Department of Post Graduate Studies

From,

DR.SAJI DESAYUS B.A.M.S

PG Scholar

Department of Post Graduate Studies

In Shalya Tantra

T.M.A.E Society’s AyurvedicMedicalCollege.

To,

THE REGISTRAR,

RajivGandhiUniversity of Health Sciences, Karnataka

Bangalore.

Through:

The Principal and Head of the Department of Shalya Tantra

T.M.A.E Society’s AyurvedicMedicalCollege

Sanklapur, Thanda, Hospet-583 201.

Respected Sir,

Subject :- SUBMISSION OF COMPLETE PR0FORMA FOR

REGISTRATION OF SUBJECT FOR DISSERTATION

I request you to kindly register the below mentioned subject against my name for the submission of dissertation to the Rajiv Gandhi University of Health Sciences,

Karnataka, Bangalore for the partial fulfilling of M.S [Ayu] in Shalya Tantra.

Title of dissertation:

MANAGEMENT OF BAHYA GUDA GATA VRANA(PERI-ANAL WOUND) WITH LEKHANA KARMA AND APPLICATION OF ANALADI THAILA PICHU

- A CLINICAL STUDY-

Herewith I am enclosing the complete Proforma for the registration of subject for dissertation.

Place: HospetYours faithfully

Date: 27/11/08[Dr. Saji Desayus]

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RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGLORE, KARNATAKA

PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION.

ANNEXURE – II

1. NAME OF THE CANDIDATE :DR. SAJI DESAYUS

AND ADDRESS :T.M.A.E SOCIETY’S AYURVEDIC

MEDICALCOLLEGE

SANKLAPUR THANDA

HOSPET-583 201.

2. NAME OF THE INSTITUTION :POST GRADUATE STUDIES AND

RESEARCHCENTER

DEPARTMENT OF SHALYA TANTRA

T.M.A.E AYURVEDIC MEDICAL

COLLEGE AND HOSPITAL

HOSPET. PIN ; 583 201

3. COURSE OF STUDY : AYURVEDA VACHASPATHI M.S.[AYU]

SUBJECT : SHALYA TANTRA

4. DATE OF ADMISSION : 07/06/08

5. TITLE OF THE TOPIC :MANAGEMENT OF BAHYA GUDA GATA VRANA (PERI-ANAL WOUND) WITH LEKHANA KARMA AND APPLICATION OF ANALADI THAILA PICHU

- A CLINICAL STUDY -

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1. BRIEF RESUME OF THE STUDY

6.1] Need for the study :

Bahya guda gata vrana or peri-anal wound or ulcer is one of the most common problem man is encountering in the present day scenario. The supersonic lifestyle of modern circumstances summed up with irregular dietary and defecatory habits ,thresholding the natural urge, sedentary life pattern, lack of sanitary hygiene and awareness drags him into this situation.

Most people take it as a very simple wound, but when unattended and not properly treated it takes you for a real hazardous situation called Nadi vrana or Fistula in ano or Bhagandhara.

The neglected peri-anal wound which is converted into Fistula in ano either needs a surgical intervention or the Kshara sutra ligation therapy.In case of high anal fistulae, fistulectomy is done.In this cases the sphincter muscles of the anus is affected and sometimes irreversibly damaged and incontinence of stool is inevitable. After the Kshara sutra treatment also in some cases anal stricture will occur. This is a very complicated situation where a ano rectal surgeon’s efficacy and success is periodically put under scrutiny.

The said modalities are of long term duration which is an obvious nuisance and agony for the patients. The cost factor also is very high. This will really affect a patient’s social, economical, domestic, physical and mental equilibrium. All these unwanted maladies are only because bahya guda gata vrana is neglected or improperly treated.

Hence, by considering all these above mentioned factors, an early intervention or treatment of bahya guda gata vrana or peri anal wound seems to be the need of this hour. To carry out the above mentioned clinical study serves ‘a stitch in time saves nine’ philosophy and a very appropriate necessity and hence the study.

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6.2) Review of Literature :

1.Nidana,samprapti,lakshana of vrana,dusta vrana, nadi vruna.

2. Lekhana Karma

1,2

(1)Susruta Samhita

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(2)Charaka Samhita

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(3)Astanga Hrudaya

6

(4)Yogachandrika

8,9

(5)Astanga Sangraha

2. Signs and symptoms of peri anal wounds, abscess, sinus and fistula.

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(a)Bailey and Love’s short practice of surgery.

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(b)S.Das concised text book of surgery.

6.3)Objectives of the study :

(1)A literary work on Vrana, Vidradi and Nadi vrana.

(2)A literary study regarding Lekhana Karma in Vrana.

(3)To evaluate the efficacy of Analadi tail and Lekhana Karma in Bahya guda gata vrana.

(4)To evaluate the efficacy of Analadi Tail Pichu in Bahya guda gata vrana.

6.4)Previous work done :

(1)S.N.Mishra, Studies on VranaRopanaBanarasHinduUniversity,1969.

(2) A.K.Tripathi, Effect of Madhu-Sarpi in the management of Vrana, BanarasHinduUniversity,1999.

