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All Journal journal of internal medicine E-Jurnal Medika Udayana E-Jurnal Udayana Medica The Indonesian Biomedical Journal Jurnal Penyakit Dalam Udayana International Journal of Retina ISM (Intisari Sains Medis) : Jurnal Kedokteran
I Wayan Losen Adnyana
Divisi Hematologi Onkologi Medik, Bagian Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Udayana-RSUP Sanglah Denpasar
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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PENATALAKSANAAN PASIEN DIABETES MELITUS DI POLIKLINIK RUMAH SAKIT SANGLAH DENPASAR Adnyana, Losen; -, Hensen; Gde Budhiarta, Anak Agung
journal of internal medicine Vol. 7, No. 3 September 2006
Publisher : journal of internal medicine

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Abstract

A cross-sectional study was conducted from March until May 2003 among 100 diabetic patients, registered inDiabetic Clinic, Department of Internal Medicine Sanglah Hospital for management of diabetes for more than 12months. Primary objective was to evaluate diabetes control, diabetes management and late complications status in thediabetic population managed by Diabetic Clinic as urban health care clinics. The subjects were 65% men and 35%women with mean of age 59.4 years and known having diabetes since 1-5 years (mean 2.1 years). Samples consist of4% type-1 diabetes; 95% type-2 diabetes and 1% gestational diabetes. Antidiabetic medication were sulfonylurea67%; metformin 55%; insulin 26% and others (glucosidase inhibitors, thiazolidenedione and others) were 0%.According to the level of AIC, lipid profile and blood pressure, 40% (AIC < 6.5%); 50% (HDL-chol >-45 mg/dl);27.0% (LDL-cho! < 100 mg/dl); 67.6% (triglyceride < 150 mg/dl) and 23% (blood pressure < 130/80 mmHg) werecategorized as good diabetic controls. Large proportion of poor diabetic controls partly may be due to low proportionof education days received on diabetes in the past year (57% have only I education day and 32% with zero educationday). This condition also impact on lifestyle modification where 63% not regularly and 14% never follow the diet and50% never . exercise. Also 12% still smoker and 4% sti 11 consume alcohol on a regu lar basis. Micral test to detectmicroalbuminuria as an early I phase of diabetic nephropathy were not commonly used (7%), and dipstick to detectmakroalbuminuria (99%). Blood test for serum creatinin showed 89% with serum creatinin <2 mg/dl and 11% withserum creatinin >2 mg/dl. Another chronic complication were neuropathy (10.1%); cataract (10.4%); backgroundretinopathy (8.6%), healed ulcer (3%), stroke (2%), leg amputation (1%), absence of foot pulse (1%), acuteulcer/gangrene (1%), myocard infard/CABG/angioplasty (1%).
GAMBARAN AKTIVITAS FISIK TERHADAP KADAR GULA DARAH PADA PENDERITA DIABETES MELITUS DI WILAYAH KERJA PUSKESMAS KARANGASEM I PADA SEPTEMBER-OKTOBER 2013 I Gusti Bagus Aginda Dwi Pawana; I Wayan Sudhana; I Wayan Losen Adnyana
E-Jurnal Medika Udayana vol 4 no 7(2015):e-jurnal medika udayana
Publisher : Universitas Udayana

