ascorbic-acid and Wounds-and-Injuries

Topics: Antioxidants; Ascorbic Acid; Burns; Hemorrhage; Humans; Sepsis; Wounds and Injuries

Vitamin C is not only an essential nutrient involved in many anabolic pathways, but also an important player of the endogenous antioxidant defense. Low plasma levels are very common in critical care patients and may reflect severe deficiency states.. Vitamin C scavenges reactive oxygen species such as superoxide and peroxynitrite in plasma and cells (preventing damage to proteins, lipids and DNA), prevents occludin dephosphorylation and loosening of the tight junctions. Ascorbate improves microcirculatory flow impairment by inhibiting tumor-necrosis-factor-induced intracellular adhesion molecule expression, which triggers leukocyte stickiness and slugging. Clinical trials in sepsis, trauma and major burns testing high-dose vitamin C show clinical benefit. Restoration of normal plasma levels in inflammatory patients requires the administration of 3 g/day for several days, which is 30 times the daily recommended dose.. The recent research on the modulation of oxidative stress and endothelial protection offer interesting therapeutic perspectives, based on the biochemical evidence, with limited or even absent side-effects.

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Burns; Critical Care; Critical Illness; Dietary Supplements; Humans; Nutrition Therapy; Oxidative Stress; Reactive Oxygen Species; Vitamins; Wounds and Injuries

The complex regional pain syndrome is a neuroinflammatory pathology that affects the central and peripheral nervous system, characterized by disproportional pain in relation to the trauma experimented by the patient. It has been proposed that vitamin C could prevent the development of this syndrome in patients with limb trauma and surgery. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified two systematic reviews that indentified four primary studies, including one randomized controlled trial. We generated a summary of findings table following the GRADE approach. We concluded it is uncertain whether vitamin C prevents complex regional pain syndrome because the certainty of the evidence is very low.. El síndrome de dolor regional complejo es una patología neuroinflamatoria que afecta tanto al sistema nervioso central como al periférico, y se caracteriza por dolor desproporcionado en relación al trauma experimentado por el paciente. Se ha planteado que el uso de vitamina C podría prevenir la aparición de este síndrome en pacientes con trauma y cirugía de extremidades. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos dos revisiones sistemáticas que en conjunto incluyen sólo un estudio controlado aleatorizado. Realizamos una tabla de resumen de los resultados utilizando el método GRADE. Concluimos que existe incertidumbre sobre si la vitamina C podría ser útil en la prevención del síndrome de dolor regional complejo en estos pacientes porque la certeza de la evidencia es muy baja.

Topics: Antioxidants; Ascorbic Acid; Complex Regional Pain Syndromes; Extremities; Humans; Randomized Controlled Trials as Topic; Wounds and Injuries

The transport mechanisms of ascorbic acid (AA) are described. The metabolism of AA and its function as an antioxidant are covered in some detail. Subsequently, indications for postoperative substitution are discussed. The supplementation of up to 300 mg of AA per day in postoperative intensive care unit patients during par-/enteral nutrition is recommended to prevent hypovitaminosis. It is not clear if this is the optimal dosage of AA in postoperative/-trauma patients. New aspects for an AA substitution are discussed.

Topics: Antioxidants; Ascorbic Acid; Humans; Postoperative Care; Wounds and Injuries

Some biochemical functions of vitamin C make it an essential component of parenteral nutrition (PN) and an important therapeutic supplement in other acute conditions. Ascorbic acid is a strong aqueous antioxidant and is a cofactor for several enzymes. The average body pool of vitamin C is 1.5 g, of which 3%-4% (40-60 mg) is used daily. Steady state is maintained with 60 mg/d in nonsmokers and 140 mg/d in smokers. Shocked surgical, trauma, and septic patients have a drastic reduction of circulating plasma ascorbate concentrations. These low concentrations require 3-g doses/d to restore normal plasma ascorbate concentrations, questioning the recommended PN dose of 100 mg/d. Determination of intravenous requirements is usually based on plasma concentrations, which are altered during the inflammatory response. There is no clear indicator of deficiency: serum or plasma ascorbate concentrations <0.3 mg/dL (20 micromol/L) indicates inadequate vitamin C status. On the basis of available pharmacokinetic data the 100 mg/d dose for patients receiving home PN and 200 mg/d for stable adult patients receiving PN are adequate, but requirements have been shown to be higher in perioperative, trauma, burn, and critically ill patients, paralleling oxidative stress. One recommendation cannot fit all categories of patients. Large vitamin C supplements may be considered in severe critical illness, major trauma, and burns because of increased requirements resulting from oxidative stress and wound healing. Future research should distinguish therapeutic use of high-dose ascorbic acid antioxidant therapy from nutritional PN requirements.

Topics: Antioxidants; Ascorbic Acid; Burns; Critical Illness; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Interactions; Drug Stability; Glucose; Home Care Services; Humans; Nutritional Requirements; Parenteral Nutrition; Patients; Pediatrics; Perioperative Care; Practice Guidelines as Topic; Wounds and Injuries

The high forces undergone during repetitive eccentric, or lengthening, contractions place skeletal muscle under considerable stress, in particular if unaccustomed. Although muscle is highly adaptive, the responses to stress may not be optimally regulated by the body. Reactive oxygen species (ROS) are one component of the stress response that may contribute to muscle damage after eccentric exercise. Antioxidants may in turn scavenge ROS, thereby preventing or attenuating muscle damage. The antioxidant vitamins C (ascorbic acid) and E (tocopherol) are among the most commonly used sport supplements, and are often taken in large doses by athletes and other sportspersons because of their potential protective effect against muscle damage. This review assesses studies that have investigated the effects of these two antioxidants, alone or in combination, on muscle damage and oxidative stress. Studies have used a variety of supplementation strategies, with variations in dosage, timing and duration of supplementation. Although there is some evidence to show that both antioxidants can reduce indices of oxidative stress, there is little evidence to support a role for vitamin C and/or vitamin E in protecting against muscle damage. Indeed, antioxidant supplementation may actually interfere with the cellular signalling functions of ROS, thereby adversely affecting muscle performance. Furthermore, recent studies have cast doubt on the benign effects of long-term, high-dosage antioxidant supplementation. High doses of vitamin E, in particular, may increase all-cause mortality. Although some equivocation remains in the extant literature regarding the beneficial effects of antioxidant vitamin supplementation on muscle damage, there is little evidence to support such a role. Since the potential for long-term harm does exist, the casual use of high doses of antioxidants by athletes and others should perhaps be curtailed.

