Hirudo Medicinalis Research Articles

Successful Microsurgical Replantation of Scalp Amputation Using Medicinal and Chemical Leech Therapy: A Case Report

Scalp amputation is a very rare occurrence worldwide. In particular, replantation failure may occur from venous congestion, which represents a major complication of replantation. Accordingly, this study reports on a scalp amputation case with successful replantation treatment using medicinal and chemical leech therapy. On November 11, 2017, a 47-year-old female patient experienced a complete amputation injury starting from the top of the nose involving the total scalp by rolling machine that packs laundry. Severe venous congestion was controlled by medicinal leech therapy performed six times a day and chemical leech therapy (subcutaneous low-molecular-weight heparin injection) three times a day for 10 days. Approximately 85% of the scalp was replanted, and hair growth was confirmed. The basic concept of replantation surgery, “replace tissue with like tissue,” makes replacement impossible with tissues other than the hair-bearing scalp. Accordingly, the authors present a case of successful replantation with both medicinal and chemical leech therapy.

Estimating population density of the medicinal leech Hirudo orientalis Utevsky and Trontelj, 2005 (Clitellata: Hirudinida) using Visible Implant Elastomer tags

ABSTRACT Medicinal leeches have lately come into the spotlight as useful and effective invertebrates in the treatment of some diseases and surgical procedures. Populations of the Iranian medicinal leech, Hirudo orientalis, are under considerable threat due to over-exploitation. To find a viable technique for estimating leech population size in their natural habitat, a tagging method using fluorescent dye was investigated. In the present study, to test the method’s efficiency, numbers of medicinal leeches were estimated in the artificial leech ponds of the University of Tehran, by the capture–mark–recapture method, using the Lincoln index. Leeches were caught from the ponds, marked using commercially available visible implant elastomer (VIE) tags, released and later recaptured. The technique proved successful, and low standard error values (7.07–11.85) in this study showed that the VIE tagging method could be applied as a useful tool for evaluating medicinal leech population size. This is the first use of this method to estimate medicinal leech population size.

Leech Therapy for Complex Facial Lacerations.

Facial trauma can pose challenging reconstructive obstacles in both maintaining tissue viability and restoring aesthetic appearance. Medicinal leech therapy can help to promote vascular decompression in the setting of venous congestion. A retrospective chart review was conducted to identify patients who underwent medicinal leech therapy following venous stasis secondary to repair of a complex facial laceration. Three patients were identified; 2 suffered auricular avulsion, while 1 suffered a lip avulsion. All patients suffered from venous congestion and underwent medicinal leech therapy for 48 to 72 hours with reduction of edema and stasis. Decompression was successfully achieved with no further sequelae on last follow-up. Medicinal leech therapy is an adequate treatment for venous congestion following traumatic soft-tissue repair of the face. The authors advocate for the utilization of medicinal leeches to combat venous congestion after repair, particularly when arterial inflow remains intact.

Multidrug resistant Aeromonas infection following medical leech therapy: A case report and development of a joint antimicrobial stewardship and infection prevention protocol

ObjectiveAeromonas sp. infections are a recognized complication of medical leech therapy (MLT). In patients requiring MLT, ciprofloxacin or trimethoprim–sulphamethoxazole are commonly used to prevent such nosocomial infections. After a patient at our institution developed a MLT-associated multi-drug resistant (MDR) Aeromonas infection, we developed and evaluated a joint antimicrobial stewardship and infection prevention protocol for MLT at our institution. MethodsWe describe a case of a surgical site infection with MDR Aeromonas following MLT that was resistant to typically prescribed prophylactic antimicrobials, and development of a new leech culture protocol to proactively monitor for antimicrobial resistance among our institution’s leech supply. We also report the rates of MLT-associated infections prior to and following implementation of this protocol and the antimicrobial susceptibility profiles detected in leech culture at our institution. ResultsBetween October 2014 and February 2018, 46 patients received MLT at our institution. Other than the case described in this report, no other instances of MLT-related infections were noted during this time period. Culture results from 22 leeches in six batches since February 2018 showed that all were susceptible to ciprofloxacin, TMP-SMX, and ceftriaxone. Since initiation of a leech culture protocol, no further cases of MLT-associated infections have been reported at our institution. ConclusionsIn light of increasing antimicrobial resistance and the potentially devastating consequences of MLT-associated infections, institutions offering MLT should be aware of these risks and ensure that protocols are in place to minimize infection risks for patients.

