Dyslipidemia in MS
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Transcript of Dyslipidemia in MS
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Presenter: Gilang KusdinarModerator: Dr.Maimun Z.A., MKes, Sp.PK
1
Tropic infection-ase Discussion
!ig" #e$el Protein of S% &D'slipidemia
in patient (it" Multiple Sclerosis
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Summary of Database
Mrs. )* ++ 'ears old* !ospitalied: 1-1-/1+* M0 1/23++4
Chief complaint: Tetraparesis 5(ea6ness on + e7tremities8
T"e patient suddenl' felt (ea6ness on legs + da's 9efore
admission 5(orsening t"an 9efore8 and da's 9efore
admission, "er arms and legs "ad (ea6ness and num9.
S"e also felt nec6 pain 9ut didnt radiated.
;o complaint on "er urination and passed stool.
S"e felt decrease of appetite and 9od' (eig"t since 1 mont"
ago 5
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Past medical illness: Parese in "er left e7tremit' 5+ mont"s
ago8
"ospitalied 11 da's (it"outclinical impro$ed.
!T & Dia9etes denied!istor' of treatment: Drug 5from general practitioner8 +
mont"s
Acupuncture3
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Physical Examination
General Appearance: moderately ill GCS 456!:4" #$% &: '56 cm
>italSign
?P /*2/ Pulse: 11/ 7*m
00: +7*mnt
Ta7 32,2/
!ead on@uncti$a anemis 5-8 S6lera icteric 5-8;ec6 #'mp"adenopati 5-8, >P 0B/ cm!C,pain 5B8
T"ora7 or ctus in$isi9le, palpa9le in M# 5S8 >#!M E ictus 0!M E Sternal line DS1-Ssingle, reguler
Pulmo Simetric, Stem %remitus D F SAus6ultasi : 0onc"i 5-8, )"eeing 5-8
A9domen
Soe, ?S 5B8 ;, li$er span = cm, lien unpalpa9le
H7tremit )arm acral, anemis 5-8, edema 5-8 M + +
+
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(aboratory )esults
CC '*+'"+",'4 "-+'"+",'4 )eference
!9 1, 11, g*dl 11,+ J 14,1
Hritroc'te +,23 +,+/ 1/2*l +,/ J 4,4
!ct 3,/ 32,1/ L +/ J +
M> =1,/ =,// f# =/ - 3
M! ,+/ ,// pg - 31
0D) 14,3/ 1+,1 L 11.4 - 1+.4
)? +/ 1.==/ *# +3// - 1/3//
P#T 43+./// 4+./// *# 1+.///-++.///
HS0 2=
Di count5Ho*?a*St*Seg* #'*Mo8
2*-*-*+*3=* 1*-*-*=/*13*2 L /-+ * /-1* 3-4*41-2* 4-33* -4
4
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(aboratory )esults1-1 ",+'" "'+'" ""+'" 0eference
0?S =1 N // mg*dl
%?G 2 24 2/ J 1// mg*d#
?G " pp 112 N 13/ mg*dl
Oreum 1, 11,+/ 1,// 12,2J+=,4 mg*dl
reatinin /,4= /,44 /,4+ N1, mg*dl
Oric acid +, 3,1 ,+ J 4, mg*d#
SGCT 1= 13 12 12 / J +/ mO*dl
SGPT 1 1= 1= / J +1 mO*dl
Total"ol.
1=+ 34 N // mg*d#
TG 13/ 131 N 14/ mg*d#
!D#-"ol 34 32 N 32 mg*d#
#D#-"ol 11+ 1=1 N 1// mg*d#
Al9umin 3,/ 3, 3,4 J 4,4 g*d#
2
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Electrolyte )esults
1-1-1+ ",+'"+'4
""+'"+'4
0eference
;a 13= 13+ 133 132-1+4mmol* #
K 3,= 3, +,3 3,4-4,/mmol* #
l 1/ 114 11 =-1/2mmol*#
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!emostasis 0esult
/*1*1+ *1*1+
PPT 5sec8 11,1 13,+/
ontrol 5sec8 11.+ 1./
;0 /.2 1.14
APTT ./ 34.3/
ontrol 5sec8 +.3 4.3
onclusion PPT and APTT(it"in normal
limit
PPT and APTT(it"in normal
limit
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3*1*1+ 0eference
larit' &colour
lear -ello(is"
p! 2,/ +,4-=,/
SG 1,/4 1,//4-1,/3/
Glucose ;egati$e -5negati$e8
Protein ;egati$e -5negati$e8
Keton Trace -5negati$e8
?iliru9in ;egati$e -5negati$e8
Oro9ilinogen
;egati$e -5negati$e
8
.rinalysis
Microscopic
)ef/
+/7Hr't"roc't
eHumorp"icD'smorp"ic
,
--
Q 3 !P%
#eucoc'te 1+2,= Q 4 !P%
r'stal -3 3
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(01.2) CE)E)2SP03A(A3A(S0S3*1*1+ 3*1*1+
Macroscopic
olour lot Appearance
lear;egati$elear
lear;egati$elear
Microscopic Hr'troc'te
count #eucoc'te count PM; M;
3// *R#
1/ *R#/ L1//L
+// *R#
1/ *R#/ L1// L
"emistr' Protein Total Glucose #D!
