BALIN YARA İYİLEŞMESİ ÜZERİNE ETKİSİNİN DEĞERLENDİRİLMESİ

Bal, yüzyıllar boyunca Çin, Mısır, Rum, Asur ve Roma gibi çeşitli medeniyetler tarafından çeşitli yaraları ve hastalıkları tedavi etmek amacıyla kullanılmıştır. Ancak zaman içinde antibiyotiğin bulunması ile balın teda-vi amaçlı kullanımı azalmıştır. Son zamanlarda, mikrobik patojenlerde antibiyotik direncinin ortaya çıkması ile alternatif tedavi seçeneği olarak bal pansumanlarının etkisi araştırılmış. Teknolojinin gelişimi ile balın antibakteriyel ve iyileştirici etki mekanizmaları da yavaş yavaş anlaşılmaya başlanmıştır. Literatürde balın; antimikrobiyal, antienflamatuvar ve antioksidan özelliği nedeniyle, bağışıklık sistemini güçlendirici etki gös-terdiği belirtilmektedir. Bu özelliklerinin yanı sıra balın içeriğindeki protein, glikoz çeşitli vitamin ve mine-raller sayesinde yara iyileşmesi üzerinde de olumlu etkileri olduğu ve yara iyileşmesini hızlandırdığı tespit edilmiştir. Ayrıca balın, debridman eylemini uyarıcı, sahip olduğu osmotik etki, asiditesi, enzimatik reaksiyon sonucunda oluşturduğu hidrojen peroksit ve nitrik oksit oluşumunu uyarma özellikleri sayesinde, yara ye-nilenmesine önemli ölçüde katkıda sağladığı vurgulanmaktadır. Yapılan çalışmalarda, diğer yara iyileştirme yöntemlerinin başarısız olduğu yaralarda ve farklı yara tipleri üzerinde, balın etkili olduğu kanıtlanmıştır.Uygun pansuman ve yara bakımı iyileşmeyi desteklemede oldukça önemlidir. Bu nedenle yara bakımının primer sorumlusu olan sağlık profesyonellerinin alternatif tedavi seçeneği olarak bal pansumanı uygulaması ve etkileri konusunda bilgi sahibi olmaları oldukça önemlidir.Sonuç olarak bu derleme güncel çalışmalar ışığında balın yara iyileşmesi üzerine nasıl etki gösterdiğinin incelenmesi ve bal pansumanlarının yara iyileşmesinde tedavi seçeneği olarak kullanımını artırmak amacı ile yapıldı.

Evaluation of the Effect of Honey on Wound Healing

Honey has been used by various civilizations such as China, Egypt, Greece, Assyria and Rome for centuries to treat various injuries and diseases. However, over time, the discovery of antibiotics reduced the use of honey for therapeutic purposes. Recently, the effect of honey dressings as an alternative treatment option has been investigated with the emergence of antibiotic resistance in microbial pathogens. With the development of technology, the antibacterial and healing action mechanisms of honey have begun to be understood gradually. Honey in literature; antimicrobial, antiinflammatory and antioxidant properties, it is indicated that it has an immune system strengthening effect. In addition to these properties, it has been found that the protein, glucose, and other vitamins and minerals in the content of honey, have positive effects on wound healing and accelerate wound healing. It is also emphasized that honey provides significant contribution to wound renewal by stimulating debridement, osmotic action, acidity, stimulating the formation of hydrogen peroxide and nitric oxide, which is the result of the enzymatic reaction. Studies have proven that honey is effective on different wound types and that other wound healing methods have failed. Proper dressing and wound care are very important in supporting healing. For this reason, it is very important that health professionals who are primary responsibility of wound care have knowledge about the application and effects of honey dressing as an alternative treatment option. In conclusion, this review is aimed at examining how honey affects wound healing in current studies and to increase the use of honey dressings as a treatment option in wound healing.

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Rao PV, Krishnan KT, Salleh N, Gan SH. Biological and therapeutic effects of honey produced by honey bees and stingless bees: a comparative review. Revista Brasileira de Farmacognosia. 2016;26(5):657-664.
