A systematic review and meta-analysis of dressings used for wound healing: the efficiency of honey compared to silver on burns

Perception, Awareness, and Practices Related to Burn First Aid Among the General Population in Qassim Region, Saudi Arabia

OBJECTIVES

This study aims to assess the perception, awareness, and practices related to burn first aid among the general population in the Qassim region of Saudi Arabia.

METHODS

 This is an observational, cross-sectional study that assesses perception, awareness, and practices related to burn first aid among the general population in the Qassim region of Saudi Arabia. The data was collected using questionnaires. The data was initially filtered and checked for completeness to rectify any errors or discrepancies. The Statistical Package for the Social Sciences (SPSS) version 24.0 (IBM SPSS Statistics, Armonk, NY, USA) was used for data analysis. The data was coded before entry into the software program. Descriptive statistics were applied, summarizing the data in terms of frequency and percentage. Chi-square tests were used for analyzing categorical variables and to determine the association between the groups, with significance set at a P-value of 0.05.

RESULTS

 Of the participants, 72.8% had previous knowledge regarding burns' first aid management. Furthermore, 3% obtained knowledge and information about burn first aid from a certified course, while 21.1% obtained the information from the Internet. Of the respondents, 77.8% indicated that during the exposure to burn, they would remove accessories and clothes that covered the injured area. Of them, 79.4% noted that they would apply water to the injured area in case of exposure to burns. In addition, 61.9% of the respondents used honey as a home remedy to treat burns, and 30.1% used toothpaste to treat burns.

CONCLUSION

Of the general population in the Qassim region of Saudi Arabia, 72.8% had basic knowledge regarding burns' first aid management. The study found certified courses and the Internet to be the main sources of information and knowledge about burns' first aid management. The study found that clothes and accessories that covered the injured area should be removed when exposed to burns. In addition, cold water should be applied for a period of at least 10 minutes. The study found honey and toothpaste to be the most common home remedies used to treat burns. The use of pure honey is an accepted intervention in the treatment of burns due to its benefit in stimulating the rapid regeneration of tissues and decreasing incidences of scar formation. However, there are wrong beliefs about the use of toothpaste in cases of burns because it exacerbates the initial injury, making it even worse. There are significant differences in the perception, awareness, and practice of the general population according to their education level (P-value = 0.003) and employment (P-value = 0.007).

Review of History of Basic Principles of Burn Wound Management

Thermal energy is an essential and useful resource to humans in modern society. However, a consequence of using heat carelessly is burns. Burn injuries have various causes, such as exposure to flame, radiation, electrical, and chemical sources. In this study, we reviewed the history of burn wound care while focusing on the basic principles of burn management. Through this review, we highlight the need for careful monitoring and customization when treating burn victims at each step of wound care, as their individual needs may differ. We also propose that future research should focus on nanotechnology-based skin grafts, as this is a promising area for further improvement in wound care.

Variation in definitions of burn wound infection limits the validity of systematic review findings in burn care: A systematic review of systematic reviews

INTRODUCTION

Systematic reviews (SR) of high-quality randomised controlled trials can identify effective treatments for burn wound infections (BWIs). Clinical heterogeneity in outcome definitions can prevent valid evidence synthesis, which may limit the reliability of the findings of SRs affected by this heterogeneity. This SR aimed to investigate whether there is variation BWI definitions across studies in SRs of burn care interventions and its impact on identification of effective treatments for patients with burn injuries.

METHODS

A systematic search of five databases was conducted. Included SRs were: in English, published from January 2010 to October 2018, assessed intervention effects for patients with a burn injury, and reported data about BWI.

RESULTS

Twenty-nine SRs, which included 248 studies reporting BWI outcomes, were included in our final dataset. Three SRs used a definition of BWI to select studies for inclusion. Fourteen reported BWI definitions from included studies in the review results. There was heterogeneity of BWI definition in their included studies; across 29 SRs, 32 different BWI indicators were used, with the median across SRs ranging from 1 to 7 (range 1-14). Fourteen SRs accounted for BWI definition heterogeneity in their conclusions, indicating that the issue impacted whether a conclusion could be drawn, and limited the validity of the SR findings.

CONCLUSIONS

There is variation in BWI definition across SRs and within the studies included in SRs of interventions assessing BWI outcomes. This heterogeneity has prevented conclusions about intervention effects being drawn, and only half of the SR authors have accounted for it in their findings. Reviews that have collated this data without reference to the heterogeneity should be viewed with caution, since it may limit the validity of evidence for the identification of effective treatments for BWI. The use of a newly developed core indicator set to support consistent reporting of indicators and standardisation of BWI outcome reporting will enable effective evidence synthesis.

