Treatment of Chronically Infected Open Mastoid Cavities With Medical Honey: A Randomized Controlled Trial

Ceftazidime Poloxamer Gel: Expanding the Therapeutic Armamentarium for Ciprofloxacin-Resistant Pseudomonas Mastoid Cavity Otorrhea

OBJECTIVE

To present and evaluate the treatment of ciprofloxacin-resistant Pseudomonas mastoid cavity otorrhea with a ceftazidime thermosensitive poloxamer gel.

STUDY DESIGN

A retrospective clinical capsule report.

PATIENTS

Three patients diagnosed with ciprofloxacin-resistant Pseudomonas otorrhea in the setting of a previous canal-wall-down mastoidectomy between March 2019 and June 2023 visiting our tertiary care institution were retrospectively reviewed.

INTERVENTION

Application of a 2% ceftazidime thermosensitive poloxamer gel to mastoid cavity.

MAIN OUTCOME MEASURES

No evidence of disease during microscopic inspection of the ear within a month of initial treatment or bacterial eradication on subsequent culture.

RESULTS

Two patients had complete resolution of symptoms and achieved a safe and dry ear after topical application of the hydrogel. The second patient had pseudomonal eradication on culture, but persistent otorrhea due to other multidrug-resistant bacteria and an anatomically unfavorable mastoid cavity, which ultimately resolved after revision surgery.

CONCLUSIONS

This small case series suggests that topical treatment of mastoid cavity otorrhea with a 2% ceftazidime poloxomer gel is a potential therapeutic avenue in patients with ciprofloxacin-resistant Pseudomonas .

Geographical Origin Authentication-A Mandatory Step in the Efficient Involvement of Honey in Medical Treatment

Nowadays, in people's perceptions, the return to roots in all aspects of life is an increasing temptation. This tendency has also been observed in the medical field, despite the availability of high-level medical services with many years of research, expertise, and trials. Equilibrium is found in the combination of the two tendencies through the inclusion of the scientific experience with the advantages and benefits provided by nature. It is well accepted that the nutritional and medicinal properties of honey are closely related to the botanical origin of the plants at the base of honey production. Despite this, people perceive honey as a natural and subsequently a simple product from a chemical point of view. In reality, honey is a very complex matrix containing more than 200 compounds having a high degree of compositional variability as function of its origin. Therefore, when discussing the nutritional and medicinal properties of honey, the importance of the geographical origin and its link to the honey's composition, due to potential emerging contaminants such as Rare Earth Elements (REEs), should also be considered. This work offers a critical view on the use of honey as a natural superfood, in a direct relationship with its botanical and geographical origin.

Autologous Platelet- and Extracellular Vesicle-Rich Plasma Is an Effective Treatment Modality for Chronic Postoperative Temporal Bone Cavity Inflammation: Randomized Controlled Clinical Trial

Purpose

To determine the efficacy of autologous platelet- and extracellular vesicle-rich plasma (PVRP) to treat chronic postoperative temporal bone cavity inflammation (CPTBCI) after exhausting surgical and standard conservative therapies.

Materials and Methods

Patients were randomly allocated to treatment with PVRP (PVRP group) or standard conservative methods (control group) in a setting of four once-monthly checkups and subsequent follow-up. The treatment outcome was measured with the Chronic Otitis Media Questionnaire-12 (COMQ-12), CPTBCI focus surface area, and CPTBCI symptom-free time after the fourth checkup.

Results

Eleven patients from each group completed the trial; 95% of patients suffered from chronically discharging mastoid cavity (the type of CPTBCI). Within four checkups, the COMQ-12 score decreased statistically significantly in the PVRP group (p < 0.001) but not in the control group (p = 0.339). The CPTBCI foci surface area decreased statistically significantly between the first and second checkups (p < 0.0005) but not between other checkups (p > 0.05) in the PVRP group. No statistically significant differences in CPTBCI foci surface area were detected between checkups in the control group (p = 0.152). Nine patients from the PVRP group and three patients from the control group were CPTBCI symptom-free at the fourth checkup. The median symptom-free time was 9.2 months (95% CI [7.4, 11.9]) in the PVRP group. Cumulatively, 49% of patients in the PVRP group remained CPTBCI symptom-free for 12.7 months after the fourth checkup.

Conclusion

Autologous PVRP represents a novel additional and successful treatment modality for a chronically discharging radical mastoid cavity when the surgical and standard conservative treatment methods have been exhausted.

Trial Number

https://clinicaltrials.gov (NCT04281901).