Terrab A, González AG, Díez MJ, Heredia, FJ. Characterisation of Moroccan unifloral honeys using multivariate analysis. European Food Research and Technology. 2003;218:88–95.
Ciulu M, Solinas S, Floris I, Panzanelli A, Pilo MI, Piu, PC, et al. RP-HPLC determination of water-soluble vitamins in honey. Talanta. 2011;83:924–929.
Taormina PJ, Niemira BA, Beuchat LR. Inhibitory activity of honey against foodborne pathogens as influenced by the presence of hydrogen peroxide and level of antioxidant power. International Journal of Food Microbiology. 2001;69:217–225.
Bittmann S, Luchter E, Thiel M, Kameda G, Hanano R, Langler A. Does honey have a role in paediatric wound management? Br J Nurs. 2010;19(15): S19-S24.
Oryan A, Alemzadeh E, Moshiri A. Biological properties and therapeutic activities of honey in wound healing: A narrative review and meta-analysis. Journal of Tissue Viability. 2016;25(2):98-118.
Lindberg T, Andersson O, Palm M, Fagerström C. A systematicreviewand meta-analysis of dressingsusedforwoundhealing: theefficiency of honeycomparedtosilver on burns. Contemporarynurse. 2015;51(2-3):121-134.
Kassim M, Achoui M, Mustafa MR, Mohd MA, Yusoff KM. Ellagic acid, phenolic acids, and flavonoids in Malaysian honey extracts demonstrate in vitro anti-inflammatory activity. Nutr. Res. 2010;30:650–659.
Fauzi AN, Norazmi MN, Yaacob NS. Tualang honey induces apoptosis and disrupts the mitochondrial membrane potential of human breast and cervical cancer cell lines. Food Chem. Toxicol. 2011;49:871–878.
Samarghandian S, Afshari JT, Davoodi S. Chrysin reduces proliferation and induces apoptosis in the human prostate cancer cell line pc-3. Clinics. 2011;66:1073–1079.
Al-Waili NS, Salom K, Butler G, Al Ghamdi AA. Honey and microbial infections: a review supporting the use of honey for microbial control. J Med Food 2011;14(10):1079-96.
Kamaruddin MY, Bekdemir Y, Öztürk F, Akka ZS, Suhaımı A, Mohdrazif MA, et al. Bal Sargısının Kronik Yaralar ve Ülserlerin İyileşmesindeki Etkinliği, Arı Ürünleri ve Sağlık (Apiterapi). 2015;11:78-89. https://www.researchgate.net/publication/289250940.
Lee DS, Sinno S, Khachemoune A. Honey and wound healing: an overview. Am J Clin Dermatol.2011;12(3):181e90
Kwakman PH, Zaat SA. Antibacterial components of honey. IUBMB Life. 2012;64(1):48e55.
Özler M, Şimşek K, Topal T, Öter Ş, Korkmaz A. Pinealektomili ratlarda yara iyileşmesi, Gülhane Tıp Dergisi. 2012;52:181-184.
Eming SA, Krieg T, Davidson JM. RETRACTED: Gene therapy and wound healing. Clin Dermatol. 2007;25(1):79-92.
Nguyen A, Hoang V, Laquer V, Kelly KM. Angiogenesis in cutaneous disease: part I. Journal of the American Academy of Dermatology. 2009;61(6):921-942.
Ribatti D. Endogenous inhibitors of angiogenesis: a historical review. Leuk Res. 2009;33(5): 638-44.
Henderson B, Nair S, Pallas J, Williams MA. Fibronectin: a multidomain host adhesin targeted by bacterial fibronectin-binding proteins. FEMS Microbiology Reviews. 2010;35(1):147-200.
AL-Waili N. Peritoneal macrophages transfusion in the treatment of chronic postoperative wound infections. J. Pak. Med. Assoc. 1989;39:310–312.
Bilik Ö. İnflamasyon, cerrahi yara iyileşmesi ve bakımı. İçinde: Eti Aslan F (editörler). Cerrahi bakım vaka analizleri ile birlikte. Ankara, Akademisyen Tıp Kitapevi, 2016.s.115-145.