Topics: Antioxidants; Ascorbic Acid; Dietary Supplements; Exercise; Humans; Muscle, Skeletal; Tocopherols; Wounds and Injuries

This review presents the rationale for the therapeutic use of antioxidants in treating critically ill patients; it is not a systematic review of the clinical evidence that has been assessed recently by others. Clinical and nonclinical evidence is presented to support the notion that natural antioxidants are of therapeutic value in treating cardiovascular shock. Oxidative stress is a major promoter and mediator of the systemic inflammatory response. The microcirculation is particularly susceptible to oxidative stress that causes hemodynamic instability, leading to multiple organ failure due to systemic inflammatory response syndrome. Vitamin C is the antioxidant used experimentally to demonstrate oxidative stress as a key pathophysiologic factor in septic shock. Pharmacologic studies reveal that vitamin C (as ascorbate), at supraphysiologic doses, significantly affects the bioavailability of nitric oxide during acute inflammation, including inhibiting nitric oxide synthetase induction. Parenteral high-dose vitamin C inhibits endotoxin-induced endothelial dysfunction and vasohyporeactivity in humans and reverses sepsis-induced suppression of microcirculatory control in rodents. In severe burn injury, in both animals and patients, parenteral high-dose vitamin C significantly reduces resuscitation fluid volumes. Therefore, a significant body of pharmacologic evidence and sound preliminary clinical evidence supports the biological feasibility of using the exemplary antioxidant, vitamin C, in the treatment of the critically ill.

Topics: Animals; Antioxidants; Ascorbic Acid; Critical Illness; Dose-Response Relationship, Drug; Endothelium, Vascular; Humans; Microcirculation; Multiple Organ Failure; Oxidative Stress; Shock, Septic; Systemic Inflammatory Response Syndrome; Vasodilation; Vitamins; Wounds and Injuries

Although nutrition is an extrinsic factor regulating wound healing, nutritional supplementation for the modulation of wound healing remains experimental. Evidence on the efficacy of supplementation in animals and humans is reviewed.

Topics: Animals; Arginine; Ascorbic Acid; Clinical Trials as Topic; Dietary Supplements; Drug Evaluation, Preclinical; Humans; Malnutrition; Nutrition Assessment; Nutritional Status; Nutritional Support; Treatment Outcome; Vitamin A; Wound Healing; Wounds and Injuries; Zinc

Clinical studies provide evidence that wound healing in subjects judged not deficient in vitamin C can be significantly accelerated with supplements of this nutrient above the recommended daily allowance (RDA). The authors administered daily dosages of 500 to 3,000 mg., which is roughly 8 to 50 times the RDA of 60 mg., to subjects recovering from surgery, other injuries, decubital ulcers, and leg ulcers induced by hemolytic anemia. Genetic impairment of collagen synthesis has also been observed to be responsive to ascorbic acid supplementation in an 8-year-old boy with Type VI Ehlers-Danlos syndrome. Four grams of ascorbic acid daily produced a significant improvement in the quality of newly synthesized collagen but did not alter that formed prior to the supplementation of C. The combined evidence in this review provides a substantial base for further research, both clinical and experimental trials, concerning the interrelationships between vitamin C and the body's healing potential.

Topics: Adult; Animals; Ascorbic Acid; Child; Collagen; Ehlers-Danlos Syndrome; Female; Guinea Pigs; Humans; Male; Middle Aged; Pressure Ulcer; Rabbits; Surgical Procedures, Operative; Time Factors; Wound Healing; Wounds and Injuries

Topics: Amino Acids; Animals; Ascorbic Acid; Chick Embryo; Copper; Dogs; Fatty Acids, Unsaturated; Humans; Iron; Proteins; Trace Elements; Vitamin A; Vitamin B Complex; Vitamin E; Vitamin K; Wound Healing; Wound Infection; Wounds and Injuries; Zinc

Topics: Anti-Bacterial Agents; Ascorbic Acid; Collagen; Cross Infection; Debridement; Diet; Fibrin; Granulation Tissue; Humans; Surgical Instruments; Surgical Wound Dehiscence; Surgical Wound Infection; Sutures; Tissue Adhesives; Wound Healing; Wounds and Injuries; Zinc

Topics: Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Collagen; Diet; Guinea Pigs; Humans; Nutritional Requirements; Wound Healing; Wounds and Injuries

Topics: Anemia; Animals; Ascorbic Acid; Biomechanical Phenomena; Cicatrix; Collagen; Denervation; Fibrin; Fibroblasts; Glucocorticoids; Glycoproteins; Glycosaminoglycans; Granulation Tissue; Guinea Pigs; Histamine; Humans; Lathyrism; Microbial Collagenase; Oxygen; Rabbits; Rats; Species Specificity; Stress, Physiological; Time Factors; Wound Healing; Wounds and Injuries

