dyslipidemia in ms

7/26/2019 Dyslipidemia in MS

1/54

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


2/54

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


3/54

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


4/54

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 + +

+


5/54

(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


6/54

(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


7/54

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*#


8/54

!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


9/54

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


10/54

(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/


11/54

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


12/54

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


13/54

Discussion

1


14/54

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


15/54

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.


16/54

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


17/54

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 //=


18/54

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


19/54

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


27/54


28/54

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 '/


29/54


30/54


31/54


32/54

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


33/54



34/54

Strasinger SK oreno M,

Orinal'sis and?od' %luids, 4t"

ed, //=


35/54



ed, //=


36/54

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.


37/54


38/54

Multiple Sclerosis: dentiIcation And linical H$aluation Cf

;o$el S% ?iomar6ers, an Ctter$ald Ht Al, S(eden. ournal Cf


39/54


40/54


41/54



42/54


43/54


44/54



ed, //=


45/54


46/54


47/54



48/54



49/54

Strasin er SK & #oreno M Orinal sis and ?od %luids


50/54


51/54



52/54

=ype 0 cell+mediated disease7syndrome> autoanti$en and conseBuence8


53/54


54/54

dyslipidemia in ms

Documents