Honey for wounds

Has a low pH of 3.2-4.5 which increases the release of oxygen from hemoglobin and discourages proliferation of harmful proteases.

Has a high sugar content with a beneficial osmotic effect on the wound by drawing in moisture to hydrate and cleanses as well as provides anti-bacterial activity by drawing moisture from bacterial cells, inhibiting their growth.

Medicinal honey is not table use honey.

Different types of honey have different potency and antibacterial activity depending upon the amount of hydrogen peroxide and and it’s effect on osmolarity and acidity.

Bacterial activity of honey derived from manuka trees does not depend on hydrogen peroxide content, but on methylgloxal.

Methylglyoxal is a small water soluble molecule with antibacterial, immunostimulatory, and anti-inflammatory abilities.

Medicinal honey is sterilized by gamma radiation rather than heat to kill spores of Clostridium maybe present.

Can be used on any type of wound and at any stage of the healing process.

Use capable of clearing infection, healing infected surgical wounds, thwarting the progression of necrotizing fasciitis.

Has been used when wounds do not respond to conventional antibiotics and anti-septic therapy and in wounds infected with antibiotic resistant bacteria.

Can deodorize and debride wounds.

Can negate the need for plastic surgery by stimulating epithelium growth.

Reduces inflammation, edema, and exudate and soothes wounds and burns and minimizes scarring.

Has benefits in skin grafts, infected donor sites and traumatic wounds, abscesses, pilonidal sinuses, pressure ulcers, venous ulcers, diabetic ulcers, tropical holsters, sickle cell ulcers and malignant ulcers.

Can be used to manage peristromal excoriations around ileostomies and colostomies to facilitate epithelialization.

A biologic wound dressing with multiple bioactivities that expedite the healing process.

The physical properties expediting the healing process include: acidity increases the release of oxygen from hemoglobin thereby making the wound environment less favorable for the activity of destructive proteases, and the high osmolarity of honey draws fluid out of the wound bed to create an outflow of lymph as occurs with negative pressure wound therapy.

Has a low pH Of 3.2-4.5.

Increases release of oxygen from hemoglobin.

Decreases proliferation of harmful proteases.

Has a broad-spectrum antibacterial activity,

In most honeys the antibacterial activity is due to hydrogen peroxide, but much of this is inactivated by the enzyme catalase that is present in blood, serum, and wound tissues.

In manuka honey, the activity is due to methylglyoxal which is not inactivated, and can withstand dilution by wound exudate and maintain activity to inhibit the growth of bacteria.

Honey also has bioactivities that stimulate the immune response, promotes wound repair, suppresses inflammation, and brings autolytic debridement.

Its pH is less favorable for protease activity, thus reducing the destruction of the matrix needed for tissue repair.

The high osmolarity of honey due to its high sugar content is also beneficial to the healing process.

The osmotic effect of the sugar draws water out of the wound bed causing an outflow of lymph which is beneficial to the healing process,

Sugar also draws water out of bacterial cells and inhibits the growth of bacteria.

Honey is more effective than sugar in reducing bacterial contamination and promoting wound healing.

Reports suggest honey has antibacterial action in vitro against a wide range of species of bacteria and fungi.

Antibacterial potency can vary 100-fold between different types of honey.

Honey used in most products for wound care is typically standardized to be equivalent to 12% to 16% phenol.

Standardized honeys have reported MIC values for a range of species of bacteria present in infected wounds including: S. aureus, various coagulase-negative Staphylococci, various species of Streptococci, various species of Enterococci, Pseudomonas aeruginosa, Escherichia coli, Klebsiella oxytoca, and a number of anaerobes.

MIC values are below 11%, which means even when honey is heavily diluted by wound exudate, it still has enough potency of antibacterial activity to inhibit growth of bacteria.

Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) are sensitive to the antibacterial activity of honey as the nonresistant strains of those species.

Studies have shown no permanent decrease in susceptibility to honey could be created and no honey-resistant mutants could be detected, concluding that the risk of bacteria acquiring resistance to honey is low as long as high concentrations of honey are maintained clinically.

Constant exposure of bacterial organisms to increasing sublethal concentrations of honey does not raise the level of resistance past the initial MIC of the honey.

In most honeys, the antibacterial activity beyond that which is due to the osmolarity and acidity of the honey is due to hydrogen peroxide.

This antibacterial agent hydrogen peroxide is generated by glucose oxidase, an enzyme that bees add to the collected nectar stored in honeycombs.

Glucose oxidase enzyme is inactive under the low level of free water present in honey, but becomes active if the honey becomes diluted, as with wound exudate.

Serum and wound tissue contain the enzyme catalase which rapidly breaks down hydrogen peroxide.

Honey from manuka trees has antibacterial activity not due to hydrogen peroxide, and is not affected by the catalase enzyme activity in wounds.

Antibacterial activity is due to methylgloxal, which forms by spontaneous conversion in ripened honey from its precursor substance dihydroxyacetone that is found in manuka nectar.

Methylglyoxal on its own is a cytotoxic substance, an may contribute to delayed wound healing in patients with diabetes.

The antibacterial component of manuka honey is a water-soluble molecule that diffuses easily, which explains exhibiting efficacy against bacteria in biofilms.

The prolonged chronicity of wounds is due to colonization that develops into a biofilm in which the bacteria stay protected by its matrix.

These bacteria cannot be cleared by the host immune system and show resistance to both systemic and topical antimicrobial agents, explain why antibiotics are of limited use in treating chronic wounds.

Manuka honey is effective in achieving healing of chronic wounds.

The clearance of infection by the antibacterial activity of honey may be further augmented by its immunostimulatory action.

By helping suppress infection, it contributes to healing through the stimulation and growth of repair tissue.

