Clinical efficacy of medicinal leech therapy in treating third- and fourth-degree hemorrhoids / Eficácia clínica da hirudoterapia no tratamento de hemorroidas de terceiro e quarto graus

Abstract Objectives Hemorrhoids are characterized by bleeding, mucous discharge, itching, pain, and prolapse. This condition is known as bawaseer in Unani medicine, and Hirudinaria granulosa has been used for its treatment in Irsal-e Alaq, or medicinal leech therapy (MLT), for centuries. Hirudinaria granulosa with antithrombotic and antiinflammatory action is used in the treatment of chronic venous disease and hemorrhoids. The present study was aimed to investigate the efficacy of MLT in third and fourth-degree hemorrhoids. Methods A single-centre prospective, clinical trial with a pre and postanalysis design was conducted at the hospital of the National Institute of UnaniMedicine. Twenty male and female patients, with a mean age of 38 years, presenting moderate symptoms assessed with the colorectal evaluation of clinical therapeutics scale (CORECTS) questionnaire were included in the study. Hirudinaria granulosa were applied around the pile mass for 15 minutes weekly, for 4 weeks. The efficacy of the treatment was measured by an objective and subjective assessment using the CORECTS. Results When analyzed by the clinician, MLT reduced the symptoms' severity score in the following domains: pain (55% improvement; p < 0.001); anorectal itching (30% improvement; p < 0.10); and bleeding (10% improvement; p < 0.7963). Significant improvement (p < 0.001) was reported in the CORECTS score in relation to pain (44.09% improvement; p < 0.001), itching (38.55% improvement; p < 0.001), swelling (44% improvement; p < 0.001), bleeding (17.28% improvement; p < 0.007), discomfort (34.01% improvement; p < 0.001), and wellbeing (32.35 % improvement; p < 0.001), giving an average overall opinion on the therapy of 4/10. Conclusion The results of the study albeit smaller in sample size show that MLT is an effective and safe therapeutic option in reducing the symptoms of 3rd and 4th degree haemorrhoids.

Resumo Objetivos As hemorroidas são caracterizadas por sangramento, secreção mucosa, prurido, dor e prolapso. Esta condição é conhecida como bawaseer namedicina Unani, e a Hirudinaria granulosa tem sido usada para seu tratamento na Irsal-e Alaq, ou hirudoterapia, há séculos. A H. granulosa, devido à sua ação antitrombótica e antiinflamatória, é utilizada no tratamento de doenças venosas crônicas e hemorroidas. O presente estudo teve como objetivo investigar a eficácia da hirudoterapia em hemorroidas de terceiro e quarto graus. Métodos Este ensaio clínico prospectivo e unicêntrico com delineamento pré e pósanálise foi conduzido no hospital do National Institute of Unani Medicine. Foram incluídos no estudo 20 pacientes de ambos os sexos, com média de idade de 38 anos, que apresentavam sintomas moderados avaliados pelo questionário colorectal evaluation of clinical therapeutics scale (CORECTS). Espécimes de H. granulosa foram aplicadas em volta da área afetada por um período de 15 minutos semanais, durante 4 semanas. A eficácia do tratamento foi medida por uma avaliação objetiva e subjetiva usando o questionário CORECTS. Resultados Quando analisada pelo clínico, a hirudoterapia reduziu o escore de gravidade dos sintomas nos seguintes domínios: dor (55% de melhora; p < 0,001); prurido anorretal (melhora de 30%; p < 0,10); e sangramento (melhora de 10%; p < 0,7963). Melhora significativa (p < 0,001) foi relatada no escore CORECTS em relação à dor (44,09% de melhora; p < 0,001), prurido (38,55% de melhora; p < 0,001), inchaço (44% de melhora; p < 0,001), sangramento (17,28 % de melhora; p < 0,007), desconforto (34,01% de melhora; p < 0,001) e bem-estar (32,35% de melhora; p < 0,001), o que resultou em uma opinião geral média sobre a terapia de 4/10. Conclusão Os resultados do estudo, embora com tamanho de amostra pequeno, mostram que a hirudoterapia é uma opção terapêutica eficaz e segura na redução dos sintomas de hemorroidas de terceiro e quarto graus.

