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Background It is important and challenging to distinguish between acute myocardial infarction and Wellens syndrome due to its time to intervention. Difficulties in differentiating between subtypes could mean the patients are overtreated or receive undertreatment. Case report A 57-year-old man was referred to our emergency ward with acute onset of chest pain. Electrocardiograms changes were suggestive of type A Wellens syndrome. Nitroglycerin was administrated, the patient's chest pain disappeared, and we planned an early invasive strategy. He had a previous documented electrocardiogram before he went for catheterization and based on the second electrocardiogram changes were suggestive of an ST-elevation. As the result of the invasive strategy, it was found that there was single-vessel disease, critical occlusion in the middle of the left anterior descending artery coronary artery with collateral from the right coronary artery. After two days of observation in the Intensive Cardiovascular Care Unit, the patient improved and was transferred to Low Care Unit. Conclusions The case highlights Wellens syndrome in acute critical occlusion with collateral artery.

Background It is important and challenging to distinguish between acute myocardial infarction and Wellens syndrome due to its time to intervention. Difficulties in differentiating between subtypes could mean the patients are overtreated or receive undertreatment. Case report A 57-year-old man was referred to our emergency ward with acute onset of chest pain. Electrocardiograms changes were suggestive of type A Wellens syndrome. Nitroglycerin was administrated, the patient's chest pain disappeared, and we planned an early invasive strategy. He had a previous documented electrocardiogram before he went for catheterization and based on the second electrocardiogram changes were suggestive of an ST-elevation. As the result of the invasive strategy, it was found that there was single-vessel disease, critical occlusion in the middle of the left anterior descending artery coronary artery with collateral from the right coronary artery. After two days of observation in the Intensive Cardiovascular Care Unit, the patient improved and was transferred to Low Care Unit. Conclusions The case highlights Wellens syndrome in acute critical occlusion with collateral artery.

Background: It is important and challenging to distinguish between acute myocardial infarction and Wellens syndrome due to its time to intervention. Difficulties in differentiating between subtypes could mean the patients are overtreated or receive undertreatment. Case report: A 57-year-old man was referred to our emergency ward with acute onset of chest pain. Electrocardiographic (ECG) changes were suggestive of Wellens syndrome type A. Nitroglycerin was administrated, the patient's chest pain disappeared, and we planned an early invasive strategy. He had a previous documented ECG before he went for catheterization and based on the second ECG changes were suggestive of an ST elevation. As the result of the invasive strategy, it was found that there was single-vessel disease, near total occlusion in the middle of the left anterior descending artery (LAD) with collateral from the right coronary artery. After two days of observation in the Intensive Cardiovascular Care Unit (ICCU), the patient improved and was transferred to the Low Care Unit. Conclusions: The case highlights Wellens syndrome in acute total occlusion with collateral artery.

Background: Management of systemic lupus erythematosus (SLE) and lupus nephritis (LN) in pregnancy has been improving in recent decades. However, SLE can still lead to adverse pregnancy outcomes if not appropriately treated. Optimal dose of steroids, as one of the most commonly used for the treatment of SLE and LN in pregnancy is still a subject of debate. In this review, we determine the pregnancy outcomes in SLE and LN patients treated with low vs high doses of steroids. Methods: ProQuest, Pubmed, Science Direct, Scopus, and Web of Science were carefully searched for relevant studies published in English. A total of 2,596 studies were reviewed. We extracted the data from previous studies showing the use of steroids treatment in high-dose and low-dose related to pregnancy outcomes. We provide larger data about maternal (preterm rupture of membrane, fetal loss, pre-eclampsia, and flare up) and fetal outcomes (prematurity, small gestational age, low birth weight) receiving high vs low steroid in patients with SLE and LN in this systematic review and meta-analysis. Results: A total of 13 studies were included. Of these, one study discussed a group with LN and 12 other studies discussed SLE with related maternal and fetal outcomes. Maternal outcome in the group with low-dose steroid showed a lower risk of fetal loss (odds ratio (OR): 1.93; 95% confidence interval (CI) 1.01-3.70), but there were no differences in other maternal outcomes. The low-dose steroid group showed a better fetal outcome, with a lower risk of prematurity (OR: 3.06; 95% CI 1.98-4.71), small gestational age (OR: 2.63; 95% CI 1.15-6.00), and low birth weight (OR: 2.43; 95% CI 1.23-4.79). Conclusions: In pregnant patients with SLE or LN, high-dose steroids are associated with the high risk of fetal loss during pregnancy, preterm birth, small gestational age, and low birth weight.

Background: Several aspects of chronic kidney disease (CKD) such as the incidence rate and mortality rate are concerning. Oxidative stress contributes to progression and mortality in patients with CKD; however, a specific correlation between several markers of oxidative stress and the estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR) in the Indonesian population has not been sufficiently described yet. Methods: This study was an analytic observational study with a sample of 56 patients with CKD in Universitas Airlangga Hospital, Surabaya, Indonesia, from December 2019 – March 2020. The markers for oxidative stress investigated were urinary 8-hydroxy-2 deoxyguanosine (8-OHdG), serum symmetric dimethylarginine (SDMA) and asymmetric dimethylarginine (ADMA). The correlations between each variable of oxidative stress and CKD were analyzed using Pearson analysis. Results: There was a positive correlation between 8-OHdG and eGFR (p=0.00, r=0.51); however, there was a negative correlation between 8-OHdG and ACR (p=0.025, r=-0.30). SDMA and eGFR showed a negative correlation (p=0.00, r=-0.648), while SDMA and ACR showed a positive correlation (p=0.03, r=0.349). ADMA showed a negative correlation with eGFR (p=0.00, r=-0.476). There were significantly decreased 8-OHdG but increased ADMA and SDMA as the CKD stage progressed (p=0.001, p=0.00, and p = 0.00, respectively). Higher urine 8-OHdG was detected in patients without history of hemodialysis, whereas ADMA and SDMA showed higher value in patients with hemodialysis (p=0.00, p=0.00, and p=0.004, respectively), patients with history of diabetes mellitus (DM) had higher mean 8-OHdG (p 0.000) yet lower serum ADMA and SDMA (p=0.004 and p=0.003, respectively). Conclusions: In patients with CKD in Indonesia, the markers for oxidative stress 8-OHdG, SDMA, and ADMA are correlated with eGFR and ACR levels. There were also significant difference in 8-OHdG, SDMA, and ADMA levels among CKD stages, between dialysis vs non dialysis, and DM vs non DM patients.