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All Journal BALI MEDICAL JOURNAL (BMJ) Medicina journal of internal medicine E-Jurnal Medika Udayana Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Medical Journal of Indonesia Mutiara Medika: Jurnal Kedokteran dan Kesehatan INDONESIAN JOURNAL OF PHARMACY The Indonesian Biomedical Journal Paediatrica Indonesiana JBN (Jurnal Bedah Nasional) Jurnal Penyakit Dalam Udayana ISM (Intisari Sains Medis) : Jurnal Kedokteran Majalah Patologi Indonesia Ina Kidney Neurologico Spinale Medico Chirurgico Journal of Clinical and Cultural Psychiatry
I Gde Raka Widiana
Departemen Penyakit Dalam, Fakultas Kedokteran, Universitas Udayana, Denpasar, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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DISTRIBUSI GEOGRAFIS PENYAKIT GINJAL KRONIK DI BALI: KOMPARASI FORMULA COCKCROFT-GAULT DAN FORMULA MODIFICATION OF DIET IN RENAL DISEASE Raka Widiana, I Gde
journal of internal medicine Vol. 8, No. 3 September 2007
Publisher : journal of internal medicine

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Abstract

Chronic kidney disease (CKD) is related to the increased of cardiovascular morbidity and mortality. Thisstudy is aiming to identify the prevalence of CKD based on demographical distribution in Bali. A communitybased study has been conducted in Bali, 1) height region among indigenous community in a village at northernpart of Bali island using cluster random samples.; 2) in urban area at Denpasar city using stratified randomsampling and 3) in isolated coastal area in Nusa Ceningan island using cluster random sampling. The glomerularfiltration rate was calculated by Cockroft-Gault (C-G) formula and abbriviated Modification of Diet in RenalDisease ringkas with 4 variables (MDRD-4). The results of GFR using both calculation were compared. CKDwas defined based on KDOQI classification, namely GFR less than 60 ml/mnt. During the study 826 sampleswere collected consisted of 219 from height region (males/females 118/101, aged 48±15 years, BW 48.9±10.4kg, creatinine 0.97±0.64 mg/dL), 302 from urban area (males/females 137/165, aged 43±16 years, BW56.1±12.1 kg, creatinine 0.81±0/.19 mg/dL) and 305 isolated coastal area (males/females 150/155, aged 42±16years, BW 53.5±10.3 kg, creatinine 1.00±0.18 mg/dL). Using C-G, mean prevalence of CKD was 56.0%(95%CI 51.2-60.7%) consisted of 69.9% (95%CI 60.6-77.9%) in height region, 61.9% (95%CI54.5-68.8%) inurban and 42.3% (95%CI 33.7-51.4%) in isolated coastal area. Using 4-MDRD formula, mean prevalence ofCKD was 6.0% ( 95%CI 1.4-18.2%) consisted of 4.8% (95%CI 0.00-31.2%) in height region, 2,6% (95%CI50.3-43.1%) in urban and 9.8% (95%CI 2.5-27.4%) in isolated coastal area. In conclusion, there is a significantdifference of CKD prevalence in Bali if calculated by C-G compared with MDRD-4. Prevalence of CKD in Baliwith MDRD-4 (6.0%) is similar to those in other countries such as USA (4.2%) and Thailand (8.8%). Whetherthe calculation of GFR using MDRD-4 is more accurate than C-G in this setting, needs further study.
Ekspresi P16INK4a pada Squamous Cell Carcinoma Serviks Uteri dan Cervical Intraepithelial Neoplasia 1, 2, 3 Luh Yeni Laksmini; Moestikaningsih .; Gede Raka Widiana; Ni Putu Sriwidyani; Ketut Mulyadi
Majalah Patologi Indonesia Vol 23 No 3 (2014): MPI
Publisher : Perhimpunan Dokter Spesialis Patologi Indonesia (IAPI)

