Development and application of hydroxyapatite-based scaffolds for bone tissue regeneration: A systematic literature review.

Hydroxyapatite [HA, Ca10(PO4)6(OH)2], with its robust biocompatibility and bioactivity, has found extensive utility in bone grafting, replacement therapies, and supplemental medical materials. HA is highly regarded for its osteoconductive properties because it boasts hydrophilicity, nontoxicity, non-allergenicity, and non-mutagenicity. Nevertheless, HA's intrinsic mechanical weakness has spurred efforts to enhance its properties. This enhancement is achieved through ion incorporation, with elements such as magnesium, zinc, lithium, strontium, boron, and others being integrated into the HA structure. In the domain of orthopedics, HA-based scaffolds have emerged as a solution for addressing prevalent issues like bone deformities and defects stemming from congenital anomalies, injuries, trauma, infections, or tumors. The fabrication of three-dimensional scaffolds (3D scaffolds) has enabled advancements in bone regeneration and replacement, with a focus on practical applications such as repairing calvarial, skull, and femoral defects. In vitro and in vivo assessments have substantiated the effectiveness of 3D scaffolds for bone defect repair, regeneration, and tissue engineering. Beyond bone-related applications, scaffolds demonstrate versatility in enhancing cartilage healing and serving as bioimplants. The wide array of scaffold applications underscores their ongoing potential for further development in the realm of medical science.

Correlation of serum interleukin-6 levels and neutrophil-lymphocyte ratio in the severity of COVID-19.

Background: Interleukin-6 (IL-6) is a pro-inflammatory cytokine that is produced at varying levels in patients with coronavirus disease 2019 (COVID-19). The neutrophil-lymphocyte ratio (NLR) is one of the new inflammatory markers of COVID-19. This study aimed to evaluate the differences in IL-6 level and the NLR in mild and severe COVID-19 and assess their correlation with COVID-19 severity and the correlation of IL-6 and NLR in COVID-19. Methods: A total of 91 patients with COVID-19 were divided into mild (n = 57) and severe (n = 34) COVID-19 groups. IL-6 levels were measured using the electrochemiluminescence immunoassay method on Roche Cobas e411. The NLR was the ratio of the total neutrophil and lymphocyte counts from complete haematology on the Sysmex XS-800i. Data were analysed using the Kolmogorov-Smirnov, Mann-Whitney, receiver operating characteristic curve, chi-square and Spearman correlation tests. The statistical test was significant at p <0.05. Results: Serum IL-6 levels and NLR significantly differed in mild and severe COVID-19. The median (min-max) IL-6 levels for mild and severe COVID-19 were 3.59 (1.50-638.30) pg/mL and 28.82 (5.52-926.30) pg/mL, respectively (p <0.001). The median (min-max) NLR in mild and moderate COVID-19 was 2.18 (0.69-15.58) and 8.13 (2.24-30.90), respectively (p <0.001). The obtained cut-off values for IL-6 and NLR were >6.99 pg/mL and >4.18, with odds ratios of 29.29 and 26.19, respectively. A positive correlation was found between IL-6 and NLR and COVID-19 severity (r = 0.612; p <0.001). Conclusions: The results indicated that serum IL-6 levels and NLR are higher in severe COVID-19 than in mild COVID-19. Patients with IL-6 levels >6.99 pg/mL and NLR >4.18 are 29 and 26 times more likely to suffer from severe COVID-19, respectively. Serum IL-6 levels and NLR are strongly correlated with COVID-19 severity. Serum IL-6 levels correlate with NLR in COVID-19.

Novel Complex of Zinc (II) Dichloroethylenediamine: Synthesis, Characterization, In-silico, and In-vitro Evaluation against Cervical Cancer Cells.

