ArticleLiterature Review

The efficacy of Aloe vera used for burn wound healing: A systematic review

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Abstract

Aloe vera has been traditionally used for burn healing but clinical evidence remains unclear. We conducted a systematic review to determine the efficacy of topical aloe vera for the treatment of burn wounds. We electronically searched relevant studies in MEDLINE, CINAHL, Cochrane Library, HealthSTAR, DARE, South-East Asia Database, Chinese Databases, and several Thai local Databases (1918-June 2004). Only controlled clinical trials for burn healing were included. There were no restrictions on any language of publication. Two reviewers independently extracted data on study characteristics, patient characteristics, intervention, and outcome measure. Four studies with a total of 371 patients were included in this review. Based on a meta-analysis using duration of wound healing as an outcome measure, the summary weighted mean difference in healing time of the aloe vera group was 8.79 days shorter than those in the control group (P=0.006). Due to the differences of products and outcome measures, there is paucity to draw a specific conclusion regarding the effect of aloe vera for burn wound healing. However, cumulative evidence tends to support that aloe vera might be an effective interventions used in burn wound healing for first to second degree burns. Further, well-designed trials with sufficient details of the contents of aloe vera products should be carried out to determine the effectiveness of aloe vera.

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... Aloe vera decreases wound healing time in skin wound and injuries due likely to the interplay of the above processes. An efficacy study on wound healing times indicated a summary weighted mean difference in healing time that was 8.79 days shorter in the Aloe vera group [52]. Results were most improved in first and second degree burns, where perfusion is salvageable. ...
... Because the concentration of active ingredients in plants may vary depending on age, growing environment, and extraction methods, it is beneficial to extract the ingredients as a concentrate before application [52] [58]. This is seen with the use of Dermaide Aloe  , a commercially purified extract, which when compared to other crude extracts, was shown to have higher antimicrobial effects with lower doses of the product [59]. ...
... This is seen with the use of Dermaide Aloe  , a commercially purified extract, which when compared to other crude extracts, was shown to have higher antimicrobial effects with lower doses of the product [59]. Active ingredients in Aloe extracts also deteriorate with time [52] [60]. Auto-degradation of the mucilage polysaccharides can be retarded with the addition of microalgae polysaccharides [60]. ...
... solid material contains over 75 different potentially active compounds including copper, iron, calcium, zinc, manganese, sodium, potassium, sugars, lignin, saponins, salicylic acid, vitamins A, B, C, E, B12, folic acid, and other nutrients that support general health (El-Gammal et al., 2018;Panahi et al., 2012;Radha & Laxmipriya, 2015;Takzare et al., 2009;Tanaka et al., 2016a). Moreover, only minimal adverse reactions such as mild pain or discomfort may occur with the use of AV and all these negative effects of AV are generally reversible and well-tolerated (Burusapat et al., 2018;López-Jornet et al., 2013;Maenthaisong et al., 2007). ...
... Another systematic review analysed data only from four RCTs to explore the efficacy of AV application in burn wound-healing process and reported that AV may be effective for first-to second-degree burns. However, the same review also highlighted the importance of differences between AV products and outcome measures (Maenthaisong et al., 2007). We included only a single study in this meta-analysis that compared the effects of AV gel phonophoresis and silver nanoparticle phonophoresis for seconddegree burn wound-healing. ...
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Abstract Aims: To analyse the different types of Aloe vera (AV) effects on various mucocuta- neous problems among adults. Design: A systematic review and meta-analysis. Data Sources: An exhaustive scanning of PubMed, Medline, ScienceDirect, and Google Scholar databases was conducted from January 2000–December 2019. Review Methods: Randomized controlled trials (RCTs) publishing reports on the ef- fects of AV in various mucocutaneous problems, psoriasis, burn, wound-healing were included. The standardized mean differences (SMD) with 95% confidence Intervals (CIs) were determined for the main outcomes, heterogeneity was analysed using the I2 test and the risk of bias in the studies was reviewed by the Cochrane risk of bias assessment tool. Results: The study included 23 trials with a total of 4,023 participants. Six trials were included in the meta-analysis. The results indicated no significant differences in pain scores as assessed by the Visual Analog Scale (VAS) (SMD = 0.11, 95% CI: −0.37 to 0.59). The Psoriasis Area Severity Index (PASI) scores were significantly lower follow- ing AV gel application in two of the studies (SMD = −1.32 95% CI: −1.86 to −0.78). Considering results in a systematic manner, AV accelerated tissue epithelialization and wound-healing process (N = 3), reduced oral mucositis (N = 3), and improved quality of life (N = 1). Conclusion: AV might have beneficial effects in reducing pain scores and the severity of mucocutaneous problems compared with placebo, especially with limited mild to moderate adverse effects. Impact: AV may be used as an alternative and integrative approach to reducing symp- tom severity in mucocutaneous problems and the wound-healing process. High qual- ity and well-designed RCTs are still needed to elucidate the effects of AV in a variety of dosages and forms among adults with mucocutaneous problems.
... This goal could be achieved by administering aloe, a medicinal plant that has mainly been used to treat skin disorders for thousands of years. Among the many aloe species, the gel of Aloe barbadensis Miller, commonly called Aloe vera, obtained by peeling the skin off the leaves and has been most widely used as a food supplement and cosmetic ingredient due to its various biological effects, such as the treatment of burns and anti-inflammatory and antibacterial properties [11][12][13]. However, the remaining parts of Aloe vera have not been utilized much due to their very bitter tastes and hardness, although they contain more biologically active substances, such as aloins, aloe-amodin, and polyphenols [12,13]. ...
... Further evidence of the protective effect of AF on mitochondria damaged by UV b light is shown in Figure 6, where mitochondrial cytochrome II activities are compared in UV b -irradiated skin fibroblasts because succinate dehydrogenase (SDH) is an enzyme complex that is bound to the inner mitochondrial membrane in respiratory complex II and is considered to prevent ROS generation [11,48]. A more recent study also revealed a strong correlation between age and a significant decrease in complex II activity that was specific to senescent skin cells but not with a decrease in complex IV activity [49]. ...
Article
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This study is the first to show that increased mitochondrial activities improved the antiaging effects of Aloe vera leaf skin fermented by Lactobacillus plantarum on UVb-irradiated skin fibroblasts. The fermented extract (AF) increased the activities of mitochondrial reductase and the complex II and significantly reduced reactive oxygen species (ROS) production, even under UVb stress conditions, and also increased DPPH free radical scavenging activities compared with the hot water extract of outer layers of aloe leaf (AW) and quercetin itself. AF exerted a synergistic effect with quercetin and bioactive substances derived from the fermentation process. Moreover, mitochondrial activation of UVb-irradiated human skin fibroblasts by 0.3% (w/v) of the AF plays important roles in increasing collagen production up to 125 ± 5.45% and decreasing MMP-1 secretion down to 69.41 ± 2.63% of the control levels. The AF enhanced the upregulation of collagen gene expression, and this change was also greater than those induced by the AW and quercetin. Therefore, this study concludes that fermentation of the skin of aloe leaves increases the activation of mitochondria and inhibits the photo-aging of UVb-irradiated skin fibroblasts.
... Several studies support the role of Aloe vera in wound healing [10][11][12][13][14][15][16][17][18][19]. It has been found to decrease the healing time of burn wound patients in comparison with petroleum gel [18]. ...
... It has been found to decrease the healing time of burn wound patients in comparison with petroleum gel [18]. Its effects have been postulated to be exerted through its antiinflammatory effects by prostaglandins and bradykinin [7,14,16,17]. However, aloe vera was not better that placebo in the treatment of slight to moderate psoriasis vulgaris [20]. ...
Article
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Objectives: Atopic dermatitis (AD) is a prevalent and chronic, pruritic inflammatory skin condition that can influence all age groups. AD is associated with a poor health-related quality of life. This randomized clinical trial was performed to compare the effectiveness of Olivederma (combination of aloe vera and virgin olive oil) or betamethasone regarding disease severity, quality of life, serum IgE and eosinophil count. Methods: Thirty-six AD patients were randomly allocated to topical Olivederma or betamethasone, and were followed for 6 weeks. Results: Total SCORAD severity scores showed significant decrease in both groups, while it was more prominent in Olivederma group (64.5% improvement in Olivederma vs. 13.5% improvement in Betamethasone, p-value < 0.001). Quality of life (DLQI questionnaire) of AD patients was significantly improved after 6 weeks treatment with Betamethasone (22.3%, p < 0.001) and Olivederma (60.7%, p-value < 0.001). Olivederma group showed a significantly lower DLQI score in comparison with Betamethasone treated patients after 6 weeks of therapy (p < 0.001). Improvements in eosinophil count and serum IgE was observed. Conclusion: In summary, this study shows that Olivederma is superior to topical Betamethasone after 6 weeks of therapy with regard to disease severity, quality of life and eosinophil count.
... It is a cactus that has thorny lance-shaped leaves. It proliferates in warm and dry weather (Maenthaisong et al., 2007;Vogler and Ernst, 1999). It is available as both powder and gel. ...
... It is available as both powder and gel. The gel is extracted from its leaves and is famous all over the world for its antiinflammatory, antimicrobial, antifungal, and healing action (Gupta et al., 2010;Maenthaisong et al., 2007). ...
Chapter
Intracanal medicaments are recommended to supplement chemomechanical preparation to enhance disinfection. Calcium hydroxide is the most widely used intracanal medicament for this purpose. However, innovation in material sciences has led to exponential growth in the field of endodontics. Many of these newly developed formulations, including specific new synthetic and herbal medicaments, have shown promising results. Few of them have already been commercialized. However, for the majority of them to be commercialized and used on a regular basis, large sample clinical trials with extended follow-up are required. Furthermore, the exact dose, treatment time, form of dispensation, and ideal vehicle for delivery are yet to be experimented and patented. On the other hand, currently, there are highly developed medicaments available that are being widely used and serve the purpose well. This chapter highlights the conventional, new, and developing intracanal medicaments and their methods of placement and removal.
... The inflammation and granulation tissue formation was minimal and bacteria was not found in this specimen. On the other hand, much research on humans shows aloe vera gel treated partial thickness burns and the wound healed quicker (11.8 days) than the Vaseline gauze (18.2 days) and other topical medication taking a longer time [34,35]. Aloe Vera contains salicylic acid which is an aspirin-like compound with anti-inflammatory analgesic and anti-bacterial properties [37 ]. ...
Article
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S. aureus poses an important problem in hospitals, nursing homes, and other health care settings. Serious infections due to these organisms currently necessitate the use of non-β-lactam antibacterial therapy. H2SO4 comes from strong poisons, because the symptom poison appears after five minutes from apple on skin. If possible treatment by Na2Co3 as antidot for H2SO4, but the necrosis or bacterial infection cases should by use drugs. Aloe vera gel is used topically for its anti-inflammatory and wound-healing properties, but it has also been used internally as a general tonic.The aim of this study is to evaluate the efficacy of aloe vera extract to treatment of normally induced and infected wounds with Staphylococcus aureus . In this study Twenty rabbits were used in this experiment. All of these rabbits were males. Burning techniques: These animals were divided in four groups and burning induced by H2SO4. After 1 hour of washing with distilled water, group 1 was still without treatment , group 2 was treated with aloe Vera extract for 7 days, group 3 was infected with staphylococcus aurous and group 4 was infected with staphylococcus aureus and aloe Vera extract for 14 days. Re-isolation of bacteria: Swabs were taken from all experimented burns every 24 hours before and after treatment to detect the progress of infection and recovery respectively. The result appeared whilst signs of burns and infected animals were recorded after 24–48 hours of infection as redness, ulceration, edematous and thickening of skin tissue was shown in non infected group I. The extract used for group II of non infected animals showed some signs after nearly 2 days, however after 7 days the wound progressed to healing and there was no swelling and ulceration. The skin began to soften and there was no cracked tissue. Infected group III, with staphylococcus aureus, showed thickening areas and swelling with pus cell. Group IV was infected with staphylococcus aureus and treated with aloe Vera extract for 14 days. There was not any inflammation areas caused by bacteria pus cell and swelling and they showed a degree of healing. While Histopathological sections appeared in the skin of the rabbits at 14 days, post-wound of the extracts shows granulation tissue in the wound area, irregular fibrous connective tissue proliferation with congested blood vessel, as well as mononuclear cell infiltration in some areas and an edematous. These results in the present study prove that aloe Vera extracts have the ability to accelerate burn healing time and act as an antibacterial through inhibition. Staphylococcus aureus were experimentally infected in burns and therefore are recommended to be used for treatment of wounds and burns .
