RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION IN AYURVEDA DHANWANTHARI M.S.(Ay) IN SHALYATANTRA
“ EVALUATION OF EFFICACY OF BAMBOO FIBRE THREAD
AS A SUTURING MATERIAL – AN EXPERIMENTAL STUDY ”
Submitted by:
Dr. SREEJITH SATHEESAN B.A.M.S.
1st year P.G. Scholar
Department of P.G. Studies in Shalyatantra
Alva’s Ayurveda Medical College
Moodbidri, D.K. (Dist)
Karnataka
Guide Co-Guide
Dr. RAVISHANKAR.A.G M.S.(Ay) Dr. SUBRAHMANYA.P M.D.(Ay), Ph.D.
Assistant Professor Professor & H.O.D.
Dept. of P.G. Studies in Shalyatantra Dept. of P.G. Studies in Dravyaguna Vijnana Alva’s Ayurveda Medical College Alva’s Ayurveda Medical College
Moodbidri, D.K. Moodbidri, D.K.
______
2011 – 2012
Alva’s Ayurveda Medical College
Moodbidri, Dakshina Kannada District
Karnataka – 574 227
From,
Dr. SREEJITH SATHEESAN
1st year P.G. Scholar
Department of P.G. Studies in Shalyatantra,
Alva’s Ayurveda Medical College,
Moodbidri, Dakshina Kannada District,
Karnataka – 574 227
To,
THE REGISTRAR
Rajiv Gandhi University of Health Sciences,
4th ‘T’- Block, Jayanagar, Bangalore – 560 041
Through,
THE PRINCIPAL
Alva’s Ayurveda Medical College,
Moodbidri, Dakshina Kannada District,
Karnataka – 574 227
Sub: Submission of completed proforma for registration of subject for Dissertation in M.S.(Ay) – regarding –
Respected Sir,
I humbly request you to register the below mentioned subject against my name for the submission of dissertation to the Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka; for the partial fulfillment of M.S.(Ay) in Shalyatantra.
TITLE OF DISSERTATION:
“ EVALUATION OF EFFICACY OF BAMBOO FIBRE THREAD
AS A SUTURING MATERIAL – AN EXPERIMENTAL STUDY ”
I am here with enclosing the completed proforma for the registration of subject for the dissertation in M.S. (Ay).
Thanking you.
Yours faithfully,
Place: Moodbidri
Date : Dr. Sreejith Satheesan
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
IN M.S.(AY) SHALYATANTRA
1. Name of the Candidate & Address : / Dr. SREEJITH SATHEESAN1st year P.G. Scholar,
Department of P.G. Studies in Shalyatantra,
Alva’s Ayurveda Medical College,
Moodbidri, Dakshina Kannada District, Karnataka
Permanent Address : / “Sumithra”, T.C. 30/1986,
Kallummoodu, Anayara P.O. ,
Thiruvananthapuram, Kerala – 695 029
2. Name of the Institute : / ALVA’S AYURVEDA MEDICAL COLLEGE,
Moodbidri, Dakshina Kannada District,
Karnataka – 574 227
3. Course of Study and Subject : / M.S. (AYURVEDA), SHALYATANTRA
4. Date of Admission to Course : / 30th August, 2011
5. Title of the Research Topic :
“ EVALUATION OF EFFICACY OF BAMBOO FIBRE THREAD
AS A SUTURING MATERIAL – AN EXPERIMENTAL STUDY ”
6. BRIEF RESUME OF THE INTENDED WORK
6.1 NEED FOR THE STUDY
The first and foremost aim in the field of Surgery is imparting wound care by preserving the intact tissues and supporting the damaged parts. In that respect, Seevana Karma1 or Suturing technique comes first especially regarding the approximation of the cut wound or surgeon-made wound. Surgical suture is the commonest medical device which is used for tissue repairs and most of the wound closures even today. Function of the suture is to provide closing tension to promote healing2. Detailed description of suturing materials and methods available are date back to the Saṃhita period. Later several researches and advancements have been made in field of suturing techniques and wound closure. Sutures are classified as natural vs. synthetic, absorbable vs. non-absorbable, and multifilament vs. monofilament in different sizes2. Non-absorbable sutures can be made from nylon, polypropylene, stainless steel, cotton fibres, Teflon, polyester, Dacron and a variety of less commonly used synthetic materials3. Even though synthetic sutures are highly efficient, their cost of production is more and not affordable by common people; and also their method of production is not eco-friendly.
