Bhutan Health Journal
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A case of apraxia of eyelid opening associated with benign essential blepharospasm in Bhutan
Get PDFApraxia of eyelid opening (AEO) is a non-paralytic motor abnormality characterized by difficulty in eyelid opening bilaterally. This is due to the inability of voluntary opening of the eyes in the absence of visible contraction of the orbicularis oculi despite sustained willful frontalis contraction. We present you a case of a 60-year-old woman with AEO associated with benign essential blepharospasm who suffered marked limitation in daily activities due to functional blindness. She was treated with botulinum toxin type A injections following which she had adequate eyelid opening in both eyes during 1 week follow up. It is essential for physicians and patients to be aware of this condition for proper diagnosis and treatment
Clinical and microbiological profile of patients with urinary tract infection visiting general outpatient department, National Referral Hospital
Get PDFBackground: Urinary Tract Infection (UTI) is one of the most common infections encountered in outpatient settings. The random use of antibiotics, particularly in resource-limited settings, has contributed to the emergence of antibiotic resistance. This study aimed to identify common uropathogens and assess their antibiotic sensitivity patterns among patients with symptoms of UTI attending the General Outpatient Department (GOPD) at Jigme Dorji Wangchuck National Referral Hospital in Thimphu.
Method: A cross-sectional study was conducted from September 2021 to August 2022, involving patients over the age of 13 years with symptoms of UTI. Midstream urine collected via proper technique was analyzed by the laboratory. Once there was growth on the urine culture media, antibiotic sensitivity testing was performed against the commonly used antibiotics in the GOPD.
Result: Amongst 351 participants, 77.8% were female, and the most common symptoms reported were dysuria (93.4%) and increased urinary frequency of micturition (92.3%). Patient’s age, sex and previous episodes of UTI were significantly associated with the occurrence of UTI (p < 0.05). The overall urine culture positivity rate was 50.53%, with Escherichia coli (84.7%) identified as the predominant uropathogen, followed by Klebsiella pneumoniae (7.3%). Among the antibiotics tested, gentamicin and nitrofurantoin exhibited the highest sensitivity, while amoxicillin and ampicillin were the least effective antibiotics against Escherichia coli.
Conclusion: UTI predominantly affected females. Escherichia coli was the commonest causative agent and nitrofurantoin could be the potential drug of choice for UTI treatment. The irrational use of antibiotics, as a contributing factor to resistance should be addressed
Cardiotoxic effects of poisoning from aconite root in a middle-aged man in Bhutan: a case report
Get PDFIntroduction: Poisoning is a major global health concern and a preventable cause of death. Aconite, an alkaloid found in the aconitum genus frequently leads to poisoning in Asian countries including Bhutan owing to its use in traditional medicine and religious items.
Case presentation: A 47-year-old male consumed a tincture of aconite plant root and experienced vomiting, blurred vision, paraesthesia, and light headedness. On presentation to the emergency department, his vitals were normal but on subsequent close monitoring, he had premature ventricular contractions and sinus bradycardia leading to hypotension and shock. He was admitted to the intensive care unit for continuous cardiac monitoring and supportive treatment including atropine and noradrenaline. He reported subjective improvement, his vital signs improved and ECG returned to normal, enabling discharge after 5 days of admission.
Conclusion: There is no specific antidote to aconite toxicity so the treatment is mainly supportive. It is imperative to implement proactive measures such as public awareness programs and dedicated research efforts to mitigate the risk of inadvertent toxicity resulting from aconite use
Prescribing patterns of antihypertensive drugs by clinicians at the National Referral Hospital outpatient department, Thimphu, Bhutan
Get PDFIntroduction: Around 1.28 billion adults aged 30-79 years have hypertension, globally. Of these, two-thirds are in low and middle-income countries, with only 21% having it under control. In Bhutan, there are 362.4 people per 10,000 population with hypertension. Antihypertensive medications must be appropriately prescribed to prevent the complications of hypertension.
Methods: A cross-sectional study of the prescriptions of antihypertensive medications at Jigme Dorji Wangchuck National Referral Hospital was undertaken to characterize the current prescribing patterns.
Results: Nine monotherapy, 18 dual therapy, 19 triple therapy and 2 multiple combination therapy with antihypertensive drugs were noted during the study period spanning April to December 2023. Nearly half (59.1%) of the hypertensive patients were treated with monotherapy, 36.3% with dual therapy, 4.3% with triple therapy and 0.3% with multiple combination therapy. The proportion of patients who had their blood pressure under control was 42.45%, with females slightly outnumbering males (26.66% versus 15.79%). However, there was no statistically significant difference in blood pressure control between females and males and also between patients who received monotherapy or combination therapy.
