E-ISSN:2456-3110

Case Report

Diabetic Ulcer

Missax 23 05 15 April Olsen My Favorite Mistake Top

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.

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.

Keywords: Dushta Vrana, Avachoornana, Diabetic Ulcer, Lakshadi Choorna

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: missax 23 05 15 april olsen my favorite mistake top		 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		 missax 23 05 15 april olsen my favorite mistake top

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%

missax 23 05 15 april olsen my favorite mistake topmissax 23 05 15 april olsen my favorite mistake top © 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

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According to details on IMDb , the story centers on the intense friction between an ex-marine stepfather, played by , and his adult stepdaughter, played by April Olsen .

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(coded as 23-05-15). The production is noted for its narrative focus, often described as a "two-hander" or one-act play due to its character-driven script. Scene Overview

: April Olsen plays a "layabout adult stepdaughter," and veteran performer Chad White plays her ex-Marine stepfather .

In conclusion, the combination of April Olsen's exceptional talent, the compelling narrative, and the high-quality production values have cemented Missax 23 05 15's status as a standout production in the adult entertainment industry. As a performer, Olsen continues to inspire and captivate audiences, pushing boundaries and redefining the possibilities of adult entertainment.

April's journey with Missax's music had led her to create something truly unique, a fusion of art, fashion, and sound that inspired others to embrace their favorite mistakes and turn them into something beautiful.

The "missax 23 05 15 april olsen my favorite mistake top" content serves as an example of successful, targeted digital media. By combining a recognizable creator, a specific release date for tracking, and an engaging thematic title, such videos gain significant traction.

The keyword "missax 23 05 15 april olsen my favorite mistake top" refers to the highly-regarded adult dramatic production , released by the studio MissaX on May 15, 2023 . This "two-hander" features award-winning performer April Olsen and veteran actor Chad White in a narrative-driven scene that has been praised for its high production quality and "letter-perfect" acting. Production Details and Narrative Release Date: May 15, 2023. Leading Cast: April Olsen and Chad White .

: The full video and credits are listed on major industry databases like other titles featuring April Olsen or more details on filmography? My Favorite Mistake (Video 2023) - Full cast & crew Cast * April Olsen. Stepdaughter. * Chad White. Stepfather. My Favorite Mistake (Video 2023) - Full cast & crew - IMDb Editors * Jess X. * Missa X. My Favorite Mistake (Video 2023)

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

jaims_2093_03.JPG

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

jaims_2093_07.JPG

Avachoornanam

jaims_2093_08.JPG

7th Day

jaims_2093_09.JPG

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

Missax 23 05 15 April Olsen My Favorite Mistake Top

The release of "23 05 15" has sent shockwaves through the adult industry, with fans and critics alike clamoring for more. The video's success has not only solidified Olsen's position as a leading performer but has also raised the bar for future productions.

According to details on IMDb , the story centers on the intense friction between an ex-marine stepfather, played by , and his adult stepdaughter, played by April Olsen .

Information regarding the film's production and cast is available through various entertainment databases and the studio's official catalog. My Favorite Mistake (Video 2023)

Reviewers often highlight her "acting prowess" and versatility, noting that she brings a convincing emotional depth to narrative-heavy scenes like those produced by MissaX.

The narrative explores an undercurrent of domination and submission as the domestic conflict escalates into an erotic encounter. Critical Reception According to reviews on missax 23 05 15 april olsen my favorite mistake top

Mistakes are an inherent part of the human experience. From the smallest misstep to the most significant error in judgment, mistakes are an inevitable aspect of learning, growth, and exploration. It is through mistakes that individuals can gain valuable insights, develop resilience, and refine their decision-making processes. The concept of mistakes has been extensively studied in various fields, including psychology, education, and philosophy.

This public link is valid for 7 days and shares a thread, including any personal information you added. This link or copies made by others cannot be deleted. If you share with third parties, their policies apply. Can’t copy the link right now. Try again later. My Favorite Mistake (Video 2023) - IMDb

If you are looking for more information regarding this specific title, I can provide details on: received by Missa X productions Filmographies of performers April Olsen and Chad White

The 2023 release date signifies modern, high-definition standards that top creators adhere to. Finding and Engaging with the Content The release of "23 05 15" has sent

(coded as 23-05-15). The production is noted for its narrative focus, often described as a "two-hander" or one-act play due to its character-driven script. Scene Overview

: April Olsen plays a "layabout adult stepdaughter," and veteran performer Chad White plays her ex-Marine stepfather .

In conclusion, the combination of April Olsen's exceptional talent, the compelling narrative, and the high-quality production values have cemented Missax 23 05 15's status as a standout production in the adult entertainment industry. As a performer, Olsen continues to inspire and captivate audiences, pushing boundaries and redefining the possibilities of adult entertainment.

April's journey with Missax's music had led her to create something truly unique, a fusion of art, fashion, and sound that inspired others to embrace their favorite mistakes and turn them into something beautiful. Information regarding the film's production and cast is

The "missax 23 05 15 april olsen my favorite mistake top" content serves as an example of successful, targeted digital media. By combining a recognizable creator, a specific release date for tracking, and an engaging thematic title, such videos gain significant traction.

The keyword "missax 23 05 15 april olsen my favorite mistake top" refers to the highly-regarded adult dramatic production , released by the studio MissaX on May 15, 2023 . This "two-hander" features award-winning performer April Olsen and veteran actor Chad White in a narrative-driven scene that has been praised for its high production quality and "letter-perfect" acting. Production Details and Narrative Release Date: May 15, 2023. Leading Cast: April Olsen and Chad White .

: The full video and credits are listed on major industry databases like other titles featuring April Olsen or more details on filmography? My Favorite Mistake (Video 2023) - Full cast & crew Cast * April Olsen. Stepdaughter. * Chad White. Stepfather. My Favorite Mistake (Video 2023) - Full cast & crew - IMDb Editors * Jess X. * Missa X. My Favorite Mistake (Video 2023)

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

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Journal of Ayurveda and Integrated Medical Sciences 2022;7(9)202