Closed Genome Sequence of Aeromonas veronii Strain Hm21, an Isolate from the Medicinal Leech Hirudo verbana.

Aeromonas veronii strain Hm21 was isolated from the medicinal leech Hirudo verbana and is used for genetic studies. We present here the 4.71-Mbp genome with a 56-kb plasmid and identify the mutations present in strains commonly used for genetic engineering.

The Hirudo Medicinalis Microbiome Is a Source of New Antimicrobial Peptides.

Antimicrobial peptides (AMPs) are considered a promising new class of anti-infectious agents. This study reports new antimicrobial peptides derived from the Hirudo medicinalis microbiome identified by a computational analysis method applied to the H. medicinalis metagenome. The identified AMPs possess a strong antimicrobial activity against Gram-positive and Gram-negative bacteria (MIC range: 5.3 to 22.4 μM), including Staphylococcus haemolyticus, an opportunistic coagulase–negative pathogen. The secondary structure analysis of peptides via CD spectroscopy showed that all the AMPs except pept_352 have mostly disordered structures that do not change under different conditions. For peptide pept_352, the α–helical content increases in the membrane environment. The examination of the mechanism of action of peptides suggests that peptide pept_352 exhibits a direct membranolytic activity. Furthermore, the cytotoxicity assay demonstrated that the nontoxic peptide pept_1545 is a promising candidate for drug development. Overall, the analysis method implemented in the study may serve as an effective tool for the identification of new AMPs.

The effect of hirudotherapy on cerebral circulatory homeostasis in patients with genital endometriosis

The results of the treatment of women (n = 94) suffering from genital endometriosis are presented. The first (control, n = 30) group of women received standard drug therapy; the second (main, n = 64) group of women additionally had hirudotherapy procedures using medical leeches. The course of treatment consisted of 10–12 procedures. The state of cerebral circulation was assessed according to the rheoencephalography data before and after the treatment, as well as after 1, 3, 6, and 9 months. As a result, in patients in the 2-nd (main) group receiving complex treatment, the state of cerebral circulation improved signifi cantly. Moreover, according to the statistical regression analysis, it was possible to predict its further decrease by two periods ahead, compared with the treatment results in patients in the 1-st (control) group.

Güney tıbbi sülüğü, Hirudo verbana Carena, 1820 yetiştiriciliğinde farklı ortamların koza ve yavru sayısına etkisi

Breeding medicinal leeches in controlled environments is extremely important in order to prevent their extinction. Moreover, due to medicinal leeches coming into contact with the patient's blood, breeding medicinal leeches in hygienic conditions is essential to prevent possible complications. In this study, breeding patterns of Hirudo verbana were studied in controlled conditions and the effects of various moist environments were examined. Peat, hydrogel and chopped sponge materials were compared in terms of number of cocoon and offspring in medicinal leech breeding. Peat and hydrogel environments didn’t show any statistically significant difference for number of cocoon and offspring breeding. Cocoon per leech was 3.13 ± 0.74 for peat and 2.80 ± 0.56 for hydrogel respectively. Offspring per cocoon was 11.81 ± 2.27 for peat and 12.52 ± 1.98 for hydrogel (P>0.05) respectively. In conclusion, hydrogel could be a new material for medicinal leech cocoon deposition environment especially for laboratory breeders.

Caught red handed: iDNA points to wild source for CITES-protected contraband leeches

In October of 2018, Canada Border Services Agency (CBSA) at Pearson International Airport in Toronto notified the Wildlife Enforcement Branch of Environment and Climate Change Canada that a passenger had arrived aboard a flight from Russia with a large quantity of live leeches. The leeches had been discovered in the passenger’s carry-on luggage. An enforcement officer with Environment and Climate Change Canada detained the leeches to identify the species in order to determine whether the import was lawful. We identified the leeches as Hirudo verbana and extracted DNA from the bloodmeals of a subsample of 240 leeches and used metabarcoding of 6 mitochondrial loci to determine the vertebrate host species on which the leeches had previously fed. Sixteen undomesticated vertebrate host species were identified from the bloodmeals of the imported leeches, indicating that these leeches were collected from wild habitats. Furthermore, the overlap of host species’ distributions point to a possible collecting source in the Volga delta, the Danube delta, or the coastal area region on the east side of the Sea of Azov. Our findings support the utility of invertebrate-derived DNA (iDNA) as a valuable tool in forensic evaluation of trafficked wildlife and provide new evidence regarding illegal exploitation of the European medicinal leech.