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Abstract

Background Cervical cancer is the second most common cancer in female in the world. In Bali, in 2008, cervical cancer is the second most common malignancy after breast cancer. This cancer has known to develop from precancerous lesions, cervical intraepithelial neoplasia (CIN).There is difficulty to determine grade of dysplasia of the uterine cervix and to predict wheather the lesion has potency of progression. The expression of P16INK4a has correlation with degree of cervical dysplasia and carcinoma. The aim of this study is to evaluate expression of P16INK4a in squamous cell carcinoma (SCC) of cervix uteri and CIN1, CIN2, CIN3. Methods A cross sectional analytic study was performed on 60 samples that divided into 10 CIN1, 10 CIN2, 10 CIN3, and 30 SCC. Samples were tooken from block paraffin archive from Private Laboratory in Denpasar and Anatomical Pathology Laboratory Sanglah Hospital, during January 1st 2011 until Juny 30th 2013. Immunostaining was performed to determine the expression score of P16INK4a. Expression of P16INK4a was determined by for scoring system base on staining grade and intensity. The result was analyzed by Kruskal Wallis test with level of significance α at p
EFFECT OF POLYETHERSULFONE COMPARED TO CELULLOSE DIACETATE DIALYZER MEMBRANE ON SERUM INTERLEUKIN-6 AND C-REACTIVE PROTEIN LEVES IN HEMODIALYSIS Raka Widiana, I Gde
journal of internal medicine Vol. 9, No. 2 Mei 2008
Publisher : journal of internal medicine

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Abstract

Synthetic dialyzer membrane is considered to have greater biocompatibility properties than cellulose based dialyzermembrane. This study is aiming to determine whether the use of polyethersulfone synthetic dialyzer (PES) membrane producelower inflammatory (IL-6 and CRP) response compared to celullose diacetate (CDA).Study samples were selected consecutively from all kidney failure patients who were undergoing routine HD at HDcenters in Denpasar Mayoralty. Thirty HD patients consisted of 15 with PES (11 males and 4 females, aged 45 ±10 years) and 15patients with CDA (8 males and 7 females, aged 48 ±13 years) were included in this study.A significant increase of plasma IL-6 per 1000 monocytes (Z=-4.103, p=0.003), from18.56±21.00 pg/dl before HD to56.00±105.41 pg/dl after HD among two groups was found. When the increase of plasma IL-6 per 1000 monocytes duringhemodialysis was compared bewteen the two groups, a significant higher increase of plasma IL-6 per 1000 monocytes in CDAgroup compared to PES group (71.47±142.51 pg/dl versus 3.38±4.46 pg/dl, Z=-2.883, p=0.003). There was no significant increaseof plasma hs-CRP levels before-after HD among both groups. Also, there was no significant difference of plasma hs-CRPchanges during HD between the two groups. Using multivariate ANCOVA, a consistent effect between the two membrane (F=18.401,p=0.000) on logistic transformed of plasma IL-6 per 1000 monocytes changes. However, this effect was not significant (F=1.937,p=0.176) on logistic transformed of plasma hs-CRP changes. It was found that plasma levels of pre HD albumin related to logistictransformed of plasma IL-6 per1000 monocytes (F=5.610, p=0.026), however, there were no relationship between HD factor(KT/V) and HD age (months), with logistic transformed of plasma IL-6 per 1000 monocytes changes.Increament of plasma IL-6 levels per 1000 monocytes during HD is smaller, however, changes of plasma hs-CRP levelsduring HD is similar among HD patients with PES than CDA membrane. In addition, plasma levels of pre HD albumin may affectplasma IL-6 changes during HD.
THE ROLE OF NEOPTERIN AS A NOVEL BIOMARKER FOR REDUCED KIDNEY FUNCTION: A COMMUNITY BASED STUDY Widiana, G Raka; Suwitra, K; Effendi, Imam
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Abstract

