Silver serum levels in burned patients treated with silver sulfadiazine and its toxicity on inflammatory cells

Effectiveness of silver and iodine dressings on wound healing: a systematic review and meta-analysis

OBJECTIVE

To evaluate the effects of silver and iodine dressings on healing time, healing rate, exudate amount, pain and anti-infective efficacy.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Databases including PubMed, Cochrane Library, Embase, Web of Science and CINAHL were surveyed up to May 2024.

ELIGIBILITY CRITERIA

Randomised controlled trials comparing silver and iodine dressings on wound healing in humans.

DATA EXTRACTION AND SYNTHESIS

Evidence certainty was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Data extraction was done independently by two reviewers, with the risk of bias assessed using the Cochrane tool. Narrative synthesis was performed to evaluate the effects of silver and iodine dressings on healing time, healing rate, pain, exudate amount and anti-infective efficacy. Meta-analysis using Review Manager V.5.4 calculated standardised mean differences for healing time and relative risks for rate to quantify the impacts of the treatments.

RESULTS

17 studies (18 articles) were included. The meta-analysis indicated that silver dressings significantly reduced healing time compared with iodine dressings (SMD=-0.95, 95% CI -1.62 to -0.28, I2=92%, p=0.005, moderate-quality evidence), with no significant difference in enhancing healing rate (RR=1.29, 95% CI 0.90 to 1.85, I2=91%, p=0.16, low-quality evidence). Based on low-quality evidence, for exudate amount (3/17), 66.7% (2/3) of the studies favoured silver dressings over iodine in reducing exudate volume. For pain (7/17), 57.1% (4/7) of the studies reported no significant difference between silver and iodine dressings, while 42.9% (3/7) studies indicated superior pain relief with silver dressings. For anti-infective efficacy (11/13), 54.5% (6/11) of the studies showed equivalence between silver and iodine dressings, while 36.4% (4/11) suggested greater antibacterial efficacy for silver.

CONCLUSION

Silver dressings, demonstrating a comparable healing rate to iodine dressings, significantly reduce healing time, suggesting their potential as a superior adjunct in wound care.

PROSPERO REGISTRATION NUMBER

CRD42020199602.

Traditional uses, botany, phytochemistry, pharmacology and applications of Labisia pumila: A comprehensive review

ETHNOPHARMACOLOGICAL RELEVANCE

Labisia pumila (Blume) Fern.-Vill, also known as Kacip Fatimah, is a traditional medicinal herb common throughout Southeast Asia. It is primarily used to facilitate childbirth and postpartum recovery in women. Additionally, it can also be used to treat dysentery, rheumatism, gonorrhea, and as an anti-flatulent.

AIM OF THIS REVIEW

This article aims to provide a comprehensive review of the traditional uses, botany, cultivation, phytochemistry, pharmacological effects, practical applications, and potential uses of L. pumila (LP). Furthermore, we also explore the safety of this plant and its potential prospects for application.

MATERIALS AND METHODS

The keywords "Labisia pumila," "Kacip Fatimah," and "Marantodes pumilum" were used to collect relevant information through electronic searches (including Elsevier, PubMed, Google Scholar, Baidu Scholar, CNKI, ScienceDirect, and Web of Science).

RESULTS

This review summarizes 102 chemical components from different parts of the plant, including flavonoids, phenolic acids, saponins, and other chemical components. In addition, we also address the associated cultivation conditions, traditional uses, pharmacological effects and toxicity. A large number of reports indicate that LP has various pharmacological effects such as antioxidant, phytoestrogenic, antiinflammtory, antimicrobial, anti-osteoporosis and anti-obesity properties. These results provide valuable references for future research on LP. In addition, LP is also a potential medicinal and edible plant, and is currently sold on the market as a dietary supplement.

CONCLUSIONS

LP is a renowned traditional ethnic medicine with numerous pharmacological activities attributed to its bioactive components. Therefore, isolation and identification of the chemical components in LP can be a focus of our future research. Current studies have focused only on the effects of LP on estrogen deficiency-related diseases in women and bone diseases. There is no scientific evidence for other traditional uses. Therefore, it is important to further explore its pharmacological activities and fill the research gaps related to other traditional uses. Furthermore, research on its safety should be expanded to prepare clinical applications.

