CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter presents the Related Literature and Studies used in providing the

direction for the study. This also includes the Synthesis of the State of the Art and the

Gap to be Bridged by the Study, Theoretical Framework, Theoretical Paradigm,

Conceptual Framework, Conceptual Paradigm and Definition of Terms for better

understanding of the study. Information were gathered in several books, unpublished

thesis, journals and from the internet related to the proposed study.

Related Literature

International

Wounds are the result of injuries to the dermis that disrupt the other tissue.

Healing of a wound is a complex process of tissue repair and remodeling. Different plant

products have been used in treatment of wounds over the years. Wound healing herbal

extracts promote anticoagulation, fight infection, and accelerate the healing of wounds.

Phytoconstituents derived from plants need to be identified and screened for

antimicrobial activity for management of wounds. Small animals provide a multitude of

model choices for various human wound conditions. (Thakur, 2011)

Surgical site infection or SSI is one of the most common complications following

cesarean section.It has an incidence of 3%–15%. It places physical and emotional

burdens on the mother and a significant financial burden on the health care system. It is

associated with a maternal mortality rate of up to 3%. With the global increase in

cesarean section rate, it is expected that the occurrence of SSI will increase in parallel,

hence its clinical significance. Given its substantial implications, recognizing the
consequences and developing strategies to diagnose, prevent, and treat SSI are essential

for reducing postcesarean morbidity and mortality. (Garmi, 2017)

Herbal drugs are formulated in different forms and one of which is in the form of

ointment. It is used topically for several purposes, e.g. as protectants, antiseptics,

emollients, antipruritic, keratolytics and astringents. Ointment bases are always

anhydrous and generally contain one or more medicaments in suspension or solution or

dispersion. Ointment bases may be hydrocarbon (oleaginous), absorption, water

removable and water soluble type. It is classified as: epidermatic, endodermatic and

diadermatic depending on their action (Carter, 1987).

Ointments are semisolid formula that thicker than creams but thinner than pastes.

The ointment formulation consists of active and inactive ingredient. An ointment is made

by emulsifying oil phase in water. During the preparation, the oil is heated to

approximately 70C and the water to 75C. The water phase contains an extract of the

herb to be incorporated into the mixture. When added together and mixed in the presence

of an emulsifying agent, the two phases quickly form a stable emulsion. Mixing

continues at room temperature until the formulation begins to congeal. (Shodhganga)

Guava leaves have been used in management of diarrhea, wounds, ulcer,

toothache, and stomach-ache and in the diabetes. Decoction of the leaves are used as

gargles or the sore throats, swelling of the mouth, laryngitis, external ulcer on the skin

and vaginal irritations in the Latin America, Central and West Africa and South East

Asia. Psidium guajava leaves possess the anti-inflammatory property and is also used in

various lung problems. In addition to this, leaves are used in various bacterial infection.

Leaf extract of the Psidium guajava has been reported for the strong anti-microbial

properties (Rishika, 2012).

National

Wound is the break in the continuity of the skin. It is a natural response of the

body to injuries. It is classified into 4 kinds, namely: open wound, intentional &

accidental wound, incision & lacerated wound, and abrasion & superficial wound. Open

Wound is a kind of wound that has disruption when it comes to the continuity of the skin.

Intentional & Accidental Wound is a kind of wound that resulted from surgical

operation/s where there is the disruption of the skin’s integrity. Incision & Lacerated

Wound is a kind of wound that has been done through by clean cut edges, sharp objects.

Abrasion & Superficial Wound is a kind of wound that was covered by scraping of the

skin over fixed thing that resulted to the removal of the dermis or epidermis. When the

skin is broken, several foreign objects such as dirt and bacteria which can lead to

infection and complications. (Benton, 1991)

Treatment of postpartum wound complications following caesarean section

usually involves antibiotic therapy and source control. Localized infections can be treated

empirically with agents directed towards gram-positive organisms such as cefazolin and

vancomycin. Systemic symptoms of any type warrant treatment with intravenous broad-

spectrum antibiotics including gentamicin (5 mg/kg q24 h) and clindamycin (900 mg IV

q8 h) plus or minus ampicillin (2 g then 1 g q4 h). Alternatively, a regime with

ampicillin, gentamicin, and metronidazole (500 mg q8 h) or levofloxacin (500 mg q24 h)

and metronidazole can be effective. (Larsen)

