Browsing by Author "Gupta, N"
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Publication A National Equity Initiative to Address Noncommunicable Diseases and Injuries: Findings and Recommendation from the Nepal NCDI Poverty Commission(Kathmandu University, 2022) Koirala, B; Adhikari, SR; Shrestha, A; Vaidya, A; Aryal, KK; Kalaunee, SP; Shrestha, A; Mishra, SR; Sharma SK; Karki, A; Maharjan, B; Singh, S; Schwarz, D; Gupta, N; Bukhman, G; Karmacharya, BMABSTRACT We aimed to assess the burden of NCDIs across socioeconomic groups, their economic impact, existing health service readiness and availability, current policy frameworks and national investment, and planned programmatic initiatives in Nepal through a comprehensive literature review. Secondary data from Global Burden of Disease estimates from GBD 2015 and National Living Standard Survey 2011 were used to estimate the burden of NCDI and present the relationship of NCDI burden with socioeconomic status. The Commission used these data to define priority NCDI conditions and recommend potential cost-effective, poverty-averting, and equity-promoting health system interventions. NCDIs disproportionately affect the health and well-being of poorer populations in Nepal and cause significant impoverishment. The Commission found a high diversity of NCDIs in Nepal, with approximately 60% of the morbidity and mortality caused by NCDIs without primary quantified behavioral or metabolic risk factors, and nearly half of all NCDI-related DALYs occurring in Nepalese younger than 40 years. The Commission prioritized an expanded set of twenty-five NCDI conditions and recommended introduction or scale-up of twenty-three evidence-based health sector interventions. Implementation of these interventions would avert an estimated 9680 premature deaths per annum by 2030 and would cost approximately $8.76 per capita. The Commission modelled potential financing mechanisms, including increased excise taxation on tobacco, alcohol, and sugar-sweetened beverages, which would provide significant revenue for NCDI-related expenditures. Overall, the Commission’s conclusions are expected to be a valuable contribution to equitable NCDI planning in Nepal and similar resource-constrained settings globally. KEY WORDS NCDI Poverty Commission, Noncommunicable diseases and injuriesPublication Achondroplasia: Case Report and Review of Literature(Nepal Paediatric Society (JNPS), 2011) Shah, GS; Shrivastava, MK; Shah, D; Gupta, NAbstract+ A two month old male child presented to emergency of B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan and was admitted to Paediatric ward with history of fever, cough and respiratory distress. On examination the breathing was rapid and shallow. The child was small for age with an upper to lower segment ratio of 1.9. The anteroposterior diameter of thorax was reduced. We report a very rare case of achondroplasia which was recognized in a two month age child who presented with severe pneumonia. Usually the clinically features of achondroplasia is more prominent when the child is growing in height but we diagnosed it in a two months child after performing the skeletal survey.Publication Anatomic c haracteristics of foramen vesalius(Kathmandu University, 2005) Gupta, N; Ray, B; Ghosh, SObjectives: Foramen Vesalius is an inconstant foramen that gives passage to an emissary vein that connects pterygoid venous plexus with cavernous sinus, the importance of which lies in the fact that an infected thrombus from an extracranial source may reach cavernous sinus. This study presents some data on characteristics of foramen vesalius. Methods: We studied 70 sides of 35 dried adult human skulls available in the Department of Anatomy, Manipal College of Medical Sciences, Pokhara, Nepal. Variation in number and incidence of foramen Vesalius were noted. Differences between the right and the left side and between the male and the female sex are discussed. Main Findings: Foramen Vesalius was present in 23 sides (14 right, 9 left) out of the 70 sides observed, the incidence being 32.85% (20.0% right side, 12.85% left side) of all the sides observed. Incidence of bilateral and unilateral foramen vesalius was 22.85% (8 out of 35 skulls) and 20% (7 out of 35 skulls) respectively. Foramen vesalius was found in 10 sides in males and in 13 sides in females. No remarkable differences were observed in the incidence of foramen vesalius between the sides within same sex but the incidence was more in females compared to male skulls. Significance of findings: Anatomic variations of the foramen vesalius could be explained by developmental reasons. Knowledge about characteristics of foramen vesalius