A systematic review of honey uses and its potential value within oncology care

Accuracy and costs of bedside methods for confirming nasoenteral feeding tube position: a diagnostic accuracy study

AIM

To analyze the accuracy and costs of bedside methods for confirming the position of a nasoenteral feeding tube newly inserted blindly by nurses.

DESIGN

Diagnostic accuracy study of three clinical methods (ultrasound, epigastric auscultation, and pH measurement) compared to radiography. The direct costs of each method used to confirm the positioning of the nasoenteral tube were also measured.

METHODS

Seventy-six adult patients underwent a total of 87 nasoenteral tube insertion procedures in hospital units located within the Northeast region of the State of São Paulo, Brazil. The clinical methods were conducted on all study participants in the specified sequence: ultrasound (as index test), followed by epigastric auscultation and pH measurement (also index tests).

RESULTS

The outcomes regarding the confirmation of the accurate positioning of the nasoenteral tube are as follows: ultrasonography demonstrated sensitivity and specific of 79.0% and 66.7%, respectively. Epigastric auscultation exhibited a sensitivity of 81.3% and specificity of 83.3%. The pH measurement method displayed sensitivity and specificity of 89.3% and 100% respectively. Additionally, in terms of estimated direct costs, the pH measurement method incurred a higher cost (USD $8.31) compared to the other methods, with a difference of USD $6.68.

CONCLUSIONS

Based on these results, X-ray examination remains the primary method for confirming the placement of nasoenteral tubes recently inserted blindly at the bedside. However, when considering the costs of the evaluated methods, it is advisable to consider the variations in expenses between non-radiological methods and X-ray examinations.

Honey and Aloe vera Solution Increases Survival and Modulates the Tumor Size In Vivo

SCOPE

The combination of honey and Aloe vera is used as a popular complementary treatment for cancer due to their nutraceutical properties. This study aims to investigate the anticancer activity of honey and A. vera solution and its ethanolic extraction through in vitro and in vivo approaches.

METHODS AND RESULTS

After comparisons of honey and A. vera (HA) solution and its ethanolic extraction solution (E) samples by UPLC-ESI-MS/MS, the study verifies HA-treatment affected only Walker tumor cells viability at the highest dose, and E-treatment has a more cytotoxic/antiproliferative effect in MCF-7 and Walker-256 cells. The in vivo results show a higher survival rate in Walker-256 tumor-bearing rats (WHA), with higher NK cell infiltration in tumor tissue and a tendency in the WE group. These results are possible due to decreased mannose-based immunomodulatory polysaccharides and aloin-A contents in the ethanolic extract solution compared to HA solution.

CONCLUSION

The current study provides compelling evidence of selectively cytotoxic against tumor cells under honey and A. vera solution and ethanolic extraction solution treatment, due to the cytotoxic/antiproliferative compounds. Therefore, the use of honey and A. vera solution could be used as a basis for coadjuvant therapy in cancer treatment.

Manuka Honey Inhibits Human Breast Cancer Progression in Preclinical Models

Manuka honey (MH) exhibits potential antitumor activity in preclinical models of a number of human cancers. Treatment in vitro with MH at concentrations ranging from 0.3 to 5.0% (w/v) led to significant dose-dependent inhibition of proliferation of human breast cancer MCF-7 cells, but anti-proliferative effects of MH were less pronounced in MDA-MB-231 breast cancer cells. Effects of MH were also tested on non-malignant human mammary epithelial cells (HMECs) at 2.5% w/v, and it was found that MH reduced the proliferation of MCF-7 cells but not that of HMECs. Notably, the antitumor activity of MH was in the range of that exerted by treatment of MCF-7 cells with the antiestrogen tamoxifen. Further, MH treatment stimulated apoptosis of MCF-7 cells in vitro, with most cells exhibiting acute and significant levels of apoptosis that correlated with PARP activation. Additionally, the effects of MH induced the activation of AMPK and inhibition of AKT/mTOR downstream signaling. Treatment of MCF7 cells with increased concentrations of MH induced AMPK phosphorylation in a dose-dependent manner that was accompanied by inhibition of phosphorylation of AKT and mTOR downstream effector protein S6. In addition, MH reduced phosphorylated STAT3 levels in vitro, which may correlate with MH and AMPK-mediated anti-inflammatory properties. Further, in vivo, MH administered alone significantly inhibited the growth of established MCF-7 tumors in nude mice by 84%, resulting in an observable reduction in tumor volume. Our findings highlight the need for further research into the use of natural compounds, such as MH, for antitumor efficacy and potential chemoprevention and investigation of molecular pathways underlying these actions.

PDDA/Honey Antibacterial Nanofiber Composites for Diabetic Wound-Healing: Preparation, Characterization, and In Vivo Studies

In this paper, Poly (diallyldimethylammonium chloride) (PDDA)/honey nanofiber wound dressing composites were prepared and their effects on the diabetic wound-healing was evaluated using in vivo experiments. The release of effective compounds and the solubility of nanofibers were controlled through the crosslinking process by glutaraldehyde. The crosslinked nanofibers (crosslinking time was 3 h) showed an absorption capacity at a maximum value of 989.54%. Interestingly, the resultant composites were able to prevent 99.9% of Staphylococcus aureus and Escherichia coli bacteria. Furthermore, effective compounds were continuously released from nanofibers for up to 125 h. In vivo evaluation indicated that the use of PDDA/honey (40/60) significantly enhanced wound-healing. On the day 14th, the average healing rate for samples covered by conventional gauze bandage, PDDA, PDDA/honey (50/50), and PDDA/honey (40/60) were 46.8 ± 0.2, 59.4 ± 0.1, 81.7 ± 0.3, and 94.3 ± 0.2, respectively. The prepared nanofibers accelerated the wound-healing process and reduced the acute and chronic inflammation. Hence, our PDDA/honey wound dressing composites open up new future treatment options for diabetic wound diseases.