Natural non-absorbable sutures now available are made from silk, linen, and cotton. As the natural fibres have more tissue acceptance and bio-tolerance than synthetic fibres and moreover with the growing demand for healthier and environmental friendly products, the current study is designed to experiment a new non-absorbable suture made of natural fibres obtained from Bamboo plant or Twaksara4 / Vamsha5, 6, 7.
One of the latest developments in new fibre researches is the use of bamboo fibre in various textiles and other industires8. Natural fibres are eco-friendly, abundantly available, renewable, and cheap and have low density8. The biodegradability of plant fibres can contribute to a healthy ecosystem while their low cost and high performance fulfills the economic interest too9. The antimicrobial effect of the bamboo is significantly higher than that of cotton for both gram-positive and gram-negative bacteria10. So the bacteriostatic and antimicrobial properties of bamboo fibres cannot be proved to be false10.
In the United States Pharmacopoeia (USP) the Tensile Strength11 and Cross-diameter are the only physical data that are used to specify surgical suture materials. Many other properties such as distensibility, surface friction, flexibility and knot properties are of great interest to the surgeon. Hence, the present experimental study is undertaken to evaluate the efficacy of Bamboo fibre thread as a suturing material focusing upon its tensile strength and other physical properties along with its tissue acceptance and reactivity.
6.2 REVIEW OF LITERATURE
Literature review will include the following aspects:
Ø Detailed description of Seevana Dravyas and Seevana Karma as in Ayurveda classics.
Ø Modern suturing techniques and suturing materials.
Ø Anatomy of skin of Albino rats in comparison to that of Human skin.
Ø Physical, Mechanical, and Histological properties of bamboo fibre.
The review of literature will be done by screening classical Ayurveda and Modern literatures, textbooks, journals, articles and reliable internet sources to collect sufficient data for the study.
Previous works done
1. Dr. Swati Yedke, “Experimental evaluation of Horse hair as non-absorbable monofilament suture”, Govt. Ayurvedic College, Nagpur University, Nagpur; 2007.
2. Dr. Yashaswini Bharadwaj.B. , “Evaluation of efficacy of Murva as suturing material in operated cases of Inguinal hernia”, S.D.M. College of Ayurveda, Rajiv Gandhi University of Health Sciences, Bangalore; 2011.
6.3 OBJECTIVES OF THE STUDY
1. To process the Phyllostachys heterocycla pubescens12 fibres, to make it into an acceptable non-absorbable suturing material, and study its physical properties.
2. To observe the Tensile Strength of the Bamboo fibre thread at various stages.
3. To note its merits / demerits as a suturing material for skin and compare it with the standard Surgical Linen No. 20.
4. To evaluate its tissue acceptance and reactivity.
7.0 MATERIALS AND METHODS
7.1 SOURCE
Ø Literary Source
All the classical Ayurveda and modern literatures and contemporary texts including information from reliable websites will be reviewed and documented for the intended study.
Ø Raw Materials for Suture
The present study will utilize Bamboo fibres extracted from Bamboo species Phyllostachys heterocycla pubescens f.subconvexa12.
Ø Test and Control Animals
The experimental study is to be carried out in Albino rat species Rattus norvegicus13,14 provided at the animal house of Alva’s Ayurveda Medical College, Moodbidri; where the study is to be undergone.
7.2 METHOD OF COLLECTION OF DATA
7.2.1 STUDY DESIGN
The present study is planned to be conducted with Albino rats - an experimental design.
7.2.2 SAMPLE
Twelve Albino rats (Rattus norvegicus13,14) of either sex will be selected randomly for the study.