... The biological activities of AV have been extensively studied, and most reports have revealed its multiple pharmacological activities such as anti-inflammatory, anti-diabetic, antibacterial, antioxidant, antiviral, and wound healing activities [40][41][42]. Wound healing activity is one significant prescription of AV gel use in various countries [43]. AV contains amino acids (e.g., glutamine threonine, isoleucine, valine, and phenylalanine), enzymes (e.g., bradykinase, catalase, lipase, cellulase, carboxypeptidase, and peroxidase), polymers (e.g., Acemannan and aloverose), and constituents vital for the wound healing process ( Figure 3). ...
Article
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The treatment of wounds is one challenging biomedical field due to delayed wound healing common in chronic wounds. Several factors delay wound healing, including microbial infections, malnutrition, underlying physiological conditions, etc. Most of the currently used wound dressing materials suffer from poor antimicrobial properties, poor biodegradability and biocompatibility, and weak mechanical performance. Plant extracts, such as Aloe vera, have attracted significant attention in wound management because of their interesting biological properties. Aloe vera is composed of essential constituents beneficial for the wound healing process, such as amino acids, vitamins C and E, and zinc. Aloe vera influences numerous factors that are involved in wound healing and stimulates accelerated healing. This review reports the therapeutic outcomes of aloe vera extract-loaded polymer-based scaffolds in wound management.
... Bioactive compounds of the plant have potential properties such as astringent, haemostatic, antidiabetic, antiulcer, antiseptic, [24] antibacterial, anti-inammatory, antioxidant and anticancer agent . Aloe vera is often touted as the "burn plant" and it is also used in burn [25] wound healing . ...
Article
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Wound healing is a biological process and it is achieved through programmed cellular and molecular phases. The four significant & overlapping phases are haemostasis, inflammatory, proliferative and remodelling. In each phase the tissues undergo enormous changes and these changes may or may not occur in proper sequence and time frame depends on various factors. The wound healing is a natural process where in the medications applied on the wound site may reduce the rate of healing. Natures have gifted us enormous plant based drugs with potential to wound healing. Plants plays a vital role in wound therapy, there are several plants in nature have wound healing properties such as Aloe vera, Angelica sinensis, Centella asiatica, Curcuma longa, Euphorbia hirta, Ginkgo biloba, Helianthus annuus and Rosmarins officinalis. The drugs in the present market are the synthetic formulations obtained from natural plants and these products exhibit possible side effects. This article reviews on medicinal plants and its wound healing benefits.
... La mayoría de los estudios relacionados con la aplicación tópica directa del AG y la recuperación de heridas, se han realizado principalmente en modelos animales y escasamente en humanos (Akaberi, Sobhani, Javadi, Sahebkar & Emami, 2016;Maenthaisong, Chaiyakunapruk, Niruntraporn & Kongkaew, 2007). Si bien es cierto, que el modelo animal proporciona información importante sobre el comportamiento de los factores internos y externos que intervienen en la recuperación de las heridas, también posee un sistema de cicatrización cutáneo diferente al humano. ...
Article
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La recuperación de las heridas en la piel es un proceso complejo e interrelacionado que se desarrolla a través de varias fases (hemostasia, inflamatoria, proliferativa y remodelación). El Aloe-gel (AG) ha sido considerado un biomaterial que puede coadyuvar en la modulación, regeneración y aceleración de la recuperación del tejido celular dañado e incluso se ha recomendado para su aplicación en heridas o quemaduras superficiales de tipo cutáneas.Debido a lo anterior, se ha promovido el uso del AG como un importante biomaterial que puede ser utilizado en la fabricación de recubrimientos para heridas (RH). Sin embargo, su aplicación directa sobre las heridas presenta desventajas, ya que puede inducir a deshidratación en la zona, rápida oxidación de sus fitoconstituyentes y baja proporción de solutos. Una estrategia que puede ayudar a conservar su actividad biológica y a sus componentes inalterados y funcionales, es su incorporación hacia matrices de polisacáridos como el alginato, pectina y quitosano. Aunque existen ya algunos biomateriales de esta mezcla que se han propuestos como RH, su aplicación en modelos in vivo es aún limitado. Por lo anterior, la presente revisión pretende documentar el desarrollo de RH con AG incorporado en polisacáridos y sus efectos en la recuperación de heridas in vivo.
... La evidencia científica de estudios en animales y en seres humanos ha incrementado la credibilidad de los beneficios para la salud debidos a la ingesta del jugo de Aloe vera (Pedroza, 2001). Las investi-gaciones sobre los efectos medicinales del Aloe vera L, refieren en que desde hace muchos años es utilizada en la elaboración de medicamentos destinados a tratar quemaduras (Campos, 1998;Maenthaisong et al., 2007), ulceras pépticas (Stevens, 2006), lesiones de la mucosa gástrica (Lujan et al., 2008), así como antiinflamatorio y de proliferación celular (Rodríguez et al., 2006;Khorasani et al., 2009). De igual manera se ha empleado en la fabricación de fármacos antimicóticos, antibacteriales y antivirales (Hamman, 2008;Tereza et al., 2008), basándose en investigaciones realizadas en modelos animales de laboratorio, para evaluar su efecto en el combate de enfermedades (Álvarez et al., 1996). ...
... The documented reduction of MDA production in the COX-1 test by feralolide constitutes the first attribution of biological activity to a dihydroisocoumarin of an Aloe species. The presented proof of its anti-inflammatory activity is of high relevance in the context of the typical application of A. vera in wound healing and a variety of inflammatory diseases, all of which have been validated by successful clinical studies [42][43][44][45] and even meta-analysis [46]. Feralolide might be of especial interest in these dermatological indications, as similar dihydroisocoumarins have been identified as active constituents of Japanese amacha (meaning "sweet tea") (Hydrangea macrophylla Seringe var. ...
Article
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The present study aims at the isolation and identification of diverse phenolic polyketides from Aloe vera (L.) Burm.f. and Aloe plicatilis (L.) Miller and includes their 5-LOX/COX-1 inhibiting potency. After initial Sephadex-LH20 gel filtration and combined silica gel 60- and RP18-CC, three dihydroisocoumarins (nonaketides), four 5-methyl-8-C-glucosylchromones (heptaketides) from A. vera, and two hexaketide-naphthalenes from A. plicatilis have been isolated by means of HSCCC. The structures of all polyketides were elucidated by ESI-MS and 2D 1H/13C-NMR (HMQC, HMBC) techniques. The analytical/preparative separation of 3R-feralolide, 3′-O-β-d-glucopyranosyl- and the new 6-O-β-d-glucopyranosyl-3R-feralolide into their respective positional isomers are described here for the first time, including the assignment of the 3R-configuration in all feralolides by comparative CD spectroscopy. The chromones 7-O-methyl-aloesin and 7-O-methyl-aloeresin A were isolated for the first time from A. vera, together with the previously described aloesin (syn. aloeresin B) and aloeresin D. Furthermore, the new 5,6,7,8-tetrahydro-1-O-β-d-glucopyranosyl- 3,6R-dihydroxy-8R-methylnaphtalene was isolated from A. plicatilis, together with the known plicataloside. Subsequently, biological-pharmacological screening was performed to identify Aloe polyketides with anti-inflammatory potential in vitro. In addition to the above constituents, the anthranoids (octaketides) aloe emodin, aloin, 6′-(E)-p-coumaroyl-aloin A and B, and 6′-(E)-p-coumaroyl-7-hydroxy-8-O-methyl-aloin A and B were tested. In the COX-1 examination, only feralolide (10 µM) inhibited the formation of MDA by 24%, whereas the other polyketides did not display any inhibition at all. In the 5-LOX-test, all aloin-type anthranoids (10 µM) inhibited the formation of LTB4 by about 25–41%. Aloesin also displayed 10% inhibition at 10 µM in this in vitro setup, while the other chromones and naphthalenes did not display any activity. The present study, therefore, demonstrates the importance of low molecular phenolic polyketides for the known overall anti-inflammatory activity of Aloe vera preparations.
... Some polysaccharides in A. vera have therapeutic properties such as immune-stimulation, anti-inflammatory, wound healing, promotion of radiation damage repair, antibacterial, anti-viral, anti-fungal and anti-oxidant [8][9][10][11][12]. Several pre-clinical and clinical trials showed a blood glucose and lipid lowering effect for A. vera gel preparations [13][14][15][16]. ...
Article
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Aloe.vera has a long history as a medicinal plant with diverse therapeutic applications. This study was conducted to determine chemical composition and biochemical activity of A. vera leaves. Proximate composition (moisture, ash, crude protein, crude lipid and crude fibre), ascorbic acid, superoxide dismutase, catalase, peroxidase, amylase, reducing sugars and total soluble sugars were determined. Moisture content of 97.42 ± 0.13% was observed, while average percent ash, fiber, protein and fat contents were 16.88 ± 0.04%, 73.35 ± 0.30%, 6.86 ± 0.06% and 2.91 ± 0.09% respectively along with traces of ascorbic acid (0.004 ± 0.05%). Variable levels (IU/mg) of superoxide dismutase (802.14 ± 55.6-2830.19 ± 37.09), peroxidase (1.46 ± 0.06-3.72 ± 0.19), catalase (1.56 ± 0.14-2.8 ± 0.19) and amylase (0.97 ± 0.82-24.02 ± 1.5) were observed in the extracts. Total soluble and reducing sugars accounted for 120.68 ± 7.24-363.03 ± 9.25 mg/mL and 97.23 ± 0.05-123.33 ± 0.74 mg/mL. Overall, this investigation has provided a succinct resume of information regarding the chemical composition and biochemical activity of A. vera leaves. It would be worthwhile embarking on an intensive scientific experimentation and investigation on this valuable medicinal plant and to promote its large-scale utilization.
... Some polysaccharides in A. vera have therapeutic properties such as immune-stimulation, anti-inflammatory, wound healing, promotion of radiation damage repair, antibacterial, anti-viral, anti-fungal and anti-oxidant [8][9][10][11][12]. Several pre-clinical and clinical trials showed a blood glucose and lipid lowering effect for A. vera gel preparations [13][14][15][16]. ...
Article
Full-text available
Aloe.vera has a long history as a medicinal plant with diverse therapeutic applications. This study was conducted to determine chemical composition and biochemical activity of A. vera leaves. Proximate composition (moisture, ash, crude protein, crude lipid and crude fibre), ascorbic acid, superoxide dismutase, catalase, peroxidase, amylase, reducing sugars and total soluble sugars were determined. Moisture content of 97.42 ± 0.13% was observed, while average percent ash, fiber, protein and fat contents were 16.88 ± 0.04%, 73.35 ± 0.30%, 6.86 ± 0.06% and 2.91 ± 0.09% respectively along with traces of ascorbic acid (0.004 ± 0.05%). Variable levels (IU/mg) of superoxide dismutase (802.14 ± 55.6-2830.19 ± 37.09), peroxidase (1.46 ± 0.06-3.72 ± 0.19), catalase (1.56 ± 0.14-2.8 ± 0.19) and amylase (0.97 ± 0.82-24.02 ± 1.5) were observed in the extracts. Total soluble and reducing sugars accounted for 120.68 ± 7.24-363.03 ± 9.25 mg/mL and 97.23 ± 0.05-123.33 ± 0.74 mg/mL. Overall, this investigation has provided a succinct resume of information regarding the chemical composition and biochemical activity of A. vera leaves. It would be worthwhile embarking on an intensive scientific experimentation and investigation on this valuable medicinal plant and to promote its large-scale utilization.