and its incidence is not only important for anatomists but equally essential for an operating surgeon. Key words: foramen vesalius, skull, anatomical variation.Publication Antenatal diagnosis of large sacro-coccygeal teratoma with foetal cardiomegaly and hydrops(Kathmandu University, 2008) Gupta, N; Shah, D; Singh, U; Tiwari, AAbstract We report the case of a young primigravida who presented with a 20 weeks pregnancy with a previous diagnosis of uterine broid. However, ultrasound evaluation revealed the presence of a large sacro-coccygeal teratoma in the foetus which was heterogeneous with cystic areas and calci c foci, and showed increased vascularity. There was also evidence of foetal cardiomegaly and hydrops foetalis, indicated by subcutaneous oedema in the foetus, thickened placenta and polyhydramnios. The presence of hydrops with sacro-coccygeal teratoma has a grave prognosis for the mother and child; hence termination of pregnancy was done. A 20 weeks old foetus with a huge sacro-coccygeal mass, which was ruptured at many places and showed areas of active bleed, was expelled.Publication Clinical Efficacy of Subgingivally Delivered Punica Granatum Chip and Gel in Management of Chronic Periodontitis Patients(Kathmandu University, 2020) Tyagi, P; Dodwad, VM; Vaish, S; Chowdhery, T; Gupta, N; Kukreja, JBABSTRACT Background Periodontitis has a multifactorial etiology, and the pathogenic bacteria that reside in the subgingival area are the primary etiologic agent. Objective The study aimed to evaluate the clinical efficacy and benefits of herbal chip and gel made from extracts of Punica granatum as a subgingival adjunct to scaling and root planing (SRP). Method A randomized control clinical trial was conducted on 30 systemically healthy patient’s sites having chronic periodontitis, and they were randomly allocated to into three treatment groups followed by Scaling and Root Planing in all patients. Group 1 - Ten patients received Scaling and Root Planing and Punica granatum chip at selected sites. Group 2 - Ten patients received Scaling and Root Planing and punica granatum gel at selected sites. Group 3 - Ten patients with Scaling and Root Planing alone. Clinical parameters were recorded at baseline, 21 days and at 45 days which included plaque index (PI), gingival index (GI), probing pocket depth (PPD) and relative attachment level (RAL). Result Plaque Index and Gingival index showed better reduction in group I compared to group II and group III at 21st day 45th day follow up. Analysing Pocket Probing Depth the intergroup comparison revealed similar results with maximum reduction being seen in group I from baseline to 21 and baseline to 45 days (p < 0.001). On analysing Relative Attachment Loss revealed reduction in all three groups with maximum reduction in group I from baseline to 45 days and reduction in group III was not statistically significant (p < 0.090). Conclusion The study concluded that Punica granatum chip as an adjunct to Scaling and Root Planing was more effective than Punica granatum gel and scaling and root planing alone. KEY WORDS Hydrolysable tannins, Periodontal regeneration, Punica granatum, Relative attachment level, Subgingival drug deliveryPublication Community Based Nutrition Education for Promoting Nutritional Status of Children under Three Years of Age in Rural Areas of Mahottari District of Nepal(Nepal Paediatric Society (JNPS), 2014) Yadav, DK; Gupta, N; Shrestha, N; Kumar, A; Bose, DKAbstract: Introduction: Maternal and child mortality have declined significantly in Nepal to the extent that Nepal is on track to meet the Millennium Development Goals for maternal and child mortality. Similar improvements have not been seen in general nutrition status of them. Objective of this study was to evaluate a nutrition-education intervention designed to improve nutritional status (reduce stunting, wasting and underweight) of children. Materials and Methods: It was an intervention with separate sample pretest posttest design. Two groups of Village Development Committee (VDC) from Mahottari district were recruited as interventional and control areas. The intervention was a 12-months nutrition education program and comprised of twelve times with 2-3 hour nutrition lectures and discussion classless conducted by the Female Community Health Volunteers (FCHVs). Results: The Present study found that number of underweight children increased by 7.6% in control group while it decreased by 17.7% in intervention group from baseline to endline in both groups. So, intervention programme was able to decrease the number of underweight children significantly. Study shows that wasting status of children increased