Kaegi C. Honey for healing. Schweitz. Bienen-Zeitung. 1995 ;118:590–592.
Banby M. Healing effect of floral honey from sugar-fed bee, on surgical wounds (animal model). In Proceedings of the 4th International Conference on Apiculture in Tropical Climates, Cairo, November 6–10. International Bee Research Association, Cardiff, U.K. 1988;pp. 46–49.
Gilliand E, Dore C, Natchwani N. Bacterial colonization of leg ulcers and its effects on the success rate of skin grafting. Ann. R. Coll. Surg. Engl. 1988;70:105–108
Van der Weyden A. The use of honey for the treatment of two patients with pressure ulcers. Br. J. Community Nurs. 2003;8:S14– 20.
Al-Waili N, Saloom K. Effects of topical honey on post-operative wound infections due to gram positive and gram negative bacteria following caesarean sections and hysterectomies. Eur. J. Med. Res. 1999;4:126–130.
Finnegan M, Linley E, Denyer SP, McDonnell G, Simon C, Maillard JY. Mode of action of hydrogen peroxide and other oxidizing agents: differences between liquid and gas forms. J. Antimicrob. Chemother. 2010;65:2108–2115.
Brudzynski K, Abubaker K, St-Martin L, Castle A. Reexamining the role of hydrogen peroxide in bacteriostatic and bactericidal activities of honey. Front Microbiol. 2011;2(213):1-9.
Knight A. The therapeutic effects of honey. Plymouth Student Sci. 2013;6(1):376-385.
Rossiter K, Cooper AJ, Voegeli D, Lwaleed BA. Honey promotes angiogenic activity in the rat aortic ring assay. J Wound Care 2010;19(10):440-446.
Sell SA, Wolfe PS, Spence AJ, Rodriguez IA, McCool JM, Petrella RL, et al. A preliminary study on the potential of manuka honey and platelet-rich plasma in wound healing. Int J Biomater. 2012;2012(313781):1-14. doi:10.1155/2012/313781
Cho M, Hunt TK, Hussain MZ. Hydrogen peroxide stimulates macrophage vascular endothelial growth factor release. Am. J. Physiol. Heart Circ. Physiol. 2001;280:H2357–H2363.
White J, Subers M, Schepartz A. The identification of inhibine, the antibacterial factor in honey, as hydrogen peroxide and its origin in a honey glucose-oxidase system. Biochem. Biophys. Acta. 1963;73:57–79.
Molan PC. Honey as a topical antibacterial agent for treatment of infected wounds. 2001 Available from: http://www.worldwidewounds.com/2001/november/Molan/honey-as-topical-agent.html
Bang LM, Buntting C, Molan P. The effect of dilution on the rate of hydrogen peroxide production in honey and its implications for wound healing. J Altern Complement Med. 2003;9(2):267-73.
Brudzynski K. Effect of hydrogen peroxide on antibacterial activities of Canadian honeys. Can. J. Microbiol. 2006;52(12):1228–1237.
George NM, Cutting KF. Antibacterial honey (Medihoney):in vitro activity against clinical isolates of MRSA, VRE, and other multi resistant gram-negative organisms including Pseudomonas aeruginosa. Wounds. 2007;19(9):231-6.
Banaeian-Borujeni S, Mobini GR, Pourgheysari B, Validi M. Comparison of the effect of honey and miconazole against Candida albicans in vitro. Adv Biomed Res. 2013;30(2):57-74.
Yaghoobi R, Kazerouni A, Kazerouni O. Evidence for clinical use of honey in wound healing as an anti-bacterial, anti-inflammatory anti-oxidant and anti-viral agent: a review. Jundishapur J Nat Pharm Prod. 2013;8(3):100-4.
Kaufman T, Eichenlaub EH, Angel MF, Levin M, Futrell JW. Topical acidification promotes healing of experimental deep partial thickness skin burns: a randomized double-blind preliminary study. Burns Incl. Therm. Inj. 1985;12(2):84–90.
