Journal Issue: Vol. 63 No. 283 (2025): JNMA
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Volume
63
Number
Issue Date
Journal Title
Journal ISSN
JNMA Print ISSN: 0028-2715; Online ISSN: 1815-672X
Journal Volume
Volume 63
(63)
Articles
Clinical Profile of Patients with Infertility Presenting to Tertiary Care Center: An Observational Study
(Nepal Medical Association, 2025) Tiwari, Jyotshna; Shrestha, Dipty; Thapa, Durga; Rawal, Sirjana; Kafle, Rijan
Abstract
Introduction: Infertility, defined as the inability to conceive after a year of regular unprotected sexual activity, is a significant global health concern. It affects couples across the world, with prevalence rates varying between 3.5-16.7% in developed countries and 6.9-9.3% in developing nations. This study aims to explore the sociodemographic profiles and contributing factors in both men and women among infertility patients at a tertiary care center.
Methods: An observational cross-section study was conducted at a tertiary care center and participants were between 18 and 42 years old with infertility for one year or longer, excluding those who had received treatment or were pregnant. The data was collected from December 2023 to May 2024. Ethical approval and informed consent were obtained. Data were collected using a structure proforma through in-person interviews or telephone calls and analyzed using Statistical Package for the Social Sciences with descriptive statistics.
Results: Among 170 couples with infertility, primary infertility was observed in 124 (72.94%) and secondary infertility in 46 (27.06%). The median duration of marriage was 5 years (IQR: 4–7). Among women, 37 (21.76%) had tubal blockages, 16 (9.41%) had polycystic ovarian disease, and 6 (3.53%) had fibroids. Among men, 58 (34.12%) had semen abnormalities, with oligospermia being the most common in 25 (14.71%). Hormonal analysis revealed that 68 (40%) of women had elevated anti-Müllerian hormone levels, frequently linked to polycystic ovarian syndrome.
Conclusions: These findings show that infertility is rarely due to a single cause. It commonly involves both partners and requires a comprehensive approach to diagnosis and treatment.
Diagnostic Dilemma in Intra-abdominal Cancers
(Nepal Medical Association, 2025) Baral, Gehanath
Abstract
Problem statement: A diagnostic dilemma exists in cancer care, especially in intraabdominal lesions. Despite the diagnostic means available so far, clinical decision-making is practically difficult due to diagnostic limitations. The inherent variation of any means influences decision-making. There is an iceberg-like diagnostic inaccuracy in revealing the specific condition or disease. This clinical decision-making gap is worrisome.
Conclusion: Besides technological and bio-molecular advancements, the structured working framework would be protective and persuasive in mitigating dilemmas to some extent.
The Burden of Maternal and Neonatal Disorder in Nepal from 1990 to 2019; An Analysis of Data from Global Burden of Disease Study: An Observational Study
(Nepal Medical Association, 2025) Rai, Pramila; Ackerman, Ilana N.; O’Connor, Denise A.; Dangal, Ganesh; Buchbinder, Rachelle
Abstract
Introduction: Nepal continues to face significant challenges with high maternal and neonatal mortality. To improve health and achieve the Sustainable Development Goals of reducing maternal and newborn mortality by 2030, Nepal needs to focus on addressing high-burden maternal and neonatal disorders. The objective of the study was to examine the current burden of maternal and neonatal disorders in Nepal and to assess any changes over time.
Methods: We examined the annual Global Burden of Disease Study data on prevalence, deaths, Years Lived with Disability, and Disability-Adjusted Life Years for maternal and neonatal disorders in Nepal for the 1990-2019 period. Estimated annual percentage changes were also calculated to assess the trends of the age-standardised rates of these burden metrics.
Results: The analysis found that the prevalence of overall maternal disorder in Nepal decreased by 37% from 128,176 in 1990 to 80,724 in 2019 with Age-Standarised Ratio of 432.07 per 100,000 in 2019 and Estimated Annual Percentange Change of -4.34 (CI 95%: -4.49 to -4.18). Similarly, the overall prevalence of neonatal disorder increased by 57% from 303,146 in 1990 to 475,544 in 2019 with Age-Standarised Ratio of 1521.14 per 100,000 in 2019 and Estimated Annual Percentage Change of 0.98 (95% CI: 0.67-1.29).
Conclusions: Our findings emphasise the need to address maternal haemorrhage, indirect maternal deaths, maternal abortion and neonatal disorders in Nepal in future national health programs.
DECAF Score in Predicting Outcomes of Acute Exacerbation of Chronic Obstructive Pulmonary Disease: An Observational Study
(Nepal Medical Association, 2025) Prajapati, Amit; Sharma, Yuba Raj; Thapa, Suman; Devkota, Sadina
Abstract
Introduction: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can often lead to hospital admission and has the potential to be fatal. Lack of prognostic research in exacerbation requiring hospitalization that can accurately predict inhospital mortality is a challenge. This study aims to assess value of the DECAF (Dyspnea, Eosinopenia, Consolidation, Acidemia and Atrial fibrillation) score as a clinical prediction tool for inhospital mortality, need of intensive care unit (ICU) stay and risk stratification in patients with Acute exacerbation of chronic obstructive pulmonary disease.
Methods: This is an observational cross-section, hospital based study conducted from April 2022 to February 2023 at a tertiary care centre. The patients admitted with the diagnosis of acute exacerbation of chronic obstructive pulmonary disease were included in the study and their DECAF score were calculated. Patients were followed up during hospital stay and their outcome were recorded. The prognostic value of DECAF score was assessed by area under receiver operator characterstics curve.
Results: There were 83 patients enrolled in the study out of which 13 (15.66%) died in the hospital and 20 (24.09%) required ICU stay. The area under receiver operator characteristic curve value for mortality owas 0.89 and that for intensive care unit stay was 0.84.
Conclusions: This study shows that DECAF score is a good predictor of inhospital mortality and ICU admission.
Appropriate Use of Proton Pump Inhibitors in General Out Patient Department of a Tertiary Care Center of Kathmandu Valley: An Observational Study
(Nepal Medical Association, 2025) Bhandari, Jeetendra; Bhandari, Narendra
Abstract
Introduction: Proton Pump Inhibitors (PPIs) are widely used medications that suppress gastric acid secretion worldwide. However, they have been linked to an increased risk of chronic kidney disease, hypomagnesemia, and bacterial infections, including C. difficile and acid hypersecretion. This study aimed to identify the appropriateness of PPI prescriptions in general clinics.
Methods: An observational cross-section study was conducted in General out patient department of a tertiary care center of Nepal . Purposive sampling was done. The study included 355 clinical notes from the clinic’s out patient department with at least one proton pumb inhibitor prescription. Data was collected, and the proportion of different parameters was calculated.
Results: Appropriate use of proton pumb inhibitor was 255 (57.74%). Among the total study population, 186 (51.22%) were male. The appropriate use of proton pump inhibitor use by faculties was 83 (61.02%) and 68 (33.68%) reported that it was given to prevent Non-steroidal Anti-Inflammatory Drug-related complications. Pantoprazol was prescribed in 256 (74.62%) cases.
Conclusions: This study suggests that PPIs were appropriate more than 50 percent of the time, but a high number of patients have been prescribed PPIs without a clear indication.