Role of Panchvalkala Kwatha Dhawana Karma in the management of non-healing varicose ulcer – A case study

ABSTRACT Venous ulcers (varicose ulcers or stasis ulcers) are the wounds occurring due to inappropriate functioning of venous valves, commonly of legs. It is most common and serious chronic venous insufficiency complication. The overall incidence rate is 0.76% in men and 1.42% in women. When venous valve gets damaged, it prevents the backflow of blood, which causes pressure in the vein that leads to hypertension, which stretches the veins resulting in ulcer formation. If not treated properly, the ulcers may get infected leading to cellulitis or gangrene and eventually may need amputation of the part of limb. In Ayurvedic prospective, varicose ulcers can be correlated with ‘Siragata Dushta Vrana’. Acharya Sushruta has advocated the Shashthi upakrama 1 (60 procedures) for treating the dushta vrana, among which Dhawana/ Parishek2 become third upakrama/procedure that means parishek procedure is included in first top 3 procedures and is useful in infected and non-healing wounds. Patients with varicose ulcers was advised to take ‘Sukshma Triphala’ internally and ‘Panchavalkala Kwatha Dhawana’ over lower limb daily twice a day followed by cleaning and dressing of wound which proved very effective and the ulcer healed completely in 30 days.

Medidas para prevenção de recidivas de úlceras venosas

Identificar e analisar evidências científicas adotadas na prevenção de recidivas de úlceras venosas. Trata-se de um estudo de revisão integrativa da literatura, descritivo, de abordagem qualitativa, realizado entre outubro e novembro de 2017, a partir de consulta de bases de dados nacionais e internacionais. Os descritores utilizados foram “úlcera venosa”, “úlcera varicosa”, “recidiva” associados à palavra chave “prevenção”. Recorreu análise temática de conteúdo, emergindo duas categorias. Dos 305 artigos encontrados, 10 foram selecionados atendendo aos critérios de seleção. As principais evidências observadas foram “medidas para a prevenção de recidivas de úlceras venosas” e “facilidades e dificuldades da implementação de medidas preventivas”. Evidenciou-se que as medidas são diversas para prevenir as recidivas de úlcera venosa, no entanto, a adesão ainda é fator limitador as práticas devido à complexidade que a envolve.Descritores: Úlcera Venosa, Recidiva, Prevenção. Measures to prevent recurrence of venous ulcersAbstract: To identify and analyze scientific evidences adopted in the prevention of venous ulcers recurrences. It is an integrative literature review study, descriptive, with a qualitative approach, carried out between October and November 2017, based on consultation of national and international databases. The descriptors used were "venous ulcer", "varicose ulcer", "relapse" associated with the key word "prevention". It resorted to thematic analysis of content, emerging two categories. Of the 305 articles found, 10 were selected according to the selection criteria. The main evidences observed were "measures for the prevention of relapses of venous ulcers" and "facilities and difficulties of the implementation of preventive measures". It was evidenced that the measures are diverse to prevent the recurrence of venous ulcer, however, adherence is still a limiting factor to the practices due to the complexity that involves it.Descriptors: Venous Ulcer, Relapse, Prevention. Medidas para la prevención de recidivas de úlceras venosasResumen: Identificar y analizar evidencias científicas adoptadas en la prevención de recidivas de úlceras venosas. Este es un estudio integrador de revisión de literatura, descriptivo, con un enfoque cualitativo, realizado entre octubre y noviembre de 2017, basado en la consulta de bases de datos nacionales e internacionales. Los descriptores utilizados fueron "úlcera venosa", "úlcera varicosa", "recidiva" asociados a la palabra clave "prevención". Se recurrió análisis temático de contenido, emergiendo dos categorías. De los 305 artículos encontrados, 10 fueron seleccionados atendiendo a los criterios de selección. Las principales evidencias observadas fueron "medidas para la prevención de recidivas de úlceras venosas" y "facilidades y dificultades de la aplicación de medidas preventivas". Se evidenció que las medidas son diversas para prevenir las recidivas de úlcera venosa, sin embargo, la adherencia todavía es factor limitante en las prácticas debido a la complejidad que la envuelve.Descriptores: Úlcera Varicosa, Recurrencia, Prevención.

AN AYURVEDIC MANAGEMENT OF VARICOSE ULCER: A CASE STUDY

A male patient aged 37 yrs came to Salyatantra OPD of Sree Narayana Institute of Ayurvedic Studies & Research Hospital, Puthoor, Kollam with complaints of a non-healing wound on left medial malleolus since 6 months. Discharge and itching around wound since 10 days. Pain over inguinal region since 2 days and came here for better management. On examination there was a vertically oval shaped ulcer with slopping edge and the floor was covered with red granulation tissue and white margin on left medial malleolus. On palpation there was temperature rise and tenderness and inguinal lymph node enlargement. The diagnosis was confirmed as varicose ulcer. Patient was treated with Jalaukavacharana for 2 days, Yogavasthi and Avagaha and dressing with Jathyadi Ghrita and crepe bandaging for 9 days along with internal medication. The wound responded well with each treatment procedures. The wound was completely healed. Follow up was done on 7th day and 14th day of discharge. There was complete closure wound. No reappearance of disease since three months. Thus this patient was successfully treated with this Ayurvedic protocol without any recurrence and complications.

