The Risk-Benefit Ratio of Leech Therapy: A Single-Center Retrospective Study

Background: Venous congestion in transplanted or replanted tissues remains a common and challenging complication of plastic and reconstructive surgery. The local application of medicinal leeches is effective in reducing postoperative venous congestion in skin flaps and restoring normal blood flow. However, leech therapy is associated with a number of risks, including infections; in order to digest blood, leeches have a symbiotic relationship with Aeromonas species in their gut. Aeromonas infections are associated with a dramatic decrease in flap salvage rates. This is why prophylactic antibiotic treatment and external decontamination of the leeches are widely recommended. Methods: We performed a single retrospective study of patients having undergone leech therapy between January 1st, 2010, and December 31st, 2018, at Amiens-Picardie University Hospital, France. Each patient’s medical history, clinical data, laboratory results, prophylactic antibiotic use, and complications were recorded.Results: A total of 37 patients (mean age: 47) had undergone leech therapy after reconstructive surgery. Antimicrobial prophylaxis was documented in 32 (84.6%) patients. However, there are no guidelines on the choice of prophylactic antibiotic treatment. Twenty-four of the 37 (64.8 %) patients had anemia (mean hemoglobin level: 8.5 (6-11.1) g/dL), and 13 of the 24 (54%) required a transfusion. Thirteen of the 37 patients (35.1%) had a post-operative infection mainly due to Aeromonas spp. (76.9%). Leech therapy was effective in 23 of the 37 patients (62%) overall and in 2 of the 10 patients (20%) with an Aeromonas infection. The association between Aeromonas infection and flap salvage failure was highly significant (p = 0.005).Conclusions: The results of the study emphasized that clinical bacteriologists and surgeons should be aware that leeches are potential sources of infection.

Ayurveda View on Raktamokshan and its Mode of Action as per Modern Science

Ayurveda is old science which deals with many surgical and parasurgical procedures for the management of different pathological conditions. Amongst the many unique modalities Raktamokshan (bloodletting) is one of the important modality which provides health benefits in many diseases. Acharya Sushruta described importance of this procedure in conditions involving vitiation of Rakta and Dosha. Vitiation of Rakta is responsible for many health issues including skin problems and Raktamokshan helps greatly in this regard. Leech therapy, venesection and cupping therapy are subtype of Raktamokshan which helps in blood purification. The bloodletting therapies gaining attention of modern science due to their technical advancement. Raktamokshana mainly involves various techniques of blood liberation. Raktamokshan helps to treat conditions like eczema, swellings, inflammations and poisoning, etc.

Management of Non-Healing Ulcer by the Use of Crushed Raw Papaya along with Leeching: A Case Study

The incidence of non-healing ulcer is 1-2 percent in developed countries. In Indian community its prevalence reported in year 2004 was 4.8 per 1000 populations. It may increase many folds in future because of increase in number of old persons, diabetes mellitus and vascular diseases A male patient aged 63yrs. came to surgery OPD Majeedia Unani Hospital, Jamia Hamdard, New Delhi, in October 2019, with the complain of ulcer on antero-medial aspect of right foot. The ulcer was painful and movement was limited on affected side. After required investigations and local examination of wound, treatment was started by local application of meshed papaya and combination of oral Unani drugs formulations along with leech therapy as described in texts of Unani System of Medicine. It was observed that Unani treatment of non-healing ulcer with papaya and leech therapy is an option to avoid amputation and its complications. The ulcer completely healed without any locomotor disturbances. Recovery was very fast and the condition of leg totally resolved without any complications and side effects. Keywords: Non-healing ulcer, Unani medicine, leech therapy, Qurooh-e-Aseeratul Indemal.

