case repor

Clopidogrel, a selective thienopyridine, is used for secondary prevention of major adverse cardiovascular events. Some studies have reported inflammatory arthritis as a rare adverse effect of Clopidogrel. A 47-year-old male underwent percutaneous coronary intervention and was subsequently prescribed a 600 mg loading dose of Clopidogrel, followed by a daily dose of 75 mg. After six days of taking Clopidogrel, the patient presented to the emergency department with right knee pain. The knee joint exhibited swelling, warmth, and tenderness, although there was no redness or crusting. After two and six days of hospitalization, despite receiving antibiotics and Indomethacin, he developed arthritis of the metacarpophalangeal and metatarsophalangeal joints, respectively. According to the laboratory investigation, cultures, synovial fluid analysis, and imaging, infectious, rheumatologic, and crystallopathy diseases were ruled out for the patient. Clopidogrel was discontinued, and the patient was switched to ticagrelor 90 mg twice daily. All symptoms and signs of joint inflammation had improved within five days of stopping the Clopidogrel. After one week and one and six months of follow-up, there has been no recurrence of symptoms.

Every 30 seconds, one lower limb amputation due to diabetes is performed in the world. This study was conducted on a 64-year-old woman with a diabetic foot on her left leg [Sci Rew1] . The patient had pain with a visual analog scale (VAS) score of 80 mm on 100 mm. This study aimed to evaluate the effect of a product derived from leeches in the treatment of DFUs. Wound grade 1 according to Wagner’s classification system was covered with leech cream. A decoction of Hirudo orientalis was prepared by lyophilizing leeches at -80°C, the proteins containing biologically active substances (BAS) were extracted with normal saline, and this BSA was formulated in the form of cream. In vitro control of this pharmaceutical product was estimated according to the activity of these BSA. The leech cream was applied twice a day from the knee to the tail of the left toe for a month. The patient used no antibiotics and only received hygiene. After treatment, the patient was followed up for two months. Pain decreased significantly in terms of VAS: 40 mm after two days. At the end of the 3rd day, the pain completely disappeared. The granulation tissue was apparent on the toeschr('39') ulcers after a week. The diameter of the wound was reduced by ~50% in three weeks. After four weeks, the ulcers were completely healed. After two months follow up there was no sign of wound recurrence. Topical leech cream enhanced the wound healing process and, therefore, may have curative effects on DFUs.