Coronavirus disease 2019 (COVID-19) is a global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Coagulopathy is frequently found in severe cases of COVID-19 and is usually manifested as a prothrombotic state. Hyperinflammation, endotheliitis, and immobilization during illness are hypothesized to play a role. Acute limb ischemia (ALI) is one of the presentations of arterial thrombosis in COVID-19. We present two cases of middle-aged men with COVID-19 infection, who developed ALI. The first patient developed ALI after 16 days from the initial COVID-19 diagnosis, and the second patient was admitted to the emergency ward due to sudden discoloration of his right lower limb, and COVID-19 was diagnosed during the evaluation.

Type 2 diabetes mellitus is a major risk factor for all forms of cardiovascular diseases, including peripheral arterial disease (PAD). Chronic limb-threatening ischemia (CLTI) is determined by the presence of ischemic rest pain, and may or may not be accompanied by tissue loss (such as ulcers and gangrene) or infection. Treatments for CLTI consist of wound treatment, infection control, and ischemia control by arterial revascularization, which can be performed by either open surgical procedure (bypass) or an endovascular approach. We present two cases of chronic limb-threatening ischemia, one with an above-knee lesion and the other with a below-knee lesion. In addition to good wound treatment and glucose control as the risk factor management, we performed endovascular therapy in both patients. Both patients showed good wound improvement after the procedure.

Evans syndrome is a combination of autoimmune hemolytic anemia and idiopathic thrombocytopenic purpura. Evans syndrome is a rare disease encountered in medical practice. Evans syndrome can also co-occur with other autoimmune diseases, such as Hashimoto's thyroiditis, although rare. Hashimoto's thyroiditis is a condition that causes hypothyroidism, where the thyroid gland cells are destroyed so that the thyroid hormone produced cannot meet the body's needs. This case report describes a pregnant female patient who has several autoimmune conditions, namely Evans Syndrome and Hashimoto's Thyroiditis. The patient came to the hospital with bruises on the abdomen and waist and felt weak, tired, and lethargic. The previous examination showed that this patient had positive anti-platelet and anti-TPO test results, enlarged liver and spleen on ultrasound examination, and thyroid hormone examination, which showed hypothyroidism. A physical examination of the patient also showed minimal enlargement of the thyroid gland and bruising on the patient's body. The results of routine blood tests showed a decrease in hemoglobin, hematocrit, erythrocyte, and platelet counts. Morphological examination of the peripheral blood revealed the appearance of macroovalocytes and burr cells. During treatment in the ward, the patient was given therapies such as methylprednisolone, levothyroxine, and blood transfusions. During 9 days of treatment in the ward, the patient's clinical condition improved, and there was an increase in hemoglobin, hematocrit, erythrocyte, and platelet counts. The patient was discharged in good condition.

Introduction: Contrast-induced acute kidney injury (CI-AKI) is a common and potentially serious complication of percutaneous coronary intervention (PCI) procedures, as it induces acute kidney injury (AKI), especially in previously diagnosed chronic kidney disease (CKD) patients, particularly in those who also have diabetes. Adequate hydration and using a minimal volume of contrast media are the recommended measures to decrease CI-AKI in CKD patients. A combination of sodium bicarbonate and N-acetylcysteine (NAC) may be a superior strategy for preventing CI-AKI. This study is aimed to evaluate the safety of PCI in moderate to severe CKD patients.Method: This was a prospective, single-center study, from 2019 to 2021. We included all chronic kidney disease who undergo PCI procedures. The kidney level was measured on admission and 24 hours after the PCI procedure. The patients received 75 meq/500 mL of sodium bicarbonate one to six hours before procedures, oral acetylcysteine 600 mg bid for three days, and rehydration with 1000 ml of normal saline infusion for eight hours in patients without congestive heart failure. SPSS Version 23.0 (IBM SPSS Statistics for Windows, Version 23.0., IBM Corp., Armonk, NY) was used to input and process the data.Results: This study included 118 subjects, with baseline characteristics of age 58.77 ± 9.08 years, 80.5% male, 47.5% diabetic, 50% hypertension, and 59.5% congestive heart failure. From the coronary angiogram, we found most of our subjects (57.6%) had three-vessel disease, 28.8% had two-vessel disease, and 15.6% had one-vessel disease. About 67.8% of subjects used <50 ml of low molecular contrast. The baseline creatinine level was 2.46 ± 1.04 mg/dL and the estimated glomerular filtration rate (eGFR) was 30 ± 12.65 mL/min. There were 19 (16.1%) patients with stage 3A CKD, 45 (38.1%) stage 3B, 41 (34.7%) stage 4, and 41 (34.7%) stage 5. The kidney function test after 24 hours of contrast admission showed a creatinine level of 2.37 ± 1.20 mg/dL (P<0.05) and the eGFR of 34.74 ± 16.10 mL/min. There was no significant difference in creatinine levels between stage 3A and stage 5 CKD. There was a significant reduction in creatinine in stage 3B CKD, from 1.917 ± 0.22 to 1.71 ± 0.37 mg/dL (P = 0.001); and stage 4 CKD, from 2.77 ± 0.55 to 2.72 ± 0.94 mg/dL (P = 0.013).Discussion: CKD is a risk factor for developing CI-AKI after PCI, which is a marker of poor long-term outcomes. The development of CI-AKI is a strong predictor of post-PCI bleeding, which aggravates hemodynamic instability. The combination of NAC and NaHCO 3 exerts a better antioxidative effect, which reduces the harmful short-term and long-term consequences of contrast media. Previous studies revealed the use of low-to-zero contrast media was safer in CKD patients who had undergone PCI. By applying these measures, our study showed a good outcome of PCI with no worsening renal function in CKD patients.Conclusion: With good prophylaxis measures, such as using minimal volume contrast media, adequate rehydration, and the combi...

Chest pain is a common clinical symptom that leads to a patient's admission to the emergency department, which may be caused by acute coronary syndrome (ACS). Electrocardiography (ECG) is a useful tool for diagnosis, risk stratification, and treatment response monitoring in clinical practice. The coronary angiography should be done in ACS, which may detect spontaneous atherosclerotic coronary artery dissection (SCAD) that should be followed by urgent revascularization. We present a case of a 55-year-old male with the augmented Vector Right (aVR) ST-segment elevation myocardial infarction due to spontaneous atherosclerotic coronary artery dissection. The patient had a good outcome after we performed early coronary angiography, followed by the percutaneous coronary intervention (PCI).