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Dorji T, Wangmo S, Dargay S, Dorji N, Dorjey Y, Pradhan B, Pema D, Dema C, Choden J, Dorji T, Mynak ML, Pempa, Jamphel K. Population-level cancer screening and cancer care in Bhutan, 2020-2023: a review. Lancet Reg Health Southeast Asia 2024; 24:100370. [PMID: 38444883 PMCID: PMC10910341 DOI: 10.1016/j.lansea.2024.100370] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/25/2024] [Accepted: 02/05/2024] [Indexed: 03/07/2024]
Abstract
Screening of cancers is an important intervention in reducing the incidence and mortality related to cancers. Bhutan is one small country that is witnessing an increasing incidence and mortality related to cancers. The government implemented a time-bound population-level screening for gastric, cervical and breast cancers from 2020 to 2023 with an overall coverage of 91.2% of the eligible population. Among 370,225 individuals screened for H pylori, 32.4% tested positive; among 53,182 who underwent upper gastrointestinal endoscopy and biopsy, 255 (0.07%) had gastric cancer. Among 10,749 tested for HPV DNA, 9.3% were positive; among 9887 evaluated with colposcopy and biopsy, 154 (0.13%) had cervical cancer. For breast cancer screening, 72,283 underwent clinical breast examination, 845 mammography and cancer was detected in 73 (0.10%) individuals. In this article, we review how Bhutan implemented a population-level cancer screening programme with on boarding of multiple stakeholders and the participation of people across all districts.
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Affiliation(s)
- Thinley Dorji
- Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Sangay Wangmo
- Department of Surgery, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Sonam Dargay
- Department of Surgery, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Namkha Dorji
- Department of Obstetrics and Gynaecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Yeshey Dorjey
- Department of Obstetrics and Gynaecology, Phuentsholing General Hospital, Phuentsholing, Bhutan
| | - Birendra Pradhan
- Department of Pathology and Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Dechen Pema
- Department of Radiodiagnosis and Imaging, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Choney Dema
- National Medical Services, Ministry of Health, Thimphu, Bhutan
| | - Jamyang Choden
- Department of Health Services, Ministry of Health, Thimphu, Bhutan
| | | | | | - Pempa
- Department of Health Services, Ministry of Health, Thimphu, Bhutan
| | - Kinga Jamphel
- Department of Health Services, Ministry of Health, Thimphu, Bhutan
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Dorji T, Dorjee S, Wangdi T, Tshokey T, Pradhan AR, Penjor K, Namgay R, Togbye T, Karunaweera N. Efforts toward the Elimination of Visceral Leishmaniasis in South Asia: A Review of Progress in Bhutan. Am J Trop Med Hyg 2024; 110:633-638. [PMID: 38471147 PMCID: PMC10993832 DOI: 10.4269/ajtmh.23-0642] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/11/2023] [Indexed: 03/14/2024] Open
Abstract
Leishmaniases are a group of diseases under the category of neglected tropical diseases targeted for global elimination. However, they continue to pose major clinical and public health problems, especially among those living in poor socioeconomic conditions. Here, we summarize leishmaniasis elimination efforts in Bhutan. Between 1994 and 2022, Bhutan recorded 54 cases of leishmaniasis across 14 of its 20 districts. There are seven species of Phlebotomus and three species of Sergentomyia sand flies documented in the country. At a subnational level, all endemic districts recorded a visceral leishmaniasis annual incidence <1 per 10,000 population, meeting the regional elimination targets. Serological testing with ELISA and molecular testing with polymerase chain reaction were established at the Royal Center for Disease Control in 2022. A leishmaniasis prevention and management guideline was adopted in 2023 to aid clinicians in diagnosis and management. Active and passive case surveillance was integrated with the national infectious disease early warning and response system. Risk-based entomological surveillance and control have also been prioritized. Climate change may play a major role in rendering districts in the temperate zone favorable for vector proliferation. The country's medical university introduced a diploma course in medical entomology in 2023 to augment the human resources needed for vector surveillance efforts. However, leishmaniasis elimination lacks dedicated programmatic management amid competing priorities for resources against other infectious diseases. Leishmaniasis elimination requires a targeted and programmatic approach in Bhutan, including cross-border collaborative efforts with neighboring Indian states. Bhutan remains highly committed to achieving leishmaniasis elimination targets.
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Affiliation(s)
- Thinley Dorji
- Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Sithar Dorjee
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Tenzin Wangdi
- Vector-Borne Disease Control Programme, Ministry of Health, Gelephu, Bhutan
| | - Tshokey Tshokey
- Department of Pathology and Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Ambika Rani Pradhan
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
- Department of Dermatology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Kinley Penjor
- Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Rinzin Namgay
- Vector-Borne Disease Control Programme, Ministry of Health, Gelephu, Bhutan
| | - Togbye Togbye
- Vector-Borne Disease Control Programme, Ministry of Health, Gelephu, Bhutan
| | - Nadira Karunaweera
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Chophel U, Dorji S, Sonam K, Dorji T. Suspected cutaneous anthrax in a yak herder in a highland community in Bhutan, 2023: A case report. Clin Case Rep 2024; 12:e8647. [PMID: 38487638 PMCID: PMC10940008 DOI: 10.1002/ccr3.8647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/17/2024] Open
Abstract
This case presents cutaneous anthrax in yak herder from a central highland community in Bhutan. We highlight the clinical presentation, diagnosis and management of the case in a resource-limited setting, and the public health response through the One Health approach.
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Affiliation(s)
| | | | - Kuenga Sonam
- Department of Internal MedicineCentral Regional Referral HospitalGelephuBhutan
| | - Thinley Dorji
- Department of Internal MedicineCentral Regional Referral HospitalGelephuBhutan
- Faculty of Postgraduate MedicineKhesar Gyalpo University of Medical Sciences of BhutanThimphuBhutan
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Dorji T, Horan K, Sherry NL, Tay EL, Globan M, Viberg L, Bond K, Denholm JT, Howden BP, Andersson P. Whole genome sequencing of drug-resistant Mycobacterium tuberculosis isolates in Victoria, Australia. Int J Infect Dis 2024; 138:46-53. [PMID: 37967715 DOI: 10.1016/j.ijid.2023.11.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVES Whole genome sequencing (WGS) can identify clusters, transmission patterns, and drug resistance mutations. This is important in low-burden settings such as Australia, as it can assist in efficient contact tracing and surveillance. METHODS We conducted a retrospective cohort study using WGS from 155 genomically defined drug-resistant Mycobacterium tuberculosis (DR-TB) isolates collected between 2018-2021 in Victoria, Australia. Bioinformatic analysis was performed to identify resistance-conferring mutations, lineages, clusters and understand how local sequences compared with international context. RESULTS Of the 155 sequences, 42% were identified as lineage 2 and 35% as lineage 1; 65.8% (102/155) were isoniazid mono-resistant, 8.4% were multi-drug resistant TB and 5.8% were pre-extensively drug-resistant / extensively drug-resistant TB. The most common mutations were observed in katG and fabG1 genes, especially at Ser315Thr and fabG1 -15 C>T for first-line drugs. Ser450Leu was the most frequent mutation in rpoB gene. Phylogenetic analysis confirmed that Victorian DR-TB were associated with importation events. There was little evidence of local transmission with only five isolate pairs. CONCLUSION Isoniazid-resistant TB is the commonest DR-TB in Victoria, and the mutation profile is similar to global circulating DR-TB. Most cases are diagnosed among migrants with limited transmission. This study highlights the value of WGS in identification of clusters and resistance-conferring mutations. This information is crucial in supporting disease mitigation and treatment strategies.
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Affiliation(s)
- Thinley Dorji
- Department of Microbiology and Immunology at The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Kristy Horan
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology at The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Norelle L Sherry
- Department of Microbiology and Immunology at The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia; Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology at The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Ee Laine Tay
- Communicable Disease Epidemiology and Surveillance, Health Protection Branch, Public Health Division, Department of Health, Melbourne, Australia
| | - Maria Globan
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Linda Viberg
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Katherine Bond
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia; Royal Melbourne Hospital, Melbourne, Australia
| | - Justin T Denholm
- Royal Melbourne Hospital, Melbourne, Australia; Victorian Tuberculosis Program. Melbourne Health at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia; Department of Infectious Diseases at The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Benjamin P Howden
- Department of Microbiology and Immunology at The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia; Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology at The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia; Centre for Pathogen Genomics, University of Melbourne, Australia.
| | - Patiyan Andersson
- Department of Microbiology and Immunology at The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia; Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology at The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
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5
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Tamang M, Dorji N, Wangdi K, Letho Z, Lhaki K, Dorji T. Perspectives on chronic musculoskeletal pain management among healthcare professionals in Bhutan: A qualitative study. Musculoskeletal Care 2023; 21:1401-1411. [PMID: 37706565 DOI: 10.1002/msc.1821] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
INTRODUCTION Musculoskeletal pain disorders continue to be one of the leading causes of disability worldwide. Best practice care recommends patient-centred biopsychosocial models of care. Little is known about the chronic musculoskeletal pain management in low- and middle-income countries. OBJECTIVES To explore the management of chronic musculoskeletal pain by healthcare professionals in Bhutan. METHODS This study employed a qualitative design involving 19 Bhutanese healthcare professionals managing chronic musculoskeletal pain in Bhutan. We collected data using a semi-structured interview guide. Thematic analysis was done manually. RESULTS Healthcare professionals reported that patients rely on a combination of home remedies and seek help from local healers and hospitals for chronic musculoskeletal pain management. While healthcare professionals understand chronic musculoskeletal pain as multi-dimensional phenomenon, the primary focus was on identifying and treating structural anomalies. Time constraints, inadequate knowledge and skills, lack of confidence, facilities and expertise were reported as barriers to the effective management of chronic musculoskeletal pain. They proposed a need for clinical guidelines, relevant skills training and creating awareness of chronic musculoskeletal pain. CONCLUSION The management of chronic musculoskeletal pain in Bhutan is focused on identifying and treating physical abnormalities. Healthcare professionals consider psychosocial dimensions important but lack any form of actionable interventions in this domain.
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Affiliation(s)
- Monu Tamang
- Department of Physiotherapy, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Nidup Dorji
- Department of Public Health and Allied Health Sciences, Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Kuenzang Wangdi
- Department of Orthopaedic Surgery, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Zimba Letho
- Medical Education and Research Unit, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Karma Lhaki
- Department of Physiotherapy, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Thinley Dorji
- Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan
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Dorji T, Giri S, Tshering U, LeVine S, Tshering U, Chhetri S, Dhakal N, Gaikwad SN, Flaherty GT, Lucero-Prisno DE, McIntosh S. Challenges in the management of high-altitude illnesses and emergencies in Bhutan and Nepal. Travel Med Infect Dis 2023; 56:102660. [PMID: 37926372 DOI: 10.1016/j.tmaid.2023.102660] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/04/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
Many popular tourist attractions and trekking routes in Bhutan and Nepal are situated between 3000 and 6000 m in elevation. High-altitude emergencies are becoming more common and medical providers must be aware of the practical and medical issues in managing these disorders. We reflect on the challenges in providing high-altitude emergency medical services in Bhutan and Nepal.
