Mati Otak Diagnosis dan Aplikasi Klinis

Istilah mati otak mempunyai sejarah panjang. Konsep tentang mati otak timbul pertama kali pada pertengahan abad ke-20, seiring dengan perkembangan ilmu kedokteran dan teknologi medis. Perkembangan ilmu resusitasi dan perawatan intensif, disertai teknologi mesin bantu napas, menimbulkan permasalahan baru tentang batas antara hidup dan mati secara medis. Konsep mati sebelumnya banyak dikaitkan dengan fungsi napas dan jantung, Rene Laennec menemukan stetoskop pada tahun 1819 dan bisa melakukan pemeriksaan jantung lebih teliti dan saat itu berhentinya detak jantung dianggap suatu tanda kematian seseorang

Intraventricular Transplantation of Autologous Bone Marrow Mesenchymal Stem Cells for Stroke: Rationale, Technique and Early Clinical Experience

Stroke, one of the most devastating diseases, is a leading cause of death and disability throughout the world and is also associated with emotional and economic problems. The main purpose of this article is to report the technique and clinical outcome of the intraventricular transplantation of bone marrow mesenchymal stem cells (BM-MSCs) in post-hemorrhagic stroke patients. This clinical study was performed with eight patients with supratentorial hemorrhagic stroke, who had undergone 24 weeks of standard treatment of stroke with stable neurological deficits. All of the patients received stem cell transplantation intraventricularly via an Ommaya reservoir using autologous BM-MSCs. Six months and twelve months after stem cell treatment, the clinical outcomes were measured using the National Institute of Health Stroke Scale (NIHSS).The results of this study showed improvement of NIHSS score values before and after the treatment in 5 patients. No adverse effects or complications were dete cted during the 1 year of observation. Intraventricular transplantation of BM-MSCs showed benefits in improving the functional status of post-hemorrhagic stroke patients. The repeated transplantation procedure is easier and safer to perform via a subcutaneously implanted Ommaya reservoir

Neuroplasticity: How it Works?

Them term ' plasticity', first applied to the brain in 1890 by William James, and then used as 'neural plasticity' in 1948 by Jerzy Konorsky. We can define neuroplasticity (brain plasticity or neural plasticity) as the capacity of neurons and neural circuits in the brain to change and adapt, structurally and functionally, in respons to experience. The mechanisms of neuroplasticity are so many, and so diverse, and until now neuroscientist still have not fully defined the neuroplasticity as a whole. But, we all hope to bridge this link between biomolecular theory and the clinical practice, related behavior and thought process, aging phenomena, neurodegenerative disease and developmental anomaly

New Neurons: The Future of Regenerative Brain Therapy

The world's future will be an aging society because enormous 'baby boom' generation will reach retirement age over the next decade with 'aging brain' as a related problem. Aging brain is common and is not a sign of a serious neurological disorder, but it can be a frustrating and cause reduction of productivity, a burden to community and nation. Adult neural stem cell and neurogenesis confer a unique mode of neuroplasticity in the brain, creates a glimmer of hope in the development of future therapies to 'prevent' aging brain, and more speciafically, treat some untreatable disease. A lot of research is being done on this topic and some of them have opened a new perspective for the identification and development of new therapeutic approaches to enhance neurogenesis and produce new neurons for neurodegenerative disorders

THE RELATION OF STROKE PATIENT'S CORTISOL LEVEL TO NATIONAL INSTITUTES OF HEALTH STROKE SCALE CORE ON SPONTANEOUS INTRACEREBRAL HEMORRHAGE: AN OBSERVASIONAL STUDY AT RUMAH SAKIT UMUM DAERAH (REGIONAL PUBLIC HOSPITAL) DR. SOETOMO IN SURABAYA

Objective: The objective of the study was to find out differences in the cortisol level characteristics and National Institutes of Health Stroke Scale (NIHSS) score in the 1st and 7th days on patients treated at Dr. Soetomo Regional Hospital; thus, it can be the right education for stroke patients.Methods: A prospective observational study was carried out against stroke patients treated in the neurosurgery department on September 2016– March 2017. Evaluation was done to all patients treated at the neurosurgery department. The evaluation process began with basal hormones within the first 24 h and taken at 6:00 and repeated on the 7th day to surviving patients. Of all the data obtained, the category scale data are presented by its frequency distribution, while numerical scale data are presented by its descriptive value (average and standard deviation).Results: Of the 17 patients surviving until the 7th day, there is a decrease at the average cortisol level on the 1st day when compared to the average cortisol level on the 7th day with a mean value of 39.67–36.57 and so is the highest cortisol level; it decreases from the 1st day of 61.45 to the 7th day of 56.70. Meanwhile, in the NIHSS score value, the decrease in score only occurs in the average value on the 1st and 7th days from an average of 22.82 into 21.41, whereas minimum and maximum scores do not change. With the test result, the cortisol level characteristic gets a score of p<0.05; thus, there is a significant difference.Conclusion: Of the result of observation already carried out on stroke patients treated at Dr. Soetomo Regional Hospital, treatment and education levels for patients who have a risk of stroke factor are very important

Clinical Outcome of Intraventricular Implantation Autologous Adipose Derived Neural Progenitor Cells in Parkinson