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Abstract

Di Puskesmas Karangasem I, diabetes melitus termasuk dalam daftar sepuluh besar penyakit yang paling sering ditemui oleh petugas pelayanan medis. Untuk mengetahui prevalensi kadar gula darah,aktivitas fisik, gambaran aktivitas fisik terhadap kadar gula darah penderita diabetes melitus di wilayah kerja Puskesmas Karangasem I. Jenis penelitian adalah penelitian deskriptif potong lintang, dilakukan bulan September - Oktober 2013. 55 penderita diabetes melitus yang tercatat dalam register Puskesmas Karangasem I pada tahun 2012 sebagai sampel dipilih secara acak. Didapatkan prevalensi kadar gula darah terkontrol pada penderita diabetes melitus di wilayah kerja Puskesmas Karangasem I sebanyak 56,4% dan yang tidak terkontrol 43,6%. Dari 55 sampel, sebanyak 9 orang (16,4%) memiliki aktivitas sedang, 25 orang (45,4%) memiliki aktivitas ringan, 21 orang (38,2%) merupakan penderita diabetes melitus yang tidak aktif dalam beraktivitas. Tidak ditemukan penderita diabetes melitus yang memiliki aktivitas berat. Secara umum, kadar gula darah yang tidak terkontrol lebih banyak dialami oleh penderita diabetes melitus yang tidak aktif dalam beraktivitas fisik, yaitu sebanyak 52,4% (11 orang) dari total 21 penderita yang tidak aktif dalam aktivitas fisik. Sedangkan dari 25 penderita diabetes melitus yang melakukan aktivitas ringan sebanyak 17 orang (68,0%) memiliki kadar gula darah yang terkontrol dan 8 orang (32,0%) memiliki kadar gula darah yang tidak terkontrol. Kadar gula darah yang tidak terkontrol justru lebih tinggi pada kelompok penderita diabetes melitus dengan aktifitas sedang yaitu 5 orang (55,6%) dari 9 orang yang didapatkan memiliki aktivitas sedang. Tidak ditemukan kecenderungan peningkatan presentase kadar gula darah pada penderita diabetes melitus dengan aktivitas fisik yang tidak aktif, ringan, sedang maupun berat.
PERUBAHAN GOLONGAN DARAH PADA PENDERITA LEUKEMIA MIELOBLASTIK AKUT Losen Adnyana, IW; Suega, K
journal of internal medicine Vol. 12, No. 1 Januari 2011
Publisher : journal of internal medicine

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Abstract

We reported a case of acute leucemia (AML-M6) that experienced change of blood group. Leukemia is hematologicmalignancy with differentiation abnormality at grades haematopoetic stem cell that can make progressive expansión frommalignant clone cell in bone marrow and than spread to systemic circulation. In ABO blood system, group A with A antigenand anti B antibody, group B with B antigen and A antibody, O group without AB antigen and antibody. In this case, acuteleukemia be con! rmed with blood smear and bone marrow puncture. Changes of blood group known after remission inductionchemotherapy accordng to AML-M6 regiment. Post chemotherapy, there was changes O to A blood group according to ABOsystem. On family examination showed result of subgroup A of blood group previously. On acute leucemia or other hematopoiticdisease, there are two mechanism for explanation change of ABO blood system. The ! rst hematologic malignancy induced lossof ABO antigen due to inactivity of transferae A and B as the result was loss or decreased of antigen A and or B with simultantincrease of H antigen. Second, loss of ABH antigen in certain type of leucemia preceeding by loss of heterogenicity. ABO antigenwill reversed after proper treatment of leucemiaitself.
SEORANG PENDERITA HAMIL DENGAN LEUKEMIA MIELOID AKUT Sukrawan, Gede; Losen Adnyana, Wayan; Suega, Ketut
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Abstract

Leukemia during pregnancy is extremely rare, the estimate one per100,000 pregnancies each year. Intrauterine growthdisorders have been reported in pregnant women with untreated AML. A pregnant female patient, 28 years old, Balinese, privateemploy came with chief complain fever, sweaty, nausea and vomiting, body weekly, Physical examination: anemic, pale, bloodpressure; 120/80mmHg, pulse 88 x/minute, respiration 20 x/minute, axillary temperature of 36.7 degrees Celsius, heart andlungarenormal, Abdoment: fundus uteri-high processusxipoideus, distention and bowel sounds normal. Laboratory January 14th 2011:leukocyte 63,2 103/ul, Hb 11.7 g/dl, hematocrite 33.6%, MCV 30.7 pg, trombocite 40 103/ul, anatomicalpathology on November26th 2009 with increasing blast dysplasia eritroid series, allowing a leukemia acute. January 16th 2010 chemotherapyAra-C150 mg in 500 ml NaCl 0.9% 24 hours for 7 days and daunorubicine 60 mg IV bolus for 3 days. January 18th 2010 laboratoryresultleukosit 46.2 x 103/ul, Hb 9.2 g/dl, hematocrite 26.3%, MCV 87.4 fl, MCH 30.4 pg and thrombocyte 10 x 103/ul. The patienthad complite remission after chemoterapy and laboratory results on February 12th 2010 were leucocyte 7.02 x 103/ul, Hb 8.6g/dl, hematocrite 25.5%, MCV 74.5 fl, MCH 25.5 and thrombocyte 125 x 103/ul. The baby was born with normal condition withoperation. Acute leukemia in pregnancy should be managed together hematologist, obstetrics-gynaecology and neonatologists.
DIAGNOSIS CEPAT INFEKSI SALURAN KEMIH DENGAN MENGHITUNG JUMLAH LEUKOSITURIA PADA URINALISIS METODE FLOWCYTOMETRY SYSMEX UX-2000 DENGAN BAKU EMAS KULTUR URIN DI RSUP SANGLAH DENPASAR Pratistha, Fernanda Savitri Mega; Sudhana, I Wayan; Adnyana, I Wayan Losen
Jurnal Penyakit Dalam Udayana Vol 1 No 2 (2017): Vol. 1 No. 2 (2017) June-December 2017
Publisher : PAPDI BALI