Kakawate or Madre de cacao (Gliricidia sepium) is a leguminous tree, 3 to 10

meters high. Leaves are 15 to 25 centimeters with 13 leaflets which are opposite, oblong-

ovate, 4 to 6 centimeters long, with a pointed tip and rounded base. It is belong to the

family Fabaceae, and originated in Central America Different parts of the plant like
leaves, root, and bark are used by many tropical and sub-tropical countries for different

purposes. It has been used in the treatment of patients with different bacterial infections,

skin diseases, nematodes. Several studies has also been reported that it has antioxidants

and insecticidal properties. (Delos Santos, 2019)

Gliciridia Sepium has many uses according to the different folklores. It is used for

skin diseases such as Dermatitis or simple itching by applying the juice or decoction of

leaves, bark or roots on the the skin as antipruritic. Fresh leaves are also applied to the

skin an insect repellent. It is also used as counterirritant by crushing the leaves and

applying it as poultice for rheumatic pains, sprains and closed fracture. Sap of bark,

leaves and roots have been used for wound healing. In Guatemala, the bark and leaves are

used to treat skin diseases. Many folkloric regimens used this for headache, bruises,

burns, colds, cough, fever, fatigue, gangrene, gonorrhea, skin itches and sores; as

antidote, insecticide, insect repellent. (AgriPinoy.net)

Guava is well known tropic tree which is abundantly grown for fruit. It uses has a

long history for medicinal purposes. It is treatment of diarrhea, dysentery, gastroenteritis,

hypertension, diabetes, caries and pain relief and for improvement in locomotors

coordination. Its leaf’s extract is being used as a medicine in cough, diarrhea, and oral

ulcers and in some swollen gums wound. Its fruit is rich in vitamins A, C, iron,

phosphorus and calcium and minerals. It contains high content of organic and inorganic

compounds like secondary metabolites e.g. antioxidants, polyphenols, antiviral

compounds, anti-inflammatory compounds.(Naseer, 2018)

Local

Traditional medicine or also known as indigenous or folk medicine comprises the

knowledge that has been developed over generations within various societies before the

era of modern medicine. Practices known as traditional medicines include Herbal,

Ayurveda, Siddha, Unani, Iranian, Islamic, Vietnamese, Chinese, Acupuncture, Muti, Ifá,

African and other pseudo-medical knowledge and practices all over the globe. It may

include formalized aspects of folk medicine, i.e. longstanding remedies passed on and

practiced by lay people. (Ananda, 2012)

Kakawate is usually leafless during dry season but flowers bloom at the same

time. The flowers are pea-like with petals that are usually lavender, pink or white. It also

bears fruits that look like a leathery pod and seeded. Kakawate is very easy to propagate

and inexpensive. The tree could re-sprout very quickly after pruning. Many people plant

them mainly to shade other perennial crops like cacao, coffee and tea. Aside from this,

kakawate could provide a lot of uses to the farmers from its roots to its leaves. Its

multipurpose use makes it a good plant crop in agroforestry. (Bureau of Agricultural

Research)

Guava leaf or also called bayawas in Bicol is one of the parts of the said tree

which has its abundant functions. The leaf was used by the rural folks to a procedure

called “ugas” to wash ulcers and wounds. A Philippine herbal medicine used as

antiseptic, anti-inflammatory, anti-spasmodic, antioxidant hepatoprotective, anti-allergy,

antimicrobial, anti-plasmodial, anti-cough, antidiabetic, and antigenotoxic in folkloric

medicine. (Kilusang Bagong Lipunan)

Related Studies

International

In the study of Biswas, B. et al. (2013) entitled “Antimicrobial Activities of Leaf

Extracts of Guava (Psidium guajava L.) on Two Gram-Negative and Gram-Positive

Bacteria “, the study focused on the antimicrobial potential of guava (Psidium guajava)

leaf extracts against two gram-negative bacteria (Escherichia coli and Salmonella

enteritidis) and two gram-positive bacteria (Staphylococcus aureus and Bacillus cereus)

which are some of foodborne and spoilage bacteria. The guava leaves were extracted in

four different solvents of increasing polarities (hexane, methanol, ethanol, and water).

