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Introduction

World health organization (WHO) reports that today's scenario of health system is really on a decline state and not meeting the sated demand and changing needs Paying less attention to the diet and lifestyle. Faulty Lifestyle has given rise to a good number of ailments challenging the scientific community among which worm infestation is one of the major conditions encountered in paediatric practice. Worm infestation refers to the worms that live as parasites in the human body and are one of the main causes of diseases associated with health and nutrition problems beyond just gastrointestinal tract disturbances. Worldwide more than 3.5 billion people are infested with worms out of which 400 million are children among whom 1.47 billion have round worm, 1.3 billion have hook worm and 1.05 billion have whip worm infestations. Children aged 3-15 years makeup the group with highest worm burden, which is caused greatly due to the contamination of environment, poor sanitation and hygiene. All the available data of prevalence of helminthic remains almost the same even after aggressive implementation of eradication programs with mass administration of anti-helminthic drugs. It is noticed that recurrence rate is very high due to development of resistance towards routine anti-helminthic drugs. An intestinal worm infection in humans is a silent epidemic that destroys the health, well-being and learning potential of millions of children in many developing countries today. It is time to take collective action to deal with this silent calamity among our children to ensure that they grow up healthy both  physically and mentally .So it is the need of the hour to think about alternative treatments which can eradicate or assist in eradicating this mammoth challenge. Countries like India where most of the people is below poverty line and living under unhygienic conditions and are also suffering from malnutrition, there is great need to explore our properties in the field of medicine and ayurveda so that we can offer economy and safe drugs to community that can cure all kinds of parasitic infestations. In this century, Ayurveda has come back into picture and propagation as tomorrow’s medical science.The term Krumi is used to denote tiny living beings which reside in the human body.

Concept of Krumi and their relation in the development of disease is described in all available Ayurvedic Literature. Acharyas also describe Krumi as an etiological factor in various diseases; The legend, Acharya Charaka classified Krumi into 20 types which come under the two broad groups i.e. Bahya and Abhyantara. He also postulated the line of treatment of Krimiroga i.e, Apakarshana (extraction of krumi), Prakriti Vighata (destruction of the favourable environment for survival of krumi) and Nidana Parivarjana (avoidance of etiological factors responsible for growth of krimi) mainly by through diet, medicines, hygiene and lifestyle management. This set of protocol for the management of Krumiroga (intestinal worm infestations) is very logical and also easy to follow.

MATERIALS & METHODS

The children of either sex  in the age group of 3-5 years  full filling the criteria of inclusion were included in the study. They were duly registered in the OPD Swsathyarakshan SKRPAC Nagpur.

SAMPLING:The subjects were selected as per the selection criteria and randomly distributed into Intervention and Standard control groups. For the random distribution of subjects, electronic digital randomization table was used. Sampling element was children between the ages of 3 to 5 years of either sex.

INCLUSION CRITERIA:

1. Age >3 year and < 5 years
2. Ajirna (Indigestion)
3. Chhardi (vomiting)
4. Anaha (flatulence)
5. Udar shoola (Children having pain in abdomen )
6. Kshudha Mandya (Children with poor appetite).
7. Vivarnata (Children with hypo pigmented patches on skin)
8. Kandu (Children with anal itching)

EXCLUSION CRITERIA:

1. Children with increased frequency of Stool and Urination
2. Children with Fever, AGE, Jaundice, Severe Anemia
3. Children with Pneumonia, RDS, cough
4. .Children with infectious diseases such as hepatitis, allergic diseases, other metabolic diseases/errors, endocrine diseases, genetic anomalies

5. EXPERIMENTAL DRUG(TRIAL DRUG): Krumihara Modaka

   Particulars	Group A(study)
   DRUG	Krumihara modak
   DOSE	2 gm in 2 divided doses
   Anupaan	Koshna jala
   Bhaishaj kala	Nisha  kala
   Duration	Three consecutive months

    

   E) Method of preparation:

   Krumihara Modaka  were prepared in the Department of rasashastra and Bhaishajya Kalpana at SKRPAC College and hospital, Nagpur

   F) Diet:

   Regular food as patient was taking in the past. No special dietary regime was advised during the study period.