Peceleganan Spray for the Treatment of Skin Wound Infections: A Randomized Clinical Trial

Importance

Peceleganan spray is a novel topical antimicrobial agent targeted for the treatment of skin wound infections. However, its efficacy and safety remain unclear.

Objective

To assess the safety and efficacy of peceleganan spray for the treatment of wound infections.

Design, Setting, and Participants

This multicenter, open-label, phase 3 randomized clinical trial recruited and followed up 570 adult patients diagnosed with secondary open wound infections from 37 hospitals in China from August 23, 2021, to July 16, 2022.

Interventions

Patients were randomized to 2 groups with a 2:1 allocation. One group received treatment with 2% peceleganan spray (n = 381) and the other with 1% silver sulfadiazine (SSD) cream (n = 189).

Main Outcomes and Measures

The primary efficacy outcome was the clinical efficacy rate (the number of patients fulfilling the criteria for efficacy of the number of patients receiving the treatment) on the first day following the end of treatment (day 8). The secondary outcomes included the clinical efficacy rate on day 5 and the bacterial clearance rate (cases achieving negative bacteria cultures after treatment of all cases with positive bacteria cultures before treatment) on days 5 and 8. The safety outcomes included patients' vital signs, physical examination results, electrocardiographic findings, blood test results, and adverse reactions.

Results

Among the 570 patients randomized to 1 of the 2 groups, 375 (98.4%) in the 2% peceleganan treatment group and 183 (96.8%) in the 1% SSD control group completed the trial (n = 558). Of these, 361 (64.7%) were men, and the mean (SD) age was 48.6 (15.3) years. The demographic characteristics were similar between groups. On day 8, clinical efficacy was achieved by 339 patients (90.4%) in the treatment group and 144 (78.7%) in the control group (P < .001). On day 5, clinical efficacy was achieved by 222 patients (59.2%) in the treatment group and 90 (49.2%) in the control group (P = .03). On day 8, bacterial clearance was achieved by 80 of 334 patients (24.0%) in the treatment group and in 75 of 163 (46.0%) in the control group (P < .001). On day 5, bacterial clearance was achieved by 55 of 334 patients (16.5%) in the treatment group and 50 of 163 (30.7%) in the control group (P < .001). The adverse events related to the application of peceleganan spray and SSD cream were similar.

Conclusions and Relevance

This randomized clinical trial found that peceleganan spray is a safe topical antimicrobial agent with a satisfactory clinical efficacy rate for the treatment of skin wound infections, while the effectiveness of bacterial clearance remains uncertain.

Trial Registration

Chinese Clinical Trial Registry Identifier: ChiCTR2100047202.

Distribution characteristics of pathogens in different stages of pressure ulcers and the therapeutic effect of linear polarized polychromatic light combined with silver sulfadiazine cream

To investigate the distribution characteristics of pathogens in different stages of pressure ulcers and observe the application of linear polarized polychromatic light (LPPL) combined with silver sulfadiazine cream in treating varying stages of pressure ulcers. This study comprised 88 patients with pressure ulcers who were enrolled in the department of burn and plastic surgery of our hospital from April 2019 to April 2022. The wound exudates from patients were collected, followed by analyzing the distribution of pathogens in different stages of pressure ulcers. Patients were randomly divided into 2 groups. The first group (n = 44) received LPPL combined with silver sulfadiazine. The other group was intervened with LPPL group only for 2 weeks. The clinical efficacy, condition, and pain in the 2 groups, as well as the healing timeframes for patients were measured at different stages. The findings showed that among 88 patients with pressure ulcers, 62 were infected, and the infection rate was 70.45%. The pathogens that were observed in stage II and III to IV pressure ulcers were mainly Gram-negative bacteria. The total effective rate in the combined group was 90.91%, which was much higher than that of LPPL group (70.45%). Compared with LPPL group, the pressure ulcer scale for healing and visual analogue scale scores in the combined group were markedly lower (P < .05). It is important to note that in LPPL group, the healing time of patients in stage II and stage III to IV in the combined arm were 9.76 ± 2.38 days and 13.19 ± 2.54 days, respectively. The corresponding time in the LPPL group was prolonged to 13.20 ± 3.76 and 18.82 ± 4.17 days, respectively. The main pathogens associated with wound infection in patients with pressure ulcers are Gram-negative bacteria. The curative effects of LPPL combined with sulfadiazine silver cream on patients with pressure ulcer is obviously improved, and the recovery and pain relief are faster while the healing time of pressure ulcer is shorter.