The roles of strawberry and honey phytochemicals on human health: A possible clue on the molecular mechanisms involved in the prevention of oxidative stress and inflammation

BACKGROUND

Oxidative stress and inflammation contribute to the etiopathogenesis of several human chronic diseases, such as cancer, diabetes, cardiovascular diseases and metabolic syndrome. Besides classic stimuli, such as reactive oxidant species, endotoxins (i.e., bacteria lipopolysaccharide), cytokines or carcinogens, oxidative stress and inflammation can be triggered by a poor diet and an excess of body fat and energy intake. Strawberry and honey are common rich sources of nutrients and bioactive compounds, widely studied for their roles exerted in health maintenance and disease prevention.

PURPOSE

This review aims to summarize and update the effects of strawberry and honey against oxidative stress and inflammation, with emphasis on metabolism and on the main molecular mechanisms involved in these effects.

METHODS

A wide range of literature, published in the last 10 years, elucidating the effects of strawberry and honey in preventing oxidative stress and inflammation both in vitro (whole matrix and digested fractions) and in vivo was collected from online electronic databases (PubMed, Scopus and Web of Science) and reviewed.

RESULTS

Strawberry and honey polyphenols may potentially prevent the chronic diseases related to oxidative stress and inflammation. Several in vitro and in vivo studies reported the effects of these foods in suppressing the oxidative stress, by decreasing ROS production and oxidative biomarkers, restoring the antioxidant enzyme activities, ameliorating the mitochondrial antioxidant status and functionality, among others, and the inflammatory process, by modulating the mediators of acute and chronic inflammation essential for the onset of several human diseases. These beneficial properties are mediated in part through their ability to target multiple signaling pathways, such as p38 MAPK, AMPK, PI3K/Akt, NF-κB and Nrf2.

CONCLUSIONS

Available scientific literature show that strawberry and honey may be effective in preventing oxidative stress and inflammation. The deep evaluation of the factors that affect their metabolism as well as the assessment of the main molecular mechanisms involved are of extreme importance for the possible therapeutic and preventive benefit against the most common human diseases. However, published literature is still scarce so that deeper studies should be performed in order to evaluate the bioavailability of these food matrices and their effects after digestion.

Medicinal honey in clinical practice: viable alternative or useful adjunct in wound care management?

In light of concerns raised about antimicrobial resistance, especially in hospitals, and the rise in bacteria that are resistant to antibiotics scientists are examining alternative sources and strategies to combat infection. Among the plethora of complementary medicines now being considered is honey, particularly manuka honey. Medicinal honey is a relatively new label given to some types of honey that have been shown to be effective antimicrobial agents in in vitro studies. Large-scale clinical trials are yet to be conducted but there is considerable interest and numerous case studies that demonstrate the benefits of medicinal honey, especially in wound healing.

Honey as a Treatment in Otorhinolaryngology: A Review by Subspecialty

OBJECTIVES

To provide an up-to-date review of honey's effectiveness and potential applications in otorhinolaryngology.

METHODS

A literature search of the online databases PubMed, EMBASE, and Cochrane Central Register of Controlled Trials was conducted.

RESULTS

Sixty-three studies were identified within head and neck surgery (n = 23, 36%); pediatric otolaryngology (n = 18, 29%); rhinology, sinus, and skull base surgery (n = 11, 17%); otology (n = 6, 10%), facial plastic and reconstructive surgery (n = 3, 5%); and laryngology (n = 2, 3%). Studies included 6 meta-analyses, 44 randomized control trials, 5 case reports, and 8 animal models or in vitro studies. Of 55 clinical studies, 50 reported Level 1 evidence (prospective randomized control trials), and 5 reported Level 4 evidence (case series). The evidence level by subspecialty was: head and neck surgery (Level 1 n = 23), pediatrics (Level 1 n = 18), rhinology (Level 1 n = 7, level 4 n = 1), otology (Level 1 n = 1, Level 4 n = 3), facial plastics and reconstructive surgery (Level 4 n = 1), and laryngology (Level 1 n = 2).

CONCLUSIONS

Honey can be used for a variety of otolaryngology conditions. The highest quality meta-analyses support oral honey for prevention and treatment of oral mucositis in cancer patients, cough associated with upper respiratory infection in children, and pain control after tonsillectomy. Further research will likely justify broader applications.

Histopathological and Inflammatory Features of Chronically Discharging Open Mastoid Cavities: Secondary Analysis of a Randomized Clinical Trial

Importance

Many patients with an open radical mastoid cavity experience therapy-resistant otorrhea. Little is known about the underlying histopathological substrate of unstable cavities and the correlation with treatment failure.