by 11.4% in control group from baseline to endline period. While in intervention group wasting status of children decreased by more than 5% from baseline to endline period. Conclusion: Nutrition education intervention was effective to reduce wasting and underweight but did not reduce the stunting status of children. Stunting reflects failure to receive adequate nutrition over a long period of time and is affected by recurrent and chronic illness. Findings suggested that nutrition programme of longer duration should be implemented to control the stunting status of children.Publication Effect of haemodynamic and metabolic predictors on echocardiographic left ventricular mass in non-diabetic hypertensive patients(Kathmandu University, 2010) Gupta, N; Karki, P; Sharma, S; Shrestha, N; Acharya, PAbstract Background: Left ventricular hypertrophy is a forerunner of coronary heart disease, congestive cardiac failure, stroke and may also lead to sudden death. Estimation of left ventricular mass by echocardiography offers prognostic information better than the evaluation of traditional cardiovascular risk factors. Objective: The aim of this study was to determine the relative contributions of haemodynamic and metabolic factors affecting left ventricular mass in non-diabetic patients with essential hypertension. Material and methods: 100 non-diabetic hypertensive patients were taken. The association between age, gender, smoking, alcohol, height, weight, heart rate, clinic blood pressure, fasting blood glucose, lipid profile, haemoglobin, body mass index and stroke volume with LV mass was studied. Left ventricular mass was measured by using standard M-mode echocardiography measurement obtained by way of standard recommended by the American Society of Echocardiography. Results: Left ventricular mass was analyzed as a continuous variable. In males body mass index (r=.35, p<.004) and stroke volume(r=-.26, p<.039) were significantly correlated with LV mass. In females body weight was significantly related to left ventricular mass(r=.36, p<.02). The independent association between significant factors and left ventricular mass was assessed by stepwise multivariate logistic regression. Body mass index and systolic blood pressure came as independent determinants of left ventricular mass in all patients. A maximum of 13% of left ventricular mass variability could be explained by these two factors. Conclusion: In untreated patients with hypertension patient’s body mass index and systolic blood pressure are independent predictors of left ventricular mass after adjustment for other haemodynamic and metabolic factors. They explain a maximum of 13% of left ventricular mass variability. More knowledge is needed about factors that may alter cardiac morphology in the evolution of hypertensive patients. Key words: Echocardiography, Haemodynamic, Metabolic Factors, Left Ventricular Mass, Non-diabetic, HypertensivePublication Exploring the Job Satisfaction among Workforce Working in Four Medical Colleges in Nepal: a cross-sectional study(Kathmandu University, 2025) Dahal, DP; Gupta, NABSTRACT Background Job satisfaction is a critical factor influencing healthcare quality, patient’s outcomes and overall wellbeing in medical profession. Job satisfaction is an important component of improving job performance and maintaining overall quality of work in any organization. The result of job satisfaction will have an impact not only at the individual level but also in the institutional, societal, and national level. Objective To explore overall job satisfaction among the workforce of four different medical colleges in Nepal, as well as the factors associated with it. Method A cross-sectional study was conducted from August to December 2024 among medical, nursing, and administrative staff who had at least one year of teaching or working experience in their respective institutions. A 36-items job satisfaction questionnaire with 6-point Likert type responses was administered in-person. Data analysis was carried out with STATA version 18 software. Categorical variables were presented as frequencies and percentages, whereas continuous variables were described using means, standard deviations, medians, and ranges. Inferential statistical analyses comprised independent t-tests for comparisons between two groups and analysis of variance (ANOVA) for comparisons among multiple groups. A multivariable linear regression model was used to identify the significant factors associated with health workforce job satisfaction. Statistical significance was defined as p < 0.05, with results reported at a 95% confidence interval. Result This study analyzed job satisfaction among 