7.2.3 INCLUSION CRITERIA
Healthy Albino rats each weighing 150 – 200 g.
7.2.4 EXCLUSION CRITERIA
Animals which are infected, diseased, and pregnant and those which are under other experiments will be excluded.
7.2.5 GROUPING
Ø Control Group (I) : A surgeon-made skin incision in 6 Albino rats will be sutured with autoclaved Surgical Linen No. 20.
Ø Test Group (II) : A surgeon-made skin incision in 6 Albino rats will be sutured with autoclaved Bamboo fibre thread.
7.2.6 PROCEDURE
All procedures on experimental rats are conducted in accordance with the standards of the Institutional Animal Ethical Committee (IAEC) of this institution.
Ø Materials Used :
Needle holder, Toothed forceps, BP handle with blade, Bamboo fibre thread, Surgical linen no. 20, Suture cutting scissors, Surgical spirit, Insulin injecting syringe, Curved cutting needle with eye, Razor, Gloves, Sterile mops, Betadiene.
Ø Pre-Operative :
Induction of anesthesia will be achieved on each Albino rats from both groups I & II by a single intra-peritoneal injection of Ketamine/Medetomidine (75/0.5 mg/kg)15. Anesthesia will be prolonged by inhalation of ether as required. After anesthesia, the dorsum of each rat will be shaved with razor and the skin cleaned with Betadiene followed by surgical spirit.
Ø Operative :
A full thickness skin incision of about 2 - 2.5 inches length is made on the dorsum of the rat starting from back of the neck towards the tail. Wound is secured with Vertical Mattress sutures at a distance of 1cm. The Test group (II) animals will be sutured using autoclaved Bamboo fibre thread and the Control group (I) animals with autoclaved Surgical Linen No. 20.
Ø Post-Operative :
Surrounding areas of the wound will be cleaned using Betadiene. Analgesics and sedatives will be given according to the necessity till 24 – 48 hours after the operation, and furthermore if required. Each sample will be maintained in separate cages.
7.2.7 DURATION OF STUDY
Ø Study period : From the day of operation till the suture is removed.
Ø Follow – up period : 7th day after removal of the suture.
7.2.8 OBSERVATION
Ø Each animal from both groups will be observed daily from the day of operation and the wound will be cleaned with Betadiene to prevent infection from outside.
Ø Sutures are removed when the wound heals completely.
Ø During the follow-up, the Length and Breadth of the scar will be measured in centimeters and millimeters respectively.
7.2.9 ASSESSMENT CRITERIA
Ø Assessment of the Bamboo fibre thread
1. Thickness (before & after autoclaving, and after removal of suture)
2. Tensile Strength (before & after autoclaving, and after removal of suture)
3. Knot Security
4. Capillarity
5. Elasticity
6. Handling
Ø Assessment of the Wound
1. Pain
2. Oedema
3. Colour of surrounding skin
4. Local rise of temperature
5. Discharge
6. Days taken for healing
7. Tensile Strength of the wound edge
8. Size of scar
A detailed proforma will be prepared and assessment is done based on gradation given for the objective parameters and analyzed statistically.
7.3 Does the study require any investigations or interventions to be conducted on patients or humans or animals? If so, please describe briefly :
Yes, this study will be conducted on experimental animals.
7.4 Has ethical clearance been obtained from your institution in case of above statement?
Yes, ethical clearance has been obtained from the ‘Institutional Animal Ethical Committee’ of this institution.
