Bhutan Health Journal
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Strangulation - a rare complication of inguinal hernia in a neonate
Get PDFStrangulation is a rare complication of incarcerated inguinoscrotal hernia in the neonate and infants. We report a case of a 15-day old male neonate, who presented with strangulated inguinal hernia containing loop of ileum. Resection of the gangrenous part of the ileum was done and end-to-end anastomosis was performed. Strangulated inguinal hernia in neonates is a rare occurrence
A supposed delicacy gone wrong: a case report of stink bug meal consumption
Get PDFA stink bug species, locally called ‘Hayhem’ or ‘Knabu’is consumed as a meal in certain regions in Bhutan. While it is considered a therapeutic food and a delicacy, interviews with some local people reveal that it often causes severe illnesses in some. No published literature has reported any suchcases.A case of intoxication following the stink bug consumption in a healthy 35 year old female is reported here. She presented with severe vertigo and recurrent vomiting. Examination revealed no focal neurological deficits and there was no physical evidence of an allergic reaction. Her vital signswere within normal range. Blood investigations revealed minimally deranged kidney function. She was treated symptomatically and was managed for acute kidney injury with intravenous fluids and strict input and output monitoring. She recovered after 5 days. Such intoxication can be treated effectively with just conservative management as demonstrated in this case report
Alcohol consumption and academic performance among higher secondary students in Thimphu, Bhutan
Get PDFIntroduction: Despite known alcohol abuse among adolescence, precise information on the prevalence and pattern of drinking in Bhutan remain sparse. This study, therefore, assesses the pattern of alcohol drinking and consequences including its effects on academic performance among high school students in Thimphu.
Methods: Multistage random sampling was employed and a survey was conducted in November 2014 using a self-administered semi-structured questionnaire. A total of 403 students were invited, however, 3 students were absent during the time of survey and 13 respondents were rejected due to incompleteness of the questionnaire. Thus, the findings are based on a sample size of 387.
Results: Prevalence of long term alcohol drinkers were 38.8% and 26.6% were current drinkers. The mean age of onset of alcohol use was 15.5 (± 2.6). Binge drinking (greater than or less than four times a week) and GPA (Grade Point Average) were significantly orrelated (p less than or equal to 0.01, r = - 0.120). Therefore, students involved in binge drinking greater than or equal to four times a week are likely to obtain less GPA.
Conclusions: Students, comprising both males and females, drink alcohol and those who are involved in frequent binge drinking are more likely to have lower GPA
Incidence and pattern of leukemia in Bhutanese population: a retrospective analysis of eight years (January 2008 to December 2015)
Get PDFIntroduction: The burden of haematological malignancies in developing countries is on the rise. This burden may be further aggravated in Bhutan due to the aging population and rapid modernization of the nation. Despite this, there is a paucity of information about the incidence and pattern of leukemia in the Bhutanese population. In this retrospective study, we aim to investigate the incidence and pattern of leukemia in Bhutan using a database of leukemia diagnosed at Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan from January 2008 to December 2015.
Methods: The diagnoses and classification of leukemias were based on the morphology of blood cells on peripheral blood and bone marrow smears. The data was analyzed with descriptive statistics. The age-standardized incidence rate per 100,000 populations and its 95% confidence interval was calculated to assess the statistical significance.
Results: In total 118 patients were diagnosed with leukemia over the period of eight years. Leukemia was found to be more frequent in male (51.69%) compared to female (48.30%) with a male to female ratio of 1.1:1. Acute leukemia accounted for 66.95% of all leukemia case diagnosed, whereas chronic leukemia accounted for only 33.05% of the cases. The average, annual, age-standardized incidence rate of leukemia per 100,000 population was 2.30 (95% CI: 1.87-2.73).
Conclusions: The incidence and pattern of leukemia in the Bhutanese population is similar to other published literature. Leukemia is not uncommon in the Bhutanese population, thus additional studies on risk factors for leukemia in the Bhutanese population is necessary
Management of corrosive oesophageal injuries: a review
Get PDFWith the increasing incidence of corrosive oesophageal injuries, especially in the developing countries, understanding thepathophysiology and the approach to its management in the emergency and elective settings has become of paramount importance for the surgeon. The approach to the management varies depending on the time of the diagnosis and the location of injury. Endoscopy plays a key role as the first step in the evaluation of such patients in the emergency as well as late elective setting. With the advancement in endoscopic interventions, there has been a shift of preference towards the less invasive and less morbid endoscopic techniques to address the late sequelae of corrosive oesophageal injuries. Refractory cases eventually merit surgery, even at the cost of the morbidity and mortality associated with such rocedures. The surgical approach also varies depending on the location of the stricture, with the proximal 1/3rd strictures epresenting the most challenging location. A regular follow up and endoscopic surveillance are needed in these patients to screen for any late complications such as cancer or dysmotility
Predictors of multiple sexual partnerships among women and men in two urban townships in Bhutan
Get PDFIntroduction: Multiple sexual partnering is a known predictor for risk of STI and HIV transmission. This study explored the multiple sexual partnering and its predictors among people who visited public social venues (bars, restaurants, hotels, lodges, cafes, karaokes and discos) in Bhutan’s two largest townships of Thimphu and Phuntsholing.
