Time-to-survival from COVID-19 disease and its associated factors in Osun State, Nigeria.

Introduction This study focused on estimating the probability of survival and the specific time to survival from COVID-19 among patients who had COVID-19 in Osun state, Nigeria. Also, we examined some factors associated with the time to survival among COVID-19 patients in Osun state, Nigeria. Methods The retrospective data of 2596 records of COVID-19 patients in Osun state were analysed in this study. The outcome variable was the "COVID-19 treatment outcome (survived=1, dead=0)". The time date used in the survival analysis was treatment duration (in days). The explanatory variables were demographic characteristics, type of health facility, vaccination status, symptoms, and mode of admission. The descriptive statistics was computed and presented. Kaplan Meier was used to estimate the median time to survival. Bivariate analysis and multivariate analysis were done using the Log-Rank test and Cox regression, respectively. P values were set at P<0.05. Results The mean age was observed to be 40 (SD=17.51) years, ranging from mostly, 2 months to 98 years old. More (56.1%) of the participants were males. Most (99.5%) of them were Nigerians. Only 1.4% were vaccinated. The survival rate from COVID-19 was 98.1% in Osun State. The median time for survival was 14 (IQR= 14- 16) days. COVID-19 reduces as the number of days for being on treatment increases. Unvaccinated (HR=0.93, 95%CI: 0.43-2.03) and those whose vaccination status was unknown (HR=0.52, 95%CI: 0.37-0.74) were less likely to survive COVID-19 diseases. Conclusion The Survival rate was high, the observed median time to survival was 14 days, and the probability of survival reduces as the number of days of being on treatment for COVID-19 increases. Also, gender, vaccination, type of care, and ethnicity were associated with survival time. Similarly, unvaccinated and inpatients were less likely to rapidly survive COVID-19. This study recommends that the COVID-19 vaccine should be encouraged among patients who have the COVID-19 virus. Also, home care may be further explored to assess its effectiveness in caring for COVID-19 patients. In the same vein, COVID-19 data capturing, and databases need strengthening in Nigeria.

Loss-of-Function GRHL3 Variants Detected in African Patients with Isolated Cleft Palate.

In contrast to the progress that has been made toward understanding the genetic etiology of cleft lip with or without cleft palate, relatively little is known about the genetic etiology for cleft palate only (CPO). A common coding variant of grainyhead like transcription factor 3 ( GRHL3) was recently shown to be associated with risk for CPO in Europeans. Mutations in this gene were also reported in families with Van der Woude syndrome. To identify rare mutations in GRHL3 that might explain the missing heritability for CPO, we sequenced GRHL3 in cases of CPO from Africa. We recruited participants from Ghana, Ethiopia, and Nigeria. This cohort included case-parent trios, cases and other family members, as well as controls. We sequenced exons of this gene in DNA from a total of 134 nonsyndromic cases. When possible, we sequenced them in parents to identify de novo mutations. Five novel mutations were identified: 2 missense (c.497C>A; p.Pro166His and c.1229A>G; p.Asp410Gly), 1 splice site (c.1282A>C p.Ser428Arg), 1 frameshift (c.470delC; p.Gly158Alafster55), and 1 nonsense (c.1677C>A; p.Tyr559Ter). These mutations were absent from 270 sequenced controls and from all public exome and whole genome databases, including the 1000 Genomes database (which includes data from Africa). However, 4 of the 5 mutations were present in unaffected mothers, indicating that their penetrance is incomplete. Interestingly, 1 mutation damaged a predicted sumoylation site, and another disrupted a predicted CK1 phosphorylation site. Overexpression assays in zebrafish and reporter assays in vitro indicated that 4 variants were functionally null or hypomorphic, while 1 was dominant negative. This study provides evidence that, as in Caucasian populations, mutations in GRHL3 contribute to the risk of nonsyndromic CPO in the African population.

Paediatric burn epidemiology as a basis for developing a burn prevention program.