A Scoping Review of the Evidence for the Medicinal Use of Natural Honey in Animals

Honey has a history of medicinal use that predates written records. In recent decades, there has been renewed interest in the use of honey in human medicine, particularly for the treatment of burns and other wounds. Several recent systematic reviews in the human literature have demonstrated the efficacy of honey in the treatment of a number of conditions, including burns, wounds and oral mucositis. The goal of this scoping review was to describe the nature and extent of the current body of evidence addressing the medicinal use of natural honey and/or its derivatives in animals. Although the focus of this review was the veterinary literature, all animal species except insects and humans were eligible, including animals used for biomedical research. Electronic databases searched were MEDLINE, CAB Abstracts, AGRICOLA, Web of Science Core Collection, and Web of Science SciELO Citation Index. A total of 397 articles reporting 436 primary research studies were included in this review. The majority of the articles were biomedical research articles (n = 350); fewer veterinary research articles were identified (n = 47). Apart from one systematic review, all biomedical studies were challenge trials. Most veterinary studies were case reports/series (n = 23), followed by challenge trials (n = 18) and controlled trials (n = 8). The animal species examined within veterinary articles consisted primarily of dogs, horses, cats and cattle, whereas the majority of biomedical research articles examined rats and mice. Wound healing was the most common indication examined; other indications examined included the prevention or treatment of gastric ulcers, bacterial and parasitic infections, toxic exposures, metabolic conditions (e.g., diabetes) and neoplasia. The majority of interventions consisted of non-medical grade honey (n = 412/436), followed by medical-grade honey (n = 29/436) and derivatives of natural honey (n = 9/436). With much of the current veterinary literature consisting of case reports and case series, high-quality primary veterinary research in the form of controlled trials or challenge trials is needed to advance this field, as well as to provide sound data for evidence-based assessments of the efficacy of honey in clinical veterinary practise.

Efficacy of a Natural Topical Skin Ointment for Managing Split-Thickness Skin Graft Donor Sites: A Pilot Double-blind Randomized Controlled Trial

OBJECTIVE

To evaluate the safety and efficacy of a new topical skin ointment with natural ingredients (aloe vera, honey, and peppermint) for dressing skin graft donor sites.

DESIGN

A double-blind, placebo-controlled, randomized clinical trial.

PATIENTS AND INTERVENTION

Researchers enrolled patients who were referred for split-thickness skin graft after burns or surgical wounds on the scalp or face area. For each patient, a thin layer of skin (depth, 0.04 mm; approximate size, less than 15 × 7 cm) was harvested from the thigh by a plastic surgeon with an electric or manual dermatome. The donor sites were divided and randomized to receive either natural ointment or petroleum jelly as a topical agent to dressing. Topical agents were applied on donor site wounds on days 0, 4, 7, and 14.

MAIN OUTCOME MEASURES

Wound size, pain, erythema, pruritus, patient discomfort, complications, and physician satisfaction were evaluated at each visit.

MAIN RESULTS

Among 28 patients, there was no significant difference between the two treatment agents regarding the rate of wound healing (P = .415), pain (P = .081), pruritus (P = .527), and patient discomfort (P = .616). The ointment was superior to petroleum jelly in reducing wound erythema (P = .001) and was associated with significantly better treatment satisfaction (P < .001).

CONCLUSIONS

The natural topical ointment investigated in this study may be an acceptable alternative to petroleum jelly in caring for split-thickness donor skin graft donor site wounds to effectively promote wound healing, prevent infection and scarring, reduce pain, and comfort the patient.

Antimicrobial activity of honey in periodontal disease: a systematic review

BACKGROUND

Honey has shown positive antimicrobial and anti-inflammatory actions in several dermatological studies; however, it is unclear if it could be effective in the treatment of periodontal disease.

OBJECTIVES

To answer the question: Does honey have antimicrobial activity against periodontopathogens?

METHODS

Six electronic databases were screened from initiation to 31 January 2019 for randomized clinical trials (RCTs) and controlled in vitro studies exploring the antimicrobial effect of honey against periodontopathogens. Honey's botanical origin, periopathogens that showed microbial susceptibility to honey, MICs, microbial growth conditions, control product and clinical follow-up were the main investigated outcomes. The risk of bias (RoB) of included RCTs was assessed using the Cochrane Collaboration RoB tool. The RoB of in vitro studies was evaluated based on the Sarkis-Onofre judgement model adapted to the context of honey.

