It has been estimated that there are about 60,000 stat mis or more blood vass within a human organic structure where blood, gases and foods are being circulated.[ 1 ]Any obstruction of these vass will do blood congestion and therefore give rise to assorted vascular diseases. For case, a engorged coronary arteria will do bosom onslaughts, and a engorged carotid arteria will do shots. Other common illustrations are inflammatory reactions, hematoma, deep vena thrombosis, and so on. Hirudotherapy, besides known as the bloodsucker therapy, is an ancient redress now being revived and evaluated scientifically, trusting that it could be a one remedy for all these diseases and supply a much more effectual yet safer intervention.
So, how a bloodsucker can bring around and is it truly more effectual over presently prescribed drugs in handling vascular congestion and related diseases?
The mechanism behind hirudotherapy can be simplified as such: when a medicative bloodsucker ( hirudo medicinalis ) bites a mark, the patient will non experience much hurting because its spit contains particular anesthetics. It so starts its active eating by sucking the blood. At the same clip, the spit besides contains assorted constituents that prevent the formation of blood coagulum at the lesion and let blood to seep out continuously for hours even after the bloodsucker has been removed. This state of affairs is known as inactive hemorrhage.
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Figure 1: Anatomy of a Hirudo bloodsucker. & lt ; hypertext transfer protocol: //www.digitalmediatree.com/library/image/88/leech.jpg & gt ;
Figure 2: Medicative bloodsucker spit contents and their effects.[ 2 ]
I have classified the bloodsucker intervention into 3 common types based on these effects of saliva contents and their applications.
Type 1: Hirudin as an decoagulant
It has been recognised that the acute coronary syndromes affecting the atherosclerotic plaques or thrombus have direct connexion to the thrombin in the blood. Thrombin triggers platelet collection and gives rise to fibrin coagulum formation. Intravenous Lipo-Hepin, acetylsalicylic acid, and anti-ischemic medicines are the standard interventions provided by infirmaries. On the other manus, hirudin appears to hold more advantages over Lipo-Hepin. It can move independently while Lipo-Hepin works indirectly with anti-thrombin III as its cofactor. As a consequence of this, Lipo-Hepin is non effectual when it comes to the fibrin coagulum that already has thrombin bounded to it.
In add-on, thrombocyte factor 4 or plasma proteins might neutralize the consequence of Lipo-Hepin. Some patients might even develop thrombopenia, which affects 5 to 15 per centum of the patient population. In such instances, hirudin is extremely selective for thrombin and is non affected by peptides and enzymes in the blood. It binds with thrombin to organize an inactive hirudin-thrombin composite and hold the transition of factor I into fibrin. Another high spot of hirudin would be its stableness as its signifier can stay unchanged when it is removed from the organic structure through micturition.
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Figure 3: Different onslaught points of hirudin and hementin in forestalling blood coagulum formation.[ 3 ]
In a research, patients with acute coronary syndromes were indiscriminately given either endovenous Lipo-Hepin and hirudin placebo or hidurin infusion and Lipo-Hepin placebo and followups on a dual unsighted footing. This led to the possibility of comparing the consequence of hirudin and Lipo-Hepin in handling coronary syndromes and forestalling deceases.
Figure 4: Estimate on chance of decease or MI after hours of randomization.[ 4 ]
The result consequences showed that hirudin had significantly decreased the hazard of decease or myocardial infarction ( MI ) over hours of survey compared to heparin.
Figure 5: Estimate on chance of decease or MI in all patients.
The graph illustrated that over a long period of survey, hirudin was still able to expose important advantage over Lipo-Hepin.
Type 2: Removal of blood via active eating and inactive hemorrhage
Detached organic structure tissues or limbs can be reattached, transferred or transplanted through modern rehabilitative surgeries. Microsurgical techniques are being used to reconstruct the blood vass providing blood and O to the linking tissues or limbs to guarantee their endurance. However, frequently we see that after a complicated plastic or rehabilitative surgery, venous congestion occurs at the linking tissues due to the formation of blood coagulum after a venous escape. Therefore, the blood can non be circulated and the tissue flap will finally decease off and is lost if the congestion prolonged.
