BAB VI KESIMPULAN DAN SARAN
6.2. Saran
6.2.1.Diperlukan deteksi secara dini pemeriksaan penyaring hemostasis
pada pasien yang mempunyai faktor resiko timbulnya stroke
iskemik.
6.2.2.Perlu dilakukan penelitian lebih lanjut tentang hemostasis yang
DAFTAR PUSTAKA
1. Suharti C. Dasar-Dasar Hemostasis. Dalam : Aru W Sundaru dkk. (editor) Buku Ajar Ilmu Penyakit Dalam. Edisi keempat. Pusat Penerbitan Departemen Ilmu Penyakit Dalam FKUI. Jakarta. 2006.
2. Oesman F, Setiabudy R D. Fisiologi Hemostasis dan Fibrinolisis. Dalam : Rahajuningsih D Setiabudy (editor). Hemostasis dan Trombosis. Edisi ketiga. Balai Penerbit FKUI. Jakarta. 2007.
3. Setiabudy R D. Patofisiologi Trombosis. Dalam : Rahajuningsih D Setiabudy (editor). Hemostasis dan Trombosis. Edisi ketiga. Balai Penerbit FKUI. Jakarta. 2007.
4. Aulia D. Pemeriksaan penyaring pada kelainan hemostasis. Dalam : Rahayu D Setiabudy (editor). Hemostasis dan Trombosis. Edisi Ketiga. Balai Penerbit FKUI. Jakarta. 2007.
5. Natalya MA, Diana VK, Midori S, Evgueni LS, Intrinsic Pathway of Blood Coagulation Contributes to thrombogenicity of
Atherosklerotic plaque,Blood 2002:99: 4475-4485.
6. Suri MFK, Yamagishi K, Aleksic N el al. Novel Hemostatic factor levels and risk of ischemic stroke : The Atherosclerosis Risk in Communities (ARIC) study. Cerebrovasc Dis 2010 ; 29 (5) : 497-502.
7. Shinichi S, Hiroyasu I, Hiroyuki et al, Plasma Fibrinogen Concentration and Risk of Stroke and its subtypes among Japanese Men and Women, Stroke 2006 : 37 : 2488-2492.
8. Widjaja AC, Imam BW, Indranila KS, Uji Diagnostik Pemeriksaan kadar D-dimer Plasma pada Diagnosis Stroke Iskemik 2010:1-9.
9. Jie Zi W, Shuai J. Plasma D-dimer levels are associated with stroke subtypes and infarction volume in patients with acute ischemic stroke. Plos One 2014.
11.Hankey GJ, Preventable stroke and stroke prevention, Journal of Thrombosis and Haemostasis 2005: 3: 1638-1645.
12.American Family Physician, Using Anticoagulans for stroke prevention, 2000.
13.Kamphuisen PW, Agnelli G, Sebastianelli M, Prevention of VTE after acute Ischaemic Stroke ,Journal of Thrombosis and Haemostasis 2005: 3: 1187- 1194.
14.Laszlo, Olah, Hemodinamic and Hemostasis Investigations in Cerebrovascular Disease, University of Debrecen, Faculty of Medicine, Departement of Neurology, 2002.
15.Ageno W, Dentalli F. Venous thromboembolism and Arterial Thromboembolism. Many Similarities, far beyond Thrombosis. Throm Haemost 2008; 100 : 181- 183.
16.Previtali E, Bucciarelli P, Passamonti SM, Martinelli P. Risk Factors for Venous and arterial Thrombosis. Blod Transfus 2011 :9 (2) : 120-138. 17.Takano K, Yamaguchi T, Uchida K, Markers of Hypercoagulable state
Following acute ischemic stroke, Stroke 1992 : 23 : 194-198.
18.Skoloudik D, Bar M, Sanak D, et al, D-dimers increase in acute Ishemic Stroke Patients with The Large Artery Occlusion, but not Depent on The Time of Artery Recanalization. J Throm Thrombolysis 2010 : 29(04) : 277-482.
