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Clinical Data of Patients with Wounds Attending Government Hospitals in Ondo State, Nigeria

Authors:
_____________________________________________________________________________________________________
*Corresponding author: E-mail: glorypalmer88@yahoo.com;
Asian Journal of Research in Dermatological Science
3(3): 11-19, 2020; Article no.AJRDES.58946
Clinical Data of Patients with Wounds Attending
Government Hospitals in Ondo State, Nigeria
A. K. Onifade
1
and O. G. Palmer
1*
1
Department of Microbiology, Federal University of Technology, Akure, Ondo State, Nigeria.
Authors’ contributions
This work was carried out in collaboration between both authors. Both authors read and approved the
final manuscript.
Article Information
Editor(s):
(1)
Dr. Giuseppe Murdaca, University of Genova, Italy.
Reviewers:
(1) María Teresa Cacua Sanchez, University El Bosque, Colombia.
(2)
Mallikarjuna Manangi, Rajiv Gandhi University of Health Sciences, India.
Complete Peer review History:
http://www.sdiarticle4.com/review-history/58946
Received 10 May 2020
Accepted 17 July 2020
Published 31 July 2020
ABSTRACT
Clinical data of patients with wounds attending government hospitals in Ondo state, Nigeria was
investigated. It was observed that most patients with wound that visited government hospitals in
Ondo state were 45-54 years age group with percentage of 41.0%. The most gender that visits
government hospitals for the treatment of wound was male in the course of the research with the
percentage of 59.3%. In the course of the study 31.0% of the respondents that participate in the
survey were single while 69% were married. Self-employed had the highest percentage distribution
of 27.8% while driver had the lowest percentage of 4.8%. Most of the respondents reside in Akure
while Ilara had the lowest respondent patients with wounds that visited hospitals in the course of
the study. Four-point-five percent (4.5%) of the patients with wounds were diagnosed with diabetes
and 4.0 percent of the respondents were on diabetes drug. Eighteen-point-three percent (18.3%) of
the patients with wounds take alcohol. Patients with wounds that take alcohol regularly were 16.3%
while 2.0% take alcohol occasionally. In the course of the survey at government hospitals in Ondo
State, 9.3% of the respondent smoke cigarette. Two-point-five percent (2.5%) smoke regularly
while 6.8% smoke occasionally. Thirty-six-point five percent (36.5%) of the patients with wounds
were on traditional herb. Patients with wounds that take traditional herb were 16.8%, 19.8% takes
traditional herb occasionally, while 63.5% of the respondent did not take at all. None of the patient
was diagnosed with obesity.
Original Research Article
Onifade and Palmer;
AJRDES, 3(3): 11-19, 2020; Article no.AJRDES.58946
12
Keywords: Clinical; wound; patients; hospitals; gender; diabetes.
1. INTRODUCTION
A wound is a break in the integrity of the skin or
tissues, which may be associated with disruption
of the structure and function. Another way, a
wound may be defined as disruption of the
normal continuity of bodily structures due to
trauma, which may be penetrating or non-
penetrating [1]. Wounds are inescapable events
of life, which arise due to physical injury,
chemical injury and microbial infections. It is
defined simply as the disruption of the cellular
and anatomic continuity of a tissue [2]. Open
injuries have a potential for serious bacterial
wound infections, including gas gangrene and
tetanus, and these in turn may lead to long term
disabilities, chronic wound or bone infection, and
death. Wound infection is particularly of concern
when injured patients present late for definitive
care or in disasters where large numbers of
injured survivors exceed available trauma care
capacity. Cutaneous lesions may have a variety
of forms and appearance at initial presentation,
including small papules or vesicles that progress
into a rapidly spreading cellulitis [3] with a
characteristic serosanguineous draining fluid,
single necrotic bullae [4], and gas-gangrenelike
infections with extensive soft tissue involvement
resembling clostridial myonecrosis [3]. Single or
multiple papulovesicular lesions can even mimic
cutaneous anthrax [3,4]. Necrotic or hemorrhagic
bullous lesions [4] such as those observed in our
patient, are rare. Exposed areas such as
extremities and digits are most often affected,
presumably due to entrance of spores from soil,
water, decaying organic material, or fomites
through skin microabrasions or trauma induced
wounds [3]. Once in the tissue, the crystalline
surface protein layer (S-layer) of the bacilli
promotes adhesion to human epithelial cells and
neutrophils, followed by release of virulence
factors including proteases, collagenases,
lecithinase like enzymes, necroticzing exotoxin
like hemolysins, phospholipases, and most
importantly a dermonecrotic vascular
permeability factor [5,3]. Toxins produced by B
cereus are similar to those closely related to
Bacillus anthracis, the agent of anthrax [3].