It is so critical to take extra blood accumulated at the site so that hazard of cell decease can be minimised. Furthermore, it provides clip for the ingrowth of new venous escape from the environing normal tissues or the reconnection of venas. Surgical alteration is seldom possible or successful to repair the job.
When a tissue flap brushs venous congestion, live medicative bloodsuckers ( Hirudo medicinalis ) are placed on it to throw out the dead blood. This method is reportedly to hold a great consequence in reconstructing blood flow and salving tissues.[ 5 ]The seepage of blood from the lesion besides has the consequence of cleansing the lesion and cut downing the hazard of infection. Leechs are applied continuously until a new vascular circuit develops and replaces the old one.
Type 3: Effectss of other substances in the bloodsucker spit
As the bloodsucker spit besides contains anti-inflammatory and anesthetics substances, the patient will experience no hurting being bitten. This particular consequence attributes towards the intervention of diseases such as arthritis of the joint.
Although arthritis belongs to immunological upset, the redness around the articulations causes hurting to the patients. Therefore, leech therapy might be utile in comforting the hurting suffered. A survey designed by research workers from Germany ‘s Academic Teaching Hospital by using life bloodsuckers at the hurting site on randomly chosen patients described that ‘one application of bloodsuckers can cut down trouble 60 % ‘ for more than 2 months and it is even more effectual than Diclofenac, a group of drugs which is normally used to handle hurting or redness caused by arthritis by cut downing the endocrines doing such symptoms.[ 6 ]
Figure 6: Both bloodsucker and Diclofenac interventions compared by the entire hurting mark.
The consequence had backed up a old survey on leech therapy for handling articulatio genus degenerative arthritis.
Figure 7: Both groups in the survey class compared by hurting mark.
Not known by many, an interesting survey reported that the usage of recombinant leech-derived tryptase inhibitor ( LDTI ) had successfully blocked the reproduction of HIV-1 virus in host cells. Such instances are the incentives that drive scientists to go on their surveies as the potency of leech therapy for the better life quality is so worthy.
Options
Recombinant Hirudin
A bloodsucker ‘s spit contains limited sum of natural hirudin, so the thought of mass hirudin extraction for interventions is about impractical as this will multiply the cost. What can be done? One possible solution to this is to synthesize a similar substance. Scientists have antecedently cloned the complementary DNA for hirudin and it is expressed in barm. However, the ensuing recombinant protein was found unsulfated, holding at least 10 times lower affinity for thrombin than natural hirudin.
However, recombinant hirudin has been approved by United States ‘ FDA to be produced and applied commercially. It can be an alternate when life bloodsuckers are non available and the patient seems to develop intolerance against Lipo-Hepin. A sawbones must ever see the followers advantages and disadvantages when carry oning interventions.
Hirudin
Heparin
Recombinant Hirudin
Advantages
Led to a really consistent anticoagulant consequence over clip, independently of the usage of thrombolytic therapy
Inexpensive, performed good as an anti-thrombin agent in the surveies and should still be regarded as the criterion therapy
Demonstrable and consistent consequence, particularly on the rate of reinfarction
Disadvantages
Excessive use will increase hemorrhage hazard, no known counterpoison
Might cause serious thrombotic complications such as thrombopenia
Small clinical consequence
Table 1: Comparison between hirudin, Lipo-Hepin, and recombinant hirudin by agencies of advantages and disadvantages[ 7 ]
Hementin
Hementin is a alone secernment in the spit of Amazon Giant Leech ( Haementeria ghilianii ) . As shown in Figure 3, it inhibits the curdling of blood by interrupting down the factor I. Because Haementeria ghilianii does non belong to the order of Arhynchobdellida but Rhynchobdellida, therefore it was non recognised as medicative bloodsucker. However, Professor Maurice Moloney from Canada ‘s University of Calgary discovered that while hirudin prevents coagulum formation, hementin interruptions down coagulums formed more efficaciously than conventionally used drugs like streptokinase and plasminogen activator.