19.Ageno W, Finazzi S, Steidl L et al. Plasma Measurement of D-dimer Levels for The Early Diagnosis of Ishemic Stroke subtypes. Arch Intern Med 2002 : 162 : 2589- 2593.
20.Yang DT, Flanders MM, Kim H et al. Elevated factor XI activity level are ascociated with an increased odds ratio for cerebrovascular events. Am J Clin Pathol 2006 ;126 (3) : 411-415.
21.Kofold SC, Wittrup, Sillesen H. Fibrinogen predicts ischemic stroke and advanced atherosclerosis but not echolucent, ruptur prone carotid plaque, The Copenhagen City Heart Study. European Heart Journal 2002;24 : 567-576.
Risk of Ischemic Stroke and Acute Coronary Events in 5113 Patients with Transient Ischemic Attack and Minor Ischemic Stroke 2004 ; 35 : 2300-2305.
23.Cucciara BL, Evaluation and Management of stroke, ASH Education 2009: 293-301.
24.Bushnell CD , Goldstein LB, Diagnostic Testing for Coagulopathies in Patients With Ischemic Stroke, Stroke 2000: 31 : 3067-3078.
25.Couli BM, Clark WM, abnormalities of hemostasis in ischemic stroke , Med Clin North Am 1993 :77:77-94.
26.Barber M, Langhorne P, Rumley A et al, Hemostatic function and progressing ischemic stroke D dimer predic early clinical progression, stroke 2004; 35: 1421-1425.
27.Ann S, Chris P, John Y et al, Which hemostatic Marker Add to The Predictive value of Conventional Risk Factors for Coronary Heart Disease and Ischemic Stroke, Circulation 2005 : 112 : 3080-3087.
28.Razecki M, Pajunen P, Jousilahti P et al, Haemostatic factors as predictor of stroke and cardiovascular disease : the FINRISK 92 hemostasis study, PubMed, 2005 : 119-24.
29.Mario ND, Puneetpal S. Is Plasma Fibrinogen Useful in evaluating Ischemic Stroke Patients ? Why, How, and When. Stroke 2009 : 40 : 1549-1552.
30.Meng R, Yong Li Z, Xunming J et al. Antithrombin III associated with fibrinogen predicts the risk of cerebral ischemic stroke. Clin Neurology & Neurosurgery 2011; 113; 380-386.
31.Chitsaz A, Mousavi SA, Yousef Y et al. Comparison of changes in serum fibrinogen level in primary intracranial hemorrage ICH and ischemic stroke. Arya Atherosclerosis 2012 ;7 ;4.
32.Qizilbash N, Jones L, Warlow Celal. Fibrinogen and Lipid concentrations as risk factors for transient Ischemic Attacks and minor Ischemic strokes. BMJ ; 1991; 303 : 605-609.
33.Berge E, Friis P, Sanset PM, hemostatic activation in acute ischaemic stroke, International congress of the International Society on Thrombosis an Haemostasis 2001 : 101 : 13-21.
34.Robert C, Christina W, Susan S, et al, Hemostatic marker in patients at risk of cerebral ischemia, Stroke 2000: 31 : 1856-1862.
35.Oiwa K, Yamamoto Y, Hayashi M et al. Hemostatic Molecular Markers in Acute Ischemic Stroke, Differences between various subtipes of atherotrombotic infarction, Japanese J of Stroke 2002 : 24 : 277-282.
36.Koch HJ, Horn M, Bogdahn U et al. The Relationship between plasma D-dimer concentrationss and acute ischemic stroke subtypes. J of Stroke & Cerebrovascular Disease 2005 : 14 : 75-79.
37.Tetsuya O, Eyal S, Lloyd EC, et al, Risk factor for ischemic stroke subtypes, Stroke 2006 :37 : 2493-2498.