The efficacy of these extracts was tested against those bacteria through a well-diffusion

method employing 50 𝜇L leaf-extract solution per well. According to the findings of the

antibacterial assay, the methanol and ethanol extracts of the guava leaves showed

inhibitory activity against gram-positive bacteria, whereas the gram-negative bacteria

were resistant to all the solvent extracts. The methanol extract had an antibacterial

activity with mean zones of inhibition of 8.27 and 12.3 mm, and the ethanol extract had a

mean zone of inhibition of 6.11 and 11.0mm against B. cereus and S. aureus, respectively.

On the basis of the present finding, guava leaf-extract might be a good candidate in the

search for a natural antimicrobial agent.

Wubante, D. et al. (2018) in their study, “Evaluation of the Wound Healing

Activity of the Crude Extract of Leaves of Acanthus polystachyus Delile (Acanthaceae),”

The crude extract was prepared in 5% (w/w) and 10% (w/w) ointment and evaluated for

wound healing activity using excision, infected, and incision wound models in Swiss

albino mice. Results. Both 5% and 10% (w/w) ointments significantly reduced period of

epithelialization and increased wound contraction rate and tensile strength compared to

the negative control group (P < 0.05). The wound healing activity of 10% (w/w) ointment

treated group was greater than 5% (w/w) and nitrofurazone ointment treated groups in S.
aureus infected wound model. Conclusion. These results demonstrate that the crude

extract of A. polystachyus leaves possesses wound healing activities.

In the study of Fernandez, K.P. et al. (2010) entitled “Healing and cytotoxic

effects of Psidium guajava (Myrtaceae) leaf extracts “, the study is focused on the

evaluation of wound healing potential in vivo and the cytotoxic effects in vitro of

Psidium guajava (Myrtaceae) leaf extract and commonly used corticosteroids. The result

showed that in a short-term cytotoxicity analysis, the guava extract reduced the cell

population in vitro, while in vivo, the extract accelerated wound healing.

Díaz-de-Cerio, E., et al. (2017) on their study entitled, “Health Effects of Psidium

guajava L. Leaves: An Overview of the Last Decade),” demonstrated the potential in the

treatment of the most common worldwide diseases. The effects of the leaves have been

related to individual compounds such as quercetin, catechin, vescalagin, gallic acid,

peltatoside, hyperoside, isoquercitrin, and guaijaverin. The proponents recommended to

investigate the biodiversity of guava and/or the purification of the different compounds

present in guava leaves in order to obtain functional ingredients for further uses as

alternative agents in natural therapeutic approaches.

Another study conducted by Mallapu, P. (2017), “Medicinal Properties of

Gliricidia sepium: A Review),” concluded that the pharmacological studies with plant

sources can result in novel and effective pattern of treatment. The article intend to

provide an overview of the phytochemical constituents present in G.sepium (L) with

special emphasis on their pharmacological actions like It was used as mosquito repellent,

fumigants, treatment of dysentery, wound-dressing, antibacterial, antifungal, antiviral

agent. By using Entire parts of plant like flowers, roots, leaves etc. which have ethno
medicinal properties. Based upon the presence of flavonoids reported many

pharmacological activities like antiulcer, anti-oxidant and other pharmacological

activities can be carried out. Hence, pharmacologists need to take more active interest in

evaluation of herbal drugs for potential therapeutic effects and standardization of such

herbal drugs to be clinically effective and globally competitive.

National

On the study entitled, “Wound Healing and Guava Leaves,” as the title implies,

guava leaf is the main subject for this research. The researchers had hypothesized that

guava ointment can accelerate wound healing faster than the tincture due to the

concentration of the leaf extract. In making the ointment, the leaves must be washed,

chopped and extracted with the use of oil. Added into it was melted candle wax. The

product was been put into a sterile container and solidified. While in making tincture, add

a cup of gin to the chopped guava leaves. The researchers conducted the experiment in

two different people with the same kind of wound. After 4 days, they concluded that the

ointment was way better than the tincture because of the extract’s concentration and the

nutritional status of the specimen.