Cardiovascular disease is a major complication for patents with reduced kidney function. Neopterin is well known as abiomarker for cardiovascular disease, however it is not clear whether it is associated with reduced kidney function. Study wascarried out in a Legian Kuta village a tourist town in Bali. Samples were underwent a series of interview, physical examinationand were taken blood samples for neoperin and creatinine tests. Neoptein concentrations were tested for its normal distributionand associated with C-G formula for estimated glomerular filtration rate. Cut-off value for prediction of reduced renal functionwas rested using ROC curve, and calculated for sensitivity, specificity.Seventy nine samples were selected through cluster random sampling from 284 residents (177 males and 107 females)with age 46 ± 10 years, body weight 67 ± 13 kg and height 162 ± 9 cm. It was shown that neopterin concentration was normallydistributed (K-S Z = 1.175, p = 0.126), with mean 6.66 ± 3.35 ng/ml and e-GFR was 89 ± 25 ml/mnt. There was significantnegatively correlation between neopterin concentrations and e-GFR (R = -0.26, Rsq = 0.068, p = 0.021), using regressionequation it was revealed that every 1 unit increased of neopterin concentrations produce 1.42 decrease of e-GFR. Using ROCcurve, neopterin was accurately detect reduced kidney function defined as e-GFR of 60 ml/mnt or less (AUC = 0.88; 95%CI0.74 to 1.00; SE = 0.07; p = 0.02). Using 7.46 ng/ml as cut-off value for normal neopterin concentrations, it was showed thatsensitivity and specificity were 100% and 72% to detect the presence of reduced kidney function, consecutively. Neopterin maybe used as a novel biomarker for reduced kidney function, for its role in the pathogenesis of cardiorenal syndrome in generalpopulation.
PENGARUH SPIRONOLAKTON SEBAGAI TERAPI TAMBAHAN ACE INHIBITOR DAN/ATAU ANGIOTENSIN RECEPTOR BLOCKERS TERHADAP ALBUMINURIA PADA PENYAKIT GINJAL KRONIK PRADIALITIK STUDI KLINIS ACAK TERKONTROL BUTA GANDA -, Yuriawantini; Suwitra, Ketu; Raka Widiana, I Gde; Sidharta Loekman, Jodi; Sudhan, Wayan; Kandarini, Yenny
journal of internal medicine Vol. 9, No. 3 September 2008
Publisher : journal of internal medicine

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Abstract

Recently studies suggest that aldosterone contributes to progressive kidney disease. This has raised the possibility ofusing aldosterone antagonist in CKD. To evaluate effects of spironolactone 25 mg/day on albuminuria in CKD patients, thirtyCKD patients were enrolled in randomized double blind placebo controlled study. Permutted block randomization was done toreceive spironolactone 25 mg/day or placebo as control in addition to ACE inhibitors and/or ARBs. Albuminuria and bloodpressure were examined at baseline and 12 weeks. Albuminuria was measured as urinary albumin:creatinine ration and comparedas primary out come. During this study 15 patient were received conventional therapy and spironolactone 25 mg/day and 15patient were received placebo. One of patient dropped-out after 4 weeks due to hiperkalemia in spironolactone group and one ofpatient in the control group lost to follow-up. After 12 weeks of therapy, in spironolactone group albuminuria was decreased from510 (180.0 ? 798.0) to 254.0 (40.3 ? 491.8) mg/g, MD, 187.0 (29.0 ? 332.3) mg/g, p= 0.035 and in control group from 804.0 (52.0? 1126.0) to 637.0 (99.0 ? 1098.8) mg/g MD -10.5 (-186.5-86.0) mg/g, p= 0.490. There was significant difference of decreamentof albuminuria in both groups (Z=-0.69, p=0.046). There were no statistically different of serum potassium levels and bloodpressure in both groups after treatment. Baseline aldosterone levels were not significantly correlated with albuminuria (r = -0.128,p = 0.499). As Conclusion in this study is spironolactone reduces albuminuria in pradialytic CKD patients
HUBUNGAN ANTARA BEBERAPA PARAMETER ANEMIA DAN LAJU FILTRASI GLOMERULUS PADA PENYAKIT GINJAL KRONIK PRADIALISIS Paramita Ayu, Nyoman; Suega, Ketut; Raka Widiana, Gede
journal of internal medicine Vol. 11, No. 3 September 2010
Publisher : journal of internal medicine