8.0 LIST OF REFERENCES
1. Suśruta, “Suruta Saṃhitā”, commentary by Dalhana, edited by Acharya,Vaidya Jadvji Trikamji, Acharya,Narayan Ram; Chaukambha Sanskrit Sansthan, Ed. 2010, Sootra Sthana 25: 16 – 28 shloka, pp. 118
2. Yang, Cheng-San; Chen,Chin-Yi; “The Effect of Suture Size on skin wound healing Strength in Rats”, Journal of Medical and Biological Engineering, 31(5): 339-343, 4th Aug. 2010
3. Greenwald,Daniel; Shumway,Scott; Alber,Paul; Gottlieb,Lawrence; “Mechanical Comparison of 10 Suture Materials before and after in Vivo Incubation”, Journal of surgical Research, Academic Press Inc; 56, 372-377 (1994)
4. Suśruta, “Suruta Saṃhitā”, commentary by Dalhana, edited by Acharya,Vaidya Jadvji Trikamji, Acharya,Narayan Ram; Chaukambha Sanskrit Sansthan, Ed. 2010, Sootra Sthana 8: 15th shloka, pp. 41
5. Suśruta, “Suruta Saṃhitā”, commentary by Dalhana, edited by Acharya,Vaidya Jadvji Trikamji, Acharya,Narayan Ram; Chaukambha Sanskrit Sansthan, Ed. 2010, Sootra Sthana Ch.8, pp. 41
6. Pandeya,Gangasahaya, “Bhavaprakasha Nighantu”, commentary by Chumekar,Krishnachad, Chaukambha bharati Academy, 2010, ISBN 978-81-909872-0-2, p. 362-364
7. Pandey,Gyanaendra, “Dravyaguna Vijnana, Materia Medica – Vegetable Drugs”, Krishnadas Academy, Ed. 1, Vol. Part III, 2001, ISBN 81-218-00870-0, p. 770-777
8. Erdumulu,Nazan; Ozipek,Bulent; “Investigation of Regenerated Bamboo Fibre and Yarn Characteristics”, J. Fibres & Textiles in Eastern Europe 2008, Vol. 16, No. 4(69) pp. 43-47
9. Kispotta,Usha Gracy; “Synthesis and Characterization of Bio-Composite Material”, Department of Physics, National Institute of Technology, Rourkela; 1(5) pp. 11
10. Gercke,Adine; Jani van der Pol; “A Comparative Study of Regenerated Bamboo, Cotton and Viscose Rayon fabrics. Part 2: Antimicrobial Properties”; Journal of Family Ecology and Consumer Sciences, 2011; Vol.39, ISSN 0378-5254; pp. 17
11. Holmlund,Dan.E.W.; “Physical Properties of Surgical Suture Materials: Stress-Strain Relationship, Stress-Relaxation and Irreversible Elongation”, Dept. of Surgery, University of Umea, Sweden; Ann. Surg. pp. 189
12. http://en.wikipedia.org/wiki/phyllostachys_edulis
Page last modified on 20 February 2012 at 11:29
13. http://www.uniport.org/taxonomy/10116 © 2002-2012 Uniport Consortium, 17th March 2012, 12:30
14. http://en.wikipedia.org/wiki/Laboratory_rat
Page last modified on 28 February 2012 at01:50
15. Hedenqvist, Patricia; “Anesthesia and Analgesia for Surgery in Rabbits and Rats: A Comparison of the Effects of different Compounds”, Department of Physiology and Pharmacology, Karolinska Institute, Sweden; ISBN 978-91-7357-578-2, 2008; pp.17
9. Signature of the candidate :
10. Remarks of the Guide :
11. Names and Designation of :
11.1 Guide
Dr. RAVISHANKAR.A.G. M.S.(Ay)
Assistant Professor
Department of P.G. Studies in Shalyatantra,
Alva’s Ayurveda Medical College,
Moodbidri, Dakshina Kannada District,
Karnataka – 574 227
11.2 Signature and seal
11.3 Co-Guide
Dr. SUBRAHMANYA.P. M.D.(Ay), Ph.D.
Professor & H.O.D.
Department of P.G. Studies in Dravyaguna Vijnana,
Alva’s Ayurveda Medical College,
Moodbidri, Dakshina Kannada District,
Karnataka – 574 227
11.4 Signature and seal
11.5 Head of the Department
Dr. MANJUNATHA BHAT M.S.(Ay)
Assistant Professor & H.O.D.
Department of P.G. Studies in Shalyatantra,
Alva’s Ayurveda Medical College,
Moodbidri, Dakshina Kannada District,
Karnataka – 574 227
11.6 Signature and seal
12. Remarks of Principal :
12.1 Signature and seal