Lampiran 1 LEMBARAN PENJELASAN KEPADA CALON SUBJEK
Selamat pagi/siang Bapak/Ibu, saya Dr.Zainal Abdi, pada hari ini akan melakukan penelitian yang berjudul : “ Perbandingan Status koagulasi Penderita Stroke Iskemik dengan non Stroke “. Penelitian ini bertujuan untuk mendapatkan informasi tentang hiperkoagulasi yang menjadi faktor resiko terjadinya trombosis pada penderita stroke iskemik.
Pada Bapak/Ibu akan dilakukan pemeriksaan penyaring hemostasis untuk mengetahui adanya hiperkoagulasi. Pemeriksaan dilakukan dengan mengambil sampel darah sebanyak ±10 ml melalui pembuluh darah vena yang terdapat di lipatan siku tangan.
Dengan pemeriksaan penyaring hemostasis ini dapat dideteksi gambaran hiperkoagulasi yang nantinya dapat menjadi panduan pemberian obat untuk mencegah atau mengurangi terjadinya trombosis.
Keikutsertaan Bapak/Ibu dalam penelitian ini adalah sukarela dan tidak dipungut biaya apapun. Bila ada keterangan yang saya berikan masih belum jelas atau masih ada hal-hal yang hendak ditanyakan, maka Bapak/ Ibu dapat menghubungi saya :
Nama : Dr. Zainal Abdi
Alamat : Jl.Lembaga Pemasyarakatan, Tj.Gusta
Lampiran 2 FORMULIR PERSETUJUAN SETELAH PENJELASAN
(Informed Consent)
Nama Instansi : Divisi hematologi-Onkologi Medik, Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Sumatera Utara
Surat Persetujuan Ikut Penelitian
Saya yang bertandatangan dibawah ini :
Nama : ...
Umur : ...
Jenis Kelamin : Laki-laki / Perempuan
Pekerjaan : ...
Alamat : ...
Setelah mendapat penjelasan secukupnya serta menyadari manfaat dan resiko dari penelitian tentang “ Perbandingan status koagulasi penderita stroke iskemik dengan non stroke “. Saya dengan sukarela menyatakan bersedia untuk diikutsertakan dalam penelitian diatas. Bila sewaktu waktu saya sebagai pihak yang diteliti merasa dirugikan oleh pihak peneliti maka saya berhak membatalkan persetujuan ini tanpa menuntut ganti rugi.
Medan,...2009
Lampiran 5 Uji Statistik
Npar Tests (stroke Iskemik)
Npar Tests (kontrol)
One-Sample Kolmogorov-Smirnov Test
21 60.48 11.869 .188 .116 -.188 .862 .447 21 153.43 63.500 .198 .198 -.171 .908 .382 21 26.10 4.898 .132 .132 -.121 .604 .859 21 1.014 .1931 .165 .104 -.165 .757 .615 21 25.43 5.600 .146 .146 -.126 .668 .764 21 25.25 7.960 .134 .088 -.134 .612 .848 21 152.86 23.694 .142 .078 -.142 .652 .789 21 86.19 10.713 .353 .218 -.353 1.619 .011 21 .9962 .14682 .129 .129 -.112 .592 .875 21 1.1486 .18826 .127 .127 -.075 .583 .886 21 .8848 .11285 .173 .173 -.115 .795 .553 21 314.71 125.560 .210 .210 -.118 .963 .311 21 385.33 864.011 .394 .394 -.370 1.808 .003 Umur (tahun) KGD Ureum Kreatinin SGOT SGPT TD S TD D Rasio PT INR Rasio aPTT Fibrinogen D-Dimer N Mean Std. Deviation Normal Parametersa,b
Absolute Positive Negative Most Extreme Differences
Kolmogorov-Smirnov Z As ymp. Sig. (2-tailed)
Test distribution is Normal. a.
Calculated from data. b.