Combined Silver Sulfadiazine Nanosuspension with Thermosensitive Hydrogel: An Effective Antibacterial Treatment for Wound Healing in an Animal Model

Introduction

Silver sulfadiazine (AgSD) is widely used in burn wound treatment due to its broad-spectrum antibacterial activity. However, its application in wound healing is greatly hindered by the low solubility of AgSD particles and their cellular cytotoxicity. Herein, we studied the safety and in vivo efficacy of nano-sized silver sulfadiazine loaded in poloxamer thermosensitive hydrogel (NS/Gel).

Methods

In NS/Gel, silver sulfadiazine was prepared into silver sulfadiazine nanosuspension (NS) to improve the solubility and enhance its antibacterial activity, whereas the poloxamer thermosensitive hydrogel was selected as a drug carrier of NS to achieve slow drug release and reduced cytotoxicity. The acute toxicity of silver sulfadiazine nanosuspension was first evaluated in healthy mice, and its median lethal dose (LD₅₀) was calculated by the modified Karber method. Furthermore, in vivo antibacterial effect and wound healing property of NS/Gel were evaluated on the infected deep second-degree burn wound mice model.

Results

The mortality ratio of mice was concentration-dependent, and the LD₅₀ for silver sulfadiazine nanosuspension was estimated to be 252.1 mg/kg (230.8 to 275.4 mg/kg, 95% confidence limit). The in vivo dosages used for burn wound treatment (40-50 mg/kg) were far below LD₅₀ (252.1 mg/kg). NS/Gel significantly accelerated wound healing in the deep second wound infection mice model, achieving > 85% wound contraction on day 14. Staphylococcus aureus in the wound region was eradicated after 7 days in NS/Gel group, while the bacterial colony count was still measurable in the control group. Histological analysis and cytokines measurement confirmed that the mice treated with NS/Gel exhibited well-organized epithelium and multiple keratinized cell layers compared to control groups with the modulated expression of IL-6, VEGF, and TGF-β.

Conclusion

The combination of silver sulfadiazine nanosuspension and thermo-responsive hydrogel has great potential in clinical burn wound treatment.

Efficacy and Safety of PL-5 (Peceleganan) Spray for Wound Infections: A Phase IIb Randomized Clinical Trial

OBJECTIVE

To assess the safety and efficacy of antimicrobial peptide PL-5 (Peceleganan) spray in the treatment of wound infections.

BACKGROUND

Antimicrobial peptide PL-5 spray is a novel topical antimicrobial agent.

METHODS

We conducted a multicenter, open-label, randomized, controlled phase IIb clinical trial to evaluate the efficacy and safety of PL-5 spray, as compared with silver sulfadiazine, in patients with skin wound infections. The primary efficacy outcome was the clinical efficacy rate on the first day after ending the treatment (D8). The secondary efficacy outcome was the clinical efficacy rate on the fifth day posttreatment (D5), the bacteria clearance rate, and the overall efficacy rate at the mentioned 2 time points. The safety outcomes included adverse reactions and pharmacokinetic analysis posttreatment.

RESULTS

A total of 220 patients from 27 hospitals in China were randomly assigned to 4 groups. On D8, the efficacy rate was 100.0%, 96.7%, 96.7% for the 1‰ PL-5, 2‰ PL-5, 4‰ PL-5 groups, respectively, as compared with 87.5% for the control group. The efficacy rate among the 4 groups was significantly different ( P <0.05). On D5, the efficacy rate was 100.0%, 93.4%, 98.3% for the 1‰ PL-5, 2‰ PL-5, 4‰ PL-5 groups, respectively, as compared with 82.5% for the control group. The efficacy rate among the 4 groups was significantly different ( P <0.05). The blood concentration of PL-5 was not detectable in pharmacokinetic analysis. No severe adverse event related to the application of PL-5 was reported.