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Affiliation(s)
- Thinley Dorji
- Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan.
| | - Sweta Giri
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan; Department of Emergency Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan; Bhutan Emergency Aeromedical Retrieval, Ministry of Health, Thimphu, Bhutan.
| | - Ugyen Tshering
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan; Department of Emergency Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan; Bhutan Emergency Aeromedical Retrieval, Ministry of Health, Thimphu, Bhutan.
| | - Shankar LeVine
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan; Department of Emergency Medicine at Dartmouth, Geisel School of Medicine at Dartmouth, NH, USA.
| | - Ugyen Tshering
- Department of Health Services, Ministry of Health, Thimphu, Bhutan.
| | - Sunit Chhetri
- Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
| | - Narayan Dhakal
- Department of Internal Medicine, Shree Birendra Hospital, Kathmandu, Nepal.
| | | | | | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Scott McIntosh
- Department of Emergency Medicine, University of Utah Health, Salt Lake City, UT, USA.
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Dorji T, Lamichaney J, Gyaltshen C, Lungten L, Dhakal GP, Dorjee S, Mynak ML. Human rabies encephalomyelitis in the background of rabies outbreak in animals in Gelephu, Bhutan, 2023: a case report. Infect Dis Poverty 2023; 12:94. [PMID: 37845744 PMCID: PMC10577971 DOI: 10.1186/s40249-023-01148-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/11/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Rabies continues to pose significant public health challenges in many developing countries including Bhutan. A probable case of rabies was admitted to our hospital and its reporting led to the uncovering of an outbreak in domestic and wild animals. We discuss the challenges in the diagnosis and management of rabies in a resource-limited setting. CASE PRESENTATION A 35-year-old male presented with intermittent fever, bilateral lower limb weakness that was rapidly progressive, urinary incontinence with episodes of palpitations and sweating. He had sustained a Category III bite on the right lower thigh with four bite marks, inflicted by a stray dog. He had received post-exposure prophylaxis with intra-dermal anti-rabies vaccine. On initial examination, the patient was in distress but cooperative for the interview. He had pulse rate ranging from 60 to 100/min with episodes of diaphoresis and palpitations, but with normal capillary blood glucose. In the lower limb, the muscle power was zero with absent tendon reflexes in the lower limb and impaired abdominal reflex below T10 level. He had hyperaesthesia below T8, hydrophobia, aerophobia and photophobia. He had multiple spontaneous fasciculations in both the thighs and right deltoid and these later involved the intercostal muscles, neck and face muscles. He had altered sensorium and desaturation for which he required mechanical ventilation. Polymerase chain reaction for rabies virus was negative in cerebrospinal fluid and saliva. Rabies virus neutralizing antibody was negative in cerebrospinal fluid but had high titres in the serum. He received Human Rabies Immunoglobulin after admission. He was managed in the intensive care unit and died 23 days later. After this case was notified, a rapid response team was deployed in the field, and uncovered rabies outbreak in animals in the locality. CONCLUSIONS This case called for a serious evaluation of the country's efforts in achieving zero rabies deaths by 2030. The management of this case identified several critical areas of context-specific interventions in Bhutan. There is also an urgent need to improve diagnostic capabilities at the national reference laboratory and enhance the technical competencies of healthcare workers in the management of dog bite cases.
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Affiliation(s)
- Thinley Dorji
- Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan.
| | - Jeewanath Lamichaney
- Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Choeda Gyaltshen
- Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Lungten Lungten
- Regional Veterinary Hospital and Epidemiology Centre, Gelephu, Bhutan
| | - Guru Prasad Dhakal
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Sithar Dorjee
- Office of the President, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Mimi Lhamu Mynak
- Office of the President, National Medical Services, Ministry of Health, Thimphu, Bhutan
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Gyeltshen K, Sangye N, Tenzin KC, Dorji T. Clinical description and treatment outcomes of Paederus dermatitis in Phuentsholing, Bhutan in 2021: A cross-sectional study. Skin Health Dis 2023; 3:e223. [PMID: 37538335 PMCID: PMC10395627 DOI: 10.1002/ski2.223] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/17/2023] [Accepted: 02/13/2023] [Indexed: 08/05/2023]
Abstract
An increasing number of beetle population and outbreaks of irritant contact dermatitis are reported from newer geographic locations. Bhutan is one such country that witnessed an outbreak of Paederus dermatitis (PD) in Phuentsholing sub-district in 2021. This study describes the clinical symptoms, skin lesions and treatment outcomes of PD in Bhutan. This was a descriptive cross-sectional study of an outbreak of Paederus-related contact dermatitis in Phuentsholing, Bhutan. Clinical symptoms, skin lesions, duration of illness, recovery time and response to treatment were recorded. Of the 81 patients with PD, the males constituted 54% (44) and the mean age was 22 years (range: 1-51 years). The commonly affected groups were those aged 11-20 years (40.7%) and school or college students (50.6%). The common symptoms were pain, itching, redness, tenderness and blister formation. The lesions were erythematovesicular (70%), linear (54.3%) and kissing lesions (28.4%). All patients received some form of topical or oral steroid therapy and recovery was 100%. The mean duration from the onset till the recovery of the skin rash was 13 days (SD ± 8.3 days). PD outbreak is a self-limiting form of contact dermatitis. This is the first report of PD in the sub-Himalayan region and may be linked to climate change. There is a need for active surveillance and monitoring of such emerging weather/climate-related agents for appropriate health system response in disease prevention and treatment.
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Affiliation(s)
- Kinley Gyeltshen
- Inpatient and Outpatient DepartmentGidakom HospitalMinistry of HealthThimphuBhutan
| | - Ngawang Sangye
- Inpatient and Outpatient DepartmentTrashigang General HospitalTrashigangBhutan
| | - Kunzang C. Tenzin
- Emergency DepartmentPhuentsholing HospitalMinistry of HealthPhuentsholingBhutan
| | - Thinley Dorji
- Department of Internal MedicineCentral Regional Referral HospitalGelegphuBhutan
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Chuki P, Dorji T, James R, Wangchuk K, Yangzom S, Dema Y, Wangchuk S, Wangdi D, Deki T, Limbu C, Dorji KR, Wangda S, Buising K, Thursky K. Antibiotic use and quality indicators of antibiotic prescription in Bhutan: a point prevalence survey using the Australian National Antimicrobial Prescribing Survey tool. JAC Antimicrob Resist 2023; 5:dlad100. [PMID: 37614960 PMCID: PMC10443734 DOI: 10.1093/jacamr/dlad100] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023] Open
Abstract
Background The National Action Plan on Antimicrobial Resistance in Bhutan promotes the rational use of antibiotics. It is important to establish baseline data on the use of antibiotics and the quality indicators of antibiotic prescriptions to identify where improvement efforts may need to be focused. Objectives To describe the prevalence and patterns of antibiotic prescription and establish baseline data regarding quality indicators of antibiotic prescriptions in four major hospitals in Bhutan. Methods This was a point prevalence survey of antibiotic use among inpatients in June 2022 conducted using the Australian National Antibiotic Prescribing Survey (NAPS). Results There were 314 patients (41.5%) receiving at least one antibiotic on the audit day. Among prescriptions reviewed, 278 (88.5%) had indications for use documented, 102 (32.5%) had a review or stop date documented and 120 (38.2%) had microbiology samples collected prior to antibiotics. Ceftriaxone (68; 21.7%), cefazolin (41; 13.1%) and metronidazole (32; 10.2%), were the common antibiotics prescribed. The most common indications for use were surgical prophylaxis (42; 13.4%), community-acquired pneumonia (39; 12.4%) and sepsis (26; 8.3%). There were 125 prescriptions (39.8%) that were compliant with national/therapeutic antibiotic guidelines and 169 (53.8%) where antibiotic prescriptions were appropriate. Conclusions This study identified key areas for targeted interventions in antimicrobial stewardship programmes in Bhutan. The prevalence of antibiotic use, indications for use, and drug choices were similar to data from other countries. Documentation plans for durations of use, prolonged surgical prophylaxis and concordance of choices with guideline recommendations present opportunities for improvement.
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Affiliation(s)
- Pem Chuki
- Antimicrobial Stewardship Unit, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Thinley Dorji
- Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Rodney James
- Department of Infectious Diseases, National Centre for Antimicrobial Stewardship, University of Melbourne, Melbourne, Victoria, Australia
- Guidance Group, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Khando Wangchuk
- Antimicrobial Stewardship Unit, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Sonam Yangzom
- Department of Internal Medicine, Eastern Regional Referral Hospital, Monggar, Bhutan
| | - Yangchen Dema
- Department of Internal Medicine, Eastern Regional Referral Hospital, Monggar, Bhutan
| | - Sangay Wangchuk
- Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Dorji Wangdi
- Department of Pharmacy, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Tshering Deki
- Antimicrobial Stewardship Unit, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Chandra Limbu
- Antimicrobial Stewardship Unit, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | | | - Sonam Wangda
- Antimicrobial Resistance Prevention Program, Ministry of Health, Thimphu, Bhutan
| | - Kirsty Buising
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Karin Thursky
- Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan
- Department of Infectious Diseases, National Centre for Antimicrobial Stewardship, University of Melbourne, Melbourne, Victoria, Australia
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Senevirathna K, Jayawickrama SM, Jayasinghe YA, Prabani KIP, Akshala K, Pradeep RGGR, Damayanthi HDWT, Hettiarachchi K, Dorji T, Lucero‐Prisno DE, Rajapakse RMG, Kanmodi KK, Jayasinghe RD. Nanoplatforms: The future of oral cancer treatment. Health Sci Rep 2023; 6:e1471. [PMID: 37547360 PMCID: PMC10397482 DOI: 10.1002/hsr2.1471] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/16/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023] Open
Abstract
Background and Aims Cytotoxicity is a key disadvantage of using chemotherapeutic drugs to treat cancer. This can be overcome by encapsulating chemotherapeutic drugs in suitable carriers for targeted delivery, allowing them to be released only at the cancerous sites. Herein, we aim to review the recent scientific developments in the utilization of nanotechnology-based drug delivery systems for treating oral malignancies that can lead to further improvements in clinical practice. Methods A comprehensive literature search was conducted on PubMed, Google Scholar, ScienceDirect, and other notable databases to identify recent peer-reviewed clinical trials, reviews, and research articles related to nanoplatforms and their applications in oral cancer treatment. Results Nanoplatforms offer a revolutionary strategy to overcome the challenges associated with conventional oral cancer treatments, such as poor drug solubility, non-specific targeting, and systemic toxicity. These nanoscale drug delivery systems encompass various formulations, including liposomes, polymeric nanoparticles, dendrimers, and hydrogels, which facilitate controlled release and targeted delivery of therapeutic agents to oral cancer sites. By exploiting the enhanced permeability and retention effect, Nanoplatforms accumulate preferentially in the tumor microenvironment, increasing drug concentration and minimizing damage to healthy tissues. Additionally, nanoplatforms can be engineered to carry multiple drugs or a combination of drugs and diagnostic agents, enabling personalized and precise treatment approaches. Conclusion The utilization of nanoplatforms in oral cancer treatment holds significant promise in revolutionizing therapeutic strategies. Despite the promising results in preclinical studies, further research is required to evaluate the safety, efficacy, and long-term effects of nanoformulations in clinical settings. If successfully translated into clinical practice, nanoplatform-based therapies have the potential to improve patient outcomes, reduce side effects, and pave the way for more personalized and effective oral cancer treatments.