Objective

To study the histopathological and inflammatory features of chronically discharging open radical mastoid cavities and the influence of different treatments.

Design, Setting, and Participants

This secondary analysis of a randomized clinical trial was a histopathology study of tissue samples of a cohort of 30 patients with a chronically discharging open mastoid cavity. Samples were taken from the cavities, which were treated with either honey gel or conventional eardrops in a tertiary center between 2012 and 2013. Tissue staining was performed in May 2014; final computer analysis/correlation studies were performed in June 2016.

Main Outcomes and Measures

Differences of epithelial tissue coverage, infiltration of T cells (CD3, CD4, CD8) and macrophage (CD68, isoenzyme nitric oxide synthase, arginase 1) (sub-)populations, infection status, and the correlation with clinical presentation.

Results

There were 30 patients (24 [80%] male; mean [SD] age, 59 [14] years). Cavities were covered with either stratified squamous (keratinized) epithelium (n = 10), respiratory columnar epithelium (n = 9), or granulation tissue (n = 10). The presence of respiratory epithelium was associated with lower treatment success (posttreatment VAS improvement of 3.1 [95% CI, 0.5 to 5.8] for discomfort and 3.6 [95% CI, 0.2 to 6.9] for otorrhea in the group with granulation tissue coverage vs 4.9 [95% CI, 0.2 to 9.6] and 5.8 [95% CI, -0.1 to 11.6] in the group with squamous [keratinized] epithelium coverage and 1.4 [95% CI, -1.2 to 4.1] and 2.5 [95% CI, -1.3 to 6.2] in the group with respiratory columnar epithelium coverage). In all 3 tissue types of cavity-covering tissues, T-cell infiltrates consisted of helper T cells and cytotoxic T cells, together with a lower number of macrophages. The immunopositivity for isoenzyme nitric oxide synthase and arginase 1 was high and not restricted to a macrophage subpopulation, but seen in various cell types. Inflammatory infiltrations varied strongly in all 3 tissue modalities.

Conclusions and Relevance

Discharging open mastoid cavities can be classified histologically into 3 different types, based on their coverage: squamous epithelium, respiratory epithelium, or granulation tissue. Treatment is less successful in cavities covered with respiratory epithelium, possibly explained by the status of bacterial infection and local immunological differences.

Effect of United States buckwheat honey on antibiotic-resistant hospital acquired pathogens

INTRODUCTION

Due to an upsurge in antibiotic-resistant infections and lack of therapeutic options, new approaches are needed for treatment. Honey may be one such potential therapeutic option. We investigated the susceptibility of hospital acquired pathogens to four honeys from Wisconsin, United States, and then determined if the antibacterial effect of each honey against these pathogens is primarily due to the high sugar content.

METHODS

Thirteen pathogens including: four Clostridium difficile, two Methicillin-resistant Staphylococcus aureus, two Pseudomonas aeruginosa, one Methicillin-Susceptible Staphylococcus aureus, two Vancomycin-resistance Enterococcus, one Enterococcus faecalis and one Klebsiella pneumoniae were exposed to 1-50% (w/v) four Wisconsin honeys and Artificial honey to determine their minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) using the broth dilution method.

RESULTS

Buckwheat honey predominantly exhibited a bactericidal mode of action against the tested pathogens, and this varied with each pathogen. C. difficile isolates were more sensitive to the Wisconsin buckwheat honey as compared to the other pathogens. Artificial honey at 50% (w/v) failed to kill any of the pathogens. The high sugar content of Wisconsin buckwheat honey is not the only factor responsible for its bactericidal activity.

CONCLUSION

Wisconsin buckwheat honey has the potential to be an important addition to therapeutic armamentarium against resistant pathogens and should be investigated further.

Honey in the Prevention and Treatment of Infection in the CKD Population: A Narrative Review

Infection is a major cause of morbidity and mortality at all stages of chronic kidney disease (CKD). Multiresistant organisms are becoming increasingly common, particularly in the CKD population. Unfortunately, the rapid evolution of antibiotic resistance has not been mirrored by innovation in new antibiotic agents. Novel treatments are therefore urgently needed. Honey has garnered much interest due to its broad-spectrum antibacterial properties based on extensive experimental data. Unlike conventional antibiotics, honey has an added advantage as it appears to avoid inducing antimicrobial resistance in bacteria. This review discusses the potential mechanisms of action and role of honey in infection management in the general population, epidemiology and special challenges of infections in CKD populations, and the clinical trial evidence pertaining to the safety and efficacy of honey for the prevention and treatment of infections in CKD population.