... Whereas, in another double-blind, randomized, and controlled clinical trial in patients with split-thickness skin graft donor-sites showed that topical A. vera gel had a more significant and faster healing effect, but no meaningful pain relief was observed [50]. According to the conducted clinical trials, A. vera was more effective in first-and second-degree burn wounds than in the other degrees, and it can shorten the healing time to 9 days [51]. The beneficial effects of A. vera were also investigated in the treatment of patients with skin ulcers, postoperative wounds [52,53], and chronic wounds [54,55]. ...
Article
Wound is defined as any injury to the body such as damage to the epidermis of the skin and disturbance to its normal anatomy and function. Since ancient times, the importance of wound healing has been recognized, and many efforts have been made to develop novel wound dressings made of the best material for rapid and effective wound healing. Medicinal plants play a great role in the wound healing process. In recent decades, many studies have focused on the development of novel wound dressings that incorporate medicinal plant extracts or their purified active compounds, which are potential alternatives to conventional wound dressings. Several studies have also investigated the mechanism of action of various herbal medicines in wound healing process. This paper attempts to highlight and review the mechanistic perspective of wound healing mediated by plant-based natural products. The findings showed that herbal medicines act through multiple mechanisms and are involved in various stages of wound healing. Some herbal medicines increase the expression of vascular endothelial growth factor (VEGF) and transforming growth factor-β (TGF-β) which play important role in stimulation of re-epithelialization, angiogenesis, formation of granulation tissue, and collagen fiber deposition. Some other wound dressing containing herbal medicines act as inhibitor of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and inducible nitric oxide synthase (iNOS) protein expression thereby inducing antioxidant and anti-inflammatory properties in various phases of the wound healing process. Besides the growing public interest in traditional and alternative medicine, the use of herbal medicine and natural products for wound healing has many advantages over conventional medicines, including greater effectiveness due to diverse mechanisms of action, antibacterial activity, and safety in long-term wound dressing usage.
... Acemannan, a linear polysaccharide of polydispersed b-(1,4)-acetylated mannan-based, is one of the main active constituents of Aloe vera gel 10 . Acemannan can stimulate fibroblast proliferation in the gingival tissue, promote the synthesis of growth factors, and induce the secretion of several cytokines that modulate the wound healing and immune response 12,13 . It can promote oral aphthous ulcer healing and enhance tertiary dentin and periodontium formation [14][15][16][17] . ...
Article
Acemannan, a linear polysaccharide produced by Aloe vera, has been shown to have important biological effects promoting wound healing and tissue regeneration. The aim of this randomized clinical trial was to investigate the impact of acemannan in guided bone regeneration (GBR) with simultaneous implant placement. Twenty patients were randomly allocated to a test group (deproteinized bovine bone with particulate acemannan (mean size 32.45 μm)) and a control group (deproteinized bovine bone only). Twenty implants were placed with simultaneous GBR. Radiographic measurements were conducted on cone beam computed tomography (CBCT) scans immediately post-surgery and at 3 and 6 months. Vertical and horizontal dimensions of the buccal bone were measured at the implant platform (0) and at points 2, 4, 6, and 8 mm apically. The dimensional reduction of vertical and horizontal buccal bone was significantly smaller in the test group at 3 months postoperative (P < 0.05) at every position measured (0, 2, 4, 6, 8 mm), but the difference was not statistically significant at 6 months. Acemannan was found to be a safe and predictable biomaterial for GBR, which resulted in enhanced dimensional stability of the regenerated tissue at 3 months. However, these results were not replicated at 6 months. Further studies are required to document the long-term efficacy and potential of acemannan use as a supplement in bone regeneration.
... Hypoglycemic (Rajasekaran et al., 2004;Yongchaiyudha et al., 1996), anti-inflammatory (Reynolds and Dweck, 1999;Vázquez et al., 1996), antiviral (Kahlon et al., 1991), antibacterial, antifungal, antioxidant activity (Khaing, 2011), immunomodulatory (Chow et al., 2005;Im et al., 2014;Shida et al., 1985), intestinal drug absorption enhancement (Chen et al., 2009;Vinson et al., 2005), skin penetration enhancement and healing (Choi et al., 2001;Cole and Heard, 2007), anti-cancer (Boudreau and Beland, 2006), laxative (Odes and Madar, 1991), hepato and nephron-protective (Arosio et al., 2000;Bolkent et al., 2004), hormonal regulation (Kar et al., 2002), treating burning mouth syndrome (Maenthaisong et al., 2007). The following side effects were noted from the use of A. vera; dehydration and electrolyte imbalance, emesis, hypoglycemia, hyperpigmentation and photosensitivity (Luyckx et al., 2002;Shen et al., 2012), hepatotoxicity, acute tubular necrosis and acute interstitial nephritis (Chen et al., 2012;Eshun and He, 2004;Mahomoodally, 2013;Wabuyele and Kyalo, 2008), hypersensitivity (Morrow et al., 1980), allergic reactions (Ernst, 2000), massive intraoperative bleeding (Lee et al., 2004), acute renal failure (Luyckx et al., 2002), severe vomiting (Wang et al., 2003), development of melanosis coli after prolonged anthranoid self-medication in case studies (Willems et al., 2003), acute hepatitis (Rabe et al., 2005). ...
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Introduction There is widespread use of Aloe species in traditional healing practices in East Africa for a variety of diseases. Unfortunately, there is a tendency of mistakenly referring to all species of the genus Aloe as Aloe vera, despite the diversity of aloes in the region. The names for the different Aloe species in local languages are usually the same for the different species. Aim The aim of this review was to assess the medicinal uses of the indigenous little-known and other popular Aloe species in East Africa. Methods Relevant articles, books, theses, dissertations, patents, and other English-only reports on the ethnobotany, traditional medicinal uses, pharmacological or biological activity, toxicity, phytochemistry, trade, conservation, etymology, and distribution of aloe species in East Africa (Uganda, Tanzania, Kenya, Rwanda, and Burundi) were reviewed. Databases such as PubMed, Web of Science, Scopus, Science Direct, and search engines such as Google Scholar, were searched between May and September 2020. Scientific names and synonyms of the aloe species were verified and resolved using Plants of the World Online (POWO, http://powo.science.kew.org/). Results Forty-nine of the over 180 Aloe species known in East Africa, are traditionally used for treating various ailments. Most of the Aloe species (85.7%) had direct references to their use in traditional medicine. Thirty-six species (73.5%) had some form of phytochemical analysis performed on them. Most of the Aloe species (67.3%) have never been investigated for any biological activity. The distinctive constituents in aloe leaves are phenolic compounds including chromone, anthraquinone or anthrone derivatives. Aloe aageodonta, A. ballyi, and A. christianii are known to be poisonous to humans when used in high doses, despite being used in traditional medicine. Aloe elgonica, A. ferox, and A. lateritia are all highly toxic to brine shrimp, whereas A. macrosiphon, A. vera, and A. volkensii cause a wide range of toxic side effects, such as bloody diarrhoea, dehydration, kidney damage, miscarriage, nausea and vomiting, hepatotoxicity, and acute renal failure, when used for long periods and in high doses. Conclusion Several Aloe species are used in East Africa for treating various ailments. However, most of the local Aloe species have not been scientifically investigated for their biological activity, as well as their toxicity.
... It also increases synthesis of hyaluronic acid and dermatan sulfate in the granulation tissue of a healing wound. [43,44] ...
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Aims: This study aims to review the diverse uses of Aloe vera (true aloe) as well as the conservation measures and conventional cultivation techniques. Study Design: Best evidence review. Place and Duration of Study: Biomedicinal Research Centre, Forestry Research Institute of Nigeria. Methodology: Search inputs such as Aloe vera, Aloe barbadensis in conjunction with the following terms: ‘uses’, ‘overexploitation’, ‘conservation’, ‘policy’, ‘cultivation’, ‘yield’, and ‘agronomic practices’ were queried on several scientific databases. Search engines, were also queried for publications covering exploitation, conservation approaches, and cultivation requirements on Aloe vera. Other databases such as ScienceDirect and SciFinder were accessed for relevant papers and supplement acquired information after articles (outside the defined scope of the review) were excluded. Results: Aloe vera (true aloe) has been engaged particularly for medicinal and cosmetic purposes for thousands of years, and its utilization remains popular till date. Aloe vera is popularly valued for its natural products, including nutritional benefits in food, source of nectar for honey bees and nectarivorous birds and horticulture. In this study, several studies demonstrating the botanical characteristics and ecological adaptation of A. vera were discussed; agronomic techniques involving the requirements for land preparation, propagation and harvesting were also considered as well as the growth yield of the plant due to different soil types and nutrient applications. Conclusion: For the multifarous uses of Aloe vera, adequate policy should be appropriated to regions where this plant is put to industrial uses, over-exploited and threatened. Calcareous and non-calcareous soil have maximum yield on true aloe. Azotobacter chroococcum of strain 12 has turned out to be a good growth stimulant bacterium when treated with A. vera. Aloe rust and anthracnose disease are known fungal infections, while Aloe vera aphid (Aloephagus myersi) is an identified pest of the plant.
... Aloe vera contains multiple antioxidant and antiinf lammatory compounds which have including superoxide dismutase and vitamins C and E [20]. Previous studies showed that A. vera has been widely used to treat various conditions such as burn wound, radiationrelated dermatitis, mucositis, esophagitis, acne vulgaris, and psoriasis vulgaris [1,[21][22][23]. However, but studies investigating the effect of this dry and warm weather plant in ARP are not available. ...
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Objective To examine the preventive effects of Aloe vera in colorectal cancer patients undergoing radiotherapy. Material and Method Twenty colorectal cancer patients, who received radiation, were randomized to receive Aloe vera 3% or placebo ointment, 1 g twice daily for 6 weeks. At weekly visits, acute radiation proctitis (ARP) was evaluated by Radiation Therapy Oncology Group and clinical presentation criteria as the primary endpoint. We also evaluated secondary endpoints of quality of life, psychosocial status, by applying Hospital Anxiety-Depression (HAD) Scale and laboratory measures of quantitative measurement of C-reactive protein (CRP) as a marker for systemic inflammation. Results There was a significant improvement in the symptom index (before treatment vs. after treatment with Aloe vera) for diarrhea (p = 0.029, median score: 0.5 vs. 0.001). The overall primary and secondary outcomes favored Aloe group, while the measures of toxicity did not achieve a statistical significant difference. The lifestyle score improved significantly with A. vera (p = 004), and they also had a lower depression score in HAD scale (p = 0.008). Furthermore, quantitative CRP decreased significantly during the course of treatment with Aloe vera. Conclusion The use of topical formulation of Aloe vera 3% diminishes the severity of ARP in colorectal cancer patients.
... Their results revealed that treatment with Aloe vera gel speeds up the wound healing process by increasing the rate of collagen synthesis, affecting fibroplasia and wound size reduction. In another study, Maenthaisong et al. (2007) evaluated the effectiveness of Aloe vera in burn wounds. Aloe vera was observed to increase the rate of re-epithelialization and reduce the wound healing period for burn wounds. ...
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Background The present study aimed to prepare effective silk derived formulations in combination with plant extract ( Aloe vera gel) to speed up the wound healing process in diabetic mice. Methods Diabetes was induced in albino mice by using alloxan monohydrate. After successful induction of diabetes in mice, excision wounds were created via biopsy puncture (6 mm). Wound healing effect of silk sericin (5%) and silk fibroin (5%) individually and in combination with 5% Aloe vera gel was evaluated by determining the percent wound contraction, healing time and histological analysis. Results The results indicated that the best biocompatible silk combination was of 5% silk fibroin and 5% Aloe vera gel in which wounds were healed in 13 days with wound contraction: 98.33 ± 0.80%. In contrast, the wound of the control group (polyfax) healed in 19 day shaving 98.5 ± 0.67% contraction. Histological analysis revealed that the wounds which were treated with silk formulations exhibited an increased growth of blood vessels, collagen fibers, and much reduced inflammation. Conclusion It can be concluded that a combination of Bombyx mori silk and Aloe vera gel is a natural biomaterial that can be utilized in wound dressings and to prepare more innovative silk based formulations for speedy recovery of chronic wounds.