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Affiliation(s)
- Kalpani Senevirathna
- Centre for Research in Oral Cancer, Faculty of Dental SciencesUniversity of PeradeniyaPeradeniyaSri Lanka
| | - Shalindu M. Jayawickrama
- Centre for Research in Oral Cancer, Faculty of Dental SciencesUniversity of PeradeniyaPeradeniyaSri Lanka
| | - Yovanthi A. Jayasinghe
- Centre for Research in Oral Cancer, Faculty of Dental SciencesUniversity of PeradeniyaPeradeniyaSri Lanka
| | - Karunakalage I. P. Prabani
- Centre for Research in Oral Cancer, Faculty of Dental SciencesUniversity of PeradeniyaPeradeniyaSri Lanka
| | - Kushani Akshala
- Department of Agricultural Biology, Faculty of AgricultureUniversity of PeradeniyaPeradeniyaSri Lanka
| | | | | | - Kalani Hettiarachchi
- Centre for Research in Oral Cancer, Faculty of Dental SciencesUniversity of PeradeniyaPeradeniyaSri Lanka
| | - Thinley Dorji
- Department of Internal MedicineCentral Regional Referral HospitalGelegphuBhutan
| | - Don E. Lucero‐Prisno
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
| | | | - Kehinde K. Kanmodi
- Faculty of DentistryUniversity of PuthisastraPhnom PenhCambodia
- School of DentistryUniversity of RwandaKigaliRwanda
- School of Health and Life SciencesTeesside UniversityMiddlesbroughUK
- Cephas Health Research Initiative IncIbadanNigeria
| | - Ruwan D. Jayasinghe
- Centre for Research in Oral Cancer, Faculty of Dental SciencesUniversity of PeradeniyaPeradeniyaSri Lanka
- Faculty of DentistryUniversity of PuthisastraPhnom PenhCambodia
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11
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Penjore Y, Dorji T, Dorji S, Tamang ST. Profile and outcome of patients with Warfarin Toxicity admitted in a tertiary care hospital in Bhutan: a cross-sectional study investigators and institutions. BMC Res Notes 2023; 16:81. [PMID: 37202815 DOI: 10.1186/s13104-023-06359-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 05/11/2023] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVE To study the profile, clinical presentation and outcome of hospital stay among patients admitted with warfarin toxicity at the Jigme Dorji Wangchuck National Referral Hospital, Bhutan. This was a cross-sectional study with a review of hospital records of patients admitted between 01 and 2018 and 30 June 2020. RESULTS There were 22 admissions due to warfarin toxicity. The mean age of patients was 55.9 (± SD 20.2) years, the median duration of warfarin therapy was 30 months (IQR 4.8, 69 months). The indications for warfarin were atrial fibrillation (9, 40.9%), mechanical heart valves (6, 27.3%), deep vein thrombosis (6, 27.3%) and pulmonary thromboembolism (1, 4.5%). The mean of dosage of warfarin was 4.3 (± 2.6) mg and the cumulative dosage in the week prior to admission was 30.9 (± 18.6) mg. The mean of INR at presentation was 7.7 (± 4.3) with the maximum noted at 20. The patients presented with gastrointestinal bleeding, muscle haematomas, epistaxis and oral cavity bleeding. There was no mortality related to warfarin toxicity. The reasons for warfarin toxicity included patient dosing error and drug interactions. Warfarin therapy requires appropriate patient education, adequate facilities for follow-up and avoidance of warfarin wherever possible in clinical settings.
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Affiliation(s)
- Yeshey Penjore
- Department of Internal Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.
| | - Thinley Dorji
- Department of Internal Medicine, Central Regional Referral Hospital, Gelegphu, 31101, Bhutan.
| | - Sangay Dorji
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Saran Tenzin Tamang
- Department of Internal Medicine, Central Regional Referral Hospital, Gelegphu, 31101, Bhutan.
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12
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Dorji T, Yangchen, Wangmo S, Tenzin K, Jamtsho S, Pema D, Chhetri B, Nirola DK, Dhakal GP. Challenges in epilepsy diagnosis and management in a low-resource setting: An experience from Bhutan. Epilepsy Res 2023; 192:107126. [PMID: 36965308 DOI: 10.1016/j.eplepsyres.2023.107126] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/09/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
Epilepsy is an important cause of morbidity and mortality especially in low- and middle-income countries. People with epilepsy (PWE) face difficulties in access to healthcare, appropriate diagnostic tests and anti-seizure medications (ASM). Bhutan is one such country in the Himalayas that has reported doubling of the prevalence of epilepsy from 155.7 per 100,000 population in 2017 to 312.4 in 2021. The country has one centre for electroencephalography and magnetic resonance imaging for a population of 0.7 million and does not have any neurologists as of 2023. There are 16 ASMs registered in the country but only selected medications are available at the primary level hospitals (phenobarbital, phenytoin and diazepam). There are challenges in the availability of these medicines all time round the year in all levels of hospitals. Neurosurgical treatment options are limited by the lack of adequate pre-surgical evaluation facilities and lack of trained human resources. The majority of PWE have reported facing societal stigma with significant impact on the overall quality of life. It is important to screen for psychiatric comorbidities and provide psychological support wherever possible. There is a need for a comprehensive national guideline that will cater to the needs of PWE and their caregivers within the resources available in the country. A special focus on the institutional and human resource capacity development for the study and care of epilepsy is recommended.
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Affiliation(s)
- Thinley Dorji
- Department of Internal Medicine, Central Regional Referral Hospital, Gelegphu, Bhutan.
| | - Yangchen
- Department of Internal Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | | | - Karma Tenzin
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Sonam Jamtsho
- Department of Surgery, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Dechen Pema
- Department of Radiodiagnosis and Imaging, Central Regional Referral Hospital, Gelegphu, Bhutan
| | - Bikram Chhetri
- Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Damber Kumar Nirola
- Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Guru Prasad Dhakal
- Department of Internal Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan; Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
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13
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Dorji T, Verma V, Menon A. Epistaxis, paroxysmal anxiety episodes, and hypertension in a child with SDHB-associated paraganglioma: A case report. Clin Case Rep 2022; 10:e6683. [PMID: 36483865 PMCID: PMC9723394 DOI: 10.1002/ccr3.6683] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
A child presented with anxiety and weight gain which were overlooked until she had epistaxis. She was found to have hypertension secondary to paraganglioma. She was managed with curative surgery involving multidisciplinary care. The tumor removal led to the amelioration of symptoms and marked control of hypertension.
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Affiliation(s)
- Thinley Dorji
- Department of Internal MedicineCentral Regional Referral HospitalGelegphuBhutan
| | - Vishesh Verma
- Department of Internal MedicineArmed Forces Medical CollegePuneIndia
| | - Anil Menon
- Department of Internal MedicineArmed Forces Medical CollegePuneIndia
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14
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Tamang ST, Dorji T. Bhutan's preparedness for monkeypox outbreak. Lancet Reg Health Southeast Asia 2022; 7:100092. [PMID: 36254159 PMCID: PMC9547649 DOI: 10.1016/j.lansea.2022.100092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Thinley Dorji
- Central Regional Referral Hospital, Gelegphu, Bhutan
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15
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Dorji T, Lhendup K, Gyeltshen K. The Nairobi fly in the Himalayas. J Travel Med 2022; 29:6675647. [PMID: 36006838 DOI: 10.1093/jtm/taac097] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022]
Abstract
The Nairobi fly has been sighted in the sub-Himalayan range with an outbreak of Paederus dermatitis in Nepal, Bhutan and north-eastern India in 2022. With increasing international travel and a warmer earth, tropical vectors in non-native regions are an emerging global health challenge.
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Affiliation(s)
- Thinley Dorji
- Department of Internal Medicine, Central Regional Referral Hospital, Gelegphu 31101, Bhutan
| | - Karma Lhendup
- Samtse General Hospital, Ministry of Health, Samtse 22001, Bhutan
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16
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Grover J, Verma V, Menon A, Dorji T. Symptomatic hypoglycemia in a nondiabetic adult female recovering from mild
COVID
‐19 infection: A case report. Clin Case Rep 2022; 10:e6549. [PMID: 36381047 PMCID: PMC9653160 DOI: 10.1002/ccr3.6549] [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: 08/15/2022] [Revised: 10/08/2022] [Accepted: 10/19/2022] [Indexed: 11/15/2022] Open
Abstract
A 38‐year‐old lady, recently recovered from SARS‐CoV‐2 infection and taking grape seed extract, suffered multiple episodes of severe postprandial hyperinsulinemic hypoglycemia. A careful evaluation ruled out the common etiologies of hypoglycemia and identified grape seed extract consumption as a possible cause. She recovered after stopping the nutritional supplements. In her, hypoglycemia could have resulted from transient beta cell dysfunction associated with SARS‐CoV‐2 infection or proanthocyanidins in the grape seed extract.
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Affiliation(s)
- Jayant Grover
- Department of Internal Medicine Armed Forces Medical College Pune India
| | - Vishesh Verma
- Department of Internal Medicine Armed Forces Medical College Pune India
| | - Anil Menon
- Department of Internal Medicine Armed Forces Medical College Pune India
| | - Thinley Dorji
- Department of Internal Medicine Central Regional Referral Hospital Gelegphu Bhutan
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17
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Tamang M, Dahal BP, Dorji T, Tamang ST, Lucero-Prisno DE. Situation of physical activity in the prevention of non-communicable diseases in Bhutan: challenges and the way forward. BMJ Open Sport Exerc Med 2022; 8:e001448. [PMID: 36213762 PMCID: PMC9535205 DOI: 10.1136/bmjsem-2022-001448] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Bhutan is a lower-income-middle-income country in the Himalayas, between India and China. Non-communicable diseases (NCDs) are the leading cause of death and premature mortality in Bhutan, accounting for 69% and 71% of all deaths in 2014 and 2019, respectively. Although the World Health Organisation (WHO) identified physical activity as a key strategy to reduce the burden of NCDs, with rapid urbanisation, motorised transportation, and rural-urban migration, people are adapting to sedentary lifestyles, inflating the incidence of NCDs in the country. The increasing incidence of NCDs exerts a burden on the human and financial resource constraints in the health system in Bhutan. In this view point, we report evidence-based benefits of physical activity for health promotion, primary prevention of NCDs and health benefits for individuals living with NCDs. We also briefly assess the situation of physical activity in Bhutan. Then, shortcomings of existing NCDs prevention programmes are discussed along with opportunities and ways forward to effectively implementing physical activity to harness the benefits of physical activities.
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Affiliation(s)
- Monu Tamang
- Department of Physiotherapy, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Benu Prasad Dahal
- School of Business, Griffith University, Brisbane, Queensland, Australia
| | - Thinley Dorji
- Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Saran Tenzin Tamang
- Department of Emergency Medicine, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK,Faculty of Management and Development Studies, University of the Philippines Open University, Laguna, Philippines
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18
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Chopel T, Tshering S, Dorji N, Dorji T, Dorjee S, Tenzin T. Clinical profile of acute appendicitis at the National Referral Hospital in Bhutan. J Soc Surg Nepal 2022. [DOI: 10.3126/jssn.v25i1.47714] [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: 11/19/2022] Open
Abstract
Introduction: Acute appendicitis poses a diagnostic challenge in a low-resource setting like ours. Without timely and appropriate management, acute appendicitis can lead to prolonged morbidity and mortality. We describe the clinical profile of acute appendicitis at the national referral hospital in Bhutan.
Method: This was a cross-sectional descriptive study of all cases of acute appendicitis managed at the National Referral Hospital, Bhutan from 1st January-31st December 2016. Data related to patients’ symptoms, clinical examination and ultrasonographic findings, treatment details, length of hospital stay, and histopathology report were analyzed.