The immunostimulatory activity of honey on leukocytes causes the production of cytokines, which leads to the stimulation and growth of cells.

Honey at a concentration of 1% stimulates release of tumor necrosis factor alpha (TNF-α) by monocytes.

There is a modulation of the inflammatory response by the anti-inflammatory activity of honey.

Honey suppresses the production of reactive oxygen intermediates formed in the respiratory burst.

At a concentration of 1% honey stimulates the release of TNF-α, interleukin-1 beta (IL-1β), and IL-6 from monocytes, cytokines known to play a role in tissue repair.45

Keratinocytes have been found to have transcription of the genes for the cytokines TNF-α, IL-1β, and TGF-α upregulated by honey at a concentration of 1%.

It upregulates the gene for matrix metallopeptidase 9 (MMP-9), which is a protease that detaches keratinocytes from the basement membrane to allow their migration in reepithelialization.

Reepithelialization is promoted by increased levels of TNF-α and IL-1β, which induce the production of the keratinocyte growth factor fibroblast growth factor.

Myeloperoxidase Antibodies, IgG, Serum

Useful in evaluating patients suspected of having immune-mediated vasculitis, especially microscopic polyangiitis (MPA), when used in conjunction with other autoantibody tests.

May be useful to follow treatment response or to monitor disease activity in patients with microscopic polyangiitis.

Myeloperoxidase (MPO) enzyme is found in neutrophil primary granules and monocyte lysosomes.

Myeloperoxidase catalyzes the conversion of hydrogen peroxide to hypochlorite and hypochlorous acid, and is encoded by a single gene that undergoes posttranslational modification to produce the active enzyme found in leukocytes.

Autoantibodies to MPO (MPO antineutrophil cytoplasmic antibodies: ANCA) occur in several diseases and may be involved in the pathogenesis of vascular inflammation in patients with microscopic polyangiitis (MPA).

Patients with MPA often develop MPO ANCA and may present with azotemia secondary to glomerulonephritis.

MPO ANCA are not specific for MPA, and also may be detected in patients with systemic lupus erythematosus with or without lupus nephritis, Goodpasture syndrome and Churg-Strauss syndrome.

Lupus nephritis and Goodpasture syndrome, as well as Wegener granulomatosis may present with azotemia and progressive renal failure.

Myeloperoxidase antibodies

<0.4 U (negative)

0.4-0.9 U (equivocal)

> or =1.0 U (positive)

A positive result has a high predictive value for microscopic polyangiitis in patients with negative test results for systemic lupus erythematosus (antinuclear antibodies) and Goodpasture syndrome (glomerular basement membrane antibody).

A negative result significantly diminishes the likelihood that a patient has MPA.

It is not possible to distinguish between microscopic polyangiitis (MPA) and other causes of progressive renal failure or systemic illness such as Wegener granulomatosis, lupus nephritis, Goodpasture syndrome.

The test for ANCA identifies 2 types of antibodies-cytoplasmic (cANCA), which are specific for PR3 and perinuclear (pANCA), which are specific for MPO.

The presence of MPO is quite specific for MPA with a diagnostic specificity approaching 95%.

pANCA, confirms the positive MPO result and increases the diagnostic specificity for MPA to 97%.

Positive results for MPO have been reported in patients with systemic lupus erythematosus, Goodpasture syndrome, and Churg-Strauss syndrome, so it is necessary to rule out these diagnoses to maximize the specificity and positive predictive value of the MPO test result.

Sequential measurements of MPO may be used to follow treatment response or to monitor disease activity in patients with MPA, results should not be exclusively relied upon to assess response to treatment or disease activity.

Honey applied to inflamed wounds and burns results in reduced edema and exudate, providing a soothing effect, and minimizing scarring.

Honey has a direct anti-inflammatory activity, not simply being a secondary effect of the antibacterial activity of honey removing inflammation-causing bacteria.

The anti-inflammatory activity of honey reduces the severity of mucositis in radiotherapy of the head and neck region, and can be used to treat gingivitis, dyspepsia, and ophthalmological inflammatory conditions.

Decrease pain after surgical removal of children’s tonsils, and also to decrease pain in nonhealing leg ulcers.

A bee-derived protein, apalbumin-1, was identified as the component of honey that inhibits phagocytosis by macrophages, the first step in the sequence of an inflammatory response to necrotic tissue and/or microbial cells.

Manuka honey is a much stronger inhibitor of phagocytosis than other types of honey.

Manuka honey inhibits phagocytosis,prevents formation of eschar, and effective in debriding wounds.

A good alternative to surgical debridement for the treatment of necrotizing fasciitis in the genital region.

Honey increases the activity of plasmin, an enzyme that specifically digests fibrin but does not digest the collagen matrix needed for tissue repair.

Increases plasmin activity by inhibiting the production of plasminogen activator inhibitor (PAI) by macrophages.

Honey creates a moist healing environment, one in which the antibacterial activity removes all likelihood of moist conditions favoring bacterial growth.

The combination of antibacterial and anti-inflammatory activities, along with the debriding action establishes why it can bring about the healing of chronic wounds.

The immunostimulatory action of honey, modulated by the anti-inflammatory activity promotes healing of chronic wounds that have remained nonhealing for long periods of time.

Honey must be present at the wound bed interface for bioactivities to work.

Providing optimal wound bed interface can be achieved by using of dressings in which the honey is impregnated in an absorbent material.

Honey can be used on any type of wound at any stage of healing, but it should always be sterilized since bacterial spores are not.

Sterilization should be done by gamma-irradiation, not heat, which would destroy the antibacterial activity.

Different types of honey have different potency and antibacterial activity depending on the amount ofof hydrogen peroxide and it’s effect on the honeys osmolarity and acidity.

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