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Abstract Background and purpose: Diabetic foot ulcers are one of the major causes of morbidity and mortality in diabetic patients. For centuries Aleo vera has been used in treatment of diabetic foot ulcers. In this study, a mixture of honey and Aloe vera was used for diabetic foot ulcer healing. Materials and methods: In a double-blind clinical trial, patients with nonischemic, noninfected diabetic foot ulcers (attending Imam Khomeini Hospital Diabetes Center, Sari, Iran) were divided into two groups, a treatment group (n= 24) and a placebo group (n=15). To compare the effect of the mixture t-test and qui square were applied. Results: A total of 39 patients (19 males and 20 females) with diabetic foot ulcers were enrolled. Mean age of the patients, mean body mass index, and mean duration of diabetes were 56.3 ±10.2, 31.2 ± 4.2, 16.2 ± 6.6, respectively which were not significantly different between the two groups. Wound size was determined using a ruler that showed no significant difference between the two groups (P=0.36). Debridement, offloading and washing were done for all participants. Combined gel of Aleo vera and honey was used for treatment group. Wound healing was seen in 21 (95.5%) patients in treatment group and in 11 (78.6%) patients in placebo group. Conclusion: In small, non-infected, non-ischemic ulcers the effect of honey and Aloe vera gel was the same as that of the placebo. Offloading, debridement and washing with normal saline have similar effect to the mixture in healing diabetic foot ulcers.

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Background and purpose: Aloe vera is an anti-diabetic herb in traditional medicine. In the present study, the protective effect of aloe vera gel was studied on function of thyroid gland in diabetic rats.

Materials and methods: Fifty healthy male Wistar rats weighing 200-250g were randomized into 5 groups (n=10 per group). The animals in a control group were kept in normal conditions. In second group diabetes was induced by streptozotocin (STZ). In another group the streptozotocin induced diabetic rats received 400 mg/kg aloe vera gel once a day for 15 and 30 days. The next group included STZ-induced diabetic rats that received 10-15 units insulin once a day for 15 and 30 days. The Sham group included healthy normal rats that received 400 mg/kg aloe vera gel once a day for 15 and 30 days. By the end of days 15 and 30, the blood samples were taken. Then the animals were euthanized and the thyroid gland was removed and fixed in 10% buffered formalin. The semi-thin sections were prepared and stained using haematoxylin and eosin, and were observed under light microscope.

Results: Mean number and size of follicles significantly decreased in diabetic group compared to the control group (P<0.05). Histomorphometrical findings showed significant increase in mean number and size of follicles in the group receiving aloe vera gel compared to the diabetic group (P<0.05). There were significant decreases in concentrations of T3 and T4 hormones in diabetic group compared to those of the control group (P<0.05). Aloe vera treated animals showed significant increase in concentrations of T3 and T4 hormones compared to those of the control group (P<0.05).

Conclusion: Aloe vera gel could improve regeneration of damaged thyroid gland tissue in diabetic rats.

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Background and purpose: Oral chronic lesions (OCLs) are challenging inflammatory diseases. Clobetasol is the most effective corticosteroid in treatment of OCLs. Clinical studies showed positive effects of aloe vera gel in improving the signs of inflammation and ulcer in OCLs. The aim of the present study was to design a mouthwash containing aloe vera gel and clobetasol and evaluating its stability and antifungal efficacy.
Materials and methods: Aloe vera gel was standardized and clobetasol was analyzed using a validated HPLC method. They were then mixed with suitable excipients to formulate a mouthwash. At days one and 45 after preparation, the pH, clearness, clobetasol assay, and microbial control (preservative test and limit test) of the mouthwash were tested. The efficacy of the optimized mouthwash on Candida albicans was tested and compared with two natural and chemical commercial mouthwashes.
Results: Aloe vera gel 100ml contained 36 mg glucomannan. Quality control test confirmed physical, chemical and microbial stability of the mouthwashes after 45 days. The optimized mouthwash showed considerable effects on Candida albicans even at 1:10 and 1:100 dilutions.
Conclusion: Considering anti-inflammatory effects of aloe vera gel, it seems that the optimized mouthwash, in addition to having wound healing effects, may prevent candidiasis induced by Candida albicans in patients with OCLs.

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Background and purpose: Preventing ventilator-associated pneumonia (VAP) as one of the most common and also the most fatal complications caused by intubation and mechanical ventilation in intensive care units (ICU) has always been emphasized in countless studies. Chlorhexidine mouthwash is commonly used as a gold standard in the control of dental plaques and prevention of VAP. Given the increasing prevalence of gram-negative infections due to resistance to commonly used antibiotics and the associated complications, this study aimed to investigate and compare the impact of tea tree oil/aloe vera herbal mouthwash, known for its antibacterial and anti-inflammatory properties, on the occurrence of ventilator-associated pneumonia.
Materials and methods: This study is a double-blind randomized clinical trial. 62 intubated patients, aged from 16 to 65 and hospitalized in the intensive care units of Hazrat Waliasr Hospital in Arak City in 2023, were assigned using a simple randomization method in two interventions (tea tree oil/aloe vera mouthwash) and control groups (chlorhexidine mouthwash). Mouthwash bottles were covered before distribution. None of the patients, colleagues (nurses), and the specialist determining the final result of the study were aware of the allocation of patients in the intervention or control group. Oral care in both groups was performed by washing hands, wearing gloves, evaluating the mouth condition, adjusting the pressure of the endotracheal tube cuff (20-30 Cm.H₂O), brushing with a soft toothbrush, mouthwash twice daily and open suctioning of oral and subglottic secretions. Lastly, at intervals of 3 days (to assess the incidence of early VAP) and 7 days (to assess the incidence of late VAP) after the intervention, the modified clinical pulmonary infection score (MCPIS) was calculated and a score greater than or equal to 6 was considered as a diagnosis of pneumonia. This tool has been utilized in similar studies and its validity and reliability have been confirmed. Eventually, the data was statistically analyzed using the chi-square test, independent t-test, and repeated measures test to investigate the effect of the intervention over time with SPSS version 20 software.
Results: According to the results, 64.5% of the participants were male and 35.5% of them were female. There was no statistically significant difference between the two groups in terms of average age, gender, reason for admission, history of underlying diseases, invasive interventions, average number of drugs and antibiotics, type and amount of nutrition, and duration of mechanical ventilation. The incidence of early-onset pneumonia was 9.7% in the intervention group and 12.9% in the control group. Although the incidence was lower in the intervention group, there was no statistically significant difference between the two groups (P-value=0.99). The incidence of late-onset pneumonia in the intervention group was 12.9% and 16.1% in the control group. Despite of lower incidence of late-onset pneumonia in the intervention group, there was no statistically significant difference (P-value=1.00). Moreover, according to the results of Bonferroni's paired comparisons test, the difference in the average MCPIS score between 3 days and 7 days later in the intervention group was not significant and did not increase significantly (P-value=0.06), which means that in this group, the effect of the intervention can be seen at this time.
Conclusion: Oral care using tea tree oil/aloe vera mouthwash or 0.2% chlorhexidine has no preference or significant advantage over each other, and both can be effective in reducing ventilator-associated pneumonia. Considering the lower incidence of early and late pneumonia in the intervention group, it is recommended to conduct studies with a larger sample size and also use accurate oral assessment tools to confirm the removal of dental plaque (plaque score) in this population of patients.

(Clinical Trials Registry Number: IRCT20210104049936N1)