Results: Of the 3291 surgical admissions, there were 173 patients with acute appendicitis contributing to 5.3% of the total surgical burden. The median age was 27 years (IQR 20, 39), 60.1% were males. 96.5% and 91.9% of the patients presented with right iliac fossa pain and tenderness respectively. While 74.6%(n=129) had primary surgery, 18.9%(n=32) were managed conservatively. Of the 32 patients, 37.5%(n=12) had surgery after failed conservative management. Seventy-five percent presented with intraoperative features of complicated appendicitis. The negative appendectomy rate was 2.2%. The median length of hospital stay was three days (range 3–60). Ultrasonographic diagnosis compared to histopathological confirmation had a sensitivity of 87.8%, kappa agreement of 87.3%, and specificity of 66.7%.
Conclusion: Acute appendicitis is a common surgical emergency. Ultrasonography in the diagnosis of acute appendicitis was useful in a low-resource setting. A high proportion of complicated acute appendicitis in our setting needs effective interventional strategies.
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19
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Tamang ST, Dorji T. COVID-19 vaccinations in Bhutan - Mix-and-Match to Boosters: An experience. Vaccine 2022; 40:3089-3092. [PMID: 35487809 PMCID: PMC9023324 DOI: 10.1016/j.vaccine.2022.04.059] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 11/24/2022]
Abstract
Bhutan - a landlocked least developed country in the Himalayas - vaccinated 94% of its adults with the first dose of COVID-19 vaccine in March-April 2021, 90.2% with second dose in July 2021, and 89.1% with booster (third) dose by March 2022. The country used COVISHIELD (Oxford-Astrazeneca) vaccine for the first dose but decided to pursue a heterologous prime-boost strategy ("mix-and-match") for the second dose using Moderna's mRNA vaccine for adults. Bhutan rapidly rolled out Pfizer and Moderna vaccines for 12 to 17-year-olds through a school-based vaccination strategy followed by booster doses: 78.6% of adolescents aged 12-17 years were vaccinated with the first dose by August 2021, 92.8% with second dose by November 2021, and 79.7% with booster (third) dose by March 2022. More than 97% of children aged 5 to 11 years have received Pfizer's Comirnaty vaccine for their first dose. Bhutan is steadily vaccinating its population and might soon become one of the few least developed countries to achieve herd immunity-level vaccination coverage with more than 80% of its population fully vaccinated.
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Affiliation(s)
| | - Thinley Dorji
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan; Kidu Mobile Medical Unit, His Majesty's People's Project, Thimphu, Bhutan
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20
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Dorji N, Tshering S, Wangmo D, Dorji T. Intimate partner violence with vaginal insertion of a partial chili pod
(Capsicum annuum)
: A case report. Clin Case Rep 2022; 10:e05749. [PMID: 35441017 PMCID: PMC9010956 DOI: 10.1002/ccr3.5749] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
A case of intimate partner violence (IPV) with vaginal insertion of an irritant foreign body, chili pod of Capsicum annum, in a 36‐year‐old woman. She presented with severe burning sensation in the lower abdomen and vulva. This highlights the unique role of gynecologists in the recognition and treatment of IPV.
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Affiliation(s)
- Namkha Dorji
- Department of Obstetrics and Gynaecology Jigme Dorji Wangchuck National Referral Hospital Thimphu Bhutan
- Faculty of Postgraduate Medicine Khesar Gyalpo University of Medical Sciences of Bhutan Thimphu Bhutan
| | - Sangay Tshering
- Department of Obstetrics and Gynaecology Jigme Dorji Wangchuck National Referral Hospital Thimphu Bhutan
- Faculty of Postgraduate Medicine Khesar Gyalpo University of Medical Sciences of Bhutan Thimphu Bhutan
| | - Dechen Wangmo
- Tendruk Primary Healthcare Centre Samtse Dzongkhag Samtse Bhutan
| | - Thinley Dorji
- Department Internal Medicine Jigme Dorji Wangchuck National Referral Hospital Thimphu Bhutan
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21
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Dorji T, Hegde A, Asturkar V, Yangzom S, Bhanu K. Catastrophic Anti-Phospholipid Syndrome in Systemic Lupus Erythematosus: A Tsunami in the Ocean. J Assoc Physicians India 2022; 70:11-12. [PMID: 35443434] [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: 06/14/2023]
Abstract
UNLABELLED Antiphospholipid anti body syndrome is an autoimmune disorder characterized by arterial or venous thrombosis and/or pregnancy morbidity with foetal deaths or abortions in the presence of antiphospholipid antibodies. Catastrophic antiphospholipid antibody syndrome (CAPS) is an accelerated form of disease with rapid involvement of multiple organ systems often posing a diagnostic challenge. There is a paucity of literature on the presentations of CAPS owing to the orphan nature of the disease. MATERIAL We present three cases of CAPS in patients with systemic lupus erythematosus (SLE). OBSERVATION Case 1 - A 22-year-old lady with SLE presented with anasarca, abnormal mentation, anaemia, thrombocytopenia, ANA (IIF) 4+ speckled, positive lupus anticoagulant with pulmonary thromboembolism involving right middle and left lower lobes. While in hospital, she developed infarct in left middle cerebral artery territory; was managed with IVIg, anticoagulation, pulse methylprednisolone and cyclophosphamide. She had a refractory course with cytokine storm syndrome, neutropenic sepsis and eventually succumbed to her illness. Case 2 - A 23-year-old lady presented with a history of oral ulcers, alopecia, photosensitive malar rash, polyarthritis of small joints of hands, Raynaud's phenomenon, intermittent fever with headache and arterial thrombosis resulting in gangrene of the right thumb. She had ANA (IIF) 3+ speckled, raised anti-ds-DNA, positive for lupus anticoagulant; was managed as SLE with hydroxychloroquine and prednisolone. She returned to hospital with generalized tonic-clonic seizures, papilledema but no focal neurological deficit. MRI brain showed superior sagittal sinus thrombosis; was managed with pulse methylprednisolone, anti-coagulation, anti-epileptic drugs, cyclophosphamide and hydroxychloroquine; patient survived. Case 3 - A 47- year-old lady with SLE and Lupus Nephritis Class IV on Euro-Lupus regime presented with paraparesis, cold and clammy left lower limb with absent femoral, popliteal, anterior tibial and dorsalis pedis pulses. CT angiography showed thrombosis infra-renal abdominal aorta and in the left popliteal artery; was positive for high titre β2-GPI IgM. She was managed with pulse methylprednisolone, anti-coagulation, broad-spectrum antibiotics but developed sudden haemodynamic deterioration after the first cycle of plasmapheresis and was switched to IVIg. However, she developed cardiac arrest and succumbed before MR angiography for suspected anterior spinal artery thrombosis and amputation for left lower limb. CONCLUSION In our cases, timely diagnoses were made based on a high index of suspicion and were managed with a combination of IVIg, systemic glucocorticoids, plasmapheresis and other supportive measures. However, despite providing the standard of care, we encountered poor outcome in two patients, highlighting the high mortality associated with CAPS.
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Affiliation(s)
- T Dorji
- Armed Forces Medical College, Pune, Maharashtra; 2Command Hospital (Southern Command), Pune, Maharashtra
| | - A Hegde
- Armed Forces Medical College, Pune, Maharashtra; 2Command Hospital (Southern Command), Pune, Maharashtra
| | - V Asturkar
- Armed Forces Medical College, Pune, Maharashtra; 2Command Hospital (Southern Command), Pune, Maharashtra
| | - S Yangzom
- Armed Forces Medical College, Pune, Maharashtra; 2Command Hospital (Southern Command), Pune, Maharashtra
| | - Ku Bhanu
- Armed Forces Medical College, Pune, Maharashtra; 2Command Hospital (Southern Command), Pune, Maharashtra
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22
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Hegde A, Dorji T, Asturkar V, Yangzom S, Bhanu KU. Cases of catastrophic anti-phospholipid syndrome in systemic lupus erythematosus: An experience. SAGE Open Med Case Rep 2022; 10:2050313X221085099. [PMID: 35308057 PMCID: PMC8928371 DOI: 10.1177/2050313x221085099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/25/2021] [Accepted: 02/15/2022] [Indexed: 11/25/2022] Open
Abstract
Anti-phospholipid syndrome is an autoimmune disorder characterized by episodes of arterial and/or venous thrombosis and/or pregnancy morbidity in the presence of anti-phospholipid antibodies. Catastrophic anti-phospholipid syndrome is an accelerated form of the disease with rapid involvement of multiple organ systems often posing a diagnostic challenge. There is a paucity of literature on the myriad presentations of catastrophic anti-phospholipid syndrome owing to the orphan nature of the disease. We present three cases of catastrophic anti-phospholipid syndrome in patients with systemic lupus erythematosus that presented with episodes of thrombosis involving both arterial and venous systems and multisystem organ failure. Timely diagnoses were made based on a high index of suspicion and were managed with a combination of systemic glucocorticoids, cyclophosphamide, plasmapheresis, intravenous immunoglobulin and other supportive measures. However, despite providing the standard of care, we encountered a poor outcome in two of these patients, highlighting the high mortality associated with catastrophic anti-phospholipid syndrome.
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Affiliation(s)
- Arun Hegde
- Department of Rheumatology, Command Hospital (Southern Command), Pune, India
| | - Thinley Dorji
- Department of Internal Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- Department of Internal Medicine, Armed Forces Medical College, Pune, India
| | - Vikram Asturkar
- Department of Neurology, Command Hospital (Southern Command), Pune, India
| | - Sonam Yangzom
- Department of Radiodiagnosis and Imaging, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- Department of Radiodiagnosis and Imaging, Armed Forces Medical College, Pune, India
| | - Kovilapu Uday Bhanu
- Department of Radiodiagnosis and Imaging, Armed Forces Medical College, Pune, India
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23
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Tshering S, Dorji T, Dorji N, Monger R, Choden K, Lhamo K. Setting up minimal invasive surgery services in gynecology in a resource-limited setting: an experience from Bhutan. BMC Res Notes 2022; 15:59. [PMID: 35172895 PMCID: PMC8848657 DOI: 10.1186/s13104-022-05953-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To describe the clinical profile of minimal invasive procedures performed in gynecology at the national referral hospital in Bhutan. A review of such procedures performed in gynecology was needed to assess the baseline information and generate our own experience. We conducted a descriptive study with a review of hospital records of minimal invasive procedures performed from 1st January to 31st December 2020 at the Department of Gynecology. Data were extracted into a structured pro forma. Descriptive statistics were used to express the results. RESULTS The mean age of the patients was 33.9 ± 8.6 years of which the maximum was in the age group 25-34 years. 28 (17.5%) and 132 (82.5%) patients underwent emergency and elective procedures respectively. 142 (88.8%) and 18 (11.2%) patients underwent laparoscopic and hysteroscopic procedures respectively. Ovarian cystectomy was the most commonly performed procedure. The median operating time was 100 min (IQR 62.5-157.5). The overall complication rate was 2.5%. The median postoperative length of hospital stay was 24 h (IQR 3-24). Using our data and experience, we recommend a new health policy to recognize MIS in gynecology as a subspecialty and strengthen the existing service in gynecological MIS.