Methods: We interviewed 755 sexually active venue patrons from 102 randomly selected venues (56 in Thimphu, 46 in Phuntsholing) from a list of all venues identified as having sex workers or patrons seeking sexual partners. Both bivariate and multivariate analyses were carried out to characterize the predictors of multiple sexual partnering among 755 respondents who had previously had sex.
Results: Of the 755 patrons, 46.09% had one sexual partner while the remaining 54.91% had multiple sex partners (greater than or equal to 2 sexual partners) in the 12 months preceding the study. Overall, 6.23% of respondents had received payment from someone at least once for sex; 34.61% of male respondents had paid someone at least once for sex. Nearly all patrons (97.72%) had heard about HIV/ AIDS. About one quarter (24.20%) felt that they were at risk of being infected with HIV, while 37.28% had taken an HIV test in the 12 months preceding the study. In multivariate analysis, males had higher odds of multiple sexual partners compared to females (OR =3.19, 95% CI 1.90-5.20). The odds of having multiple sexual partners was 2.24 (95% CI 1.30-3.90) times higher in those never married compared to those who were married/divorced or separated; multiple partnering increased with increasing age (OR = 1.07 per year, 95% CI 1.02-1.13). Between the townships of Phuentsholing and Thimphu, the odds of multiple sexual partnering did not vary.
Conclusions: Venue patrons had a high prevalence of multiple sexual partnering and have the potential for creating sexual networks that could propagate wider transmission of infection, including to their monogamous partner. Targeting HIV prevention program to these groups of people in urban locations presents an opportunity to make a great impact in maintaining Bhutan’s current low HIV epidemic level
HBeAg negative chronic hepatitis B in South Asia
Get PDFChronic Hepatitis B (CHB) infection has an intermediate prevalence rate in South Asian countries, except for Nepal and Sri Lanka where it has a low rate. HBeAg negative CHB infection has been found to be more pronounced in this part of the world. As described previously, CHB infection has two phases with HBeAg positive and HBeAg negative based on ALT, DNA & biopsy. The latter was previously described to have a benign course. The later guidelines have distinguished HBeAg negative status into two categories with an inactive phase and a reactivation one. In this review article we have highlighted HBeAg Negative status burden in South Asian countries and shown that HBeAg negative CHB infection may not be as benign as previously thought. Furthermore , mutations at precore and basal core promoter region may contribute to disease severity in HBeAg negative CHB infection
Incidence of congenital heart diseases in children born at Eastern Regional Referral Hospital, Monggar
Get PDFIntroduction: Congenital heart diseases are the commonest birth defects worldwide. While the true incidence of congenital heart diseases is known in many countries, it has not been studied in Bhutan.
Methods: Neonates born at the Eastern Regional Referral Hospital, Monggar in the year 2010 were screened for congenital heart diseases at birth by echocardiography and clinical examination including pulse oximetry.
Results: The majority of the study subjects were natives of eastern districts of Bhutan. The incidence of congenital heart diseases was found to be 68 per 1000 live births, with Atrial Septal Defect being the commonest lesion.
Conclusions: The overall incidence of congenital heart disease is higher than what is reported in other countries although the incidence of serious lesions was similar to what is reported elsewhere
Catching congenital heart diseases early : the ten- point approach for Bhutan
Get PDFCongenital heart disease is the most common birth defect and is the main reason for out country referral of pediatric patients from Bhutan. Given the limited resources and expertise, detecting congenital heart defects is often delayed, resulting in delayed initiation of treatment and management of associated complications. Congenital heart diseases, if detected early, can be appropriately treated and complications minimized. A ten-point approach consisting of antenatal diagnosis, neonatal pulse oximetry, well child visits, sick child visits, immunization clinics, school health checkups, pediatric echocardiographers, pediatric cardiologists, basic echocardiography skills in pediatric residents and comprehensive birth defect surveillance is suggested, in order to catch congenital heart defects early in life
