Bhutan Health Journal
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Hypokalemic Periodic Parlaysis Associated with Adrenal Adenoma in a Patient with Conn’s Syndrome: A Case Report
Get PDFIntroduction: Hypokalemic paralysis secondary to Conn’s syndrome is rare. The most common presentation of this condition is hypertension, which may be asymptomatic or range from mild to severe to refractory. Case Report: A 34-year-old hypertensive female presented with acute onset of lower limb weakness. She reported two similar episodes in the past. She had profound hypokalemia and further evaluation revealed high aldosterone and low renin levels, suggesting an adrenal adenoma. She was managed with antihypertensives and spironolactone. After CT confirmation of a right adrenal adenoma, she underwent surgery. She showed significant improvement in both her symptoms and laboratory parameters after surgery, and is doing well on her follow-up. Conclusion: This case illustrates that a high index of suspicion leads to early recognition and timely management of an unusual and potentially severe clinical manifestation of primary hyperaldosteronism in the form of hypokalemic periodic paralysis, especially in the setting of unexplained hypertension
Bilateral undescended testes with intra-abdominal left testicular seminoma: a case report
Get PDFUndescended testis is a common congenital male genitalia anomaly characterized by absence of one or both testes in the scrotum. It is seen in approximately 3% of full-term male newborns and 30% of preterm male neonates. The most feared complication of undescended tests is testicular cancer. We present a case of a 31-year-old male with lower abdominal pain, fullness and urinary urge incontinence for 2 weeks’ duration. On physical examination, there was a firm non-tender suprapubic mass and absence of testes in the scrotum. A contrast enhanced computed tomography scan showed a well circumscribed lobulated heterogeneous mass in the pelvic cavity drained by the left testicular vein which was later confirmed to be a left testicular seminoma by histopathology report
Transforming healthcare through continuing medical education: World Telehealth Initiative at the Central Regional Referral Hospital, Bhutan
Get PDFTelemedicine supports both patient care and continuing education of healthcare professionals. Medical knowledge is prone to quick obsolescence, requiring healthcare professionals to regularly update with the rapidly evolving medical field. Healthcare professionals can use telemedicine facilities to build capacity and provide evidence-based patient care. Herein, we describe how the Central Regional Referral Hospital and the World Telehealth Initiative established telehealth infrastructure in the hospital that brings together global experts and local healthcare professionals to enhance patient care through Continuing Medical Education and training
Anesthesia services in Bhutan: Insights into evolution, challenges, and future directions
No full textFollowing the implementation of Bhutan’s first Five-Year Plan in 1961, the national healthcare system underwent a remarkable transformation. From its humble beginnings in primary healthcare, the country now offers anesthesia and surgical services nationwide. Despite this progress, the healthcare system continues to face persistent shortages in human resources and infrastructure, particularly in the field of anesthesia. This perspective offers a comprehensive historical overview of anesthesia services in Bhutan, while highlighting challenges and presenting recommendations for future improvement
Factors associated with health-related quality of life among kidney transplant recipients in Bhutan
Get PDFIntroduction: The health-related quality of life (HRQoL) of kidney transplant recipients (KTRs) is a crucial metric for assessing transplant outcomes. While HRQoL generally improves after kidney transplantation, KTRs often face significant HRQoL issues.
Methods: A cross-sectional study was conducted among 100 KTRs by performing face-to-face interviews using a KTQ-25 tool in a tertiary care hospital. The tool included information about physical symptoms, fatigue, fear/uncertainty, appearance, and emotions of KTRs. The objective was to assess the influence of sociodemographic factors on the HRQoL of KTRs.
Results: Out of 130 transplant recipients, 100 participated in this study, of which 48% were females. Hypertension was the cause of kidney failure in 53 participants. The overall mean±SD score of HRQoL was 4.3 ± 0.8, among which physical symptoms scored 4.9 ± 1.0, fatigue 4.4 ± 1.1, fear/uncertainty 4.2 ± 1.0, appearance 4.0 ± 1.3, and emotions 4.2 ± 1.4. Unemployment, long duration on dialysis, and donor relationship were significantly associated with the physical symptoms, emotions and uncertainty/fear (p value <0.05).