RESULTS

A total of 1448 publications were found as search results in the screened databases. Sixteen eligible papers were included based on predetermined inclusion criteria. Retained studies included 5 RCTs and 11 in vitro controlled trials. Manuka and multifloral honeys were the most studied varieties. The tested honeys showed a significant antimicrobial action, with different MICs, against eight periopathogens. Four of the five RCTs showed a high RoB, while 4 of the 11 retained in vitro studies showed a medium RoB.

CONCLUSIONS

Honey showed a significant antimicrobial activity against all targeted periopathogens. Additional experiments are required to explore the entire antimicrobial spectrum of honey towards all pathogens involved in periodontal disease.

Vitamin C Enhances the Antibacterial Activity of Honey against Planktonic and Biofilm-Embedded Bacteria

Multifactorial antibacterial action is an important feature of honey; however, its bactericidal efficacy against biofilm-embedded bacteria is limited. The aim of this study was to investigate the impact of vitamin C (Vit C) on the antibacterial activity of natural honeys against planktonic as well as biofilm-embedded bacterial pathogens. The antibacterial activity of four honey samples supplemented with Vit C was expressed as the minimum inhibitory concentration (MIC). At sub-MICs, Vit C significantly increased the antibacterial activity of the tested honeys against Pseudomonas aeruginosa in planktonic cultures. However, after supplementation, honeydew honey, the most active honey, was ineffective against Staphylococcus aureus. On the other hand, when 100% honeydew honey was supplemented with Vit C (100 mg/g of honey) in a multispecies wound biofilm model, complete eradication of almost all bacterial isolates, including S. aureus, was observed. Furthermore, a mixture of honey and Vit C was partially effective against Enterococcus faecalis, whereas honey alone exhibited no antibacterial activity against this bacterium. Vit C counteracted hydrogen peroxide in honey solution and, thus, eliminated the major antibacterial compound present in honey. It is likely that a combination of honey with Vit C may trigger the intracellular production of reactive oxygen species in bacterial cells, but the exact cellular mechanisms warrant further investigations.

Evaluation of the In Vitro Wound-Healing Activity of Calabrian Honeys

The healing of skin wounds and particularly chronic wounds, such as diabetic foot ulcers, is still a clinical emergency. Despite the many therapeutic tools that are available so far, none seems to be really effective and safe. In this context, we highlighted the renewed wound healing activity of honey, a viscous aromatic and sweet food, by way of in vitro wound-healing assays, using the HaCaT cell line. Specifically, we investigated five monofloral or multifloral honeys from different Calabrian provinces using them as such or extracted (by Amberlite^® or n-hexane and ethyl acetate). The chemical composition of honeys was ascertained by ¹H NMR spectroscopy and by the gas chromatography/mass spectrometry (GC/MS) method for volatile organic compounds (VOCs). Amongst the five tested honeys, BL1 and BL5 honeys showed the most promising healing properties. Pinocembrin, which was revealed in BL1 (multifloral) and BL5 (orange) honey samples, is a flavanol that is already known to possess interesting biological activities, including healing. This study aims to investigate how a traditional food such as honey, which is appreciated for its nutritional value and used in folk medicine, can be enhanced as an effective modern remedial to promote a multifaceted and safe healing activity for all skin wounds.

[Management of postoperative infections in urologic surgery]

INTRODUCTION

The incidence of surgical site infections (SSI) in urological surgery is highly variable. The latest report of the "Institut de veille sanitaire" (InVS) found an incidence of SSI of 3% but in some specific clinical situations, rates close to 20% are sometimes observed. The aim of this publication is to provide urology nurses with a summary of the management of the main postoperative infections that can be encountered in urological surgery.

MATERIAL AND METHOD

The main infectious pathologies likely to be encountered after urology have been classified in 4 chapters by repeating the formulations used by InVS by adding the specificities related to urological surgery. The management of the pathologies described is based on current French and European guidelines.

RESULTS

The importance for urology nurses to know how to recognize a potentially lethal SSI is here to remind, especially with the need to master the use of the "quick SOFA" score. The SSI in urology were then grouped as follows: postoperative urinary tract infection, superficial wound infection, deep wound infection, organ infection and material's infection.