OBJECTIVE: Cervical cancer is a malignancy originating from the cervix and often caused by oncogenic Human Papilloma Virus (HPV), specifically subtypes 16 and 18. Anticancer drugs are chemotherapeutic compounds used for cancer treatment. Therefore, this research aims to synthesize and characterize Zinc (II) dichloroethylenediamine (Zn(en)Cl2) complex, as well as determine its antiproliferative activity against HeLa cells. The Zn(en)Cl2 complex was successfully synthesized, and the antiproliferative activity was tested. METHODS: The synthesis involved reacting ethylenediamine and KCl with Zn metal. The complex formed was characterized using a conductometer, UV-Vis spectroscopy, FT-IR spectroscopy, and XRD, while the activity was measured against HeLa cells. RESULT: The synthesis yielded a 56.12% conversion with a melting point of 198-200 oC and a conductivity value of 2.02 mS/cm. The Zn(en)Cl2 complex showed potential activity against HeLa cells with an IC50 value of 898.35 µg/mL, which was evidenced by changes in the morphological structure of HeLa cells. Its interaction with DNA targets was investigated by employing molecular docking. CONCLUSION: The observed data indicated that the Zn(en)Cl2 complex bound to DNA at the nitrogenous base Guanine (DG) by coordinate covalent bonds. Interestingly, DG maintained interaction with the complex until the end of the docking simulation. Additionally, molecular dynamics (MD) simulation was conducted, and the results showed that Zn(en)Cl2 remained bound to the DNA binding pocket all through the process.

The positive effects and mechanisms of honey against breast cancer.

BACKGROUND: Breast cancer is a malignancy that occurs in cells in the breast tissue where cells in the breast divide and grow out of control, invade surrounding tissues, or spread (metastasize) to distant areas of the body. METHOD: This review was systematically carried out through PubMed, Scopus, ScienceDirect, and Google Scholar websites in English and Indonesian using the keyword content of the article, obtaining 21 selected articles. This review demonstrates honey's promising mechanism of combined synergistic effect for breast cancer management. CONCLUSION: Antioxidants in honey intercept free radicals of phenolic compounds which are the main factors responsible for the antioxidant activity of honey. The antimicrobial activity in most honey is due to the enzymatic production of hydrogen peroxide, and its anti-cancer properties are discussed in this section.

Ginger potency on the prevention and treatment of breast cancer.

BACKGROUND: Cancer is a type of disease caused by the uncontrolled growth of abnormal cells that can destroy body tissues. The use of traditional medicine naturally uses plants from ginger with the maceration method. The ginger plant is a herbaceous flowering plant with the Zingiberaceacea group. METHODS: This study uses the literature review method by reviewing 50 articles from journals and databases. RESULTS: A review of several articles, namely ginger has bioactive components such as gingerol. Ginger is used as a treatment in complementary therapies using plants. Ginger is a strategy with many benefits and functions as a nutritional complement to the body. This benefit has shown the effect of anti-inflammatory, antioxidant, and anticancer against nausea and vomiting due to chemotherapy in breast cancer. CONCLUSION: Anticancer in ginger is shown by polyphenols associated with anti-metastatic, anti-proliferative, antiangiogenic, anti-inflammatory, cell cycle arrest, apoptosis, and autophagy. Therefore, consuming ginger regularly affects natural herbal therapy with the prevention and treatment of breast cancer and serves as a prevention against the effects of chemotherapy.

FOXP3 regulatory T cells on prognosis of breast cancer.

BACKGROUND: FOXP3 Tregs have been found in breast cancer patients, both humoral and tumor. Survival or prognosis of breast cancer patients seems to correlate with the increase and decrease in FOXP3 Treg. OBJECTIVES: This review aims to provide insights regarding the FOXP3 Tregs involved and their mechanisms in breast cancer prognosis. METHODS: The literature study method is used from primary and secondary libraries. The library search used online-based search instruments such as NCBI-PubMed, Google Scholar, and Elsevier. The data obtained were then arranged according to the framework, data on the relationship between FOXP3 Regulatory T Cells and breast cancer, and writing a journal review was carried out according to the given format. Regulators (Tregs) can inhibit anti-tumor immunity and promote tumor growth. Tregs also play a role in inhibiting cytotoxic T lymphocyte cells by inhibiting the release of granules from CD8+, where CD8+ is important in killing tumor cells. FOXP3 is a Treg-specific biomarker and plays an important role in the development and function of Tregs. RESULTS: Studies on the presence of FOXP3+ Tregs in tumors have shown controversial results. Studies in some tumors reported the presence of FOXP3+, indicating a poor prognosis, whereas studies in other tumors found that FOXP3+ correlated with a good prognosis. CONCLUSION: Regulatory T lymphocytes and TILs in invasive breast carcinoma are still not established. Therefore, further research on the Effect of FOXP3 expression of regulatory T lymphocytes on breast cancer is still important.