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Abstract

Anemia is one of chronic kidney disease (CKD) complication and it affects many organs including cardiovascular. Earlydetection and evaluation are important to prevent more serious complications. There is scarce data with regard about correlationbetween anemia and glomerulus ltration rate (GFR) in pradialysis CKD.Aim of this study is to determine correlation between anemia parameters and GFR, also prevalence of anemia in pradialysisCKD in Sanglah Hospital, Denpasar-Bali. An analytical cross sectional study was carried out in Sanglah Hospital. Samples wereselected through simple random sampling.Eighty samples (58 males and 22 females, aged 54 ± 10 years) were included. Prevalence of anemia, serum iron belowthan 50 ug/dl, transferrin saturation below than 20% and erythropoietin below than 5 mIU/ml was 41.3%, 25%, 20%, and 25%respectively. Using Pearson?s analysis, there were signicant correlation between haemoglobin (r = 0.76, p = 0.00) and serumiron (r = 0.29, p = 0.01) with LFG. Using linier regression entering those variables into model, it found formula haemoglobin= 7.63 + 0.13GFR (R-square = 0.58, p = 0.00) and serum iron = 54.71 + 0.48GFR (R-square = 0.08, p = 0.01). There wassignicant correlation between haemoglobin and serum iron with LFG. Forty one percent pradialysis CKD patients had anemiacomplication.
RELATIONSHIP BETWEEN METHYLENE TETRA HYDRO FOLATE REDUCTASE (MTHFR) GENE POLYMORPHISM AND HYPERHOMOCYSTEINEMIA IN STROKE Raka Widiana, I Gde; -, Tianing; Santoso, Anwar; Ketut Budiarsa, Gusti Ngurah
journal of internal medicine Vol. 8, No. 3 September 2007
Publisher : journal of internal medicine

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Abstract

Cardiovascular disease is a major cause of mortality in Indonesia. Hyperhomocysteinemia (hyper-hcy) isan independent cardiovascular risk factor, which may be due to methylene tetrahydrofolate reductase (MTHFR)deficiency, frequently linked to MTHFR gene mutation. This case-control study examined the relationshipbetween homocysteine (hcy), folate, and vitamin B12 plasma concentrations with C677T mutation of MTHFRgene among 20 haemorrhagic and non-haemorrhagic stroke patients aged 18-55 years, in Sanglah Hospital,Denpasar. 10 age-matched controls were selected via random sampling of 1 of 4 neighbours; all subjects wereBalinese. Hyper-hcy (X2: 5.4; PR: 1.8; 95% CI: 1.0-2.7; p=0.03), hypertension (X2: 13.12; PR 2.66; 95%CI1.41 to 5.02; p=0.00) were associated with increased risk of stroke. There were no significant correlationbetween plasma hcy levels and plasma folate and vitamin B12 levels as co-factors of hcy metabolism. Lowplasma vitamin B12, smoking, alcohol drinking, and hypertension tend to be determinant factors of hyper-hcy.This study found no mutation on 677 from C to T (C677T), however there were substitution in nucleotidesamong stroke and controls, with or without producing chances of amino acids, including: 1) G659A substitutionthat caused changing in amino acid from glutamine to glycine found in 1 stroke patients with hyper-hcy; 2)A660G substitution that cause changing in amino acid from glutamine to glycine found among all controlsubjects and among 3 stroke patients, one of whom had hyper-hcy; and 3) A661G substitution that causechanging in amino acid from lysine to glutamine found in one stroke patients with normo-hcy. Some variationswere also found in nucleotide 659 and 660, however, did not produce changing in amino acid. Whether thissubstitution is a kind of polymorphism that specific to Balinese ethnicity needs a further study to answer.
HUBUNGAN ANTARA PERUBAHAN VOLUME DARAH RELATIF DENGAN EPISODE HIPOTENSI INTRADIALITIK SELAMA HEMODIALISIS PADA GAGAL GINJAL KRONIK Agustriadi, Ommy; Suwitra, Ketut; Raka Widiana, Gde; Sudhana, Wayan; Sidharta Loekman, Jodi; Kandarini, Yenny
journal of internal medicine Vol. 10, No. 2 Mei 2009
Publisher : journal of internal medicine