[Leech hirudo medicinalis: a therapeutic alternative available in Mexico]. / Sanguijuela Hirudo medicinalis: una alternativa terapéutica disponible en México.

Throughout history a diversity of therapeutic properties have been attributed to the leech Hirudo medicinalis, however, during the past twenty years its use has proven to be a practical and effective method for the relief of venous engorgement in reconstructive surgery. In Mexico this practice has been limited due to the lack of supply and to the time-consuming process of importation. Based on this need, the animal facilities of the Occidental Biomedical Research Center-IMSS in Guadalajara, Jalisco, has initiated a breeding and reproduction program of this species with the aim at improving its availability as a therapeutic device. The salivary gland of Hirudo medicinalis contains one of the most potent natural anticoagulants, known as hirudin, a histamine-like vasodilator, platelet aggregation inhibitors and highly specific proteases, all of which favor venous flow and turn this species into the most useful in the clinical setting. Nevertheless, it is important to know the potential risks of leech therapy since it has been associated with considerable morbidity when adequate precautions are not taken. This review exposes relevant aspects of the medicinal leech, the indications, mechanism of action and the protocol for this therapy.

Hirudo medicinalis (sanguessuga): eficácia do seu uso no tratamento da insuficiência venosa em retalhos epigástricos de ratos / Hirudo medicinalis (leech): their effective use in venous compromisedd

Objetivo: Demonstrar a eficácia do uso de sanguessugas (Hirudo medicinalis) na insuficiência venosa nos retalhos epigástricos em ilha, utilizando ratos Wistar. Métodos: Em 23 ratos foram realizados retalhos epigástricos bilateralmente, criando uma oclusão venosa de seis horas em ambos. Em um dos retalhos foi aplicado o tratamento com a sanguessuga de maneira randomizada, enquanto o lado contralateral serviu como controle. Foram analisados o número de retalhos sobreviventes e necrosados, o tempo de sucção e de sangramento após a mordida da sanguessuga. Resultados: O número de retalhos que sobreviveram com o uso de sanguessugas foi significativamente superior quando comparado com o grupo de controle, respectivamente, 86,97% e 52,18% (n = 23, p < 0,0134, teste z de proporção). O tempo médio de sucção foi de 92 minutos (mínimo de 14 minutos e máximo de 186 minutos, n = 23) e o tempo de sangramento, em média, de 63 minutos (mínimo de 17 minutos e máximo de 157 minutos), não sendo estatisticamente significante (p < 0,32 pelo teste t de Student). Conclusão: O uso de sanguessugas melhorou a sobrevida de retalhos com isquemia venosa de seis horas em modelo experimental em ratos...

In situ characterization of a rectifying electrical junction.

Electrical synapses play significant roles in neural processing in invertebrate and vertebrate nervous systems. The view of electrical synapses as plain bidirectional intercellular channels represents a partial picture because rectifying electrical synapses expand the complexity in the communication capabilities of neurons. Rectification derives, mostly, from the sensitivity of electrical junctions to the transjunctional potential (V(j)) across the coupled cells. We analyzed the characteristics of this sensitivity and their effect on neuronal signaling, studying rectifying junctions present in the leech nervous system. The NS neurons, a pair of premotor nonspiking neurons present in each midbody ganglion, are electrically coupled to virtually every excitatory motor neuron. Studied at rest, only hyperpolarizing signals can be transmitted from NS to the motoneurons, and only depolarizing signals are conducted in the opposite direction. Our results show that small changes in the NS membrane potential (V(m)) exerted an effective control of the firing frequency of the CV motoneurons (excitor of circular muscles). This effect revealed the existence of a threshold V(j) across which the electrical synapse shifts from a nonconducting to a conducting state. The junction can operate as a relatively symmetrical bidirectional bridge provided that the transmitted signals do not cross this threshold transjunctional potential.