Study of risk factors and marker status in women with breast cancer in Brunei Darussalam.

OBJECTIVE: To investigate the associations between breast cancer staging and body mass index (BMI), menopausal status, and family history of breast cancer, as well as to assess the expression of tumor markers in women with breast cancer in Brunei Darussalam. METHODS: A retrospective cross-sectional study was carried out at The Brunei Cancer Centre. Cases of women with breast cancer between 2000 and 2013 were retrieved from the medical records section and entered into a clinical proforma. These were reviewed and analyzed using appropriate statistical methods. RESULTS: Overall, the mean age at diagnosis was 53.6 years ± 9.83. The postmenopausal women had a significantly higher risk of being diagnosed with late-onset breast cancer than premenopausal women (P = 0.022). The expressions of PR (P = 0.034), Her2 (P = 0.046), and CatD (P = 0.004) were significantly different in breast cancer staging. Other factors did not have a statistically-significant association with breast cancer staging. CONCLUSION: While most of the factors studied were not significantly different in breast cancer staging, our findings showed that it is recommended that high-risk women perform regular breast screening after the age of 40 years old. A future study highly appreciates comparing breast cancer risk factors among the Bruneian and Western populations.

The new potential application for Mg(II) cysteinedithiocarbamate complex with anticancer activity.

OBJECTIVE: The new Mg(II) cysteindithiocarbamate complex drug has been synthesized by the in-situ method and tested for its anticancer activity in vitro. METHOD: Mg(II) cysteindithiocarbamate complexes were characterized using Ultra Violet Visible, Infra-Red, melting points, and molar conductivity. RESULTS: The UV-Vis data of cysteindithiocarbamate Mg(II), shows that at 296 nm and 385 nm was occurred the electronic transitions π → π* and n → π* for CS2 and N =C =S. Whereas the IR data at wavelengths in the 393-540 cm-1 shows that there has coordinated between Mg(II) with Sulfur (S), Nitrogen (N), and Oxygen (O) atoms from cysteinedithiocarbamate ligands. CONCLUSION: The cytotoxicity test results showed that the Mg complex's cytotoxicity was higher than that of the cytotoxicity of the Mg metal without ligands, which means that the Mg complex can be developed as a potential new anticancer drug.

Effectiveness of turmeric (Curcuma Longa Linn) Gel Extract (GE) on wound healing: Pre-clinical test.

OBJECTIVE: This research was basic research to identify the effect of turmeric extract tested by the in vivo method. The purpose of this study was to identify differences in the length of the wound at each concentration of gel preparations on days 3, 7, and 14, as well as differences in wound healing time at each concentration of gel preparations and, identify the most effective gel preparations for wound healing. METHOD: This study is an experimental laboratory study with experimental animals using post-test only with control groups, the type of research used is a pre-clinical test (pre-clinical trial) on female rabbits. The sample size in this study was 12 rabbits grouped randomly. The length of each group's wounds was measured and observed on days 3, 7, and 14. Gel application was carried out twice a day in the morning and evening for 14 days. In this study, the experimental data were tested using Kruskal Wallis. RESULTS: There were differences in wound length in each group treated with turmeric extract gel and base gel. Based on the mean wound length of each group, they experienced a reduction in wound length on days 3, 7, and 14. There were also differences in wound healing time in each group. In each group, wherein this case, the treatment group that was given 5% turmeric extract gel experienced a faster healing time <14 days than the other groups. CONCLUSION: In general, turmeric extract gel at each concentration is effective against wound healing. Turmeric extract gel concentration is the most effective gel with a concentration of 5%, then followed by concentrations of 10% and 15%.

The effectiveness of 7% table salt concentration test to increase collagen in the healing process of wound.

OBJECTIVE: Table salt (sodium chloride) is an ionic compound consisting of positive ions (cations) and negative ions (anions) to form neutral compounds that can provide a healing effect on wounds. This study's purpose of seeing and test the impact of soaking 7% sodium chloride concentration on people's salt toward the wound healing process. METHOD: This study was an experimental laboratory using the One-Way ANOVA test and the Mann Whitney test conducted in the animal enclosure of the Faculty of Pharmacy, Hasanuddin University, Makassar. The study was conducted from July to August 2019. Samples of 20 mice (Mus Musculus) female swiss webster strains were sliced on the abdominal skin then divided into two groups: the treatment group (n=15) and the control group (n=5). The wound area was observed from the first day to the seventh day to see the wound closure process. RESULTS: The research shows that soaking 7% of table salt concentration can significantly accelerate the wound healing process compared to the control group, with a decrease in wound diameter on the 3rd day and completely heal on the 7th day. CONCLUSION: 7% concentration of table Salt Soaking can increase the effectiveness of wound healing.

