Bhutan Health Journal

One year audit at Palliative care unit Jigme Dorji Wangchuck National Referral Hospital from 1st August 2022 to 1st August 2023

Wed, 29 Nov 2023 00:00:00 +0000

Navigating a Rare Type IV Capitellar fracture: A Case Report and Comprehensive Literature Review.

Damcho Tshering — Wed, 29 Nov 2023 00:00:00 +0000

ABSTRACT

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.

Why Planetary Health Education matters now for Bhutan and the World!

Karma Tenzin, Abdulhakim Abamecha, Netra Binod Sharma, Matthias Siebeck — Wed, 29 Nov 2023 00:00:00 +0000

An exploration into perceived stigma, discrimination, and psychological wellbeing among people living with HIV in Bhutan

Nidup Dorji, Phuntsho Choden, Tshering Dukpa, Tshering Wangmo, Wangchuk Wangchuk — Wed, 29 Nov 2023 00:00:00 +0000

Introduction: 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 Bhutan

Clinico-Demographic profile of incomplete miscarriage at National Referral Hospital, Bhutan

karma lhaden, Sonam Gyamtsho — Wed, 29 Nov 2023 00:00:00 +0000

Abstract

Introduction: Miscarriage is a leading health concern that causes maternal morbidity and mortality. According to the World Health Organization (WHO), the incidence of miscarriage is 39 per 1000 women aged between 15-49 years. There is no reliable information regarding miscarriage in Bhutan. This investigation attempts to study the clinical and demographic profile of incomplete miscarriages and their outcome at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Bhutan.

Methods: An observational study was carried out from February 2020 to February 2021 including 132 women with incomplete miscarriage at JDWNRH. Purposive sampling was done and patient with incomplete miscarriage presenting to the JDWNRH was interviewed using structured questionnaire after diagnosis or before they were discharged from hospital.

Results: The study found that the proportion of incomplete miscarriage was 25.4 per 1000 pregnant women at JDWNRH. The common age group was 21-30 years with a mean age of 29.9 years. Of them, 65.91% were married, 55.3% had a stable job and 90% were gravida 2 and above. Nearly 80% reported that it was an unplanned pregnancy and 73.5% due to lack of awareness of contraceptive use. Nearly 92% required hospital admission and 88.64% received surgical management.

Conclusions: Women with incomplete miscarriages had mostly unintended pregnancies. The majority had surgical management with no mortality.

Determination of Water Quality Indices and Assessment of Heavy Metal Pollution of Drinking Water Sources in Thimphu

Chimmi Dorji, Pema Chophel — Wed, 29 Nov 2023 00:00:00 +0000

ABSTRACT

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 concentrations

Distribution and preferences of conventional fixed dental prostheses among patients at the National Referral Hospital, Bhutan

Kunga Penjor , Tshering Choeda , Tashi Norbu — Wed, 29 Nov 2023 00:00:00 +0000

ABSTRACT
Introduction: 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.

Outcome of Pterygium surgery with conjunctival autologous graft using suture and tissue glue at the tertiary eye center, Thimphu, Bhutan

Tashi Norbu, Zimba Letho, Dechen Wangmo, Deki Deki — Wed, 29 Nov 2023 00:00:00 +0000

ABSTRACT
Introduction: Pterygium is a degenerative condition of the conjunctiva characterized by fibro vascular growth of tissue onto the cornea, often necessitating surgical treatment. Currently the conjunctival autograft technique using either suture or fibrin glue is the preferred method of treatment. The aim of the study was to evaluate the outcome of Pterygium surgery using sutures and glue to fix the graft.

Methods: This observational study was carried out at the tertiary eye hospital, involving fifty-one patients (51 eyes) with primary Pterygium who underwent Pterygium surgery using either suture (19 eyes) or fibrin glue(32 eyes).
The outcome measures were operative time, post-operative symptoms (pain, photophobia, foreign body sensation), and graft complications (displaced, edema, hemorrhage). Patients were followed up on day1, day 7, and day 28 after the surgery as per the standard protocol.

Results: The study consisted of 17 males and 34 females, with mean ages of 51.95 (SD 9.82) in the suture
group and 51.75 (SD 5.77) in the fibrin glue group. In the suture group, mean operation time was 14.16 (SD 2.71) minutes, and in the fibrin glue group, it was 13.72 (SD 4.54) minutes. With regard to the post- operative symptoms, the intensity of foreign body sensation was found to be higher in the suture group on day 1 and day 7 (p<0.003 and p<0.001, respectively). However the foreign body sensation was not observed in both groups on day 28. There was no significant difference in symptoms like Pain and photophobia. Notably, no graft complications were observed in either group on day 28. All patients completed the required follow ups.

Conclusions: The use of fibrin glue in Pterygium surgery with conjunctival autografts relatively reduces surgery time and decreases early post-operative foreign body sensation thus improving early post-operative patient comfort compared to sutures.

Seminal parameters among patients visiting infertility clinic at the National Referral Hospital, Bhutan

Wed, 29 Nov 2023 00:00:00 +0000

ABSTRACT
Introduction: Seminal fluid analysis is the initial investigation for any couple presenting with either primary or secondary infertility. In this study, we aim to study the seminal fluid parameters among Bhutanese patients who presented at the infertility clinic for an initial seminal fluid examination.

Methods: This retrospective descriptive study was conducted at the Infertility Clinic of the National Referral Hospital, Bhutan from January to December 2022. Using the census sampling technique, data on seminal parameters of 304 patients was extracted from the clinic’s register. A descriptive analysis of frequencies and percentages on the above data was performed using IBM Corp’s SPSS version 26.0, Armonk, NY).

Results: The result showed that the majority 217(70.4%) of the patients who came for semen analysis were in the age range between 30 and 39 years. Among 304 patients examined, 72(23.7%) showed normal semen parameters while 232(76.3%) displayed abnormalities in their semen parameters. These abnormalities were further categorised as follows: Azoospermia 14(4.6%), Oligozoospermia 109(35.9%), Asthenozoospermia 23(7.6%) and 86(28.2%)
cases were Oligoasthenozoospermia.

Conclusions: This study provides a scientific data for the first time regarding seminal parameters of patients that visited infertility clinics. This data can serve as a reliable reference and valuable source of evidence for clinicians and future researchers. As the pioneering study of its kind in the country, this study generates fundamental evidence-based data for the global scientific community as well, promoting sustained research involvement in the field of reproductive medicine over the long run.

Containment of a local outbreak of COVID-19 through community isolation and quarantine in rural Bhutan: An experience

Purushotam Bhandari, Dinesh Pradhan, Tshokey Tshokey, Thinley Dorji — Wed, 29 Nov 2023 00:00:00 +0000

ABSTRACT
Introduction: Bhutan experienced the third and a larger outbreak of COVID-19 in the summer of 2021, with huge surge of cases from several districts on the southern border. A remote sub-district of Jomotshangkha in Samdrup Jongkhar district, was suddenly caught with a large number of cases in May 2021. All the COVID-19 cases during the outbreak were successfully managed at the community level or with home isolation without the need for sophisticated infrastructure and specialized manpower. In this article, we discuss the advantages of community-level management of COVID-19 in the context of Bhutan’s health system.