom dispepsia fungsional Hervina Dwijayanti; Neneng Ratnasari; Susetyowati Susetyowati
Jurnal Gizi Klinik Indonesia Vol 5, No 1 (2008): Juli
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, FK-KMK UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ijcn.17514

Abstract

Background: A high-salt diet is known to cause gastritis, has been associated with a high risk of atrophic gastritis, and is considered a gastric tumor promoter. Excessive NaCl intake enhances Helicobacter pylori colonization in mice and in humans and that chronic salt intake may exacerbate gastritis by increasing Helicobacter pylori colonization. Furthermore, elevated salt intake may potentiate Helicobacter pylori-associated carcinogenesis by inducing proliferation, pit cell hyperplasia, and glandular atrophy.Objective: The aim of this research was to describe the correlation between sodium and potassium intake and relapse frequent functional dyspepsia syndrome in Sardjito Hospital Yogyakarta.Method: This was an observational research with cross sectional design. The subjects of this research were 32 course care patients in Sardjito Hospital Yogyakarta on November 2006–Januari 2007 who met the inclusion criteria. Those were who diagnosed as functional dyspepsia, with or without Helicobacter pylori infection, and above eighteen years old. Data were collected by interviewing and gathered from medical record, then analyzed using Rank-Spearman test.Results: The average of the relapse frequent of dyspepsia syndrome in Sardjito Hospital was 14.38 ±2.93, with the minimum score was 4 and the maximum score was 32. The result showed that sodium intake gave a positive relation and significant for relapse frequent of dyspepsia syndrome (p<0.05). The potassium intake gave a negative relation and significant for relapse frequent of dyspepsia syndrome (p<0.05).Conclusion : There was a positive and significant correlation between sodium intake and relapse frequent of dyspepsia syndrome, but there was a negative and significant correlation between potassium intake and relapse frequent of dyspepsia syndrome.
Pemberian diet ekstra formula komersial dan diet ekstra filtrat ikan gabus intradialisis serta pengaruhnya terhadap kadar serum albumin dan kreatinin pasien dengan hemodialisis di RSU Dr. Saiful Anwar Malang Etik Sulistyowati; Hamam Hadi; Susetyowati Susetyowati; Atma Gunawan
Jurnal Gizi Klinik Indonesia Vol 5, No 2 (2008): November
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, FK-KMK UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ijcn.17550

Abstract

Background: Nowadays chronic kidney disease (CKD) is a serious health problem because of its increasing incidence. In Indonesia, approximately there are 100 CKD patients per 1 million people per year. Hemodialysis is one of ways to prolong CKD patient’s life that should be done recurrently and for a long time. However, hemodialysis causes loss of nutrients leading to high prevalence of malnutrition among CKD patients. Until today intradialysis diet therapy which can replace loss of nutrients particularly protein has not been initiated as part of diet therapy in Indonesian hospitals. To improve nutritional status and minimize mortality rate, oral intradialysis diet therapy with proper formula is needed.Objective: To study the effect of the supply of commercial formula and local catfish filtrate extra diet to albumin and creatinine serum level among hemodialysis patients.Method: The study was experimental with randomized control trial design carried out at Dialysis Installation of Dr. Saiful Anwar Hospital, Malang. There were as many as 36 hemodialysis patients divided into 3 groups; 1 group with standard diet, 1 group with commercial formula and standard diet, and 1 group with local catfish filtrate and standard diet. Data were obtained through interview, note taking, and laboratory tests which consisted of subject characteristics in weight, height, albumin and creatinin serum level as well as food intake one day before, during and one day after hemodialysis. Data analysis was done descriptively and inferentially using chi square, anova, and paired t-test. The conclusion was based on significance level (α ) 0.05 or p < 0.05.Results: There was no significant difference in the characteristics of the subject at the beginning of the study with average albumin serum level 3.61 ± 0.48 g/dL and creatinine serum level 9.04 ± 2.73 mg/dL. There was no difference in average energy and protein intake of the subject. At the end of the study average albumin serum level was 3.38 ± 0.42 g/dL, creatinine serum level 8.34 ± 3.6 mg/dL, and there was significant difference in albumin serum level (p = 0.000) of the subject. Although there was an increase of creatinine serum level in the group with local catfish filtrate extra diet, it was statistically insignificant.Conclusion: There was significant effect of the supply of commercial formula and local catfish filtrate extra diet to increase of albumin serum level of the subject and there was no significant effect of the supply of extra diet to creatinine serum level; however, the supply of local catfish filtrate extra diet could maintain creatinine serum level.
Pengaruh diet rendah protein modifikasi terhadap keseimbangan nitrogen pada pasien penyakit ginjal kronik predialisis di RSU Dr. Soeradji Tirtonegoro Agus Sunaryo; Ahmad Husein Asdie; Susetyowati Susetyowati
Jurnal Gizi Klinik Indonesia Vol 3, No 3 (2007): Maret
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, FK-KMK UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ijcn.17560

