Asian Journal of Modern and Ayurvedic Medical Science (ISSN 2279-0772)
Vol.1,no.1, July 2012.[
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The Author 2012]
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Research Paper
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A Clinical Study to evaluate the efficacy of SnuhiKsharasutra in the management of complicated high anal fistula.
Dr. Gaurav Singh. Rathore
Declaration
T
he Declaration of the author for publication of Research Paper in
Asian Journal of Modern and Ayurvedic Medical Science (ISSN 2279-0772)
i
Gaurav Singh. Rathore
the author of the research paper entitled
A Clinical Study to evaluate the efficacy of SnuhiKsharasutra in the management of complicated high anal fistula.
declare that ,
i
take the responsibility of the content and material of my paper as I myself have written it and also have read the manuscript of my paper carefully. Also, I hereby give my consent to publish our paper in ajmams , This research paper is my original work and no part of it or it’s similar version is published or has been sent for publication anywhere else.I authorise the Editorial Board of the Journal to modify and edit the manuscript. I also give my consent to the publisher of ajmams to own the copyright of my research paper.
Received january 1,2012;accepted june 20, 2012 ,published july1,2012
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ABSTRACT
Snuhi Ksharasutra is one of the oldest and most popular Ksharasutra for treating the complicated high anal Fistula. Hence, this clinical study was designed and carried out to establish its efficacy in terms of clinical features- Pain, Edema and Discharge. The obtained results and their analysis clearly reveals that theSnuhi Ksharasutra is very effective in terms of these three clinical parameters, as the application of this ksharasutra significantly and gradually reduces all the three clinical features.
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INTRODUCTION
The complicated high anal Fistula is, perhaps, one of the most difficult colo-rectal diseases to deal with nowadays. This can be gauzed by the fact that, in spite of vast advancement and development in the area of modern surgical tools and techniques the exact and full proofed treatment of this disease is still not available. Although, the modern surgery provides many surgical techniques to deal with this disease but the all are full of complications like gross anatomical distortion and also the bright chances of loss of anal incontinence. Not only this, the chances of reoccurrences are also there.
Therefore, the exact solution of this problematic disease is described in ancient Ayurvedic texts, which are referred to as Ksharasutra Therapy. Presently this Ksharasutra Therapy has emerged as the choice of treatment for fistula in ano. This entire development is the resultant of many
tireless efforts, carried out in the last almost forty years, for the refinement of this treatment modality. The
Snuhi Ksharasutra is the first one, which is prepared after getting clues from the ancient writings and put on clinical application in complicated Fistulas. The initial
Clinical observations obtained, clearly suggests that this Ksharasutrasis really very effective for the treatment of complicated fistulas as it has very good unit cutting time as well as also has good wound healing properties.
Hence, considering these facts, this clinical study has been carried out to assess the effectiveness of Snuhi Ksharasutra in terms of clinical features- Pain, Edema and Discharge. The criteria of assessment were (A) total reduction in pain; (B) total reduction in edema; and (C) total reduction in discharge.
METHODOLOGY
This study was designed to be carried out on total 50 patients who were suffering from High Anal fistulas and came for their treatment in the OPD Clinic of Department of ShalyaTantra, Institute of Medical Sciences, Banaras Hindu University during the period November 2009 to April 2011 at their own will.
INCLUSION CRITERIA
: These 50 patients were randomly selected irrespective of age, group, sex, duration of sign-symptom and associated disease like diabetes, hypertension, anaemia etc.
EXCLUSION CRITERIA
: Thepatients having diseases like uncontrolled diabetes mellitus, tuberculosis and biopsy of the track suggestive of malignancy or fistulas which occurred due to other systemic disease like osteomyelitis etc were excluded from this study.
Further, these50 selected patients were put on for clinical trails as they were treated by application ofSnuhi Ksharasutra.