One-Sample Kolmogorov-Smirnov Test
21 59.14 10.795 .125 .100 -.125 .571 .901 21 130.76 21.482 .096 .096 -.081 .440 .990 21 26.48 6.630 .133 .131 -.133 .611 .849 21 .957 .2271 .136 .136 -.116 .625 .829 21 25.57 5.706 .115 .115 -.115 .528 .943 21 28.19 5.164 .151 .093 -.151 .690 .727 21 110.95 13.002 .181 .181 -.138 .830 .496 21 70.95 7.684 .216 .216 -.214 .990 .281 21 1.0186 .12515 .127 .127 -.089 .583 .886 21 .9686 .17934 .119 .113 -.119 .545 .928 21 .9596 .09834 .183 .094 -.183 .838 .484 21 293.90 111.308 .180 .180 -.143 .826 .503 21 99.00 .000c Umur (tahun) KGD Ureum Kreatinin SGOT SGPT TD S TD D Rasio PT INR Rasio aPTT Fibrinogen D-Dimer N Mean Std. Deviation Normal Parametersa,b
Absolute Positive Negative Most Extreme Differences
Kolmogorov-Smirnov Z As ymp. Sig. (2-tailed)
Test distribution is Normal. a.
Calculated from data. b.
The dis tribution has no variance for this variable. One-Sample Kolmogorov-Smirnov Test cannot be performed. c.
Mann Whitney Test
Independent Samples Test
15.262 .000 1.550 40 .129 22.667 14.628 -6.898 52.232 1.550 24.519 .134 22.667 14.628 -7.491 52.824 4.526 .040 -.212 40 .833 -.381 1.799 -4.017 3.255 -.212 36.820 .833 -.381 1.799 -4.026 3.264 1.054 .311 .878 40 .385 .0571 .0650 -.0743 .1886 .878 38.992 .385 .0571 .0650 -.0744 .1887 .024 .878 -.082 40 .935 -.143 1.745 -3.669 3.383 -.082 39.986 .935 -.143 1.745 -3.669 3.383 1.079 .305 -1.419 40 .164 -2.938 2.071 -7.123 1.247 -1.419 34.299 .165 -2.938 2.071 -7.145 1.268 6.030 .019 7.105 40 .000 41.905 5.898 29.985 53.825 7.105 31.043 .000 41.905 5.898 29.877 53.933 1.706 .199 5.297 40 .000 15.238 2.877 9.424 21.053 5.297 36.273 .000 15.238 2.877 9.405 21.071 Equal variances as sumed Equal variances not ass umed Equal variances as sumed Equal variances not ass umed Equal variances as sumed Equal variances not ass umed Equal variances as sumed Equal variances not ass umed Equal variances as sumed Equal variances not ass umed Equal variances as sumed Equal variances not ass umed Equal variances as sumed Equal variances not ass umed KGD Ureum Kreatinin SGOT SGPT TD S TD D F Sig. Levene's Test for Equality of Variances
t df Sig. (2-tailed) Mean Difference
Std. Error
Difference Lower Upper 95% Confidence
Interval of the Difference t-test for Equality of Means
Ranks 21 29.14 612.00 21 13.86 291.00 42 Kelompok pengamatan Pasien Kontrol Total TD D
N Mean Rank Sum of Ranks
Test Statisticsa 60.000 291.000 -4.163 .000 Mann-Whitney U Wilcoxon W Z
As ymp. Sig. (2-tailed)
TD D
Grouping Variable: Kelompok pengamatan a. Ranks 21 28.00 588.00 21 15.00 315.00 42 Kelompok pengamatan Pasien Kontrol Total D-Dimer
Test Statisticsa 84.000 315.000 -4.206 .000 Mann-Whitney U Wilcoxon W Z
As ymp. Sig. (2-tailed)
D-Dimer
Grouping Variable: Kelompok pengamatan a. Group Statistics 21 .9962 .14682 .03204 21 1.0186 .12515 .02731 21 1.1486 .18826 .04108 21 .9686 .17934 .03914 21 .8848 .11285 .02463 21 .9596 .09834 .02146 21 2.14 .359 .078 21 2.14 .359 .078 21 385.33 864.011 188.543 21 99.00 .000 .000 Kelompok pengamatan Pasien Kontrol Pasien Kontrol Pasien Kontrol Pasien Kontrol Pasien Kontrol Rasio PT INR Rasio aPTT Fibrinogen D-Dimer N Mean Std. Deviation Std. Error Mean
Independent Samples Test
