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Baral S, Yadav RK, Yadav DK, Marahatta SB, Baral Y, Khadka KB, Thakur SK, Paudel S, Sharma P, Pandey S, Shrestha K, Shah NP, Basaula L, Nagila A, Mahato RK, Ranabhat CL. Feasibility of implementing public-private mix approach for tuberculosis case management in Pokhara Metropolitan City of western Nepal: a qualitative study. Front Public Health 2023; 11:1132090. [PMID: 37293622 PMCID: PMC10244665 DOI: 10.3389/fpubh.2023.1132090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/12/2023] [Indexed: 06/10/2023] Open
Abstract
Background The Public-Private Mix (PPM) approach is a strategic initiative that involves engaging all private and public health care providers in the fight against tuberculosis using international health care standards. For tuberculosis control in Nepal, the PPM approach could be a milestone. This study aimed to explore the barriers to a public-private mix approach in the management of tuberculosis cases in Nepal. Methods We conducted key informant interviews with 20 participants, 14 of whom were from private clinics, polyclinics, and hospitals where the PPM approach was used, two from government hospitals, and four from policymakers. All data were audio-recorded, transcribed, and translated into English. The transcripts of the interviews were manually organized, and themes were generated and categorized into 1. TB case detection, 2. patient-related barriers, and 3. health-system-related barriers. Results A total of 20 respondents participated in the study. Barriers to PPM were identified into following three themes: (1) Obstacles related to TB case detection, (2) Obstacles related to patients, and (3) Obstacles related to health-care system. PPM implementation was challenged by following sub-themes that included staff turnover, low private sector participation in workshops, a lack of trainings, poor recording and reporting, insufficient joint monitoring and supervision, poor financial benefit, lack of coordination and collaboration, and non-supportive TB-related policies and strategies. Conclusion Government stakeholders can significantly benefit by applying a proactive role working with the private in monitoring and supervision. The joint efforts with private sector can then enable all stakeholders to follow the government policy, practice and protocols in case finding, holding and other preventive approaches. Future research are essential in exploring how PPM could be optimized.
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Affiliation(s)
- Sushila Baral
- Center for Mental Health and Counselling Nepal (CMC Nepal), Kathmandu, Nepal
- Department of Public Health, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | | | - Dipendra Kumar Yadav
- Department of Public Health, School of Health and Allied Sciences, Pokhara University, Pokhara, Nepal
| | - Sujan Babu Marahatta
- Department of Public Health, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Yadunath Baral
- Department of Orthopedics, Pokhara Academy of Health Sciences, Pokhara, Nepal
| | - Khim Bahadur Khadka
- Health Directorate, Minstry of Health and Population (MoHP), Gandaki Province, Pokhara, Nepal
| | | | - Srijana Paudel
- Department of Medicine, Pokhara Academy of Health Sciences, Pokhara, Nepal
| | - Prabin Sharma
- Provincial Health Training Center, Gandaki Province, Pokhara, Nepal
| | - Sony Pandey
- Department of Public Health, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Kusum Shrestha
- Provincial Government, Health Office, Damauli, Tanahun, Nepal
| | | | - Laxman Basaula
- Health Directorate, Minstry of Health and Population (MoHP), Gandaki Province, Pokhara, Nepal
| | - Amar Nagila
- Department of Medical Microbiology, School of Health and Allied Sciences, Pokhara University, Pokhara, Nepal
| | | | - Chhabi Lal Ranabhat
- Department of Public Health, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
- Global Center for Research and Development, Kathmandu, Nepal
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Shrestha S, Karn M, Regmi SM, Pradhan S, Nagila A, Prajapati R. Clinical profile and biochemical abnormalities in Scrub Typhus: A cross-sectional study. Ann Med Surg (Lond) 2022; 84:104903. [DOI: 10.1016/j.amsu.2022.104903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/30/2022] [Accepted: 10/30/2022] [Indexed: 11/17/2022] Open