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Abstract

Infeksi Saluran Kemih (ISK) merupakan infeksi bakteri pada saluran kemih, merupakan salah satu penyakit infeksi tersering di Negara berkembang. ISK menempati peringkat kedua, setelah infeksi luka operasi sebagai infeksi nosokomial. Kultur urin merupakan baku emas yang masih digunakan sampai saat ini untuk mendiagnosis ISK, namun memiliki kelemahan yaitu biaya yang mahal, dan waktu yang cukup lama untuk mendapatkan hasil. Pemeriksaan urinalisis otomatis dengan metode flowcytometry dapat digunakan karena lebih praktis dan lebih cepat dalam mendiagnosis ISK. Penelitian ini bertujuan untuk menentukan nilai sensitivitas, spesifisitas, dan akurasi pada Urinalisis Otomatis metode Flowcytometry menggunakan Sysmex UX-2000. Penelitian ini merupakan penelitian uji diagnostik dengan menggunakan data rekam medis pasien yang didiagnosis secara klinis mengalami ISK di RSUP Sanglah pada tahun 2016 sampai dengan 2017. Subjek penelitian berjumlah 100 orang dengan rentang usia 2 tahun sampai dengan diatas 65 tahun. Analisis statistik menggunakan program komputer SPSS.23 dan kurva ROC untuk mendapatkan cut-off point leukosituria paling optimal lalu dihitung sensitivitas, spesifisitas, nilai prediksi positif, nilai prediksi negatif dan akurasinya. Berdasarkan analisis kurva ROC didapatkan area under the curve (AUC) jumlah leukosituria berdasarkan metode flowcytometry sebesar 0,846 dan dengan menggunakan cut-off point ≥52,8/mL, memberikan hasil sensitivitas 82,3% spesifisitas 76,3%, nilai prediksi positif 85% nilai prediksi negatif 72,5% dan akurasi 80%. Alat Urinalisis Otomatis dengan metode Flowcytometry memiliki nilai sensitivitas, spesifisitas, dan akurasi yang tinggi sehingga dapat diterapkan untuk membantu diagnosis ISK.
Resolution of Retinal Bleeding And Exudative Retinal Detachment After Chemotherapy with Melphalan In Multiple Myeloma Andayani, Ari; Budhiastra, I Putu; Adnyana, I Wayan Losen; Wijayati, Made Paramita
International Journal of Retina Vol 1 No 1 (2018): International Journal of Retina (IJRetina) - INAVRS
Publisher : International Journal of Retina