.162 .690 -.532 40 .598 -.02238 .04210 -.10746 .06270 -.532 39.022 .598 -.02238 .04210 -.10753 .06277 .014 .907 3.172 40 .003 .18000 .05674 .06533 .29467 3.172 39.906 .003 .18000 .05674 .06532 .29468 .196 .660 -2.292 40 .027 -.07486 .03267 -.14088 -.00884 -2.292 39.266 .027 -.07486 .03267 -.14092 -.00880 .000 1.000 .000 40 1.000 .000 .111 -.224 .224 .000 40.000 1.000 .000 .111 -.224 .224 7.658 .009 1.519 40 .137 286.333 188.543 -94.725 667.392 1.519 20.000 .144 286.333 188.543 -106.960 679.626 Equal variances as sumed Equal variances not ass umed Equal variances as sumed Equal variances not ass umed Equal variances as sumed Equal variances not ass umed Equal variances as sumed Equal variances not ass umed Equal variances as sumed Equal variances not ass umed Rasio PT INR Rasio aPTT Fibrinogen D-Dimer F Sig. Levene's Test for Equality of Variances
t df Sig. (2-tailed) Mean Difference
Std. Error
Difference Lower Upper 95% Confidence
Interval of the Difference t-test for Equality of Means
Jenis Kelamin * Kelompok pengamatan Crosstab 14 13 27 13.5 13.5 27.0 51.9% 48.1% 100.0% 66.7% 61.9% 64.3% 33.3% 31.0% 64.3% 7 8 15 7.5 7.5 15.0 46.7% 53.3% 100.0% 33.3% 38.1% 35.7% 16.7% 19.0% 35.7% 21 21 42 21.0 21.0 42.0 50.0% 50.0% 100.0% 100.0% 100.0% 100.0% 50.0% 50.0% 100.0% Count
Ex pec ted Count % within Jenis kelamin % within K elompok pengamatan % of Total Count
Ex pec ted Count % within Jenis kelamin % within K elompok pengamatan % of Total Count
Ex pec ted Count % within Jenis kelamin % within K elompok pengamatan % of Total Laki-laki Perempuan Jenis k elamin Total Pasien Kontrol Kelompok pengamatan Total Chi-Square Tests .104b 1 .747 .000 1 1.000 .104 1 .747 1.000 .500 .101 1 .750 42 Pearson Chi-Square Continuity Correctiona Likelihood Ratio Fis her's Exact Test Linear-by-Linear As sociation N of Valid Cases Value df As ymp. Sig. (2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided)
Computed only for a 2x2 table a.
0 cells (.0%) have expected count less than 5. The minimum expected count is 7. 50.
Ju mla h Hi perkoag ula si * Kelo mp ok p eng ama tan Cro ssta bul atio n 11 16 27 13.5 13.5 27.0 40.7% 59.3% 100.0% 52.4% 76.2% 64.3% 26.2% 38.1% 64.3% 8 2 10 5.0 5.0 10.0 80.0% 20.0% 100.0% 38.1% 9.5% 23.8% 19.0% 4.8% 23.8% 1 1 2 1.0 1.0 2.0 50.0% 50.0% 100.0% 4.8% 4.8% 4.8% 2.4% 2.4% 4.8% 1 2 3 1.5 1.5 3.0 33.3% 66.7% 100.0% 4.8% 9.5% 7.1% 2.4% 4.8% 7.1% 21 21 42 21.0 21.0 42.0 50.0% 50.0% 100.0% 100.0% 100.0% 100.0% 50.0% 50.0% 100.0% Count
Ex pec ted Count % within Jumlah Hiperk oagulasi % within K elom pok pengam atan % of Total Count
Ex pec ted Count % within Jumlah Hiperk oagulasi % within K elom pok pengam atan % of Total Count
Ex pec ted Count % within Jumlah Hiperk oagulasi % within K elom pok pengam atan % of Total Count
Ex pec ted Count % within Jumlah Hiperk oagulasi % within K elom pok pengam atan % of Total Count
Ex pec ted Count % within Jumlah Hiperk oagulasi % within K elom pok pengam atan % of Total 0 1 2 >= 3 Jumlah Hiperk oagulasi Total Pasien Kontrol Kelom pok pengam atan Total Chi-Square Te sts 4.859a 3 .182 5.126 3 .163 .271 1 .603 42 Pearson Chi-S quare
Lik elihood Ratio Linear-by-Linear As soc iation N of V alid Cases Value df As ymp. Sig. (2-sided)
4 c ells (50.0%) have ex pec ted c ount les s than 5. The minimum expected count is 1.00.