1/1,2 g*d#/ mg*d#3 O*#
1/=2,/ g*d#2= mg*d#+4 O*#
Special Test
;onne Pand
Positi$ePositi$e
Positi$ePositi$e
1/
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Cerical )0 7"4+'"+",'48:
ntramedullar multiple lesion at le$el$erte9rae cer$ical 1-, 3-+ and 4-2,susp. multiple sclerosis
!;P9ulging t'pe at le$el > 3-+ and +-4
Discus and corpus degeneration of -T1 Spond'losiscer$icalis and straig"t cer$icalis
Chest 9+)ay 7'+'"+",'48:
nIltrate and ca$it' in lo9us superior 5D8 onclusion: susp. spesiIc process 5T?
pulmonal8 DD pneumonia
E;G 7'+'"+",'48: S'nus r't"m, !0 =7*m
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Data 0nterpretation
#a9orator' results s"o(ed leu6oc'tosis,t"rom9oc'tosis, ele$ated total c"olesterol,lo(er !D#-c"olesterol, ele$ated #D#-
c"olesterol, ele$ated total protein and positi$enonne-pand' in #S anal'sis, 6etonuria,nitrituria and leu6oc'turia.
%rom "istor' ta6ing, p"'sical e7amination,
la9orator' results and ot"er e7aminationsindicated Multiple Sclerosis DD T? cer$icalis(it" S0S susp sepsis, and d'slipidemia.
Suggestion: Protein electrop"oresis of
S%,urine culture, %A?, sputum culture and 1
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Discussion
1
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ultiple Sclerosis
Multiple sclerosis 5MS8 is aneuroinammator' andneurodegenerati$e disease t"at results in
damage to m'elin s"eat"s and a7ons int"e central ner$ous s'stem and ("ic"preferentiall' aects 'oung adults.
T"is disease is c"aracteried (it"multiple neurological disorderss'mptoms including $ision, sensor', 9od'(ea6ness, diculties in (al6ing and
a9dominal and 9ladder disorders due toSerum lipid proIles are associated (it" disa9ilit' and M0 outcomes inmultiple sclerosis
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MS can 9e clinicall' di$ided into t"reedierent ma@or forms: relapsingremitting 500MS8, secondar' progressi$e5SPMS8 and primar' progressi$e 5PPMS8,respecti$el'.
n addition, t"e clinicall' isolated
s'ndrome 5S8 "as 9een descri9ed in("ic" a single episode of t"e s'mptomsof 00MS patients ma' 9e a Irstindication of MS.
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urrent diagnosis relies on clinicale7amination supported 9' la9orator'in$estigations including Magnetic 0esonance
maging 5M08 to $isualise lesions, and S%9ioc"emistr' measurements t"at includeassessment of t"e oligoclonal 9and5s8 of gGand 9arrier inde7.
S% protein electrop"oresis is for t"e detectionof oligoclonal 9ands representinginammation (it"in t"e ;S.
T"e 9ands are located in t"e gamma region of
t"e protein electrop"oresis, indicatingMultiple Sclerosis: dentiIcation And linical H$aluation Cf
;o$el S% ?iomar6ers, an Ctter$ald Ht Al, S(eden. ournal Cf
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T"e S%*serum al9umin inde7 is calculatedafter determining t"e concentration of S%al9umin in mg*d# and t"e serum concentration
in g*d#. T"e formula used is as follo(s:
An inde7 $alue less t"an represents an intact9lood 9rain 9arrier. T"e inde7 increases relati$eto t"e amount of damage to t"e 9arrier.