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Abstract

Introduction: Multiple myeloma is the second most common hematologic cancer. It is characterized by the clonal proliferation of malignant plasma cells and associated organ dysfunction. Ophthalmic manifestations include hyperviscosity retinopathy and retinal detachment.&nbsp;The aim of this study is to report retinal manifestation in Multiple Myeloma. Methods: A man 45 years old, complained loss of vision on both eyes especially left eye over 1 month. He also feels weakness and 3 times spontaneous nose bleeding. His visual acquity is 6/12 on the right and 2/60 left eye with Retinal Bleeding and Retinal Detachment. His Laboratory examination result increase in WBC 65.91 x 103/µL (Neutrophil, Monocyte, Basophil and Lymphocyte) decrease RBC 3 x 106/µL, HGB 6.85 g/dL, normal PLT 193.60 103/µL, Normal Bleeding and Clotting Time and increase ESR 140 mm/hour. Multiple myeloma was diagnosed by Internal Department with bone marrow biopsy and increase of Gamma Globulin. Results: The patient was treated with melphalan 3 tablet 2 times a day and prednisone 4 mg 3 times a day for 5 days every 28 days.&nbsp; After 8 month the VA 6/6 on the right and 6/10 on the left with complete resolution of on the right eye and there are resolution on the left eye with fibrosis, the laboratory examination normal WBC 3.8 x 103/µL with Neutrophil 59.3%, Monocyte 6.1 %, Eosinophil 6.3 %, Basophil 0.3 % and Lymphocyte 28.0 %, normal RBC 4.6 x 106/µL, slightly decrease HGB 12.8 g/dL, normal PLT 177.0 x 103/µL and decrease Gamma Globulin. Discussion: This case of bilateral Retinal Bleeding and Exudative Retinal Detachment are remarkable for both its presentation and response to melphalan therapy. Treatment with melphalan and prednison alone was sufficient to clear the Retinal Bleeding and restoration of Exudative Retinal Detachment. Conclusion: Complication of Multiple Myeloma can caused organ disfunction such as retinal bleeding and exudative retinal detachment. Early Diagnosis&nbsp; is very crucial. In our case combination cemotheraphy with&nbsp; Melphalan and Prednison showed clinically significant resolution. Workship Internal Department and Ophthalmology Department are very important for management and monitoring ophthalmology manifestation in multiple myeloma.
Kadar hemoglobin awal sebagai faktor prognostik penderita limfoma non-hodgkin (LNH) yang menjalani kemoterapi Winarto, Daniel; Rena, Ni Made Renny A; Adnyana, Wayan Losen; Dharmayuda, Tjokorda Gede; Suega, Ketut; Bakta, I Made
Jurnal Penyakit Dalam Udayana Vol 2 No 2 (2018): Vol 2 No 2 (2018) July-December 2018
Publisher : PAPDI BALI

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Abstract

Latar belakang: Anemia sering ditemukan pada saat diagnosis awal LNH. Anemia dapat terjadi karena beberapa kondisi, seperti perdarahan terkait LNH dengan atau tanpa anemia defisiensi besi, anemia karena penyakit kronik, infiltrasi sel-sel LNH ke sumsum tulang, anemia hemolitik autoimun maupun anemia terkait kemoterapi. Anemia mempengaruhi perjalanan klinis dan kesintasan pasien-pasien LNH. Tujuan: Penelitian ini bertujuan untuk membuktikan bahwa kadar Hb awal merupakan faktor prognostik penderita LNH yang menjalani kemoterapi.&nbsp; Metode: Penelitian ini merupakan penelitian kohort retrospektif mulai bulan Januari 2013 sampai bulan September 2017 pada penderita LNH yang menjalani kemoterapi di RSUP Sanglah Denpasar. Hubungan antara kadar Hb dengan skor R-IPI dianalisis menggunakan uji Mann Whitney. Analisis kesintasan menggunakan metode Kaplan Meier dan Cox Proportional Hazard Mode dengan menggunakan software SPSS. Hasil: Dari 88 penderita LNH, dieksklusi 31 penderita, sehingga total sampel sebanyak 57 orang. Dengan menggunakan analisis komparatif Mann Whitney didapatkan perbedaan signifikan pada skor R-IPI antara pasien LNH dengan Hb ≥ 10 g/dl (md=1, n=46) dan kadar Hb &lt; 10 g/dl (md=3, n=11) (z= -2,106; p= 0,035; d= 0,28). Analisis dengan Kaplan Meier, didapatkan penderita dengan kadar Hb&lt;10 gram/dL memiliki kesintasan lebih pendek dibanding penderita dengan kadar Hb≥10 gram/dL (± 255 vs ± 850 hari; p= 0,002; IK 95%) dan&nbsp; dengan analisis Cox Regression didapatkan Hazard ratio sebesar 4.46 (p= 0,005). Simpulan: Kadar hemoglobin awal dapat digunakan sebagai faktor prognostik mortalitas penderita LNH yang menjalani kemoterapi.
HUBUNGAN ANTARA POLA MAKAN DENGAN OBESITAS REMAJA PADA SISWA-SISWI SEKOLAH MENENGAH ATAS (SMA) DI DENPASAR Nyoman Arya Shridewi Abhigamika; Wayan Losen Adnyana; I Wayan Sudhana
E-Jurnal Medika Udayana Vol 8 No 7 (2019): Vol 8 No 7 (2019): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