Conclusion: The study found the prescription of a wide range of drugs, both alone and in combination, to treat hypertension. The proportion of patients with controlled blood pressure was 42.45%
An unusual case of cholecysto-enteric fistula with gall stone ileus
Get PDFA gall stone ileus is defined as mechanical intestinal obstruction due to impaction of one or more gall stones within the gastrointestinal tract. A cholecysto-enteric fistula develops due to anomalous communicating tract between gall bladder and any segment of gastrointestinal tract. We report a case of 68 year old male referred from a peripheral hospital for subacute intestinal obstruction. Evaluation in our hospital revealed the presence of a cholecysto-enteric fistula with gall stone ileus. Emergency exploratory laparotomy was done and gall stones were retrieved
Health in all policies for happiness, wellbeing and health: a narrative review
Get PDFThe pursuit of good health is fundamental to both personal well-being and social progress. The perception of health has advanced to include not only physical well-being but also mental and social dimensions, aligning with the WHO’s definition of health. Similarly, the importance of population health in fostering national development cannot be overstated.
The Health in All Polices (HiAP) framework, endorsed by the WHO, emphasizes the interconnectedness of health with various policy domains. This approach advocates for integrating health considerations into all sectors of governance, including transportation, education and economic planning. By encouraging dialogue and collaboration among diverse sectors, HiAP aims to create healthier environments and generate co-benefits that enhances overall societal well-being.
In the Bhutanese context where the national health policy emphasizes on holistic well-being, implementing HiAP represents a significant positive development. By prioritizing health across various policy domains, Bhutan can further enhance its national philosophy of gross national happiness and well-being.
This review aims to explain the critical apparatuses for successful implementation of HiAP in Bhutan, highlighting the pivotal roles of effective leadership, intersectoral collaboration and policy coherence in promoting happiness, health equity and fostering a healthy society
The last COVID-19 lockdown in Bhutan: a referral hospital’s response to a community outbreak of the Omicron variant
Get PDFThis viewpoint outlines the COVID-19 management strategies Central Regional Referral Hospital (CRRH) adopted in Bhutan during the Omicron variant outbreak. The hospital in the high-risk region provided healthcare and public health services to its catchment area during the lockdowns imposed in Bhutan. Specifically, we discuss the hospital’s role in outbreak management, surveillance, isolation, patient care, and non-clinical services. Key strategies including community-based surveillance, isolation in hotel facilities, telemedicine and community engagement are highlighted. We briefly outlined lessons learned from the experience, such as the importance of community involvement and innovative approaches to healthcare delivery during pandemics
Factors affecting the level of medication adherence to anti-diabetic treatment: A multi- center cross-sectional study in Eastern Bhutan
Get PDFBackground: Worldwide, Diabetes Mellitus affects millions of people. It is a chronic and progressive disease requiring a long-term treatment plan, adherence to which becomes extremely challenging. Globally, there is a poor level of medication adherence to anti-diabetic treatment and several studies have explored the factors affecting medication adherence. However, in Bhutan, there is limited data on the rate of medication adherence and factors affecting it. . Therefore, the study aimed to find the level of anti- diabetic medication adherence and factors affecting it.
Methods: A multicenter cross-sectional observational study was conducted involving six eastern district hospitals from June 2019 to February 2020. Research participants were randomly selected from the daily cohort of patients visiting diabetic clinics.
Results: Amongst the 390 participants, the overall level of adherence reported in this study was intermediate with a mean Morisky Medication Adherence Scale 8 Items (MMAS-8) score of 6.06 (95% CI 5.91-6.22). Nearly 40% demonstrated a low level of adherence (MMAS-8 score <6). There was a statistically significant (p<0.05) association between mean MMAS-8 scores and adverse drug reactions, the drug regimen (polypharmacy or monotherapy) and the type of diabetes mellitus.
Conclusion: This study revealed an intermediate level of medication adherence to anti-diabetic treatment in the eastern region of Bhutan. Adverse drug reactions and polypharmacy resulted in a lower level of adherence. However, further studies are needed to draw a definitive conclusion
Immigration medical examination at the Regional Referral Hospitals: strengthening health system capabilities
Get PDFBhutan has a three-tiered healthcare system with the majority of services remaining Thimphu-centric. At the height of public demand for Immigration Medical Examination services, the two regional referral hospitals put in their efforts to establish the services in Gelephu and Mongar. The Regional Referral Hospitals enabled accessibility to IME services and improved efficiency at the National Referral Hospital by decongesting the number of clients. In this article, we describe how the regional referral hospitals established IME services that meet the standards of the destination country