Honey Against Radiation-induced Oral Mucositis in Head and Neck Cancer Patients. An Umbrella Review of Systematic Reviews and Meta- Analyses of the Literature

Backround: Oral mucositis (OM) consists of a major side effect of radiotherapy (RT) in head and neck (H-N) cancer patients and natural honey is gaining more and more scientific interest due to its beneficial effects in tissue repair.

OBJECTIVE

The aim of this review is to better clarify the preventive/therapeutic role of honey in the management of OM in patients with H-N cancer undergoing RT with or without chemotherapy (CT).

METHODS

We used the PubMed database to retrieve journal articles and the inclusion criteria were only reviews and meta-analyses that illustrated the effective use of honey for either the prevention or treatment of OM in H-N cancer patients receiving either RT alone or in combination with CT.

RESULTS

Our search resulted in 92 citations, of which 12 eventually fulfilled the inclusion criteria of our study. Decreased incidence and severity of OM, extended time of occurrence of mucositis, less weight loss and less treatment interruptions were occasionally documented with conventional honey use in the included reviews and meta-analyses. In contrast to conventional honey, manuka honey proved to be weak in improving OM management in the small number of included reviews in our search.

CONCLUSION

Conventional honey might constitute a highly promising natural product against OM attracting much scientific interest due to its easy accessibility and low financial cost. Hence, the lack of studies with high evidence requires further advanced research to enhance the existing knowledge about the potential value of honey in radiation-induced OM in H-N cancer patients.

Uses of Complementary and Alternative Medicine for Perioperative and Other Patients

The efficacy of using complementary and alternative medicine (CAM) is supported by the literature to decrease preoperative anxiety, postoperative pain and opioid requirements, as well as nausea and vomiting and to improve severity of headaches and increase wound healing. Nursing care includes interventions using CAs for treatment of a range of patient needs. Being supportive while educating parents and patients demonstrates altruism, which also is beneficial for improving health outcomes with CAM.

Effect of local bee honey on dihydrofolate reductase enzyme inhibitor-induced mucositis: A histological study on albino wistar rats

Introduction

Mucositis is a common complication in around 40% of patients receiving chemotherapy which profoundly impact the quality of life. Despite the availability of many therapeutic agents that claim to prevent or reduce the severity of oral mucositis, no intervention that is completely successful at preventing oral mucositis exists. The present study aimed to demonstrate the effect of local honey on methotrexate-induced mucositis of the tongue.

Materials and Methods

The study was done in albino rats (n = 24), divided into four groups: honey-normal saline group (H/NS), distilled water-NS group (DW/NS), DW-methotrexate group (DW/MTX), and H/MTX group. Local honey was given (2.5 g/kg) twice a daily for 8 days. NS or methotrexate (60 mg/kg) interrupted the experiment procedure on day 4. At day 8, rats were sacrificed and middle third of tongue was removed for preparation of histological slides. Slides were examined for inflammatory cell infiltration (ICI), cell vacuolization (CV), congested blood vessels (CBV), thickness of epithelium (both dorsal and ventral mucosa), and thickness keratin.

Results

Statistically significant association was found between the groups for ICI and CV, χ² (3) = 11.97, P= 0.003 for ICI, and χ² (3) = 8.307, P= 0.023 for CV. Mean number of CBV per microscopic filed was 0.445, 0.389, 1.28, and 0.5 for H/NS, DW/NS, DW/MTX, and DW/H groups, respectively. Mean value of dorsal epithelial thickness (μm) was 96.78 ± 13.59, 100.50 ± 9.75, 75.53 ± 9.24, and 98.75 ± 10.92 for H/NS, DW/NS, DW/MTX, and DW/H groups, respectively. Mean value of ventral epithelial thickness (μm) was 70.45 ± 13.60, 58.38 ± 14.26, 37.04 ± 5.37, and 52.80 ± 7.97 for H/NS, DW/NS, DW/MTX, and DW/H groups, respectively. The thickness of epithelium of DW/MTX group was significantly different from other groups (P < 0.05).

Conclusion

The present study demonstrated the palliative effect of local honey over the mucositis induced by the chemotherapeutic drug (methotrexate).

Comparison of Physicochemical, Microbiological Properties and Bioactive Compounds Content of Grassland Honey and other Floral Origin Honeys

The aim of this study was to compare the physicochemical, the microbiological, and the antioxidant characteristics of unifloral honey, polyfloral honey, honeydew, and hay meadows honey. Hay meadow is type of semi-natural grassland with a great floral diversity, an important resource for pollinators. Grasslands are the source of the spring nectar honey obtained in May and June. Water content, sugars (fructose, glucose, sucrose, trehalose, melezitose, maltose, erlose, turanose, and raffinose), electrical conductivity, phenolic content (gallic acid, protocatechuic acid, 4-hydrxybenzoic acid, vanilic acid, chlorogenic acid, caffeic acid, p-coumaric acid, rosmarinic acid, myricetin, quercitin, luteolin, kaempferol), color, viscosity, and microbiological characteristics were performed for all samples of honey. The total polyphenols content was significant for grassland honey (21.50 mg/100 g) and honeydew (30.49 mg/100 g) and less significant for acacia (0.08 mg/100 g) and rape honey (0.14 mg/100 g). All samples were microbiologically safe, and standard plate count (SPC) values were <10 cfu/g for all the samples, but the grassland honey had the highest microbiological quality: 33.3% of samples without microorganisms, 50.0% with the presence of yeast under limit, and 16.7% with yeast and mold under limit, a situation that does not meet other types of honey. The results of statistical analysis obtained with principal component analysis (PCA) showed a major difference between the grassland honey and the other types of honey.