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Affiliation(s)
- Sangay Tshering
- Department of Obstetrics & Gynecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.
| | - Thinley Dorji
- Department of Internal Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.,Kidu Mobile Medical Unit, His Majesty's People's Project, Thimphu, Bhutan
| | - Namkha Dorji
- Department of Obstetrics & Gynecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Renuka Monger
- Department of Obstetrics & Gynecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Kesang Choden
- Department of Obstetrics & Gynecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Kezang Lhamo
- Department of Obstetrics & Gynecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
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Dorji T, Dorji N, Yangdon K, Gyeltshen D, Tenzin L. Exploring the Ethical Dilemmas in End-of-Life Care and the Concept of a Good Death in Bhutan. Asian Bioeth Rev 2022; 14:191-197. [PMID: 35462966 PMCID: PMC8986937 DOI: 10.1007/s41649-021-00199-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 11/15/2021] [Accepted: 12/06/2021] [Indexed: 11/24/2022] Open
Abstract
Buddhists, including the Bhutanese, value human life as rare and precious, and accept sickness, ageing and death as normal aspects of life. However, death and dying are subjects that evoke deep and disturbing emotions often characterised by denial related to high-tech medicalisation and its inspiring hope. Advanced medical interventions such as cardiopulmonary resuscitation are believed to interfere with the natural process of dying. However, some excessively pursue medical interventions in the hope of prolonging and preserving life, refusing its finitude. Healthcare workers are faced with increasing instances of ethical and moral dilemmas exacerbated by inadequate training and lack of proper understanding of the socio-cultural context on end-of-life care and to facilitate good death in Bhutan. We discuss these ethical dilemmas in providing quality end-of-life care and good death against the backdrop of rapidly changing social values and expectations.
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Affiliation(s)
- Thinley Dorji
- Department of Internal Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- Kidu Mobile Medical Unit, His Majesty’s People’s Project, Thimphu, Bhutan
| | - Nidup Dorji
- Department of Public Health and Allied Sciences, Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Kinley Yangdon
- Adult Intensive Care Unit, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Dorji Gyeltshen
- Department of Traditional Medicine Services, Ministry of Health, Thimphu, Bhutan
| | - Langa Tenzin
- Supreme Court, Royal Court of Justice, Thimphu, Bhutan
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Dorji T, Wangmo K, Yezer, Wangchuk T, Tshokey, Wangdi K. Knowledge, Attitude, and Practice Toward COVID-19 Among Sherubtse College Students in Bhutan: A Web-Based Cross-Sectional Study. Front Public Health 2021; 9:721493. [PMID: 34869145 PMCID: PMC8637861 DOI: 10.3389/fpubh.2021.721493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/18/2021] [Indexed: 12/21/2022] Open
Abstract
Bhutan has reopened schools and colleges after an initial closure to contain coronavirus disease 2019 (COVID-19) transmission. However, the risk of transmissions is higher in the schools and colleges due to crowding. Therefore, this study aimed to assess the level of knowledge, attitude, and practice (KAP) toward COVID-19 among the students of Sherubtse College in Bhutan. A cross-sectional study using a questionnaire was conducted in September 2020 among the students of Sherubtse College, Bhutan. The questionnaire was made in the Google Forms and administered through a social forum WeChat app. The KAP scores were calculated that include mean scores. The association between the KAP was assessed using the Pearson's correlation coefficient. A total of 613 students participated in the survey. The majority of the participants (57%) were female and 56% were from the third year. The mean knowledge score was 10.7 (SD = 1.7; range 0–14), mean attitude score of 3.67 (SD = 1.0; range: 0–5), and mean practice score of 5.19 (SD = range: 0–6). A majority of the students had good knowledge (98%) and practice (93.5%) scores, and a positive attitude (86.6%) toward COVID-19. A positive but weak correlation between good knowledge and practice (r = 0.1, p = 0.0126) was observed. Having a positive attitude led to practicing appropriately most of the time (r = 0.1866, p < 0.001). The students had good KAP scores and followed the COVID-19 prevention protocols advocated by the government. Good knowledge and a positive attitude were translated into good practice. Therefore, the education campaign of the Bhutan government seems to be effective in the students.
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Affiliation(s)
| | - Karma Wangmo
- Regional Livestock Development Centre, Kanglung, Bhutan
| | - Yezer
- Sherubtse College, Royal University of Bhutan, Trashigang, Bhutan
| | | | - Tshokey
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Kinley Wangdi
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
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Dorjee K, Kathirvel S, Jeyashree K, Dorji T, Choeda T, Pelzom D, Gurung MS, Tenzin K, Wangmo S, Penjor T. Prevalence, Pattern, and Factors Associated With Self-reported Disability Among the Bhutanese Population: A Secondary Data Analysis of Population and Housing Census. Asia Pac J Public Health 2021; 34:221-229. [PMID: 34696620 DOI: 10.1177/10105395211049856] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We analyzed the Population and Health Census of Bhutan (PHCB) 2017 to assess the prevalence and pattern of self-reported disability among people aged ≥15 years and the associated factors. The PHCB 2017 used the Washington Group Short Set on Functioning questionnaire to assess the disability ("lot of difficulty" or "cannot do at all") in seeing, hearing, mobility, cognition, self-care, and communication. Of the 536 443 persons included in the analysis, 384 101(71.6%) were aged <45 years, 283 453(52.8%) were men, and 206 103(38.4%) were from the rural area. The prevalence of any self-reported disability was 2.8%, among whom 34.2% reported multiple disabilities. The disability prevalence (any) was significantly higher among people aged ≥65 years, illiterate, economically inactive, permanent residents, residing in a rural area, and from central and eastern regions of the country compared with their respective counterparts. Further research on access to rehabilitation and linking with social protection schemes for the disabled is required in this country.
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Affiliation(s)
- Kinley Dorjee
- Sustainable Development, Health Management Information System and Research Unit, Ministry of Health, Thimphu, Bhutan
| | - Soundappan Kathirvel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, Chandigarh, India
| | | | - Thinley Dorji
- Kidu Medical Unit, His Majesty's People's Project, Thimphu, Bhutan
| | - Tshering Choeda
- Gyesar Gyalpo University of Medical Sciences, Royal Government of Bhutan, Thimphu, Bhutan
| | - Dorji Pelzom
- Health Management Information System and Research Unit, Ministry of Health, Thimphu, Bhutan
| | - Mongal Singh Gurung
- Health Management Information System and Research Unit, Ministry of Health, Thimphu, Bhutan
| | - Karma Tenzin
- Gyesar Gyalpo University of Medical Sciences, Royal Government of Bhutan, Thimphu, Bhutan
| | | | - Tashi Penjor
- Policy and Planning Division, Ministry of Health, Bhutan
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Dorji T, Dorji P, Gyamtsho S, Tamang ST, Wangden T, Wangmo S, Prisno DEL. Rates and indications of caesarean section deliveries in Bhutan 2015-2019: a national review. BMC Pregnancy Childbirth 2021; 21:698. [PMID: 34663258 PMCID: PMC8522038 DOI: 10.1186/s12884-021-04173-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Bhutan has made much efforts to provide timely access to health services during pregnancy and increase institutional deliveries. However, as specialist obstetric services became available in seven hospitals in the country, there has been a steady increase in the rates of caesarean deliveries. This article describes the national rates and indications of caesarean section deliveries in Bhutan. METHODS This is a review of hospital records and a qualitative analysis of peer-reviewed articles on caesarean deliveries in Bhutan. Data on the volume of all deliveries that happened in the country from 2015 to 2019 were retrieved from the Annual Health Bulletins published by the Ministry of Health. The volume of deliveries and caesarean deliveries were extracted from the Annual Report of the National Referral Hospital 2015-2019 and the data were collected from hospital records of six other obstetric centres. A national rate of caesarean section was calculated as a proportion out of the total institutional deliveries at all hospitals combined. At the hospital level, the proportion of caesarean deliveries are presented as a proportion out of total institutional deliveries conducted in that hospital. RESULTS For the period 2015-2019, the average national rate of caesarean section was 20.1% with a statistically significant increase from 18.1 to 21.5%. The average rate at the six obstetric centres was 29.9% with Phuentsholing Hospital (37.2%), Eastern Regional Referral Hospital (34.2%) and Samtse General Hospital (32.0%) reporting rates higher than that of the National Referral Hospital (28.1%). Except for the Eastern Regional Referral and Trashigang Hospitals, the other three centres showed significant increase in the proportion of caesarean deliveries during the study period. The proportion of emergency caesarean section at National Referral Hospital, Central Regional Referral Hospital and the Phuentsholing General Hospital was 58.8%. The National Referral Hospital (71.6%) and Phuentsholing General Hospital reported higher proportions of emergency caesarean sections (64.4%) while the Central Regional Referral Hospital reported higher proportions of elective sections (59.5%). The common indications were 'past caesarean section' (27.5%), foetal distress and non-reassuring cardiotocograph (14.3%), failed progress of labour (13.2%), cephalo-pelvic disproportion or shoulder dystocia (12.0%), and malpresentation including breech (8.8%). CONCLUSION Bhutan's caesarean section rates are high and on the rise despite a shortage of obstetricians. This trend may be counterproductive to Bhutan's efforts towards 2030 Sustainable Development Goal agendas and calls for a review of obstetric standards and practices to reduce primary caesarean sections.
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Affiliation(s)
- Thinley Dorji
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, 11001 Bhutan
- Kidu Mobile Medical Unit, His Majesty’s People’s Project, Thimphu, Bhutan
| | - Phurb Dorji
- Kidu Mobile Medical Unit, His Majesty’s People’s Project, Thimphu, Bhutan
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Sonam Gyamtsho
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, 11001 Bhutan
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | | | - Tshering Wangden
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, 11001 Bhutan
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Sangay Wangmo
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, 11001 Bhutan
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
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Abstract
Bhutan—a landlocked country in South Asia—has reported 3381 COVID-19 cases per million population and three deaths until August 2021. The country implemented stringent public health measures to prevent widespread outbreak of COVID-19. This paper describes travel-related measures taken by Bhutan and discusses the way forward after COVID-19 vaccination.
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Affiliation(s)
| | | | - Thinley Dorji
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.,Kidu Mobile Medical Unit, His Majesty's People's Project, Thimphu, Bhutan
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Tamang M, Dorji T. Physiotherapy services in patient care in Bhutan. Hum Resour Health 2021; 19:107. [PMID: 34479592 PMCID: PMC8414470 DOI: 10.1186/s12960-021-00649-1] [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] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/25/2021] [Indexed: 06/13/2023]
Abstract
Physiotherapy and rehabilitative services are an integral part of patient care, but in many developing countries they are not considered a priority and are either not available or not easily accessible to those who need them. Bhutan is one such country where healthcare is provided free of cost to all, but as of 2021 physiotherapy services were available only in 26 of 48 hospitals and 19 of 20 districts. The number of physiotherapy professionals per 10,000 population is 1.4 with significant rates of attrition. There is lack of awareness among patients and other health professionals about physiotherapy and rehabilitation services. The country needs to integrate physiotherapy and rehabilitation services into the overall health policy framework and develop proper planning of human resources and infrastructure to meet the current and future demands.
