Sugar for wounds

Treatment of recalcitrant chronic leg ulcer in a known sickle cell anaemia patient using honey and fresh hbaa red cell concentrate in a Nigerian secondary healthcare facility

Sickle hemoglobin (HbS) formed by the point mutation in the genetic code of beta-globin chain leading to valine substituting glutamic acid at position 6 of the beta-chain. The resultant sickle cell disease (SCD) characterized by occlusion of microvasculature by red blood cells is associated with multiple organ pathologies. One of such complications is chronic leg ulcers. We report a case of chronic leg ulcer, in a known sickle cell anemia patient, which did not respond to the wound dressing methods at the hospital's disposal. The ulcer was successfully treated using standard operative procedure (S.O.P) in wound care, applying local honey, and use of blood transfusion. EA was a 20-year-old university undergraduate who was admitted to April 2019 in Central Hospital Benin City with chronic leg ulcer of 1 year duration. She was also anemic with hemoglobin concentration of 3.0 g/dl (packed cell volume 15%). The wound was dressed with local honey, and anemia corrected with blood transfusion using concentrated red cells lacking the HbS trait. There was a progressive improvement in the healing of the ulcer with total closure after 4 months of treatment. Maintenance and follow-up measures were instituted to prevent reoccurrence. This report showed that honey has remarkable properties in promoting wound healing. Its usage in combination with transfusion of HbA red blood cells to manage chronic leg ulcers in SCD patients is advocated. However, this calls for further studies and research.

Clinical characteristics, treatment, and outcome for cattle that developed retroperitoneal abscesses following paralumbar fossa laparotomy: 32 cases (1995-2017)

OBJECTIVE

To describe the clinical and clinicopathologic characteristics, treatment, and outcome for cattle that developed a retroperitoneal abscess (RA) following paralumbar fossa laparotomy (PFL).

ANIMALS

32 Holstein cows with RA.

PROCEDURES

The record database of a veterinary teaching hospital was searched to identify cattle that were treated for an RA between January 1995 and March 2017. Cattle with an RA > 30 cm in diameter located 3.5 cm subjacent to the skin that had undergone a PFL < 3 months before examination for the RA were evaluated. Information extracted from the record of each cow included signalment; physical examination, clinicopathologic, and transabdominal ultrasonographic findings; treatments administered; and outcome. Milk production data were analyzed for the lactations before, during, and after RA treatment.

RESULTS

Common physical examination findings were rumen hypomotility, anorexia, and fever, and common clinicopathologic findings were anemia and neutrophilia. Abdominal palpation per rectum and transabdominal ultrasonography facilitated RA diagnosis and identification of the optimal location for drainage. Thirty of 32 cows underwent surgical drainage of the RA and prolonged administration of systemic antimicrobials. Two cows were euthanized because of concurrent peritonitis, including 1 that underwent surgical RA drainage. Thirty cows were discharged from the hospital alive, and most returned to their previous level of milk production.

CONCLUSIONS AND CLINICAL RELEVANCE

Although uncommon, RA should be suspected in cows that develop anorexia and fever within 3 months after PFL. Cows with RA often returned to their previous level of milk production, but treatment was generally prolonged and costly.

Dressings, Topical Therapy, and Negative Pressure Wound Therapy

The current epidemic of diabetes has created a high demand for skilled wound-care professionals. Wound-care treatment begins with an appreciation of the cause of the ulceration and an adherence to the fundamental pillars of wound care. Also critical in the wound management paradigm is the optimization of the wound environment to facilitate the progression through the stages of healing. This can be accomplished through the use of different topical therapies and wound dressings to generate a favorable condition conducive to healing. This article summarizes the updated literature and best practices related to this topic.

Comparative Assessment on Selected Physicochemical Parameters and Antioxidant and Antimicrobial Activities of Honey Samples from Selected Districts of the Amhara and Tigray Regions, Ethiopia

The composition and properties of natural honeys differ with plant species on which the bees forage and the climatic conditions of the production areas. In Ethiopia, Amhara and Tigray are neighboring regions consisting of different agricultural activities and blossoms from different types of vegetations which may influence the natural composition and hence the properties of honey. So, the aim of the current study was to assess the quality of honey from selected districts of the two regions. In the study, 18 composited honey samples were collected from six selected districts and analyzed for selected physicochemical parameters and antioxidant and antimicrobial activities. The analyses of physicochemical parameters were carried out following standard procedures of IHC and QSAE. The antioxidant activity was determined by analyzing the RSA using DPPH while the antibacterial activities were determined by the agar well diffusion method. The moisture, ash content, electrical conductivity, pH, free acidity, reducing sugar, and sucrose content of the honey samples were found to be in the range 16.34 ± 0.26 to 19.83 ± 0.43 %, 0.08 ± 0.00 to 0.45 ± 0.03 %, 0.19 ± 0.00 to 0.89 ± 0.03 mS/cm, 3.79 ± 0.04 to 4.20 ± 0.01, 19.56 ± 1.13 to 38.11 ± 1.54 meq/kg, 62.10 ± 0.48 to 66.37 ± 0.20 %, and 1.35 ± 0.08 to 5.96 ± 0.10 %, respectively. The total phenolic content ranged from 1165.60 ± 23.45 to 1854.83 ± 10.47 mg/kg with antioxidant activity of 21.64 ± 0.26 to 36.12 ± 0.52 AEAC/100 g. The total phenolic contents showed strong correlation with RSA. Furthermore, all honey samples showed an antibacterial activity varying from 23.23 ± 0.12 to 28.84 ± 0.24 mm.