Promising Alternative Therapeutics for Oral Candidiasis

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Candida is the main human fungal pathogen causing infections (candidiasis), mostly in the elderly and immunocompromised hosts. Even though Candida spp. is a member of the oral microbiota in symbiosis, in some circumstances, it can cause microbial imbalance leading to dysbiosis, resulting in oral diseases. Alternative therapies are urgently needed to treat oral candidiasis (usually associated to biofilms), as several antifungal drugs’ activity has been compromised. This has occurred especially due to an increasing occurrence of drugresistant in Candida spp. strains. The overuse of antifungal medications, systemic toxicity, cross-reactivity with other drugs and a presently low number of drug molecules with antifungal activity, have contributed to important clinical limitations.

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We undertook a structured search of bibliographic databases (PubMed Central, Elsevier’s ScienceDirect, SCOPUS and Springer’s SpringerLink) for peer-reviewed research literature using a focused review in the areas of alternatives to manage oral candidiasis. The keywords used were “candidiasis”, “oral candidiasis”, “biofilm + candida”, “alternative treatment”, “combination therapy + candida” and the reports from the last 10 to 15 years were considered for this review.

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This review identified several promising new approaches in the treatment of oral candidiasis: combination anti-Candida therapies, denture cleansers, mouth rinses as alternatives for disrupting candidal biofilms, natural compounds (e.g. honey, probiotics, plant extracts and essential oils) and photodynamic therapy.

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The findings of this review confirm the importance and the urgency of the development of efficacious therapies for oral candidal infections.

Exploratory Monitoring of the Quality and Authenticity of Commercial Honey in Ecuador

Honey is one of the oldest sweetening foods and has economic importance, making this product attractive to adulteration with cheap sugars. This can cause a critical problem in the honey industry and a possible health risk. The present work has the aim of evaluating the authenticity of honey commercialized in two different provinces of Ecuador (Pichincha and Loja) by performing physicochemical and spectroscopic analyses. For this study 25 samples were collected from different places and markets and characterized by water, sucrose, reducing sugars and electric conductivity measurement. Also, their Raman and Infrared (IR) spectra were recorded and analysed using a Principal Component Analysis (PCA) in order to verify the quality of the honeys. In addition, a screening of several pesticides was performed in order to verify possible chemical threats to human health and honey bees. It was found that 8 samples have a deviation from the Standard established parameters. Two of them have a high difference in the content of sucrose and reducing sugars, which are located deviated from all the other samples in the PCA of the applied vibrational spectroscopy (IR/Raman), shaping two clear clusters. The results show that Raman and IR spectroscopy is appropriate techniques for the quality control of honey and correlates well with the physicochemical analyses.

Evaluation of Antibacterial Effect of Propolis and its Application in Mouthwash Production

Objectives:

Our purpose was to determine the antibacterial properties of propolis and to evaluate its use as an antibacterial mouthwash with minimal complications.

Materials and Methods:

In this experimental laboratory study, an alcoholic propolis extract was prepared. The minimum inhibitory concentration (MIC) was calculated for four bacterial species including Staphylococcus aureus (S. aureus), Streptococcus mutans (S. mutans), Lactobacillus acidophilus (L. acidophilus), and Enterococcus faecalis (E. faecalis) using agar dilution. According to the MIC, a propolis antibacterial mouthwash was produced and compared to water, chlorhexidine (CHX), and Listerine using laboratory rats for clinical examination. Salivary specimens of rats were collected at 12 hours, 1 week, and 2 weeks after using the mouthwash and examined by real-time polymerase chain reaction (RT-PCR). Data were analyzed using one-way analysis of variance (ANOVA) and repeated measures ANOVA (α=0.05).

Results:

The results of agar dilution by the number of colony-forming units showed the lowest MIC for S. aureus and the highest for L. acidophilus. Our RT-PCR findings indicated that water alone had no effect on the level of oral bacteria. Propolis mouthwash showed a significant difference with CHX and Listerine (P<0.05) in terms of the number of S. mutans, E. faecalis, and L. acidophilus colonies, while CHX and Listerine were less efficient. There was no significant difference between CHX and propolis (P=0.110) regarding S. aureus colonies, but Listerine had a lower efficacy than either (P<0.05).

Conclusion:

According to the results, propolis mouthwash was more efficient against the studied oral bacteria compared to CHX and Listerine.