Dasigan, Y., et al. also utilized the use of Guava (Psidium guajava linn.) leaves

extract in treating wounds. The study showed that the guava leaves extract has a great

potential to be used as a natural treatment for wounds. There was no significant

difference in the effect of treatment using commercial medicines and in using guava

leaves extract. On the study of Manriquez D.S., entitled “Malunggay and Guava Leaves

Decoction on Wound Healing: Basis for Health Education,” it used the process of

decocting same with Dasigan, Y., et al which where they added the desired amount of
leaves to liter of boiling water, strained using sterile strainer and cool the decoction then

transfer it to a sterile container.

Carandang, R.R, et al. (2015) on the study, “The Wound Healing Action of

Kakawati Gel from Gliricidia sepium (Jacques) Steudel (Family Fabaceae),” used

Gliricidia sepium or locally known as kakawati in their study to determine its wound

healing property. Wound healing property was determined by three methods: (1)

measurement of the rate of wound contraction, (2) tensile strength of the healed tissue

using a tensiometer and (3) histological examination of collagen deposition. The gel

formulation has been proven to have wound healing properties and was found to be safe,

effective, stable and low cost.

Another study entitled, “The Antifungal Property of Madre de Cacao (Gliricidia

sepium) Leaves Extract: Its Effects on Skin Diseases” was conducted by Saep, M.R., et

al. Two hundred fifty (250) grams of Madre de Cacao and one hundred fifty (150) grams

of Herba Buena leaves was mixed with 1 cup of coconut oil or any cooking oil, added to

the boiled preparation, mixed until all chopped candles are melted. Then, using the

strainer, drain and transfer the mixture into a clean glass container. The extracts obtained

from Madre de cacao leaves were tested. Base on the study conducted, it was found out

that it can cure and effective in treating skin diseases such as scabies, dermatitis, skin

itchiness/allergies. The effectiveness was tested and valuable information (data) shows

up. Macao Ointment was determined to have antifungal effects and it is more effective in

curing skin diseases because it cured faster than Brand X. Results of the tests showed that

gliricidia extractives significant inhibitor of skin diseases.

Local
 A study conducted by Yap, J.V., entitled “Potential Insecticidal Activity of

Gliricidia sepium (Kakawate), Allium Sativum Linn (Bawang), and Nepeta Cataria

(Catnip) against Periplaneta Americana (American Cockroach),” from Bicol University

College of Nursing, studied the potential Insecticidal Activity of Gliricidia sepium

(Kakawate) and other organic compounds) leaves were gathered and were removed from

the different stems. The leaves were checked with some parasites or worm stepping on it.

Dirt and other extraneous material were thoroughly removed first by washing it with

distilled water. These extracts were obtained by using a Soxhlet apparatus. Then, the

extract was transferred into a sterile bottle. Fresh extract were prepared throughout the

period of experiment to ensure homogeneity of the treatments.

Another study conducted by Salvadora, J.O., from Bicol University College of

education, used kakawate leaves and chili fruits and seeds extract to determine the

efficacy of the extracts as pesticide for common garden aphids. Extraction was done

using mortar and pestle, blender and cheesecloth. No agents have been included in the

extraction process to ensure purity. Kakawate leaves and Chili fruits and seeds extracts

exhibit remarkable pesticidal activity against aphids. The more concentrated the

Kakawate leaves and Chili fruits and seeds extracts is the more it is effective than the

diluted one, thus the effectiveness rises when the degree of concentration increases.

Arcueno, R.O., et al from Bicol University College of Nursing and Guerrero, J.J.

from College of Science conducted a study entitled, “Wound healing potential of

Tinospora Crispa (Willd) Miers [Menispermaceae] stem on diabetic mice),” the variable

used was the Tinospora crispa of the family Menispermaceae that has been traditionally

used in the Philippines to treat a variety of illnesses, including diabetes milletus and its
accompanying complications. Fresh stems of Tinospora crispa were obtained from a local

source, air dried for 24-48 hours, and cut into small pieces. These were soaked in ethanol

for 48 hours in a 1:1 w/v ratio. These were strained afterwards. Simple distillation was

done to separate the ethanol from the extracts. Extract was stored in the refrigerator at 4C

before use. Preparation of Tinospora crispa ointment was done using a common

household procedure in the Philippines. Fresh stem weighing 100g were cut into small

pieces and slowly fried until crispy in 200 ml of vegetable oil. Stems were removed while

the oil was mixed with two wax candles (Esperma 5) sliced into small cubes. All debris

were strained. The wax was thoroughly mixed and allowed to melt and settle. From the

results of the study, Tinospora crispa stem extracts showed potentials to be harnessed as a

remedy for diabetic wounds, primarily in reducing blood glucose level and second, in

possibly preventing microbial infection in affected area.