   G) Follow-up:

   1) Clinically patients were screened on Day 0, Day 7, Day 14,and on next day of 21st day.

   2)  Blood investigation(Haemoglobin) were done before and after the study..

   ASSESSMENT CRITERIA:

   The assessment was based on the following parameters –

   1.Criteria assess by general status of health

   2.Improvements in sign of krimi like lalastrava, Udar Shoola etc

   3.Vyadhi upashamanrth

   4.Nutrition

   5.Weight and Diet

   6.Haemoglobin %

   SUBJECTIVE CRITERIA:

   1.Improvements in Signs and Symptoms of Krimi

   2.General status of health

   3.Improvement in investigation

    

    

    

   Sr.no	SUBJECTIVE PARAMETERS
   1	VAIVARNATA
   2	ARUCHI
   3	GUDAKANDU
   4	KAARSHYA
   5	CHARDI
   6	ANAAHA
   7	GUDEN KRUMI NIRGAMAN

    

   ASSESSMENTOFTOTALEFFECTOFTHERAPY:

   1.Cured/ Excellent response : 100% relief of signs and symptoms.

   2.Markedly improved : Improvement between >75 – 99%

   3.Moderately improved : Improvement between >50 – 75%

   4.Mildly improved: Improvement between 25 – 50%

   5.Unchanged : No Relief in signs and symptoms

STATISTICAL ANALYSIS

Subjective parameters

Objective parameters

Discussion

DISCUSSION

ON CLINICALSTUDY

NIDANA: Diwaswapna, Asatmyabhojana, Viruddhashanna were reported by 100% of patients, while Ajirna bhojana was observed in 98.28% patients. The statement goes hand in hand with those Nidanas mentioned by Acharya Charaka for manifestation of Krimi Roga.

HABITS: In the current clinical trail, 17 (42.5 percent) children had nail biting habits and 5 (12.5 percent) of PICA/ others and teeth grinding 15 (37.5 percent). Developing the habit of consuming these substances at a very early age suggests a lack of parental care and education in these children, hence hygienic activity and behavior expectations are comparatively lower, which is a major cause. As children have increased nutritional carving, they tend to show this sign of nonnutritional substances being consumed. Various studies have identified Intestinal parasites in 63% - 70.3% of pica cases''suggesting strong relationship between patients suffering from pica and worm infestation. As children have increased carving for nutrition they tend to exhibit this sign of consuming non-nutritive substances.

PERSONALHYGIENE: Personal hygiene was observed to be children in maximum number of children isn't maintain hygine 25(62.5) and 15(37.5%) of children maintain personal hygine. Children need to learn good personal hygiene very early in life. In addition to making them more socially acceptable, they should practice cleanliness to stay healthy. If they start early, they are more likely to develop a habit of good hygiene that will serve them well through life.

SROTAS: In the present study, involvement of Ananvaha, Rasavaha and Purishvaha Srotas was seen in all the patients. Kaphaja Krimi is located in Amashaya whereas Purishaja Krimi in Pakwashaya.These Krimi survive by deriving the Poshana from the Ahara consumed hence involvement of Annavaha, Rasavaha and Purishajavaha Srotas according to their anatomical positioning can be justified. Further intestinal worms affect the GI tract mainly having their effect on other systems. These 3 Srotas form the integral part of GI tract and involvement of worms is obvious.

DISCUSSION ON EFFECT OF THERAPY

VAIVARNATA: There is a 77.5% relief was observed in the symptoms Vivarnata, while these result was found statistically significant. These statistical findings are suggesting that, Krumihara Modaka having good effect in relieving the symptoms.

UDARSHOOLA: There is a 32.5% relief was observed in the symptoms Udarshoola, while these result was found statistically significant. These statistical findings are suggesting that, Krumihara Modaka having good effect in relieving the symptoms.