Abstract

Background: Chronic kidney disease (CKD) is a decreasing function of kidney chronically, progressive, and irreversible. In this condition, one of the symptom found is uremia where gastrointestinal disturbance such as vomiting and anorexia occurred. This causes less nutrition intake, therefore careful diet is needed in attention. One of important aspect of diet procedures for CKD patients is eating management.Objective: To find out the influence of the modification of low protein diet intake towards nitrogen balance in predialysed CKD patients.Method: This was an experimental research using randomized controlled trial design.The subjects were predialysed CKD patients treated who fulfilled the following criteria: adult patients, obtained a low protein diet therapy, treated for at least two days, and willing to be examined. The treatments were a modification of low protein diet compare with a hospital standard of low protein diet.The twenty patients were devided into two groups namely a-ten-people treatment group and a-ten-people control.Result: The statistical test showed that there were no significant difference (p>0.05) in energy and protein intake, urea nitrogen appearance, and nitrogen balance between modification of low protein diet and the hospital standard of low protein diet in predialysed CKD patients.Conclusion: There were no significant difference in nitrogen balance between modification of low protein diet and the hospital standard of low protein diet in predialysed CKD patients.
Status gizi pasien bedah mayor preoperasi berpengaruh terhadap penyembuhan luka dan lama rawat inap pascaoperasi di RSUP Dr Sardjito Yogyakarta Susetyowati Susetyowati; Maya Ija; Akhmad Makhmudi
Jurnal Gizi Klinik Indonesia Vol 7, No 1 (2010): Juli
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, FK-KMK UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ijcn.17608

Abstract

Background: Severe malnutrition affects morbidity due to disrupted wound healing and decreased endurance against infection. There are some factors that cause malnutrition in surgical patients. Two major factors are lack of food intake and process of inflammation that cause increase of catabolism and decrease of anabolism. The condition can be identified from the decrease of albumin serum and muscle hypothrophy.Objective: The study aimed to identify impact of nutrition status of preoperative major surgical patients based on Nutritional Risk Index (NRI) indicator to wound healing and post operative length of stay.Method: The study was observational with prospective cohort study design. Nutrition screening was undertaken to the group that met inclusion criteria at the preliminary process of hospitalization using NRI indicator to identify nutrition status of surgical patients. Next, the group was split into two, one with undernourished nutrition status and the other with good nutrition status. Assessment of nutrition status of patients was based on NRI obtained from level of serum albumin and current and usual weight ratio within the last 6 months. Weight assessment was made during early hospitalization or weight within the last 6 months.Result: The result of the study showed there was signifiant association between nutrition status and wound healing and post operative length of stay (p<0.05). The result of logistic regression test showed there was impact of nutrition status to wound healing and post operation length of stay. Patients with undernourished nutrition status based on NRI contributed 4.8 times greater for the prevalence of poor wound healing than those with good nutrition status (95%CI: 1.179-19.880). Patients with undernourished nutrition status based on NRI contributed 5.5 times greater for extended length of stay > 7 days than those with good nutrition status (95% CI:4.701-50.914).Conclusion: There was impact of nutrition status of preoperative major surgical patients based on NRI indicator to wound healing and post operative length of stay.
Status gizi awal berdasarkan Patient Generated Subjective Global Assessment (PG-SGA) berhubungan dnegan asupan zat gizi dan perubahan berat badan pada penderita kanker rawat inap di RSUP Dr. Mohammad Hosein Palembang Susetyowati Susetyowati; Yenita Yenita; Johan Kurnianda
Jurnal Gizi Klinik Indonesia Vol 7, No 2 (2010): November
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, FK-KMK UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ijcn.17741