Burn injuries are often seen among the paediatric population. Mortality from burn injuries is high in developing countries. Poor facilities and poverty contribute to this. A look at the epidemiology of burn injuries among children from this part of the world will therefore serve as a means for developing programs for burn injury prevention. A retrospective review of burn injuries among the paediatric population was conducted. The aim was to outline common aetiologies, sex predisposition and sites of injury with a view to recommending possible ways of preventing these injuries. A total of 148 children sustained burn injuries during the period under study. There were 85 (57.4%) boys and 63 (42.6%) girls. Scald was the most common cause of injury, observed in 127 (85.8%) children, followed by flame burn in 18 (12.2%), chemical burn in 2 (1.4%), and friction burn in 1 (0.68%). Almost all of the injuries (144, 98%) occurred at home. Sources of heat were hot water, which caused injury in 109 (73.6%) children, and hot oil, hot soup and hot soya milk which were responsible for 7 (4.7%), 7 (4.7%) and 3 (2.0%) cases, respectively. Other sources were kerosene explosion (7, 4.7%), burning firewood (1, 0.6%) petrol explosion (5, 3.4%), candlelight (3, 2.0%), hot ashes (1, 0.6%), soot (1, 0.6%), burned house, chemicals and friction (1, 0.6%). Preventive methods are suggested based on aetiologies, and include education and certain precautions in the home environment. These will reduce burn injuries and associated morbidity and mortality in developing countries.

Les enfants sont une population particulièrement à risque de brûlure, grevées d'une mortalité élevée dans les pays en développement, à laquelle contribuent la pauvreté et des infrastructures défaillantes. L'étude de l'épidémiologie des brûlures dans ces pays a pour but de cibler les campagnes de prévention. Cette étude a été réalisée rétrospectivement, en recueillant les étiologies les plus fréquentes, le sexe et le site de l'accident chez 148 victimes. On comptait 85 garçons (57,4%) et 63 filles (42,6%). Un ébouillantement était observé 127 fois (85,8%), une brûlure par flamme 18 fois (12,2%), une brûlure chimique 2 fois (1,4%) et une dermabrasion 1 fois (0,68%). Presque toutes les brûlures étaient survenues au domicile (114, 98%). De l'eau chaude était en cause 109 fois (73,6%), d'autres liquides (huile 7/ 4,7%, soupe 7/ 4,7%, lait de soja 3/ 2%) 17 fois. On observait par ailleurs des explosions de kérosène (7,4%) ou de pétrole (3,4%), un feu de bois (0,6%), des bougies (2%), des braises (0,6%), de la suie, un incendie de maison (0,6% à chaque fois). Les mesures préventives suggérées comprennent l'éducation et l'adaptation de l'environnement domestique.

Association Studies and Direct DNA Sequencing Implicate Genetic Susceptibility Loci in the Etiology of Nonsyndromic Orofacial Clefts in Sub-Saharan African Populations.

Orofacial clefts (OFCs) are congenital dysmorphologies of the human face and oral cavity, with a global incidence of 1 per 700 live births. These anomalies exhibit a multifactorial pattern of inheritance, with genetic and environmental factors both playing crucial roles. Many loci have been implicated in the etiology of nonsyndromic cleft lip with or without cleft palate (NSCL/P) in populations of Asian and European ancestries, through genome-wide association studies and candidate gene studies. However, few populations of African descent have been studied to date. Here, the authors show evidence of an association of some loci with NSCL/P and nonsyndromic cleft palate only (NSCPO) in cohorts from Africa (Ghana, Ethiopia, and Nigeria). The authors genotyped 48 single-nucleotide polymorphisms that were selected from previous genome-wide association studies and candidate gene studies. These markers were successfully genotyped on 701 NSCL/P and 163 NSCPO cases, 1,070 unaffected relatives, and 1,078 unrelated controls. The authors also directly sequenced 7 genes in 184 nonsyndromic OFC (NSOFC) cases and 96 controls from Ghana. Population-specific associations were observed in the case-control analyses of the subpopulations, with West African subpopulations (Ghana and Nigeria) showing a similar pattern of associations. In meta-analyses of the case-control cohort, PAX7 (rs742071, P = 5.10 × 10(-3)), 8q24 (rs987525, P = 1.22 × 10(-3)), and VAX1 (rs7078160, P = 0.04) were nominally associated with NSCL/P, and MSX1 (rs115200552, P = 0.01), TULP4 (rs651333, P = 0.04), CRISPLD2 (rs4783099, P = 0.02), and NOG1 (rs17760296, P = 0.04) were nominally associated with NSCPO. Moreover, 7 loci exhibited evidence of threshold overtransmission in NSOFC cases through the transmission disequilibrium test and through analyses of the family-based association for disease traits. Through DNA sequencing, the authors also identified 2 novel, rare, potentially pathogenic variants (p.Asn323Asp and p.Lys426IlefsTer6) in ARHGAP29 In conclusion, the authors have shown evidence for the association of many loci with NSCL/P and NSCPO. To the best of this knowledge, this study is the first to demonstrate any of these association signals in any African population.

