Medicinal leeches and the microsurgeon: A four-year study, clinical series and risk benefit review

Background: There are case reports and small series in the literature relating to the use of medicinal leeches by plastic surgeons; however, larger series from individual units are rare. The aim of this article is to present a comprehensive 4-year case series of the use of medicinal leeches, discuss the current evidence regarding indications, risks, and benefits and highlight the recent updates regarding leech speciation. Methods: Patients prescribed leeches in a 4-year period (July 2004–2008) were collated from hospital pharmacy records (N = 35). The number of leeches used, demographic, clinical, and microbiological details were retrospectively analyzed. Results: Thirty-five patients were treated with leeches. The age range was 2 to 98 years (mean = 49.3). Leeches were most commonly used for venous congestion in pedicled flaps and replantations. Blood transfusions were necessary in 12 cases (34%) [mean = 2.8 units, range 2–5 units]. Our infection rate was 20% (7/35) including five infections with Aeromonas spp. (14.2%). The proportion of patients becoming infected after leech therapy was significantly greater in the group of patients that did not receive prophylactic antibiotic treatment (Fisher's Exact test P = 0.0005). In total, 14 cases (40%) were salvaged in entirety, in 7 cases 80% or more, in 2 cases 50 to 79%, and in 1 case less than 50% of the tissues were salvaged. In 11 cases (31%), the tissues were totally lost. Conclusion: Our study highlights both the benefits and the risks to patients in selected clinical situations and also the potential risks. The routine use of antibiotic prophylaxis is supported. In view of the emerging evidence that Hirudo verbana are now used as standard leech therapy, and the primary pathogen is Aeromonas veronii, until a large prospective multicenter study is published, large series of patients treated with leeches should be reported. © 2011 Wiley-Liss, Inc. Microsurgery, 2011

Packages of Care for Epilepsy in Low- and Middle-Income Countries

In the second in a series of six articles on packages of care for mental health disorders in low- and middle-income countries, Caroline Mbuba and Charles Newton discuss treatment for epilepsy

Indicators and outcomes of Canadian university research: proxies becoming goals?

This paper analyzes Canadian Government attempts to encourage and measure commercialization of university knowledge for socio-economic improvement. Universities are regarded as major, insufficiently exploited, repositories of knowledge. Here, paths by which knowledge can be transferred across institutional boundaries, and various input and output/outcome measures are identified. Available Canadian data are evaluated and a detailed quantitative and qualitative study of one institution is presented. Three key issues emerge: (1) current proxies focus on licensing and spin-off, and do not measure several important paths of knowledge flow; (2) most readily available proxies are derived from aggregate data and are inadequate to fully reflect the idiosyncratic and path-dependent nature of innovation; (3) if the goals and incentives of the actors in the ‘triple helix’ are skewed or misinterpreted by indicators, universities and firms may engage in counterproductive activities. We propose additional indicators that might help to prevent one measurable dimension from becoming the policy driver to the detriment of the overall goals