Original research articleEffects of hypericum perforatum, clinoptilolite and hydrocolloid dressing on wound healing in diabetic rats
Introduction
Diabetic foot ulcer is an important diabetes complication that reduces individual's and family's quality of life, puts a strain on individual's and society's finances and that can cause amputation, infection and even death [[1], [2], [3]]. 19%–34% of diabetic patients are likely to be affected diabetic. It occurs in approximately 20% of diabetic diabetic foot. Amputation in people with diabetes is 10–20 times more common than in people without diabetes and it is estimated that every 30 s a lower limb or part of a lower limb is lost somewhere in the world as a consequence of diabetes [3,4].
As diabetic foot ulcer is complex, it takes a long time to heal [5,6]. The studies conducted in diabetic human and animal models have shown that there were some anomalies such as inflammation, collagen accumulation, intercellular matrix differentiation, fibroblast proliferation, and wound contraction during the healing process [[7], [8], [9], [10]]. Various methods have been used in the treatment of diabetic foot ulcer [[10], [11], [12]]. Hypericum Perforatum known as St. John’s wort has been used as a traditional treatment method in many countries [7,[13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25]]. Wound dressings have been used in diabetic ulcer care and treatment quite often. [12,[26], [27], [28], [29], [30], [31]]. The superiority of any wound dressing over another wound dressing hasn't been proved yet [32]. Clinoptilolite is a natural mineral that is used frequently in wound care among people [[35], [36], [37], [38], [39], [40], [41]].
Diabetic foot treatment requires a multidispliner approach. The nurse who is the primary professional in care of members of the team is an important element. Nowadays, nursing provides new evidence to look at evidence-based research rather than just to plan care in line with existing research results. Therefore, the care of diabetic foot ulcer is becoming increasingly important. It is important that the efficacy of Hypericum perforatum and Clinoptilolite used frequently among patients should be proved although they aren't used in clinic, and suitable conditions for preparation and their dosage should be determined. This study was conducted to compare the contribution of the three substances used in wound care to the healing of diabetic foot ulcer.
Section snippets
Material-Method
This study was carried out in Adnan Menderes University Faculty of Medicine Laboratory Animals Unit between June 2015 and August 2015. Researcher has got certificate of animal use in experimental research. All experimental procedures were approved by the Institutional Animal Ethics Committee. 30 Sprague-Dawley Rats at first (Hypericum perforatum Group = 6, clinoptilolite Group = 6, hydrocolloid Group = 6, Positive Control Group = 6 and Negative Control Group = 6) formed the sample of the study.
Materials
The effect of three different wound care products on wound healing was compared in this study. Hypericum perforatum, Clinoptilolite and Hydrocolloid Dressing were used.
The Hypericum perforatum that used in our study was prepared in Ege University Faculty of Pharmacy. 50 g fresh St John Worth flower was added to the 200 ml of olive oil and it aged for 40 days in the dark. Clinoptilolite (Froximun AG, Schlanstedt, Germany) and Hydrocolloid dressing (Comfeel® Plus, Coloplast A/S) which used in
Results
Diabetes developed in all rats in the experimental group. Polyuria, polydipsia and weight loss were observed in diabetic rats. The weight of the rats was tracked both before the experiment and on the 21st day. Blood glucose level was measured for diagnostic purpose at the 48th hour after streptozotocin injection and blood glucose level was measured for diabetes tracking on the 10th and 21st days. Accordingly, it was determined that blood glucose level of all the rats in the experimental group
Examination of hemotoxilen-eosine staining methods
Histopathological evaluations were performed with the aim of evaluating the wound healing microscopically; the findings were evaluated through histopathological grading created according to literature. Through Hemotoxilen-Eosine stain, routine histological examination was made. (Fig. 2).
According to the study results, while the score of inflammatory cell number in the group which wound care was applied with Hypericum perforatum was moderate level in the examination conducted on the 3rd day, it
Discussion
Wound healing is a physiological process. This process is impaired due to the presence of the diseases delaying the healing and causing wound formation such as diabetes. Factors that will accelerate the healing are needed because wound is open to infection and complications [3,6].