Sidr Kashmiry honey and its fractions induced apoptosis in hepatocellular carcinoma in vitro

Positive evidence for anticancer activities of honey is growing and the mechanism on how honey has anticancer characteristics is an area of great interest. Honey has been studied in various cancer cell lines for its ability to induce apoptosis, with several mechanisms of action being suggested. This study aims to evaluate the apoptotic activity of the non cytotoxic Sidr Kashmiry honey and its residue of successive fractionation as well as the cytotoxic chloroform-methanol and ethyl acetate fractions against hepatocellular carcinoma cells in vitro. Apoptosis was assessed by DNA fragmentation, diphenyl amine assay, and ultrastructure investigation. Micronuclei test was carried out to assess genotoxicity. Crude honey, residue, ethyl acetate and chloroform-methanol induced apoptosis, however, the residue and ethyl acetate caused high genotoxicity. Non cytotoxic Sidr Kashmiry honey and its cytotoxic chloroform-methanol fraction could be a powerful pro-apoptotic and non-genotoxic anticancer agent.

The effect of an oral care protocol and honey mouthwash on mucositis in acute myeloid leukemia patients undergoing chemotherapy: a single-blind clinical trial

OBJECTIVES

The purpose of the study is to evaluate and compare the effectiveness of honey mouthwash and an oral care protocol on mucositis and weight loss in patients with acute myeloid leukemia receiving chemotherapy.

MATERIALS AND METHODS

In this single-blind clinical trial, 53 acute myeloid leukemia (AML) patients receiving chemotherapy were randomly assigned into three groups: honey mouthwash (n = 17), oral care (n = 17), and control (n = 19). The severity of mucositis and weights was examined blindly at the baseline and 4-week follow-up.

RESULTS

The prevalence of grades of mucositis in the study groups was significant at the end of the third (p = 0.002) and fourth (p < 0.001) weeks. The mucositis severity decreased at the end of the third and fourth weeks in the honey mouthwash group (p < 0.05), whereas it increased in the control group (p < 0.001). The difference in the weight was significant between the honey mouthwash and the control groups (p < 0.05, MD = 1.95) at the end of the third week, and between the honey mouthwash group with the control (p < 0.01, MD = 2.92) and oral care groups (p < 0.05, MD = 1.95) at the end of the fourth week.

CONCLUSIONS

Honey mouthwash is effective in preventing and reducing the severity of mucositis, and weight loss and can be recommended for patients undergoing chemotherapy.

CLINICAL RELEVANCE

The results of this study suggest that honey mouthwash can reduce the incidence and severity of mucositis in patients, reduce or eliminate the possibility of weight loss in them, as well as encourage some weight gain. Compared to routine oral care, honey mouthwash is also easier to use and handle.

TRIAL REGISTRATION

IRCT2015121419919N7.

Microbiological assessment of honey in México

Honey is a product used as a natural sweetener and in several regions of Mexico and other countries it is also used as a therapeutic agent. Microbiological contamination of honey can occur during its extraction and handling. Due to the use and consumption of honey we highlighted here the importance of the assessment of its microbiological quality. One thousand nine hundred twenty samples obtained from 8 honey-producing states from Mexico were analyzed. From these samples, 40.5% (777/1920) did not comply with the NMX-036-NORMEX-2006 specification. Forty five percent (777/1920) of the samples did not comply with the mesophilic aerobic microorganism specification, neither did 17% (327/1920) of the samples with the specification for molds and 18.1% (348/1920) with the specification for yeasts. With regard to coliform bacteria, the samples contained less than 3 NMP/g. Two percent of the samples contained lactic acid bacteria (LAB), Clostridium perfringens was observed in amounts of more than 100CFU/g. None of the samples from the different states contained more than 100CFU/g of Staphylococcus aureus; Salmonella spp. was absent in all samples. It is important to avoid contamination sources and implement good hygienic practices in order to maintain and improve the quality of Mexican honeys since a large percentage of them are intended for export. If these honeys are intended for therapeutic use, it is necessary to ensure that they comply with all quality parameters and to apply specific treatments that guarantee the removal of any pathogen that may represent a risk to the patients's health.

Portuguese Honeys from Different Geographical and Botanical Origins: A 4-Year Stability Study Regarding Quality Parameters and Antioxidant Activity

Portuguese honeys (n = 15) from different botanical and geographical origins were analysed regarding their quality parameters (diastase activity, hydroxymethylfurfural content, moisture and pH), colour (L*, a*, b*) and antioxidant profile (total phenolics content, total flavonoids content, DPPH^• scavenging activity, and ferric reducing power). The samples were analysed fresh and after 4-years of storage (at 25 °C and protected from light). The hydroxymethylfurfural content and diastase activity of the fresh samples were in accordance with the recommended values described in the legislation. In general, the antioxidant activity of the samples correlated more with the bioactive compounds content than with colour. The storage affected differently each individual sample, especially regarding the antioxidant profile. Nevertheless, although in general the lightness of the samples decreased (and the redness increased), after 4 years, 11 samples still presented acceptable diastase activity and hydroxymethylfurfural values.

Candida glabrata Biofilms: How Far Have We Come?

Infections caused by Candida species have been increasing in the last decades and can result in local or systemic infections, with high morbidity and mortality. After Candida albicans, Candida glabrata is one of the most prevalent pathogenic fungi in humans. In addition to the high antifungal drugs resistance and inability to form hyphae or secret hydrolases, C. glabrata retain many virulence factors that contribute to its extreme aggressiveness and result in a low therapeutic response and serious recurrent candidiasis, particularly biofilm formation ability. For their extraordinary organization, especially regarding the complex structure of the matrix, biofilms are very resistant to antifungal treatments. Thus, new approaches to the treatment of C. glabrata's biofilms are emerging. In this article, the knowledge available on C. glabrata's resistance will be highlighted, with a special focus on biofilms, as well as new therapeutic alternatives to control them.