... Factors associated with the risk of scarring in children include total body surface area (TBSA) burns, delayed wound healing, deep burns, skin type, burn location, and skin grafting [2,6,7,8,9]. Abnormal scars have a documented prevalence rate of 32% to 72% postburn and are defined as scars with physical and sensory symptoms that affect healthrelated quality of life because of itchiness, raising, pain, tightness, and contracture formation [11][12][13][14][15][16][17][18]. ...
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When burn sequelae persist in childhood, they can impair quality of life and have severe physical, psychological, and social consequences. A pressure range from 10 to 25 mmHg is suitable for children wearing pressure garments. Educating parents and children about household burn risks is necessary to prevent children from being burned because even if burn injuries are not fatal, burn scars can have a clear impact on children’s lives.This paper summarizes the literature on the effects of conservative treatments for burn scars in children to improve future treatment habits and encourage further research into this topic. Keywords - Occupational Therapist; Hypertrophic Scar; Keloid; Total Body Surface Area; Rehabilitation; Pressure Garment
... The open approach is more commonly applied [12]. Recently, new naturally based products are gaining popularity in the clinical practice [13]. ...
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Background: Worldwide, annually, 11 million people seek medical assistance due to burn traumatic injuries. Most of the mare attributable to natural disasters, work accidents and domestic burns, in some cases, they may indicate the presence of child abuse. Management of facial burns presents a challenge to surgeons as burn traumas involving the face result in both physical and psychological injury. Objective: The aim of the present study is to investigate the effect of Theresienöl® in cases of facial burns. Method: Over a period of two years, the study contingent was 53 patients. Patients were selected from those attending the-Plovdiv‖. They were subdivided into groups according to age, gender, etiology and degree of burns as well as duration of treatment. Once per day our patients received treatment with Theresienöl® based on an open approach, with rubbing of the substance with massage movements, thus securing impregnation of the oil in the damages areas. Results: We monitored a very good penetration of the oil in the eschars and consequently-their more rapid separation and better esthetic results. Patients reported complete recovery with very good esthetic result to day 14. Based on our study protocol, it was used in the management of superficial facial wounds with a very good outcome. Conclusions: Theresienöl® is a patent product that is used in the treatment of difficult to heal wounds, burns, edemas and after surgery. Highlights The first application of Theresienöl® reduce the post-burn edema Compared to other medical products used for treatment of facial burns, we monitored a very good penetration of the oilintheeschars and consequently-their more rapid separation and better esthetic results Regardless of the short lived rubor of the underlying epithelium, no pigmentation was noted Patients reported complete recovery with very good esthetic result to day 14 Based on this evidence, we consider the results and outcomes following treatment with Theresienöl® as very good
... Also, the leaves are the source of various organic acids, phenolic compounds, minerals, and vitamins [21]. erapeutic effects of Aloe vera in wound healing [22], inflammation, intestinal absorption, and reducing oxidative status were assessed in recent research [23]. It also has been used empirically to increase high-density lipoprotein, reduce low-density lipoprotein, and decrease glycemia in diabetics [19]. ...
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Background. Ulcerative colitis is a worldwide chronic gastrointestinal disease characterized by variable extensions of colon mucosal inflammation. The available drugs have an incomplete response with various side effects and socioeconomic impacts. Aloe barbadensis Miller (Aloe vera) is a well-known medicinal plant with diverse pharmacological and therapeutic activities. As a result, in the current study, Aloe vera was selected to evaluate its therapeutic effects on experimental colitis in rats. Methods. This study is intended to evaluate the possible beneficial effect of Aloe vera for the treatment of experimental colitis. Trinitrobenzenesulfonic acid (TNBS) was used to induce experimental colitis in 60 of 70 Wistar rats. The rats were grouped in 7 clusters including healthy control, negative, positive control (received sulfasalazine), and test groups treated with Aloe vera extracts via oral or rectal routes. Macroscopic and histologic factors as well as the biochemical parameters were evaluated on day 7. Results. In the present study, it was found that serum levels of tumor necrosis factor-α (75 vs. 44 pg./ml), interleukin-6 (41 vs. 21 pg/ml), and nitric oxide (24 vs. 6 μm/ml) in TNBS-induced untreated colitis treatment were significantly increased as compared to healthy control. Similar patterns were also observed in malondialdehyde (76.41 vs. 236.35 μg/mg) and myeloperoxidase (4.24 vs. 29.38 U/mg) in colonic tissue. Among different treatments, rectal administration of Aloe vera extract (400 mg/kg) exhibited the best result in which serum concentration of tumor necrosis factor-α (55 pg/ml), interleukin-6 (24 pg/ml), and nitric oxide (10 μm/ml) and the levels of malondialdehyde (102.67 μg/mg), as well as myeloperoxidase (12.29 U/mg) in colon tissue, were reduced as compared to the untreated group. Also, the body weight and colon weight/length ratios were more improved in the treated group with 400 mg/kg Aloe vera extract, rectally. Conclusion. Aloe vera extract exhibited a therapeutic effect in TNBS-induced colitis, and local, rectal administration of Aloe vera extract was more effective than oral administration. 1. Introduction Ulcerative colitis (UC) as an annoying chronic problem is one of the two major subtypes of inflammatory bowel diseases (IBDs) with different geographic prevalences and worldwide distribution [1, 2]. Although UC may present insidiously, its hallmark is subacute bloody diarrhea, accompanied by anemia and fatigue. It also may change to acute severe colitis, presenting temperature above 37.5°C, heart rate above 90/min, and hemoglobin concentration below 10.5 g/dL with more than 6 bloody stools daily [3, 4]. Its manifestation is due to continuous inflammation of the rectum with the variable extension but usually with decreasing severity up to the cecum [5]. Its etiology and exact underlying pathophysiologic aspects are unclear, but most probably is due to aberrant deregulated mucosal immune responses (humoral and cellular immunity) to environmental factors in a genetically susceptible population. Following epithelial barrier dysfunction and immune cell activation, inflammatory cytokines and mediators (interferon-γ (IFN-γ), interleukin-2 (IL-2), IL-4, IL-5, IL-10, IL-13, IL-17, IL-23, and tumor necrosis factor α (TNF-α)) are released which may be used as disease activity indicators [6, 7]. The diagnosis of UC is based on clinical presentation and chronic colon inflammation confirmed by histology [8]. Uncertain definitive pathogenesis, variable presentation, natural course, and lack of standard disease activity index are obstacles for definite therapeutic effect assessment. In any case, the accepted therapeutic goals are (a) accentuating induction of remission and maintenance period, (b) improving the nutritional status, (c) decreasing disease complications, and (d) considering side effects and cost effectiveness. In current medicine, the main treatments are focused on 5-ASA and steroids. Biologic therapies such as antitumor necrosis factor antibodies are prescribed for resistant patients. Antiadhesion molecules and kinase inhibitors are under research for UC treatment [9–12]. The inadequate response, frequent relapse, steroid dependency, and side effects result in developing a new candidate as the second line of treatment. Considering therapeutic effects of some herbal medicine such as heartleaf houttuynia [13, 14], boswellic acid [15, 16], diamonnium glycyrrizhinate [17], slippery elm [18], fenugreek [18], devil’s claw [18], tormentil [18], and wei tong ning [18] in various diseases, especially in China, Middle-East, and Africa, new research in this field is rational. Aloe vera (Aloe barbadensis Mill.) belongs to the Aloeaceae family with thick, tapered, green lance-shaped, juicy, sharp, and edged leaves [19]. Aloe vera grows in dry regions of Africa, Europe, Asia, and America. Aloe vera is probably the most applied medicinal plant commercially and the most popular plant worldwide [20]. Various parts of the plant contain amino acids, sugars, enzymes, vitamins, minerals, saponins, anthraquinones, lignin, and salicylic acid. Also, the leaves are the source of various organic acids, phenolic compounds, minerals, and vitamins [21]. Therapeutic effects of Aloe vera in wound healing [22], inflammation, intestinal absorption, and reducing oxidative status were assessed in recent research [23]. It also has been used empirically to increase high-density lipoprotein, reduce low-density lipoprotein, and decrease glycemia in diabetics [19]. Furthermore, the anti-inflammatory effects of Aloe vera in the human colon were confirmed in vitro by Langmead et al. [24]. In 2017, the healing effect of the aqueous leaf extract of Aloe vera in an animal model of experimentally induced colitis was investigated. The favorable effects confirmed through the significant reduction in Bax mRNA expression and elevation in Bcl-2 mRNA expression when compared with the colitis group without treatment [25]. In another study, 50 and 300 mg/kg of Aloe vera gel extract were used to evaluate the improvement in the symptoms of UC in rats. According to microscopy and macroscopic observations, the symptoms of UC were improved significantly [26]. Park et al. showed that 0.1% and 0.5% aloesin supplement (one of the compounds of Aloe vera) decreased the myeloperoxidase (MPO) activities as well as TNF-α and interleukin-1β (IL-1β) mRNA expressions on the UC rat colitis model [27]. In another study, glucomannan extracted from Aloe vera balanced pro- and anti-inflammatory cytokines regulated the expressions of TLR-2 and improved the health state of colitis in mice [28]. Similarly, assessments on polysaccharides extracted from Aloe vera on UC-animal models depicted an improvement in colitis, via JAK2, p-JAK2, STAT-3, and p-STAT3 protein expression [29]. In a randomized, double-blind, placebo-controlled trial, oral Aloe vera gel (100 mL twice daily for 4 weeks, in a 2 : 1 ratio) was administered for active UC patients. The supplement reduced the clinical colitis activity index and histological scores significantly during treatment with Aloe vera [30]. However, it seems that further evaluation about the therapeutic potential of Aloe vera extract on UC as well as its effect on new biochemical factors related to UC is needed to get more insight into signaling pathways. Furthermore, in the current study, for the first time, the different routes and doses of Aloe vera administrations (intragastrically and rectally) were studied. Regarding the therapeutic dose of Aloe vera used in the previous studies with no report of toxicity in the tested range, 200 and 400 mg/kg Aloe vera extract were chosen for further study [31–35]. This study was designed to evaluate and compare the dose and route treatment of Aloe vera extract on colitis in rats and its impacts on proinflammatory cytokines. 2. Materials and Methods 2.1. Ethical Statement The animal experiments were performed in accordance with the guidelines of the Laboratory Animal Center of Shiraz Medical University (No. 91-01-36-4560). All the experimental procedures were strictly conducted according to the international standards and national legislation on animal care and the Animal Research Reporting In Vivo Experiments (ARRIVE) guidelines. Experimental research on the plant was under international legislation and guidelines of the Pharmacognosy Department of Shiraz University of Medical Sciences, Shiraz, Iran. At the end of the study, rats were euthanized with the rapid and humane method using a 70% volume displacement rate of CO2 increased to around 100% in the induction chamber. 2.2. Study Design and Induction of Colitis The Laboratory Animal Center of Shiraz University of Medical Sciences with a pathogen-free environment, constant temperature (23 ± 2), and acceptable humidity (55 ± 5%) provided us with 70 male Wistar rats (175–215 grams) supplied with a balanced diet along with free access to water. The rats were fasted with free access to water for 24 h before induction of colitis. After rats were anesthetized with ketamine (50 mg/kg i.p), the rubber-tipped gavage needle was inserted into the anus of rats (7 cm) and 1 ml solution of 2,4,6-trinitrobenzenesulfonic acid (TNBS, 150 mg/kg dissolved in ethanol) was slowly injected into the colon while the control group received only ethanol. Animals were held in the head-down position for 30 seconds and then returned to their cages [36–38]. Later, water and food were available. 12 hours after colitis induction, the treatments were started and continued one a day for six consecutive days. The effectiveness of treatment was assessed by clinical, macroscopic, biochemical, and histopathological assessments. The rats’ general conditions were assessed daily. 2.3. Experimental Animals A total of 70 Sprague Dawley male rats (aged 10-12 weeks, weighing initially 220 ± 20 gram) were obtained from the Laboratory Animal Center of Shiraz University of Medical Sciences. Animals were divided into seven groups (10 rats per group, n = 10). Group (1): healthy control group Group (2): TNBS-induced colitis untreated rats Groups (3): TNBS-induced colitis treated rats who received 200 mg/kg Aloe vera extract once a day, intragastrically Groups (4): TNBS-induced colitis treated rats who received 400 mg/kg Aloe vera extract once a day, intragastrically Groups (5): TNBS-induced colitis treated rats who received 200 mg/kg Aloe vera extract once a day, rectally Groups (6): TNBS-induced colitis treated rats who received 400 mg/kg Aloe vera extract once a day, rectally Group (7): TNBS-induced colitis treated rats who received 500 mg/kg sulfasalazine once a day, intragastrically as a positive control group The dose of Aloe vera extract for treatments was selected according to previously reported research [33–35]. According to the published articles, evaluation on the acute and subacute toxicity of Aloe vera in rats indicated that the methanol extract at the doses of 1, 2,4, 8, and 16 g/kg B.wt did not produce significant toxic effects [31]. In the other study, assessments on the subacute toxicity test showed that Aloe vera did not produce marked subacute toxic effects up to a maximum concentration of 3330 mg/kg body weight on rats with no mutagenic activity in ICR mice exposed to 10000 mg Aloe vera/kg body weight [32]. As a result, at the tested dose of Aloe vera extract, the toxic effect in rats without colitis was not assessed. Sulfasalazine also was purchased from Merck chemical company. The appropriate amount of extract or sulfasalazine based on the treated group was dissolved in sterile water. Intragastric administration was used in conscious rats with biomedical needles (length 76.2 mm, diameter 3 mm, straight). To prepare extract for rectal administration, 5% glycerol was mixed with 2% sodium carboxymethyl cellulose (NaCMC) as an inert preservative substance [39]. Next, 200 and 400 mg/kg body weight of the dried extract was dissolved in deionized water, and the mixtures were gradually added to the glycerol-NaCMC solution. The gel was homogenized for 30 minutes, and the gel was collected in an aluminum tube in the refrigerator. For rectal administration, the gavage needle was inserted into the anus of rats (7 cm) and 1 ml of the prepared gel was injected [40]. 2.4. Plant Extract Aloe vera leaves were obtained in Shiraz, Fars Province, Iran, and its species was endorsed by SUMS taxonomists at a pharmacy school. 100 g dried Aloe vera was powdered and percolated with 70% ethanol (3 times), at room temperature, and the extracts were filtered and evaporated under reduced pressure to acquire 9.8 g of dried extracts (9.8% yield). This procedure was repeated several times to get enough amounts of extract for in vitro and in vivo studies. 2.5. Macroscopic Scoring The dosage and period of treatments were accompanied by daily body weights, gross stool evaluation for visible and/or occult bleeding. On the last day of the experiment (7th), the degree of colonic inflammation and damage was scored (Table 1) as described by Morris et al. with slight modifications [41, 42]. Score Gross morphology 0 No damage 1 Localized hyperemia, but no ulcers or erosions 2 Ulcers or erosions with no significant inflammation 3 Ulcers or erosions with inflammation at one site 4 Two or more sites of ulceration and/or inflammation 5 Two or more major sites of inflammation and ulceration or one major site of inflammation and ulceration extending >1 cm along the length of the colon
... Wound repairs include, physiological process that could be categorized into phases: inflammation, hemostasis, proliferation (granulation), and remodeling (maturation) of the extracellular matrix [6]. The inflammation phase comprises the coagulation process and the response of the immune system [7]. ...
