Bhutan Health Journal
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Navigating a Rare Type IV Capitellar fracture: A Case Report and Comprehensive Literature Review.
Get PDFABSTRACT
Capitellar fractures are rare, it accounts 1% of elbow fractures, and can be challenging to diagnose initially. Distinctive "double arc sign" on lateral elbow radiograph is pathogonomic. 3D CT scans is . ORIF is the preferred treatment, but the choice of fixation methods lacks consensus, although headless compression screws are commonly used.
This case report presents a Type IV capitellar fracture in a 14-year-old boy resulting from a fall. The patient underwent successful ORIF using 4.0mm cannulated screws inserted posterior to anterior without penetrating joint surface, leading to complete functional recovery. At the 6-month follow-up, the patient exhibited robust healing without signs of capitellar avascular necrosis (AVN).The case underscores the significance of clinical suspicion and meticulous radiographic evaluation to avoid overlooking capitellar fractures. Moreover, it showcases the effectiveness of cannulated screws as a viable alternative in the absence of headless compression screws, offering comparable stability and excellent functional outcomes
Distribution and preferences of conventional fixed dental prostheses among patients at the National Referral Hospital, Bhutan
Get PDFABSTRACTIntroduction: Structural defects in teeth significantly impact oral health, leading to broader implications for an individual’s overall well-being. Porcelain-fused-to-metal (PFM) crowns and bridges are the preferred forms of fixed dental prostheses (FDP) for restoring lost form, function, and aesthetics of the missing or damaged tooth/teeth. This study aimed to investigate the distribution pattern and proportions of FDP across genders, age groups, types of teeth, and jaw locations.
Methods: This was a retrospective analysis of records of dental prostheses availed at the National Referral Hospital from July 2016 to June 2021. Specific data on FDP were extracted and utilized for the analysis.
Results: The median age of patients was 33 (23 - 41) years for females and 37 (26 - 50) years for males. Female patients accounted for the majority of FDP recipients, consisting of 56.7% of the total cases. Posterior crowns (80.7%) and, anterior bridges (48.7%) are the most prevalent FDP types. In the upper jaw, a significant proportion of FDP consisted of posterior crowns (70.5%) and, anterior bridges (55.9%). In contrast, the lower jaw predominantly received more crowns (96.0%) and bridges (49.3%) in the posterior region.
Conclusions: FDP are prevalent among female patients with a lower median age. Anterior bridges restoring aesthetics are more prevalent in the upper jaw, whereas the bridges and crowns for posterior teeth are more in the lower jaw. Dental practitioners can tailor treatment approaches to meet patient expectations, whether to focus on aesthetics or functionality
An exploration into perceived stigma, discrimination, and psychological wellbeing among people living with HIV in Bhutan
Get PDFIntroduction: HIV-related stigma and discrimination affect health and wellbeing and pose greater challenges to PLHIV. Stigma and discrimination remain as a major obstacle in curbing HIV epidemic, undermining HIV prevention efforts including uptake of voluntary testing, counseling, access to HIV treatment services and care. This study explored the experience of stigma and discrimination and its perceived influence on the psychological well-being of PLHIV in Bhutan.
Methods: Explorative qualitative in-depth interviews were completed with 28 PLHIV in four geographical locations Thimphu, Phuntsholing, Gelephu, and Samdrupjongkhar, Bhutan. Participants were interviewed on the experience of stigma and discrimination and the perceived influence on their psychological wellbeing.
Results: About 43% participants, slightly more among females, mentioned having experienced stigma and faced discrimination. Content analysis revealed individuals in the community, family members and relatives, workstations and healthcare providers as the potential sources of stigma and discrimination. Two-third of the participants appeared to have better psychological wellbeing. Nevertheless, about 36% admitted either feeling sad, worried, or lonely due to their HIV status. Introspection, support from family, relatives and friends, and meditation were perceived to help alleviate negative thoughts about HIV status and its influence.
Conclusions: Despite vigorous advocacy and awareness campaign, HIV related stigma and discrimination is still prevalent in the Bhutanese society influencing psychological wellbeing among PLHIV. Findings provided important insights meriting the designing of effective interventions including the involvement of certified counselors to counter stigma and discrimination, promote wellbeing and positive living among PLHIV in Bhuta
One year audit at Palliative care unit Jigme Dorji Wangchuck National Referral Hospital from 1st August 2022 to 1st August 2023
No full textDetermination of Water Quality Indices and Assessment of Heavy Metal Pollution of Drinking Water Sources in Thimphu
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Introduction: The well-being of public health is associated with the availability of safe and clean drinking water. Heavy metals, known for their toxicity and potential health risks, are a particular focus of water quality assessments. This study investigates the heavy metal concentrations in five primary drinking water sources of Thimphu city: Motithang, Jungshina, Taba, Dechencholing and Chamgang.
Methods: The ten heavy metals, known for their toxicity (Aluminum (Al), Boron (B), Barium (Ba), Cadmium (Cd), Chromium (Cr), Copper (Cu), Manganese (Mn), Nickel (Ni), Lead (Pb), and Zinc (Zn)), were assessed using inductively coupled plasma optical emission spectroscopy (ICP-OES) for precise analysis. The study employed the Heavy Metal Pollution Index (HPI) and the Heavy Metal Evaluation Index (HEI) to evaluate water quality.