Normal wound healing requires a sufficient
supply of blood to the affected tissues. A delay in
healing can be caused by a number of factors,
both local (related to the wound itself) and
systemic (related to the patient and their clinical
condition). Many of these factors not only delay
healing but also increase the likelihood of
infection developing in the wound.
Local factors which may delay wound healing
include [6,7]: (a) The underlying cause and
severity of the wound, (b) A delay in the patient
presenting for medical attention, (c) The
presence of necrotic tissue in the wound this
can promote the growth of bacteria, especially
anaerobes, (d) The presence of foreign bodies in
the wound, (e) Impairment of the local circulation,
(f) The site of the wound, e.g. wounds near the
anal area are at increased risk of contamination,
(g) A haematoma or any “dead space” in a
wound – this can provide an ideal environment
for bacterial growth, (h) An Oedema in the
tissues surrounding the wound, and (i) Continued
trauma or pressure to the wound site
Systemic factors which may delay wound healing
include: [8,7] (a) Predisposing medical condition,
e.g. diabetes, which compromises the health of
the skin and increases the risk of infection, (b)
Older age, (c) Obesity, (d) Smoking, (e) Poor
nutrition, and (f) Immunosuppression associated
with either an illness, e.g. AIDS, or medicine, e.g.
chemotherapy, corticosteroids.
The aim of this study was to investigate the
clinical data of patients with wounds attending
government hospitals in Ondo State, Nigeria.
2. MATERIALS AND METHODS
2.1 Description of Study Location
This research work was carried out from October
2018 to May 2019 in Ondo state, Nigeria. The
study area for this research is Ondo, Nigeria.
Ondo state covers an area of 15,195.2 sqaure
kilometers and lies at latitude 7°10′ North and
longitude 5°05′ east. Ondo State is a state in
Nigeria created on 3 February 1976 from the
former Western State. It originally included what
is now Ekiti State, which was split off in 1996.
Akure is the state capital. Each Nigerian state
has several ministerial offices representing the
federal government.
Ondo state borders Ekiti
state to the north, Kogi State to the northeast,
Edo State to the east, Delta State to the
southeast, Ogun State to the southwest, and
Osun State to the northwest. The state contains
eighteen local government areas, the major ones
being Akoko, Akure, Okitipupa, Ondo and Owo.
The ethnic composition of Ondo State is largely
from the Yoruba sub groups of the Akoko, Akure,
Onifade and Palmer;
AJRDES, 3(3): 11-19, 2020; Article no.AJRDES.58946
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Okitipupa, Ilaje, Ondo and Owo people. Ijaw
such as Apoi and Arogbo populations inhabit the
coastal areas, while a sizable number of the
Ondo State people who speak a variant of the
Yoruba language similar to Ife dialect reside in
Oke-Igbo.
To supplement the efforts of the federal medical
centre, Owo and University of Medical Sciences
Teaching Hospital, Akure, in this regard, there
are other government health centres and private
clinics. 'Abiye' health programme of Governor
Mimiko administration was recognized by World
Health Organization (WHO) as one of the best
health programmes on maternal health
programme with the establishment of Mother-
Child hospital in Akure.
2.2 Administration of Questionnaire
Questionnaires containing relevant information
were administered to the Laboratory scientists to
fill in the information about the patients (117
inpatients and 283 outpatients). Swab Samples
of wound from the patients attending University
of Medical Sciences Teaching Hospital, Akure
and Federal Medical Center, Owo, was collected
between October 2018 and May 2019. The
questionnaires contained information about the
age, gender, marital status, educational status,
occupational status, city of residence, patients
with wounds and diabetes, patients with wounds
and diabetes on diabetic drug, alcohol intake,
frequency of alcohol intake, cigarette smoker,
how frequent patients with wounds smoke
cigarette, patients with wounds currently on
traditional herbal medication, how frequent
patients with wounds take traditional herbal
medication and obsese patients with wounds
were included in the questionnaire.