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Abstract

Obesitas merupakan suatu kondisi penumpukan lemak yang abnormal atau berlebih yangmengganggu kesehatan. Prevalensi kegemukan pada anak-anak di Indonesia menurut data RisetKesehatan Dasar (RISKESDAS) tahun 2013 di berbagai rentang usia terbilang masih tinggiterutama saat usia remaja (usia 10-19 tahun) yang dapat disebabkan oleh interaksi kompleksdari banyak faktor seperti genetik, pola makan, aktivitas fisik, status sosial-ekonomi, sertalingkungan. Secara sederhana, obesitas dapat diukur dengan menghitung Indeks Massa Tubuh(IMT) maupun mengukur lingkar pinggang. Tujuan dari penelitian ini adalah untuk mengetahuihubungan antara pola makan dengan obesitas remaja pada siswa-siswi Sekolah Menengah Atas(SMA) di Denpasar. Penelitian ini menggunakan studi observasional analitik potong lintangdengan sampel sebanyak 100 siswa SMA di Denpasar yang dipilih menggunakan teknikpurposive sampling. Variabel bebas penelitian ini meliputi kualitas makanan, kuantitasmakanan, dan intensitas makan. Data yang diperoleh adalah data primer dengan pengumpulandata menggunakan media kuesioner 24 hour recall serta mengukur berat badan, tinggi badan,dan lingkar pinggang sampel. Pengambilan data dilakukan sejak bulan Agustus-Oktober 2015 diSMAN 8 Denpasar, SMAN 3 Denpasar, SMAK Santo Yoseph Denpasar, dan SMAN 2Denpasar. Penelitian ini menghitung nilai Chi-square hitung lalu membandingkan dengan nilaiChi-square tabel, koefisien korelasi (r), determination coefficient (R2), dan nilai contingencycoefficient (C) dari masing-masing variabel bebas. Pada penelitian ini didapatkan hasil nilaiChi-square hitung seluruh variabel bebas lebih kecil daripada nilai Chi-square tabel yangmenunjukkan adanya hubungan ketiga variabel bebas terhadap obesitas remaja di Denpasar.Variabel kualitas makanan memiliki r = 0,063, R2 = 0,39%, dan C = 1,74%. Variabel kuantitasmakanan memiliki r = 0,068, R2 = 0,46%, dan C = 1,4%. Variabel intensitas makan memiliki r =0,068, R2 = 0,46%, dan C = 1,27%. Berdasarkan hasil penelitian ini, dapat disimpulkan bahwavariabel kualitas makanan, kuantitas makanan, dan intensitas makan memiliki hubungan dengankejadian obesitas remaja dan hubungan tersebut searah meskipun dengan tingkat keyakinanyang kecil. Tingkat keyakinan yang kecil tersebut menunjukkan bahwa masih terdapat faktorlain yang turut mempengaruhi obesitas pada remaja selain pola makan yang tidak diteliti padastudi ini. Kata kunci : Pola Makan, Obesitas, Remaja
NEGATIVE CORRELATION BETWEEN LEUKOCYTE COUNT AND HIGH DENSITY LIPOPROTEIN IN TYPE 2 DIABETES MELLITUS PATIENTS IN SANGLAH GENERAL HOSPITAL, BALI Ni Luh Made Novi Ratnasari; Made Ratna Saraswati; I Wayan Losen Adnyana; I Wayan Sudhana
Bali Journal of Medical and Health Sciences vol 1,no 2(2017):volume 1 no 2 Mei 2017
Publisher : Faculty of Medicine, Udayana University