To evaluate the protective effects of selenium with vitamins A, C and E (selenium ACE, i.e. antioxidants), verapamil (calcium channel blocker), and losartan (angiotensin receptor blocker) against extracorporeal shockwave lithotripsy (ESWL)-induced renal injury.. A randomised controlled trial was conducted between August 2012 and February 2015. Inclusion criteria were adult patients with a single renal stone (<2 cm) suitable for ESWL. Patients with diabetes, hypertension, congenital renal anomalies, moderate or marked hydronephrosis, or preoperative albuminuria (>300 mg/L) were excluded. ESWL was performed using the electromagnetic DoLiS lithotripter. Eligible patients were randomised into one of four groups using sealed closed envelopes: Group1, control; Group 2, selenium ACE; Group 3, losartan; and Group 4, verapamil. Albuminuria and urinary neutrophil gelatinase-associated lipocalin (uNGAL) were estimated after 2-4 h and 1 week after ESWL. The primary outcome was differences between albuminuria and uNGAL. Dynamic contrast-enhanced magnetic resonance imaging was performed before ESWL, and at 2-4 h and 1 week after ESWL to compare changes in renal perfusion.. Of 329 patients assessed for eligibility, the final analysis comprised 160 patients (40 in each group). Losartan was the only medication that showed significantly lower levels of albuminuria after 1 week (P < 0.001). For perfusion changes, there was a statistically significant decrease in the renal perfusion in patients with obstructed kidneys in comparison to before ESWL (P = 0.003). These significant changes were present in the control or antioxidant group, whilst in the losartan and verapamil groups renal perfusion was not significantly decreased.. Losartan was found to protect the kidney against ESWL-induced renal injury by significantly decreasing post-ESWL albuminuria. Verapamil and losartan maintained renal perfusion in patients with post-ESWL renal obstruction.

Topics: Adult; Angiotensin II Type 1 Receptor Blockers; Antioxidants; Ascorbic Acid; Calcium Channel Blockers; Drug Therapy, Combination; Female; Humans; Kidney; Lithotripsy; Losartan; Male; Selenium; Verapamil; Vitamin A; Vitamin E; Vitamins; Wounds and Injuries

To determine the effectiveness of early, routine antioxidant supplementation using alpha-tocopherol and ascorbic acid in reducing the rate of pulmonary morbidity and organ dysfunction in critically ill surgical patients.. Oxidative stress has been associated with the development of the acute respiratory distress syndrome (ARDS) and organ failure through direct tissue injury and activation of genes integral to the inflammatory response. In addition, depletion of endogenous antioxidants has been associated with an increased risk of nosocomial infections. The authors postulated that antioxidant supplementation in critically ill surgical patients may reduce the incidence of ARDS, pneumonia, and organ dysfunction.. This randomized, prospective study was conducted to compare outcomes in patients receiving antioxidant supplementation (alpha-tocopherol and ascorbate) versus those receiving standard care. The primary endpoint for analysis was pulmonary morbidity (a composite measure of ARDS and nosocomial pneumonia). Secondary endpoints included the development of multiple organ failure, duration of mechanical ventilation, length of ICU stay, and mortality.. Five hundred ninety-five patients were enrolled and analyzed, 91% of whom were victims of trauma. The relative risk of pulmonary morbidity was 0.81 (95% confidence interval 0.60-1.1) in patients receiving antioxidant supplementation. Multiple organ failure was significantly less likely to occur in patients receiving antioxidants than in patients receiving standard care, with a relative risk of 0.43 (95% confidence interval 0.19-0.96). Patients randomized to antioxidant supplementation also had a shorter duration of mechanical ventilation and length of ICU stay.. The early administration of antioxidant supplementation using alpha-tocopherol and ascorbic acid reduces the incidence of organ failure and shortens ICU length of stay in this cohort of critically ill surgical patients.

Topics: Adolescent; Adult; Aged; alpha-Tocopherol; Antioxidants; Ascorbic Acid; Confidence Intervals; Critical Illness; Dietary Supplements; Female; Follow-Up Studies; Humans; Male; Middle Aged; Multiple Organ Failure; Postoperative Complications; Postoperative Period; Probability; Prospective Studies; Reference Values; Respiratory Distress Syndrome; Surgical Procedures, Operative; Survival Analysis; Treatment Outcome; Wounds and Injuries

Reactive oxygen species have been implicated in the etiology of multiorgan dysfunction syndrome and infectious complications in trauma patients by either direct cellular toxicity and/or the activation of intracellular signaling pathways. Studies have shown that the antioxidant defenses of the body are decreased in trauma patients; these include glutathione, for which N-acetylcysteine is a precursor, and selenium, which is a cofactor for glutathione. Eighteen trauma patients were prospectively randomized to a control or antioxidant group where they received N-acetylcysteine, selenium, and vitamins C and E for 7 days. As compared with the controls, the antioxidant group showed fewer infectious complications (8 versus 18) and fewer organs dysfunctioning (0 versus 9). There were no deaths in either group. We conclude that these preliminary data may support a role for the use of this antioxidant mixture to decrease the incidence of multiorgan dysfunction syndrome and infectious complications in the severely injured patient. This remains to be confirmed in larger trials.

Topics: Acetylcysteine; Antioxidants; Ascorbic Acid; Humans; Infections; Injury Severity Score; Multiple Organ Failure; Prospective Studies; Selenium; Treatment Outcome; Vitamin E; Wounds and Injuries

The advancement of autologous mesenchymal stem cell (MSC) therapy for the treatment of non-healing diabetic wounds is hampered by endogenous MSC dysfunction and limited viability of cells post-transplantation into the pathological wound environment. The development of effective strategies to restore the functional capabilities of these impaired MSCs prior to transplantation may be a key to their ultimate success as wound repair mediators. The current study therefore investigated whether antioxidant preconditioning [7.5 mM N-acetylcysteine (NAC) + 0.6 mM ascorbic 2-phosphate (AAP)] could restore the growth rate, migration ability and viability of impaired MSCs and whether this restored state is maintained in the presence of diabetic wound fluid (DWF). Healthy control (source: wild type, C57BL/6J mice) (n = 12) and impaired/diabetic MSCs (source: obese prediabetic, B6.Cg-Lepob/J mice) (n = 12) were isolated from the bone marrow of mice. Treatment groups post-isolation were as follow: (a) No treatment (baseline phenotype): MSCs expanded in standard growth media (SGM) (±8 days) and only exposed to growth media. (b) DWF (baseline response): MSCs expanded in SGM (±8 days) followed by exposure to DWF (24 hours, 48 hours, 96 hours). (c) Antioxidant preconditioning (preconditioned phenotype): MSCs expanded in the presence of NAC/AAP (±8 days). (d) Antioxidant preconditioning + DWF (preconditioned response): MSCs expanded in the presence of NAC/AAP (±8 days) followed by exposure to DWF (24 hours, 48 hours, 96 hours). The results demonstrated that expansion of MSCs (both healthy control and impaired diabetic) in the presence of combined NAC/AAP treatment improved ex vivo MSC viability and protected MSCs in the presence of DWF. Despite improved viability, AAP/NAC could however not rescue the reduced proliferation and migration capacity of impaired diabetic MSCs. The protective effect of NAC/AAP preconditioning against the toxicity of DWF could however be a potential strategy to improve cell number post-transplantation.