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Affiliation(s)
- Monu Tamang
- Physiotherapy Unit, Central Regional Referral Hospital, 31101 Gelegphu, Bhutan
| | - Thinley Dorji
- Department of Internal Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- Kidu Mobile Medical Unit, His Majesty’s People’s Project, Thimphu, Bhutan
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Dorji T, Tamang ST, Tilak T. Self-learning on COVID-19 among medical students in Bhutan: A cross-sectional study. Heliyon 2021; 7:e07533. [PMID: 34307948 PMCID: PMC8287235 DOI: 10.1016/j.heliyon.2021.e07533] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/06/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022] Open
Abstract
Background Bhutan lacks a medical school and all medical students are trained in Sri Lanka, Bangladesh and India. When the COVID-19 pandemic led to the closure of medical schools in these countries in March–April 2020, the medical students were repatriated to Bhutan. Upon return, they were kept in government-sponsored facility quarantine for 21 days. This study assessed their knowledge on COVID-19 as a part of self-learning and their attitude towards participation in government's health response to COVID-19. Methods This was a cross-sectional study among medical students who had returned to the country. The survey was conducted through an online questionnaire while the students were in facility quarantine. The sample size calculated was 129 and convenient sampling was used. Knowledge was assessed using 20 questions, each scored 1/20. Knowledge was considered “good” if the cumulative score was ≥80%, “satisfactory” if ≥60–79% and “poor” if <60%. Correlation between knowledge score and duration of clinical clerkship was tested using Pearson's correlation coefficient. Attitude of students towards their willingness to participate in the national COVID-19 response was tested using rating scales. Data were analysed using Stata 13.1. Results 120 medical students responded to the survey (response rate = 93%). Eighty-eight (74%) had good knowledge, 28 (23%) had satisfactory knowledge and only four (3%) had poor knowledge on COVID-19. The students scored high on the symptomatology, mode of transmission, prevention and treatment options and on local epidemiology; and scored low on the forms of mechanical ventilation and on home-management of non-critical cases. The knowledge score correlated with the duration of clinical clerkship they had undertaken (r = 0.326, p = 0.001). The primary source of information were social media sites (102, 85%), television (94, 78%) and newspapers (76, 63%). The majority (78, 65%) were willing to participate in the government's COVID-19 response but could not identify what roles they could play. The fear of contracting COVID-19 was reported by eight students (7%). Conclusions Medical students had good knowledge on COVID-19 and had self-learned through social media, television and newspapers. The students held positive attitude towards participation in the government's COVID-19 response.
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Affiliation(s)
- Thinley Dorji
- Department of Internal Medicine, Armed Forces Medical College, Maharashtra University of Health Sciences, Pune, India
- Kidu Mobile Medical Unit, His Majesty's People's Project, Thimphu, Bhutan
- Corresponding author.
| | - Saran Tenzin Tamang
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - T.V.S.V.G.K. Tilak
- Department of Internal Medicine, Armed Forces Medical College, Maharashtra University of Health Sciences, Pune, India
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Lhendup K, Dorji T. Probable rabies in a child in a Bhutanese town bordering India, 2020. SAGE Open Med Case Rep 2021; 9:2050313X211019786. [PMID: 34104446 PMCID: PMC8170276 DOI: 10.1177/2050313x211019786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/28/2021] [Indexed: 11/17/2022] Open
Abstract
Rabies is a neglected tropical disease that causes mortality and high economic burden in many developing countries. Rabies is a vaccine-preventable disease if timely post-exposure prophylaxis is available after animal exposure. The control of rabies requires limiting the transmission of the virus in the animal reservoir, effective public health measures to control outbreaks and increasing accessibility and uptake of rabies post-exposure prophylaxis. Bhutan is a small Himalayan country where rabies is endemic. In this article, we describe the death of a 3-year-old female child due to probable rabies in a Bhutanese village located along the border with India. The child had a furious form of rabies with encephalitic syndrome developing 57 days after a category III dog bite on the chest. The child was managed at a district hospital with the available resources. This is the first rabies death in Bhutan in the last 5 years and the 18th since 2006. This case report focuses on the efforts required to increase the timely uptake of post-exposure prophylaxis in a free healthcare system in Bhutan.
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Affiliation(s)
| | - Thinley Dorji
- Department of Internal Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.,Kidu Mobile Medical Unit, His Majesty's People's Project, Thimphu, Bhutan
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Dorji T, Tamang ST. Bhutan's experience with COVID-19 vaccination in 2021. BMJ Glob Health 2021; 6:bmjgh-2021-005977. [PMID: 34006520 PMCID: PMC8136800 DOI: 10.1136/bmjgh-2021-005977] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 04/20/2021] [Accepted: 04/23/2021] [Indexed: 12/16/2022] Open
Affiliation(s)
- Thinley Dorji
- Department of Internal Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Saran Tenzin Tamang
- Department of Emergency Medicine, Central Regional Referral Hospital, Gelegphu, Bhutan
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Dorji T, Tshomo U, Gyamtsho S, Tamang ST, Wangmo S, Pongpirul K. Gender-neutral HPV elimination, cervical cancer screening, and treatment: Experience from Bhutan. Int J Gynaecol Obstet 2021; 156:425-429. [PMID: 33930178 DOI: 10.1002/ijgo.13728] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/19/2021] [Accepted: 04/28/2021] [Indexed: 11/10/2022]
Abstract
Cervical cancer is preventable and also curable when detected early and treated adequately, yet it remains a leading cause of morbidity and mortality among women. In Bhutan, cervical cancer is the most common cancer among women. Bhutan was the first country among the low- and middle-income economies to have instituted a national HPV vaccination program, in 2010, and has achieved >90% coverage. In 2019, Bhutan launched a cervical cancer elimination flagship program well ahead of WHO's launch of the global strategy for accelerated elimination of cervical cancer. Bhutan initiated vaccination of adolescent boys and adopted a gender-neutral vaccination program beginning September 2020 through its well-established network of primary healthcare centres. The flagship program aims to screen women aged 30-69 years with HPV testing using liquid-based cytology (LBC) as triaging for screen positive women. For women aged 25-29 years, LBC will be continued as per American Society of Colposcopy and Cervical Pathology guidelines. Colposcopy and treatment will be performed in camps to decrease loss of follow up of screen positive women. This program is also expected to improve early diagnosis of cervical cancer and provide timely and adequate cancer treatment and palliative care services. This article reviews the progress made and the challenges facing the 2030 cervical cancer elimination targets in Bhutan.
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Affiliation(s)
- Thinley Dorji
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.,Kidu Mobile Medical Unit, His Majesty's People's Project, Thimphu, Bhutan
| | - Ugyen Tshomo
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Sonam Gyamtsho
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.,Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu
| | | | - Sangay Wangmo
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.,Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Choeda T, Jeyashree K, Kathirvel S, Dorji T, Dorjee K, Tenzin K, Thinley S, Tenzin T, Gurung MS. Dietary behavior of school-going adolescents in Bhutan: Findings from the global school-based student health survey in 2016. Nutrition 2021; 90:111290. [PMID: 34111832 DOI: 10.1016/j.nut.2021.111290] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Bhutan is experiencing a dual burden of undernutrition and overnutrition among adolescents. Understanding dietary behavior is vital to designing evidence-based interventions to improve adolescent nutrition and prevent non-communicable diseases in adults. The aim of this study was to assess the pattern of dietary behavior and associated sociodemographic, behavioral, and metabolic risk factors among school-going adolescents in Bhutan. METHODS The Bhutan Global School-based Student Health Survey 2016 studied students in grades 7 to 11 (N = 7576), sampled from 50 schools, randomly selected based on probability proportional to enrollment size, using a standardized self-administered questionnaire. Consumption of adequate fruits and vegetables (each at least twice daily, or a combination of at least five times daily), high-protein food at least twice weekly) in the past 30 d, no fast food in the past week, and no carbonated/sweetened drinks in the past 30 d were studied. Weighted prevalence of dietary behaviors and adjusted prevalence ratio (95% confidence interval) for factors associated with them were calculated. RESULTS Of 5809 students from 13 to 17 y of age comprising 3255 (56%) girls and 3184 (54.8%) day students, 1166 (20.1%) were underweight, 1655 (28.5%) were tobacco users, and 1349 (23.2%) were alcohol users. Adequate fruit and vegetable intake, high protein consumption, not consuming fast foods and carbonated beverages were reported by 29.6%, 31.8%, 9.6%, and 14.9%, respectively. Being a day student, sex, and not reporting health risk behaviors were significantly associated with any healthy dietary behavior. CONCLUSION Healthy eating behavior was low among Bhutanese adolescents. Policies influencing availability, affordability, and acceptability of healthy diets through peer-led, school- and community-based interventions are required to promote adolescent health and prevent non-communicable diseases.
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Affiliation(s)
- Tshering Choeda
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan.
| | | | - Soundappan Kathirvel
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Thinley Dorji
- Kidu Medical Unit, His Majesty's People's Project, Thimphu, Bhutan; Jigme Dorji Wangchuck National Referral Hospital, Ministry of Health, Thimphu, Bhutan
| | - Kinley Dorjee
- Policy and Planning Division, Ministry of Health, Thimphu, Bhutan
| | - Karma Tenzin
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | | | - Tashi Tenzin
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan; Jigme Dorji Wangchuck National Referral Hospital, Ministry of Health, Thimphu, Bhutan
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35
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Affiliation(s)
| | - Thinley Dorji
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.,Kidu Mobile Medical Unit, His Majesty's People's Project, Thimphu, Bhutan
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Dorji T, Nopsopon T, Tamang ST, Pongpirul K. Human papillomavirus vaccination uptake in low-and middle-income countries: a meta-analysis. EClinicalMedicine 2021; 34:100836. [PMID: 33997733 PMCID: PMC8102703 DOI: 10.1016/j.eclinm.2021.100836] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/12/2021] [Accepted: 03/24/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The proportion of incident cases of HPV-attributable cancers is highest in the low- and middle-income countries (LMICs) but many are yet to initiate HPV vaccination programs. This meta-analysis was performed to assess the uptake of HPV vaccination in LMICs at the beginning of the global strategy to eliminate cervical cancer and describes the gaps and challenges. METHODS A systematic search was conducted in PubMed, EMBASE, Scopus, Web of Science, and CENTRAL databases for observational studies that reported the uptake of HPV vaccination until October 2020. The meta-analysis was done using a random-effects model to assess the pooled estimate of HPV uptake. CRD42021218429. FINDINGS During 2008-2020, an estimated 3.3 million females received at least one dose of HPV vaccine with 61.69% of the target population vaccinated. In countries with high uptake, the pooled estimate of uptake was higher in females than males (45.48% vs 8.45%) and showed significant decline in 2015-2020 compared to 2006-2014 (89.03% vs 41.48%). In countries with low uptake, the estimate of uptake was low in both males and females (5.31% vs 2.93%) and showed increase in uptake in 2015-2020 compared to 2006-2014 (0.76% vs 5.22%). In countries with high uptake, compared to routine programs, the estimate was higher when delivered through demonstration programs (89.94% vs 59.74%). INTERPRETATION The major concern was a significant drop in the uptake in countries that started with high uptake, challenges in the maintenance of vaccine uptake, sustainability of funding and the lack of standard monitoring and reporting.
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Key Words
- 2vHPV, bivalent HPV vaccine
- 4vHPV, quadrivalent HPV vaccine
- 9vHPV, 9-valent HPV vaccine
- CENTRAL, cochrane central register of controlled trials
- CI, confidence interval
- CIN2+, cervical intra-epithelial neoplasia grade II
- Cervical cancer elimination
- EMBASE, excerpta medica dataBASE
- GNI, gross national income
- HPV vaccine
- HPV, human papillomavirus
- LMICs, Low- and middle-income countries
- Low-and middle-income countries
- MSM, men having sex with men
- Meta-analysis
- RR, relative risk
- STROBE, strengthening the reporting of observational studies in epidemiology
- Systematic review
- US, United States
- Vaccine uptake
- WHO, World Health Organization
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Affiliation(s)
- Thinley Dorji
- Department of Internal Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- Kidu Mobile Medical Unit, His Majesty's People's Project, Thimphu, Bhutan
| | - Tanawin Nopsopon
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Saran Tenzin Tamang
- Department of Obstetrics and Gynaecology, Central Regional Referral Hospital, Gelegphu, Bhutan
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Bumrungrad International Hospital, Bangkok, Thailand
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Adhikari TR, Dorji T. Recurrent ear bleed with profound bilateral sensorineural hearing loss: A case of Munchausen syndrome. SAGE Open Med Case Rep 2021; 9:2050313X211000869. [PMID: 33786189 PMCID: PMC7958153 DOI: 10.1177/2050313x211000869] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 11/16/2022] Open
Abstract
Factitious disorders and Munchausen syndromes present with history and physical symptoms
to all specialties, and they are often extensively evaluated. Diagnosis of Munchausen
syndrome is a challenge and patients often do not receive the correct diagnosis and
appropriate care especially in settings where access to mental health professionals is
difficult. We present a case of recurrent bleed from the right ear, bilateral profound
hearing loss and jerky movement of limbs that was extensively evaluated and followed up
for 4 years until a diagnosis of Munchausen syndrome was reached. This case reports the
risk of harm to the patient and wastage of healthcare resources unless physicians begin to
actively evaluate for factitious disorders.