Strasinger SK & #oreno M, Orinal'sis and ?od' %luids,4t" ed //=
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1=
Susp. Multiple
sclerosis DD T?
T"eor' Patient
nammator',
dem'elinating andneurodegenerati$edisease aect 'oungadult.
Disorders of $ision,sensor', 9od'(ea6ness, diculties in(al6ing and a9dominaland 9ladder
d'sfunction.Protein 5S%8 Indings5ele$ated gG inde7 or or more oligoclonal
9ands8M0: U of + lesions in
%emale, ++ '.o
TetraparesisPatient cant (al6ing;um9ness in +e7tremities
;ec6 painT"rom9oc'tosisM0: ntramedullarmultiple lesion at le$el>. er$i$al
S%: M; 1//L, "ig"le$el of protein andpositi$e nonne-pand'.
Su$$estion:Protein
electrop"oresis of
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S0)S susp/ sepsis in this patient Sepsis and Septic shoc# associated ?ith 2DSbased on ACCP%SCC Consensus Conference 7.SA '@@"8
S'stemicnammator'
0esponse S'ndrome5S0S8
* V clinical signs 9elo(:Temp V 3=o or N 32o !eart rate V /7*mTac"'pneu 500 V/7*m 8 or
"'per$entilation 5PaC N 3 mm!g8 )? V 1,///*Rl or N +///*Rl or V 1/L
immature neutrop"il 59ands8
Sepsis 5S0S BSource of infection8
T(o or more S0S criteria (it" suspectedor present source of infection.
Se$ere Sepsis Sepsis (it" organ d'sfunction,"'potension or "'poperfusion 5not limitedto t"e lactic acidosis, oliguria, altered
mental status8, S?P N / or S?P drop U +/mm!g of normal.
Septic S"oc6 Se$ere sepsis (it" "'potension despiteadeWuate uid resuscitation and"'poperfusion.
Multiple Crgan H$idence of U organs falling
2
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T"ere is complete agreement t"at isoelectricfocusing 5H%8 on agarose gels follo(ed 9'
immuno9lotting s"ould 9e t"e Xgold standardYfor detecting t"e presence of oligoclonal 9ands.
Ct"er met"ods suc" as pol'acr'lamide gelcom9ined (it" H% and sil$er staining of
proteins mig"t "a$e pro$en useful in t"e past,9ut t"e' lac6 speciIcit' for gG and, "ence, arenot supported 9' consensus.
A direct comparison of t"e accurac' of t"e tec"niWues is gi$en in =able '/
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andidate 9iomar6ers t"at signiIcantincreases in t"e S% le$els: alp"a-1antic"'motr'psin 5A1A8, alp"a-1macroglo9ulin 5AMG8 and I9ulin 1.
Anot"er 9iomar6er t"at increases in t"eS%: protein contactin 1, fetuin A, $itamin
D 9inding protein and angiotensinogen5A;GT8.
mmunoassa'
Measurement
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Strasinger SK & #oreno M, Orinal'sis and ?od' %luids,4t" ed //=
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Strasinger SK oreno M,
Orinal'sis and?od' %luids, 4t"
ed, //=
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Strasinger SK oreno M,
Orinal'sis and?od' %luids, 4t"
ed, //=
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ES)
Pisets6' DS. #a9orator' testing in t"e r"eumatic diseases. n: Goldman #, Sc"afer A,eds. Goldman's Cecil Medicine. +t" ed. P"iladelp"ia, PA: Saunders Hlse$ier /11:c"ap 24.
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Multiple Sclerosis: dentiIcation And linical H$aluation Cf
;o$el S% ?iomar6ers, an Ctter$ald Ht Al, S(eden. ournal Cf
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Strasinger SK & #oreno M, Orinal'sis and ?od' %luids,4t" ed //=
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Strasinger SK oreno M,
Orinal'sis and?od' %luids, 4t"
ed, //=
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Strasinger SK & #oreno M, Orinal'sis and ?od' %luids,4t" ed //=
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Strasinger SK & #oreno M, Orinal'sis and ?od' %luids,4t" ed //=
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Strasin er SK & #oreno M Orinal sis and ?od %luids
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Strasinger SK & #oreno M, Orinal'sis and ?od' %luids,4t" ed //=
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=ype 0 cell+mediated disease7syndrome> autoanti$en and conseBuence8
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