Bhutan Health Journal最新文献

{"title":"Open Achilles tendon laceration in Bhutanese population- Retrospective study at tertiary health care center of Bhutan","authors":"Kuenzang Wangdi, Sagar Rai, S. Dorji, Sonam Choden","doi":"10.47811/bhj.132","DOIUrl":"https://doi.org/10.47811/bhj.132","url":null,"abstract":"Introduction: 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.\u0000Methods: 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.\u0000Results: 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.\u0000Conclusions: 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.","PeriodicalId":410038,"journal":{"name":"Bhutan Health Journal","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115704534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A march towards evidence based medicine","authors":"Kinley Tshering","doi":"10.47811/bhj.129","DOIUrl":"https://doi.org/10.47811/bhj.129","url":null,"abstract":"","PeriodicalId":410038,"journal":{"name":"Bhutan Health Journal","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125323729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antecedents of Maternal Mortality in Well- and Under-Resourced Countries: a case of United Kingdom and Bhutan","authors":"C. Wangmo","doi":"10.47811/bhj.137","DOIUrl":"https://doi.org/10.47811/bhj.137","url":null,"abstract":"Despite 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.","PeriodicalId":410038,"journal":{"name":"Bhutan Health Journal","volume":"132 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127366005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The histopathological characteristics of gastric carcinoma in Bhutanese population: a Retrospective study","authors":"Sonam Choden, Chimi Wangmo","doi":"10.47811/bhj.134","DOIUrl":"https://doi.org/10.47811/bhj.134","url":null,"abstract":"Introduction: 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.\u0000Methods: 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.\u0000Results: 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%).\u0000Conclusions: 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.","PeriodicalId":410038,"journal":{"name":"Bhutan Health Journal","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123567146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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","authors":"Nidup Gyeltshen, Rojna Rai","doi":"10.47811/bhj.131","DOIUrl":"https://doi.org/10.47811/bhj.131","url":null,"abstract":"Introduction: 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.\u0000Methods: 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.\u0000Results: 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.","PeriodicalId":410038,"journal":{"name":"Bhutan Health Journal","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117283928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Financing","authors":"P. Tshering","doi":"10.47811/bhj.121","DOIUrl":"https://doi.org/10.47811/bhj.121","url":null,"abstract":"Health financing has become an important part of the health system strengthening in order to achieve Universal Health Coverage (UHC) and to provide equitable health services without financial burden to the users. The world health report 2010 defines the health financing for universal coverage as: “Financing systems need to be specifically designed to: provide all people with access to needed health services (including prevention, promotion, treatment and rehabilitation) of sufficient quality to be effective; [and to] ensure that the use of these services does not expose the user to financial hardship”1. Health financing is a core function of health systems that can enable progress towards the UHC by improving effective service coverage and financial protection.Today, millions of people do not have access to health services due to high cost. Many others receive poor quality of services even when they pay out-ofpocket. Carefully designed and implemented health financing policies can help to address these issues2. Every country works toward enhancing the equity in health services, service quality and financial protection for her populations. The pursuit of UHC is relevant to every country. Health financing policy is an integral part of efforts to maneuver towards UHC. Health system reforms need to be aimed explicitly at improving coverage linked to efficiency, equity in health resource distribution and transparency and accountability3. Health financing has evolved from personal payment to financing through health insurance schemes. In most of the developed countries health financing is provided by the government through social security or general taxation in addition to out-of-pocket expenditures. Insurance schemes and out of pocket payment are usually not available for the vulnerable population. Therefore, Governments are required to make funding to provide health services to those vulnerable population or for those services which are not covered by the insurance schemes. Health financing is not only about raising money for health care but also about allocation of these funds. Therefore, prioritizing the health care services and allocation of the fund is very important to achieve the desired outcome and goals. Allocation of resources requires a skillful planning process to balance spending on different subsectors of the system and to ensure equity between regions and various socioeconomic groups in society4. Question of sustainability in the policy makers arises while reviewing the health financing systems due to ageing populations, technological advances and economic recessions5. In the broadest terms, there are four major healthcare models: the Beveridge model, the Bismarck model, National Health Insurance, and the out-of-pocket model. While each model is distinct in itself, most countries do not adhere strictly to a single model; rather, most create their own hybrids that involve features of several. Each model has its own benefits and risks of ","PeriodicalId":410038,"journal":{"name":"Bhutan Health Journal","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116288624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden and outcome of community-acquired pneumonia in adult patients admitted to National Referral Hospital, Bhutan","authors":"Sonam Choki, C. L. Adhikari, Dhrupthob Sonam, Sonam Chhoden R","doi":"10.47811/bhj.122","DOIUrl":"https://doi.org/10.47811/bhj.122","url":null,"abstract":"ABSTRACT \u0000Introduction: Community acquired pneumonia is one of the leading causes of morbidity and mortality globally with the highest burden being reported from Asia. In Bhutan, community acquired pneumonia was reported to be one of the top five causes of mortality and one of the top ten causes of morbidity. \u0000Methods: This was an observational study done in a cohort of adult patients with community acquired pneumonia who were admitted to National Referral Hospital of Bhutan from February 2020 – February 2021 using purposive sampling. The Research Ethics Board of Health, Bhutan, gave ethical approval. We evaluated the burden and outcome of the community acquired pneumonia, and assessed the predictive capability of CURB-65 score to predict mortality as an outcome in these patients. \u0000Results: The inpatient burden of community acquired pneumonia was found to be 4.7% among patients admitted to medical wards. The mortality was 7.8%. 15.7 % of patients were managed in the intensive care unit out of which 5.9% patients needed mechanical ventilation. The mean hospital length of stay of these patients was 13 days. The sensitivity, specificity, PPV and NPV of CURB-65 score to predict death as an outcome in these patients were 87.5%, 43.6%, 11.7% and 97.6% respectively. \u0000Conclusion: The inpatient burden of Community Acquired Pneumonia in the National Referral Hospital is of concern. The CURB-65 score can be used a supplement to clinical judgement to assess the severity of the disease and make appropriate management decisions.","PeriodicalId":410038,"journal":{"name":"Bhutan Health Journal","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128535296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radio-pathological correlation of a retroperitoneal teratoma in a 2-year-old girl: a case report","authors":"Deki Choden, K. Dorji, Sonam Choden","doi":"10.47811/bhj.127","DOIUrl":"https://doi.org/10.47811/bhj.127","url":null,"abstract":"ABSTRACTRetroperitoneal teratoma is a extragonadal germ cell tumor comprising 5% of all teratomas in children, and the third most common retroperitoneal neoplasm in children. This is a case report of a 2 years old girl who presented with abdominal distension and palpable mass. The imaging findings of the mass was characteristic of retroperitoneal teratoma which was confirmed by histopathology report following complete excision. Retroperitoneal tumor is an uncommon tumor in children with characteristic imaging findings. Computed tomography is mainly used to evaluate the extent of the disease. Most of the retroperitoneal tumors are benign and curable with complete surgical excision.","PeriodicalId":410038,"journal":{"name":"Bhutan Health Journal","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128263380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indications and types of hysterectomy in the National Referral Hospital of Bhutan, 2020","authors":"N. Dorji, Kencho Zangmo, Sangay Tshering, R. Mongar, S. Sonam","doi":"10.47811/bhj.125","DOIUrl":"https://doi.org/10.47811/bhj.125","url":null,"abstract":"Introduction: Hysterectomy, the removal of uterus, is a major gynecological surgery performed in Bhutan. It is performed for both benign and malignant gynecological conditions. This study was conducted to assess the socio-demographic profiles, types of hysterectomies and their indications, and duration of surgery and duration of peri-operative hospital stay among women who had hysterectomy at the national referral hospital of Bhutan.  \u0000Method: This was a retrospective study conducted at the Jigme Dorji Wangchuck National Referral Hospital, Thimphu. Data of women, who had hysterectomy from 1st January to 31st December, 2020 was extracted into a structured questionnaire by investigators from the patients record maintained at the record section, JDWNRH. Ethical approval was sought from the Research Ethics Board of Health. Data were entered into EpiData 3.1 and was analyzed using descriptive commands of STATA 13.1 \u0000Result: Hysterectomy comprised of 9.8% of gynecological surgery in 2020. The commonest route of approach was total abdominal hysterectomy which comprised of 81.7% of hysterectomies. It was found out that 92.9% of hysterectomies were performed under general anesthesia and 97.4% of the surgeries were done as elective or planned cases. The mean (+SD) duration of surgery from skin incision to closure was shortest for vaginal hysterectomy (68.8 + 17.6 minutes) and longest for total laparoscopic hysterectomy (210 + 35.2 minutes). The duration of peri-operative hospital stay was shortest for vaginal hysterectomy. \u0000Conclusion: Total abdominal hysterectomy was the common approach despite vaginal hysterectomy being performed under regional anesthesia with shorter duration of surgery and shorter hospital stays.","PeriodicalId":410038,"journal":{"name":"Bhutan Health Journal","volume":"114 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124502048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidental diagnosis of Herlyn-Werner-Wunderlich Syndrome in a nulliparous woman: a case report in Bhutan","authors":"Dhrupthob Sonam, G. Pradhan, U. Tshomo","doi":"10.47811/bhj.126","DOIUrl":"https://doi.org/10.47811/bhj.126","url":null,"abstract":"Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare congenital syndrome with features of uterus didelphys, ipsilateral absent kidney and obstructed hemivagina. Ultrasound findings of absent kidney or abnormalities in the kidney should alert the clinicians about the syndrome. Complications like endometriosis, infertility and pelvic inflammation occurs with late diagnosis.A 42-yearold nulliparious married woman who presented with right sided abdominal pain to the National Referral Hospital was diagnosed to have HWWS. The diagnosis was supported by ultrasound, CT and MRI findings. Patient was treated for endometriosis and had symptomatic improvement. The diagnosis of the syndrome is challenging as it is rare but clinicians should suspect the syndrome in women who present with infertility. Ultrasound scan is the basic investigation to screen the syndrome which is available in most hospitals.","PeriodicalId":410038,"journal":{"name":"Bhutan Health Journal","volume":"303 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114025678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}