Abstract

Background: Weight loss is commonly detected among cancer patients in their early stages. This presumably happens due to low calory intake and increasing energy requirements which finally lead to malnutrition in cancer patients. Early detection to identify nutrition problems of cancer patients is through screening so as to maximize nutrient intake through nutrition therapy and diet modification and to improve nutrition status as well as quality of life of cancer patients.Objective: The study aimed to identify the relationship between nutrition status based on PS-SGA and nutrient intake and weight loss of cancer patients hospitalized at Dr. M. Hoesin Hospital of Palembang.Methods: The study was observational with prospective cohort study design. In this study the group that had fulfilled inclusion criteria were screened during their early hospitalization (within 24 hours) using patient-generated subjective global assessment score to identify their nutrition problem. Next, the group was divided into 2 smaller groups consisting of one group with malnutrition and another group without malnutrition. Analysis of nutrient intake obtained from foods provided by the hospital and outside the hospital was made to the two groups within 2 weeks of hospitalization using visual comstock and food record. Anthropometric measurement was made to find weight loss the subject of the study.Results: The results of the study showed that there was significant relationship between nutrition status and intake of energy and protein with p=0.000. The result of logistic regression test to nutrition status based on weight changes indicated that there was significant relationship between risk of nutrition and weight changes; patients with risk of nutrition had 7.016 times greater probability for weight loss than those without risk of nutrition (95% C5  2.896-16.997).Conclusion: There was significant relationship between nutrition status and nutrient intake among cancer patients and there was greater probability for weight loss.
Kajian metode Subjective Global Assessment (SGA) dan Nutrition Services Screening Assesment (NSSA) sebagai status gizi awal pasien dewasa sebagai prediktor lama rawat inap dan status pulang Agustinus I Wayan Harimawan; Hamam Hadi; Susetyowati Susetyowati
Jurnal Gizi Klinik Indonesia Vol 7, No 3 (2011): Maret
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, FK-KMK UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ijcn.17750