CONCLUSIONS

Antimicrobial peptide PL-5 spray is safe and effective for the treatment of skin wound infections.

TRIAL REGISTRATION

ChiCTR2000033334.

Heavy Metal Ions Detection Using Nanomaterials-Based Aptasensors

Heavy metals ions as metallic pollutants are a growing global issue due to their adverse effects on the aquatic ecosystem, and human health. Unfortunately, conventional detection methods such as atomic absorption spectrometry exhibit a relatively low limit of detection and hold numerous disadvantages, and therefore, the development of an efficient method for in-situ and real-time detection of heavy metal residues is of great importance. The aptamer-based sensors offer distinct advantages over antibodies and emerged as a robust sensing platform against various heavy metals due to their high sensitivity, ease of production, simple operations, excellent specificity, better stability, low immunogenicity, and cost-effectiveness. The nucleic acid aptamers in conjugation with nanomaterials can bind to the metal ions with good specificity/selectivity and can be used for on-site monitoring of metal ion residues. This review aimed to provide background information about nanomaterials-based aptasensor, recent advancements in aptamer conjunction on nanomaterials surface, the role of nanomaterials in improving signal transduction, recent progress of nanomaterials-based aptasening procedures (from 2010 to 2022), and future perspectives toward the practical applications of nanomaterials-based aptasensors against hazardous metal ions for food safety and environmental monitoring.

Evaluation of Fluorescent Light Energy for the Treatment of Acute Second-degree Burns

INTRODUCTION

The use of photobiomodulation has been proposed to improve wound healing for the last two decades. Recent development in photobiomodulation has led to the development of a novel biophotonic platform that utilizes fluorescent light energy (FLE) within the visible spectrum of light for healing of skin inflammation and wounds.

MATERIALS AND METHODS

In this article, FLE was used in preliminary analysis on 18 case studies of acute second-degree burns and in a pilot study using an ex vivo human skin model. Efficacy of FLE on wound healing and tissue remodeling was evaluated by monitoring improvements in the treated tissues, assessing pain for the patients, and by performing human genome microarray analysis of FLE-treated human skin samples.

RESULTS

Healing was reported for all 18 patients treated with FLE for acute second-degree burns without reported adverse effects or development of infections. Furthermore, preliminary ex vivo skin model data suggest that FLE impacts different cellular pathways including essential immune-modulatory mechanisms.

CONCLUSIONS

The results presented in this article are encouraging and suggest that FLE balances different stages of wound healing, which opens the door to initiating randomized controlled clinical trials for establishing the efficacy of FLE treatment in different phases of wound healing of second-degree burns.

The Comparison of Clinical and Histopathological Effects of Topical Psyllium (Plantago ovata) Powder and Silver Sulfadiazine on Second-Degree Burn Wound Healing in Rats

BACKGROUND

Burn wounds are a worldwide health problem, leading to physical and psychological disabilities in all age's groups. With regard to absorbent properties of Plantago ovata mucilage which can decrease wound moisture, we aimed to compare the effect of silver sulfadiazine (SSD) 1% and powdered P. ovata on second-degree burn wound healing in rats.

METHODS

This experimental study was conducted on 30 male Wistar rats with second-degree burn in three groups. Group 1 (control) did not receive any treatment; group 2 and group 3 (treated groups) were dressed daily using SSD cream and P. ovata powder, respectively. The weight of rats, wound size (by applying ImageJ software) and percentage of wound healing on the 5^th, 7^th, 10^th, 13^th, 16^th, 19^th, and 22^nd days (by diagnosing a plastic surgeon) and histological cutaneous changes at day 22 were evaluated. The Prism software was applied for data analysis. The Haematoxylin & Eosin as well as Masson's trichrome staining were performed on wound skin biopsies.

RESULTS

On day 22^nd, 20%, 50% and 60% of the rats had complete wound healing in the control, SSD and P. ovata groups, respectively. A significant decrease in wound size was shown in the treated groups compared to the control group (P<0.01), but no significant difference was shown between the treated groups (P>0.05).

CONCLUSION

However, the wound healing in P. ovata group or SSD was better than the control group, and the significant difference was not found with the treated group.