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Abstract

Intradialytic hypotension (IDH) is a common complication in chronic hemodialysis (HD) patients, in turn would increase morbidity and mortality. Relative blood volume changes during HD play a role in IDH episode. Those changes can be assessed by total plasma protein measurement before and after HD. To determine relationship between relative blood volume changes (assessed by percentage of total plasma protein changes during HD) and IDH episode during HD in chronic renal failure, an analytical cross-sectional study was perferomed in 51 patients (28 males and 23 females, age 47.8 ±11.6 years) underwent chronic HD at Hemodialysis Unit of Sanglah Hospital Denpasar. Data were collected during single HD session. Blood pressure was measured every 30 minutes and relative blood volume changes assessed by measuring percentage of total plasma protein changes during HD. Among them, IDH episode experienced in 10 (19.6%) patients. Logistic regression analysis revealed a strong and significant relationship between relative blood volume changes and IDH episode during HD in chronic renal failure (Beta = 0.29; OR = 1.35; CI 95%: 1.1 - 1.6; p < 0.01) and it was found that every 1% changes in relative blood volume, would increase risk of hypotension episode by 35%. This relationship was still strong and significant (Beta = 0.46; OR = 1.58; CI 95%: 1.11 -2.25; p = 0.01) after adjusted by hemoglobin levels, intradialytic body weight changes, use of antihypertensive medi¬cations and diabetes melitus. Using ROC curve, found that optimal cut of point of intradialytic total plasma protein changes to predict an IDH episode during HD was 5.56% with 90.0% sensitivity and 80.5% specificity (95% CI: 0.83-0.99; p < 0.01). Our data revealed a strong and significant relationship between intradialytic relative blood volume changes assessed by intradialytic total plasma protein changes and IDH episode during HD in chronic renal failure.
KEJADIAN PERITONITIS PADA PASIEN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS: IDENTIFIKASI MIKROORGANISME DAN SENSITIFITAS ANTIBIOTIK Haryanti, Elizabeth; Kandarini, Yenny; Widiana, I Gde Raka; Sudhana, Wayan; Loekman, Jod; Suwitra, Ketut
journal of internal medicine Vol. 11, No. 2 Mei 2010
Publisher : journal of internal medicine

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Abstract

Patients treated with Continuous Ambulatory Peritoneal Dialysis (CAPD) are constantly exposed to microbial invasionof the peritoneal cavity and rapid microbiological diagnosis of peritonitis is essential due to Hospitalization and imposes asignicant burden of morbidity. The aims of this study were to enumerate the association between microorganisms, sensitity,and resistence of antibiotic on CAPD patients with clinical peritonitis.We collected data through medical records by the number of CAPD patients with clinical peritonitis from June 2004 untilJune 2009. The study was analysis with one-way ANOVA. We found 23 patients clinical peritonitis out of 77 CAPD patients,with insidence was 14% per-year, aged 14 ? 65 y (15M; 8F). The chronic pyelonephritic was a leading (16/23) cause of endstages renal disease. Each patients underwent HD prior (5 ? 60 months) to CAPD, with survival time was 2 ? 51 months. Out of23 patients, 4 were returned to hemodialisis, 15 were died, due to cardiogenic shock 46.7%. Aseptic peritonitis was 31.3%, andthe common microorganism was staphylococcus 18.8%. Peritoneal !uid test showed mean score of sensitivity were tetracycline22.93, cipro!oxacin 19.36, piperacillin-tazobactam 17.36, thrimetropin/sulfamethoxazole 16.5, fosfomycin 15.78, consecutivelyand the rest were resistent. Staphylococus was strongly related to insidence peritonitis, and tetracycline was the most highlysensitive antibiotic in CAPD patients.
Microalbuminuria in non-insulin dependent diabetes mellitus: an Indonesian experience Suwitra, Ketut; Roesli, Rully; Widiana, I Gede R.
Medical Journal of Indonesia Vol 7, No 3 (1998): July-September
Publisher : Faculty of Medicine Universitas Indonesia