Abstract

Background: Assessment of nutrition status of newly hospitalized patients is an initial stage of nutrition intervention which will bring effects to the duration of stay and the history of patients' diseases during hospitalization. Appropriate nutrition intervention as part of  patients' care can be used as an indicator of the quality of hospital service.Objective: The study aimed to identify preliminary nutrition status of newly hospitalized adult patients using SGA method, its effects to length of stay and status of discharge and compare the capacity of SGA and NSSA indicators in predicting length of stay and status of discharge of adult patients.Method: This observational study used prospective cohort study design. It was carried out at Anuntaloko Hospital of Parigi, District of Parigi Moutong, Sulawesi Tengah from July to September 2008. Subject consisted of 162 people comprising 82 undernourished people and 80 people with good nutrition status based on assessment using SGA method. Data analysis used bivariable and multivariable, receiver operating characteristics (ROC) curve and diagnostic methods using computer program.Result: The majority of newly hospitalized patients were undernourished (50.6%); preliminary status of patients assessed using SGA method could affect length of stay, relative risk (RR)=3.67 but not status of discharge (RR=0.97). The capacity of SGA indicator, area under the curve (AUC)=0.81 and maximum sum of sensitivity and specifcity (MSS) =1.57 was better than NSSA indicator (AUC=0.76 and MSS 1.43) in predicting length of stay. The capacity of SGA indicator (AUC=0.50 and MSS=1.01) was better than NSSA indicator (AUC=0.49 and MSS=0.98) in predicting discharge status of the patient.Conclusion: SGA and NSSA indicators could be implemented in assessing preliminary nutrition status of newly hospitalized adult patients; SGA indicator had better capacity than NSSA indicator.
Co-Authors A Fahmy Arif Tsani Adi Utarini Agus Santosa Agus Sunaryo Agus Sunaryo Agustinus I Wayan Harimawan Ahmad Husain Asdie Ahmad Husain Asdie Ahmad Husein Asdie Ahmad Husein Asdie Ahmad Husein Asdie Ahmad Husein Asdie Ahmad Husein Asdie Ahmad Syauqy Akhmad Makhmudi Akhmad Makhmudi, Akhmad Amir, Chindy Amir, Safrullah Anak Agung Gede Sugianthara Anggraini, Lusia Arjuna, Tony Arta Farmawati Atma Gunawan Atma Gunawan Aviria Ermamilia Ayuningtyas, Cita Eri Banudi, La Barida, Iram Benny, Yohanes Budi Wikeko Burhan, Fatimah Zahra Catur Saptaning Wilujeng Daud, Zulfitri Azuan Mat Defriani Dwiyanti, Defriani Dewi Renaningtyas Dian Caturini Sulistyoningrum Djoko Agus Purwanto Dwijayanti, Hervina Emy Huriyati Emy Huriyati Emy Huriyati Endy Paryanto Prawirohartono Endy Paryanto Prawirohartono, Endy Paryanto Ernawati Hardani Etik Sulistyowati Eva Nurlindayanti Farah Faza Farah Faza Farah Rizqi Farida Fitriyanti Farida Fitriyanti Fera Nofiartika Fery Lusviana Widiany Fithia Dyah Puspitasari Fithia Dyah Puspitasari, Fithia Dyah Hamam Hadi Hamam Hadi Hamam Hadi Hamam Hadi Hamam Hadi Hamam Hadi Hamam Hadi Handayani, Sri Hanifah Wulandari Hanifah Wulandari Hardani, Ernawati Herni Astuti Hervina Dwijayanti I Dewa Putu Pramantara I Dewa Putu Pramantara I Dewa Putu Pramantara I Gede Agung Kusumayanti IDP Pramantara IDP Pramantara, IDP Ija, Maya Iram Barida Ismail Setyopranoto Jaelani, M Johan Kurnianda Juffrie, Muhammad Juleka Juleka Juleka, Juleka Kartika Handayani Kartika Handayani Kusumayanti, I Gede Agung La Banudi La Supu Larasati, Adisti Qamahadlina Lientje Setyawati Maurits Lily Arsanti Lestari Lusia Anggraini M Jaelani M Ridwan Ansari M Ridwan Ansari, M Ridwan Madarina Julia Madarina Julia Mae Sri Hartati Wahyuningsih MAHDIAH Martalena Br Purba, Martalena Br Maya Ija Mayangsari, Riska Mei Neni Sitaresmi Mochammad Sja’bani Mohammad Hakimi Mohammad Hakimi Muhammad Hakimi Muhammad Hakimi Muhammad Juffrie Muhammad Rivai Nadira D&#039;mas Getare Sanubari Neneng Ratnasari Ninna Rohmawati Ninna Rohmawati Nofiartika, Fera Nur Fitri Widya Astuti Nurmala Nurmala Nurmala Nurmala Probosuseno Probosuseno Probosuseno Probosuseno PUJI LESTARI Puji Lestari R. Dwi Budiningsari Rachmadanty, Ajeng Saskia Sekar Rachmawati, Azizah Isna Rahman, Listhia Hardiati Renaningtyas, Dewi Retno Pangastuti Retno Pangastuti Retno Pangastuti Retno Pangastuti Rizki Andini Rizki Andini Rochadi Rochadi Roselani, Ari Ruth R Wijaya Safrullah Amir Sanubari, Nadira D'mas Getare Sholikhati, Amalia Sarah Sopiyandi Sopiyandi Sopiyandi, Sopiyandi Sri Kadaryati Sri Mulatsih Sri Mulatsih Sri Retna Dwidanarti Sri Sudarminingsih Sudarminingsih, Sri Suhardi . Suhardi . Teguh Aryandono Toto Sudargo Toto Sudargo Untung Widodo Untung Widodo, Untung Vera Utami Waluyo Waluyo Wasilah Rochmah Wasilah Rochmah Weni Kurdanti Weni Kurdanti Wijaya, Ruth R Winarti, Hesti Wiryatun Lestariana Wiryatun Lestariana Wiryatun Lestariana Wiryatun Lestariana, Wiryatun Wulandari, Hanifah Yayi Suryo Prabandari Yayuk Hartriyanti Yeni Prawiningdyah Yenita . Yenita Yenita Yhona Paratmanitya Yhona Paratmanitya Yohanes Benny Yosephin Anandati Pranoto Yunita Yunita Yunita Yunita