Mechanical Leech
Additions in blood loss volumes from congested tissue flaps may better postoperative blood perfusion, guaranting tissue flap viability and endurance. However, inactive blood loss from a individual bloodsucker bite is non sufficient to decongest an impaired tissue flap. So, is at that place a manner of hiking blood lost volumes? The thought increasing the tissue viability with mechanical devices was therefore provoked.
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Figure 8: Simplified design for mechanical bloodsucker device.[ 8 ]
( 1 ) A leech-bite alike cut is produced by the device and Lipo-Hepin is dripped onto the lesion.
( 2 ) Blood irrigant removed from device chamber by suction force per unit area produced.
( 3 ) Bubble turbulency created by room air prevents thrombosis on skin surface.
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Figure 9: Prototype of mechanical device experimented and used to decongest tissue flap.[ 9 ]
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Figure 10: Use of mechanical device significantly increased blood retrieval relative to passive shed blooding entirely.
Ethical Deduction
The surveies have raised several ethical issues to be concerned. If leech therapy is proven to be more effectual than all of the current interventions, it would be unjust for those patients being rejected for having better interventions. However, before leech therapy was proven to be safe, the surveies had really risked the patients ‘ lives. Another concern is whether the physicians ‘ patterns are maintaining gait with current research in supplying leech intervention with best promising consequences. Continuous surveies have been supplying the latest found methods but despite being recommended through several publications, a figure of physicians were discovered to be incognizant of them, therefore the common complications of leech intervention remain to be unsolved. Therefore, it is of import for a leech healer to often update themselves exhaustively with the latest information and equip themselves with better accomplishments through practicals.
Social Implication
A interpreter of the Australian Society of Plastic Surgeons, Mr Randall Sach estimated that one tierces of patients will experience fearful holding slimy and writhing bloodsuckers on their organic structure.[ 10 ]This might go forth traumatic experience on patients. However, most sawboness commented that when the conditions are critical, patients will usually see bloodsuckers as their life rescuers and cooperate with their physicians. Furthermore, development of mechanical bloodsuckers might be a solution to this, as patients would experience more confident to scientific devices. In future, we might see more mechanical bloodsucker devices being invented and commercialised, supplying low-cost yet effectual intervention.
Evaluation
I have gone through several esteemed medical diaries and books related to leech therapy. One of the beginnings I referred to is an article “ A Comparison of Recombinant Hirudin with Heparin for the Treatment of Acute Coronary Syndromes ” published in The New England Journal of Medicine, a peer-reviewed, oldest continuously published hebdomadal medical diary in the universe. I believe the consequence is dependable as similar consequences can be reproduced by other research squads. Besides that, it besides involved a big sample of 12,142 patients in entire, conducted at 373 infirmaries in 13 states. Furthermore, the purpose of the survey is intended to bring around, non for fiscal involvements. All these are straight credited to its dependability.
Another beginning would be an article “ Effectiveness of Leech Therapy in Osteoarthritis of the Knee ” published in Annals of Internal Medicine, one of the most-cited general clinical medical diaries in the universe. It stated that leech therapy had successfully surpassed conventional drugs in alleviating hurting. The consequence was subsequently backed up by a similar survey and consequence published in Pain, another esteemed medical diary, despite both consequences might be affected by anti-thrombolytic, antinociceptive ( trouble contending ) effects, antagonistic annoyance or placebo consequence.[ 11 ]
Bibliography
Vogel, S. & A ; A Calvert, R.A. ( 1993 ) , Critical Circuits: On pumps, pipes, and the workings of circulatory systems, Oxford University Press, US
Michalsen A. , A Roth M. , A Dobos G.J. , & A ; A Aurich M. ( 2007 ) , Medicinal Leech Therapy, Thieme Medical Publishers, Germany