Parkinson’s disease (PD) involves the malfunction and death of vital nerve cells in the brain, is a chronic and progressive movement disorder. Supportive medications and surgery may conduct, but no optimal results have been obtained. The main goal of this study was to investigate the effectiveness of the intraventricular implantation of adipose derived neural progenitor stem cells in post-Parkinson’s disease patients. 12 patients were included in this study. Small adipose tissue was isolated by small lipopectomy under local anesthesia, cultured and derived become neural progenitor cells. Intraventricular implantation was performed in the operating room. The evaluation was carried out using the Unified Parkinson’s Disease Rating Scale (UPDRS), include non-motor experiences and motor experiences of daily living, motor examination, and motor complications. The primary target was the UPDRS over the time period of 12 months after treatment as the end point. Descriptive statistics are provided. 10 of 12 patients (83.33%) had a significant improvement in mentation, behavior and mood, activity of daily living, and motor examination after treatment. There were no serious adverse events reported, limited to mild headaches, fever or vomiting, and all side effects resolved within few days. Because of the small sample size and non-randomised trial performed, we could not reach a definitive conclusion regarding the potential of intraventricular implantation. However, this study shows that repeated intraventricular implantation of autologous stem cells is advantageous

The Relation of Stroke Patient's Cortisol Level To National Institutes of Health Stroke Scale Core On Pontaneous Intracerebral Hemorrhage: An Observasional Study at rumah Sakit Umum Daerah (regional Public Hospital) Dr. Soetomo in Surabaya

Objective: The objective of the study was to find out differences in the cortisol level characteristics and National Institutes of Health Stroke Scale (NIHSS) score in the 1st and 7th days on patients treated at Dr. Soetomo Regional Hospital; thus, it can be the right education for stroke patients. Methods: A prospective observational study was carried out against stroke patients treated in the neurosurgery department on September 2016– March 2017. Evaluation was done to all patients treated at the neurosurgery department. The evaluation process began with basal hormones within the first 24 h and taken at 6:00 and repeated on the 7th day to surviving patients. Of all the data obtained, the category scale data are presented by its frequency distribution, while numerical scale data are presented by its descriptive value (average and standard deviation). Results: Of the 17 patients surviving until the 7th day, there is a decrease at the average cortisol level on the 1st day when compared to the average cortisol level on the 7th day with a mean value of 39.67–36.57 and so is the highest cortisol level; it decreases from the 1st day of 61.45 to the 7th day of 56.70. Meanwhile, in the NIHSS score value, the decrease in score only occurs in the average value on the 1st and 7th days from an average of 22.82 into 21.41, whereas minimum and maximum scores do not change. With the test result, the cortisol level characteristic gets a score of p<0.05; thus, there is a significant difference. Conclusion: Of the result of observation already carried out on stroke patients treated at Dr. Soetomo Regional Hospital, treatment and education levels for patients who have a risk of stroke factor are very important

Knowledge, Attitude and Practice of Primary Care Physicians in Dealing with Acute Stroke in Indonesia

Abstract Objective: There are still many things that interfere with the practice of effective acute stroke management, with one of them being the failure of health workers providing appropriate management. Hence, this study was conducted to evaluate the level of knowledge, attitude and practices of primary care physicians (PCPs) in acute stroke management in Indonesia. Material and Methods: This cross-sectional face-to-face survey was conducted among all PCPs, from 63 primary health care centres; from October, 2019 to January, 2020 in Surabaya, Indonesia. A self-designed questionnaire, consisting of 25 questions, based on several guidelines, was used as the instrument of this survey. Results: In total, 134 PCPs participated. The majority of their level of knowledge obtained was in the moderate category (51.5%), while the majority of their attitude and practices towards stroke were in the good category (67.9% and 75.2%). Nearly 75.0% of PCPs also knew about thrombolytic therapy, but only <50.0% knew the ‘golden period’ of thrombolytic therapy. A significant correlation was found between PCPs knowledge-attitude (p-value<0.001), knowledge-practices (p-value=0.002) and attitude-practices (p-value<0.001). There was also a significant difference in the level of stroke knowledge between PCPs, with different clinical practice experience (p-value=0.015). Better stroke knowledge tended to be obtained by PCPs with younger clinical practice experience. Conclusion: The level of knowledge, attitude and practices of PCPs in acute stroke management in Indonesia is good, but should still be improved; especially knowledge about the use of thrombolytic therapy and its ‘golden period.

Brain Death: Diagnosis and Clinical Application

Brain death has a story of nearly one full century. In most cases brain death occurs as a sequelae toincreased intracranial pressure. Nearly every neurosurgeon has experienced it. In addition, neurologist,emergency care physicians and intensivists may also experienced brain death state. However it is unlikelythat all clinicians will encounter this condition. The fact is that there are a large number of medicalprofessional lacking on criteria of drain death. A particular aim of this article is to give every neurosurgeonand intensivist sufficient theoretical knowledge to feel confident in diagnosing brain death

Eyebrow Keyhole Approach in Aneurysm Surgery

The concept of keyhole neurosurgery is not only to perform small incision and reduce the craniotomy size for the sake of a small opening as we called “keyhole,” but it is rather to make “minimum craniotomy” required to access deep intracranial lesions at the end of the route. Standard craniotomy forms a “funnel-shaped surgical corridor" to reach deeper area of the brain. In contrast, keyhole mini craniotomy forms a “reverse funnel-shaped surgical corridor” that provides adequate working space through small incision and bone window to reach the target. This concept of this approach is that the deep area of the brain can be accessed through smaller craniotomy since the superficial optical field is widened if the size of craniotomy is bigger