Leech extract: A candidate cardioprotective against hypertension-induced cardiac hypertrophy and fibrosis

The prevalence of cardiovascular diseases (CVDs) has been increasing worldwide. Despite significant improvements in therapeutics and on-going developments of novel targeted-treatment regimens, cardiac diseases lack effective preventive and curative therapies with minimal side effects. Therefore, there is an urgent need to identify and propagate alternative and complementary therapies against cardiovascular diseases. Some traditional Chinese medicines can contribute to the prevention and treatment of CVDs and other chronic diseases, with few side effects. Hirudo, a medicinal leech, has been acclaimed for improving blood circulation and overcoming blood stagnation; however, the precise molecular mechanisms of leech extract treatment against pathological cardiac remodeling remain elusive. In this study, we aimed to delineate the molecular mechanisms of medicinal leech extract in the treatment of cardiac hypertrophy and fibrosis, using both in vitro and in vivo assessments. We conducted in vitro and in vivo animal experiments, including cell-viability assays, fluorescence microscopy, immunoblotting, immunohistochemistry, and Masson's trichrome staining. Pre-treatment with leech extract conferred a survival benefit to spontaneously-hypertensive rats (SHRs) and significantly reduced angiotensin II (ANG II)-induced cardiac hypertrophy and fibrosis. ANG II-stimulated cardiac hypertrophy markers were attenuated by leech extract treatment, versus controls. Translational expression of stress-associated mitogen-activated protein kinases (MAPKs) was also repressed. In vivo, leech extract treatment significantly ameliorated the cardiac hypertrophy phenotype in SHRs and diminished interstitial fibrosis, accompanied with reduced fibrosis markers. Leech extract treatment under a hypertensive condition exerted significant cardio-protective benefits by reducing the expression of cardiac hypertrophy-related transcription factors, stress-associated MAPKs, and fibrosis mediators. Our findings imply that medicinal leach extract may be effective against hypertension-induced cardiac hypertrophy and fibrosis.

Hirudotherapy in Wound Healing.

Leeches are hermaphrodite, bloodsucking parasitic worms usually found in places with fresh water. Leech therapy existed 3000 years, and it is being used at a different scope. Several species of leeches have been used in medicine, and the most common species used is Hirudo medicinalis. Leeches suck the excess blood, reduce the swelling in the tissues, and promote healing by allowing fresh oxygenated blood to reach the area until normal circulation can be restored. Pain relief from leech therapy is rapid, effective, and long-lasting in many conditions. The aim of this study was to evaluate the efficacy and duration of healing utilizing sterile medicinal leeches, Hirudinaria manillensis, in the management of pain and wound healing. Leech was taken out from its sterile tube by using a pair of non-tooth sterile plastic forceps and gloved hands. Each leech was left in place for as long as it was feeding. Leeches were removed only after they became detached from the patient. The specimen jars containing the used leeches were sealed in either a biohazard bag or in a small yellow clinical waste bin liner securely fastened with a cable tie. The leech was killed by using 70% alcohol prior to disposal into a yellow hazard bin, which undergoes incineration. All 3 patients had improvements in their condition, especially in terms of reduction in the pain and improvement in their sense of balance. All the wounds healed well. Therefore, leech therapy is effective in reducing pain and increasing perfusion to allow the wounds to heal quickly. However, a more robust trial is needed to show significance as the sample size is small.

Letter to the Editor: A Comprehensive Review of Medicinal Leeches in Plastic and Reconstructive Surgery.

Letter to the Editor: A Comprehensive Review of Medicinal Leeches in Plastic and Reconstructive Surgery.

Time to Change Theory; Medical Leech from a Molecular Medicine Perspective Leech Salivary Proteins Playing a Potential Role in Medicine.

