LEECH THERAPY
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Leeches are segmented worms that are used in medicinal leech therapy. The European medicinal leech, Hirudo medicinalis, is commonly used. It secretes substances like hirudin that prevent clotting and have anti-inflammatory effects. Leech therapy involves applying leeches to remove congested blood and can help with reattachment of tissue flaps. It has historically been used to treat conditions like joint pain but is still studied for modern uses such as complications from meningitis. Chemical advances like the anticoagulant bivalirudin aim to replicate the effects of hirudin but with fewer side effects than leeches.
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LEECH THERAPY
- 2. WHAT IS A LEECH TYPES OF LEECHES BIOLOGICAL SPECIES USED – MEDICINAL LEECH HABITAT ANATOMY OF THE LEECH ADMINISTRATION OF LEECH THERAPY Pre Procedure Procedure Post Procedure APPLICATIONS Historical applications Modern uses of leech therapy COMPLICATIONS ADVANCEMENTS MECHANICAL LEECH CHEMICAL ADVANCEMENTS (BIVALIRUDIN)
- 3. Leeches are annelids or segmented worms, closely related to the earthworms, are anatomically and behaviourally more specialized.
- 4. EUHIRUDINE -with both anterior and posterior suckers Rhynchobdellae -these are jawless armed with muscular straw like probiscus and a retractable sheath Arhynchobdellae - These lack a probiscus and which may or may not have jaws armed with teeth Gnathobdelae Glossiphoniidae -European Medicinal Leech ( Hirudo Medicinalis) Piscicolidae Pharyngobdellae
- 5. The medicinal leech or Hirudo medicinalis is used therapeutically. DESCRIPTION – Fully mature adults can be up to 20cm in length are green, brown or greenish brown darker tone on the dorsal side and a lighter ventral side the dorsal side also has a thin red stripe.
- 6. The preferred habitat for this species is muddy freshwater pools and ditches with plentiful weed growth. Most leeches are freshwater animals, but many terrestrial and marine species occur.
- 9. Educate the patient Obtain informed patient consent Place order for sterile leeches Specify how many leeches are required Specify localized area to be treated & frequency of application Order baseline haemoglobin & haematocrit Fax order to pharmacy
- 10. Physician initiates application of leech to determine desired site of application Remove leech with a non-toothed forceps Place in a cup or a syringe with the plunger removed Clean the site of application &localize the area of application with barrier of gauze dampened with sterile water Hold the leech in the cup & steer towards area to be treated
- 11. After leech detaches drop it in a cup containing 70% alcohol Never place used leech with unused leech Place in bags and dispose Encourage each bite to bleed gently removing locally forming clots Once sufficient amount of blood is removed, wipe the wound with antiseptic and cover till bleeding stops
- 12. Historical applications Modern uses of leech therapy Plastic / Reconstructive Surgery Meningococcal purpura fulminans Osteoarthiritis
- 13. 1800’s – High Demand 129-199 AD - Galen 200 BC – Nicader of Colophain End of 19th Century – Use began declining, Ho wever, in 1884 Haycraft isolated Hirudin 1955 – Hirudin was finally isolated and characterised .
- 14. Used to relieve venous congestion Thus leeches are used to prevent pooling of blood. The leech sucks the blood thereby increasing perfusion of the tissue and maintains tissue viability until neovascularization occurs.
- 15. Application of medical leech reportedly increases blood flow within congested tissue via active feeding and indirectly by passive bleeding from the leech bite after detachment. Active & Passive bleeding are both facilitated by the actions of different salivary secretions of the leech such as hirudin – an anticoagulant.
- 16. 24 hours postoperative 48 hours postoperative 6 days postoperative 72 hours postoperative 2 months postoperative
- 17. The most important constituent – hirudin Other substances which have anaesthetic action, vasodilator, anti-inflammatory and analgesic action
- 18. What is Meningococcal purpura fulminans? What happens in Meningococcal purpura fulminans? How do leeches help in treatment of this condition?
- 19. The saliva of the leeches contain a large number of substances which are found to have antiinflammatory and analgesic properties which have still not been properly characterized. It was suspected that the anti-inflammatory and analgesic agents in leech saliva could be used for the symptomatic treatment of osteoarthritis. Currently this hypothesis is being tested. They have found that there was a rapid pain relieving effect from the leeches, without any complications. However, since the treatment is unusual, they could not compare with any placebo.
- 20. Aeromonas veronii and other species of Aeromonas. Transfusion of blood may be required.
- 21. Mechanical Leech Chemical Advancements (Bivalirudin)
- 22. A DEVICE TO AUGMENT BLOOD REMOVAL AFTER PASSIVE BLEEDING
- 24. Semisynthetic derivative of Hirudin. It consists of 20 amino acids formed from residues 53 to 64 of hirudin with addition of a sulphated tyrosine at position 63. Peptide Sequence of Bivalirudin
- 25. Bivalirudin consists of 3 domains 1) The –COOH terminal domain 2) The –NH2 terminal domain 3) The linker tetraglycine chain Peptide Sequence of Bivalirudin
- 28. Bivalirudin inhibits clot bound thrombin as well as circulating thrombin. Unfractionated Heparin binds to plasma protein and therefore is unpredictable. Low Molecular Weight Heparin binds comparatively lesser to plasma proteins but many other disadvantages compared to Bivalirudin.
- 29. Hirudin is a 65 amino acid peptide and due to its larger size may induce immunogenic reactions (However none are reported as yet) Plasma half life of Hirudin is 2- 3 hours as compared to Bivalirudin (30 minutes). Bivalirudin has 1000 times lower affinity for thrombin as compared to Hirudin and therefore is a reversible inhibitor of thrombin.
- 30. Percutaneous Coronary Intervention (Angioplasty) Acute Coronary Syndromes Heparin Induced Thrombocytopenia Vascular Brachytherapy Percutaneous Peripheral Intervention.
- 33. Trease & Evans ( Ed.) Pg. 443 Wikipedia –http://en.wikipedia.org/wiki/Leech MARK D. WELLS, ET. AL. THE MEDICAL LEECH: AN OLD TREATMENT REVISITED, MICROSURGERY 14:183-186 1993. A. Eldor, M. Orevi, M. Rigbi The role of the leech in medical therapeutics, Blood Reviews (1996) 10,201-209. James J. Nawarskas et. al. Bivalirudin A New Approach to Anticoagulation, Heart Disease 2001;3:131– 137 Nicolas W. Shammas, Bivalirudin: Pharmacology and Clinical Applications, Cardiovascular Drug Reviews Vol. 23, No. 4, pp. 345–360. Ricky Dippenaar et. al. Meningococcal purpura fulminans treated with medicinal leeches. Pediatric Care Med 2006 Vol. 7, No. 5 Pg- 476-478. Claire L. Haycox, MD, PhD. et al. Indications and complications of medicinal leech therapy, Journal of the American Academy of Dermatology Volume 33. Number 6, Pg. 1053-1055. Andreas Michalsen et. al. Leech therapy for symptomatic treatment of knee osteoarthritis: Results and implications of a pilot study Alternative Therapies in Health and Medicine. Aliso Viejo: Sep/Oct 2002. Vol. 8, Iss. 5; pg. 84, 5 pgs. Nadine P. Connor, et. al. Augmented blood removal after medicinal leech feeding in congested tissue flaps. Journal of Rehabilitation Research and Development. Vol. 39 No. 4, July/August 2002 Pages 505512 Australian Museum Online – http://www.amonline.net.au/factsheets/leeches.html