Synthesis of the State of the Art

And Gap to be Bridged by the Study

Theoretical Framework

Conceptual Framework

Definition of Terms

Antimicrobial. An agent that kills microorganisms or inhibits their growth

Decoction. The action or process of extracting the essence of something.

Extract -is a substance made by extracting a part of a raw material, often by using

a solvent such as ethanol or water. Extracts may be sold as tinctures or in powder form.

 Guava (Psidium guajava). A Philippine herbal medicine used as antiseptic, anti-

inflammatory, anti-spasmodic, antioxidant hepatoprotective, anti-allergy, antimicrobial,

anti-plasmodial, anti-cough, antidiabetic, and antigenotoxic in folkloric medicine.

Herbal Creams And Ointments. An ointment usually is mixed with beeswax (or

something similar) to make it more applicable to outside the body, such as on a cut or

scrape.

Infection. The invasion of an organism's body tissues by disease-causing agents

Inflammation. A condition in which a part of your body becomes red, swollen,

and painful

Kakawate- is a smooth, deciduous tree, 3 to 10 meters high. Leaves are 15 to 25

centimeters long with 13 leaflets which are opposite, oblong-ovate, 4 to 6 centimeters

long, with a pointed tip and rounded base. Racemes are numerous on leafless branches,

containing many flowers.

Endnotes

Agri Pinoy. Medicinal plant kakawate, cacao, Gliricidia sepium. (n.d). Retrieved from
agripinoy.net/medicinal-plantKakawate-cacao-gliricidia-sepium.html

An Overview of the Last Decade. Retrieved from

https://www.semanticscholar.org/paper/Health-Effects-of-Psidium-guajava-
L.Leaves%3A-An-of-D%C3%ADaz-de-Cerio-
Verardo/523c4f9b2de55e31f81adb03aa9bffbb3d6ac4de

Arcueno, R.O. et al. (2015). Wound healing potential of Tinospora Crispa

(Willd.)Miers [Menispermaceae] stem on diabetic mice. Retrieved from
https://www.academia.edu/30822930/Wound_healing_potential_of_Tinospora_Cri
spa_Willd._Miers_Menispermaceae_stem_on_diabetic_mice

Biswas, B., et al. (2013). Antimicrobial activities of leaf extracts of guava (Psidium
guajava L.) on two gram-negative and gram-positive bacteria.
https://www.hindawi.com/journals/ijmicro/2013/746165/#copyright
Carandang, R.R., Buemio, K.C., Lopez, A. The Wound Healing Action of Kakawati Gel
from Gliricidia sepium (Jacques) Steudel (Family Fabaceae). IJPTP, 2015, 6(4),
2642-2649.
https://pdfs.semanticscholar.org/d0c9/de0b863f1437e2d919bc89e2469cd687b389.
pdf
Carter, S.J. (1987). Cooper and Gunn’s dispensing for pharmaceutical students:
ointments, pastes and jellies. 12 th Edition, CBS Publishers and Distributors,
India

Dasigan, Y., Regidor, E., Tomatao, T., (n.d). The utilization of guava (Psidium guajava
linn.) leaves extract in treating wounds. Retrieved from
https://www.academia.edu/35877396/The_Utilization_of_Guava_Psidium_guajav
a_linn._Leaves_Extract_in_Treating_Wounds

Delos Santos, J., Molina, M.O., Noceto, M.G., Quelonio, C.E. (2019). Effectiveness of
madre de cacao (Gliricidia sepium) as an alternative medicine against scabies
caused by mites and ticks of dogs. Retrived from
https://www.scribd.com/document/422172101/Effectiveness-of-Madre-de-Cacao

Díaz-de-Cerio, E., Verardo, V., Gómez-Caravaca, A., Fernández-Gutiérrez, A. and

Segura-Carretero, A. (2017) Health Effects of Psidium guajava L. Leaves:
diagnosis, treatment and prevention of postoperative infections.