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Shrestha S, Karn M, Regmi SM, Nagila A, Pahari S. Clinical profile and biochemical abnormalities in brucellosis: A cross-sectional study. Ann Med Surg (Lond) 2022; 79:103922. [PMID: 35860119 PMCID: PMC9289301 DOI: 10.1016/j.amsu.2022.103922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/28/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Brucellosis is the commonest zoonotic disease worldwide and a common public health problem in Nepal. Because of the highly variable clinical presentation and non-specific manifestations, it remains a big challenge for clinicians from developing countries. Brucellosis has a tropism for the reticuloendothelial system, the liver is frequently involved. There is a paucity of data about the laboratory and clinical findings of human Brucellosis from Nepal. To address this knowledge gap, we conducted this study to find out the clinical profile and biochemical abnormalities of patients with brucellosis at a tertiary-care teaching hospital in western Nepal. Methods A cross-sectional study was carried out at Gandaki Medical College Teaching Hospital, Pokhara, Nepal. All patients admitted to the in-patient department of our hospital with probable or definitive diagnoses of brucellosis were included. We excluded those who did not consent to their participation in our study, those who were under 18 years of age, and those who had deranged liver function due to other pre-existing illnesses. Descriptive statistics were used to analyze the data in terms of demography, clinical manifestations, and laboratory parameters. Results There was a total of 40 confirmed cases of Brucellosis (age: 18–66 years) during the study period. More than half (55%, n = 22) of the study participants were males and most of them lived in a rural setting (77.5%, n = 31). Most of them (70%, n = 28) gave history of ingestion of high-risk food. The commonest clinical findings were fever with/out chills (90%, n = 36) followed by nausea/vomiting (72.5%, n = 29), headache (40%, n = 16) and malaise (37.5, n = 15). Liver function was deranged in a majority of the patients, the common parameters being Alkaline phosphatase in 96% (n = 38) cases, followed by SGOT (62.5%, n = 25), leukocytosis (57.5%, n = 23), total bilirubin (52.5%, n = 21) and SGPT (37.5%, n = 15). Characteristic increment (more than two folds of the upper limit of normal) was observed for alkaline phosphatase. Conclusion The reticuloendothelial system is frequently involved in brucellosis. Notable changes were observed in liver function and hematological parameters in a majority of the participants in our study. These findings highlight the need for the implementation of effective control programs to address this problem in the Nepalese context. There is a lack of evidence about human Brucellosis from Nepal. Liver function was deranged in majority of the cases. Characteristics increment was seen for alkaline phosphatase. There is a need of effective brucellosis control program.
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Affiliation(s)
- Sanjeeb Shrestha
- Department of Biochemistry, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, 33700, Nepal
- Corresponding author.
| | - Mitesh Karn
- School of Medicine, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, 33700, Nepal
| | - Sanjib Mani Regmi
- Department of Microbiology, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, 33700, Nepal
| | - Amar Nagila
- Faculty of Health Sciences, Pokhara University, Pokhara, 33700, Nepal
| | - Sandip Pahari
- Department of Community Medicine, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, 33700, Nepal
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Karki D, Nagila A, Dhakal N, Chhetri S. Prevalence of peripheral neuropathy in diabetes mellitus and its association with therapy, ethnicity and duration of diabetes mellitus. Asian J Med Sci 2018. [DOI: 10.3126/ajms.v10i1.21743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Diabetic peripheral neuropathy (DPN) is a most common micro vascular complication of diabetes posing significant morbidity and mortality with early and insidious onset. Studies has variably pointed that older age, gender, duration of diabetes, dyslipidemia, are linked with development of DPN.
Aims and Objectives: To determine the prevalence of neuropathy in diabetic patients and see its link with age, gender, duration of diabetes, therapy and ethnicity.
Materials and Methods: This is a cross-sectional study involving 110 clinically diagnosed diabetic patients, meeting the inclusion criteria. Basic demographic data were taken during clinical examination. Presence of degree of neuropathy was screened by measuring vibration perception threshold using Biothesiometer. Data was entered on SPSS and were categorized, necessary non parametric statistical tests were applied to these categorical variables as needed. The level of significance was set at p value less than 0.05.
