Bhutan Health Journal
Not a member yet
193 research outputs found
Sort by
The histopathological characteristics of gastric carcinoma in Bhutanese population: a Retrospective study
Get PDFIntroduction: Gastric cancer is not only the most common cancer, but also the cancer with the highest mortality in Bhutan. The baseline data on the histological phenotype of gastric cancer in Bhutan is not established. Different histological phenotypes have distinct etiology, clinical features, and prognosis. We aimed to assess the histological phenotypes of gastric carcinoma, evaluate the grading, staging, and the association of depth of invasion with the clinicopathological findings.
Methods: We conducted a retrospective study, involving 494 cases diagnosed with gastric carcinoma from January 2018 to June 2021. The histopathological characteristics of the patients were presented in frequency, percentage, and mean ± standard deviation.
Results: Gastric carcinoma was most prevalent in males (60.7%) and predominantly diagnosed in patients more than 60 years of age (67.6%). Antrum (76.5%) was the most common location for gastric carcinoma, and tubular adenocarcinoma (81.6%) was the most common histological phenotype in this study followed by poorly cohesive carcinoma, signet-ring-cell type (12.8%). Most of the patients were at an advanced stage (pT4) at the time of diagnosis (32.7%).
Conclusions: The histopathological characteristics of gastric carcinoma in the Bhutanese population were similar to regions with high gastric cancer incidence with the preponderance of distal location of the tumor and tubular adenocarcinoma being the most common subtype. As established in other regions, gastric carcinomas were more prevalent among males and patients over 60 years in Bhutan
Ruptured primary abdominal ectopic pregnancy- management in a resource-low setting
Get PDFAbdominal ectopic pregnancy is a rare form of ectopic pregnancy, which has a high mortality. Herein, we present a case of ruptured primary abdominal ectopic pregnancy implanted on sigmoid mesocolon in a 36-year-old woman. This case report highlights the challenges faced by obstetrician-gynecologist in the diagnosis and management of abdominal ectopic pregnancy in a resource-low setting
Maternal and fetal outcome of term pre labour rupture of membrane in a regional referral hospital in Bhutan from 2018-2020: a retrospective cross sectional study
Get PDFIntroduction: Term premature or prelabour rupture of membrane (PROM) refers to the disruption in fetal membranes before the onset of labor, after 37 weeks of gestation. PROM is commonly encountered in our practice but there is no published study on PROM in our country. This study was conducted to determine the incidence, clinical profile and it’s association with maternal and fetal outcome in term PROM in our hospital.
Methods: A retrospective cross sectional study, carried out at a regional referral hospital in Bhutan. Medical records-based data was collected from clinically diagnosed cases of term PROM, from 1st January 2018 to 31st December 2020.
Results: The incidence of term PROM among deliveries was 5.5 %. Unfavourable maternal outcome was seen in Primigravida (p-value=0.05), PROM duration greater than or equal to 24 hours (p-value= 0.007), Prolonged latency period of 24 hours or more (p-value=0.03), prophylactic antibiotics after 18 hours (p-value=0.05) and vaginal delivery (p-value=0.0001). Unfavourable fetal outcome was observed in cases referred in from regional health centres (p-value=0.01). Conclusions: Early initiation of appropriate prophylactic antibiotics, Early induction of labour as opposed to expectant management, Prompt referral of all PROM cases from primary health centres and district hospitals and availability of appropriate prophylactic antibiotics at all health centres may improve maternal and fetal outcome in term PROM
Evaluation of antimicrobial efficacy of different hand sanitizers available in Thimphu, Bhutan
Get PDFIntroduction: Hand washing and the use of alcohol based hand-rub are two effective hand-hygiene procedures. Though the compliance to hand washing was relatively low, the COVID-19 pandemic situation has drastically increased the use of hand sanitizers. Thus, many hand sanitizer brands have entered the market and this study was taken up to assess the microbial efficacy of different types of hand sanitizers available in Thimphu.
Methods: Ten gel based and ten liquid hand sanitizers were collected from various retail pharmacy shops in Thimphu during first quarter of 2020. Laboratory based experiment was performed using standard organism; Gram Negative Bacteria (GNB) Escherichia coli (American Type Culture Collection 25922) and Pseudomonas aurigenosa (American Type Culture Collection 27853), Gram Positive Bacteria (GPB) Staphylococcus aureus (American Type Culture Collection 25923) and a cocktail of GNB and GPC. The efficacy of hand sanitizer was assessed with the size of the Zone of Inhibition (ZoI).
Results: The hand sanitizers were found to be effective against all strains of micro organism but with differentsize of ZoI. The maximum size of Zone of Inhibition was observed by sample N and Q (ZoI diameter 33.0±0.14mm) for American Type Culture Collection 25923. The Zone of Inhibition of liquid base hand sanitizers was significantly higher than that of gel base (p<0.05).
Conclusions: The study presents that liquid base alcohol based hand sanitizer is more efficient than the gel form
Potential sources of lead in children’s environments, Thimphu, Bhutan
Get PDFIntroduction: There is no level of lead in one’s blood that is known to be safe. Infants and children are exposed to lead through various sources in the environment. Lead-based paint, toys, play equipment, dust, and soil may all be potential sources of lead. Preventing lead exposure is essential to eliminate the permanent and life-long disability caused from lead poisoning. Previous work showed that 44% of children aged 2 - 60 months in a Bhutanese population have dangerously high (greater or equal to 5mg/dL) levels of lead. The sources of this lead toxicity, however, are unknown. This study was carried out to identify potential sources of lead in infants’ and children’s environments at health facilities, early childhood care and development and creche centers, public playgrounds, and schools in Thimphu Dzongkhag.