Total Reconstruction of the Upper Lip Using Bilateral Nasolabial Flaps, Submental Flap, and Mucosa Graft following Complete Resection for Squamous Cell Carcinoma.

Lip reconstruction following resection for tumour or following extensive trauma may pose a challenge. This is more so when the resection is total and a complete lip has to be constructed. We present a case of lip reconstruction following a total resection of the upper lip. The procedure used in this case was a combination of bilateral nasolabial flaps with a submental flap and buccal mucosal graft lining. We believe that this provides an alternative method of total upper lip reconstruction with minimal disruption of the facial aesthesis.

Knowledge, attitude and practice of perioperative antibiotic prophylaxis among nurse-anaesthetists in Nigeria.

BACKGROUND: In Nigeria, nurse-anaesthetists are responsible for administering perioperative prophylactic antibiotics in a large number of operations but this practice is poorly studied. AIMS: The aim of this study was to evaluate the knowledge, attitude and practice of perioperative antibiotic prophylaxis among nurse-anaesthetists in Nigeria. METHODS: A cross-sectional study was conducted among nurse-anaesthetists at an Annual General Meeting/Scientific Conference of Nigeria Association of Nurse-Anaesthetists, using a pre-tested questionnaire. RESULTS: Of 70 questionnaires. 67 were returned. Antibiotic administration at induction of anaesthesia was considered inappropriate by 79.1% (n = 67) and safe by 42.6% (n = 61). There was poor knowledge of indications for intraoperative administration. There was agreement by 81.9% of respondents that anaesthetists should administer prophylactic antibiotics (n = 66) but 72.2% would want the surgeon to indicate the time of administration (n = 60). About 69.3% and 77.2% of respondents administered prophylactic antibiotics before tourniquet application (n = 62) and skin incision (n = 66) respectively in their practice but the latter finding was not corroborated by internal validity check. Availability of a hospital perioperative antibiotic prophylaxis protocol (p = 0.048) and practice for 10 or more years (p = 0.009) were associated with higher knowledge score. CONCLUSION: Inclusion of lectures on perioperative antibiotic prophylaxis in nurse-anaesthesia training curriculum, having hospital perioperative antibiotic prophylaxis protocol, stating in the protocols that surgeons give instructions on timing of antibiotic administration and ensuring adherence to the protocols may improve knowledge and practice of perioperative antibiotic prophylaxis among nurse-anaesthetists.

Accidental Peno-Scrotal Degloving Injuries in a Child. A Case Report and Literature Review.

Injury to male external genitalia is very rare because of some intrinsic factors like location, strong investing tunica albuginea and cremasteric muscles. However, when it occurs it is considered a urological emergency. Child labour with poor understanding of risks and safety precautions, especially under harsh supervision, surely poses major challenges. This case illustrates degloving injury of the penis and avulsion of the scrotum in a young boy while operating a roller type machine used in palm trees plantation. The penis was primarily regloved and avulsed skin primarily repaired. A good cosmetic outcome was observed from this treatment. This case also illustrates the importance of early presentation and emergency intervention in this condition.

Sharp injuries among hospital waste handlers.

BACKGROUND: Health care workers are generally predisposed to injuries from sharps as a health hazard. This is more pronounced among waste handlers. OBJECTIVE: It is therefore important to assess these injuries among this group of people with a view to identifying the risk factors and suggesting preventive methods. METHODS: Questionnaires were administered to People handling wastes in our hospital to assess their level of education on injury prevention, immunization status and preventive methods used by them to prevent these injuries and subsequent infections. RESULTS: Forty three waste handlers were interviewed. Twenty eight (65.8%) of them received training before commencing on the job while 14 (32.5%) never received any training. Only thirty nine (90.7%) of them always use hand gloves before carrying wastes. Only three (7.0%) of the respondents have been screened for Hepatitis B, 19 (44.2%) for HIV, while 10 (23.3%) were screened for Hepatitis B, C, and HIV. Eleven (25.6%) of them have been injured with sharps. The finger was the most injured in 7 (93%) of them. CONCLUSION: Training and re-training of health workers is important and should be encouraged. All health workers should have pre-employment immunization against Hepatitis B, C as well as other before commencing on their jobs. Workers should be screened for infective diseases that can be of legal problem while at the job and the workers should be effectively immunized.

