MULTIDISCIPLINE APPROACH IN STROKE.

Join between Faculty of Medicine University of Indonesia and Dutch Foundation

DUTCH FOUNDATION FOR POSTGRADUATE MEDICAL COURSES IN INDONESIA

Founded in 1986 on the initiative of HRH Prince Claus of The Netherlands.

This symposium was organized under the auspices of the Dutch Foundation for Postgraduate Medical Courses in Indonesia. Since 1986 the Foundation has organized postgraduate medical courses at the University of Indonesia in Jakarta and the Airlangga University in Surabaya in a continuous with the staff of the medical faculties of both universities.
The Foundation was instituted in 1986 on the initiative of H.R.H Princes Claus of the Netherlands and Prof.Dr.W.J.F Beks, neurosurgeon in Groningen. The Dutch Ministry of Education, Culture and Science pledged financial support. From the beginning Indonesian counterparts in Jakarta and Surabaya were heavily involved in this initiative and the subsequent continuous collaboration during the past years.

The Topics.

Stroke or brain attack, is the clinical term for acute loss of brain perfusion due to vascular disorder, resulting in ischemia and corresponding loss of clinical neurological function. Incidence and prevalence of stroke is different between each country in the world. Approximately, 700.000 strokes occur each year in USA, including both new and recurrent cases. Of these stroke, approximately 625.000 are ischemic stroke. In developing countries as the aging population rise because of better health care and information, the burden of stroke is also intriguing, as it is the leading cause of disability and health economic cost.
Classified as either hemorrhagic, strokes typically manifest with the sudden onset of focal neurologic deficits, such as loss of consciousness, weakness, sensory deficit, imbalance disorder or cognitive disturbances like difficulties with language or memory impairment. Stroke has a heterogeneous group risk factors, including hypertension, diabetes, cardiac diseases, dyslipidemia, hematologic disorder and smoking. Due to those fact, multidiscipline approach and fast treatment will make a big difference in outcome for someone having a stroke.

Organizing Committee.

Patron.

Dean of FMUI – Dr.Dr.Ratna Sitompul,SpM(K).
Vice Dean of FMUI – Prof.Dr.Pratiwi Pudjilestari Sudarmono,PhD,SpMK.
Academic & Student affair Manager of FMUI – Dr.Pradana Soewondo,SpPD-KEMD.

Director.

Chairman CME – PDU FMUI.
Prof.Dr.Djoko Widodo,SpPD-KPTI.

Chairman.

Dr.Salim Harris,SpS(K)

Scientific.

Prof.dr.Jusuf Misbach,SpS(K),FAAN.
Dr.Salim Harris,SpS(K).
Dr.Nizar Yamani,SpS(K).
Dr.Freddy Sitorus,SpS(K).

Scientific Program.

In Auditorium of Faculty of Medicine University of Indonesia,
2nd – 4th March 2009.

Speakers.

Prof.Dr.A.F.H Stalenhoef (Netherlands).
Prof .Dr.J.Van Gijn (Netherlands).
Prof.Dr.F.L Moll (Netherlands).
Dr.J.D.M Metzemaekers (Netherlands).
Prof.Dr.Jusuf Misbach,SpS(K),FAAN.
Prof.Dr.Teguh AS Ranakusuma,SpS(K).
Dr.Salim Harris,SpS(K).
Dr.Mursyid Bustami,SpS(K).
Dr.Freddy Sitorus,SpS(K).
Dr.Terawan AP,SpRad.
Dr.Al Rasyid,SpS.
Dr.Diatri Nari Lastri,SpS.

Topics.

In the Scientific Programs PT. Kosmojaya Pandu Nusa with the product SALAKINASE^® follow in discuss topic on day 2 as new drug agent an alternative therapy for prevention thrombosis and maintaining blood flow and also as the opportunity of SALAKINASE^® as a thrombolysis and anticoagulant intervention in ischemic stroke in :

Date / day   : Tuesday, March 3, 2009.
Time       : 13.00 – 15.00.
Place       : Auditorium of Faculty of Medicine University of Indonesia.
Moderator   : Dr.Eva Dewati,SpS(K).
Speacher   : Prof.Dr.J.Van Gijn.
           Assessing efficacy of treatment (in general).
           Prof.Dr.F.L Moll.
           Severe carotid stenosis : endarterectomy or stenting ?
           Dr.Salim Harris,SpS(K).
           Salakinase® as anti thrombosis management in stroke prevention.

SALAKINASE^® as anti thrombosis management in stroke prevention.
In 1847. Rudolph Virchow analyzed the connection between thrombi and infarction and he concluded that thrombosis and emboli could be the cause of infarction. Then, Virchow postulated that the cause of vascular occlusion by triad of circulation disturbance endothelial injury and the changes in blood coagulation potentiation, which then known as triad of Virchrow.

The edhothel could protect the thrombosis process by the production of nitric oxide, prostacyline, anti thrombin, tissue plasminogen activator, protein C and protein S, besides heparin sulphate, chondroitine sulphate and ADP-ase enzyme. The process of thrombosis induced by the endhothelial injury will diminished the endhothelial protection which cause the platelet adhesion and platelet aggregation.

The platelet activity in thrombosis process is clearly seen in high-sheared flow. In the area of low-sheared flow, the thrombosis dominantly consist of fibrin and erythrocyte product. The prevention of thrombi formation should be basically based on understanding the condition that could be injured the endothel, besides understanding of coagulation process. There are many conditions which could induce thrombosis like chemical toxin (cigarette smoking), hypertension, metabolic disorder and traumatic injury. The condition that increase coagulation factor and reduce the anticoagulant factor could also easily stimulate the production of thrombosis in a vessel which had injured endothelial.

The platelet aggregation process should be prevent as soon as possible to protect the production of thrombi in the high shear rate. Many anti platelet aggregation could be used to prevent the GpIIb/IIa receptor as the end point of platelet aggregation pathway by increasing c-AMP whatever the medication used. Many type medication with different mechanism can be used in platelet aggregation prevention like asetosal, which reduce the production of arachidonic acid from thromboxane.

The injured endothel at the first step will going to induced adhesion by activating vW-factor as the site of platelet adhesion which stimulate by the collagen, fibronectin and thrombin. The thrombus will be dissolved by the plasmin. Plasminogen activator will increase the changes of plasminogen to plasmin. Plasmin in the fibrin/blood clot will dissolve fibrin into fibrin degradation product (FDP). In the circulation, plasmin also plays it’s role by destructing fibrinogen, Factor V and factor VIII to make degradation product.

Stroke or brain attack, 85% are ischemic. Among the ischemic stroke, around 20% are caused by emboli and almost 50% by thrombosis. Because of the high rate of thrombosis in stroke, the understanding of how to prevent thrombosis and how to dissolve thrombus formation are necessary in the stroke prevention. Salakinase® from the traditional Japanese food is a new drag as an alternative therapy for prevention thrombosis can make choice to stroke prevention.
Keywords : stroke, thrombosis, anti thrombosis and prevention is a SALAKINASE^®.

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