Methods: An environmental survey using a portable X-ray Fluorescence (pXRF) was conducted from May 2021 to April 2022 to identify potential sources of lead in the environment in and around Thimphu, Bhutan.
Results: A total of 777 tests were done to identify excessive amounts of lead from various items, including: toys, playground equipment, furniture, paints, and soil. A total of 16 tests had excessive amounts of lead, of which 15 were detected from playground equipment at public playgrounds. The most common color with excessive lead was yellow.
Conclusions: Excessive amounts of lead were found in playground equipment as a possible source of lead exposure in children
Poor Lung Function of Industrial Workers of Bhutan: a retrospective study
Get PDFIntroduction: Occupational lung diseases are some of the common causes of lung function impairment. Spirometry is a gold standard to determine lung function and, to diagnose obstructive and restrictive lung diseases. Therefore, this study aimed to determine the prevalence of abnormal lung function among employees of different industries of Bhutan.
Methods: This retrospective study was carried out by retrieving all the spirometry findings and demographic variables of employees of different industries of Bhutan from the Spirometry Software of Respiratory Laboratory at the Center for Research in Respiratory and Neuroscience (CRRN), Khesar Gyalpo University of Medical Sciences of Bhutan (KGUSMB) . All these retrieved data were saved in Microsoft Excel and simple descriptive statistics were used to analyze the data and were expressed in numbers, percentages, mean and standard deviation.
Results: Spirometry and demographic results of 3508 industrial employees were obtained. The mean age was 33.8years and mean BMI was 24.95 Kg/m2. Non-smokers comprised 79.9% (2804) of the total industrial employees. Abnormal forced expiratory volume between 25% and 75% of vital capacity (FEF25%-75%), a marker of small airway disease, constituted 24.1% (846) of the total industrial employees. Furthermore, 1.1% (39) had abnormal forced vital capacity (FVC), 1.3% (46) presented abnormal forced expiratory volume in 1 second (FEV1 ) and 1.5% (53) showed reduced FEV1 /FVC.
Conclusions: Small airway impairment is common among industrial workers of Bhutan indicating presence of high prevalence of occupational lung diseases in its early stage which may potentially become clinically apparent after long latency
Assessment of knowledge, attitude, and practice on preconception care among pregnant women at National Hospital, Thimphu, Bhutan
Get PDFIntroduction: Preconception care provided before conception or between subsequent pregnancies aims to identify and modify risks to women`s health or pregnancy through prevention and management. For successful implementation and uptake of preconception care services, adequate level of knowledge and positive attitude of women is important. Therefore this study was undertaken to assess the knowledge, attitude and level of practice of preconception care by our women.
Methods: This was a hospital based cross sectional study done from July 2021 to December 2021. All pregnant women visiting the Mother and Child Hospital for booking visit were considered for the study. Stringent inclusion and exclusion criteria were utilized during recruitment. Data was collected using an interviewer administered questionnaire.
Results: A total of 340 pregnant women consented for the study. The mean age of the participants was 28.3 (SD±4.5) years, 57.6% of the pregnant women had higher education and 54.4% were employed. The overall mean knowledge score on assessment of preconception care was 6.96±2.4 and 217(63.8%) had good knowledge. Of the 340 women, 98.2% had positive attitude towards the preconception care with a median score of 27 (Min-Max: 10-30) but 78.2% had poor practice. A significant association was found between good practice of preconception care with their knowledge level (p=0.012) but not with positive attitude (p=0.346).
Conclusions: The study found that despite having good knowledge with positive attitude, the practice of preconception care among the study participants was poor. Therefore, we recommend further detailed study on factors associated with poor practice of preconception care among pregnant women
Medication errors and associated factors as perceived by nurses working at the national referral hospital in Bhutan
Get PDFIntroduction: A common patient safety issue is medication error and this has remained a serious problem in hospital settings. Medication error occurs at any point of medication process: prescription, transcription, dispensing, and administration. Administration error is the most common type of error occurring among nurses; although nurses play a vital role in preventing harms of prescription and dispensing errors from reaching the patient. Therefore, this study was aimed at assessing medication errors and associated factors as perceived by nurses.
Methods: The study was conducted at a tertiary hospital in Bhutan and 225 nurses participated through self-reported questionnaire. Data were double entered and validated in Epidata and analyzed using descriptive commands of statistical software STATA.
Results: Among total participants of N = 225, 62.7% reported to have experienced medication error in past six months. Common type of error experienced were omission of dose; wrong time; wrong dose, and administering drugs without physician’s order. Nurses in intensive care units and those caring for pediatric patients reported experiencing more errors. The perceived factors were look-alike drugs, many patients with similar medicines, more medicines to single patient, and oral instructions and acronyms in prescription.
Conclusions: The nurses reported to have experienced quite a high rate of medication error. The results may be used by relevant stakeholders in preventing and reducing medication errors, the biggest challenge of patient safety in hospital settings.
Antecedents of Maternal Mortality in Well- and Under-Resourced Countries: a case of United Kingdom and Bhutan
Get PDFDespite 88.4% reduction in maternal mortality between 1984 and 2017, Bhutan remains 70 years behind the United Kingdom. Due to difference in resource availability, disparity in access to specialized care and high-end investigations are expected. Fortunately, the variations in Routine Perinatal Care (RPC) are adjustable. Therefore, instead of complete reliance on existing long-term policy-level strategies, initiating a robust maternal mortality reviews and report dissemination; tied with a well-formulated quality metrics for RPC may contribute significantly towards achievement of SDG target 3.1: to reduce global Maternal Mortality Ratio to less than 70 per 100000 live births by 2030