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Burns are the most common skin injuries associated with many complications and high incidences of wound infections. Many compounds of plant products have been assessed to accelerate wound healing or reduce contamination. The possible healing effect of two Cucurbita spp. in skin burns was investigated. Cucurbita maxima and Cucurbita pepo leaves and seeds were extracted using ethanol and analyzed by gas chromatography–mass spectrometry. Second-degree burn wounds were made on laboratory rats, and the burn wounds were applied topically with extracts for 14 days and silver sulfadiazine (SS) for comparison. Serum vascular endothelial growth factor (VEGF) was analyzed post�treatment. Hydroxyproline content and histopathological changes were evaluated in skin biopsy. Phytochemical analysis displayed that C. maxima leaf extracts contain linolenic acid (21.94%), phytol (6.45%), and ascorbic acid (9.09%), and they were characterized by glucopyranoside (8.49%) and limonene (5.39%) compounds. The C. pepo leaves were characterized by palmitic acid (48.04%) and alkaloid (tetratriacontane: 13.11%). The seeds extracts of both Cucurbita spp. revealed a high ratio of linoleic acid, palmitic acid, and ascorbic acid. The leaf extracts accelerated wound contraction by 100%, with normal skin appearance, due to their more structural tissue layers, regular collagen fibers, ability to reduce inflammation, and high hydroxyproline content compared to the seed extracts and SS group. The bioactivity of unsaturated fatty acids, ascorbic acid, monoterpene, glycosides, and alkaloids provided the therapeutic property of these extracts. Serum VEGF was significantly reduced in the groups treated with extracts compared with those treated by the SS group. The leaf extracts of both Cucurbita species exhibited a healing efficiency on burn wounds, which were more effective than the seed extracts. Thus, they can be used as a promising plant derivative in burn treatments.
... In the present study, SNPs have been synthesized using aloe vera extract. The medicinal plant aloe vera is an excellent candidate that can be used as an anticancer, antioxidant, and antimicrobial agent [19,20]. Herein, we have integrated the benefits of green synthesized SNPs using aloe vera with chitosan in one nanocomposite film. ...
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Over the last decade, chitosan films have promising applications due to their biocompatible, biodegradable, non-toxic, and mucoadhesive nature; haemostatic effects; as well as antimicrobial and biological activities. The conjugation of chitosan with green synthesized silver nanoparticles (SNPs) to form a nanocomposite film will greatly affect the structural properties of chitosan film. This study aimed to evaluate the physical properties of chitosan films doped with different concentrations of SNPs (100–400 μg). X-ray diffraction (XRD) and dynamic mechanical analysis (DMA) were measured for pure chitosan and chitosan films doped with SNPs (100–400 μg). XRD pattern for chitosan film doped with the highest concentration of SNPs (400 μg) showed a decrease in the crystallinity of the chitosan matrix compared with the other doped films. Also, DMA results showed that the storage modulus of the nanocomposite films is dependent on the concentration of SNPs. Accordingly, chitosan film doped with high concentration of SNPs (400 μg) affected the structure and viscoelastic behaviour of chitosan. Thus, the integration of green synthesized silver nanoparticles using aloe vera extract with chitosan films identifies promising candidate in biomedical applications.
... Plenty of pharmaceutical, medicinal, and cosmetics products have been developed from the mucilaginous tissue, called AV gel. 32,33 In this concept, numerous studies reported the beneficial role of AV in the wound healing process. AV gel contains various amino acids, long-chain polysaccharides, carbohydrates, ascorbic acid, Vit A, and Vit E, and salicylic acid. ...
Article
The main aim of the current study was to develop a chitosan hydrogel containing Aloe vera gel and Ethylenediaminetetraacetic acid (EDTA) as the wound healing materials. Chitosan with the concentration of (2% w/v) was prepared in AA (0.5%, v/v) and Tetrasodium EDTA (0.01% w/w) and AV (0.5% v/v) were added to the prepared polymer solution. As prepared solution was cross‐linked by β‐GP with the weight ratio of 1/6 w/w (1 chitosan and 6 β‐GP). The characterization of the hydrogels showed that the hydrogels have porous structures and interconnected pores with the pores size range from 41.5 ± 14 to 48.3 ± 11 μm. The swelling and weight loss measurements of the hydrogels showed that the hydrogels could swell up to 240% of their initial weight during 8 h and loss 79.7 ± 3.5% of the initial weight during 14 days. The antibacterial studies depicted that the prepared Cs/tEDTA/AV hydrogel inhibited the growth of Staphylococcus aureus (the minimum inhibition concentration, MIC of 73 ± 4.8) and Pseudomonas aeruginosa (the MIC of 40 ± 7.9). Moreover, the prepared hydrogels were hemocompatible (Cs/tEDTA/AV: OD of 0.24 ± 0.30) and biocompatible (Cs/tEDTA/AV: OD of 0.38 ± 0.01). At the final stage, the wound healing assessments in the animal model revealed that the application of the prepared hydrogels effectively enhanced the wound healing process. In conclusion, the results confirmed the efficacy of the prepared hydrogels as the wound healing materials.
... For example, chitosan was associated with the followings: PMNs recruitment to the wounded area, facilitating coarse fibrin formation as a stimulator of fibroblast migration to wound, stimulating macrophages migration, fibroblast proliferation, and synthesis of collagen type 3. [24,25] Similarly, aloe proved effective in modulating wound histopathologic parameters, especially in burn wound studies and to a lesser extent in excisional wound works. [26,27] In the present study, there was a relatively complete correspondence between the macroscopic and microscopic findings in each experimental group. For instance, wounds treated with aloe/chitosan mixture presented the best efficacy in wound closure which was in accordance with their positive histopathologic profiles of wound healing; reepithelialization was almost complete and bridged the wound margins with a keratinized layer formed normally after 14 days. ...
... As a result, delayed or non-healing of a wound will affect the patient's life quality, prolong the treatment episodes and increase the treatment cost (7). Therefore, these conditions lead to the investigation of complementary or alternative practices in wound-healing (2), either from plant derivatives like monoterpene (1) and the gel of Aloe vera (8), microbial cellulose which synthesized by Acetobactor xylinum (9), tissue-engineered wound healing products (10) or even animal-based products like propolis or bee glue (11) and Channa striatus extract (12). ...
... Wound repairs include, physiological process that could be categorized into phases: inflammation, hemostasis, proliferation (granulation), and remodeling (maturation) of the extracellular matrix [6]. The inflammation phase comprises the coagulation process and the response of the immune system [7]. ...
... Cleaning with mild soap and water was used to facilitate softening and removal of dead skin. Aloe vera appeared to be helpful for managing dry skin, which appeared to prevent the skin from sloughing, and allegedly has anti-inflammatory effects and promotes wound healing [25,26]. This product had been reported to cause pruritus in some horses [5], but such adverse side effects were not observed in D1 and D2. ...
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Burn injuries are uncommon in large animals and there are no reports of these injuries in donkeys. Burns cause local and systemic effects. Extensive thermal injuries can be challenging to manage and the extent of the burn surface affected will directly impact the severity of the illness and the prognosis. Burns are classified according to the depth of injury into four categories, from first-degree burns, and the least affect to fourth-degree burns, which are the more severely affected patients. This case report describes the medical management of four donkeys that sustained various degrees of external burn injuries during the wildland–urban interface fire in Valparaiso, Chile. The donkeys were treated topically for several weeks and closely monitor for inadequate nutritional intake. Water based topical medications are preferred in burn cases because they can be easily applied and removed without interfering with wound healing. Of note, the caloric demands of these cases can be achieved by increasing the amount of grain, adding fat (i.e., vegetable oil), and free-choice alfalfa hay. All donkeys recovered and were retired to an animal shelter.
... Its ethnomedical use as an aphrodisiac was earlier reported by Erhabor et al. (2013) and this was validated in vivo using an animal model (Erhabor and Idu, 2017). Other previously reported biological activities of this plant include the use of its gel in wound healing (Davis et al., 1994;Maenthaisong et al., 2007), inflammatory problems (Che et al., 1991;Robbers and Tylers, 1999) as well as in moisturizing and anti-aging activities (West and Zhu, 2003;Sahu et al., 2013). The leaves have been used for treating fungal infections associated with superficial mycoses (Shamim et al., 2004). ...
... Aloe Vera contains over 200 active components including vitamins, minerals, amino acids, enzymes, polysaccharide, and fatty acids. The vitamins including A, C, E, folic acid, choline, B1, B2, B3 (niacin), B6 [11] . It is also one of the few plants that contains vitamin B12, while the minerals include: calcium, magnesium, zinc, chromium, selenium, sodium, iron, potassium, copper, manganese,and important fatty acids include HCL cholesterol (which lowers fats in the blood), campesterol, and B-sitosterol [12] . ...