2.3 Statistical Analysis of Data
Each treatment was replicated three times and
data obtained were subjected to one way
analysis of variance (ANOVA) and Duncan’s
new Multiple Range Test at p˂0.05 using
Statistical Package for Social Sciences version
23.0.
3. RESULTS
The age distribution of patients with wounds is
presented in Table 1. The highest age group of
patients with wounds that visited government
hospitals was 50-69 years with 41.0%, while the
least age range was ˂ 12 year old in the course
of the research.
The Gender Distribution of patients with wounds
attending hospitals in Ondo State was shown in
Table 2. Male patients with wounds were the
highest gender with 59.3% while the female
patients with wounds were 40.8%.
Table 3 shows the marital status of patients with
wounds attending government hospitals in Ondo
state. Six-Nine percent (69%) of the observed
sample population were married while 31.0%
were single in the course of the research.
Table 1. Age distribution of patients with wounds attending hospitals in ondo state
Age range
Frequency
Percent
Valid percent
Valid less than 12 years 8 2.0 2.0 2.0
12-17
21
5.3
5.3
18-24 28 7.0 7.0 14.3
25-34 29 7.3 7.3 21.5
35-44 25 6.3 6.3 27.8
45-54 164 41.0 41.0 68.8
55-64 51 12.8 12.8 81.5
65-74 44 11.0 11.0 92.5
75 and above 30 7.5 7.5 100.0
Total 400 100.0 100.0
Table 2. Gender distribution of patients with wounds attending hospitals in ondo state
Gender
Frequency
Percent
Valid percent
Cumulative percent
Valid Male 237 59.3 59.3 59.3
Female
163
40.8
40.8
100.0
Total 400 100.0 100.0
Onifade and Palmer;
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Table 3. Marital distribution of patients with wounds attending hospitals in ondo state
Marital Status
Frequency
Percent
Valid percent
Cumulative percent
Valid Single 124 31.0 31.0 31.0
Married 276 69.0 69.0 100.0
Total 400 100.0 100.0
Table 4. Educational status distribution of patients with wounds attending hospitals in Ondo
state
Educational status
Frequency
Percent
Valid percent
Cumulative percent
Valid Primary School 42 10.5 10.5 10.5
Secondary school 96 24.0 24.0 34.5
Tertiary School 152 38.0 38.0 72.5
None 110 27.5 27.5 100.0
Total 400 100.0 100.0
Table 5. Occupational status distribution of patients with wounds attending hospitals in Ondo
state
Occupational status
Frequency
Percent
Valid percent
Cumulative percent
Valid Civil Servant 30 7.5 7.5 7.5
Self Employed 111 27.8 27.8 35.3
Unemployed 99 24.8 24.8 60.0
Farming 70 17.5 17.5 77.5
Driver 19 4.8 4.8 82.3
Butcher 24 6.0 6.0 88.3
Business 47 11.8 11.8 100.0
Total 400 100.0 100.0
Table 4 shows the educational status of patients
with wounds. Those that their level of education
was primary school were 10.5%, follow by
secondary school education which was 24.4%,
tertiary education were 38.0%, while those that
did not go to school at all were 27.5%.
Occupational status distribution of patients with
wounds attending hospitals in Ondo States
presented in Table 5. Self-employed had the
highest frequency of 27.8% followed by
unemployed 24.8%, farming 17.5%, Business
11.8%, Civil servant 7.5%, Butcher 6.0% and
driver 4.8%
Table 6 shows the city of resident of patients with
wounds. Most of the patients with wounds
that visited government hospitals were resident
of Akure community with the percentage of
42.3%, followed by Owo with the percentage of
21.0%, Akoko, Igara Oke and Bolunduro had
8.3% respectively, Okitipupa 8.0% and Ilara
4.0%.
Table 7 shows the patients with wounds
diagnoses with diabetes in Ondo State. It was
observed that 4.5% of the patients with wounds
were with diabetes while 95.5% were diabetes
free.