Two-Sample Kolmogorov-Smirnov Test
Frequencies 21 21 42 Kelompok pengamatan Pasien Kontrol Total Jumlah Hiperkoagulasi N Test Statisticsa .238 .048 -.238 .772 .591 Absolute Positive Negative Most Extreme Differences Kolmogorov-Smirnov Z As ymp. Sig. (2-tailed)Jumlah Hiperkoa
gulasi
Grouping Variable: Kelompok pengamatan a.
Lampiran 6 DAFTAR RIWAYAT HIDUP
I.DATA PRIBADI
Nama : Dr. Zainal abdi
Tempat/Tanggal Lahir : Medan / 28 Agustus 1977
Status : Peserta PPDS-1 Ilmu Penyakit Dalam FK USU
Alamat : Jl. Lembaga Pemasyarakatan ,Tj.Gusta
Istri : Prima Irani Ibra S.Si, Apt
Anak : 1. Aurellia Zahrany
2. Athallia Zaliany
3. Aylani Puteri
4. Anasya Zahira
Telp/ HP : 081376045344
II. RIWAYAT PENDIDIKAN
1. SDN 20 Banda Aceh : Ijazah tahun 1989 2. SMPN 4 Banda Aceh : Ijazah tahun 1992
3. SMAN 11 Medan : Ijazah tahun 1995
4. Fakultas Kedokteran USU : Ijazah tahun 2001 5. PPDS-1 Ilmu Penyakit Dalam
III. RIWAYAT PEKERJAAN
1. Dokter PTT Depkes RI di Puskesmas Tanjung Batu, Kepulauan Riau 2002-2004
IV.KEANGGOTAAN PROFESI
1. Ikatan Dokter Indonesia (IDI)
2. Persatuan Ahli Penyakit Dalam Indonesia (PAPDI)
V. KARYA ILMIAH DI BAGIAN PENYAKIT DALAM
1. Zainal Abdi, Refli Hasan, Peripartum Dilated Kardiomiopati, Kongres
Nasional XIV Perhimpunan Penyakit Dalam Indonesia . Jakarta 11-14
November 2009
2.Zainal Abdi, Abdurrahim Rasyid Lubis, Salli Roseffi Nasution, Lupus
Nephritis with Manifestation of Nephrotic Syndrome in SLE Patient,
Pertemuan Tahunan Perhimpunan Nefrologi Indonesia (PERNEFRI)
Semarang 22-24 Oktober 2010.
VI.PARTISIPASI DALAM KEGIATAN ILMIAH
1.Peserta Gastroentero-Hepatologi Update IV 2006,Convention Hall Hotel
Danau Toba Medan, 08-09 September 2006.
2.Peserta Simposium The Scientific Evidence to Date : Reduction of
Events in Cardiovascular Disease ,Hotel Emeral Garden 9 Desember
2006.
Smart Solution for Asian?, Hotel Tiara Medan 14 April 2007.
4.Peserta simposium Trombosis-Hemostasis regional pertama, Tema :
Meningkatkan Peran Trombosis-Hemostasis Dalam Multi Disiplin Ilmu
Kedokteran, Hotel Danau Toba Medan 1-2 Mei 2007.
5.Peserta Workshop ECG in Daily Practice, Hotel Tiara Medan 14 April
2007.