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Affiliation(s)
- Tika Ram Adhikari
- Department of ENT and Head and Neck Surgery, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Thinley Dorji
- Department of Internal Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.,Kidu Mobile Medical Unit, His Majesty's People's Project, Thimphu, Bhutan
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Tamang ST, Dorji T, Yoezer S, Phuntsho T, Dorji P. Knowledge and understanding of obstetric danger signs among pregnant women attending the antenatal clinic at the National Referral Hospital in Thimphu, Bhutan: a cross-sectional study. BMC Pregnancy Childbirth 2021; 21:104. [PMID: 33530968 PMCID: PMC7852084 DOI: 10.1186/s12884-021-03580-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The third Sustainable Development Goal for 2030 development agenda aims to reduce maternal and newborn deaths. Pregnant women's understanding of danger signs is an important factor in seeking timely care during emergencies. We assessed knowledge of obstetric danger signs using both recall and understanding of appropriate action required during obstetric emergencies. METHODS This was a cross-sectional study among pregnant women attending antenatal clinic at Bhutan's largest hospital in Thimphu. Recall was assessed against seven obstetric danger signs outlined in the Mother and Child Health Handbook (7 points). Understanding of danger signs was tested using 13 multiple choice questions (13 points). Knowledge was scored out of 20 points and reported as 'good' (≥80%), 'satisfactory' (60-79%) and 'poor' (< 60%). Correlation between participant characteristics and knowledge score as well as number of danger signs recalled was tested using Pearson's correlation coefficient. Association between knowledge score and participant characteristics was tested using t-tests (and Kruskal-Wallis test) for numeric variables. Socio-demographic and clinical characteristics associated with the level of knowledge ('good' versus 'satisfactory' and 'poor' combined) were assessed with odds ratios using a log-binomial regression model. All results with p < 0.05 were considered significant. RESULTS Four hundred and twenty-two women responded to the survey (response rate = 96.0%). Mean (±SD) knowledge score was 12 (±2.5). Twenty women (4.7%) had 'good' knowledge, 245 (58.1%) had 'satisfactory' knowledge and 157 (37.2%) had 'poor' knowledge. The median number of danger signs recalled was 2 (IQR 1, 3) while 68 women (20.3%) could not recall any danger signs. Most women were knowledgeable about pre-labour rupture of membranes (96.0%) while very few women were knowledgeable about spotting during pregnancy (19.9%). Both knowledge score and number of danger signs recalled had significant correlation with the period of gestation. Women with previous surgery on the reproductive tract had higher odds of having 'good' level of knowledge. CONCLUSIONS Most pregnant women had 'satisfactory' knowledge score with poor explicit recall of danger signs. However, women recognized obstetric emergencies and identified the appropriate action warranted.
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Affiliation(s)
- Saran Tenzin Tamang
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Gongphel Lam, Thimphu, 11001, Bhutan.
| | - Thinley Dorji
- Department of Internal Medicine, Armed Forces Medical College, Maharashtra University of Medical Sciences, Pune, India.,Kidu Mobile Medical Unit, His Majesty's People's Project, Thimphu, Bhutan
| | - Sonam Yoezer
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Gongphel Lam, Thimphu, 11001, Bhutan
| | - Thinley Phuntsho
- Kidu Mobile Medical Unit, His Majesty's People's Project, Thimphu, Bhutan
| | - Phurb Dorji
- Kidu Mobile Medical Unit, His Majesty's People's Project, Thimphu, Bhutan.,Department of Obstetrics and Gynaecology, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
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Dorji T, Wangmo K, Dorjey Y, Dorji N, Kiran Chhetri D, Tshering S, Wangmo P, Tshokey T. Indications and factors associated with cesarean section in Bhutan: A hospital-based study. Int J Gynaecol Obstet 2020; 153:520-526. [PMID: 33259634 DOI: 10.1002/ijgo.13506] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/30/2020] [Accepted: 11/26/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate the factors associated with cesarean section (CS) in Bhutan. METHODS This was a cross-sectional study, using the retrospective data from the birth registers maintained in comprehensive emergency obstetric care centers for the year 2018. The data were entered in excel 2013 and analyzed using STATA 13. Multiple logistic regression was used to understand the factors associated with CS in Bhutan. RESULTS The rate of CS in Bhutan was 18.7%. The indications for CS were previous CS, fetal distress, prolonged labor, and failed induction. The factors associated with CS were maternal age over 25 years, male child, women with smaller number of living children, multiple pregnancy, and gestation over 40 weeks. In addition, mothers delivering in Samtse Hospital and Central Regional Referral Hospital had higher odds of CS. CONCLUSION In Bhutan, CS was commonly performed for mothers with previous CS, fetal distress, and prolonged labor. Increasing maternal age, multiple pregnancy, and postdated pregnancy and those with one child, or none, were more likely to undergo CS. To reduce the CS rate, Bhutan should focus on decreasing the primary CS rate as well as preventing over-diagnosis of prolonged labor by focusing on the partograph.
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Affiliation(s)
| | - Karma Wangmo
- Regional Livestock Development Center, Khangma, Bhutan
| | | | - Namkha Dorji
- Central Regional Referral Hospital, Gelephu, Bhutan
| | | | - Sangay Tshering
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | | | - Tshokey Tshokey
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
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Dorji T. The Gross National Happiness Framework and the Health System Response to the COVID-19 Pandemic in Bhutan. Am J Trop Med Hyg 2020; 104:441-445. [PMID: 33355069 PMCID: PMC7866366 DOI: 10.4269/ajtmh.20-1416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 11/02/2020] [Accepted: 12/15/2020] [Indexed: 11/25/2022] Open
Abstract
Bhutan is a lower-middle–income country with limited tertiary-care health infrastructure and shortage of human resources. The country’s response to the COVID-19 pandemic is guided by the principle of Gross National Happiness (GNH), which prioritizes the well-being and happiness of people over conventional socioeconomic indicators. The king’s leadership and government’s decisions based on public health science helped in the control of the pandemic and reduce economic losses. The government implemented some unique and unconventional public health measures such as facility quarantine for those with high-risk exposure, an increase in quarantine period to 21 days, free testing and treatment, and population-based screening tests. Early and extensive contact tracing, extensive testing, effective communications, zoned travel restrictions, and adoption of physical distancing and hygiene measures limited COVID-19 transmissions within the country. Community participation from voluntary groups and civil society organizations helped deliver non-health services while hospitals provided uninterrupted routine health services through its primary healthcare network. All COVID-19 cases were treated in hospitals, and the country has had zero reported COVID-19 deaths. This article describes how the concept of GNH provided the framework for the government to respond to this pandemic.
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Affiliation(s)
- Thinley Dorji
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
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Dorji T, Wangmo S, Gurung MS, Tenzin K, Penjore T, Lucero-Prisno DE. Knowledge, attitude and practice towards health research and its utilization among health professionals in Bhutan: Results of a nationwide cross-sectional survey in 2019. J Health Serv Res Policy 2020; 26:115-124. [PMID: 33256479 DOI: 10.1177/1355819620954481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Research is an important tool for sustainable development and the advancement of health. In Bhutan, the need for strengthening the national health research effort has been recognized only in recent years. As a part of research capacity building, this study was conducted to assess the knowledge, attitude and practices of the country's health care professionals towards research. METHODS This was a nationwide cross-sectional study. Simple random sampling was used to obtain a proportionate composition of health professionals. A self-administered questionnaire was developed to assess knowledge through 10 multiple-choice questions, attitude through rating statements, and practices through assessing experiences with research. Knowledge was scored out of 10. Besides analysing proportions, correlation and simple linear regression coefficients were calculated to assess the association of knowledge score with age, work experience, qualification, and the number of research projects undertaken. RESULTS A total of 420 valid questionnaires were collected (response rate = 95.2%). The mean knowledge score was 6.2 (±2.0) out of 10. There was a negative correlation between the knowledge score and the participant's age (r = -0.15, p = 0.002) and work experience (r = -0.17, p < 0.001). Participants' knowledge score increased by 0.58 (95% CI: 0.50-0.65, p < 0.001) for each unit increase in qualification level and by 0.75 (95%CI: 0.64-0.87, p < 0.001) for every research project conducted. The majority believed that local research would contribute to better clinical decision making (92.8%) by building local evidence (90.3%). Four out of five participants expressed interest in conducting research. However, only 27.4% had ever conducted research, 6.0% had published in journals and 4.3% had presented in scientific conferences. Less than half of the respondents had read (35.2%) or participated in discussions (42.1%) of research articles in their workplace. The major challenges were lack of knowledge (61.2%), time (49.9%) and resources to undertake literature searches (42.6%). CONCLUSIONS Self-reported knowledge about health research was fair, and the conduct of research and utilization of research articles were poor. However, the majority hold positive attitudes and there is a need for supporting professional development in this area.
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Affiliation(s)
- Thinley Dorji
- Medical Officer, Jigme Dorji Wangchuck National Referral Hospital, Bhutan.,Medical Officer, Kidu Mobile Medical Unit, His Majesty's Peoples' Project, Bhutan
| | - Shacha Wangmo
- Medical Officer, Royal Bhutan Army Medical Services, Bhutan
| | - Mongal Singh Gurung
- Senior Research Officer, Health Research and Epidemiology Unit, Ministry of Health, Bhutan
| | - Karma Tenzin
- Assistant Professor, Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Bhutan
| | - Tashi Penjore
- Medical Officer, Central Regional Referral Hospital, Bhutan
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Dorji T, Tshering T, Wangdi K. Assessment of knowledge, attitude and practice on tuberculosis among teacher trainees of Samtse College of Education, Bhutan. PLoS One 2020; 15:e0241923. [PMID: 33156845 PMCID: PMC7647099 DOI: 10.1371/journal.pone.0241923] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/23/2020] [Indexed: 02/04/2023] Open
Abstract
Background Tuberculosis (TB) is a major public health problem in Bhutan despite the implementation of directly observed treatment short-course since 1997. This study aimed to assess the knowledge, attitude and practice on TB among the teacher trainees of Samtse College of Education. Methodology A cross-sectional study was conducted among the teacher trainees of Samtse College of Education. A standardized pretested questionnaire was distributed and self-administered. The participants were selected randomly using randomization. The data was entered in Epi-data 4.4.2.1 and analysed using STATA version 13. A score of 1 point for a correct answer and 0 for wrong/don’t know answer was given. The knowledge, attitude and practice score were divided into good and poor based on 50% cut off. Logistic regression was used for the analysis to identify the significant covariates. Results A total of 420 trainees responded to the survey questionnaire. The average knowledge score on TB was 10.7 (Range = 0–21). Two hundred and forty respondents (58.6%) had low knowledge (mean score 7.8±2.5) on TB. Cough, chest pain and weight loss were correctly reported as the symptoms of TB by 306 (72.9%), 187(44.5%) and 187 (44.5%) participants. Eighty-nine-point five percent (376) of participants reported coughing as the main route of TB transmission and 85% (357) of the participants said that it could be prevented by covering the mouth while coughing. In multivariable analysis; the trainees in the junior years of college had good knowledge of TB compared with the senior years (adjusted odds ratio [AOR] 2.02; 95% confidence interval [CI] 1.18–3.5; p-value 0.011). Respondents previously treated for TB were more likely to have good knowledge on TB compared to those who never had TB in the past (AOR 2.39; 95% CI 1.07–5.31; p-value 0.033). The majority (93%) of respondents had a good attitude towards TB cases. Female trainees were 2.4 (95% CI 1.02–5.62; p-value 0.045) times more likely than male trainees to have a positive attitude towards TB. Eighty-eight percent of the respondents reported that they would visit the hospital if they had TB symptoms. The mean score for the practice on TB was 1.33±0.59 (Range:0–2). Conclusion In this study, the majority of the trainees had poor knowledge on TB, especially among the trainees in senior years of college and those who had never suffered from TB. The attitude towards TB was good especially among the female trainees. However, the overall practice was poor among the participants. Therefore, the Ministry of Health should collaborate with relevant stakeholders especially the Ministry of Education to incorporate topics on TB in the syllabus of students and colleges to create awareness on it.