Table 6. City of residence distribution of patients with wounds attending hospitals in Ondo
state
City of residence
Frequency
Percent
Valid percent
Cumulative percent
Valid Akure 169 42.3 42.3 42.3
Ilara 16 4.0 4.0 46.3
Owo 84 21.0 21.0 67.3
Akoko 33 8.3 8.3 75.5
Igbara Oke 33 8.3 8.3 83.8
Okitipupa 32 8.0 8.0 91.8
Bolunduro 33 8.3 8.3 100.0
Total 400 100.0 100.0
Onifade and Palmer;
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Table 7. Patients with wounds diagnose with diabetes attending hospitals in ondo state
Diagnose with diabetes
Frequency
Percent
Valid percent
Cumulative percent
Valid Yes 18 4.5 4.5 4.5
No 382 95.5 95.5 100.0
Total 400 100.0 100.0
Table 8. Patients with wounds diagnose with diabetes on diabetes drug attending hospitals in
ondo state
Diabetes patient on diabetes
drug
Frequency
Percent
Valid percent
Cumulative percent
Valid Yes 16 4.0 88.9 88.9
No 2 0.5 11.1 100.0
Total 18 4.5 100.0
Missing Not diagnose with
diabetes
382 95.5
Total 400 100.0
Table 9. Alcohol intake of patients with wounds attending hospitals in ondo state
Alcohol intake
Frequency
Percent
Valid percent
Cumulative percent
Valid Yes 73 18.3 18.3 18.3
No 327 81.8 81.8 100.0
Total 400 100.0 100.0
Patients with wounds diagnose with diabetes on
diabetes drug attending hospitals in Ondo State
is presented in Table 8. Four percent (4.0%) of
the patients with wounds were on diabetes drug
while 0.5% of the patients with wounds were not
on diabetes drug.
Table 9 shows the alcohol intake of patients with
wounds in Ondo State. It was observed that 18.3
% of the patients with wounds take alcohol while
81.8% did not take alcohol.
Frequency of alcohol intake of patients with
wounds in Ondo attending government hospitals
is presented in Table 10. Sixteen-point-Three
percent (16.3%) of the patients with wounds
takes alcohol regularly, 2.0% of the patients with
wounds takes alcohol occasionally while 81.8%
does not take alcohol at all.
Frequent cigarette intake of patients with wounds
in Ondo State is presented in Table 11. Nine-
point-three percent (9.3%) smoke cigarette while
90.3% of the patients with wounds does not
smoke cigarette at all.
Table 12 shows how frequent patients with
wounds attending hospitals in Ondo State smoke
cigarette. Two-point-five percent (2.5%) of the
patients with wounds smoke cigarette, 6.8%
does not smoke occasionally while 90.8 percent
does not smoke at all.
Patients with wounds currently on traditional herb
is presented in Table 13. Thirty-six-point-five
percent (36.5%) of the wound attending
government hospitals patient takes traditional
herb while 63.5% of the patients with wounds did
not takes traditional herb at all.
Table 10. Frequency of alcohol intake of patients with wounds attending hospitals in Ondo
state
How often do you take alcohol
Frequency
Percent
Valid percent
Cumulative percent
Valid Regularly 65 16.3 89.0 89.0
Occasionally 8 2.0 11.0 100.0
Total 73 18.3 100.0
Missing None alcohol taker 327 81.8
Total 400 100.0
Onifade and Palmer;
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Table 11. Cigarette intake of patients with wounds attending hospitals in Ondo state
Do you smoke
Frequency
Percent
Valid percent
Cumulative percent
Valid Yes 37 9.3 9.3 9.3
No 363 90.8 90.8 100.0
Total 400 100.0 100.0
Table 12. How frequent patients with wounds attending hospitals in Ondo state smoke
cigarette
How often do you smoke
Frequency
Percent
Valid percent
Cumulative percent
Valid Regularly 10 2.5 27.0 27.0
Occasionally 27 6.8 73.0 100.0
Total 37 9.3 100.0
Missing Non Smoker 363 90.8
Total 400 100.0
Table 13. Patients with wounds currently on intake of traditional herb attending hospitals in
Ondo state
Traditional herb
Frequency
Percent
Valid percent
Cumulative percent
Valid Yes 146 36.5 36.5 36.5
No 254 63.5 63.5 100.0
Total 400 100.0 100.0
Table 14. How frequent patients with wounds attending government hospitals in ondo state
take traditional herb
Traditional herb intake
Frequency
Percent
Valid percent
Cumulative
percent
Valid Regularly 67 16.8 45.9 45.9
Occasionally 79 19.8 54.1 100.0
Total 146 36.5 100.0
Missing Don’t use
traditional herb
254 63.5
Total 400 100.0
Table 15. Patients with wounds diagnose with obesity attending hospitals in ondo state
Patient diagnose with obesity
Frequency
Percent
Valid percent
Cumulative
percent
Valid No 400 100.0 100.0 100.0
Table 14 shows how frequent patients with
wounds attending government hospitals in Ondo
State take traditional herb. It was observed that
16.8% of the patients with wounds takes alcohol
regularly, 19.8% takes alcohol occasionally while
63.5% of the patients with wounds did not takes
traditional herb at all.