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Background: Aloe vera was used to enhance defense mechanisms, and it has a variety of components that affected on periodontal healing and other oral condition .It was used also around dental implants to control inflammation from bacteria contamination. Vascular endothelial growth factor(VEGF) is of particular interest because of its ability to induce neovascularization (angiogenesis), VEGF also acts to recruit and activate osteoclasts as well as stimulate osteoblast chemotaxis, differentiation, and matrix mineralization.
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Objective: Several studies have used aloe vera hydrogel to enhance various tissues regeneration to reduce scar formation in wounds. This study aimed to prepare a hydrogel specified for the oral cavity and observe scar formation and healing of free gingival graft after its application compared with the natural healing and scaring of the graft without any material. Design: This study is a randomized controlled clinical trial that included 22 patients with a width of attached gingiva less than 2 mm. after preparing the aloe vera hydrogel and completing the laboratory stage, the hydrogel was randomly applied for 11 patients after the free gingival graft procedure while the other 11 patients did not use any material after the same surgery. Landry’s scale was used to assess the healing index, scarring was evaluated using Mucosal Scarring Index. Results: The healing index was higher in the intervention group with a statistical difference P
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Introdução: Recursos disponíveis na internet, como vídeos, passaram a ser utilizados como meios de informação da população sobre tratamento de queimaduras por se tratar de uma informação mais acessível e direta. Objetivos: Analisar as informações de vídeos do Youtube® sobre o tratamento de queimaduras. Método: Estudo descritivo com abordagem quantitativa, realizadopor meio de levantamento de vídeos disponíveis no Youtube® sobre tratamentos para queimaduras produzidos entre janeiro de 2013 a julho de 2019.Resultados: Foram incluídos 70 vídeos sobre tratamento de queimaduras, sendo identificados 30 (42,9%) sobre terapias complementares, seguidos de nove (12,9%) sobre tratamentos caseiros, nove (12,9%) sobre notícias ou entrevistas com profissionais, oito (11,4%) sobre tratamento tópico, sete (10,0%) educativos, cinco (7,1%) sobre tratamento cirúrgico e dois (2,9%) sobre reabilitação. Conclusões: Este estudo proporcionou conhecimento sobre os tratamentos abordados nos vídeos do Youtube®, destacando a importância em avaliar os conteúdos disponibilizados na internet para orientação da população.
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Aloe vera L. is a common succulent plant that has been used for centuries regarding their healing properties and health benefits. Nowadays, scientific investigations on its gel have gained more attention because of its interesting antioxidant and antimicrobial properties. Also, the food industry encounters the need to preserve safety and quality of fresh produce; fruits and vegetables are in high demand due to their reported health benefits, and fresh-cut products are a new trend that meets the restless needs of the society. Edible coatings are an effective way to maintain freshness of these products, extend their shelf life, and even act as an alternative to modified atmosphere packaging to be used in conventional packaging. Aloe vera gel is a natural hydrocolloid, composed mainly by polysaccharides, that has been applied in the last years on fruits and vegetables. It can act as a semipermeable barrier for gases and water vapor, decreasing the respiration and ripening processes of the fruit, thus maintaining weight, firmness and valuable compounds. Its antioxidant and antimicrobial properties make it also an interesting material for increasing the shelf-life of fruits and vegetables. This review aims to describe the preparation and preservation of Aloe vera gel as well as the properties and compounds that are effective against oxidation and microbial growth. Moreover, the recent findings of its use – with or without additives – as an edible coating on fruits and vegetables have been widely detailed, showing that Aloe vera gel is a promising preservative method in this industry.
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IntroductionIn this study, ultrasound measurement was used to reveal objective differences between male and female patients in arm burn scar thickness.Methods An experienced physician trained by radiologists used an ultrasound machine and a digital height and weight scale to measure normal skin and scar thicknesses and patients’ body mass indices (BMIs). On the day of testing, the pressure garments (PGs) on the patients’ arms were removed.ResultsBonferroni 95% confidence intervals for scar thicknesses measured in female and male patients were 0.135 to 0.212 cm and 0.045 to 0.113 cm, respectively; the individual confidence level was 97.5%. For both groups, a P value of < .05 was obtained for the multiple comparison and Levene tests. The test for equal variances for both groups resulted in no overlapping intervals and significantly different corresponding standard deviations. Thus, scar thicknesses differed between male and female patients using 24-mmHg PGs. The scar tissue of female patients was thicker than that of male patients. We also observed that patients with a high BMI (22.4–23.8) had smaller mean scar thicknesses.Conclusion Patients with a high BMI had smaller mean scar thickness. Although these findings are notable, the same pressure was applied to different body types and body parts; the height of the scars also varied across different areas of patients’ bodies. We hope to recruit more patients with burns on other parts of the body to extend our findings.
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S. aureus poses an important problem in hospitals, nursing homes, and other health care settings. Serious infections due to these organisms currently necessitate the use of non-β-lactam antibacterial therapy. H2SO4 comes from strong poisons, because the symptom poison appears after five minutes from apple on skin. If possible treatment by Na2Co3 as antidot for H2SO4, but the necrosis or bacterial infection cases should by use drugs. Aloe vera gel is used topically for its anti-inflammatory and wound-healing properties, but it has also been used internally as a general tonic.The aim of this study is to evaluate the efficacy of aloe vera extract to treatment of normally induced and infected wounds with Staphylococcus aureus .
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Natural, biocompatible, and biodegradable composite nanofibers made of Aloe vera extract, pullulan, chitosan, and citric acid were successfully produced via Forcespinning® technology. The addition of Aloe vera extract at different weight percent loadings was investigated. The morphology, thermal properties, physical properties, and water absorption of the nanofibers were characterized using scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), and thermogravimetric analysis (TGA). The developed nanofiber membranes exhibited good water absorption capabilities, synergistic antibacterial activity against Escherichia coli, and promoted cell attachment and growth. Its porous and high surface area structure make it a potential candidate for wound dressing applications due to its ability to absorb excessive blood and exudates, as well as provide protection from infection while maintaining good thermal stability.
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The biocompatibility, hemostatic performance and wound healing capability are key limitations for currently available hemostatic agents. To overcome these problems, a hydrogel inspired by a platelet coagulation mediator is developed...
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Objectives Chitosan is a natural polysaccharide widely used in various clinical applications including regeneration of skin tissue. Aloe vera has properties in healing burns on the skin, anti-inflammatory effect, and leaves a protective layer on the skin after drying so it provides protection to the wound. The spray gel of chitosan– A. vera was developed as a wound healing that has combined of effect of both component and easy to use. The purpose of this study was to determine the physical stability and irritability of chitosan– A. vera spray gel. Methods The spray gel stability test was conducted using thermal cycling and centrifugation methods. The organoleptic, viscosity, and pH of the spray were evaluated. The irritation test was performed by Draize Rabbit Test method. Results Chitosan (0.5%)– A. vera (1%) spray gel characteristics has a weak yellow color, clear, and a strong A. vera odor. The pH of the spray gel was 4.88 ± 0.01; and the viscosity was 36.50 ± 0.23 cps. The result from the chitosan (0.5%)– A. vera (1%) spray gel stability test using thermal cycling method showed a decrease of viscosity, but remained stable when evaluated using centrifugation method. There was no difference in the pH and organoleptic observation from both tests. Based on the scoring and analysis of the reaction in rabbit skin, the Primary Irritation Index (PII) obtained was 0.56. Conclusions The spray gel of chitosan (0.5%)– A. vera (1%) was stable and according to response category from the acute dermal irritation test, it can be concluded that chitosan (0.5%)– A. vera (1%) spray gel had a slightly irritating effect.
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Damage to the skin causes physiological and functional issues. The most effective treatment approach is the use of wound dressings. Silk fibroin (SF) is a promising candidate biomaterial for regulating wound healing; however, its antibacterial properties and biological activity must be further improved. In this study, a photocrosslinking hydrogel was developed to treat full-thickness cutaneous wounds. The composite hydrogel (Ag-AV-SF-hydrogel) was prepared by introducing the silver nanoparticles (AgNPs) and aloe vera (AV) as the modifiers. In vitro study, it exhibited great antibacterial ability, biocompatibility, and cell-proliferation and -migration-promoting capacities. It also showed the pH-response releasing properties which release more AgNPs in a simulated chronic infection environment. The healing effect evaluation in vivo showed the healing-promoting ability of the Ag-AV-SF-hydrogel was stronger than the single-modifiers groups, and the healing rate of the it reached 97.02% on day 21, higher than the commercial wound dressing, silver sulfadiazine cream (SS) on sale. Additionally, the histological and protein expression results showed that the Ag-AV-SF-hydrogel has a greater effect on the pro-healing regenerative phenotype with M2 macrophages at the early stage, reconstructing the blood vessels networks and inhibiting the formation of scars. In summary, the Ag-AV-SF-hydrogel developed in this study had good physical properties, overwhelming antibacterial properties, satisfactory biocompatibility and significantly promoting effect on cell proliferation, migration and wound healing. Overall, our results suggest that the Ag-AV-SF-hydrogel we developed has great potential for improving the wound healing in clinical treatment.
Chapter
Aloe is a succulent plant grown in tropical climates that is cultivated for medicinal use. Its history dates back 6000 years to ancient Egypt. The gel from the pulp of aloe leaves can be used topically to treat wounds and burns, among other skin conditions. Aloe is also available in capsule and liquid forms. Researchers have investigated clinical use of aloe for diseases of the mouth and oral cavity, diabetes, irritable bowel syndrome, Alzheimer’s disease, gastroesophageal reflux, HIV, cancer, and more. This chapter examines some of the scientific research conducted on aloe, both alone and in combination formulas, for treating numerous health conditions. It summarizes results from several in vitro and human studies of aloe’s use in treating several cardiometabolic, neurologic, oncologic, and gastrointestinal conditions. Finally, the chapter presents a list of aloe’s Active Constituents, different Commonly Used Preparations and Dosage, and a Section on “Safety and Precaution” that examines side effects, toxicity, and disease and drug interactions.
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Background Hypospadias is a common congenital anomaly which is determined as an abnormal urethral opening on the ventral face of penis. The purpose of this rat model study was to research the effect of topically applied Aloe vera after a tubularized incised plate urethroplasty (TIPU). Methods The TIPU model was applied to male Wistar albino rats. A total of 30 rats were randomly grouped into 3 groups of 10. Group I was assigned as the control group, treated with 0.9% saline only twice a day for 15 days. Group II received topical Aloe vera gel once a day and Group III received Aloe vera gel twice a day. Spongiofibrosis was graded as 0: none, 1+:≤10% tissues involved, 2+:10%-49% tissues involved, 3+: ≥ 50% tissues involved. Results A higher degree of fibrosis and inflammation was determined in the Group I subjects than in Groups II and III. Fibrosis of grade 3+ was observed in 33% of the control group and not in any of the two Aloe groups (p = 0.043). Inflammation of grade 3+ was seen in 66.7% of the control group, in 10% of Group II, and in 33% of Group III (p = 0.02). Conclusions The topical application of Aloe vera to a surgically created tubularized incised plate urethroplasty model decreased inflammation and fibrosis that may affect the success rates of this operation.