Glucose as a cause of and treatment for cutaneous necrosis

Sclerotherapy remains one of the procedures most frequently performed by Brazilian vascular surgeons. Knowledge of its complications is indispensable to enable us to avoid them. The severe side effects of this method of treatment for telangiectasias of the lower limbs are rare and are often associated with technical errors or the dose injected. Complications are predominantly local, but are sometimes difficult to resolve. We report a case of formation of cutaneous necrosis after chemical sclerotherapy using hypertonic glucose (75%), which healed when treated with a topical preparation containing vaseline and 60% glucose, with satisfactory esthetic results.

Application of Hyperosmotic Nanoemulsions in Wound Healing: Partial Thickness Injury Model in Swine

Objective: In this work, we introduce a novel hyperosmotic nanoemulsion (HNE) topical agent for use in wound healing. These topical emulsion complexes combine a lipophilic thymol nanoemulsion with a hyperosmotic saccharide matrix. This combination has been previously shown to possess synergistic antimicrobial activity against a host of common and drug-resistant pathogens in vitro. Approach: In this study, we present additional data to assess the safety and efficacy of these emulsions in a partial thickness injury model in swine. Ten wounds sized 2 × 3.5 cm were created in 18 pigs using an electrodermatome set at a depth of 0.76 mm. The wounds were subsequently contaminated with a cocktail of Escherichia coli, Staphylococcus aureus, Enterococcus faecalis, and Candida albicans at 5 × 10⁷ total colony forming unit per wound. Treatments were subdivided in the control group and emulsion concentrations at 0.0%, 0.01%, 0.03%, and 0.063% thymol content. Longitudinal metrics for wound healing included rate of reepithelialization, wound bed color measurements, amount of wound exudate, wound swab culture data, and histological examination at 4, 7, and 14 days. The cosmetics of the healed wound were obtained at day 14 with three-dimensional photogrammetry. Results: Experimental results showed that HNE reduced the wound level bacteria count by ∼0.5-1 log versus controls after 24 h. The amount of pathogen reduction was weakly correlated to the concentration of the emulsion. In addition, all HNE groups maintained a moist wound environment and showed increased fibrin formation and improved hemostatic response. Innovation: No significant difference in the rate of reepithelialization or wound closure was found between treatment concentrations and control groups. HNE treatment did not demonstrate any adverse host tissue response. Conclusion: These results suggest HNE may be a candidate for reducing wound bacterial counts without compromising reepithelialization.

Use of granulated sugar therapy in the management of sloughy or necrotic wounds: a pilot study

OBJECTIVE

To determine the in vitro antimicrobial efficacy of three types of sugar and conduct a pilot clinical study with a view to developing a protocol for a randomised controlled trial (RCT).

METHOD

In the in vitro studies three types of granulated sugar (Demerara, granulated beet sugar and granulated cane sugar) were tested to determine their minimum inhibitory concentrations (MICs) against 18 Gram-negative and Gram-positive bacteria in a micro-titre broth dilution assay; growth inhibition of Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa in different concentrations of sugar (0.38-25%) was also tested over 12-hours in an agar diffusion assay. The pilot clinical study selected patients from a vascular surgical ward and a vascular outpatient department. All had acute or chronic exuding wounds, some of which were infected. White granulated sugar was applied to the wounds. The following parameters were assessed: surface area; wound characteristics including pain, malodour, appearance (slough/granulation); exudate level; pain level and bacterial load. Patients with diabetes had their blood sugar levels checked daily. All patients completed a short health questionnaire at the start and end of the study. Staff completed a satisfaction questionnaire at the end of the study. The study period was 21 days.

RESULTS

In vitro tests demonstrated that sugar inhibits bacterial growth. All three types of sugars had MICs ranging from 6-25% in the bacterial strains tested. The diffusion tests showed that strains were able to grow well in low concentrations of sugar but were completely inhibited in higher concentrations. The two granulated sugars were found to be slightly more effective than Demerara sugar, so the latter was excluded from the clinical pilot study. Twenty-two patients (20 inpatients and two outpatients) with sloughy or necrotic wounds were recruited into the clinical study. Two patients had MRSA and two had Staphylococcus colonisation at baseline. Blood sugar levels remained stable in the seven patients with insulin-dependent diabetes mellitus. All wounds were clean/debrided in a mean of 11.13 days. Pain and malodour reduced markedly. Patient and staff surveys revealed overwhelming support for the sugar therapy.

CONCLUSION

The pilot study achieved its aim of developing a protocol for a RCT. Preliminary data suggest that sugar is an effective wound cleansing and is safe to use in patients with insulin-dependent diabetes. In vitro studies demonstrate that sugar inhibits bacterial growth.

CONFLICT OF INTEREST

None.

Why do some cavity wounds treated with honey or sugar paste heal without scarring?

As well as having antimicrobial properties, honey and sugar paste are associated with scarless healing in some cavity wounds. This article uses evidence to suggest why these products can modify excessive collagen production to prevent scarring.