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Objective: The purpose of this article is to determine the effects of CWs on health-related quality of life (HRQoL) and identify wound care practices among a select population in southwestern Nigeria.

Materials and methods: This is a descriptive study of 60 patients with CWs receiving outpatient care. Adult patients > 18 years of age with a wound duration > 3 months were chosen by convenience nonprobability sampling at the point of care. A pretested, semistructured, interviewer-administered questionnaire and a guided interview was provided to each patient to complete; collected data were coded to ensure confidentiality and input into computer software for statistical analysis.

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Results: The average respondent age was 48.3 years (range, 18-80 years). Male to female ratio was 1:1.2, with 71.7% married, 96.7% of the Yoruba ethnic group, and 40% traders by occupation. The average wound duration was 23.2 months (range, 3-240 months). Trauma was the most common etiology of CWs followed by infection. There was no relationship between wound duration and patients' gender. Most patients accessed care from more than 1 source simultaneously. The presence of CWs adversely affected the quality of life (R = -.288; P = .025). Many patients had varying degrees of abnormality in their mental health.

Conclusions: Chronic wounds are associated with poorer HRQoL, and simultaneous reception of wound care from multiple sources was common. These findings also suggest a need to pay increased attention to psychological aspects of patients with CWs.

Ethnopharmacological relevance: Traditional healers in Nigeria employ a range of plant preparations as wound healing agents. Despite the use of local plants in wound healing, there is only scant literature on the wound healing properties of these plants to support the continued therapeutic application of these herbal remedies.

Materials and methods: Structured questionnaires were used to determine which plant preparations are in common use, via interviews with Yoruba traditional healers. Aqueous and ethanolic extracts of the nine most common plants cited by the healers were collected, identified and tested using relevant in vitro wound healing assays. Minimum inhibitory concentrations (MIC) were determined against Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa and Bacillus subtilis. Antioxidant activity was measured by DPPH assay and fibroblast proliferation determined by neutral red assay.

Results: A total of 20 traditional healers from South-western Nigeria were involved in the study. Thirty-six plant species were recorded with their local names and parts used in the traditional wound healing preparations. Ethanolic extracts of nine species most frequently cited by the healers exhibited strong antioxidant activities (3.8-31.3 g/ml) comparable to ascorbic acid (7.3 g/ml). Crude extracts of the selected plants also inhibited the growth of bacteria with MIC values 0.3-7.6 mg/ml. Ethanol extracts of Bridelia ferruginea Benth. (1-30 g/ml) and Parkia biglobosa Jacq. (15-30 g/ml) influenced the proliferation of dermal fibroblasts significantly (p

Conclusion: Traditional use of many wound-healing plants from Nigeria can be rationalised by activity determined in relevant in vitro investigations of ethanol and aqueous extracts. These results support the traditional selection of these plants in South-western Nigeria for wound healing.

Despite the deployment of appropriately enhanced tissue growth and repair processes, microbial contamination poses a great threat to timely and successful healing of wounds. Unfortunately, wounds provide environment conducive for the growth of microbial organisms. Microbial infection of wounds delays healing[20,27,28] and causes a more pronounced acute inflammatory reaction[5] which can lead to further tissue injury and damage. Several organisms such as Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus faecalis, Escherichia coli, Clostridium perfringens, Clostridium tetani, Coliform bacilli and Enterococcus[28,29] have been implicated as wound contaminants. Evaluation of the antimicrobial activity showed that PAME inhibited the growth of cultures of S. aureus, B. subtilis, S. typhi, P. aeruginosa and K. pneumoniae to varying extents. The magnitude of sensitivity of the bacterial strains and hence antibacterial effect is of the order B. subtilis > S. aureus > S. typhi > P.aeruginosa > K. pneumoniae as shown by the minimum inhibitory concentrations (Table 4). Although these organisms were not wound isolates, inhibition of their growth indicates that PAME may protect wounds from contamination or infection with these and related microbes. This would enhance wound healing by allowing the natural tissue growth and repair processes already activated at the time of wound creation to proceed unhindered. Elsewhere, antimicrobial activity has been shown to contribute to the wound healing effects of honey, essential oil of Melaleuca alternifolia and leaf extracts of Aspilia africana[6,28,30,31]. It is thus likely, that the antibacterial activity of PAME may contribute to its wound healing potential. The PAME may also provide the additional benefit of accelerating the healing of contaminated wounds by eradicating already established infection by susceptible microorganisms.

Phytochemical analysis revealed the presence of alkaloids, carbohydrates, glycosides, tannins, reducing sugar, steroids, terpenoids, flavonoids and saponins which are typical plant constituents responsible for the diverse pharmacological activities of medicinal plants. These constituents may act in concert to mediate the effects of PAME in wound care. The abundance of tannins, which has been implicated in the haemostatic activity of plants where they arrest bleeding from damaged or injured vessels by precipitating proteins to form vascular plugs, may partly contribute to the haemostatic activity of PAME.