CONCLUSION

While urinary tract infections are potentially the most serious and sometimes fatal, superficial or deep infections can be a source of prolonged hospitalization with repercussions on postoperative rehabilitation of patients. Nurses must therefore be fully trained to recognize them because they are often in the front line in case of occurrence of a SSI.

Advancements in Regenerative Strategies Through the Continuum of Burn Care

Burns are caused by several mechanisms including flame, scald, chemical, electrical, and ionizing and non-ionizing radiation. Approximately half a million burn cases are registered annually, of which 40 thousand patients are hospitalized and receive definitive treatment. Burn care is very resource intensive as the treatment regimens and length of hospitalization are substantial. Burn wounds are classified based on depth as superficial (first degree), partial-thickness (second degree), or full-thickness (third degree), which determines the treatment necessary for successful healing. The goal of burn wound care is to fully restore the barrier function of the tissue as quickly as possible while minimizing infection, scarring, and contracture. The aim of this review is to highlight how tissue engineering and regenerative medicine strategies are being used to address the unique challenges of burn wound healing and define the current gaps in care for both partial- and full-thickness burn injuries. This review will present the current standard of care (SOC) and provide information on various treatment options that have been tested pre-clinically or are currently in clinical trials. Due to the complexity of burn wound healing compared to other skin injuries, burn specific treatment regimens must be developed. Recently, tissue engineering and regenerative medicine strategies have been developed to improve skin regeneration that can restore normal skin physiology and limit adverse outcomes, such as infection, delayed re-epithelialization, and scarring. Our emphasis will be centered on how current clinical and pre-clinical research of pharmacological agents, biomaterials, and cellular-based therapies can be applied throughout the continuum of burn care by targeting the stages of wound healing: hemostasis, inflammation, cell proliferation, and matrix remodeling.

Poor methodological quality and reporting standards of systematic reviews in burn care management

The methodological and reporting quality of burn-specific systematic reviews has not been established. The aim of this study was to evaluate the methodological quality of systematic reviews in burn care management. Computerised searches were performed in Ovid MEDLINE, Ovid EMBASE and The Cochrane Library through to February 2016 for systematic reviews relevant to burn care using medical subject and free-text terms such as 'burn', 'systematic review' or 'meta-analysis'. Additional studies were identified by hand-searching five discipline-specific journals. Two authors independently screened papers, extracted and evaluated methodological quality using the 11-item A Measurement Tool to Assess Systematic Reviews (AMSTAR) tool and reporting quality using the 27-item Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Characteristics of systematic reviews associated with methodological and reporting quality were identified. Descriptive statistics and linear regression identified features associated with improved methodological quality. A total of 60 systematic reviews met the inclusion criteria. Six of the 11 AMSTAR items reporting on 'a priori' design, duplicate study selection, grey literature, included/excluded studies, publication bias and conflict of interest were reported in less than 50% of the systematic reviews. Of the 27 items listed for PRISMA, 13 items reporting on introduction, methods, results and the discussion were addressed in less than 50% of systematic reviews. Multivariable analyses showed that systematic reviews associated with higher methodological or reporting quality incorporated a meta-analysis (AMSTAR regression coefficient 2.1; 95% CI: 1.1, 3.1; PRISMA regression coefficient 6·3; 95% CI: 3·8, 8·7) were published in the Cochrane library (AMSTAR regression coefficient 2·9; 95% CI: 1·6, 4·2; PRISMA regression coefficient 6·1; 95% CI: 3·1, 9·2) and included a randomised control trial (AMSTAR regression coefficient 1·4; 95%CI: 0·4, 2·4; PRISMA regression coefficient 3·4; 95% CI: 0·9, 5·8). The methodological and reporting quality of systematic reviews in burn care requires further improvement with stricter adherence by authors to the PRISMA checklist and AMSTAR tool.

Honey and Wound Healing: An Update

For centuries, honey has been utilized for wound healing purposes. In recent times, this specific topic has become a field of interest, possibly due to the advent of antibiotic resistance in microbial pathogens. With constant technological advancement, the information regarding honey's mechanisms of action on wound healing has accumulated at a rapid pace. Similarly, clinical studies comparing honey with traditional wound care therapies are steadily emerging. As a follow-up to a previous review published in the journal in 2011, the current review article outlines publications regarding honey and wound healing that have been published between June 2010 and August 2016. Here we describe the most recent evidence regarding multiple types of honey and their mechanisms of action as antimicrobial agents, immunologic modulators, and physiologic mediators. In addition, outcomes of clinical studies involving a multitude of cutaneous wounds are also examined.