Topics: Acetylcysteine; Animals; Antioxidants; Ascorbic Acid; Case-Control Studies; Cell Movement; Cell Proliferation; Cell Survival; Diabetes Mellitus; Exudates and Transudates; Mesenchymal Stem Cell Transplantation; Mesenchymal Stem Cells; Mice; Mice, Obese; Osteogenesis; Prediabetic State; Transplantation, Autologous; Wounds and Injuries

Topics: Adolescent; Ascorbic Acid; Chest Pain; Cholecalciferol; Dietary Supplements; Echocardiography; Gingiva; Hemorrhage; Humans; Hypertension, Pulmonary; Iron; Leg; Male; Pain; Scurvy; Wounds and Injuries

This study focused on potential of vitamin C loaded human serum albumin (HSA) nanoparticles for treatment of wound. Nanocarrier were prepared and assessed for their effect on growth of 3T3 fibroblast cells, cell migration, wound healing rate and expression of miR-155, TGF-β1 and SMAD 1,2 genes. Wound healing assay was done and wounds were treated with vitamin C loaded HSA nanoparticles. Nanoparticles were prepared with size and zeta potential of 180±6 and -29 mV, respectively. Vitamin C loaded HSA nanoparticles showed controlled release of vitamin C into the buffer solution. Also, yield and encapsulation efficacy of loaded nanoparticles were obtained as 70.6 and 52.1 %, respectively. MTT results showed that the growth of 3T3 fibroblast cells was promoted in culture medium with 20 µg/ml of vitamin C loaded HSA nanoparticles. Cell migration assay indicated the positive effect of loaded nanoparticles on wound healing. The in-vivo results showed that the rate of wound healing was increased after treatment with 20 µg/ml of vitamin C loaded HSA nanoparticles. The wounds were healed faster when treated with vitamin C loaded HSA nanoparticles in comparison with control group. The expression of miR-155 was downregulated after treatment. Furthermore, expression of TGF-β1 and SMAD 1,2 were increased while the wounds were treated with these nanoparticles. In conclusion, these results showed for the first time that wounds were healed after treatment with albumin nanocarrier loaded with vitamin C. This nanocarrier changed expression of miR-155 and TGF-β1 towards faster healing of wounds.

Topics: Animals; Ascorbic Acid; Cell Movement; Cell Proliferation; Cells, Cultured; Disease Models, Animal; Down-Regulation; Fibroblasts; Humans; Mice; Mice, Inbred Strains; MicroRNAs; Nanoparticles; Random Allocation; Reference Values; Serum Albumin, Human; Skin; Wound Healing; Wounds and Injuries

The purpose of this study is to determine if antioxidant supplementation influences the incidence of atrial arrhythmias in trauma intensive care unit (ICU) patients.. In this retrospective pre-post study, critically ill injured patients aged ≥18 years, admitted to a single-center trauma ICU for ≥48 hours were eligible for inclusion. The control group consists of patients admitted from January 2000 to September 2005, before routine antioxidant supplementation in our ICU. The antioxidant group consists of patients admitted from October 2005 to June 2011 who received an antioxidant protocol for ≥48 hours. The primary outcome is the incidence of atrial arrhythmias in the first 2 weeks of hospitalization or before discharge.. Of the 4699 patients, 1622 patients were in the antioxidant group and 2414 patients were in the control group. Adjusted for age, sex, year, injury severity, past medical history, and medication administration, the unadjusted incidence of atrial arrhythmias was 3.02% in the antioxidant group versus 3.31% in the control group, with no adjusted difference in atrial arrhythmias among those exposed to antioxidants (odds ratio: 1.31 [95% confidence interval: 0.46, 3.75], P = 0.62). Although there was no change in overall mortality, the expected adjusted survival of patients in those without antioxidant therapy was lower (odds ratio: 0.65 [95% confidence interval: 0.43, 0.97], P = 0.04).. ICU antioxidant supplementation did not decrease the incidence of atrial arrhythmias, nor alter the time from admission to development of arrhythmia. A longer expected survival time was observed in the antioxidant group compared with the control group but without a change in overall mortality between groups.

Topics: Adult; Antioxidants; Arrhythmias, Cardiac; Ascorbic Acid; Critical Care; Critical Illness; Dietary Supplements; Female; Humans; Male; Middle Aged; Oxidative Stress; Retrospective Studies; Selenium; Trauma Centers; Vitamin D; Wounds and Injuries

This study sought to determine the effects of oral vitamin C (VitC) and mesenchymal stem cells (MSCs) on wound healing in diabetic nude mice.. Bilateral, full-skin thickness wounds were created as an in vivo wound model in BALB/C diabetic nude mice. The mice were separated into five groups: control (CON); diabetes mellitus (DM, from a streptozotocin injection); DM treated with MSCs (DM+MSCs); DM treated with VitC (DM+VitC), and DM treated with MSCs and VitC (DM+MSCs+VitC). After wounding, daily oral-feeding of high dose VitC (1.5g/l) was administered, and a single dose of MSCs (1x10. At day seven, the lowest rate of wound healing, in terms of percentage of wound closure, appeared in the DM group, as compared with the CON and all other treatment groups (mean percentage of wound closure and standard deviation), CON=75.94±7.09%; DM=55.65±9.59%; DM+MSCs=78.57±6.46%; DM+VitC=77.52±3.31%; and DM+MSCs+VitC=84.61±2.87%, p≤0.05. At day 14 post-wounding, the combination of oral high dose VitC and MSCs accelerated wound healing (91.44±3.19%, p≤0.05). In addition, the highest capillary density in DM+MSCs+VitC was obtained at 14 days post-wounding (29.49±7.30%, p≤0.05).. The findings of this study highlight the possibility of using oral high dose VitC in adjunct to MSCs to increase angiogenesis and accelerate diabetic wound healing in an animal model. This novel therapeutic approach should be studied further to test if it could be a useful adjunct of existing therapies to prevent infection and amputation in patients with diabetes.