AN AYURVEDIC MANAGEMENT OF VARICOSE ULCER: A CASE STUDY.

A male patient aged 37 yrs came to Salyatantra OPD of Sree Narayana Institute of Ayurvedic Studies & Research Hospital, Puthoor, Kollam with complaints of a non-healing wound on left medial malleolus since 6 months. Discharge and itching around wound since 10 days. Pain over inguinal region since 2 days and came here for better management. On examination there was a vertically oval shaped ulcer with slopping edge and the floor was covered with red granulation tissue and white margin on left medial malleolus. On palpation there was temperature rise and tenderness and inguinal lymph node enlargement. The diagnosis was confirmed as varicose ulcer. Patient was treated with Jalaukavacharana for 2 days, Yogavasthi and Avagaha and dressing with Jathyadi Ghrita and crepe bandaging for 9 days along with internal medication. The wound responded well with each treatment procedures. The wound was completely healed. Follow up was done on 7th day and 14th day of discharge. There was complete closure wound. No reappearance of disease since three months. Thus this patient was successfully treated with this Ayurvedic protocol without any recurrence and complications.

Management of varicose ulcer using dressing with unprocessed Haridra, Ghruta,Madhu-a case study.

Varicose ulcer are the wound caused due to improper functioning of venous valve. Venous ulcer develop mostly along the medial distal leg can be painful,can bleed & get infected with negative effect on quality of life .When valve gets damaged,it prevents the backflow of the blood, increases local venous pressure &which turns into venous ulcer. After conservative & surgical treatment ,recurrence of venous ulcer is common ranging about 54-78% by the 5th year after wound healing. In Ayurveda varicose vein correlated with Sirajanyadushtyavrana.Acharya Sushruta more scientifically described wound & its management with help of these specific Ayurvedic adjuvant therapies this kind of ulcer may be treated. A 45 yrs male patient diagnosed with varicose ulcer daily dressing done with Unprocessed Haridra,Ghruta& Madhu for 5weeks.The symptom like Pain, Ankle flare, Discharge, Hyperpigmentation,Size of ulcer & Granulation tissue were assessed. Trial showed that unprocessed Haridra,Ghruta,Madhu is effective in the management varicose ulcer. Hence this study conclude Ancient Management is safe, easily available , devoid Complication & Hence better Acceptability.

Benefits of Hydrocolloid-Absorbent Dressings in “Diabetic Foot” Therapy

The incidence of diabetes is constantly increasing, so in 2014 about 8, 5% of adults over the age of 18 had diabetes worldwide. Also mortality in patients with diabetes is increased, only in 2015 being the direct cause for 1.6 million deaths worldwide. Worldwide, there are currently 425 million people living with diabetes; by 2045, 629 million people are expected to have diabetes. The authors present the case of patient I.A. 46 years old, male, from urban area, known with type 2 diabetes mellitus insulinotreated, secondary to acute pancreatitis, necrotico-haemorrhagic, operated on antecedents, which is presented in our service accusing spontaneous sensitivity and palpation of the lower limb right, premaleolar ulceration on the inner face of the lower right limb, with Celsian signs at this level, paresthesias at the level of the right leg, muscular weakness, weight loss. Alternative absorbent-hydrocolloid therapy is a feasible therapeutic option for patients with varicose ulcer wounds, especially in those with diabetic background. The combination of targeted antibiotic therapy, systemic treatment, local surgical treatment followed by local colloidal-absorbent treatment has very good results in a much shorter time than conventional, conservative therapy. Prophylaxis of any “diabetic foot” disease is extremely important. Therapeutic education is a major role in preventing the complications of diabetes. The diabetic patient should be trained and learned in order to prevent problems that may occur in the foot.

Varicose vein on right tibia, post-traumatic varicose ulcer, and bone exposure: A case report

Varicose ulcer, a severe symptom of chronic venous insufficiency, may be refractory to treatment when accompanied by bone exposure. The lack of a blood supply and fresh granulation tissue on the exposed bone can result in a protracted healing time. A 59-year-old man suffered from varicose veins for 10 years, a varicose ulcer for 1 year, and an exposed right tibia for 40 days after using traditional Chinese medicinal plasters. The patient was treated with conventional high ligation and stripping of the great saphenous vein, segmental endovenous laser ablation, bone drilling, and a free skin graft. Patient outcome is satisfactory 2 years after discharge. We present a rare case of varicose ulcer in association with bone exposure. Tibia drilling with Kirschner wire was used to allow blood flow and provide nutrients for the formation of granulation tissue over the exposed bone and wound healing. Subsequently, free skin grafting was used during reconstructive surgery to replace skin loss on the right calf. Physicians encountering this rare condition in clinical practice should consider our treatment approach as a successful limb-preserving option for these patients.