CRITERIA FOR ASSESSING CLINICAL FEATURES
The characters of pain, edema and discharge were noted at subsequent intervals i.e. 1, 14, 28, 42, 56 and 70th day i.e. after every 14th day or on every alternate visit for changing of thread. This assessment was done on the basis of the following scoring system:
|
Pain
|
Scoring
|
Discharge
|
Scoring
|
Oedema
|
Scoring
|
|
No pain
|
0
|
No discharge
|
0
|
No swelling
|
0
|
|
Mild pain & No analgesic required
|
1
|
Serious discharge < 2 ml
|
1
|
Mild swelling < 2 cm
|
1
|
|
Moderate pain
|
2
|
Seropurulent discharge < 5 ml
|
2
|
Moderate swelling with tenderness
|
2
|
|
Severe pain
Analgesic required
|
3
|
Purulent discharge > 5 ml
|
3
|
Swelling with tenderness > 5 cm
|
3
|
OBSERVATIONS AND RESULTS
1. EFFECTIVENESS IN TERMS OF PAIN
The efficacy of SnuhiKsharasutra, was assessed in terms of reduction of pain felt by the patients during the treatment. The results pertaining to this analysis are presented in following tables:
TABLE 1: STATISTICAL ANALYSIS OF PAIN.
|
Group
|
Initial
|
Follow up
|
Mean diff I-F4
|
Paired t-test p-value
|
|
I
|
F1
|
F2
|
F3
|
F4
|
|
1
|
2.88
±
0.34
|
2.82
±
0.44
|
2.67
±
0.58
|
2.15
±
0.36
|
1.78
±
0.28
|
1.10
±
0.24
|
t=17.65
p>0.0001
HS
|
This statistical analysis suggests that there is a gradual decrease in pain on successive follow-ups. The t- value presented in the table reveals that the treatment lead to significant reduction in pain. This implies that the application of this Ksharasutraslead to significant reduction in pain experienced by the patient.
2. EFFECTIVENESS IN TERMS OF EDEMA
The second clinical parameter of comparison was the edema observed in the patients who
underwent
treatment. The results of this analysis are presented below. Data in table 2 presents the comparison of the within group edema initially and at the end of the fourth follow-up.
TABLE 2: STATISTICAL ANALYSIS OF EDEMA IN ALL THE THREE GROUPS.
|
Group
|
Initial
|
Follow up
|
Mean diff I-F4
|
Paired T-test
p-value
|
|
I
|
F1
|
F2
|
F3
|
F4
|
|
1
|
2.90
±
0.28
|
2.82
±
0.34
|
2.33
±
0.48
|
1.89
±
0.52
|
1.08
±
0.38
|
1.82
±
0.27
|
t=27.26
p<0.0001
HS
|
The mean differences (I-F4) issignificant. This indicates that trail ksharasutras is significantly reducing the edema during the treatment.
3. EFFECTIVENESS IN TERMS OF DISCHARGE
TABLE 3: STATISTICAL ANALYSIS OF DISCHARGE IN ALL THE THREE GROUPS.
|
Group
|
Initial
|
Follow up
|
Mean diff I-F4
|
Paired T-test p-value
|
|
I
|
F1
|
F2
|
F3
|
F4
|
|
1
|
2.80
±
0.44
|
2.68
±
0.50
|
1.96
±
0.62
|
1.56
±
0.37
|
0.36
±
0.28
|
2.44
±
0.29
|
t=33.08
p<0.0001 HS
|
This statistical analysis reveals that there is a gradual decrease in discharge on successive follow-ups. The t- value presented in the table reveals that the treatment leads to significant reduction in discharge also.
CONCLUSION
In this way, the obtained observations and results of this clinical study and their statistical analysis clearly shows that the application of Snuhi Ksharasutra is very effective in reducing the all the three clinical features parameters. The application of this ksharasutra gradually reduces the Pain, Edema and Discharge on subsequent follow-ups.
Therefore, from this clinical study it can be concluded that the application of this Snuhi Ksharasutra is found to be effective in terms of three
clinical features, namely Pain, Edema and Discharge, the application of this medicated thread gradually decreases all clinical features. Along with this, from these obtained observations, it can all be concluded that the ingredients of this Ksharasutra have anti-inflammatory and analgesic properties also as this is very effectively reduces the degree and intensity of clinical features.
REFERENCES
1.
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2.
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3.
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4.
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5.
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6.
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7.
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8.
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