According to the study results, inflammatory cells that were dressed with Hypericum perforatum and were at moderate level on the 3rd day decreased on the 10th day and disappeared from the wound on the 21st day. The
Conclusion and suggestions
According to macroscopic observations and molecular number, it was determined that the most effective wound healing power was in the clinoptilolite group, hypericum perforatum group followed the clinoptilolite group by a narrow margin and the wound healed up later in the hydrocolloid dressing group. Larger wound size was measured in the control groups in each macroscopic examination than the other groups, and less molecule increase was observed microscopically, and as a result, the wound wasn't
Funding
This research was supported by Adnan Menderes University unit of scientific research projects (No. TPF-15048)
Disclaimer
Material has been reviewed by the Adnan Menderes University Animal Ethics Committee. Researcher has got certificate of animal use in experimental research. Experiments involving animals and adheres to principles stated in the Guide for the Care and Use of Laboratory Animals, NRC Publication, 2011 edition. All experimental procedures were approved by the Institutional Animal Ethics Committee.
References (49)
Clinical management of diabetic ulcers
Clin. Geriatric Med.
(2013)- et al.
Topical and biologic therapies for diabetic foot ulcers
Med. Clin. North Am.
(2013) - et al.
Medicinal plants popularly used in the villages of yunt Mountain (Manisa-Turkey)
Fitoterapia
(2008) - et al.
Evaluation of in-vivo wound healing activity of Hypericum patulum (Family: Hypericaceae) leaf extract on different wound model in rats
J. Ethnopharmacol.
(2000) - et al.
Investigations on the in vivo wound healing potential of Hypericum perforatum L
J. Ethnopharmacol.
(2010) - et al.
A review of the antibacterial activity of hypericum perforatum L
J. Ethnopharmacol.
(2010) - et al.
A novel wound healing ointment: a formulation of Hypericum perforatum oil and sage and oregano essential oils based on traditional Turkish knowledge
J. Ethnopharmacol.
(2011) - et al.
Recent advances on the development of wound dressings for diabetic foot ulcer treatment- a review
Acta Biomater.
(2013) - et al.
Diabetic foot
TAF Prev. Med. Bull.
(2010) Diyabetic foot enfections
Turkiye Klinikleri J. Gen. Surg.-Special Topics
(2010)
Diabetic foot ulcers and their recurrence
N. Engl. J. Med.
IDF Diabetes Atlas
Dysfunction and diabetes: effects on angiogenesis, vascular remodeling and wound healing
Int. J. Vasc. Med.
Wort’S Effect on Skin Wounds in Diabetic Rats
Wound repair at a glance
J. Cell Sci.
The role of ımmunomodulation on the healing of diabetic foot
J. Ankem
Comparison of the Effects of st. John’s Wort Oil, Sesame Oil and Isotonizing Dressing Materials that Used for Topical Wound Healing
Wound dressing in ulcer treatment
Turk. J. Dermatol.
Wound healing activity of st. John's wort (Hypericum perforatum l.) on chicken embryonic fibroblasts
J. Ethopharmacol.
An overview on hypericum species of Turkey
J. Pharmacogn. Phytother.
Hyperforin, an anti-inflammatory constituent from St. John’s Wort, inhibits microsomal prostaglandin E(2) synthase-1 and suppresses prostaglandin E(2) formation in vivo
Front. Pharmacol.
Evaluation of the wound healing effect of a novel hyperıcum perforatum oinment in skin ınjury, Rom
J. Morphol. Embriol.
Evaluation of the wound healing potentials of two subspecies of hyperıcum perforatum on cultured NIH3T3 fibroblasts
Phytother. Res.
Cited by (4)
The effect of hypericum perforatum oil on the healing process in the care of episiotomy wounds: A randomized controlled trial
2020, European Journal of Integrative MedicineCitation Excerpt :In Turkey, its above ground parts and the macerate of its flowers in the olive oil are traditionally used for the skin cuts and burns [19,20]. There are several studies in the literature showing the activity of HP on wound healing [21–24]. These studies demonstrated that HP accelerated the proliferative phase of wound healing, decreased the inflammation process, stimulated the collagen synthesis and the migration of the fibroblasts to the wounded area [20,21,23].
Effect of allicin on wound healing: An experimental diabetes model
2020, Journal of Wound Care