Results: Presence of neuropathy was measured in 110 diabetic patients. The overall prevalence of DPN was 45.45%. Frequency of neuropathy was higher with increase in age with 72.7% in more than 60 years of age and 23.5% in less than or equal to 40 years of age group (p=0.007). Similarly, the increasing trend of DPN with increase in duration of DM was evident in this study with DPN present in more than 55% of patients with more than 5 years of diabetes(p=0.004).
Conclusion: The prevalence rate of DPN in diabetes was observed to be higher (45.45%). Our result suggested that DPN is associated with old age and the duration of diabetes mellitus.
Asian Journal of Medical Sciences Vol.10(1) 2019 72-76
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Netsawang J, Panaampon J, Khunchai S, Kooptiwut S, Nagila A, Puttikhunt C, Yenchitsomanus PT, Limjindaporn T. Dengue virus disrupts Daxx and NF-κB interaction to induce CD137-mediated apoptosis. Biochem Biophys Res Commun 2014; 450:1485-91. [PMID: 25019989 DOI: 10.1016/j.bbrc.2014.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 07/03/2014] [Indexed: 10/25/2022]
Abstract
Dengue virus (DENV) is a positive-strand RNA virus of the Flavivirus family with 4 different serotypes. Clinical manifestations of DENV infection include dengue fever, dengue hemorrhagic fever, and dengue shock syndrome. Following DENV infection, apoptosis of hepatic cells is observed both in vitro and in vivo. However, the molecular mechanisms revealing how viral components affect cellular apoptosis remain unclear. In the present study, the role of death domain-associated protein 6 (Daxx) in DENV-mediated apoptosis was characterized by RNA interference and overexpression studies, and the anti-apoptotic function of Daxx during DENV infection was identified. Furthermore, the viral component, DENV capsid protein (DENV C), interacted with Daxx to disrupt interaction between Daxx and NF-κB. The liberated NF-κB activated the promoter of CD137, which is a member of the TNF family, and is previously shown to induce apoptosis during DENV infection. In summary, DENV C disrupts Daxx and NF-κB interaction to induce CD137-mediated apoptosis during DENV infection.
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Affiliation(s)
- Janjuree Netsawang
- Faculty of Medical Technology, Rangsit University, Phathum Thani, Thailand
| | - Jutatip Panaampon
- Division of Molecular Medicine, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sasiprapa Khunchai
- Division of Molecular Medicine, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suwattanee Kooptiwut
- Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Amar Nagila
- Division of Molecular Medicine, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chunya Puttikhunt
- Medical Biotechnology Unit, National Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency, Thailand
| | - Pa-Thai Yenchitsomanus
- Division of Molecular Medicine, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thawornchai Limjindaporn
- Division of Molecular Medicine, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Nagila A, Netsawang J, Suttitheptumrong A, Morchang A, Khunchai S, Srisawat C, Puttikhunt C, Noisakran S, Yenchitsomanus PT, Limjindaporn T. Inhibition of p38MAPK and CD137 signaling reduce dengue virus-induced TNF-α secretion and apoptosis. Virol J 2013; 10:105. [PMID: 23557259 PMCID: PMC3639879 DOI: 10.1186/1743-422x-10-105] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 04/02/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Hepatic injury in dengue virus (DENV) infection is authenticated by hepatomegaly and an upsurge in transaminase levels. DENV replicates in hepatocytes and causes hepatocyte apoptosis both in vitro and in vivo. Understanding the molecular mechanisms of DENV-induced hepatic injury could facilitate the development of alternate chemotherapeutic agents and improved therapies. FINDINGS The p38 mitogen-activated protein kinase (MAPK) participates in both apoptosis-related signaling and pro- inflammatory cytokine production. The role of p38 MAPK in DENV-infected HepG2 cells was examined using RNA interference. The results showed that DENV infection activated p38 MAPK and induced apoptosis. The p38 MAPK activation and TNF-α production were controlled by p38 MAPK and CD137 signaling in DENV-infected HepG2 cells as activated p38 MAPK, TNF-α and apoptosis were significantly decreased in p38 MAPK and CD137 depleted DENV-infected HepG2 cells. Addition of exogenous TNF-α to p38 MAPK depleted DENV-infected HepG2 cells restored DENV-induced apoptosis in HepG2 cells. CONCLUSION DENV induces CD137 signaling to enhance apoptosis by increasing TNF-α production via activation of p38 MAPK.
