Bhutan Health Journal
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Systemic and pulmonary venous anomalies in children with congenital heart disease on multidetector computed tomography: A descriptive study
Get PDFIntroduction: The identification of pulmonary and systemic venous abnormalities in patients with complex congenital heart diseases is crucial for appropriate management. Multidetector CT enables detailed evaluation of these anomalies, outlining their anatomical course and drainage patterns. To our knowledge, this is the first descriptive study from the Indian sub-continent to evaluate such rare anomalies. This study aimed to evaluate the role of Multidetector computed tomography in evaluating venous anomalies associated with congenital heart disease.
Methods: A single-center retrospective descriptive study was conducted from January 2013 to August 2022 in a tertiary care hospital, including patients aged 18 years and below who were referred for evaluation for congenital heart disease. Multidetector CT scans were reviewed by three radiologists independently.
Results: Among 99 patients, 78 had systemic venous anomalies and 37 had pulmonary venous anomalies, with nine showing both. Persistent left superior vena cava was the most common systemic venous anomaly (n=62, 79.4%). Partial anomalous pulmonary venous connection was the most common pulmonary venous anomaly (n=18,48.6%).
Conclusion: Multidetector CT is a non-invasive, high-resolution imaging modality that provides detailed evaluation of pulmonary, systemic, and associated cardiac anomalies. Its multiplanar capabilities enable accurate identification of complex venous abnormalities, facilitating better diagnosis and management
Cardiovascular Surgical Services in Bhutan: Current Progress, Challenges and Future Plans
Get PDFCardiovascular diseases are rising in Bhutan, with 279 adults and 227 pediatric patients referred to India for cardiovascular disease treatment in the last 3 years. Since its establishment in 2023, the catheterization laboratory has performed close to 400 diagnostic angiograms and numerous interventions, saving many lives and reducing up to 50 million ngultrums in revenue. As Bhutan’s cardiac surgical services are still in their early stages, technical capacity in the form of human resources and equipment needs to be developed. Herein, we discuss the current state of cardiovascular services in Bhutan, the challenges, and future directions.
Uncovering Rosai-Dorfman Disease through histopathology in a middle-aged man: a case report
Get PDFRosai-Dorfman disease is a rare and benign histiocytic proliferative disorder characterized by accumulation of large S100- positive histiocytes, which typically show emperipolesis. The diagnosis can be challenging due to its rarity and diverse clinical presentations, often mimicking malignancies. We report a case of a 58-year-old man presenting with painless right cervical lymphadenopathy accompanied by intermittent low-grade fever for three months. Fine needle aspiration cytology from the node was initially misinterpreted as suspicious for Hodgkin lymphoma due to the presence of scant binucleated reactive histiocytes resembling Reed-Sternberg like cells. However, histopathological examination of an excised lymph node showed Rosai-Dorfman disease with additional confirmation provided by immunohistochemistry. Differentiating Rosai-Dorfman disease from malignancies requires a high level of clinical suspicion due to overlapping features. This case emphasized the diagnostic pitfalls in cytology and the importance of histopathological confirmation. Increased awareness of Rosai-Dorfman disease can prevent misdiagnosis and avoid unnecessary invasive procedures and treatment
Bhutan’s Medical Relief Mission to Myanmar Earthquake 2025: Operational insights and policy recommendations
Get PDFA catastrophic 7.7-magnitude earthquake struck central Myanmar on March 28, 2025, causing destruction of infrastructure, deaths, injuries and displacement of nearly 200,000 people. In response to this humanitarian crisis, Bhutan deployed its emergency medical team to support relief operations. This short report evaluates the mission’s operational strengths, challenges and lessons learned. Drawing on field observations, structured debriefings and prior mission experience, it highlights critical insights to inform future disaster preparedness, coordination and response efforts by emergency medical teams
Prevalence and profile of astigmatism in individuals availing ophthalmic services at Central Regional Referral Hospital, Gelephu, Bhutan: A cross-sectional, hospital-based study
Get PDFIntroduction: Astigmatism has been defined as a type of refractive error when parallel rays of light entering the eye are not focused at one point of the retina when accommodation is at rest due to irregular curvature of the cornea or lens surface. All-age data on the prevalence and types of astigmatism is not available in Bhutan. This study was carried out to determine the prevalence and determinants of astigmatism in the Central Regional Referral Hospital (CRRH) of Bhutan. Methods: This was a cross- sectional study done between November 2021 and August 2022 in CRRH with 302 participants. Routine visual acuity testing and refraction were done for all the individuals availing ophthalmic services and type of astigmatism was diagnosed. Results: The overall prevalence of astigmatism in individuals availing ophthalmic services at CRRH was found to be 4.18% and the most common types of astigmatism were compound myopic, with-the-rule (WTR) and mild astigmatism. Conclusion: Prevalence of astigmatism was found to be low in individuals availing ophthalmic services at CRRH. The most common types of astigmatism were compound myopic, WTR and mild astigmatism
Navigating the Ethical Terrain towards a Responsible Adoption of Health Information Systems: Recommended Ethical Pathways
Get PDFHealth Information System (HIS) improves healthcare data accuracy, care coordination, resource allocation, and informed decision-making. However, ethical concerns arise with data security, privacy, informed consent, and patient autonomy. This paper discusses the benefits and drawbacks of HIS and offers recommendations to address the ethical issues, crucial for countries like Bhutan undergoing healthcare digital transformation with Electronic Patient Information System (e-PIS) adoption. The main recommendations are: educating system personnel, establishing regulatory and ethical frameworks, implementing strong security standards, obtaining informed consent from patients, and enabling patients to access their own records. An integrated approach that balances technology and ethics is needed to successfully adopt HIS
Climate Change and Mental Health in Bhutan
Get PDFBhutan remains a largely non-industrialized country, making minimal contributions to global warming and climate change. Yet, the country suffers from the clutches of the adverse effects of climate change. Among them, the impact of climate change on mental health including psychological distress, acute stress disorder, post-traumatic stress disorder, major depressive disorder and anxiety disorder is well known. In this article, we aim to describe the various mental health issues that the country is facing or is likely to face in the future as a result of climate change
Presentation of a Locally Advanced Cervical Cancer with Hydrometrocolpos: A Case Report
Get PDFIntroduction: Early stages of cervical cancer remain asymptomatic. Its common symptoms are postcoital bleeding, postmenopausal bleeding, heavy menstrual flow and foul smelling blood stained discharge. Presentation of locally advanced cervical cancer with hydrometrocolpos is unusual.
Case report: An 83-year-old woman who presented with a large abdomino-pelvic mass was diagnosed as benign bilateral ovarian tumour with left sided hydroureteronephrosis. During laparotomy, the mass was confirmed to be a hydrometrocolpos with left hydroureteronephrosis secondary to a locally advanced cervical cancer (FIGO IIIB). Histology confirmed the diagnosis of invasive squamous cell carcinoma of the cervix.
Conclusion: Besides thorough evaluation via symptoms and signs, radiologists have an important role in guiding surgeons to the most probable diagnosis. In an elderly woman with a stenosed vagina and a pelvic mass with hydroureteronephrosis, gynecologists need to be aware of the possibility of locally advanced cervical cancer, and perform relevant preoperative assessments and plan management