Followed by developing modern medicine, leeches did not have extensive use as before; however, in the late 19th century, they were still used in most countries all over the world. Thus far, leeches were utilized in treating various diseases like skin disorders, arthritis, and cancer. In Egypt, using leeches for treatment dates back to early 1500 BC. A medical leech’s salivary glands involve over 100 bioactive proteins and the salivary gland secretion contains bacteriostatic, analgesic, and anticoagulation influences; with resolving activity, it causes microcirculation disorders elimination, restoring the hurt vascular permeability of organs and tissues, removing hypoxia, decreasing blood pressure and detoxifying the organism by antioxidant paths. The current work reviews the innovative treatment with medical leech, especially proteins in leech saliva extraction (LSE) with high potential in medicine. The virtue of salivary gland secretions which are proteinaceous enzymes, leech acts on various diseases such as venous congestion in reconstructive and plastic surgery, osteoarthritis, cardiovascular diseases caused by blood coagulation disorders, pain management, priapism, macroglossia, cancer complications, wounds and many other. To confirm the potential therapeutic impacts of leech treatment, more studies are required in more extensive areas with more exact methodologies.

Pathogenetic mechanisms of hirudotherapy and its use in otorhinolaryngology

Data from studies on the pathogenetic mechanisms of saliva secretion of medical leeches, which is an important producer of unique biological active substances (BAS), is summarized. These substances have a wide range of therapeutic effects, providing a prodounced anti-inflammatory, bacteriostatic, bactericidal, fibrinolytic, neurotropic, regenerative, energetic, immunomodulatory, anti-sclerotic effects. They regulate homeostasis, the circulatory system, lymph flow, all types of metabolic processes in the body and have no analogues in nature. We have presented the results of more than 20 years of effective experience in the use of hirudotherapy in otorhinolaryngology patients for medical, rehabilitation, and health purposes. Promising is the further study and application of hirudotherapy as a type of naturopathy and homeopathy in the 21st century of advanced technologies, significantly changing the conditions of the internal and external environment of the inhabitants of our planet.

Pathogenetic mechanisms of hirudotherapy and its use in otorhinolaryngology

Data from studies on the pathogenetic mechanisms of saliva secretion of medical leeches, which is an important producer of unique biological active substances (BAS), is summarized. These substances have a wide range of therapeutic effects, providing a prodounced anti-inflammatory, bacteriostatic, bactericidal, fibrinolytic, neurotropic, regenerative, energetic, immunomodulatory, anti-sclerotic effects. They regulate homeostasis, the circulatory system, lymph flow, all types of metabolic processes in the body and have no analogues in nature. We have presented the results of more than 20 years of effective experience in the use of hirudotherapy in otorhinolaryngology patients for medical, rehabilitation, and health purposes. Promising is the further study and application of hirudotherapy as a type of naturopathy and homeopathy in the 21st century of advanced technologies, significantly changing the conditions of the internal and external environment of the inhabitants of our planet.

A review article on Jalaukavacharan in the management of Dushta Vrana

ABSTRACT
 Method of removing blood from the body using jalauka (leech) is considered as the most easy and convenient method. Blood vitiated by vata, pitta and kapha should be removed from the body, by using sringa, jalauka and alabu respectively. Jalauka is ideal to remove blood vititated by pitta. The medicinal leech, Hirudo medicinalis, is one of the few examples of the use of invertebrates in the treatment of human disease. Leech therapy also known as Hirudotherapy (mentioned as Jalaukavacharan in Ayurveda) played an important role because it was used for medicinal "blood-letting" and "purification".
 “The destruction / break / rupture / discontinuity of body tissue / part of body, is called Vrana.” The healing of wound or an ulcer is the natural response of the body. Naturally wound will heal in one week if no doshic invasion or infection takes place. The vrana more than a week called dushta vrana which fail to heal for a long period and result into chronic wound (dheergha kalanubandhi dushta vrana), such vrana needs shodhana (Abhyantara) and ropana (Bahya) chikitsa. Virechana and Jatyadi ghruta application as well as jalaukavacharan (leech therapy) are the best line of management for vata-pitta pradushtaja dushta vrana.

Focused Ultrasound Neuromodulation and the Confounds of Intracellular Electrophysiological Investigation.