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(3) G.L.Sharma ,Vrana –Ropana mein Jatyadi Taila ki Karmukata ka Adhyayana,RajasthanUniversity,Jaipur,1997.

(4) G.L.Sharma ,Management of Dusta Vrana with Karaskaradi Ghrita ,KeralaUniversity,Thiruvananthapuram1998

(5) Guru Murthy,Management of Nadi-Vrana with Indegenous drugs Dr.BRKRGovt.AyurvedicCollege,Hyderabad2001.

7)Materials and Methods:

7.1) Source of data:

a) Patients : Patients will be selected randomly from OPD and IPD, P.G Dept of

SHALYATANTRA. T.M.A.E.S. Ayurvedic medical college and Hospital, Hospet, as per inclusion and exclusion criteria

b) Literaray : Literary aspect of the study will be collected from classical Ayurvedic and modern text with updated medical journals and

from internet.

c) Management :

i)Detailed history of selected patient will be taken.

ii)Procedure of Lekhana Karma and Analadi Tail pichu will be done under local anaesthesia. Dead tissue slough will be removed by lekhana karma with the help of scope. After achieving the total haemostasis pichu of analadi tail will be applied on the wound and dressing will be done with moderate pressure.Vrana dhavan and analadi tail pichu will be done for 10 days.

iii)Noted in specific Performa and essential investigations will be done.

iv)The follow up study will continue for 20 days.

v)Needful physical examination and investigation will be done before and after treatments.

vi)Result will be recorded ,compared and analysed statistically.

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7.2) Methods of collection of data :

i)Study design : Randomised clinical trial.

ii)Sample size : A minimum of 30 patients diagnosed with Bahya guda gata vrana irrespective of sex, religion and economic status shall be considered.

iii)Selection criteria : The cases are selected strictly as per present inclusion and

exclusion criteria.

Inclusion criteria:

(1)Patients presenting with the signs and symptoms of Bahya guda gata vrana(peri anal wound)

(2)Patients of either sex between age group 20-65 yrs.

(3) Patients fit for Lekhana Karma.

Exclusion criteria :

(1) Patients suffering from Fistula in ano or Nadi vrana.

(2) Patients suffering from T.B.,HIV,Syphillis and HbsAg.

(3) Patients suffering from severe anaemia.

(4) Patients with Malignancy of ano rectal region.

(5) Patients suffering from uncontrolled diabetes mellitus,hypertension,nephritis etc

(iv)Diagnostic criteria :

Clinically diagnosed by

(1)pain at the site(ruk)

(2)Swelling(shwayathu)

(3)Tenderness(sparshahishnutha)

(4)Change of colour(vivarnatha)

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(5)Change of skin level(Ucha neechathva)

(6)Change of hardness of skin(parushata)

(7)Smell (Gandha)

(8)Discharge(Sraavi)

(v)Duration of study :

For 20 days.

(vi)Follow up :

Follow up will be done once in 3 days for 20 days.

(vii)Assessment criteria :

(a)Subjective parameter:

Patient’s wound shall be subjectively analysed by

(1) Size and shape

(2) Discharge

(3) Colour

(4) Edge

(5) Floor

(b)Objective parameter:

Patient shall be objectively analysed by

(1)Pain

(2)Duration

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(viii)Laboratory investigation:

Blood -Hb%

ESR

CT

BT

VDRL

RBS

Tridot

Urine -Routine Examinations

Stool -Routine Examination

Monteax test

Other investigations if necessary.

7.3)Ethical clearance obtained from your institution:Yes

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8. List of references:

1. Sushruta Samhita Sutrastana Vol I by P.V.Sharma Chapter 28,pg 284.

1. Sushruta Samhita Nidana stana, Sarira stana and Chikitsa stana by P.V.Sharma Chapter 1 pg 245-250 Chapter 8 pg 349 and Chapter 16 pg 417.

1. Bailey and Love’s Short Practice of Surgery,London,ELBS, Chapman and Hall 22nd Edition,1995,1041.

1. S.Das’s concise book of Surgery,Calcutta,13 Old Mayor’s Court,3rd Edition,2001.

1. Astanga hrudaya by Prof K.R.Srikantha Murthy Chapter 25 pg 235 and Chapter 28 pg 265.

1. Yogachandrika by Sri Laksamana Pandita edited and translated by Dr.Asha kumari and Prof P.V.Tiwari Chapter 33 pg 413 and 420.

1. Charaka samhita Vol 4 by R.K.Sharma and Bhagwan Dash Chapter 25.

1. Astanga Samgraha Sutrastana Vol 1 by Dr.P.Srinivas Rao Chapter 38.

1. Astanga Samgraha Nidana stana Chikitsa stana Vol 2 Chapter 11 pg 230,Chapter 15 pg 475.

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9)Signature of the Candidate:

10)Remarks of Guide:

11)Name and Designation:

11.1)Guide:

11.2)Signature:

11.3)Co-Guide:

11.4)Signature:

11.5)Head of the Department:

11.6)Signature:

12)Remarks of Chairman and Principal:

12.1)Signature:

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