Biscuits containing Moringa oleifera leaves flour improve conditions of anemia in pregnant women.

OBJECTIVE: This study analyzes whether anemia in pregnant women improves with indicators of increased hemoglobin, intake of iron and zinc when intervened with biscuits contain Moringa oleifera leaf flour. METHOD: It was Quasy experiment carried out at Antang, Mamajang and Batua Public Health Center in Makassar, South Sulawesi, Indonesia. The subject were the pregnant women of Trimester I and III trimesters which are divided into 2 groups with the intervention Group (n=35) obtained M. oleifera leaf flour biscuits with combination iron tablet and the control group (n=35) only accept FE tablets. Intervention group was given biscuits containing 40% moringa leaf flour (2.8g per biscuits) with a dose of 2 pieces a day containing Moringa leaf flour and a combination of iron tablets with a dose of 2 times 250mg, while the control group only consumed iron tablets at a dose of 2 times 250mg. After 60 days, a posttest was carried out to examine hemoglobin, iron and zinc. RESULT: The results showed that there was a significance increasing of hemoglobin after intervention (1.04g/dl, p=0.001), increasing of iron intake significantly (2.51mg, p=0.001) and zinc intake (0.14mg, p=0.144) also increas but not statistically significant. The increase in these three indicators was higher than the control group. CONCLUSION: Biscuits containing M. oleifera leaf flour are able to provide improvement in the condition of pregnant mothers who have anemia, especially in hemoglobin levels, iron and zinc intake.

Analysis of serum levels L-arginine and 25-hydroxyvitamin D as a predictor of survival of severe preeclampsia mothers.

OBJECTIVE: This study aimed to analyze serum levels of L-arginine and 25-hydroxyvitamin D as predictors of survival in severely preeclamptic women. METHODS: This study is a retrospective descriptive study using medical record data from June to August 2019 and has received a recommendation for ethical approval with the protocol number UH20070290. The study was conducted in 4 hospitals in Makassar: Dr. General Hospital. Wahidin Sudirohusodo, Hasanuddin University Teaching Hospital, Siti Fatimah Regional Mother and Child Health Hospital, and Sitti Khadijah 1 Mother and Child Hospital. The samples of this study were mothers who gave birth with a diagnosis of normal pregnant women, severe preeclampsia, and severe preeclampsia with complications. RESULTS: Serum l-arginine level did not affect the survival of severe preeclamptic mothers. It was shown at p-value 0.799>0.05. Meanwhile, serum levels of 25-hydroxyvitamin D affect the predictors of maternal preeclampsia where the p-value is 0.024<0.05. In comparing serum levels of L-arginine and 25-hydroxyvitamin D, there was no significant difference in groups of normal pregnant women, severe preeclampsia, and severe preeclampsia with complications. CONCLUSION: Serum level of 25-hydroxyvitamin affects the survival of severe preeclamptic mothers.

Risk factors analysis of non-compliance of Tuberculosis (TB) patients taking medicine in Puskesmas Polonia, Medan, 2021.

OBJECTIVE: This study aims to analyze the risk factors (knowledge, role of health workers, drug Consumption Supervisors activity, side effects of drugs, duration of taking medication, and feeling healthy) for non-adherence to TB patients taking medication at the Puskesmas. METHOD: The research design used in this study was a case control where the population was all patients who visited the working region of the Polonia Public Health Center. The research subjects were 138 samples consisting of 68 cases and 68 controls. The data were analyzed using a tabulation and statistical system using the SPSS program with the Odds ratio test and logistic regression. RESULT: It was found that there was an influence on the role of health workers OR=8,933 (95% CI: 1,085-73.525), side effects of drugs with OR=6,873 (95% CI; 2,435-19,398), felt healthy OR=4,643 (95% CI; 1,247-17,287), and knowledge OR=2,700 (95% CI; 1,083-6,731) It is recommended to be healthy and monitor the occurrence of drug side effects in patients during treatment.