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ABSTRACT Traditional people of Sumatera Utara, Indonesia, mostly used Curcuma Longa Linn as a wound medicine. This research aims to see the wound healing bioactivity of Curcuma Longa Linn. Identify Curcuma Longa Linn content with the phytochemical screening; the displayed results contain alkaloid, terpenoid/steroid, phenolic, and saponin. FTIR analysis indicated the presence of secondary metabolite. The presence of alkaloids relieved due to the NH stretching peaks at 1579.56 cm-1, terpenoid due to the CH group peak at 2926.58 cm-1, 2106.17 cm-1, and reinforced with peaks at 971.15 cm-1 and 871.49 cm-1. O-H stretching peaks at 3316.33 cm-1, 1515.34 cm-1, 971.15 cm-1 were indicated polyphenols. Antibacterial test using Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus the result of Antibacterial test shown the secondary metabolite of Curcuma Longa Linn has high antibacterial activity. This compound play a role in increasing collagen synthesis early, which can function to restore wound tissue structure and support faster wound healing. Keywords: Wound Healing Bioactivity, Curcuma Longa Linn, Phytochemical Screening, FTIR Analysis, Antibacterial Activity. RASĀYAN J. Chem., Vol. 14, No.4, 2021
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Burn induced injuries are commonly encountered in civilian and military settings, leading to severe morbidity and mortality. Objective of this study was to construct microporous bioactive scaffolds of gelatin-hyaluronic acid suffused with aloe-vera gel (Gela/HA/AvG), and to evaluate their efficacy in healing partial-thickness burn wounds. Scaffolds were characterized using Fourier transform-infrared spectroscopy, Scanning electron microscopy, and Thermo-gravimetric analysis to understand intermolecular interactions and morphological characteristics. In-vitro fluid uptake ability and hemolytic index of test scaffolds were also determined. In-vitro collagenase digestion was done to assess biodegradability of scaffolds. Wound retraction studies were carried out in Sprague Dawley rats inflicted with partial-thickness burn wounds to assess and compare efficacy of optimized scaffolds with respect to negative and positive control groups. In-vivo gamma scintigraphy using Technetium-99m labeled Immunoglobulin-G ( 99m Tc-IgG) as imaging agent was also performed to validate efficacy results. Histological and immunohistochemical comparison between groups was also made. Scaffolds exhibited mircoporous structure, with pore size getting reduced from 41.3 ± 4.3 µm to 30.49 ± 5.7 µm when gelatin conc. was varied from 1% to 5%. Optimized test scaffolds showed sustained in-vitro swelling behavior, were biodegradable and showed hemolytic index in range of 2.4–4.3%. Wound retraction study along with in-vivo gamma scintigraphy indicated that Gela/HA/AvG scaffolds were not only able to reduce local inflammation faster but also accelerated dermis regeneration. Immunohistochemical analysis, in terms of expression levels of epidermal growth factor and fibroblast growth factor-2 also corroborated in-vivo efficacy findings. Gela/HA/AvG scaffolds, therefore, can potentially be developed into an effective dermal regeneration template for partial-thickness burn wounds.
Chapter
Plant-based foods contain flavonoids, belonging to the polyphenols class. The phytochemical and phyto-pharmacological sciences advancement has enabled composition elucidation and biological activities of various medicinal plant products. The efficacy of medicinal plants can be measured on the basis of bio-active constituents they comprise. Flavonoid is one of the classes among the bio-active constituents that are hydrophilic in nature. They have low bioavailability and efficacy due to low absorption, as they cannot cross cells lipid membrane due to larger molecular size. A variety of novel drug delivery systems have been developed for polyphenolic compounds to enhance the relative bioavailability. However, if novel drug delivery technology is applied, it may reduce the adverse effects and increase the efficacy of several herbs and their compounds. Herbal medicines were not encouraged for novel formulations development for a long time due to lack of scientific justification and processing difficulties, such as individual drug components identification, extraction and standardization in complex poly-herbal systems. However, advance phytopharmaceutical research can reduce the scientific thirst (e.g, pharmacokinetics determination, mechanism of action, the accurate dose required, site of action etc.) for herbal medicines to be incorporated in novel drug delivery systems, such as nanoparticles (NPs), liposomes, matrix systems, and micro-emulsions (-E) etc. by improving activity by reducing the side effects and required dose. Various drug delivery technologies have been summarized in this chapter which can be used for flavonoids loaded polymeric drug delivery systems.
Chapter
Aloe vera is a perennial, drought-resisting, succulent plant belonging to the Asphodelaceae family that has a long history of having many tremendous medicinal and anti-inflammatory as well as anti-bacterial properties. This chapter highlights the great potentials of the aloe vera species. Desk study and document analysis guided the systematic and extensive review of both published and unpublished resources on the Aloe vera Species. The chapter contends that horticulturists and plant scientists in the field of agriculture and medicine must pay attention to the Aloe vera as a medicinal plant that possesses the most powerful antibacterial and anti-inflammatory properties, which protects the body against constipation through enhancing the body metabolism, skin, and worm infestations.
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Ethnopharmacological relevance Aloe vera (L.) Burm. f. (Liliaceae family) is a well-known traditional medicinal plant, that has been used to treat a variety of illnesses, for decades ranging from cancer to skin disorders including wounds. It has been included in the traditional and herbal healthcare systems of many cultures around the world, as well as the pharmacopeia of different countries. Several in vitro and in vivo studies have also confirmed its potential antioxidant, anti-inflammatory, and wound-healing activities, etc. in the consistency of its historical and traditional uses. However, most studies to date are based on the A. vera gel and latex including its wound-healing effects. Very few studies have been focused on its flower, and rarely with its effects on cutaneous wound healing and its molecular mechanism. Aim of the Study: To the best of our knowledge, this is the first study to report on the synergistic effect of the A. vera flower (AVF) and Aloe gel (PAG) on cutaneous wound-healing, as well as revealing its molecular mechanism targeting microfibril-associated glycoprotein 4 (MFAP4) and its associated signaling pathway. Methods To investigate the synergistic effect of A. vera flower and Aloe gel in cutaneous wound healing, cell viability, and cell migration, as well proliferation assay was performed. This was followed by quantitative real-time polymerase chain reaction and western blot analyses in wounded conditions to check the effects of this mixture on protein and mRNA levels in normal human dermal fibroblast (NHDF) cells. Moreover, small interfering RNA (siRNA) -mediated knockdown of MFAP4 in NHDF cells was performed followed by migration assay and cell cycle analysis, to confirm its role in cutaneous wound healing. Additionally, HaCaT cells were included in this study to evaluate its migratory and anti-inflammatory effects. Results Based on our obtained results, the PAG and AVF mixture synergistically induced the proliferation, migration, and especially ECM formation of NHDF cells by enhancing the expression of MFAP4. Other extracellular components associated with MFAP4 signaling pathway, such as fibrillin, collagen, elastin, TGF β, and α-SMA, also increased at both the protein and mRNA levels. Subsequently, this mixture initiated the phosphorylation of the extracellular signal-regulated kinase(ERK) and AKT signaling pathways, and the S-phase of the cell cycle was also slightly modified. Also, the mixture induced the migration of HaCaT cells along with the suppression of inflammatory cytokines. Moreover, the siRNA-mediated knockdown highlighted the crucial role of MFAP4 in cutaneous wound healing in NHDF cells. Conclusion This study showed that the mixture of PAG and AVF has significant wound healing effects targeting MFAP4 and its associated signaling pathway. Additionally, MFAP4 was recognized as a new potential biomarker of wound healing, which can be confirmed by further in vivo studies.
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Lupeol, a triterpenoid of biological significance is present in the aloe vera leaf. Aloe vera extracts are frequently used in the field of ayurvedic medicine and cosmetics. It contains 75 potentially active constituents: vitamins, enzymes, minerals, sugars, lignin, saponins, salicylic acids and amino acids. Lupeol is one of the active phytoconstituents with known anesthetic and anti-microbial properties. Literature indicates that modified products of this compound showed a marked increase in the bioactivity compared to parent compound. The present study involves semi-synthetic modification of Lupeol which was isolated from the aloe vera leaf extract using conventional column chromatography techniques. It is to be expected that introducing nitrogen group to the olefinic bond at C-20 will enhance the bioactivity of Lupeol. The modified compound was characterized by spectroscopic techniques like Mass and IR.
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In a study of twenty-seven patients with partial thickness burn wound, they were treated with aloe vera gel compared with vaseline gauze. It revealed the aloe vera gel treated lesion healed faster than the vaseline gauze area. The average time of healing in the aloe gel area was 11.89 days and 18.19 days for the vaseline gauze treated wound. Statistical analysis by using t-test and the value of P < 0.002 was statistically significant. In histologic study, it showed early epithelialization in the treated aloe vera gel area. Only some minor adverse effects, such as discomfort and pain were encountered in the 27 cases. This study showed the effectiveness of aloe vera gel on a partial thickness burn wound, and it might be beneficial to do further trials on burn wounds.
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With the development of evidence-based dentistry it is important to consider how accurate and representative our published pool of evidence is. In this article we will describe publication bias and discuss the causes and potential effects it may have upon the pool of scientific evidence available in dentistry.
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Publication bias arises whenever the probability that a study is published depends on the statistical significance of its results. This bias, often called the file-drawer effect since the unpublished results are imagined to be tucked away in researchers' file cabinets, is potentially a severe impediment to combining the statistical results of studies collected from the literature. With almost any reasonable quantitative model for publication bias, only a small number of studies lost in the file-drawer will produce a significant bias. This result contradicts the well known Fail Safe File Drawer (FSFD) method for setting limits on the potential harm of publication bias, widely used in social, medical and psychic research. This method incorrectly treats the file drawer as unbiased, and almost always miss-estimates the seriousness of publication bias. A large body of not only psychic research, but medical and social science studies, has mistakenly relied on this method to validate claimed discoveries. Statistical combination can be trusted only if it is known with certainty that all studies that have been carried out are included. Such certainty is virtually impossible to achieve in literature surveys.
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Aloe vera has been recognized as a valuable medicinal plant for the treatment of burns. Extensive studies have described its antiinflammatory, wound healing and related activities, but the instability of aloe gel confuses pharmacological data, leads to inconsistency in treatments and inconvenience in daily preparation. These obstacles prompted us to develop a stable aloe preparation, aloe cream, that we tested on artificial thermal burns in mice. Aloe cream when applied immediately to first degree burns delayed progressive damage and accelerated the healing rate more effectively than fresh aloe gel. Both aloe cream and fresh aloe gel prevented further skin damage and casting of dead epidermis was less than in control. For second degree burns the healing rate was enhanced by aloe cream and fresh aloe gel: less inflammation was observed in areas treated with either of these than in untreated areas or those treated with the cream base. For third degree burns the efficacy of aloe cream and fresh aloe gel could not be evaluated statistically because of infection. It was observed that aloe cream enhanced epithelialization but failed to show antiinflammatory activity. No differences in epithelialization and inflammation were observed among mice treated with fresh aloe gel, cream base or control. All these findings confirm that Aloe vera gel is effective for burn treatment if it is well preserved.
Article
The polysaccharides present in Aloe vera gel are presumed to play a key role in the clinical activity of the gel. While clinical studies generally confirm the contribution of the gel to a reduction in inflammation and an acceleration of healing, in some cases the expected therapeutic activity is not observed. This variability could perhaps be attributed to differences in the source of the gel, horticultural conditions and/or post-harvest treatments. Accordingly, polysaccharide content and composition and gel consistency were studied as a function of growth conditions in gels obtained from shrubs of Aloe barbadensis Miller grown in the Negev region of Israel. Autodegradation of the polysaccharides in the freshly produced gel was also characterized, and a method was developed for retarding this process. The polysaccharides were found to consist of glucomannans. Polysaccharides constituted 0.2–0.3% of the fresh gel and 0.8–1.2% of the dry matter content. Irrigation had a greater influence on gel composition than leaf age or season. The fresh gel showed pseudoplastic behaviour, which became Newtonian as a result of post-production autodegradation. The polysaccharides remaining after degradation were mainly mannans. Addition of a natural polysaccharide extracted from a species of red microalgae produced a soft pseudoplastic gel with synergistic rheological properties. The addition of the algal polysaccharide preserved the physical properties of the natural aloe polysaccharides. Chemical means were used to retard microbial degradation.
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The positive influence of Aloe vera, a tropical cactus, on the healing of full-thickness wounds in diabetic rats is reported. Full-thickness excision/incision wounds were created on the back of rats, and treated either by topical application on the wound surface or by oral administration of the Aloe vera gel to the rat. Wound granulation tissues were removed on various days and the collagen, hexosamine, total protein and DNA contents were determined, in addition to the rates of wound contraction and period of epithelialization. Measurements of tensile strength were made on treated/untreated incision wounds. The results indicated that Aloe vera treatment of wounds in diabetic rats may enhance the process of wound healing by influencing phases such as inflammation, fibroplasia, collagen synthesis and maturation, and wound contraction. These effects may be due to the reported hypoglycemic effects of the aloe gel.