Accidental tear gas injuries in security agents.

BACKGROUND: Tear gas is a noxious vapour used in quelling civil disturbances. The law enforcement agents who usually handle this are well trained and rarely injured by the use of this weapon especially during peace times. METHODS: We report injuries sustained by two policemen handling tear gas as a result of accidents. Case notes of the patients were the source of information. RESULTS: Two policemen were injured while handling tear gas. The equipment accidentally dropped and exploded on attempting to pick them. The mechanisms of injuries and parts of the body injured were similar ie the hands and face with traumatic cataract of an eye in one patient. CONCLUSION: We conclude that proper training of the law enforcement agents will go a long way in reducing these types of morbidity from tear gas use.

Examination malpractice in our medical schools: prevalence and import on tomorrow's doctors.

UNLABELLED: AIMS AND OBJECTIVES. The objective of this paper is to estimate the prevalence of examination malpractice among medical students; its import on medical education and future doctors. MATERIALS AND METHODS: Structured questionnaires were administered to consenting medical students of participating four medical colleges in Nigeria. Data was collated and analysed using SPSS version 11. RESULTS: Three hundred and eighty two students responded. There were 210 males and 172 females (M: F-1.2:1); age range 19-45 years, mean 24.86 ± SD. Majority 304(79.6%) were in the 5th and final years. At secondary and tertiary levels, 67(18.1%) and 79(22.2%) were respectively involved in cheating. Mode of cheating included seeking examination materials, 10(2.6%); copying answers between examination rooms, 18(4.8%); copying assignments, 290(77.7%) and copying laboratory results 206(56.6%). Clinical examinations not performed were described as "normal" by 206(56.6%). Motivation for cheating included previous failures and escape punishment in 6(3.3%) and 31(10.4%) respectively. While 46(12.8%) tried to induce lecturers to change grades, 97(25.8%) would not inform the authority if they suspected that examination leaked. CONCLUSION: Examination malpractice in High schools and Tertiary institutions also includes the medical students. Educating pupils from the elementary schools on effects of cheating, inclusion of this practice in the medical curriculum as part of Medical Ethics and Institutional culture of Integrity among doctors are recommended. Stiffer punishment for offenders would reduce the practice among the students.

Genetic studies in the Nigerian population implicate an MSX1 mutation in complex oral facial clefting disorders.

BACKGROUND: Orofacial clefts are the most common malformations of the head and neck, with a worldwide prevalence of 1 in 700 births. They are commonly divided into CL(P) and CP based on anatomic, genetic, and embryologic findings. A Nigerian craniofacial anomalies study (NigeriaCRAN) was set up in 2006 to investigate the role of gene-environment interaction in the origin of orofacial clefts in Nigeria. SUBJECTS AND METHODS: DNA isolated from saliva from Nigerian probands was used for genotype association studies and direct sequencing of cleft candidate genes: MSX1 , IRF6 , FOXE1, FGFR1 , FGFR2 , BMP4 , MAFB, ABCA4 , PAX7, and VAX1 , and the chromosome 8q region. RESULTS: A missense mutation A34G in MSX1 was observed in nine cases and four HapMap controls. No other apparent causative variations were identified. Deviation from Hardy Weinberg equilibrium (HWE) was observed in these cases (p = .00002). A significant difference was noted between the affected side for unilateral CL (p = .03) and bilateral clefts and between clefts on either side (p = .02). A significant gender difference was also observed for CP (p = .008). CONCLUSIONS: Replication of a mutation previously implicated in other populations suggests a role for the MSX1 A34G variant in the development of CL(P).

DONOR SITE MORBIDITY FOLLOWING HARVEST OF SPLIT-THICKNESS SKIN GRAFTS IN SOUTH EASTERN NIGERIA.

