Introduction: Fibrinolytic therapy remains a viable reperfusion strategy in STEMI patients in locations with limited facilities. However, reperfusion injury following fibrinolysis has also led to myocardial injury. One potential intervention to prevent this injury is through remote ischemic conditioning (RIC). This study aims to evaluate the effects of RIC in reducing myocardial injury in STEMI patients undergoing fibrinolysis. Materials and methods: A systematic review is conducted from PubMed and CochraneLibrary. Inclusion criteria are RCTs enrolling STEMI patients on fibrinolysis therapy. Outcome measured are difference peak troponin I/ T and CKMB levels and incidence of ST resolution (STR). Data are pooled using random effects model as odds ratio and risk of biases assessed with RoB2 tool.Results: 4 studies with a total of 849 patients are included. Peak troponin I/ T levels are lower in the intervention in two studies. Peak CKMB level is also lower in intervention group in 2 studies while one study reported vice versa result. The results from these outcome measures however cannot be pooled due to different unit of measurements. Additionally, 2 studies demonstrate a higher incidence of STR in RIC intervention group with significant OR 1.92 (1.11 – 3.33, p = 0.02 I2 = 13%). There is no substantial risk of biases. Conclusion: RIC intervention resulted in a lower peak enzymatic troponin and CKMB level and also increases the incidence of STR in STEMI population on fibrinolysis. Further studies are required to evaluate the potential of RIC in reducing major clinical outcomes.

Abstract An 18-year-old female with Systemic Lupus Erythematosus (SLE) presented with bilateral thigh pain, fever, and diarrhea three days before admission. Diagnosed with SLE one month earlier, she reported prior symptoms, including joint pain, malar rash, hair loss, and hyperpigmented lesions. Initial investigations revealed elevated transaminase levels (AST 355, ALT 132), positive ANA, decreased complement levels (C3 68, C4 16.8), and raised creatine kinase (619). A muscle biopsy confirmed myositis. The patient was treated with immunosuppressant (a combination of steroids and hydroxychloroquine) and supportive therapy. By the eighth day of hospitalization, her symptoms, especially thigh pain, resolved. Electromyocardiography was done, and the results were normal, indicating therapeutic success. This case highlights the importance of prompt diagnosis and management of myositis as a rare SLE manifestation to achieve favorable outcomes.
Systemic Lupus Erythematosus (SLE) ; Myositis ; Muscle Biopsy ; Electromyocardiography