Fungicidal efficacy of various honeys against fluconazole-resistant Candida species isolated from HIV+ patients with candidiasis

OBJECTIVE

Honey is well known to possess a broad spectrum of activity against medically important organisms. The purpose of this study was to assess the antifungal activity of different honeys against 40 fluconazole (FLU) resistant Candida species, including Candida albicans (C. albicans), Candida glabrata, Candida krusei and Candida tropicalis.

MATERIALS AND METHODS

Three honey samples were collected from northern (Mazandaran, A), southern (Hormozgan, B) and central (Lorestan, C) regions of Iran. A microdilution technique based on the CLSI, M27-A2 protocol was employed to compare the susceptibility of honeys "A", "B" and "C" against different pathogenic Candida isolates.

RESULTS

The results showed that different Candida isolates were resistant to FLU, ranging from 64μg/mL to 512μg/mL. All of the honeys tested had antifungal activities against FLU-resistant Candida species, ranging from 20% to 56.25% (v/v) and 25% to 56.25% (v/v) for minimum inhibitory concentrations (MICs) and minimum fungicidal concentrations (MFCs), respectively. Honey "A" (MIC: 31.59%, v/v) showed higher anti-Candida activity than honey "B" (MIC: 35.99%, v/v) and honey "C" (MIC: 39.2%, v/v). No statistically significant differences were observed among the mean MIC values of the honey samples (P>0.05). The order of overall susceptibility of Candida species to honey samples were; C. krusei>C. glabrata>C. tropicalis>C. albicans (P>0.05). In addition, the mean MICs of Candida strains isolated from the nail, vagina and oral cavity were 33.68%, 36.44% and 39.89%, respectively, and were not significantly different (P>0.05).

CONCLUSION

Overall, varying susceptibilities to the anti-Candida properties of different honeys were observed with four FLU-resistant species of Candida. Further research is needed to assess the efficacy of honey as an inhibitor of candidal growth in clinical trials.

The effectiveness of thyme honey for the management of treatment-induced xerostomia in head and neck cancer patients: A feasibility randomized control trial

PURPOSE

Radiation-induced xerostomia is one of the most common side effects that head and neck cancer patients experience during and after treatment. Despite the various methods for the prevention and treatment of radiation-induced xerostomia, it remains highly prevalent among patients treated for head and neck cancers negatively influencing their lives. The purpose of this study was to evaluate the effectiveness of thyme honey as a means for managing radiation-induced xerostomia.

METHOD

This was a parallel randomised controlled trial with two equal arms, the experimental arm (thyme honey) and the control arm (saline). 72 head and neck cancer patients receiving radiotherapy or/and chemotherapy or/and surgery were recruited in a specialised cancer centre. Patients in both arms followed the same administration protocol with thyme honey and saline respectively. Identical assessments at baseline, 1 month and 6 months following completion of the intervention were performed in both arms including the National Cancer Institute (NCI) xerostomia scale and the Xerostomia Questionnaire (XQ) additionally to weekly oral clinical assessments. The ClinicalTrials.gov Identifier for this study is NCT01465308.

RESULTS

Linear Mixed Models revealed the statistically significant effect of the intervention on xerostomia (F = 8.474 p < 0.001) and overall quality of life (F = 13.158 p < 0.001). Moreover, Generalised Estimating Equations revealed a statistically significant effect on strong and unbearable pain (F = 10.524 p < 0.001) and dysphagia (F = 4.525 p = 0.033).

CONCLUSION

The study has demonstrated the safety and efficacy findings of Thyme honey in head and neck cancer patients for the management of treatment induced xerostomia.

Efficacy of Hypozalix spray and propolis mouthwash for prevention of chemotherapy-induced oral mucositis in leukemic patients: A double-blind randomized clinical trial

Background. Oral mucositis is the chief complication of head and neck chemotherapy. This study was conducted to evaluate Hypozalix artificial saliva and propolis mouthwash efficacy for the prevention of chemotherapy-induced oral mucositis in leukemic patients. Methods. The present double-blind clinical trial was carried out on 72 patients undergoing chemotherapy. The patients were assigned to 3 groups. In the control group, CHX mouthwash and fluconazole were used by the subjects. In groups 1 and 2, Hypozalix and propolis mouthwashes were added to the combination therapy used in the control group. The results were compared between the three groups after 14 days. Results. Mean score A was significantly higher than mean score B in children (P = 0.001). In contrast, mean score A was significantly lower than mean score B in young adults (P = 0.003). Conclusion. Use of Hypozalix spray or propolis mouthwash in association with CHX mouthwash and fluconazole simultaneously at the start of chemotherapy resulted in a decrease in chemotherapy complications after 14 days. In many cases the use of propolis mouthwash yielded better results and the patients exhibited a greater tendency to continue to use it.

Honey and Cancer: Current Status and Future Directions

Cancer is a leading cause of death worldwide and poses a challenge to treatment. With overwhelming evidence of the role played by diet and lifestyle in cancer risk and prevention, there is a growing interest into the search for chemopreventative or chemotherapeutic agents derived from natural products. Honey is an important source of bioactive compounds derived from plants and recent years have seen an increased interest in its anticancer properties. This review examines the role of honey in targeting key hallmarks of carcinogenesis, including uncontrolled proliferation, apoptosis evasion, angiogenesis, growth factor signalling, invasion, and inflammation. The evidence for honey as an adjunct to conventional cancer therapy is also presented. The review also highlights gaps in the current understanding and concludes that, before translation of evidence from cell culture and animal studies into the clinical setting, further studies are warranted to examine the effects of honey at a molecular level, as well as on cells in the tumour environment.