Topics: Animals; Ascorbic Acid; Diabetes Mellitus, Experimental; Disease Models, Animal; Humans; Mesenchymal Stem Cell Transplantation; Mesenchymal Stem Cells; Mice; Mice, Inbred BALB C; Mice, Nude; Wound Healing; Wounds and Injuries

Antiseptics are widely used in wound management to prevent or treat wound infections due to their proven wound healing properties regardless of their cytotoxicity. The objective of this study was to determine the bactericidal effects of three antiseptics on pathogens known to cause wound infections.. The study was carried out at a tertiary care hospital and a university microbiology laboratory in Sri Lanka in 2013. The three acids (acetic acid, ascorbic acid and boric acid) in increasing concentration (0.5%, 0.75% and 1%) were tested against bacterial suspensions equivalent to 0.5 McFarland standard. The Bacteria isolates used were isolated from wound and standard strains of Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa.. There were 33 (68.8%) Coliforms, 10 (20.8%) Pseudomonas species, and 5 (10.4%) strains of Staphylococcus aureus. Acetic acid at concentration of 0.5% inhibited growth of 37 (77%) and 42 (87.5%) of tested isolates when exposed for 30 and 60 minutes, respectively. However 100% inhibition was achieved at four hours. At a concentration of 0.75%, 40 (83.3%) and 44 (91.7%) were inhibited when exposed for 30 and 60 minutes, respectively, with 100% inhibition at 4 hours. At concentration of 1%, 46 (95.8%) inhibition was seen at 30 minutes and 100% inhibition at 60 minutes. Ascorbic acid, at 0.5% and 0.75 % concentrations, inhibited growth of 45(93.7%) and 47(97.9%) of isolates respectively when exposed for 30 minutes. At these two concentrations, 100% inhibition was achieved when exposed for one hour. At 1% concentration, 100% inhibition was achieved at 30 minutes. Boric acid did not show bactericidal effect at concentrations of 0.5%, 0.75 % and 1%. Pseudomonas species were inhibited at 30 minutes by 0.5% acetic acid. Bactericidal effect against all the standard strains was seen with three acids at each concentration tested from 30 minutes onwards. Ascorbic acid was bactericidal for all organisms tested within the shortest exposure time at the lowest concentration compared to other two acids. Despite promising bactericidal effects, further studies warrant, as ongoing debates on toxicity of acids on tissue epithelialisation. Application of antiseptics for a shorter duration could overcome this problem without losing bactericidal activity.. The authors have no conflict of interest and no funding was received for this study.

Topics: Acetic Acid; Anti-Bacterial Agents; Anti-Infective Agents, Local; Ascorbic Acid; Bacteria; Bacteriological Techniques; Boric Acids; Enterobacteriaceae; Humans; Pseudomonas aeruginosa; Staphylococcus aureus; Wounds and Injuries

In the present study, tympanic membranes (TM) harvested from myringotomized rats were analyzed histopathologically to compare the systemic and local effects of ascorbic acid on the development of myringosclerosis.. Forty male Wistar-Albino rats weighing between 350-400 g were included in this study. Under otomicroscopic examination, a standard 2-mm myringotomy incision was made on the posteroinferior quadrant of the TM of both ears. Rats were randomized into five groups as control, topical ascorbic acid 50 mg/kg, systemic ascorbic acid 50, 100, and 200 mg/kg groups, each group containing eight rats. On the 15th day of the study, the rats were decapitated, and bullas of the rats were extracted. Sections were stained with hematoxylin-eosin and examined through light microscopy. Inflammation, distribution width of plaques, edema, and neovascularization were observed on the lamina propria. Thickness of the TM was evaluated under the microscope and scored semiquantitatively.. When intergroup comparisons of parameters related to total TM thickness were performed, differences between the control group and topical AA (ascorbic acid) or systemic treatment groups were found to be statistically significant (p<0.005). A statistically significant difference was detected among control, topical and systemic 200 mg/kg ascorbic acid groups for the edematous lamina propria (p=0.003 and p<0.05, respectively).. For the total TM thickness, systemic and topical ascorbic acid use was effective when compared with the control group. It has been concluded that systemic use of higher doses of (200 mg/kg) ascorbic acid is beneficial in the resolution of the edematous lamina propria.

Topics: Administration, Topical; Animals; Antioxidants; Ascorbic Acid; Disease Models, Animal; Dose-Response Relationship, Drug; Injections, Intraperitoneal; Male; Myringosclerosis; Rats; Rats, Wistar; Tympanic Membrane; Tympanic Membrane Perforation; Wounds and Injuries

