A ROLE OF PUNARNAVADI KSHIR BASTI AND PUNARNAVADI KWATHA IN THE MANAGEMENT OF CHRONIC KIDNEY DISEASE (CKD)-A CASE STUDY

Kidney is the most useful organ for maintain the homeostatic balance of body fluids by removing waste out of body. Chronic kidney disease (CKD) refers to irreversible deterioration in renal function which develops over period of years. In CKD treatment of choice is dialysis and renal transplantation which is more cost and complexity cant afford for every CKD patients and few patients are able to obtain adequate treatment for kidney disorders. Therefore required safe and alternative therapy is needed which helpful in reducing the requirement of dialysis and the renal transplantation. Punarnava can rejuvenates the dying cell and help to revive the dying organ of the body. As the Gokshura has diuretics action which is beneficial in CKD for decrease the oliguria and Rasayana properties of Gokshura which can be prevented and repair by Rasayana drug by their antioxidative properties. Basti is the treatment mostly effective on Pakvashaya in which urine formation carried out and Punarnavdi basti rejuvenates the dying cell and improve in renal function. In this study first 12 days patients given Punarnavadi basti and Kwath then only Kwath is continues and the result is improved in renal function by reducing the value of serum creatinine and blood urea. From we suggestive that Punarnavadi kshir basti and Punarvadi kwath in chronic renal failure the improvement in renal function and general condition is observed

Vitalizing Community for Health Promotion Against Modifiable Risk Factors of Noncommunicable Diseases (V-CaN) in Rural Central India: Protocol for a Hybrid Type II Implementation Effectiveness Trial

BackgroundLow- and middle-income countries are facing the emerging burden of chronic noncommunicable diseases (NCDs). Apart from loss of human lives and premature deaths, NCDs result in huge costs for treatment to individuals and the health system. Although NCDs develop in later life, the risk factors begin at an early age. The key to the control of the global epidemic of NCDs is primary prevention based on comprehensive community-based programs. ObjectiveThis study aims to develop, implement, and evaluate the effect of a participatory health promotion initiative utilizing the existing mechanisms of Village Health Nutrition and Sanitation Committees (VHNSCs), women’s self-help groups (SHGs), and schools on modifiable risk factors for NCDs among young people aged 10-30 years. MethodsThe proposed type II hybrid effectiveness implementation cluster randomized field trial will be conducted in the catchment area of 4 primary health centers (PHCs) in Wardha district, India, comprising 100 villages with a population of 144,000. Each PHC will be randomly allocated to one of the 3 intervention arms or the control arm. The 3-intervention arm PHCs will utilize a unique strategy with either VHNSC or SHG members or school students as change agents for health action against common modifiable NCD risk factors. This study will be implemented in 3 phases from January 2022 to December 2024. First, the preparatory phase for baseline assessments includes anthropometry, behavioral and biochemical risk factors for NCDs, and participatory development of the health promotion intervention modules. Second, the implementation phase will focus on capacity building of the change agents and implementation of the participatory health promotion initiative. The implementation will include organization of community-based events, 6-monthly participatory assessment of change, and preparation of a sustainability and exit plan toward the end of this phase. Third, the evaluation phase will consist of studying the effectiveness of each intervention strategy in the reduction of risk factor prevalence at the population level. ResultsWe will assess 12,000 (3000 in each arm) randomly selected individuals for behavioral risk factors and 1600 (400 in each arm) individuals for biochemical risk factors during baseline as well as endline assessments. Difference in differences, ANOVA or multivariate analysis of covariance, and regression analysis will be performed to assess the effectiveness of the interventions. Qualitative methods such as focus group discussions and stories of change will be documented and analyzed using thematic framework analysis. The implementation outcomes will be reported using the PRISM (Practical Robust Implementation and Sustainability Model) RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. The results are expected to be published by mid-2025. ConclusionsThis study will show the magnitude of risk factors for NCDs, its determinants, feasibility, effectiveness of community-based interventions, and health promotion models for NCD prevention. Trial RegistrationClinical Trials Registration India CTRI/2020/10/028700; https://ctri.nic.in/Clinicaltrials/showallp.php?mid1=47597&EncHid=&userName=V-CaN International Registered Report Identifier (IRRID)DERR1-10.2196/4245

Recurrence of tuberculosis among newly diagnosed sputum positive pulmonary tuberculosis patients treated under the Revised National Tuberculosis Control Programme, India: A multi-centric prospective study

<div><p>Introduction</p><p>There is lack of information on the proportion of new smear—positive pulmonary tuberculosis (PTB) patients treated with a 6-month thrice-weekly regimen under Revised National Tuberculosis Control Programme (RNTCP) who develop recurrent TB after successful treatment outcome.</p><p>Objective</p><p>To estimate TB recurrence among newly diagnosed PTB patients who have successfully completed treatment and to document endogenous reactivation or re-infection. Risk factors for unfavourable outcomes to treatment and TB recurrence were determined.</p><p>Methodology</p><p>Adult (aged ≥ 18 yrs) new smear positive PTB patients initiated on treatment under RNTCP were enrolled from sites in Tamil Nadu, Karnataka, Delhi, Maharashtra, Madhya Pradesh and Kerala. Those declared “treatment success” at the end of treatment were followed up with 2 sputum examinations each at 3, 6 and 12 months after treatment completion. MIRU-VNTR genotyping was done to identify endogenous re-activation or exogenous re-infection at TB recurrence. TB recurrence was expressed as rate per 100 person-years (with 95% confidence interval [95%CI]). Regression models were used to identify the risk factors for unfavourable response to treatment and TB recurrence.</p><p>Results</p><p>Of the1577 new smear positive PTB patients enrolled, 1565 were analysed. The overall cure rate was 77% (1207/1565) and treatment success was 77% (1210 /1565). The cure rate varied from 65% to 86%. There were 158 of 1210 patients who had TB recurrence after treatment success. The pooled TB recurrence estimate was 10.9% [95%CI: 0.2–21.6] and TB recurrence rate per 100 person–years was 12.7 [95% CI: 0.4–25]. TB recurrence per 100 person–years varied from 5.4 to 30.5. Endogenous reactivation was observed in 56 (93%) of 60 patients for whom genotyping was done. Male gender was associated with TB recurrence.</p><p>Conclusion</p><p>A substantial proportion of new smear positive PTB patients successfully treated with 6 –month thrice-weekly regimen have TB recurrence under program settings.</p></div

Risk factors for unfavourable response at the end of treatment in new smear positive pulmonary TB patients [N = 1543].

<p>Risk factors for unfavourable response at the end of treatment in new smear positive pulmonary TB patients [N = 1543].</p

Treatment outcome of new smear positive pulmonary TB patients [N = 1565].

<p>Treatment outcome of new smear positive pulmonary TB patients [N = 1565].</p

Study sites for the recurrence of TB among the newly diagnosed sputum positive pulmonary TB patients treated under RNTCP in India.

<p>Study sites for the recurrence of TB among the newly diagnosed sputum positive pulmonary TB patients treated under RNTCP in India.</p

Status at 12 months after Treatment success in new smear positive pulmonary TB patients [N = 1210].

<p>Status at 12 months after Treatment success in new smear positive pulmonary TB patients [N = 1210].</p

Details of TB recurrence in new smear positive pulmonary TB patients [N = 158].

<p>Details of TB recurrence in new smear positive pulmonary TB patients [N = 158].</p