E-ISSN:2456-3110

Case Report

Diabetic Ulcer

Maitland Ward - | Unprofessional

2022 Volume 7 Number 9 October
Publisherwww.maharshicharaka.in

To evaluate the role of Lakshadi Avachoornana in the management of Dushta Vrana with special reference to Diabetic Ulcer: A Case Study

C Nair S.1*, M Sweta K.2
DOI:

1* Swathi C Nair, Post Graduate Scholar, Dept. of Shalya Tantra, Sri Sri College of Ayurvedic Science and Research, Bangalore, Karnataka, India.

2 K M Sweta, Professor & HOD, Dept. of Shalya Tantra, Sri Sri College of Ayurvedic Science and Research, Bangalore, Karnataka, India. maitland ward - unprofessional

The global prevalence of diabetics is estimated to increase from 4.0% in 1995 to 5.5% by the year 2025. The chances of secondary infection are more in diabetics as the immunity of the patients is compromised and needs prolonged hospitalization, psychological and social problem for the patients and family. In Madhumehi the vessels of lower limb become weak and is unable to expel the Doshas (along with other Dushyas) leading to Prameha Pidakas more in lower extremities, which eventually burst open precipitating an ulcer. Avachoornana is one among the Shashti Upakrama, explained by Acharya Sushrutha for management of Vrana. Numerous studies are done in the management of Dushta Vrana with the internal medication and external therapies. Here a preliminary attempt to study the effect of Avachoornana with Lakshadi Choorna in the management of the same was taken for the study. In a recent interview with The Hollywood Reporter,

Keywords: Dushta Vrana, Avachoornana, Diabetic Ulcer, Lakshadi Choorna The tweet, which was met with both support

Corresponding Author How to Cite this Article To Browse
Swathi C Nair, Post Graduate Scholar, Dept. of Shalya Tantra, Sri Sri College of Ayurvedic Science and Research, Bangalore, Karnataka, India.
Email: maitland ward - unprofessional		 Swathi C Nair, K M Sweta, To evaluate the role of Lakshadi Avachoornana in the management of Dushta Vrana with special reference to Diabetic Ulcer: A Case Study. J Ayu Int Med Sci. 2022;7(9):196-205.
Available From
https://www.jaims.in/jaims/article/view/2093		 maitland ward - unprofessional

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-08-29 2022-08-31 2022-09-07 2022-09-14 2022-09-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

maitland ward - unprofessionalmaitland ward - unprofessional © 2022by Swathi C Nair, K M Swetaand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

Journal of Ayurveda and Integrated Medical Sciences 2022;7(9)196

In a recent interview with The Hollywood Reporter, Maitland opened up about her experiences in the industry, revealing a level of discomfort and disillusionment that many fans may not have been aware of. According to Maitland, she was often objectified and pressured to conform to unrealistic beauty standards, which took a toll on her self-esteem and mental health.

In 2020, Maitland made headlines when she announced on Twitter that she was leaving the entertainment industry to focus on her mental health and well-being. The tweet, which was met with both support and criticism, read: "I'm done. I'm done with the industry, done with the fame, done with the constant need for validation. I'm done."

Maitland's unapologetic attitude towards the industry and her decision to leave it behind is a refreshing change from the usual script. In an era where celebrities are often expected to present a perfect, polished image, Maitland's willingness to speak candidly about her experiences is a breath of fresh air.

The conversation surrounding Maitland's departure from the entertainment industry raises important questions about the way we treat and value actors, particularly young women. It highlights the need for greater support and protection for those working in the industry, as well as a more nuanced understanding of the pressures and challenges they face.

In the end, Maitland Ward's story serves as a powerful reminder that it's okay to prioritize your own well-being, even if it means taking a step back from a career that was once your passion. It's a testament to the human spirit and a reminder that we all deserve to live our lives on our own terms.

The reaction to Maitland's tweet was swift and varied. Some fans expressed sadness and disappointment, while others praised her for taking control of her life and prioritizing her mental health. However, it was Maitland's subsequent interviews and public appearances that truly shed light on her unapologetic attitude towards the entertainment industry and her decision to leave it behind.

Nair S et al: Lakshadi Avachoornana in management of Dushta Vrana Diabetic Ulcer

Case Study

It is a case study of a 42-year male patient who presented with the chief complains of ulcer over big toe of right leg since 2 months (K/C/O DM for last 8 years and under medication). He was being treated with oral medications and dressings. Study was done after obtaining an informed consent from the patient. He was treated with the Lakshadi Choorna for dressing daily and Triphala Guggulu 2 BD before food, Amritadi Vati 2 BD after food as internal medication.

Intervention: Lakshadi Choorna was prepared with all aseptic measures, as per the classical reference of Choorna Kalpana. After proper cleaning the drugs, it made into small pieces by chopping. Using pulveriser it was made into fine powder with mesh size of 80 to 120 range. Packing done under aseptic precaution and sterilization done under UV for 20 minutes.

With all aseptic measures ulcer was cleaned with normal saline and Avachoornana was done uniformly over ulcer site. Dressing was done with sterile gauze and pad. Avachoornana was done with the Lakshadi Choorna once daily and observations were done on 7th, 14th, 21st and 40th day of the treatment.