Disorders in wound healing (DWH) are common in trauma patients, the reasons being not completely understood. Inadequate nutritional status may favor DWH, partly by means of oxidative stress. Reliable data, however, are lacking. This study should investigate the status of extracellular micronutrients in patients with DWH within routine setting.. Within a cross-sectional study, the plasma/serum status of several micronutrients (retinol, ascorbic acid, 25-hydroxycholecalciferol, α-tocopherol, β-carotene, selenium, and zinc) were determined in 44 trauma patients with DWH in addition to selected proteins (albumin, prealbumin, and C-reactive protein; CRP) and markers of pro-/antioxidant balance (antioxidant capacity, peroxides, and malondialdehyde). Values were compared to reference values to calculate the prevalence for biochemical deficiency. Correlations between CRP, albumin and prealbumin, and selected micronutrients were analyzed by Pearson's test. Statistical significance was set at P < 0.05.. Mean concentrations of ascorbic acid (23.1 ± 15.9 μmol/L), 25-hydroxycholecalciferol (46.2±30.6 nmol/L), β-carotene (0.6 ± 0.4 μmol/L), selenium (0.79±0.19 μmol/L), and prealbumin (24.8 ± 8.2 mg/dL) were relatively low. Most patients showed levels of ascorbic acid (<28 μmol/L; 64%), 25-hydroxycholecalciferol (<50 μmol/L; 59%), selenium (≤ 94 μmol/L; 71%) and β-carotene (<0.9 μmol/L; 86%) below the reference range. Albumin and prealbumin were in the lower normal range and CRP was mostly above the reference range. Plasma antioxidant capacity was decreased, whereas peroxides and malondialdehyde were increased compared to normal values. Inverse correlations were found between CRP and albumin (P < 0.05) and between CRP and prealbumin (P < 0.01). Retinol (P < 0.001), ascorbic acid (P < 0.01), zinc (P < 0.001), and selenium (P < 0.001) were negatively correlated with CRP.. Trauma patients with DWH frequently suffer from protein malnutrition and reduced plasma concentrations of several micronutrients probably due to inflammation, increased requirement, and oxidative burden. Thus, adequate nutritional measures are strongly recommended to trauma patients.

Topics: Adult; Aged; Aged, 80 and over; alpha-Tocopherol; Anthropometry; Antioxidants; Ascorbic Acid; beta Carotene; Biomarkers; C-Reactive Protein; Calcifediol; Cross-Sectional Studies; Female; Humans; Male; Malnutrition; Malondialdehyde; Micronutrients; Middle Aged; Nutritional Status; Oxidative Stress; Selenium; Vitamin A; Wound Healing; Wounds and Injuries; Zinc

We recently demonstrated a high-dose antioxidant (AO) protocol was associated with reduction in mortality. The purpose of this study was to evaluate the impact of AO on organ dysfunction and infectious complications following injury.. High-dose AO protocol: ascorbic acid 1000 mg q 8 h, alpha-tocopherol 1000 IU q 8 h, and selenium 200 mcg qd for 7-day course. Retrospective cohort study evaluating all patients admitted after protocol implementation (AO+), October 1, 2005 to September 30, 2006. Comparison cohort (AO-): all patients admitted in the year prior to implementation, October 1, 2004 to September 30, 2005.. 2272 patients included in the AO+ group, 2022 patients in the AO- group. Demographics and injury severity were similar. Abdominal compartment syndrome (ACS) (2.9% vs. 0.7%, <0.001), surgical site infections (2.7% vs. 1.3%, p=0.002), pulmonary failure (27.6% vs. 17.4%, p<0.001), and ventilator-dependent respiratory failure (10.8% vs. 7.1%, p<0.001) were significantly less in the AO+ group. Multivariate regression showed 53% odds reduction in abdominal wall complications and 38% odds reduction in respiratory failure in the AO+ group.. Implementation of a high-dose AO protocol was associated with a reduction in respiratory failure and ventilator-dependence. In addition, AO were associated with a marked decrease in abdominal wall complications, including ACS and surgical site infections.

Topics: Adult; Analysis of Variance; Antioxidants; Ascorbic Acid; Critical Illness; Dietary Supplements; Dose-Response Relationship, Drug; Female; Humans; Male; Retrospective Studies; Selenium; Survival Analysis; Treatment Outcome; Vitamin E; Wounds and Injuries

Lyophilized plasma (LP) is as safe and effective as fresh frozen plasma (FFP) for resuscitation after severe trauma.. Multicenter animal study.. Animal laboratories, 2 level I trauma centers.. Thirty-two Yorkshire crossbred swine.. Lyophilized plasma was analyzed for factor levels and clotting activity before lyophilization and after reconstitution. Swine were subjected to complex multiple trauma including extremity fracture, hemorrhage, severe liver injury, acidosis, and hypothermia. They were then resuscitated with FFP, LP, FFP and packed red blood cells (PRBCs) in a ratio of 1:1, or 1:1 LP and PRBCs.. Residual clotting activity of LP after reconstitution, swine mortality, hemodynamic measures, total blood loss, coagulation profiles, and inflammatory measures.. Lyophilization decreased clotting factor activity by an average of 14%. Survival and heart rate were similar between all groups. Swine resuscitated with LP had equivalent or higher mean arterial pressures. Swine treated with LP had similar coagulation profiles, plasma lactate levels, and postinjury blood loss compared with those treated with FFP. Swine treated with 1:1 FFP-PRBCs were similar to those treated with 1:1 LP-PRBCs. Resuscitation with LP resulted in a reduction in postresuscitation interleukin 6 expression compared with resuscitation with FFP.. The process of lyophilization and reconstitution of plasma reduces coagulation factor activity by 14%, without acute differences in blood loss. Lyophilized plasma can be used for resuscitation in a severe multiple trauma and hemorrhagic shock swine model with efficacy equal to that of FFP and with decreased interleukin 6 production.