Table 15 shows patients with wounds diagnose
with obesity attending government hospitals in
Ondo State. None of the patients with wounds
was diagnose with obesity in the course of the
research.
4. DISCUSSION
The aim of this study was to investigate the
clinical data of patients with wounds attending
government hospitals in Ondo state, Nigeria. It
was observed that most patients with wound that
visited government hospitals in Ondo State were
45-54 years age group with percentage of
41.0%. Specific age-related changes in the
coagulation and immune systems which may
influence wound healing include alterations in
cell adhesion, migration and functional
responses. Gould and Fulton [9] reported that
Onifade and Palmer;
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17
impaired wound healing in the elderly represents
a major clinical problem that is growing as our
population ages. Wound healing is affected by
age and by co-morbid conditions, particularly
diabetes and obesity [9]. A recent study using an
ex-vivo model demonstrated that application of a
compressive load to ischemic aged skin resulted
in sub-epidermal separation and altered
orientation of the collagen fibers similar to that
seen in patients with pressure ulcers [10].
The most gender that visits government hospitals
for the treatment of wound was male in the
course of the research with the percentage of
59.3%. This could be due to the reason that most
of the male might sustain injury at their place of
work due to the fact that male engage in hard
jobs than female and also make use of sharp tool
more than female at their places of work. This
correlate with the report of Mohammed et al. [11]
who reported that a total of 137 study
participants with wound infection were included
in their study, among these 81 (59.1%) were
males and 56 (40.9%) were females with the age
range of 2 to 80 years and mean age of 31.63 ±
15.39 years.
In the course of the study 31.0% of the
respondents that participate in the survey were
single while 69% were married. Self-employed
had the highest percentage distribution of 27.8%
while driver had the lowest percentage of 4.8%.
Most of the respondents reside in Akure while
Ilara had the lowest respondent patients with
wounds that visited hospitals in the course of the
study.
Four-point-five percent (4.5%) of the patients
with wounds were diagnosed with diabetes and
4.0 percent of the respondents were on diabetes
drug, this could delay wound healing process.
Diabetic wounds are slow to heal, are difficult to
manage, and could last for weeks, thereby
posing a serious challenge to manage in a
clinical setting [12]. Dinh et al. [13] submitted that
recent investigation has also revealed a chronic
wound environment with diminished expression
of growth factors and cytokines integral to the
wound healing process. Altered wound healing is
one of the most common complications in
Diabetes Mellitus (DM) [14]. The wound healing
process in patients with DM is deteriorated due
to hyperglycaemic conditions that lead to major
chronic complications, such as Diabetic Foot
Ulcers (DFUs) [15].
Eighteen-point-three percent (18.3%) of the
patients with wounds take alcohol. Patients with
wounds that take alcohol regularly were 16.3%
while 2.0% take alcohol occasionally. Trevejo-
Nunez [16] reported that alcohol use and
misuse have been part of human society for
centuries. Clinical evidence and animal
experiments have shown that exposure to
alcohol impairs wound healing and increases the
incidence of infection [17]. Smoking, alcohol and
drug dependency can all negatively affect
healing [18]. Like any other organ in the human
body, the skin is also affected by alcohol intake.
Alcoholism is associated with higher rates of
wound infection and delay in wound closure [16].