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Abstract

Type 2 diabetes mellitus (T2DM) is group with high cardiovascular disease (CVD) risk. Inflammation which is reflected by increasing leukocyte number, CRP, and lipid profile. Despite that, infection as one of diabetic complication commonly occurs in patient with T2DM. The dyslipidemia status reflected by lipid profile composition. So here, we aim to evaluate the relationship between leukocyte count with lipid profile to know the association between traditional and non-traditional risk factor of CVD in T2DM patient. The type of this research is cross sectional analytic research with 94 samples was enrolled into this study. The data is obtained initially by collecting from the quistionare and from laboratorium examination. Mean of samples’ age is 55 years and large number of patients had leukocytosis as reflected by high value of its mean (15.02±8.78 x 103/?L). We found that 56.4% of the subjects fall into worst category of glycemic control (HbA1C). Only 24.5% of the subjects had good glycemic control. Further evaluation showed that there were significant strong negative correlations between leukocyte count with HDL (r= -0.555; p=0.000). Inflammation which mainly related to infectious disease is common among T2DM patients which increase CVD risk by lowering HDL and worsening glycemic control.Keywords: Type 2 Diabetes Mellitus, lipid profile, leukocyte count
Diagnosis cepat infeksi saluran kemih dengan menghitung jumlah leukosituria pada urinalisis metode flowcytometry sysmex UX-2000 dengan baku emas kultur urin di RSUP Sanglah Denpasar Fernanda Savitri Mega Pratistha; I Wayan Sudhana; I Wayan Losen Adnyana
E-Jurnal Medika Udayana Vol 7 No 5 (2018): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

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Abstract

Urinary Tract Infection (UTI) is a bacterial infection of the urinary tract, one of the most common infectious diseases in developing countries. UTI menempati peringkat kedua, after surgical wound infection as a nosocomial infection. Urine culture is a gold standard that is often used to confirming the UTI diagnosis, but has some limitation that is expensive and time consuming to get results. The urine analyzer by flowcytometry method can be used because it is more practical and faster to diagnosed UTI. The aim of the study is to determine the sensitivity, specificity, and accuracy on the automatic urine analyzer by flowcytometry of Sysmex UX-2000. This study is a diagnostic test. Data used in this study is patient who is diagnosed UTI clinically in Sanglah Central Hospital from 2016 until 2017. Subject of the study were 100 people with aged 2 years till up to 65 years. The statistical analysis computer program SPSS.23 and ROC curve to get the most optimal cut off point for leukocytes count then calculated sensitivity, specificity, positif predictive value, negative predictive value and accuracy. Based on Receiver operating characteristic (ROC) curve analysis showed an area under the curve (AUC) for leukocytes count is 0.846 and applying cut off point ?52.8/mL has a sensitivity 82,3%, specificity 76,3%, positive predictive value 85% negative predictive value 72.5% and accuracy 80%. Automatic Urine Analyzer by Flowcytometry Method has high Sensitivity, Specificity, and Accuracy so that it can be applied to help diagnosed UTI. Keywords: Urinary Tract Infection, flowcytometry urine analyzer, Urine Culture
Co-Authors Anak Agung Gde Budhiarta Ari Andayani Arundina Sanyoto Dharmayuda, Tjokorda Gede Fernanda Savitri Mega Pratistha Gede Sukrawan Hensen - I Gede Eddy Pramana Agustina I Gusti Bagus Aginda Dwi Pawana I Gusti Putu Suka Aryana I Made Bakta I Putu Budhiastra, I Putu I Wayan Sudhana I Wayan Sudhana Ketut Suega MADE RATNA SARASWATI . Ni Luh Made Novi Ratnasari Ni Made Ayu Sintya D Nyoman Arya Shridewi Abhigamika Pratistha, Fernanda Savitri Mega Rena, Ni Made Renny A Wijayati, Made Paramita Winarto, Daniel