Chronic subdural hematoma as a complication of medicinal leech therapy

Applications related to the use of leeches in medical therapies date back for centuries. We present here a case of self-administered leech application for chronic low back pain who subsequently developed complication of chronic subdural hematoma. We are not aware of similar report in the literature. This was a 34-year-old man who was admitted to our Emergency Department with headache, right side numbness, and intermittent difficulty in speaking. During the neurological examination, it was observed that the patient had difficulty in speaking and pronouncing words intermittently while taking his medical history. Motor examination was normal. The patient did not report any recent trauma. There was no known history of systemic or hereditary disease, drug or substance abuse. Cranial CT and MR imaging showed a left frontoparietal chronic subdural hematoma. Further history was obtained that leech was applied to the patient for low back pain in the last 45 days, two times at 15 days intervals. The patient’s drowsiness and speech difficulties improved after the surgical operation. On one month follow-up, neurological examinations were normal. Our patient shows that leech therapy can be complicated by subdural hematoma.

Rethinking antimicrobial prophylaxis in patients receiving medicinal leech therapy

Disclaimer In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To describe challenges in the management of prophylaxis against infections for patients receiving medicinal leech therapy given changes in antimicrobial resistance patterns in the normal flora of leeches. Summary This article presents a patient case of reconstructive surgery complicated by infection associated with the use of medicinal leeches, as well as a discussion of prophylaxis in medicinal leech therapy, focusing on considerations for choosing a prophylactic agent. Conclusion Our case report highlights resistance changes in Aeromonas isolates associated with medicinal leeches and the potential for complications if isolates resistant to chosen prophylactic agents arise. When administering antimicrobial prophylaxis in patients receiving medicinal leech therapy, clinicians should be familiar with the susceptibilities of Aeromonas species but also conscious of evolving antimicrobial resistance given the extent of the consequences of infected surgical grafts.

A case report on acne vulgaris

There are various skin diseases affecting human beings but acne is the most commonly reported one. It is because face is the reflection of personality and acne affects mostly the skin of face. In Ayurveda face is one of the 56 Upangas mentioned and described at the top. Acharya Sushruta mentioned youvan pidika for the first time which can be correlated with acne. Youvan pidika means disease of young age. The main dosha vitiated in this disease is Rakta. So, Raktamokshan is done for sodhana of Rakta dosha. In the following case described, Raktamokshana is done using Jalauka Avacharana (Leech Therapy) was done to treat acne. Remarkable result was observed in the particular case.

Leech therapy (Hirudo medicinalis) attenuates testicular damages induced by testicular ischemia/reperfusion in an animal model

Background Testicular torsion/detorsion triggers tissue ischemia/reperfusion, leading to reactive oxygen species overgeneration and apoptosis. The saliva of leeches is full of anti-inflammatory, anticoagulants, antioxidants, and antimicrobial agents. Therefore, this study aimed to assess the protective mechanism of leech therapy on testicular ischemia/reperfusion damage. Methods 18 adult male rats were randomly divided into three groups: 1-Sham-operated group (SO). 2-Torsion/detorsion (T.D) group: two hours of testicular torsion with two hours of testicular detorsion was performed. 3-Torsion/detorsion + Leech therapy (TDL) group. Sperm parameters (motility, vitality, morphology, and concentration), oxidative stress biomarkers (MDA, CAT, GPx, and TAC), histopathological factors (Mean seminiferous tubular diameter, Germinal epithelial cell thickness, Testicular capsule thickness, Johnson’s score, and Cosentino’s score), and immunohistochemical markers for apoptosis detection (Bax, Bcl-2, and Caspase-3) were measured. Results There was a significant difference for all sperm parameters in the T. D group compared to the sham group. Leech therapy significantly increased progressive motility and normal morphology and reduced non-progressive motility. In the TDL group, MDA concentration significantly reduced, and levels of GPx, TAC, and CAT remarkably increased. All evaluated histopathological parameters in the TDL group significantly increased compared to the T. D group except for the testicular capsule thickness. T. D notably increased the expression of Bax and Caspase-3, while the treatment group slowed the rate of apoptosis compared to the control group. Bcl-2 expression in the T. D group was significantly lower than that in the sham group. Leech therapy increased the Bcl-2 expression. Conclusion Leech therapy attenuates damages to testicular tissue following torsion/detorsion due to its antioxidant, anti-inflammatory, and anti-apoptotic effects. Hence, it can be considered as an effective remedy for testicular ischemia/reperfusion. Graphical abstract