Analysis of antioxidant activity on cocktail honey products as female pre-conception supplements.

OBJECTIVE: Cocktail honey is derived from a mixture of honey (trigona sp.), bee bread, and homogeneous royal jelly. The material has a phenolic content rich in antioxidants that are beneficial for women's reproductive health, especially for pre-conception, because it can suppress the content of free radicals in the body. Antioxidants are useful to overcome oxidative damage due to free radicals in the body that prevent various diseases from increasing fertility during pre-conception. METHOD: This study used the DPPH (2,2-diphenyl-1-picrylhydrazyl) test method using UV-vis spectrophotometry to express the value of free radical reduction activity as IC50 (inhibitory concentration) values. RESULTS: The DPPH test on cocktail honey products obtained an average yield of 4577.7µg/mL, which was included in the product category was very weak in the antioxidant activity content. CONCLUSION: The content contained in the honey cocktail contains weak bioactive content by assessing the antioxidant content using DPPH. The difference in the results of antioxidant activity tests using DPPH is caused by the test method and the conditions used in processing, homogeneous ingredients, solvent volume, extraction time, temperature, and pressure in product management.

Ginger honey affects cortisol, estrogen and glutathione levels; preliminary study to target preconceptional women.

OBJECTIVE: This study was aimed to determine the effect of ginger honey supplementation on cortisol, glutathione, and estrogen levels. The study was conducted on mice that had not yet experienced conception, and prior stress induction was carried out so that they could be continued for human trials at the preconception stage and subjects who experienced mild stress. METHOD: It was an in vivo study, pretest-posttest control group design. The sample of this study was 2-3 months female Balb/c mice, divided into negative control and ginger honey intervention as much as 28mg/20g BW for 14 days-the ELISA method used to examine cortisol hormone, glutathione levels, and estrogen levels. The mice chosen were those that had never experienced conception, and before the intervention, swimming activities were carried out on the mice until they showed symptoms of stress. RESULTS: Results show 42mg/20g BW of ginger honey administration for 14 days increased 1.892 ng/dl of cortisol (p = 0.165), increased 2.438 ng/dl of glutathione (p=0.002), and also increased 22.754ng/ml estrogen levels in induced stress Balb/c female mice (p=0.001). CONCLUSION: Ginger honey did not affect reducing cortisol levels but increasing glutathione and estrogen levels significantly. Ginger honey supplements are the potential to use as complementary therapies.

Prenatal yoga exercise improves sleep quality in the third trimester of pregnant women.

OBJECTIVE: This study aims to determine the effect of prenatal yoga exercises on sleep quality in third-trimester pregnant women. METHODS: It was a quasi-experimental (Nonequivalent Control Group Design). The study was conducted at the Ma'rang Community Health Center in Pangkajene and Kepulauan District from January to March 2020. The sample in this study was 60 pregnant women with gestational age 28 weeks divided into two groups, namely 30 control groups, namely pregnant women who visited routine antenatal check-ups as usual, and 30 people in the intervention group were given prenatal yoga exercises four times in two weeks selected based on purposive sampling techniques. Data analysis using the Wilcoxon test (p<0.05). RESULTS: Statistical test results showed that in the control group (p-value 0.001<0.05) and intervention (p-value 0.001<0.05), there were significant differences in sleep quality before and after the intervention was given. CONCLUSION: Prenatal yoga exercises improve the sleep quality of third-trimester pregnant women.

The effect of breastfeeding on body temperature, body weight, and jaundice of 0-72h old infants.

OBJECTIVE: The research aimed to determine the effect of breastfeeding on body temperature, body weight, and jaundice of 0-72h-old infants in Sitti Khadijah I Mother and Child Hospital of Makassar. METHOD: The research was an observational longitudinal design. The samples were breastfeeding mothers and 0-72h-old newborn infants consisting of 70 people selected using the purposive sampling method. The data were analyzed using the Chi-square test. RESULT: The result of the research indicated that there are 29 respondents (41.4%) giving exclusive breastfeeding with infants normal body temperature 29 people (100%), decreasing body weight 28 people (96.6%), and no jaundice 29 people (100%), while the respondents who do not give breastfeeding consist of 41 people (58.6%) with body temperature undergoing hyperthermia one respondent (2.4%), increasing body weight three people (7.3%) and jaundice four people (9.8%). CONCLUSION: There is an effect of giving breastfeeding on body temperature (p=0.016), but there is no effect on body weight (p=0.168) and jaundice (p=0.083) of 0-72h-old infants.