BACKGROUND: Split-thickness skin grafting is a very common procedure. Few documentation of its complications exist in the literatures especially in our sub-region where excessive scarring is a major issue. OBJECTIVE: The objective of the study was to document the common complications observed at the donor site for split thickness skin grafts. METHODS: This is a prospective study carried out at the National Orthopaedic Hospital, Enugu, Nigeria over a six month period. All patients with wounds requiring split-thickness skin grafts, who gave consent, were recruited. An observer administered questionnaire was opened for each patient. Any donor site complication was noted on inspection and documented. Analysis of the results was done using SPSS with frequencies, mean and test of significance. RESULTS: A total of 120 patients were recruited for the study. Males accounted for 59.2% of the patients while females made up 40.8%. Donor site complications noted were pain which was exaggerated after 24 hours, itching, infection, dyschromia, hypo-pigmentation, hyper-pigmentation, and hypertrophic scars. At 1 month post-operative period, dyschromia was the commonest complication (39.2%), followed by itching (22.5%), hypo-pigmentation (19.2%), infection (17.5%), and exaggerated pain (1.7%). However, by 3 months, hyper-pigmentation was most common (55.4%), followed by dyschromia (37.5%), hypertrophic scar (3.6%) and itching (3.6%). Whereas by 6 months most patients had hyper-pigmentation (96.0%) while 4.0% had hypertrophic scars. The exaggerated pain was treated successfully with analgesics and was no longer present in any patient after the first month. While infection was also treated successfully following wound swab culture and sensitivity, appropriate antibiotic therapy and local wound care. Pigmentation changes were in keeping with previous studies as hyper-pigmentation was an invariable event following healing of a partial thickness wound. CONCLUSION: Donor site morbidity can be a big problem especially with regard to infection which increases duration of admission and therefore cost of management.

Keloids: assessment of effects and psychosocial-impacts on subjects in a black African population.

BACKGROUND: Keloids are vexatious swelling on the skin or the conjuctiva. The effects and impacts of these lesions have not been assessed in a keloid endemic environment like Nigeria. AIMS: The purpose of this study is to assess the psychosocial impact as well as effects of keloids on the subjects in a black African population where lesions are commonly seen. METHODS: This is a prospective study which assesses the impacts of keloid on keloid patients. Consented patients who presented to the Plastic Surgery Clinic of the Lautech Teaching Hospital, Osogbo, Nigeria were recruited into the study. A set of questionnaires were administered to all consented patients. The administered questionnaires were analyzed using SPSS version 10. RESULTS: One hundred and thirty one patients were involved in this study. They comprised of 61 males and 70 females. Most (96.8%) of them had the keloid lesion for more than one year. Sixteen (12.2%) of the patients felt that keloids negatively affect their works, 64 (48.9%) of the patients felt stigmatized by keloids, 28 (56.0%) of them who had lesions in conspicuous parts while 24 (46.2%) had lesions in non-conspicuous parts. Females (59.1%) felt stigmatized than males. Only 47 (35.8%) of the patients believed that keloid swelling limit their social interaction. CONCLUSION: Keloids do not appear to have significant negative impacts on keloid patients in a keloid-endemic community like a black African population.

Cleft lip and palate repair: the experience from two West African sub-regional centres.

Compliance with primary surgical treatment in people with cleft lip and palate is a well-known problem, especially in developing countries fraught with poverty and ignorance. Different protocols of treatment exist. In this paper, we retrospectively review a cohort from two centres, with a discussion on the outcome and its implications. The records of all patients with cleft lip and palate seen in the National Orthopaedic Hospital, Enugu, Nigeria, from January 1993 to December 1999, were sought, and all available case notes reviewed retrospectively. This included new cases seen in the period, and also cases operated during this period. Follow up took place until January 2005, when the data were collated. The records of all such patients seen at Ladoke Akintola University Teaching Hospital Osogbo, Nigeria, from September 2004 to June 2006 were also collated and analysed. During this period, 102 patients were seen (93 at Enugu and nine at Osogbo). Fifteen had isolated cleft palate, 42 had isolated cleft lip and 45 had combined cleft lip and palate. Presentation time ranged from 1 day to 43 years. The palate was not repaired in 20 people after lip repair; two patients with cleft lip and palate completely defaulted; and only one person with isolated cleft palate failed to undergo surgery in this period. Two patients in Osogbo absconded. The West African sub-region has a high drop out rate after lip repair.

Informed consent in a tertiary hospital in Nigeria: how involved is the nurse?