533 health workers in four medical colleges. The average overall job satisfaction score was 122.24 (±15.17). Multivariable linear regression identified several significant determinants of overall job satisfaction among health workers in Nepal’s teaching hospitals. Employees in Nursing (adjusted mean difference [AMD]: 5.35, 95% CI: 2.46 to 8.26) and Administration (AMD: 5.45, 95% CI: 2.20 to 8.71) departments reported higher OJS compared to those in the medical department. Contract staff had significantly lower job satisfaction (AMD: -4.23, 95% CI: -7.19 to -1.28), while differences for daily wage and other positions were not significant. Unexpectedly, employees without chronic diseases reported lower OJS (AMD: -2.66, 95% CI: -5.86 to -0.55). Higher organizational input factors were significantly associated with lower OJS (AMD: -0.37, 95% CI: -0.55 to -0.19). Conclusion This study revealed that health workforces had positive attitude towards their job however are dissatisfied with the benefits offered to them and the operating condition of their institutions. Expanding the teaching learning resources, continuing career opportunities through participation in professional development and regular promotion and increment of salary would be helpful in improving job satisfaction among health workforce in Nepal. KEY WORDS Health workforce, Medical colleges, Organizational characteristics, SatisfactionPublication Home Ventilation in Children(Nepal Paediatric Society (JNPS), 2015) Gupta, D; Sachdev, A; Gupta, N; Simalti, AKAbstract: Introduction: Home mechanical ventilation (HMV) can prolong survival and improve quality of life. The objectives were to review the challenges, clinical conditions and outcome of children who were discharged from the hospital on respiratory support. Material and Methods: Twenty four patients, who were electively discharged from PICU and had received home ventilatory support for more than 15 days, were enrolled over 11 year study period. Patients were followed up monthly, for two years, for ventilatory requirements, any problems encountered during previous month and for any complication. Results: Twenty four patients with a median age of 3.5 years were discharged home with ventilatory support. HMV was started in 2001 at our hospital. Patents received home ventilation for a median period 5.4 months. Twenty (83.3%) patients received invasive mechanical ventilation via tracheostomy and four (16.7%) patients received non-invasive mechanical ventilation. Twelve (50%) patients received ventilatory support for more than 20 hrs a day and twelve (50%) patients received only during sleep. On follow up for two years for each patient, twenty (83.3%) patients successfully came off from ventilatory support while, two (8.3%) patients died and two (8.3%) lost to follow-up. Conclusion: HMV can be safely applied in selected children with CRF after providing adequate training to the care givers. For its more efficient use, we need to have good social support and medical assistance which can be extended to their homes to meet their complete health care needs.Publication Knowledge, Behavior and Attitude towards Sexually Transmitted Infections and Acquired Immunodeficiency Syndrome of Adolescent Students(Nepal Health Research Council, 2011) Gupta, S; Khanal, T R; Gupta, N; Thakur, A; Khatri, R; Suwal, A; Seomangal, KBackground: Adolescence is a period of great physical, mental and emotional turmoil within teenagers. The objective of the study was to assess the knowledge of, attitude to and behaviour towards STI and AIDS among adolescence. Methods: Four randomly selected higher secondary school from students of class XI and XII were included after taking their verbal consent. A pre-designed and pre-tested questionnaire was given to all the participants of the school. In order to get correct answers, specific questions were explained to the students with the help of their class teachers. Results: The results were encouraging with the majority (94.16%) have heard about STIs and HIV/AIDS. Teachers (100%), Newspaper/magazine (90%) and Television (78.33%) were the main informational source about disease. Respondents correctly identified that unsafe sexual contact (86.66%) as major mode of transmission of AIDS and more than 90% of students regarded the use of condoms as the true preventive method for the disease. Among those respondents 6% were sexually active and their partners were either sex worker (71%) or friends (29%). Conclusions: The student’s attitude towards disease was positive and most of the adolescent wished inclusion of sex education in their text book from secondary level school’s curriculum. Keywords: acquired