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Administration of air under the skin produced a pouch wall that closely resembled a synovium in that the inner lining was made up of macrophages and fibroblasts. Administration of 1% carrageenan directly into the 7-day-old air pouch produced an inflammation characterized by an increased number of mast cells in pouch fluid as well as an increase in wall vascularity. A punch biopsy weight of the pouch wall did not reveal an increase in 1% carrageenan-treated animals. However, a 10% Aloe vera treatment of carrageenan-inflamed synovial pouches reduced the vascularity 50% and the number of mast cells in synovial fluid 48%. The pouch wall punch biopsy weight was increased by A. vera, which was verified by histologic examination of the inner synovial lining. Aloe vera stimulated the synovial-like membrane, as evidenced by an increased number of fibroblasts, suggesting that A. vera stimulated fibroblasts for growth and repair of the synovial model. The synovial air pouch can be used to study simultaneously the acute anti-inflammatory and fibroblast stimulating activities of A. vera.
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Three women and one man aged forty-one to sixty-five years experienced a severe burning sensation following the application of aloe vera or vitamin E preparations to a skin area that had been subjected to a chemical peel or dermabrasion. Subsequently, a severe dermatitis occurred that required hospitalization of one patient and intravenous administration of steroids. The dermatitis abated very slowly in all patients: full recovery took three months or more. One patient resumed the use of vitamin E creams two years after the episode of dermatitis and experienced no adverse effect. Patients undergoing dermabrasion or chemical peel procedures should be cautioned specifically against the use of aloe vera or vitamin E topically in the first weeks after surgery.
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An experimental study was designed using Hartley guinea pigs, who received full-thickness burns covering 3 percent of their body surface area by direct contact with a hot plate. A total of 40 animals were equally divided among four modalities of closed burn wound management as follows: group I: silver sulfadiazine (Silvadine); group II: aloe vera gel extract (Carrington Dermal Wound Gel); group III: salicylic acid cream (aspirin); and group IV: plain gauze occlusive dressing only. The dressings were changed daily, and the size and appearance of each burn wound were recorded until complete healing. On the sixth postburn day, quantitative burn wound cultures were made. The average time to complete healing in the control group was 50 days, and the only significant difference was found in the aloe vera-treated animals, which healed on an average of 30 days (p less than 0.02). Wound bacterial counts were effectively decreased by silver sulfadiazine (p = 0.015) and by aloe vera extract (p = 0.015). From our data it appears that aloe gel extracts permit a faster healing of burn wounds.
Article
The mucilaginous gel from the parenchymatous cells in the leaf pulp of Aloe vera has been used since early times for a host of curative purposes. This gel should be distinguished clearly from the bitter yellow exudate originating from the bundle sheath cells, which is used for its purgative effects. Aloe vera gel has come to play a prominent role as a contemporary folk remedy, and numerous optimistic, and in some cases extravagant, claims have been made for its medicinal properties. Modern clinical use of the gel began in the 1930s, with reports of successful treatment of X-ray and radium burns, which led to further experimental studies using laboratory animals in the following decades. The reports of these experiments and the numerous favourable case histories did not give conclusive evidence, since although positive results were usually described, much of the work suffered from poor experimental design and insufficiently large test samples. In addition some conflicting or inconsistent results were obtained. With the recent resurgence of interest in Aloe vera gel, however, new experimental work has indicated the possibility of distinct physiological effects. Chemical analysis has shown the gel to contain various carbohydrate polymers, notably either glucomannans or pectic acid, along with a range of other organic and inorganic components. Although many physiological properties of the gel have been described, there is no certain correlation between these and the identified gel components.
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This paper examines eight published reviews each reporting results from several related trials. Each review pools the results from the relevant trials in order to evaluate the efficacy of a certain treatment for a specified medical condition. These reviews lack consistent assessment of homogeneity of treatment effect before pooling. We discuss a random effects approach to combining evidence from a series of experiments comparing two treatments. This approach incorporates the heterogeneity of effects in the analysis of the overall treatment efficacy. The model can be extended to include relevant covariates which would reduce the heterogeneity and allow for more specific therapeutic recommendations. We suggest a simple noniterative procedure for characterizing the distribution of treatment effects in a series of studies.
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It has been suggested that the quality of clinical trials should be assessed by blinded raters to limit the risk of introducing bias into meta-analyses and systematic reviews, and into the peer-review process. There is very little evidence in the literature to substantiate this. This study describes the development of an instrument to assess the quality of reports of randomized clinical trials (RCTs) in pain research and its use to determine the effect of rater blinding on the assessments of quality. A multidisciplinary panel of six judges produced an initial version of the instrument. Fourteen raters from three different backgrounds assessed the quality of 36 research reports in pain research, selected from three different samples. Seven were allocated randomly to perform the assessments under blind conditions. The final version of the instrument included three items. These items were scored consistently by all the raters regardless of background and could discriminate between reports from the different samples. Blind assessments produced significantly lower and more consistent scores than open assessments. The implications of this finding for systematic reviews, meta-analytic research and the peer-review process are discussed.
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Recent evidence from in vitro and in vivo experiments suggests that topical antimicrobials may be toxic to fibroblasts and keratinocytes and retard wound healing. The purpose of this study was to determine the effects of Aloe, a potential wound-healing agent, on wound contraction in excisional wounds treated with topical antimicrobials. Sprague-Dawley rats were prepared with four 1.5 cm2 dorsal defects through the skin and panniculus. The animals were divided into five groups (n = 10 per group): (1) Aloe, (2) NaOCl solution (0.025%), (3) mafenide acetate, (4) mafenide acetate + Aloe, and (5) control. Wounds were treated topically for 14 days 3 times a day. Serial standard photographs and serial wound planimetry were performed weekly. Following healing, the breaking strength of each resultant scar was determined using an Instron tensiometer. Kruskal-Wallis, ANOVA, and multiple comparison methods were used for data analysis. Aloe and NaOCl solution significantly accelerated wound contraction (p < 0.05). In the mafenide acetate + Aloe group, contraction was similar to the control, whereas the mafenide acetate alone retarded wound healing. The addition of Aloe in combination and alone in wounds increased the breaking energy when compared to controls (p < 0.05). Aloe appears to expedite wound contraction and neutralize the wound retardant effect seen with the topical mafenide acetate alone. This effect appears to be due to an increased collagen activity, which is enhanced by a lectin, consequently improving the collagen matrix and enhancing the breaking strength.
Article
Wound healing is a fundamental response to tissue injury that results in restoration of tissue integrity. This end is achieved mainly by the synthesis of the connective tissue matrix. Collagen is the major protein of the extracellular matrix, and is the component which ultimately contributes to wound strength. In this work, we report the influence of Aloe vera on the collagen content and its characteristics in a healing wound. It was observed that Aloe vera increased the collagen content of the granulation tissue as well as its degree of crosslinking as seen by increased aldehyde content and decreased acid solubility. The type I/type III collagen ratio of treated groups were lower than that of the untreated controls, indicating enhanced levels of type III collagen. Wounds were treated either by topical application or oral administration of Aloe vera to rats and both treatments were found to result in similar effects.
Article
Research since the 1986 review has largely upheld the therapeutic claims made in the earlier papers and indeed extended them into other areas. Treatment of inflammation is still the key effect for most types of healing but it is now realized that this is a complex process and that many of its constituent processes may be addressed in different ways by different gel components. A common theme running though much recent research is the immunomodulatory properties of the gel polysaccharides, especially the acetylated mannans from Aloe vera, which are now a proprietary substance covered by many patents. There have also been, however, persistent reports of active glycoprotein fractions from both Aloe vera and Aloe arborescens. There are also cautionary investigations warning of possible allergic effects on some patients. Reports also describe antidiabetic, anticancer and antibiotic activities, so we may expect to see a widening use of aloe gel. Several reputable suppliers produce a stabilized aloe gel for use as itself or in formulations and there may be moves towards isolating and eventually providing verified active ingredients in dosable quantities
Article
The use of aloe vera is being promoted for a large variety of conditions. Often general practitioners seem to know less than their patients about its alleged benefits. To define the clinical effectiveness of aloe vera, a popular herbal remedy in the United Kingdom. Four independent literature searches were conducted in MEDLINE, EMBASE, Biosis, and the Cochrane Library. Only controlled clinical trials (on any indication) were included. There were no restrictions on the language of publication. All trials were read by both authors and data were extracted in a standardized, pre-defined manner. Ten studies were located. They suggest that oral administration of aloe vera might be a useful adjunct for lowering blood glucose in diabetic patients as well as for reducing blood lipid levels in patients with hyperlipidaemia. Topical application of aloe vera is not an effective preventative for radiation-induced injuries. It might be effective for genital herpes and psoriasis. Whether it promotes wound healing is unclear. There are major caveats associated with all of these statements. Even though there are some promising results, clinical effectiveness of oral or topical aloe vera is not sufficiently defined at present.
Article
Aloe vera has been used as a family medicine for promoting wound healing, but it is not known which component of the plant is effective for this purpose. To isolate and characterize the component effective in wound healing. Chromatography, electrophoresis and spectroscopic methods were used. The cell-proliferation activity of each component isolated was measured by a [3H]thymidine uptake assay. The cell-proliferation activity of the effective component was tested on a three-dimensional raft culture (cell culture technique by which artificial epidermis is made from keratinocytes). The effect of the active component on cell migration and wound healing was observed on a monolayer of human keratinocytes and in hairless mice. A glycoprotein fraction was isolated and named G1G1M1DI2. It showed a single band on sodium dodecyl sulphate-polyacrylamide gel electrophoresis, with an apparent molecular weight of about 5.5 kDa. It exhibited significant [3H]thymidine uptake in squamous cell carcinoma cells. The effect of G1G1M1DI2 on cell migration was confirmed by accelerated wound healing on a monolayer of human keratinocytes. When this fraction was tested on a raft culture, it stimulated the formation of epidermal tissue. Furthermore, proliferation markers (epidermal growth factor receptor, fibronectin receptor, fibronectin, keratin 5/14 and keratin 1/10) were markedly expressed at the immunohistochemical level. The glycoprotein fraction enhanced wound healing in hairless mice by day 8 after injury, with significant cell proliferation. It is considered that this glycoprotein fraction is involved in the wound-healing effect of aloe vera via cell proliferation and migration.
Article
WOC nurses may be asked to manage small burn wounds or to follow up with patients who have residual wound care issues after recovering from a major burn injury. Aspects of care include identifying patients who warrant a higher level of burn care expertise, managing small wounds, recognizing the common complications of burns, and determining the needs of patients undergoing burn rehabilitation. Persons managing burn wounds will incorporate a variety of techniques to facilitate wound cleansing and dressing, pain management, psychological support, and minimization of complications. In addition, depending on the setting, extent, and nature of the wounds, the patient's abilities and rehabilitation requirements will need to be determined. The patient and his or her family need to be educated about the normal changes that follow a burn injury and how to manage these issues.
Article
Freeze-dried juice obtained from Aloe vera and heated for 15 minutes at 80° inhibited several test microorganisms.
Aloe vera: It's influence on the physiology of wound healing and inflammation
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Bradshaw TW. Aloe vera: It's influence on the physiology of wound healing and inflammation. J Br Podiatr Med 1996;51(2):25–9.
Characterization of aloe vera gel before and after autodegradation, and stabilization of the natural fresh gel The Aloe vera phenomenon: a review of the properties and modern uses of the leaf parenchyma gel
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Characterization of aloe vera gel before and after autodegradation, and stabilization of the natural fresh gel 717 r[30] Grindlay D, Reynolds T. The Aloe vera phenomenon: a review of the properties and modern uses of the leaf parenchyma gel
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Yaron A. Characterization of aloe vera gel before and after autodegradation, and stabilization of the natural fresh gel. Phytother Res 1993;7:S11–3. burns 33 (2007) 713–718 717 r[30] Grindlay D, Reynolds T. The Aloe vera phenomenon: a review of the properties and modern uses of the leaf parenchyma gel. J Ethnopharmacol 1986;16:117–51.
People's Liberation Army medicine information
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