INTRODUCTION: We reviewed the nurse's involvement and role perception on informed consent in LAUTECH Teaching Hospital, Osogbo, Osun State, Nigeria OBJECTIVES: The study aimed at determining the nurses' knowledge, attitude and perception of role in informed consent and the level of participation in the procedure. METHODS: A descriptive cross sectional study of the nurses in the medical and surgical units of LAUTECH Teaching Hospital was carried out using semi structured questionnaire. RESULTS: Sixty five nurses participated in the study. A high proportion - 60 (92.3%) had heard of informed consent but only 26(40%) had correct and adequate knowledge of informed consent. Forty (61.5%) had participated as witnesses to the procedure of seeking informed consent. Participation was only sometimes in 38 (58.5%) of respondents. Forty seven (86.2%) nurses wanted nurses to be involved in obtaining informed consent because it improves quality of patient care while 38(58.5%) nurses believed that involvement of nurses should be because it is the nurses' statutory responsibility. CONCLUSION: It would appear that the knowledge of informed consent among nurses was inadequate and nurses were not adequately carried along in the process. Training of nurses in this important procedure would greatly enhance the quality of patient care.

Burn injuries in a young nigerian teaching hospital.

A total of 36 patients were seen and managed at the Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria, over a period of five years (2000 to 2004). There were 28 males and 8 females (male to female ratio, 3.5:1). The ages ranged from 1 to 46 yr (mean, 14.5 yr). The burn surface area percentage ranged between 2.5 and 70% (mean, 22.9%). Flame constituted the commonest source of injury (66.7%). Other agents were scalding (9 patients = 25%) and electrical burns (3 patients = 8.3%). The sources of flame burns were kerosene lantern/stove explosion (7 patients = 29.2%); petrol explosion (7 patients = 29.2%); road accidents followed by an explosion (3 patients = 12.5%); one case each (4.2%%) involving ethanol explosion, gun powder explosion, firewood, a lighted candle that ignited furniture and then a whole house; and other unexplained sources (3 patients = 12.5%). Mortality in this study was 7 cases (19.4%). Death was due to acute respiratory distress syndrome in one patient, sepsis in five, and tetanus infection in one. We conclude that most of the injuries were preventable. Education regarding refuelling a lighted lantern/stove, discouraging the storing of petrol in the house, and driving with care will reduce the number of accidents and subsequent possible burn injuries. Children should be monitored carefully to prevent scalding from hot water and food.

Marjolin's Ulcers on the Thigh two Years after Burn.

An 18-yr-old female patient presented to our unit two years after she had sustained a flame burn, with a three-month history of a right thigh scar ulcer. The ulcer had rapidly progressed with involvement of the sciatic nerve and infiltration of the right femur. Biopsy of the ulcer revealed squamous cell carcinoma. The patient however died shortly after admission from an overwhelming sepsis. The rarity of early onset of Marjolin's ulcer and the rapidity of fatality in this case constitute the reasons for presenting this report.

Honey : a Reservoir for Microorganisms and an Inhibitory Agent for Microbes

Background: Honey is an ancient remedy for the treatment of infected wounds; which has recently been 'rediscovered' by the medical profession.The use to which honey is put in medical care is increasing daily with many authors pointing out its importance and role in wound care.There have been reports that honey contains many microorganisms including bacteria and fungi. Objective:The aim of this paper is to highlight the various uses; organisms commonly found in honey; how the organisms arrived in the honey and their effects on wounds and wound care.Would the presence of these organisms not constitute a limiting factor to the use of honey in wound management? This is what this review aims to answer Methods:A literature search was done on honey using pubmed; google; local books and journals. Relevant journals were extracted and discussed with emphasis on the antimicrobial properties as well as microbial content of honey and the implications of these. Results:The production of honey as well as the storing process account for the presence of microorganisims. Most of these organisms are said to be in inactive forms as they can hardly survive in honey because of its several properties including hygroscopicity; hyperosmolarity; acidity; peroxide content; antibiotic activities etc. However there is a need for caution in the use of honey in wound management. Con- clusion: We suggest that wounds to be treated with honey should be investigated i.e with a swab for the microorganisms present on the wound and their sensitivity to the honey before commencing honey treatment.This will help in carefully selecting wounds that might do well with honey treatment not withstanding other properties of honey that aid wound healing