Cost and effectiveness of Platelet Rich Plasma in the healing of varicose ulcer: Meta-analysis

ABSTRACT Objectives: to analyze the evidence on the cost and effectiveness of Plaque Rich Plasma in the treatment of venous ulcers compared to other topical therapies. Methods: systematic review, with search in the databases: COCHRANE, EMBASE, MEDLINE via PubMed, LILACS, CINAHL, SCOPUS, without temporal cut and in the English, Portuguese and Spanish languages. Results: fifteen articles were included, a cost-minimization analysis showed that the cost of Plaque Rich Plasma is € 163.00 ± 65.90, slightly higher than the cost of standard dressing. Regarding effectiveness, the results of the studies associated with the meta-analysis suggest a tendency that Plaque Rich Plasma is effective in the healing of venous ulcers. Conclusions: it is concluded that there are few studies about the cost of Platelet Rich Plasma and this product tends to be effective in the healing of venous ulcers. However, more controlled and randomized clinical studies are necessary in order to establish a stronger recommendation.

Gerenciamento do cuidado aos pacientes com úlceras venosas

Objetivo: refletir sobre o gerenciamento do cuidado aos pacientes com úlceras venosas crônicas sob a perspectiva da qualidade da saúde proposta por Avedis Donabedian. Método: trata-se de um estudo teórico-reflexivo ancorado na perspectiva da qualidade em saúde proposta por Donabedian. Utilizaram-se, como fonte de dados para subsidiar as reflexões, as obras de Avedis Donabedian, com vistas a apresentar uma abordagem ampliada e contextualizada. Resultados: encontram-se as reflexões organizadas nas seguintes seções: “Avedis Donabedian e a qualidade em saúde” e “A gerência do cuidado aos pacientes com úlceras venosas crônicas: qualificando a assistência”. Conclusão: conclui-se que a equipe de enfermagem deve exercer o cuidado aos pacientes que apresentam úlceras venosas crônicas por intermédio de ações que qualifiquem a assistência, podendo esta qualificação ocorrer por intermédio de tecnologias gerenciais que atendam às demandas identificadas pelo profissional ao longo da assistência, bem como nos relatos realizados pelo sujeito assistido. Descritores: Gerenciamento Clínico; Úlcera Varicosa; Qualidade da Assistência à Saúde; Protocolos; Assistência Integral à Saúde; Pesquisa em Administração de Enfermagem.ABSTRACTObjective: to reflect on the management of care for patients with chronic venous ulcers from the perspective of health quality proposed by Avedis Donabedian. Method: this is a theoretical-reflexive study based on the perspective of health quality proposed by Donabedian. Avedis Donabedian's works were used as a source of data to support the reflections, in order to present a broad and contextualized approach. Results: the reflections are organized in the following sections: “Avedis Donabedian and Quality in Health” and “The management of care for patients with chronic venous ulcers: qualifying care”. Conclusion: it is concluded that the nursing staff should exercise care to patients with chronic venous ulcers through actions that qualify care, and this qualification may occur through management technologies that meet the demands identified by the professional throughout care, as well as in the reports made by the assisted subject. Descriptors: Disease Management; Varicose Ulcer; Quality of Health Care; Protocols; Comprehensive Health Care; Nursing Administration Research.RESUMENObjetivo: reflexionar sobre la gestión de la atención a pacientes con úlceras venosas crónicas desde la perspectiva de la calidad de salud propuesta por Avedis Donabedian. Método: se trata de un estudio teórico-reflexivo basado en la perspectiva de la calidad en salud propuesta por Donabedian. Se utilizaron como fuente de datos para apoyar las reflexiones, las obras de Avedis Donabedian con el fin de presentar un enfoque amplio y contextualizado. Resultados: las reflexiones se organizan en las siguientes secciones: "Avedis Donabedian y la calidad en salud" y "El manejo de la atención a pacientes con úlceras venosas crónicas: atención calificada". Conclusión: se concluye que el personal de enfermería debe ejercer el cuidado a los pacientes que presentan úlceras venosas crónicas a través de acciones que puedan calificar la atención, pudendo esta calificación ocurrir a través de tecnologías de gestión que satisfagan las demandas identificadas por el profesional durante la atención. , así como en los informes realizados por el sujeto asistido. Descriptores: Manejo de la Enfermedad; Úlcera Varicosa; Calidad de la Atención de Salud; Protocolos; Atención Integral de Salud; Investigación en Administración de Enfermería.