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Affiliation(s)
| | | | - Kinley Wangdi
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Acton, Canberra, ACT, Australia
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Dorji T, Wangdi K. Treatment outcome of tuberculosis patient of Samtse General Hospital, Bhutan. Nepal J Epidemiol 2020; 10:888-896. [PMID: 33042592 PMCID: PMC7538015 DOI: 10.3126/nje.v10i3.28397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 11/18/2022] Open
Abstract
Background Tuberculosis (TB) is one of the major public health problems in Bhutan. Evaluation of treatment outcomes of TB and identification of the risk factors are important components for the success of National TB control program. Therefore, this study was undertaken to assess the TB treatment outcome and factors associated with it in Samtse General Hospital. Methods This was a retrospective, cross sectional study using the TB data from Samtse General Hospital from 2008-2019. A univariate and multiple logistic regression was used to check for associations between the outcome and other independent variables. Results The study included a total of 634 TB patients. Of this, 44.0% (279) were smear positive TB (PTB+), 36.1% (229) were extra pulmonary TB (EPTB) and 19.9% (126) were smear negative TB (PTB-). During the study period, 56.2% (356) of them completed treatment, 33.3% (211) were declared cured, 0.2% (1) had defaulted, 5.1% (32) died and 5.4% (34) had treatment failure. The mean treatment success rate (TSR) was 89.4% (567). The TSR was highest for EPTB with 96.9% (222/229), followed by PTB- at 88.1% (111/126) and lowest for PTB+ with 83.9% (234/279). Successful treatment outcome was observed in EPTB patients (AOR: 7.3; 95% CI: 2.46-21.36), patients in age 15-28 years (AOR: 3.4; 95% CI: 1.59-7.46) and 29-42 years (AOR: 9.1; 95% CI: 2.44-33.61). Conclusion The treatment outcome of TB in Samtse General Hospital is satisfactory and at par with the national level. Since, smear positive TB and elderly patients are prone to develop poor treatment outcome, they need to be monitored and followed up adequately.
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Affiliation(s)
| | - Kinley Wangdi
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia
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Penjor D, Dorji T. Circumstances of human conflicts with bears and patterns of bear maul injuries in Bhutan: Review of records 2015-2019. PLoS One 2020; 15:e0237812. [PMID: 32817716 PMCID: PMC7446927 DOI: 10.1371/journal.pone.0237812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/02/2020] [Indexed: 12/02/2022] Open
Abstract
Bhutan is one of the biological hotspots in the world where humans and natural flora and fauna co-exist in close proximity. Bhutan is home to two species of bears: Sloth Bear and Himalayan Black Bear. Human conflicts with bears are reported from all over the country. This study describes the profile of the victims and the pattern of injury resulting from bear attacks and circumstances around human conflicts with bears in Bhutan between 2015 and 2019. This was a cross-sectional study with a review of hospital records of patients treated at the National Referral Hospital from 01 January 2015 till 31 December 2019. Data were extracted into a structured pro forma and entered into EpiData Entry 3.1 and analysed in STATA 13.1. There were thirty-four patients who were provided care for bear maul injuries, with an average annual caseload of 6.8 cases per year. The injury prevalence was 100% and the kill prevalence was 0%. Bear attacks were reported from fourteen of twenty districts of the country. The mean age of the victims was 49 (±13) years. Males (26, 76%) and farmers (26, 76%) were the common victims; the risk of bear attacks was 0.16 per 100,000 farmers per year. The commonest region of the body attacked was the face (29, 85%) and victims were provided emergency and rehabilitative care within and outside the country. Thirty-three victims (97%) were provided post-exposure prophylaxis for rabies. All victims received antibiotics despite the lack of national guidelines on the choice of antibiotics post-bear maul. Human-bear conflict is multi-faceted, puts a considerable strain on bear-conservation efforts and requires multi-disciplinary efforts in the prevention of human injury and socioeconomic losses.
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Affiliation(s)
- Dorji Penjor
- Department of Ear, Nose and Throat Surgery, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Thinley Dorji
- Kidu Mobile Medical Unit, His Majesty's People's Project, Thimphu, Bhutan
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Tenzin K, Dorji T, Choeda T, Wangdi P, Oo MM, Tripathi JP, Tenzin T, Tobgay T. Internet Addiction among Secondary School Adolescents: A Mixed Methods Study. ACTA ACUST UNITED AC 2020. [PMID: 32329462 PMCID: PMC7580451 DOI: 10.31729/jnma.4292] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Excessive use of internet can lead to "Internet Addiction". A sharp rise in the number of internet users among adolescents in Bhutan have been observed lately which could have potential side-effects on their health. The aim of this study was to find the prevalence of internet addiction and psychological co-morbidities among the secondary school-going adolescents. METHODS This is a descriptive cross-sectional quan-qual sequential mixed method design with a quantitative component and qualitative component. The study was conducted between 1st May and 30st November 2017 conducted in twelve schools across Bhutan after taking ethical clearance was from Research Ethics Board of Health of Bhutan. Data were doubleentered in EpiData Entry, validated and imported into STATA version 12.0 for analysis. Point estimate at 95% CI was calculated along with frequency and proportion for binary data. RESULTS Among 721 adolescents from twelve selected schools, prevalence of internet addiction was 248 (34.440%) at , 95% Confidence Interval (31-38%). Out of A total of 586 (81%) preferred smartphone for internet use with 388 (54%) actually using it. Depression and anxietywere the associated psychological co-morbidities seen along with internet addiction. Internet addiction was high among those using internet at home, using smartphone for internet access, social networking and night time internet use were associated with internet addiction. Boredom, stress/anxiety and peer pressure were triggers of internet use. Internet addiction also affected academic performance, social interactions and sleep. CONCLUSIONS Prevalence of internet addiction among adolescents in Bhutan is high comparing to previous standard data which requires immediate attention.
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Affiliation(s)
- Karma Tenzin
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan Thimpu, Bhutan
| | | | | | | | - Myo Minn Oo
- International Union against Tuberculosis and Lung Disease, Myanmar
| | - Jay Prasad Tripathi
- Department of community medicine, All India Institute of Medical Sciences, Nagpur, India
| | - Tashi Tenzin
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical sciences of Bhutan, Thimpu, Bhutan
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Dorji T, Pokhrel HP, Tshokey T. Socio-demographic and Clinical Characteristic of Women Availing Pap Smear Services in Samtse District, Bhutan. Asian Pac J Cancer Biol 2020. [DOI: 10.31557/apjcb.2020.5.2.63-70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: The case burden of cervical cancer has been increasing globally especially in developing countries without proper health system. Cervical cancer can be eliminated with timely vaccination and screening program as it usually takes years for pre-malignant lesions to develop into malignant lesion. Bhutan has committed to eliminate cervical cancer. Thus, it is important to understand the factors associated with abnormal Pap test findings. Methodology: A retrospective study was conducted using the Pap smear data for the year 2018. It was extracted from the records maintained in the cytology unit of Samtse General Hospital. Result: The abnormal slide rate in this study was 2.5%. The majority of women seeking Pap smear services were women in reproductive age group and housewife by occupation. There were significant differences between age groups and marital status among normal in the Pap test results. Conclusion: The slide abnormality of Pap smear in Samtse District is low. The abnormality is more common among married and older women. Therefore, additional screening efforts needs to be put into this group to detect pre-malignant lesions.
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Tshering P, Dorjee S, Dendup T, Dorji T, Wangmo D. Epidemiological and histopathological characteristics of head and neck cancers in Bhutan from 2011 to 2017: a retrospective descriptive study. Ecancermedicalscience 2020; 14:1024. [PMID: 32346390 PMCID: PMC7176063 DOI: 10.3332/ecancer.2020.1024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Head and neck cancers are among the commonest cancers in the developing world. Personal habits, such as the use of tobacco, betel nut and alcohol are strongly associated with the development of head and neck cancers at certain sites. Therefore, they are among the preventable cancers. In Bhutan, there has not yet been a study conducted on head and neck cancers. OBJECTIVE To describe baseline epidemiological and histopathological characteristics of head and neck cancers in Bhutan. METHODS This is a 7-year descriptive study of all cases of head and neck cancers presented at the Jigme Dorji Wangchuk National Referral Hospital from 2011 to 2017. The data were collected from the hospital's medical records section, histopathology records, patient referral unit and some treatment centres in India. Prior approval was sought from the Research and Ethics Board for Health, the Ministry of Health and the hospital management. RESULTS There were a total of 515 cases of head and neck cancers from 2011 to 2017. The crude incidence rate was 10 per 100,000 and the overall age adjusted rate was 12.3 (95% CI 9.5-15.1) per 100,000 population. The prevalence during this 7-year period was 69.1 per 100,000 population. The commonest cancers are thyroid, oral cavity, hypopharyngeal, laryngeal and nasopharyngeal cancer in decreasing order. Head and neck cancers are more common in males than females in the majority of sites except thyroid, salivary gland and sinonasal malignancies. Thyroid cancers and nasopharyngeal cancers are found to affect younger age groups. Tashigang (48) followed by Paro (43) recorded the highest number of cases. Squamous cell carcinoma is the commonest histopathology type in almost all the cases, while papillary carcinoma is the commonest among thyroid cancers. Personal habits, such as smoking, chewing tobacco, betel nut and alcohol consumption, were found to be more common among patients suffering from oral cavity, laryngeal, hypopharyngeal and oropharyngeal cancers. CONCLUSION Head and neck cancers are the third most common cancer in Bhutan after stomach cancer and cervical cancer. Thyroid, oral cavity and hypopharynx are the top three anatomical sites for head and neck cancers in Bhutan. The current epidemiological and histopathological profile of head and neck cancers will form a baseline of information and basis for further research on head and neck cancers in Bhutan.
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Affiliation(s)
- Phub Tshering
- Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
| | - Sithar Dorjee
- Khesar Gyalpo University of Medical Sciences, Thimphu, Bhutan
| | | | | | - Dechen Wangmo
- Minister of Health, Royal Government of Bhutan, Thimphu, Bhutan
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Abstract
The classification of snakebite is based on clinical examination and laboratory tests. In cases, of suspected hemotoxic snakebite, the anti-snakebite venom (ASV) is administered based on 20-minute whole blood clotting time. However, the use of ASV should be guided by the presence of bleeding diathesis along with raised clotting time.
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