Honey prevents oral mocositis in children undergoing chemotherapy: A quasi-experimental study with a control group

BACKGROUND

There are numerous pharmacological and non-pharmacological treatment options available in the treatment of oral mucositis. However, in spite of so many methods and products, medical professionals have not come to a consensus as to which of these offer the best results.

OBJECTIVES

This study was conducted to assess the effect of oral care with honey on children undergoing chemotherapy for the prevention and healing of oral mucositis.

METHODS

This quasi-experimental study was conducted on children undergoing chemotherapy. The study group consisted of 83 children who attended clinics and polyclinics for chemotherapy. All the children were included in the study period. The study was completed with a total of 76 children except for seven patients who were excluded from the study. The data were collected using a form and the World Health Organization Mucositis Assessment Index. The data were analyzed using percentage distributions, means, a chi-square test, a t-test, a variance analysis, and a Friedman test. Ethics approval of the study was obtained from the Institution Ethics Committee.

RESULTS

It was found that the severity of oral mucositis in the children in the experimental group was significantly less than the control group. The mucositis recovery period in the experimental group was significantly shorter than the control group.

CONCLUSION

Regular oral care with honey for children undergoing chemotherapy for hematological cancers prevents mucositis and also accelerates recovery of it when started after mucositis onset.

Honey and beehive products in otorhinolaryngology: a narrative review

BACKGROUND

Honey and beehive products were rediscovered as an alternative treatment in wounds. The medicinal properties also raised interest of their use in Otorhinolaryngology.

OBJECTIVE OF REVIEW

To give an overview of the effectiveness of beehive products in Otorhinolaryngology.

TYPE OF REVIEW

Narrative.

SEARCH STRATEGY AND EVALUATION

A literature search of the databases PubMed, EMBASE and Cochrane was performed from the last two decades till December 2014. The search terms 'honey', 'propolis' or 'royal jelly' were used. Articles, which evaluated the effectiveness of beehive products in Otorhinolaryngology, were included. The quality assessment of included studies was performed using the Cochrane Collaboration's risk of bias tool.

DISCUSSION AND CONCLUSION

A total of 36 studies were identified and evaluated. Eighteen studies investigated their effect in oral infections, seven in infection of the respiratory tract, six in rhino-sinusal diseases, four investigated the use in tonsillectomy and head and neck surgery and one study explored the preventive effect in otitis media. Honey can be considered as effective (additional) treatment in mucositis, childhood cough, persistent post-infectious cough and after tonsillectomy. Propolis may have a role in the treatment of (aphthous) stomatitis, mouth ulcer and prevention of acute otitis media. Royal jelly showed to reduce mucositis. In the presented studies, beehive products proved to be safe, with only minor adverse reactions. Studies showed to be diverse and had some methodological limitations.

Honey in dermatology and skin care: a review

Honey is a bee-derived, supersaturated solution composed mainly of fructose and glucose, and containing proteins and amino acids, vitamins, enzymes, minerals, and other minor components. Historical records of honey skin uses date back to the earliest civilizations, showing that honey has been frequently used as a binder or vehicle, but also for its therapeutic virtues. Antimicrobial properties are pivotal in dermatological applications, owing to enzymatic H2 O2 release or the presence of active components, like methylglyoxal in manuka, while medical-grade honey is also available. Honey is particularly suitable as a dressing for wounds and burns and has also been included in treatments against pityriasis, tinea, seborrhea, dandruff, diaper dermatitis, psoriasis, hemorrhoids, and anal fissure. In cosmetic formulations, it exerts emollient, humectant, soothing, and hair conditioning effects, keeps the skin juvenile and retards wrinkle formation, regulates pH and prevents pathogen infections. Honey-based cosmetic products include lip ointments, cleansing milks, hydrating creams, after sun, tonic lotions, shampoos, and conditioners. The used amounts range between 1 and 10%, but concentrations up to 70% can be reached by mixing with oils, gel, and emulsifiers, or polymer entrapment. Intermediate-moisture, dried, and chemically modified honeys are also used. Mechanisms of action on skin cells are deeply conditioned by the botanical sources and include antioxidant activity, the induction of cytokines and matrix metalloproteinase expression, as well as epithelial-mesenchymal transition in wounded epidermis. Future achievements, throwing light on honey chemistry and pharmacological traits, will open the way to new therapeutic approaches and add considerable market value to the product.

Wound care in the wilderness: is there evidence for honey?

Honey is one of the most ancient remedies for wound care. Current research has shown promising results for its use in wound care. This review is intended to inform readers of the physiological properties of honey and the evidence that exists to support its clinical use. When compared with evidence for current wound treatment, honey has proven to be a safe, effective, and sometimes superior treatment for various wounds. There are currently US Food and Drug Administration-approved medical-grade honey products available in the United States. Although there have been no clinical trials exploring the use of honey in wilderness environments, it may be a safe, improvisational wound treatment. More robust studies are needed for definitive conclusions of its efficacy and safety.