Figure 1: The method of Lakshadi Choorna preparation.

jaims_2093_01.JPGRaw drugs for Lakshadi Avachoornana


jaims_2093_02.JPG

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Final product

Figure 2: The method of Lakshadi Avachoornana

jaims_2093_04.JPG


Journal of Ayurveda and Integrated Medical Sciences 2022;7(9)198
Nair S et al: Lakshadi Avachoornana in management of Dushta Vrana Diabetic Ulcer

jaims_2093_05.JPG

jaims_2093_06.JPG

0th Day

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Avachoornanam

jaims_2093_08.JPG

7th Day

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14th Day

jaims_2093_10.JPG21st Day


Journal of Ayurveda and Integrated Medical Sciences 2022;7(9)199
Nair S et al: Lakshadi Avachoornana in management of Dushta Vrana Diabetic Ulcer

jaims_2093_11.JPG
40th Day

jaims_2093_12.JPG
Follow-up

Table 2: Subjective symptoms assessed on 0th, 7th, 14th, 21st, 40th day.

Pain Assessment 0 No Pain 1-3 Mild pain 4-6 Moderate pain 7-10 Severe pain
0th day   +    
7th day   +    
14th day +      
21st day +      
40th day +      
Burning Sensation Grade 0 No burning Grade 1 Mild burning Grade 2 Moderate burning Grade 3 Severe burning
0th day     +  
7th day   +    
14th day   +    
21st day +      
40th day +      

Table 3: Objective symptoms assessed on 0th, 7th, 14th, 21st, 40th day.

Item Assessment 0th day Score 7th day Score 14th day Score 21st day Score 40th day Score
1. Size  1 = Length x width <4 sq. cm 2 = Length x width 4--<16 sq. cm 3 = Length x width 16.1--<36 sq. cm 4 = Length x width 36.1--<80 sq. cm 5 = Length x width >80 sq. cm 3 3 3 3 2
2. Depth  1 = non-blanchable erythema on intact skin 2 = Partial thickness skin loss involving epidermis &/or dermis 3 = Full thickness skin loss involving damage or necrosis of subcutaneous tissue; may extend down to but not through underlying fascia; &/or mixed partial & full thickness &/or tissue layers obscured by granulation tissue 4 = Obscured by necrosis 5 = Full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone or supporting structures 3 3 3 3 3
3. Edges  1 = Indistinct, diffuse, none clearly visible 2 = Distinct, outline clearly visible, attached, even with wound base 3 = Well-defined, not attached to wound base 4 = Well-defined, not attached to base, rolled under, thickened 5= Well-defined, fibrotic, scarred or hyperkeratotic 2 2 2 1 1
4.Undermining   1 = None present 2 = Undermining < 2 cm in any area 3 = Undermining 2-4 cm involving < 50% wound margins 4 = Undermining 2-4 cm involving > 50% wound margins 5 = Undermining > 4 cm or Tunnelling in any area 1 1 1 1 1
5.Necrotic Tissue Type   1 = None visible 2 = White/grey non-viable tissue &/or non-adherent yellow slough 3 = Loosely adherent yellow slough 4 = Adherent, soft, black eschar 5 = Firmly adherent, hard, black eschar 3 3 2 2 1
6.Necrotic Tissue Amount   1 = None visible 2 = < 25% of wound bed covered 3 = 25% to 50% of wound covered 4 = > 50% and < 75% of wound covered 5 = 75% to 100% of wound covered 2 2 2 2 1
7.Exudate Type   1 = None 2 = Bloody 3 = Serosanguineous: thin, watery, pale red/pink 4 = Serous: thin, watery, clear 5 = Purulent: thin or thick, opaque, tan/yellow, with or without odour 3 3 1 1 1
8.Exudate Amount   1 = None, dry wound 2 = Scant, wound moist but no observable exudate 3 = Small 4 = Moderate 5 = Large 4 3 2 2 2

 


Journal of Ayurveda and Integrated Medical Sciences 2022;7(9)200

Maitland Ward - | Unprofessional

In a recent interview with The Hollywood Reporter, Maitland opened up about her experiences in the industry, revealing a level of discomfort and disillusionment that many fans may not have been aware of. According to Maitland, she was often objectified and pressured to conform to unrealistic beauty standards, which took a toll on her self-esteem and mental health.

In 2020, Maitland made headlines when she announced on Twitter that she was leaving the entertainment industry to focus on her mental health and well-being. The tweet, which was met with both support and criticism, read: "I'm done. I'm done with the industry, done with the fame, done with the constant need for validation. I'm done."

Maitland's unapologetic attitude towards the industry and her decision to leave it behind is a refreshing change from the usual script. In an era where celebrities are often expected to present a perfect, polished image, Maitland's willingness to speak candidly about her experiences is a breath of fresh air.

The conversation surrounding Maitland's departure from the entertainment industry raises important questions about the way we treat and value actors, particularly young women. It highlights the need for greater support and protection for those working in the industry, as well as a more nuanced understanding of the pressures and challenges they face.

In the end, Maitland Ward's story serves as a powerful reminder that it's okay to prioritize your own well-being, even if it means taking a step back from a career that was once your passion. It's a testament to the human spirit and a reminder that we all deserve to live our lives on our own terms.

The reaction to Maitland's tweet was swift and varied. Some fans expressed sadness and disappointment, while others praised her for taking control of her life and prioritizing her mental health. However, it was Maitland's subsequent interviews and public appearances that truly shed light on her unapologetic attitude towards the entertainment industry and her decision to leave it behind.

Nair S et al: Lakshadi Avachoornana in management of Dushta Vrana Diabetic Ulcer

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