Conclusion: The overall health-related quality of life of kidney transplant recipients was low, influenced by factors such as unemployment, extended periods on dialysis, and receiving kidneys from non-related donors. Similar research must be conducted among patients undergoing dialysis
Mortality rate and clinical profile of patients with sepsis admitted at the Department of Medicine, National Referral Hospital of Bhutan, 2021: A cross-sectional study
Get PDFIntroduction: Sepsis is a leading cause of death globally, particularly in low and middle-income countries. However, data on adult sepsis in Bhutan remains limited. This study aimed to determine the mortality rate and clinical profile of sepsis patients admitted to the medical ward of the National Referral Hospital in Bhutan. Methods: A cross-sectional study was conducted at the Jigme Dorji Wangchuck National Referral Hospital in 2022. All adult patients with sepsis admitted to the Department of Medicine were included. Data was collected using a structured pro forma and analyzed using Epi Data Analysis version 2.2.2.183 and STATA version 12.1. Results: Among 278 patients with sepsis, the in-hospital mortality rate was 26.6%. Mortality was significantly higher in patients aged over 60 years (p<0.001). Pneumonia was the most common source of infection (39.2%) while spontaneous bacterial peritonitis and bloodstream infections were more strongly associated with mortality (p<0.001). Gram-negative bacteria, particularly Escherichia coli and Klebsiella species were the predominant pathogens. Independent predictors of death included mechanical ventilation (adjusted OR 23.5, 95% CI 11.2–49.2, p<0.001), vasopressor support (adjusted OR 9.78, 95% CI 4.02– 23.8, p<0.001), spontaneous bacterial peritonitis (adjusted OR 3.85, 95% CI 1.43–10.3, p = 0.007 ), and bloodstream infections (adjusted OR 3.62, 95% CI 1.25–10.5, p = 0.018). Conclusion: Mortality was reported in one quarter of patients admitted with sepsis, particularly in the critically ill. Strengthening early recognition, prompt treatment, microbiological diagnostics, and critical care infrastructure are essential to reduce sepsis mortality and improve patient outcomes
Bilateral retinoblastoma presenting as leukocoria in unilateral eye: a case report
Get PDFRetinoblastoma (RB) is the most common ocular tumour in childhood. Presentations include leukocoria, strabismus, decreased vision and painful blind eye. RB can have extraocular extension into the orbit and also metastasise distantly to the brain. We present the case of a 2-year-old child with RB in both eyes, advanced stage in left eye and early stage in the right eye. The left eye was treated with chemoreduction followed by enucleation. The histopathology examination of enucleated eye showed RB cells with no invasion of the optic nerve. The right eye was salvaged after treatment with cryotherapy and laser therapy. This case is significant as RB is a rare disease that was not previously reported from Bhutan. If a child presents with leukocoria, paediatricians and ophthalmologists should have a high suspicion of RB. Timely referral to an ocular oncologist and vitreoretinal specialist is crucial to save vision and the child’s life
Systematic Review of Vitreoretinal Diseases in Bhutan
Get PDFUnderstanding disease epidemiology is critical for planning and implementing health programs, particularly in countries like Bhutan with limited resources and data. We reviewed published data on vitreoretinal diseases in Bhutan and found 16 such publications. Of those, two were population-based Rapid Assessment of Avoidable Blindness surveys, and others included hospital-based national survey publications and five case reports. The Rapid Assessment of Avoidable Blindness survey conducted in 2009 reported that posterior segment disorders caused 22.1% of blindness, while a similar follow-up survey in 2018 reported it had reduced to 7.8%. This improvement perhaps was due to national Vitreoretinal services established in early 2012. Hypertensive retinopathy was the most common disorder (18.9%), and other disorders included diabetic retinopathy, diabetic macular edema, retinal detachment, age-related macular degeneration, macular hole, myopic retinal degeneration and vitreous hemorrhage. Even rare disorders like seasonal hyper-acute pan-uveitis, acute retinal necrosis, central retinal artery occlusion, and nephrotic maculopathy had been treated. Bhutan, with its serene environment, is no exception to the varied vitreoretinal disease spectrum. Bhutan needs to focus on changing lifestyles, while still improving human resources and management strategies
Strategies for improving Tuberculosis notification through incentives in primary care settings: Insights from a systematic review
Get PDFBackground: Effective disease notification systems are crucial for managing public health issues, yet many countries face challenges related to under-reporting, particularly in the context of diseases such as tuberculosis. This systematic literature review aims to analyze incentive strategies designed to enhance health reporting in primary care settings.
Methods: A comprehensive search of databases was conducted to identify studies published in the last five years that focused on incentive mechanisms in healthcare settings. The inclusion criteria comprised studies that assessed the impact of financial and non-financial incentives on health reporting and service performance. A total of 93 studies were included in the final analysis.
Results: The findings indicate that both financial incentives, and non-financial incentives can significantly improve tuberculosis notification rates. Evidence suggests that well-structured incentive programs can lead to better engagement from healthcare providers, enhancing the accuracy and timeliness of disease reporting. Moreover, the effectiveness of these strategies are influenced by contextual factors, including local healthcare policies and provider awareness.
Conclusion: This review underscores the importance of tailored incentive strategies in improving health reporting systems. Future research should focus on long-term outcomes and the integration of stakeholder perspectives to develop more effective and sustainable incentive frameworks
