E-ISSN:2456-3110

Case Report

Diabetic Ulcer

Virtual Rides 3 Mods Better -

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. virtual rides 3 mods better

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. Mods, short for modifications, are user-created content that

Keywords: Dushta Vrana, Avachoornana, Diabetic Ulcer, Lakshadi Choorna The three mods discussed in this write-up –

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: virtual rides 3 mods better		 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		 virtual rides 3 mods better

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%

virtual rides 3 mods bettervirtual rides 3 mods better © 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

Mods, short for modifications, are user-created content that can be added to virtual rides to enhance the experience. They can range from simple tweaks to complete overhauls of the game's mechanics, graphics, or sound design. Mods can breathe new life into virtual rides, offering:

Virtual Rides 3 mods can significantly enhance the gameplay experience, offering improved graphics, customization options, and realistic physics. The three mods discussed in this write-up – Enhanced Graphics Mod, Custom Bike Mod, and Realistic Physics Mod – are solid choices for players looking to upgrade their experience. By installing these mods, you'll be able to enjoy a more immersive, challenging, and visually stunning game.

Virtual Rides 3 has a limited but dedicated modding scene, primarily focused on aesthetic customizations like custom jingles

So, what are you waiting for? Dive into the Discord community, start hunting for those .ogg files, and see how mods can make your fairground the best on the circuit!

The keyword is a truth that the simulation community has known for years. Vanilla Virtual Rides 3 is a well-crafted appetizer. Modded Virtual Rides 3 is a five-course meal prepared by Michelin-starred chefs who happen to be obsessive coaster fans.

The most active Virtual Rides 3 modders share their latest projects, script tweaks, and texture packs inside dedicated simulator Discord servers.

One of the most essential upgrades for any virtual carnival barker is a custom jingle pack. These mods allow you to move beyond the base game's repetitive sounds and introduce authentic fairground atmosphere.

One of the core aspects of Virtual Rides 3 is managing a ride's aesthetic. While the game provides built-in customization tools, community creations allow for much greater control over visual presentation.

Which you want to add (e.g., roller coasters, giant wheels, extreme spin rides)?

: The primary tool for importing and exporting game assets like images or scripts.

Virtual rides offer an exciting and immersive experience, but mods can take them to the next level. By enhancing graphics and realism, adding new features and gameplay mechanics, and creating immersive sound design, mods can breathe new life into virtual rides. Whether you're a seasoned gamer or a simulation enthusiast, these three mods are sure to enhance your virtual ride experience. So why not give them a try and take your virtual rides to new heights?

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

Virtual Rides 3 Mods Better -

Mods, short for modifications, are user-created content that can be added to virtual rides to enhance the experience. They can range from simple tweaks to complete overhauls of the game's mechanics, graphics, or sound design. Mods can breathe new life into virtual rides, offering:

Virtual Rides 3 mods can significantly enhance the gameplay experience, offering improved graphics, customization options, and realistic physics. The three mods discussed in this write-up – Enhanced Graphics Mod, Custom Bike Mod, and Realistic Physics Mod – are solid choices for players looking to upgrade their experience. By installing these mods, you'll be able to enjoy a more immersive, challenging, and visually stunning game.

Virtual Rides 3 has a limited but dedicated modding scene, primarily focused on aesthetic customizations like custom jingles

So, what are you waiting for? Dive into the Discord community, start hunting for those .ogg files, and see how mods can make your fairground the best on the circuit!

The keyword is a truth that the simulation community has known for years. Vanilla Virtual Rides 3 is a well-crafted appetizer. Modded Virtual Rides 3 is a five-course meal prepared by Michelin-starred chefs who happen to be obsessive coaster fans.

The most active Virtual Rides 3 modders share their latest projects, script tweaks, and texture packs inside dedicated simulator Discord servers.

One of the most essential upgrades for any virtual carnival barker is a custom jingle pack. These mods allow you to move beyond the base game's repetitive sounds and introduce authentic fairground atmosphere.

One of the core aspects of Virtual Rides 3 is managing a ride's aesthetic. While the game provides built-in customization tools, community creations allow for much greater control over visual presentation.

Which you want to add (e.g., roller coasters, giant wheels, extreme spin rides)?

: The primary tool for importing and exporting game assets like images or scripts.

Virtual rides offer an exciting and immersive experience, but mods can take them to the next level. By enhancing graphics and realism, adding new features and gameplay mechanics, and creating immersive sound design, mods can breathe new life into virtual rides. Whether you're a seasoned gamer or a simulation enthusiast, these three mods are sure to enhance your virtual ride experience. So why not give them a try and take your virtual rides to new heights?

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

9. Singh J. Laksha (Lac) - LacciferLacca [Internet]. Ayurtimes.com. 2015 [cited 2021 Jul 4]. Available from: https://www.ayurtimes.com/lac-laccifer-lacca-health-benefits-uses-side-effects.[accessed on 2021-7-1]

10. Sastry, JLN. Dravyaguna Vijnana, Varanasi: Chaukamba orientalia; 2012.p.200-4.

11. Sastry, JLN. Dravyaguna Vijnana, Varanasi: Chaukamba orientalia; 2012.p.328-33.

12. Sastry, JLN. Dravyaguna Vijnana, Varanasi: Chaukamba orientalia; 2012.p.338-42.

13. Sastry, JLN. Dravyaguna Vijnana, Varanasi: Chaukamba orientalia; 2012.p.958-9.

14. Sastry, JLN. Dravyaguna Vijnana, Varanasi: Chaukamba orientalia; 2012.p.513-8.

15. Sastry, JLN. Dravyaguna Vijnana, Varanasi: Chaukamba orientalia; 2012.p.54-6.

16. Sastry, JLN. Dravyaguna Vijnana, Varanasi: Chaukamba orientalia; 2012.p.123-7.

17. Sastry, JLN. Dravyaguna Vijnana, Varanasi: Chaukamba orientalia; 2012.p.325-7.

18. Sastry, JLN. Dravyaguna Vijnana, Varanasi: Chaukamba orientalia; 2012.p.834-5.

19. Sastry, JLN. Dravyaguna Vijnana, Varanasi: Chaukamba orientalia; 2012.p.850-1


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