Use of technology for monitoring the development of nutritional status 1000 hpk in stunting prevention in Indonesia.

OBJECTIVE: This study is reviewed about the use of technology to monitor the nutritional status of the first thousand days of life (1000 HPK), a program in Indonesia to prevent stunting. METHOD: In this study, which is looking for journals used in the literature review, journals used in literature review obtained through the database of international journal providers such as Google scholar, PubMed, and Proquest. Researchers wrote the appropriate keywords, namely nutritional status of 1000 HPK, stunting, and application. The year limit used is ten years from 2010 to 2020. RESULTS: Nutritional status in the first thousand days of life (1000 HPK), which is 270 days during pregnancy and 730 days in the baby's first life, is critical because the consequences are permanent and irreparable. Pregnant women and toddlers who are less attentive about their food intake will impact nutritional problems or nutritional status that will then affect their development in the future. The level of optimal nutritional status will be achieved if nutritional needs are met, but on the contrary unbalanced nutrition can cause several diseases, including stunting. Monitoring the development of toddlers is very important to know the existence of growth disorders early on, by taking weight measurement as the best way to assess the nutritional status of pregnant women and toddlers every month so that the child's growth will be monitored. One tool for measuring nutritional status is to use applications, and technological advances have now undergone rapid development. Application is a multifunctional product with all its sophistication which can help humans in various ways. CONCLUSION: From some journals can be concluded that the use of applications in monitoring the nutritional status of 1000 HPK facilitates parents, midwives, and other health workers in working to monitor the nutritional development of pregnant women and the growth of infants and toddlers for stunting prevention.

Date palm (Phoenix dactylifera) consumption as a nutrition source for mild anemia.

OBJECTIVE: The purpose of this review is to describe an intervention that utilizes dates as a source of nutrition for pregnant women to increase hemoglobin levels in the blood in anemia incidence. The findings in this study are related to the use of dates to increase hemoglobin levels in the blood in pregnant women. METHODS: This study uses search databases used in PubMed, Science Direct, and Google Scholar. The keywords used in the initial search for articles are dates and hemoglobin obtained as many as 189 articles. At the time of using the keywords dates, hemoglobin, anemia by obtaining 15 articles and which are used only 10 articles according to the analysis of the purpose, suitability of the topic, the method of research used, sample size, research ethics, the results of each article, as well as limitations that occur. RESULT: Anemia in pregnant women causes hemoglobin (Hb) levels to decrease in the blood; the capacity of oxygen transfer to meet the needs of vital organs in the mother and fetus is reduced. All literature reviewed shows that administration of dates increases hemoglobin levels; only one literature shows no influence of consumes date juice on hemoglobin level. The majority of the literature reviewed is mild anemia. CONCLUSION: There are effective results in the implementation of health promotion of increased hemoglobin levels in the blood in pregnant women by utilizing dates as a source of nutrition.

Care for perineal tears in vaginal delivery: An update for midwife.

OBJECTIVE: The purpose of this study will be to review several studies regarding the repair or treatment of perineal tears after vaginal delivery. This is expected to be an update for a midwife in daily caring. METHODS: Two electronic databases (PubMed and Sciencedirect) were searched to locate relevant literature about perineal tears/wound/laceration/trauma that is published in 2016-2021. 124 Pubmed articles and 452 ScienceDirect articles filtered successfully. The articles that have been obtained will be evaluated based on the inclusion criteria in this study. We summarize place and date, objective, design, samples, the measurement used, and research results. RESULTS: 9 articles were found that matched the inclusion criteria. Three articles examined the effect of the type of suture on perineal pain, and another 6 discussed therapy to reduce the adverse effects of perineal tears. The therapies used are far-infrared radiation therapy, capacitive-resistive radiofrequency therapy, pelvic floor muscle training in early postpartum, cold therapy, and treatment with TheresienOl (natural oil). CONCLUSION: Sutures and technique/suturing second-degree perineal tears or a postpartum episiotomy can affect perineal pain. Cold gel pad therapy and treatment with natural oil on perineal wounds can affect perineal pain and wound healing.