It is associated with increased risk for
Staphylococcus aureus infection, including
methicillin-resistant Staphylococcus aureus,
Streptococcus pyogenes, and Vibrium vulnificus
[16].
In the course of the survey at government
hospitals in Ondo State, 9.3% of the respondent
smoke cigarette. Two-point-five percent (2.5%)
smoke regularly while 6.8% smoke occasionally.
Smokers are exposed to a toxic mix of over
7,000 chemicals when they inhale cigarette
smoke [19]. The harmful chemicals in cigarette
smoke can damage nearly every organ in the
body [19]. Nonsmokers are exposed to many of
these same chemicals through secondhand
smoke [20]. During smoking carbon monoxide
enters into the blood cells and lowers the level of
oxygen in the blood. Oxygen is vital to wound
healing. Smoking slows the healing process as
less oxygen is delivered to the wound. McDaniel
and Browning [21] submitted that considering the
vast financial, social, and clinical impact of
chronic wounds, it is essential that clinicians
treating patients with these conditions consider
all modifiable factors that may delay wound
healing including smoking. Smoking raises blood
sugar levels. Heightened blood sugar levels have
numerous medical consequences, one of which
is a deceleration of the wound healing
process. According to Wound Care Centers, high
blood sugar, which can be caused by
smoking, creates arterial stiffness and narrows
the blood vessels. Cigarette smoking negatively
impacts wound healing on multiple levels [22,23].
As a result, chronic patients with wounds
who continue to smoke should be encouraged to
quit and provided tools by healthcare providers to
assist with that process [21].
Thirty-six-point five percent (36.5%) of the
patients with wounds were on traditional herb.
Patients with wounds that take traditional herb
were 16.8%, 19.8% take traditional herb
Onifade and Palmer;
AJRDES, 3(3): 11-19, 2020; Article no.AJRDES.58946
18
occasionally, while 63.5% of the respondent did
not take at all.
None of the patient was diagnosed with obesity.
Guo and DiPietro [24] observed that obesity is
well-known to increase the risk of many diseases
and health conditions, which include coronary
heart disease, type 2 diabetes, cancer,
hypertension, dyslipidemia, stroke, sleep apnea,
respiratory problems, and impaired wound
healing. A patient who weighs 20 percent more
than his or her ideal body weight has a higher
risk of infection leading to an interruption of the
healing process [25].
5. CONCLUSION
The clinical data such as age, gender, smoking,
obesity, occupation, health related issues etc of
the patients with wounds that visited hospitals is
one the predisposing factor which could lead to
microorganisms isolated from the patients
wounds to cause systemic infection in
immunocompromised patients. Therefore, wound
should be cover appropriately by trained
personnel in order to avoid microorganism
gaining entrance into the blood through wound.
CONSENT
It is not applicable.
ETHICAL APPROVAL
Ethical clearance for the collection of wound
swab samples from patients attending University
of Medical Sciences Teaching Hospital, Akure
and Federal Medical Center, Owo was collected
from Hospitals Management Board, Akure, Ondo
State, Nigeria.
COMPETING INTERESTS
Authors have declared that no competing
interests exist.
REFERENCES
1. Smith RL, Bohl JK, McElearney ST, Friel
CM, Barclay MM, Sawyer RG, et al.
Wound infection after elective colorectal
resection. Annals of Surgery. 2004;239(5):
599
2. Ananth A, Rajan S. Isolation and screening
of pathogenic bacteria from wound
infections. International Journal of Current
Pharmaceutical Research. 2014;6(3):15-
17.
3. Bottone EJ. Bacillus cereus, a volatile
human pathogen. Clin Microbiol Rev.
2010;23:382-398
4. Liu Y, Lai Q, Göker M, Meier-Kolthoff
JP, Wang M, Sun Y, Wang L, Shao Z.
Genomic insights into the taxonomic status
of the Bacillus cereus group. Sci Rep.
2015;5:14082.
5. Kotiranta A, Lounatmaa K, Haapasalo M.
Epidemiology and pathogenesis of Bacillus
cereus infections. Microbes Infect. 2000;2:
189-198.
6. World Union of Wound Healing Societies
(WUWHS). Wound infection in clinical
practice: an international consensus.
London: MEP Ltd; 2008.