Role of Kampo medicine in integrative cancer therapy

Clinical trials to date demonstrate that standard cancer treatments are currently the most efficient treatments for large numbers of cancer patients. Cancer treatments will increasingly require approaches that allow patients to live with cancer, by increasing their natural healing power and tumor immunity, as well as attenuating the progression of their cancers, instead of only attacking the cancer cells directly. Complementary and alternative medicine, including Kampo medicine, compensates for the drawbacks of western medicine by increasing patients' self-defense mechanisms. In Japan, clinicians who have studied both western medicine and Kampo treat cancer patients by fusing the two medical systems into a unitary one. The goal of the system is to assist the functional maintenance and recovery of the living body complex with the physical, mental, social, and spiritual balance, rather than addressing direct antitumor effects. In this review, we describe the usefulness of Kampo medicine, especially juzentaihoto, and outline the reports on evidence, in addition to the report on an attitudinal survey about the use of Kampo medicine in cancer treatment in Japan.

Cultivable microorganisms associated with honeys of different geographical and botanical origin

In this study, the composition of the cultivable microbial populations of 38 nectar honey and honeydew honey samples of different botanical and geographical origin were assessed. After growth in specific media, various colonies with different appearance were isolated and purified before phenotypic (morphological, physiological and biochemical traits) and genotypic [randomly amplified polymorphic DNA (RAPD), repetitive DNA elements-PCR (rep-PCR) and restriction fragment length polymorphism (RFLP)] differentiation. The identification was carried out by 16S rRNA gene sequencing for bacteria and, in addition to RFLP, by sequencing the D1/D2 region of the 26S rRNA gene for yeasts and the 5.8S-ITS rRNA region for filamentous fungi. The results showed the presence of 13 species of bacteria, 5 of yeasts and 17 of filamentous fungi; the species most frequently isolated were Bacillus amyloliquefaciens, Zygosaccharomyces mellis and Aspergillus niger for the three microbial groups, respectively. The highest microbial diversity was found in multifloral honeys. No correlation among the microbial species and the botanical/geographical origin was found, but some strains were highly adapted to these matrices since they were found in several samples of different origin.

Antiproliferative and apoptotic effects of spanish honeys

Background:

Current evidence supports that consumption of polyphenols has beneficial effects against numerous diseases mostly associated with their antioxidant activity. Honey is a good source of antioxidants since it contains a great variety of phenolic compounds.

Objective:

The main objective of this work was to investigate the antiproliferative and apoptotic effects of three crude commercial honeys of different floral origin (heather, rosemary and polyfloral honey) from Madrid Autonomic Community (Spain) as well as of an artificial honey in human peripheral blood promyelocytic leukemia cells (HL-60).

Material and Methods:

HL-60 cells were cultured in the presence of honeys at various concentrations for up to 72 hours and the percentage of cell viability was evaluated by MTT assay. Apoptotic cells were identified by chromatin condensation and flow cytometry analysis. ROS production was determined using 2´,7´-dichlorodihydrofluorescein diacetate (H₂DCFDA).

Results:

The three types of crude commercial honey induced apoptosis in a concentration and time dependent-manner. In addition, honeys with the higher phenolic content, heather and polyfloral, were the most effective to induce apoptosis in HL-60 cells. However, honeys did not generate reactive oxygen species (ROS) and N-acetyl-L-cysteine (NAC) could not block honeys-induced apoptosis in HL-60 cells.

Conclusion:

These data support that honeys induced apoptosis in HL-60 cells through a ROS-independent cell death pathway. Moreover, our findings indicate that the antiproliferative and apoptotic effects of honey varied according to the floral origin and the phenolic content.

Honey in modern wound care: a systematic review

Honey, known for centuries as a topical treatment for a wide range of wounds, has recently known a revival in modern wound care. The objective of this systematic review is to evaluate the available evidence and the role of honey in contemporary wound care. The search strategy was developed in the databases PubMed and ISI Web of Science. Fifty-five studies of any design, evaluating the use of honey in human burns, ulcers and other wounds, written in English, French, German or Dutch were eligible for inclusion. In all three wound categories honey seems to be a dressing with wound healing stimulating properties. In burns there is also evidence for its antibacterial capacity. In general, honey is also been mentioned to have deodorizing, debridement, anti-inflammatory and wound pain reducing properties, although the evidence for these properties is rather limited. Many of the included studies have methodological problems, and the quality of certain studies is low, making it difficult to formulate conclusive guidelines. This review reveals several gaps in the research of honey in modern wound care, and recommendations are suggested for future research.

Significance of Kampo, traditional Japanese medicine, in supportive care of cancer patients

The current standard treatment for cancer is a multidisciplinary therapy whereby various types of treatment are properly combined. Chemotherapy with multiple anticancer drugs is now common, and traditional, complementary, and alternative therapies are adopted as supportive measures. Medical care in Japan is distinguished by the ability for patients to access both Western and Kampo medical cares at the same time. There is a high degree of trust in the safety of Kampo therapies because they are practiced by medical doctors who are educated with fundamental diagnosis of Western medicine. Highly reliable clinical studies are being published, demonstrating that palliative or supportive care for cancer patients using Kampo preparations alleviates adverse effects of chemotherapy or radiotherapy. This paper reports the circumstances around cancer care in Japan where traditional therapeutic Kampo formulas are used for patients undergoing cancer treatment with cutting-edge chemotherapy, specifically to alleviate adverse effects of anticancer drugs.