Our skin is the key to our survival, sensing the environment, maintaining physicochemical and thermal homeostasis, acting as a reservoir of essential nutrients, providing passive and active defence, and responding to trauma and injury [1]. Maintaining these critical functions requires robust and effective mechanisms to protect it from trauma and insult and to repair and replace critical skin functions when damaged or lost. Humans have been treating their wounds for millennia [2]. Traditional wound management is limited by what is immediately at hand or can be acquired locally, such as water, soil, and plant and animal products, and is frequently complemented with ceremony and ritual as an added measure. For millions of people across Asia, Africa, the Middle East, and Latin America, traditional medicines derived from local plants, animals, and natural products are the mainstay of wound care; for some, it is the only source of wound care [3]. We discuss herein some of the evidence supporting the use of medicinal plants as effective and affordable treatments for cutaneous wounds.

Acemannan, a major mucopolysaccharide (mesoglycan) from Aloe vera, is a potent stimulator of macrophage and T-cell activity and induces the transcription of proinflammatory mRNAs (including IL-1tag_hash_108, IL-1tag_hash_109, IL-6, TNF-tag_hash_110, PGE2, and nitrous oxide) [38]. Mesoglycan moieties bind and capture endogenous mitogen inhibitors and reactive oxygen species and promote phagocytosis. Coincidently, glycans stabilize secreted cytokines, growth factors, and other bioactives, prolonging their activity. Topically applied acemannan has been reported to significantly reduce the time to wound closure in a rat wound healing model, acting via cyclin D1 and AKT/mTOR signal pathways [39]. Aloe vera glycans are also reported to significantly improve de novo formation of granulation tissue by an unknown mechanism [40].

The root of Astragalus propinquus is a common TCM for the treatment of urinary retention and oedema [54]. The root of Rehmannia glutinosa has been broadly used in hemorheology and diabetes-related diseases [55]. A formulation combining the root of Astragalus propinquus and Rehmannia glutinosa was initially reported to be clinically effective for the treatment of diabetic foot ulcers [56]. This outcome has subsequently been corroborated in diabetic rats [57]. Tam et al. reported that the root of Astragalus propinquus and Rehmannia glutinosa promote diabetic wound healing and postischemic neovascularization by improving angiogenesis and attenuating tissue oxidative stress in diabetic rats [58]. Zhang et al. demonstrated that the root of Astragalus propinquus and Rehmannia glutinosa activate the TGF-tag_hash_1201 signalling pathway and stimulate increased deposition of ECM in human skin fibroblasts [59].

Endemic throughout the tropics and subtropics of Asia, Blumea balsamifera (also known as ngai camphor) is used widely as a traditional medicine. In the Philippines, Blumea balsamifera is known as sambong and is used as a diuretic. In Ayurveda, Blumea balsamifera is known as kakoranda and is used to treat fevers, coughs, aches, and rheumatism. Leaf extracts are directly applied to treat eczema, dermatitis, skin injury, bruises, beriberi, lumbago, menorrhagia, rheumatism, and skin injury [87]. Extracts from Blumea balsamifera demonstrate a variety of bioactivities; including antimalarial [88], antitumour [89], antifungal [90], and antiobesity [91] properties. Pang et al. reported that oils from Blumea balsamifera improve wound healing in mice by promoting angiogenesis, perfusion, collagen deposition, formation of organised granulation tissue, reepithelialization, and wound closure [92].

Frankincense, a resinous extract from Boswellia sacra, is valued in Africa, India, and the Middle East for the treatment of trauma and inflammatory diseases such as rheumatoid arthritis [93, 94]. It has also been reported that the boswellic acid acetate extracted from frankincense induces apoptosis and differentiation in melanoma and fibrosarcoma cells [95]. It is a key component of ANBP, a TCM consisting of pulverised Agrimonia eupatoria (A), Nelumbo nucifera (N), Boswellia sacra (B), and pollen from Typha angustifoliae (P). ANBP stimulates Smad-dependent pathways in the TGF-tag_hash_1311 signalling cascade [96]. Using a rabbit ear model of hypertrophic scarring, Hou et al. demonstrated that ANBP moderates inflammation and accelerates the growth of organized granulation tissue and reepithelialization, events that reduce scar formation [96]. Intriguingly, ANBP was also noted to attenuate collagen biosynthesis and accelerate the maturation of the collagen extracellular matrix, contributing to reduced scarring and improved skin tissue repair. Recently, Hou et al. further demonstrated that ANBP reduced the time of wound closure in diabetic mice via direct effects on neovascularization [97]. 2351a5e196