Focused ultrasound (US) can modulate neuronal activity noninvasively with high spatial specificity. In intact nervous systems, however, efforts to determine its enigmatic mode of efficacy have been confounded by the indirect effects of US on mechanosensitive sensory cells and the inability to target equivalent populations of cells with precision across preparations. Single-cell approaches, either via cultured mammalian neurons or tractable invertebrate neural systems, hold great promise for elucidating the cellular mechanisms underlying the actions of US. Here, we present evidence from the medicinal leech, Hirudo verbana, that researchers should apply caution when using US in conjunction with single-cell electrophysiological recording techniques, including sharp-electrode intracellular recording. Although we found that US could elicit depolarization of the resting membrane potential of single neurons, a finding with precedent, we determined that this effect and others could be reliably mimicked via subtle manual displacement of the recording electrode. Because focused US is known to induce resonance of recording electrodes, we aimed to determine how similarly US-induced depolarizations matched those produced by micro movements of a sharp glass electrode, a phenomenon we believe can account for purported depolarizations measured in this manner. Furthermore, we show that when clonally related homologous neurons, which are essentially isopotential, are impaled before the application of focused US, they show a statistically significant change in their membrane potential as compared with the homologous cells that received US with no initial impalement. Future investigations into US’s cellular effects should attempt to control for potential electrode resonance or use alternative recording strategies.

Exploring the attachment of the Mediterranean medicinal leech (Hirudo verbana) to porous substrates.

Haematophagous ectoparasites must ensure a reliable hold to their host during blood meals and, therefore, have evolved a broad spectrum of versatile and effective attachment mechanisms. The Mediterranean medicinal leech (Hirudo verbana), for example, uses suction on both smooth and textured air-tight substrates. However, preliminary studies showed that H. verbana is also capable of attaching itself to air-permeable substrates, where suction does not work. Using high-speed videography and mechanical tests, we comparatively investigated the attachment of H. verbana on both smooth and textured air-tight as well as on porous artificial substrates, also considering the influence of mucus on sucker surfaces. In general, the leech-specific locomotion cycle did not differ between the tested surfaces, and the leeches were able to reliably attach to both air-tight and porous substrates. From our results, we conclude that suction is presumably the primary attachment mechanism of H. verbana. However, secondary mechanisms such as mechanical interlocking with surface asperities and pores or capillary forces occurring at the interface between the mucus-covered suckers and the substratum are also employed. In any case, the rich repertoire of applicable attachment principles renders the organs of H. verbana functionally highly resilient.

Reply: Letter to the Editor: A Comprehensive Review of Medicinal Leeches in Plastic and Reconstructive Surgery

Reply: Letter to the Editor: A Comprehensive Review of Medicinal Leeches in Plastic and Reconstructive Surgery

KEANEKARAGAMAN MAKROFAUNA TANAH DI PERKEBUNAN KOPI DESA BATU KALUNG KECAMATAN MUARA KEMUMU KABUPATEN KEPAHIANG

This study aims to determine the diversity of existing soil macrofauna at coffee plantations located at Batu Kalung village, Muara Kemumu subdistrict of Kepahiang regency. This research was conducted in February 2018 at the coffee plantations area. The methods used in this research were pitfall-trap and hand sorting. The result of the study at the site found there are 9 orders of macraofauna consisting of 11 families, 13 species, and 188 spesimen.The species found were Heterometrus lepturus, Scolopendrae morsitans, Trigoniulus corallines, Neocurtilla hexadactylla, Gryllus assimilis, Ceuthophilus maculates, Dolichoderus bituberculatus, Componotus carnelus, Blatta germanica, Blattella orientalis, Odontotaenius disjunctus, Ponthoscolex corethurus, and Hirudo medicinalis. The calculation of soil macrofauna index in coffee plantations found a number of 0.942. This indicates that that the level of soil macrofauna diversity at the coffee plantations is low. The highest soil macrofauna diversity index was found on Ponthoscolex corethurus, which is 0.146. In the contrary, the lowest diversity index was found onHeterometrus lepturus species, 0.011. In addition, The average physics-chemical factor of soil at the coffee plantation was obtained that the soil temperature is 280C, soil pH of 5.8, and soil moisture of 67