Available:www.mepltd.co.uk
(Accessed May, 2013)
7. Hess C. Checklist for factors affecting
wound healing. Adv Skin Wound Care.
2011;24(4):192.
8. Siddiqui A, Bernstein J. Chronic wound
infection: Facts and controversies. Clin
Dermatol. 2010;28:516–526.
9. Gould, L. J and Fulton, A. T. (2016).
Wound Healing in Older Adults. Rhode
Island Medical Journal, 34-36
10. Stojadinovic O, Minkiewicz J, Sawaya A,
Bourne JW, Torzilli P, de Rivero Vaccari
JP, Dietrich WD, Keane RW, Tomic-Canic
M. Deep tissue injury in development of
pressure ulcers: A decrease of
inflammasome activation and changes in
human skin morphology in response to
aging and mechanical load. PLoS One.
2013;8(8):e69223.
11. Mohammed A, Seid ME, Gebrecherkos T,
Tiruneh M, Moges F. Bacterial Isolates and
Their Antimicrobial Susceptibility Patterns
of Wound Infections among Inpatients and
Outpatients Attending the University of
Gondar Referral Hospital, Northwest
Ethiopia. International Journal of
Microbiology. 2017;1-10.
12. Oguntibeju OO. Medicinal plants and their
effects on diabetic wound healing,
Veterinary World. 2019;12(5):653-663.
13. Dinh T, Elder S, Veves A. Delayed wound
healing in diabetes: Considering future
treatments, Diabetes Manage. 2011;1(5):
509–519.
14. Tan WS, Arulselvan P, Ng S, Taib CNM,
Sarian MN, Fakurazi S. Improvement of
diabetic wound healing by topical
application of Vicenin-2 hydrocolloid
Onifade and Palmer;
AJRDES, 3(3): 11-19, 2020; Article no.AJRDES.58946
19
film on Sprague Dawley rats. BMC
Complementary and Alternative Medicine.
2019;19:20
15. Boulton AJ, Vileikyte L, Ragnarson-
Tennvall G, Apelqvist J. The global burden
of diabetic foot disease. Lancet. 2005;
366(9498):1719–24.
16. Trevejo-Nunez G, Kolls JK, Wit MD.
Alcohol use as a risk factor in infections
and healing. Alcohol Research. 2015;
37(2):177-184.
17. Szabo G, Mandrekar P. A recent
perspective on alcohol, immunity, and host
defense. Alcohol Clin Exp Res. 2009;33:
220-232.
18. Northamptonshire Healthcare. Guidelines
for the assessment and management of
wounds. (rev. 02/2020) CLPg005. 2002;1-
37.
19. U.S. Department of Health and Human
Services (USDHHS). A report of the
surgeon general: How tobacco smoke
causes disease: What it means to you
(Consumer Booklet). Atlanta, GA: U.S.
Department of Health and Human
Services, Centers for Disease Control and
Prevention, National Center for Chronic
Disease Prevention and Health Promotion,
Office on Smoking and Health; 2010.
20. FDA. Cigarettes; 2019.
[Retrieved on the 7th January 2020]
Available:https://www.fda.gov/tobacco-
products-ingredients-
components/cigarettes
21. McDaniel JC, Browning KK. Smoking,
chronic wound healing and implications
for evidence-based practice. J Wound
Ostomy Continence Nurs. 2014;41(5):415–
E2.
22. Chan LK, Withey S, Butler PE. Smoking
and wound healing problems in reduction
mammaplasty: Is the introduction of urine
nicotine testing justified? Ann Plast Surg.
2006;56(2):111–115.
23. Sorensen LT, Zillmer R, Agren M,
Ladelund S, Karlsmark T, Gottrup F. Effect
of smoking, abstention, and nicotine patch
on epidermal healing and collagenase in
skin transudate. Wound Repair Regen.
2009;17(3):347–353.
24. Guo S, Dipietro LA. Factors affecting
wound healing. J Dent Res. 2010;89:219-
229.
25. Elite. 10 factors that affect the wound
healing process all nurses should know;
2018.
Available:https://www.elitecme.com/resour
ce-center/nursing/10-factors-that-affect-
the-wound-healing-process-all-nurses-
should-know/on the 24
th
of January, 2020
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