Topics: Animals; Antioxidants; Ascorbic Acid; Disease Models, Animal; Disseminated Intravascular Coagulation; Fluid Therapy; Freeze Drying; Plasma; Plasma Substitutes; Resuscitation; Shock, Hemorrhagic; Swine; Wounds and Injuries

In addition to the known beneficial effects of ascorbic acid on wound healing and the immune response, it is also a potent extracellular antioxidant. Recent work in septic rats suggests that high-dose ascorbic acid total parenteral nutrition (TPN) supplementation may protect cells from free radical injury and improve survival. In this study, we determined ascorbic acid levels in the immediate post-injury/illness period and evaluated the ability of early short-term high levels of ascorbic acid in TPN to normalize plasma levels.. Ascorbic acid levels were determined in 12 critically injured patients and 2 patients with severe surgical infections. Each patient received TPN supplemented with increasing doses of ascorbic acid over a 6-day period. Therapeutic responses were determined by plasma and urine measurements using high-pressure liquid chromatography.. The initial mean +/- SEM baseline plasma ascorbic acid concentration was depressed (0.11 +/- 0.03 mg/dl) and unresponsive following 2 days on 300 mg/day supplementation (0.14 +/- 0.03; P = 1.0) and only approached low normal plasma levels following 2 days on 1000 mg/day (0.32 +/- 0.08; P = 0.36). A significant increase was noted following 2 days on 3000 mg/day (1.2 +/- 0.03; P = 0.005).. We confirmed extremely low plasma levels of ascorbic acid following trauma and infection. Maximal early repletion of this vitamin requires rapid pool filling early in the post-injury period using supraphysiologic doses for 3 or more days.

Topics: Adult; Antioxidants; Ascorbic Acid; Critical Illness; Female; Humans; Male; Middle Aged; Parenteral Nutrition, Total; Sepsis; Time Factors; Wounds and Injuries

Asiaticoside derived from the plant Centella asiatica is known to possess good wound healing activity. Enhanced healing activity has been attributed to increased collagen formation and angiogenesis. Since antioxidants have been reported to play a significant role in the wound healing process we studied the effect of asiaticoside on the levels of certain antioxidants in the wound so as to explore the possible involvement of such a mechanism in the asiaticoside induced wound healing. Asiaticoside application (0.2%, topical) twice daily for 7 days to excision-type cutaneous wounds in rats led to increased enzymatic and non-enzymatic antioxidants, namely superoxide dismutase (35%), catalase (67%), glutathione peroxidase (49%), vitamin E (77%) and ascorbic acid (36%) in newly formed tissues. It also resulted in a several fold decrease in lipid peroxide levels (69%) as measured in terms of thiobarbituric acid reactive substance. However, continued application for 14 days showed no significant difference in these antioxidants compared with their values in vehicle treated wound tissue. It appears from the present study that asiaticosides enhanced induction of antioxidant levels at an initial stage of healing which may be an important contributory factor in the healing properties of this substance.

Topics: Animals; Anti-Infective Agents; Antioxidants; Ascorbic Acid; Catalase; Glutathione; Glutathione Peroxidase; India; Male; Malondialdehyde; Plant Extracts; Plants, Medicinal; Rats; Rats, Sprague-Dawley; Superoxide Dismutase; Triterpenes; Vitamin E; Wound Healing; Wounds and Injuries

Topics: Animals; Ascorbic Acid; Lipid Peroxides; Male; Phagocytosis; Rats; Rats, Inbred Strains; Surgical Wound Infection; Time Factors; Wound Healing; Wounds and Injuries

Trauma and anaesthetics are responsible for local and general change in the organism. The characteristic changes in metabolism are caused by hormones. In addition, the increased glycogenolysis, gluconeogenesis, proteolysis and lipolysis are characteristic of this catabolic metabolism. Three groups (injured patients, patients with pulmonary disease, multiple trauma patients) showed an elevated lipid peroxidation as indicated by increased formation of TBA-reactive substances in the post-trauma or after surgery phase. The production of free radicals is supported by several stress factors. In this connection, the state of metabolism of the patients, several anaesthetics and the artificial respiration is very important. Enzymatic protecting systems (SOD, GSH-Px, Catalase) react to oxidative stress by positive adaptation. The non-enzymatic antioxidative systems (tocopherol, ascorbic acid, selen) are diminished, indicating an increased requirement.

Topics: Ascorbic Acid; Catalase; Glutathione Peroxidase; Humans; Lipid Peroxidation; Lung Neoplasms; Male; Malondialdehyde; Multiple Trauma; Postoperative Complications; Superoxide Dismutase; Vitamin E; Wounds and Injuries

Hydroxyproline and ascorbic acid were measured in wound tissues and ascorbic acid was determined in the blood sera of 230 mature male Wistar rats with aseptic and infected surface wounds on days 1-10 (daily), 12, and 15. The principal morphologic characteristics of the granulation tissue were assessed by semiquantitative methods. An infected wound is characterized by increased hydroxyproline levels in the granulation tissue and elevated ascorbic acid concentration in the blood serum. The granulation tissue ascorbic acid level augments during the first nine days in case of an aseptic wound and during twelve days in case of an infected wound. Morphologic and biochemical correlations are indicative of a relationship between the ascorbic acid level on the one hand and granulation tissue vascularization and fibroblast proliferation on the other.

Topics: Animals; Ascorbic Acid; Asepsis; Granulation Tissue; Hydroxyproline; Male; Rats; Rats, Inbred Strains; Wound Infection; Wounds and Injuries

A safe and effective method of improving repair and controlling infection of wounds is presented. It consists of debridement daily and application topically of a balanced solution of salts, amino acids, a high-molecular weight, D-glucose polysaccharide, and ascorbic acid. Wounds of several causes were treated, namely, second- and third-degree thermal burns, decubitus, varicose, and stasis ulcers, and diabetic lesions. Local infection was controlled early and the majority of the cases responded with quick formation of highly vascular, smooth, infection-free granulation tissue and centripetal epithelial growth. Small- and medium-sized lesions healed spontaneously in 4 to 8 weeks. Larger lesions were readily managed with autografts of skin as soon as satisfactory beds were obtained.

Topics: Administration, Topical; Adolescent; Adult; Aged; Amino Acids, Essential; Ascorbic Acid; Child; Child, Preschool; Female; Glucose; Humans; Infant; Infant, Newborn; Male; Middle Aged; Salts; Skin Ulcer; Solutions; Wound Healing; Wound Infection; Wounds and Injuries

Topics: Ascorbic Acid; Drug Stability; Humans; Ointments; Wounds and Injuries

Consideration of nine major factors predisposing to cerebral thrombosis, coronary thrombosis or thrombosis in the deep veins of the calf, reveals that these factors all have one thing in common. Estrogen administration, pregnancy, ageing, smoking, infection, trauma, surgery, soft water and winter season are all associated with a tendency towards decreased plasma ascorbic acid levels. Normally, ascorbic acid deficiency is thought of as causing a tendency towards hemorrhage rather than thrombosis, but it is here suggested that petechial hemorrhages under the endothelium of the blood vessels may precipitate thrombosis on the damaged endothelium. Is not blood coagulation the normal mechanism for the arrest of hemorrhage?