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Abstract

[no abstract available]
Co-Authors A. A. G. Oka, A. A. G. Ade Sinyo Aristantrisna Adnyani, Ni Made Dwi Ake, Anselmus Anak Agung Chris Tedy Pramana Anak Agung Gde Oka Anak Agung Wiradewi Lestari and N. Sutarka Anwar Santoso Arlene Elizabeth Padang Aslesa Wangpathi Pagehgiri Bagus Ngurah Putu Arhana Budi Suprapti Christopher Ryalino, Christopher Cokorda Bagus Jaya Lesmana Cokorde Istri Yuliandari Krisnawardani Kumbara Dedi Silakarma Desak Putu Puteri Diah Rahtini Dessy Maria Desy Permatasari Dewa Nyoman Putra Adiwinata Dewi Catur Wulandari Djodi Sidartha E. Elyshanti Elizabeth Haryanti Elysanti Dwi Martadiani Feliciano Pinto, Feliciano Firman Parulian Sitanggang Gede Andi Aditya Gede Sukma Pranata Darma Gede Wira Mahadita Gede Wirya Kusuma Duarsa Gusti Ngurah Ketut Budiarsa Hendra Koncoro Hendra S Hendra Salim Hizkia Robinson Junsen Lumban Gaol I Dewa Agung Sutanjaya Giri Nugraha I G. N. Anom-Supradnya I G. N. M. Sugiana I Gede Aditya Krishna Santhi I Gede Budhi Setiawan I Gede Hendra Sucipta I Gusti Agung Trisna Windiani I Gusti Kamasan Arijana I Gusti Ngurah Made Suwarba I Gusti Rai Putra Wiguna I K. Sudartana I Ketut Suwiyoga I Ketut Wiargitha I Ketut Widiana I Made Adi Satria Darma I Made Agus Endra Permana I Made Arimbawa I Made Kardana I Nengah Wiadnyana Steven Christian I Nyoman Adi Putra I Nyoman Semadi I Nyoman Wiryawan I Putu Budhiastra, I Putu I Putu Gede Budiana, I Putu Gede I Putu Gede Eka Ariawan Suyasa, I Putu Gede Eka Ariawan I W Sudhana I Wayan Gede Jayanegara I Wayan Juli Sumadi I Wayan Putu Sutirta Yasa I Wayan Wita I Wayan Yudiana IBN Mahendra Ida Bagus Gede Suparyatha Ida Bagus Putra Pramana Ida Safitri IKG Suandi Imam Effendi Inez Kartika Jetty Kalembang Jod Loekman Jodhi S Loekman Jodi Sidharta Loekman Jodi SL K Suwitra K. Suwitra Kadek Budi Santosa Ketu Suwitra Ketut Mulyadi Ketut Putu Yasa Ketut Rina, Ketut Ketut Suarta Ketut Suega Ketut Suwitra Ketut Tuti Parwati Merati Ketut Widiana Komang Ayu Witarini Loekman, Jodi Sidharta Luh Gede Yuliadewi NS Luh Yeni Laksmi Luh Yeni Laksmini Made Agus Dwianthara Sueta MADE RATNA SARASWATI . Made Satria Yudha Dewangga Made Widhi Asih Marleen MOCHAMMAD THAHA Moestikaningsih ** Moestikaningsih . Monica Sampurna Ngakan Gede Dwija Hermawan Ni Made Amelia R. Dewi Ni Made Ari Suryathi Ni Made Putri Suastari Ni Nyoman Margiani Ni Putu Sriwidyani Ni Wayan Anantika Riani Ni Wayan Winarti NP Veny Kartika Yantie Nyoman Maharmaya Nyoman Paramita Ayu Nyoman Srie Laksminingsih Nyoman Sutarka, Nyoman Oka Udrayana Ommy Agustriadi Pande M.W. Tirtayasa Pande Putu Yuli Anandasari Patriawan, Putu Paulus Wiyono PITIKA ASPR Poerwono Rahardjo Purnama Purnama Putu Astri Novianti Putu Ayu Saraswati Putu Gitanjani Mahadewi Semadhi Putu Nandika Tungga Yudanti Mahardani Putu Novi Handayani Raka-Sudewi A. A. Reny Setya Pratiwi Duarsa Rully Roesli Satrio Ryandi Sianny Herawati Silvester Kristian Taopan Sitanggang, Firman Parulian Soetjiningsih Soetjiningsih Sudaryat S Sudjana, Karismayusa Tianing - Trianto Trianto W Sudhana W. G. Jayanegara Wayan Aryadana Wayan Aryadana Wayan Sudana Wayan Sudhan Wayan Sudhana Wiradharma, Ketut Gede Y. Saskia-Javi Yenny Kandarini Yoga Putra Yuriawantini - Zulfariska, Nony