Lowe A, Bills J, Verma R, Lavery L, Davis K, Balkus Jr KJ. Electrospun nitric oxide releasing bandage with enhanced wound healing. Acta Biomater. 2015;13:121-30.
Kassim M, Achoui M, Mansor M, Yusoff KM. The inhibitory effects of Gelam honey and its extracts on nitric oxide and prostaglandin E(2) in inflammatory tissues. Fitoterapia. 2010;81(8):1196-1201.
Moncada S, Palmer RMJ, Higgs EA. Nitric oxide: physiology, pathophysiology, and pharmacology, Pharmacol. Rev. 1991;43(2):109–142.
Schwentker A, Vodovotz Y, Weller R, Billiar TR. Nitric oxide and wound repair: role of cytokines?. Nitric Oxide. 2002;7(1):1-10.
Wu HM, Huang Q, Yuan Y, Granger HJ. VEGF induces NO-dependent hyperpermeability in coronary venules,. American Journal of Physiology-Heart and Circulatory Physiology, 1996;271(6):H2735– H2739.
Childress B, Stechmiller, K. Role of nitric oxide in wound healing. Biol. Res. Nurs. 2002;4:5–15.
Koetzler R, Zaheer RS, Newton R, Proud D. Nitric oxide inhibits IFN regulatory factor 1 and nuclear factor-kappaB pathways in rhinovirus-infected epithelial cells. J. Allergy Clin. Immunol. 2009;124(3):551–557.
Al-Waili N. Identification of nitric oxide metabolites in various honeys: effects of intravenous honey on plasma and urinary nitric oxide metabolites concentrations. J. Med. Food. 2003;6:359–364.
AL-Waili N. Honey increased saliva, plasma, and urine content of total nitrite concentrations in normal individuals. J. Med. Food. 2004;7:377–380.
Ricciotti E, FitzGerald GA. Prostaglandins and inflammation. Arteriosclerosis, Thrombosis, and Vascular Biology. 2011;31(5):986-1000.
AL-Waili N. Effect of honey on urinary excretion of prostaglandin and nitric oxide urinary nitrite. Int. Urol. Nephrol. 2005;37(1):107–111.
Gülbetekin E. Tonsillektomi operasyonu yapılan çocuklarda ballı sütün kanama ağrı ve yara iyileşmesine etkisi. Atatürk Üniversitesi Sağlık Bilimleri Enstitüsü, Yüksek Lisans Tezi. 2015, Erzurum yayınlanmamış bir kaynak.
Wasiak J, Cleland H, Campbell F. Dressings for superficial and partial thickness burns. Cochrane Database Syst Rev. 2008;4;1-44.
Brudzynski K, Sjaarda C. Antibacterial compounds of Canadian honeys target bacterial cell wall inducing phenotype changes, growth inhibition and cell lysis that resemble action of b-lactam antibiotics. PLoS One. 2014;9(9):e106967.
Katiraee F, Mahmodi R, Mardani K, Babaei E. Antifungal activity of Iranian honeybees against Candida, Aspergillus species and Trichophyton Rubrum. J Food Process Preserv. 2014;38(5):2078-82.
Zahoor M, Naz S, Sangeen M. Antibacterial, antifungal and antioxidant activities of honey collected from Timergara (Dir, Pakistan). Pak J Pharm Sci. 2014;27(1):45-50.
Canonico B, Candiracci M, Citterio B, Curci R, Squarzoni S, Mazzoni A, et al. Honey flavonoids inhibit Candida albicans morphogenesis by affecting DNA behavior and mitochondrial function. Future Microbiol. 2014;9(4):445-56.
Song JJ, Salcido R. Use of honey in wound care: an update. Adv Skin Wound Care. 2011;24(1):40-44.
Tirado DJ, Hudson NR, Maldonado CJ. Efficacy of medical grade honey against multidrug-resistant organisms of operational significance: part I. J Trauma Acute Care Surg. 2014;77(3 Suppl. 2):S204-7.