Results: The test results revealed low heavy metals concentration in the water sources. The HPI and HEI values were also calculated to be low (<15 and <1.24 respectively).
Conclusions: The study provides valuable insights into Thimphu’s drinking water quality, indicating a positive status with low heavy metal concentration
Open Achilles tendon laceration in Bhutanese population- Retrospective study at tertiary health care center of Bhutan
Get PDFIntroduction: There is a wealth of literature on closed Achilles tendon injuries but open-lacerations are rarely reported. We aimed to assess the frequency of open Achilles tendon laceration in Bhutanese patients with a particular emphasis on age and sex distribution, mechanism of injury, and management provided to these patients.
Methods: Retrospective study was conducted at department of orthopedic surgery, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Thimphu. All patients treated at JDWNRH for open-laceration of Achilles tendon between January 2018 to December 2020 were included. Data were analyzed for means and frequencies using SPSS software.
Results: Of the 48 cases involved, 36 (75%) cases were male and 12 (25%) cases were female. The most affected age groups were between 21-60 years (70.8%). Majority of the cases inflicted injury following slip in squat-toilet (85.4%).Thirty-eight (79.2%) cases had a complete-laceration of the tendon and the remaining cases (20.8 %) had a partial-laceration. All patients underwent operative-irrigation, debridement and primary-repair. Complications occurred in 9 patients (18.8%), including seven early wound infection and two late infections.
Conclusions: Open Achilles tendon laceration is not an uncommon entity in developing country like Bhutan where the squat toilet is still being used regularly. Changing the toilet designs to commode-type and installing proper lighting in toilet would significantly reduce the incidence of open injury. Although management can be challenging due to irregular nature of the wound and inherent contamination present, a good outcome can be achieved with early-irrigation, debridement, surgical repair and the administration of intravenous antibiotics
Intracerebral hemorrhage (ICH)-a rare complication of Pre-eclampsia: a case report
Get PDFIntroduction: Intracerebral hemorrhage (ICH) is a rare complication in pre-eclampsia. It is potentially devastating event to occur in pregnancy and associated with significant maternal morbidity and mortality.
Case study: A 28-year-old primigravida with pre-eclampsia at 30 weeks 5 days period of gestation, presented with altered sensorium and emergency caesarean revealed massive concealed placental abruption with intrauterine fetal death. She later presented with left sided hemiparesis. Non-contrast computed tomography confirmed intracerebral frontal hemorrhage. Other radiodiagnosis tests done ruled out rupture arterial aneurysms, arteriovenous malformations and cerebral venous sinus thrombosis. She underwent decompressive craniectomy andvacuation of blood clot for intracerebral hemorrhage. Her Modified Rankin score was 2 at the time of her discharge. Conclusion: The complication of intracerebral hemorrhage with preeclampsia is rare. An early diagnosis, timely referral and interventions are associated with decreased maternal and perinatal morbidity and mortality
Incidence, risk factors and outcome of Postpartum Hemorrhage in a Jigme Dorji Wangchuck National Referral Hospital: a retrospective case-control study.
No full textIntroduction: Primary postpartum hemorrhage is one of the leading causes of maternal death in Bhutan but data on the incidence and risk factors for primary postpartum hemorrhage are scarce. The purpose of this research is to look into the incidence, its associated risk factors and maternal outcome of primary postpartum hemorrhage among women who gave birth at the national referral hospital.
Methods: The incidence of primary postpartum hemorrhage was estimated total number of primary postpartum hemorrhage cases of total deliveries during the study period. A case-control study was conducted to identify risk factors for primary postpartum hemorrhage. Cases of primary postpartum hemorrhage was defined by blood loss of greater or equal to 500ml in vaginal delivery or greater or equal to 1000ml for abdominal delivery within 24 hours of delivery. A multivariable logistic regression was used to identify associated risk factors of primary postpartum hemorrhage.
Results: Among 9,221 deliveries, primary postpartum hemorrhage occurred in 180 cases (1.95%; 95% CI=1.68%-2.26%) during two year period. The significant risk factors for primary postpartum hemorrhage were, labor induction (adjusted OR=2.27; 95% CI= 1.11-31.47, p=0.005), current pregnancy complications (aOR=2.50; 95% CI: 1.32-4.74, p=0.005), and gestational age at term delivery (aOR=6.49; 95% CI:1.12-37.48, p=0.037). The significant causes of primary postpartum hemorrhage were uterine atony (aOR=72.57; 95% CI:5.95-885.76, p=0.001), retained placenta (aOR=18.08; 95% CI:2.66-122.81, p=0.003) and perineal and cervical tear (aOR=27.80; 95% CI: 15.13-51.07, p less than 0.001).
Conclusions: The incidence of primary postpartum hemorrhage was 1.95% which is lower compared to other South East Asian countries. The causes and risk factors identified in this study may help predict primary postpartum hemorrhage and aid healthcare providers in better management of primary postpartum hemorrhage in all women giving birth