immunodeficiency syndrome, adolescent, sexually transmitted infectionPublication Needlestick Injuries in Dentistry(Kathmandu University, 2011) Gupta, N; Tak, JABSTRACT Needlestick injuries and other sharps-related injuries which expose health care professionals to bloodborne pathogens continue to be an important public health concern. Dentists are at increased risk of exposure to bloodborne pathogens, including Hepatitis B, Hepatitis C, and HIV. This article presents comprehensive information on Needlestick injuries (NSI), post exposure prophylaxis, precautions and suggestions for prevention of NSI in dentistry. Dentists should remember and apply many precautions to prevent the broad spectrum of sharps and splash injuries that could occur during the delivery of dental care. KEY WORDS bloodborne, pathogens, needlestick injuries, post exposure prophylaxisPublication ORAL SUBMUCOUS FIBROSIS: A REVIEW ARTICLE ON ETIOPATHOGENESIS(Kathmandu University, 2014) Tak, J; Gupta, N; Bali, RABSTRACT Areca quid chewing related oral mucosal lesions are potential hazard to a large population worldwide. Commercially freeze dried products such as pan masala, guthka and mawa have high concentration of areca nut per chew and appear to cause OSMF more rapidly than by self prepared conventional betel quid that contain smaller amounts of areca nut. The basic constituent of areca nut is either raw or dried or boiled or baked. Diverse agents including lime, tobacco, catechu, cloves, saffron and leaf of piper betel leaves may form a part of formulation. Many of the undesirable aspects of areca nut have been attributed to arecoline. These chemical appear to interfere with the molecular processes of deposition and or degradation of extracellular matrix molecules such as collagen, causing imbalance in the normal process. The most likely events that take place with regards to the above imbalance may be reduced phagocytosis of collagen by fibroblasts, up or down regulation of copper dependent enzyme lysyl oxidase, matrix metalloproteinases and tissue inhibitors of matrix metalloproteinases . It has been postulated that areca nut may also induce the development of the disease by increased levels of cytokines in the lamina propria. Current evidence implicates collagen related genes in susceptibility and pathogenesis of OSMF. The individual mechanisms operating at various stages of the disease- initial, intermediate and advanced–need further study in order to propose appropriate therapeutic interventions. KEYWORDS Areca-nut, matrix metalloproteinases, oral sub mucous fibrosis.Publication The Comparative Accuracy of BISAP and PANC3 Scoring System for the Disease Severity and Outcome in Acute Pancreatitis in Tertiary Care Hospital from North India(Kathmandu University, 2023) Gupta, S; Dhillon, HS; Gupta, NABSTRACT Background Acute pancreatitis has local and systemic manifestations, so it’s important to assess the severity by various scoring system. Among them bed side index for severity of acute pancreatitis and pancreatitis three score have been considered to be more predictive and easier. Objective To determine the comparative prognostic value of bed side index for severity of acute pancreatitis and pancreatitis 3 score and its correlation with the outcome. Method A prospective observational study was conducted on 50 cases of acute pancreatitis. The patients were assessed clinically, radiologically and biochemically and were categorised into mild, moderate and severe category as per Atlanta Classification. Bed side index for severity of acute pancreatitis and pancreatitis 3 score was calculated at the time of admission and followed till the time of discharge or they had mortality. Result Receiver operating characteristic curve, showed bed side Index for severity of acute pancreatitis score had sensitivity (66.67%), specificity (84.09%), diagnostic accuracy (84%) while pancreatitis 3 score had sensitivity (50%), specificity (81.82%), diagnostic accuracy (80%) for the severity of acute pancreatitis. Bed side index for severity of acute pancreatitis had sensitivity (100%), specificity (66.67%) and Pancreatitis 3 score had sensitivity (66.67%), specificity (80.85%) for predicting the mortality in acute pancreatitis. Conclusion Bed side index for severity of acute pancreatitis and pancreatitis 3 score are both simple, bedside tool for assessing the severity and mortality but bed side index for severity of acute pancreatitis score had better sensitivity, specificity for assessing the severity and mortality as compared to pancreatitis three score. KEY WORDS Acute pancreatitis, Bed side index for severity of acute pancreatitis, Pancreatitis 3 scoring system