6.Peserta Simposium DHF Course II, Ruang Prof.Ildrem Medan
24 Februari 2007.
7.Panitia Pelatihan Penatalaksanaan diabetes Melitus Bagi edukator
Diabetes, Uplatda Telkom Medan 12-15 Desember 2007.
8. Peserta simposium Astasantin, The Only Strongest and Safest
antioxidant Without Any Pro-oxidant,Hotel Emeral Garden 20 Juni
2007.
9. Panitia Pertemuan ilmiah Tahunan VIII 2007 Departemen ilmu Penyakit
Dalam FK USU. Medan, 8-10 maret 2007.
10. Peserta Simposium era Baru Pengunaan Probiotic. Medan, 28 April
2007.
11. Peserta Simposium Diabetes, The Vitamin & Mineral Antioxidans
Connection. Medan, 26 Mei 2007.
12.Peserta The 4th Juni 2007.
new trend in cardiovascular management. Medan, 15-16
14. Peserta PAPDI Road Show 2008 Eli Lilly Training For Excellence.
Medan, 26 Januari 2008.
15. Peserta Simposium On Hypertension Medan 19 januari 2008.
16.Peserta Simposium OnTarget : A land Mark Trial in Cardio & Vascular
Protection. Grand angkasa Hotel 5 Juli 2008.
17. Peserta dan Panitia Pertemuan Ilmiah Tahunan IX 2008 Departemen
Penyakit Dalam Fakultas Kedokteran Universitas Sumatera Utara New
Era In Therapeutic Options. Medan, 17-19 April 2008.
18.Peserta Fucoidan, Nature’s way for faster peptic ulcer healing. Medan,14
Juni 2008.
19.Peserta Symposium of Venous Thromboembolism. Medan, 26 Juli 2008.
20.Peserta Festschrift Prof. Dr. Harun Rasyid Lubis, SpPD-KGH. Medan
10 November 2008.
21. Peserta Road Show Nutrisi Klinik PB PAPDI, Nutrisi Klinik : dari Ilmu
Dasar Hingga Aplikasi, Medan 21-22 Februari 2009.
22.Peserta Simposium Early Insulin Inisiation, how, when and what insulin
according to daily practice need, Grand Swiss-Bel hotel 21 November
2009.
23.Peserta dan presentasi pada Kongres Perhimpunan Penyakit Dalam
Indonesia (KOPAPDI XIV)Hotel kempinski, Hotel Grand-Hyatt , Hotel
Sahid Jaya Jakarta 11-14 November 2009.
24.Peserta simposium Enercore :Finding the Missing Link Energy
Metabolism. Hotel JW Marriot 17 maret 2009.
26.Peserta Simposium 11th Annual Scientific Meeting Internal Medicine
Department of Internal Medicine , Medan 1-3 April 2010.
27.Presentasi pada PERNEFRI Semarang 22-24 Oktober 2010.
28. Peserta Simposium Reumatology Update 2010 medan Grand Aston
Hotel 1 Agustus 2010.
29.Peserta workshop Injeksi kortikosteroid Intra Lesion dan Visco
Suplement . RSU.Prof Boloni Medan 30 Juli 2010.
30.Peserta Simposium Annual Meeting of Indonesian society of
Nephrology (InaSN) 2010 Semarang 22-24 Oktober 2010.
31.Peserta Simposium Hiperglicemia of patients with Diabetes Mellitus in
clinical practice.PAPDI Sumut. Hotel Grand Aston Medan 28 november
2010.
32.Peserta Pelatihan Program pengembangan Pendidikan Keprofesian
Berkelanjutan Ultrasonografi tahap I PUSKI. Medan 21-24 Maret 2011.
33.Peserta Simposium Pertemuan Ilmiah Tahunan X , Medan 28-30 April
2011.
34. Peserta Simposium Gastro Update IX, Medan 4-5 November 2011.
35.Peserta Simposium Infection Update VI. Medan 5-7 september 2012.
36.Peserta Simposium PIT XII dan Gastro Update XII , Medan 12-14