Dorai, Ananda. Wound care with traditional, complementary and alternative medicine.
Indian Journal of Plastic Surgery, vol. 45, no. 2, 2012, p. 418. Gale Academic
OneFile, Accessed 26 Mar. 2020.

Fernandes, K., Bussadori, S., Marques, M., Sumie, N., Wadt, Y., Bach, E., Martins, M.
(2010). Healing and cytotoxic effects of Psidium guajava (Myrtaceae) leaf
extracts. Brazilian Journal of Oral Sciences.

Kakawate and its many uses. https://www.bar.gov.ph/index.php/test-archive/405-june-

2003-issue/3072-kakawate-and-its-many-uses

Kilusang Bagong Lipunan. Philippine traditional and alternative medicine. Retrieved on

https://kbl.org.ph/philippine-traditional-and-alternative-medicine/

Larsen JW, Hager WD, Livengood CH, et al. Guidelines for the Infect Dis Obstet
Gynecol 2003; 11: 65–70.

Mallapu, P. (2017). Medicinal properties of Gliricidia sepium: A review. International

Journal of Current Pharmaceutical & Clinical Research. 7. 35-39.

Naseer, S., Hussain, S., Naeem, N. et al. The phyochemistry and medicinal value of
Psidium guajava (guava). Clin Phytosci 4, 32 (2018).
https://doi.org/10.1186/s40816-018-0093-8
No Author. (n.d) Formulation of ointment
https://shodhganga.inflibnet.ac.in/bitstream/10603/40682/8/17.formulation
%20%20pharamcological%20studies%20of%20ointment.pdf

Rishika, D., & Sharma, R. (2012). An update of pharmacological activity of Psidium

guajava inthe management of various disorders. International journal of
Pharmaceutical Sciencesand Research, 3(10), 3577

Rita T. dela Cruz. (n.d). Kakawate and its many uses. Retrieved from
https://www.bar.gov.ph/index.php/test-archive/405-june-2003-issue/3072-
kakawate-and-its-many-uses

Rupesh Thakur, etal. (2011). Practices in wound healing studies of plants. Retrived from
https://doi.org/10.1155/2011/438056

Saep, M.R., Domino, R., Arranguez, M. (n.d) The antifungal property of madre de
cacao (Gliricidia sepium) leaves extract: Its effects on skin diseases. Retrieved
from
https://www.academia.edu/8147468/The_Antifungal_Property_of_Madre_de_Cac
ao_Gliricidia_sepium_Leaves_Extract_Its_Effects_on_Skin_Diseases?
email_work_card=view-paper

Salvadora, J.O., Peñarubia,J.B., .Clemente,J.B., .Consencino, G,J. (n.d). Kakawate

leaves and chili fruits and seeds extracts as pesticide for aphids. Retrieved from
https://www.scribd.com/document/427724198/Title-page-of-Kakawate-LEaves-
Chili-Fruits-extract-pdf

Wound Healing and Guava Leaves. (2017). Retrieved

fromhttps://studymoose.com/wound-healing-and-guava-leaves-essay

Wubante D. et al.(2018). Evaluation of the wound healing activity of the crude extract of
leaves of Acanthus polystachyus delile (Acanthaceae). Retrieved from
https://www.hindawi.com/journals/ecam/2018/2047896/

Yap, J.A., Collantes, J.A., Gentica, K.R., (n.d). Potential Insecticidal Activity of
Gliricidia sepium (Kakawate), Allium Sativum Linn (Bawang), and Nepeta
Cataria (Catnip) against Periplaneta Americana (American Cockroach).
Retrieved from https://vdocuments.mx/12354579014b1af9ff0608b46b0.html

Zuarez-Easton S, Zafran N, Garmi G, Salim R. (2017). Postcesarean wound infection:

prevalence, impact, prevention, and management challenges. Int J Womens
Health. 2017;9:81-88 https://doi.org/10.2147/IJWH.S98876