Topics: Age Factors; Ascorbic Acid; Cardiovascular Diseases; Communicable Diseases; Contraceptives, Oral; Female; Humans; Pregnancy; Seasons; Smoking; Surgical Procedures, Operative; Water Supply; Wounds and Injuries

Topics: Ascorbic Acid; Humans; Postoperative Care; Thiamine; Vitamin B Complex; Wounds and Injuries

Topics: Animals; Ascorbic Acid; Burns; Collagen; Granulation Tissue; Guinea Pigs; Male; Surgical Procedures, Operative; Time Factors; Wound Healing; Wounds and Injuries

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Female; Humans; Intestinal Obstruction; Leukocytes; Male; Wounds and Injuries

Topics: Ascorbic Acid; Atrophy; Body Temperature Regulation; Burns; Fractures, Bone; Glycosuria; Humans; Hyperglycemia; Muscle Proteins; Nutritional Physiological Phenomena; Proteins; Wounds and Injuries

Topics: Animals; Ascorbic Acid; Cell Differentiation; Collagen; Female; Granulation Tissue; Kidney; Male; Seasons; Skin; Skin Neoplasms; Urodela; Wound Healing; Wounds and Injuries

Topics: Animals; Ascorbic Acid; Extracellular Space; Hexosamines; Hyaluronic Acid; Inflammation; Osmolar Concentration; Potassium; Proteins; Sodium; Staphylococcal Infections; Uronic Acids; Wounds and Injuries

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Collagen; Connective Tissue; Connective Tissue Cells; Glycosaminoglycans; Granulation Tissue; Histamine Release; Iron; Ketoglutaric Acids; Microscopy, Electron; Thyrotropin; Thyroxine; Wound Healing; Wounds and Injuries

Topics: Adolescent; Adult; Ascorbic Acid; Biological Assay; Child; Drowning; Female; Humans; Hypothalamo-Hypophyseal System; Hypothalamus; Luteinizing Hormone; Male; Middle Aged; Neoplasms; Ovary; Pituitary Hormone-Releasing Hormones; Poisoning; Uremia; Vascular Diseases; Wounds and Injuries

Topics: Animals; Ascorbic Acid; Biopsy; Dimethyl Sulfoxide; Endoplasmic Reticulum; Fibroblasts; Rats; Ribosomes; Wound Healing; Wounds and Injuries

Topics: Adaptation, Physiological; Adrenal Glands; Adrenocorticotropic Hormone; Ascorbic Acid; Cholesterol; Cortisone; Hydrocortisone; Lymphocytes; Lymphopenia; Metabolism; Pharmacology; Rats; Research; Thymus Gland; Wounds and Injuries

Topics: Adolescent; Anesthesia; Anesthesiology; Ascorbic Acid; Atropine; Chlorpromazine; Diphenhydramine; Hibernation; Humans; Hypothermia, Induced; Piperidines; Scopolamine; Surgical Procedures, Operative; Thiamine; Uzbekistan; Wounds and Injuries

Topics: Ascorbic Acid; Carbohydrate Metabolism; Humans; Vitamins; Wounds and Injuries

Topics: Ascorbic Acid; Humans; Surgical Procedures, Operative; Wounds and Injuries

Topics: Animals; Ascorbic Acid; Guinea Pigs; Scurvy; Wounds and Injuries

Topics: Animals; Ascorbic Acid; Connective Tissue; Diet; Guinea Pigs; Vitamins; Wound Healing; Wounds and Injuries

Topics: Ascorbic Acid; Catalysis; Cicatrix; Flavonoids; Humans; Vitamins; Wounds and Injuries

Topics: Ascorbic Acid; Humans; Surgical Procedures, Operative; Wounds and Injuries

Topics: Ascorbic Acid; Humans; Wound Healing; Wounds and Injuries

Topics: Ascorbic Acid; Bone and Bones; Head; Humans; Skull; Thiamine; Vitamins; Wounds and Injuries

Topics: Ascorbic Acid; Carbohydrate Metabolism; Humans; Wounds and Injuries

Topics: Adrenocorticotropic Hormone; Ascorbic Acid; Humans; Vitamins; Wounds and Injuries

Topics: Ascorbic Acid; Brain; Brain Injuries; Flavonoids; Humans; Rutin; Vitamins; Wounds and Injuries

Topics: Adrenocorticotropic Hormone; Ascorbic Acid; Humans; Vitamins; Wounds and Injuries

Topics: Ascorbic Acid; Glycosaminoglycans; Guinea Pigs; Mast Cells; Polysaccharides; Scurvy; Skin; Skin Physiological Phenomena; Vitamins; Wound Healing; Wounds and Injuries

Topics: Ascorbic Acid; Cortisone; Humans; Vitamins; Wound Healing; Wounds and Injuries

Topics: Adrenocorticotropic Hormone; Animals; Ascorbic Acid; Cortisone; Guinea Pigs; Scurvy; Vitamins; Wound Healing; Wounds and Injuries

Topics: Ascorbic Acid; Glycosaminoglycans; Vitamins; Wound Healing; Wounds and Injuries

Topics: Adrenal Glands; Ascorbic Acid; Cholesterol; Wounds and Injuries

Topics: Ascorbic Acid; Deficiency Diseases; Hemorrhage; Humans; Infections; Metabolism; Niacin; Nicotinic Acids; Nutritional Sciences; Nutritional Status; Riboflavin; Thiamine; Vitamins; Wounds and Injuries

Topics: Ascorbic Acid; Carbohydrate Metabolism; Humans; Male; Wounds and Injuries