 ARUCHI: There is a 79.17% relief was observed in the symptoms Aruchi, while these result was found statistically significant. These statistical findings are suggesting that, Krumihara Modaka having good effect in relieving the symptoms.

GUDAKANDU: There is a 71.25% relief was observed in the symptoms Gudkandu, while these result was found statistically significant. These statistical findings are suggesting that, Krumihara Modaka having good effect

KAARSHYA, while these result was found statistically significant. These statistical findings are suggesting that, HVKIG syrup having good effect in relieving the symptoms.

PARUSHA: There is a 2.5% relief was observed in the symptoms Parusha, while these result was found statistically significant. These statistical findings are suggesting that, Krumihara Modaka HVKIG syrup having good effect in relieving the symptoms.

GUDEN KRIMI NIRGAMAN: There is a 2.5% relief was observed in the symptoms Guden krimi Nirgaman, while these result was found statistically significant. These statistical findings are suggesting that, , Krumihara Modaka having good effect in relieving the symptoms. CHARDI: There is a 7.5% relief was observed in the symptoms.

CHARDI: There is a 7.5% relief was observed in the symptoms Chardi, while these result was found statistically significant. These statistical findings are suggesting that, , Krumihara Modaka  having good effect in relieving the symptoms.

 ANAHA: There is a 26.5% relief was observed in the symptoms Anaha, while these result was found statistically significant. These statistical findings are suggesting that, , Krumihara Modaka  having good effect in relieving the symptoms.

HEAMOGLOBIN: There is a 2.15% haemoglobin % increased, while these result was found statistically significant. These statistical findings are suggesting that, , Krumihara Modaka having good effect. WEIGHT: There is a 2.74% weight increased, while these result was found statistically significant. These statistical findings are suggesting that, HVKIG syrup having good effect.

PHARMACOLOGICAL ACTION OF DRUGS

1.NARIKELA-being rasayana is a very beneficial herb. It is known as “ Meda-kaphavinashini” and acts as Aamdoshahar, Kaphaavilayankar.  Helps in proper functioning of digestive system and respiratory system (pranvahastrotas)also.

2.ERANDA KARKATI(carica Papaya) : being katu , ushna and specifically vibandhaanaah &shoolhar, it is useful is all types of kapha related ailments & improves appatite

3.MARICH(Piper nigrum): It is deepan, paachan and shleshmapraseki and thus is useful in dissolving the thrombosed blood and clearing the channels of blood vessels for normal passage of blood7.

4.HINGU(Asafoetida)-Helps in kshudhamaandya(loss of appatite).Gaurav,Daurbalya etc. It avoids accumulation of toxins in the body boosting the immunity system.9

Conclusion

The study entitled “ROLE OF KRUMIHARA MODAKA IN THE MANAGEMENT OF KRIMI ROGA W.S.R. WORM INFESTATION IN PAEDIATRIC AGE GROUP ” was aimed at evaluating the clinical efficacy of, Krumihara Modaka,

After a comprehensive observation and discussion on the observed data, the following conclusions may be drawn:

1.Child are more prone for Krimi Roga due to MadhuraPraya Ahara, lack of hygiene towards health, and tenacious contact with etiological factors. 

2.Krumihara Modaka  is such combination affording Apakarshana and Prakritivighata to Krimi Roga.

3.This clinical study reveals the significant effect on the subjective parameters of Krimi Roga which is suggestive that this combination is actual suitable to treat the Shleshmaja and Purishaja Krimi. Still Combination is additional effective to treat the PurishajaKrimi.

4.Shleshmaja Krimis is said to residing in upper part of the gastrointestinal tract and growing on Ama. As the literatures suggest, Purishaja Krimi is found in lower part of gastrointestinal tract living on faecal material. Ÿ

5.The trial drug Krumihara Modaka is effective in managing all types of Krimi. It contains five drugs as principle ingredient which is having antihelminthic property and are effective in the treatment of Krimi Roga in children.