Intravenous administration of manuka honey inhibits tumor growth and improves host survival when used in combination with chemotherapy in a melanoma mouse model

Manuka honey has been recognized for its anti-bacterial and wound-healing activity but its potential antitumor effect is poorly studied despite the fact that it contains many antioxidant compounds. In this study, we investigated the antiproliferative activity of manuka honey on three different cancer cell lines, murine melanoma (B16.F1) and colorectal carcinoma (CT26) as well as human breast cancer (MCF-7) cells in vitro. The data demonstrate that manuka honey has potent anti-proliferative effect on all three cancer cell lines in a time- and dose-dependent manner, being effective at concentrations as low as 0.6% (w/v). This effect is mediated via the activation of a caspase 9-dependent apoptotic pathway, leading to the induction of caspase 3, reduced Bcl-2 expression, DNA fragmentation and cell death. Combination treatment of cancer cells with manuka and paclitaxel in vitro, however, revealed no evidence of a synergistic action on cancer cell proliferation. Furthermore, we utilized an in vivo syngeneic mouse melanoma model to assess the potential effect of intravenously-administered manuka honey, alone or in combination with paclitaxel, on the growth of established tumors. Our findings indicate that systemic administration of manuka honey was not associated with any alterations in haematological or clinical chemistry values in serum of treated mice, demonstrating its safety profile. Treatment with manuka honey alone resulted in about 33% inhibition of tumor growth, which correlated with histologically observable increase in tumor apoptosis. Although better control of tumor growth was observed in animals treated with paclitaxel alone or in combination with manuka honey (61% inhibition), a dramatic improvement in host survival was seen in the co-treatment group. This highlights a potentially novel role for manuka honey in alleviating chemotherapy-induced toxicity.

Honey and apoptosis in human gastric mucosa

BACKGROUND

Gastric cancer is the fourth most common malignancy in the world. Honey is a complex mixture of special biological active constituents. Honey possesses antioxidant and antitumor properties. Nutritional studies have indicated that consumption of honey modulates the risk of developing gastric cancer. On the other hand, apoptosis has been reported to play a decisive role in precancerous changes. Our chief study was conducted to assess the relationship between consumption of honey and apoptosis in human gastric mucosa.

METHOD

This cross-sectional study was conducted on 98 subjects over 18 years old, referred to two hospitals in Tabriz, Iran. Subjects were undergone an upper gastrointestinal endoscopy, 62 subjects were finally enrolled. Honey consumption was assessed by a Food Frequency Questionnaire (FFQ) and apoptosis was detected by TUNEL technique. We tested polynomial curve to find the best fit between honey consumption and apoptosis.

RESULTS

A positive relation between honey consumption and apoptosis was found (P=0.024). Our results indicated that the final and the best fit curve was: apoptosis = 1.714+1.648(honey amount) - 0.533(honey amount)2 +1.833×10-5(honey amount)7.

CONCLUSION

Honey consumption had positive effects on gastric cancer by inducing apoptosis in gastric mucosa.

Multicentre prospective observational study on professional wound care using honey (Medihoney™)

In recent years, the treatment of wounds with honey has received an increasing amount of attention from healthcare professionals in Germany and Austria. We conducted a prospective observational multicentre study using Medihoney™ dressings in 10 hospitals - nine in Germany and one in Austria. Wound-associated parameters were monitored systematically at least three times in all patients. Data derived from the treatment of 121 wounds of various aetiologies over a period of 2 years were analysed. Almost half of the patients were younger than 18 years old, and 32% of the study population was oncology patients. Overall, wound size decreased significantly during the study period and many wounds healed after relatively short time periods. Similarly, perceived pain levels decreased significantly, and the wounds showed noticeably less slough/necrosis. In general, our findings show honey to be an effective and feasible treatment option for professional wound care. In addition, our study showed a relationship between pain and slough/necrosis at the time of recruitment and during wound healing. Future comparative trials are still needed to evaluate the extent to which the positive observations made in this and other studies can definitely be attributed to the effects of honey in wound care.

Honey and a mixture of honey, beeswax, and olive oil-propolis extract in treatment of chemotherapy-induced oral mucositis: a randomized controlled pilot study

In spite of being one of the most investigated subjects among supportive care in cancer, no therapy has been found effective in treatment of chemotherapy-induced oral mucositis. Based on the observations that honey bees products have anti-inflammatory and wound healing effects, the present study tried to evaluate the effect of topical application of honey and a mixture of honey, olive oil-propolis extract, and beeswax (HOPE) in treatment of oral mucositis. This was a randomized controlled clinical trial conducted on 90 patients with acute lymphoblastic leukemia and oral mucositis grades 2 and 3. The mean age of enrolled patients was 6.9 years. The patients were assigned into 3 equal treatment groups: Honey, HOPE, and control groups. Topical treatment for each patient consists of honey, HOPE, and benzocaine gel for honey, HOPE, and control groups, respectively. Recovery time in grade 2 mucositis was significantly reduced in the honey group as compared with either HOPE or controls (P < .05). In grade 3 mucositis, recovery time did not differ significantly between honey and HOPE (P = 0.61) but compared with controls, healing was faster with either honey or HOPE (P < .01). Generally, in both grades of mucositis, honey produced faster healing than either HOPE or controls (P < .05). Based on our results that showed that honey produced faster healing in patients with grade 2/3 chemotherapy-induced mucositis, we recommend using honey and possibly other bee products and olive oil in future therapeutic trials targeting chemotherapy-induced mucositis.