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Affiliation(s)
- Amar Nagila
- Division of Molecular Medicine, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Permpongpaiboon T, Nagila A, Pidetcha P, Tuangmungsakulchai K, Tantrarongroj S, Porntadavity S. Decreased paraoxonase 1 activity and increased oxidative stress in low lead-exposed workers. Hum Exp Toxicol 2011; 30:1196-203. [PMID: 21296834 DOI: 10.1177/0960327110388536] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Paraoxonase 1 (PON1) has been proposed as an antioxidant enzyme. Although lead-inhibited PON1 activity has been demonstrated mostly based on in vitro experiments, it is uncertain whether this phenomenon is relevant in pathogenesis of lead-induced oxidative stress in the lead exposure. We examined associations of blood lead levels (BLL) and PON1 activity along with oxidative stress parameters in lead exposure workers. We determined malondialdehyde (MDA), conjugated diene (CD), total peroxides (TP), total antioxidant status (TAS), the oxidative stress index (OSI), and PON1 activity in earthenware factory workers (n = 60) and control subjects (n = 65). The lead-exposed group significantly increased lipid peroxidation parameters and OSI compared to the control group (p < 0.001). The lead-exposed group had significantly decreased PON1 activity and TAS levels compared to the control group (p < 0.001). Multiple linear regression analysis revealed that BLL were significantly correlated with decreased TAS (r = -0.496) and PON1 activity (r = -0.434), but with increased CD (r = 0.694), TP (r = 0.614), MDA (r = 0.788), and OSI (r = 0.722). Interestingly, BLL at 10 µg/dL significantly decreased PON1 activity and increased oxidative stress parameters with insignificant changes in other biochemical and hematological parameters. Altogether, the reduction of PON1 activity may associate in an imbalance in pro-oxidants and antioxidants, leading to oxidative damage in lead-exposed workers even at low BLL.
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Affiliation(s)
- Thinnakorn Permpongpaiboon
- Department of Clinical Chemistry, Faculty of Medical Technology, Huachiew Chalermprakiet, Samut Prakarn, Thailand
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Sigdel M, Rajbhandari N, Basnet S, Nagila A, Basnet P, Tamrakar BK. Microalbuminuria among type-2 diabetes mellitus patients in Pokhara, Nepal. Nepal Med Coll J 2008; 10:242-245. [PMID: 19558062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Microalbuminuria is considered to be an early stage of diabetic nephropathy as well as a marker of cardiovascular disease. The aim of this study was to see the prevalence of microalbuminuria in type 2 diabetic patients and assess its association with cardiovascular risk factors among them. A total of 143 type 2 diabetic patients with the mean age of 56.06 +/- 1.08 years were analysed. The prevalence of microalbuminuria and overt proteinuria was 45.5% and 11.2%, respectively. Prevalence of microalbuminuria in female was marginally higher than in male (p > 0.05). Subjects with microalbuminuria had significantly higher blood pressure (p < 0.001) and duration of diabetes (p < 0.05) compared with normoalbuminuric subjects. High density lipoprotein was found to be significantly lower (p < 0.05) in subjects with microalbuminuria whereas fasting blood sugar, triglyceride, total cholesterol and very low density lipoprotein were marginally higher in microalbuminuric than in normoalbuminuric subjects (p > 0.05). High prevalence of microalbuminuria in diabetic patients and its positive association with blood pressure and altered lipid profile suggests that screening for microalbuminuria is essential for intervention and prevent further complications like end stage renal disease and cardiovascular diseases.
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Affiliation(s)
- M Sigdel
- The School of Pharmaceuticals and Biomedical Sciences, Pokhara University, Kaski, Nepal.
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