Radio-pathological correlation of a retroperitoneal teratoma in a 2-year-old girl: a case report

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.

Indications and types of hysterectomy in the National Referral Hospital of Bhutan, 2020

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. Method: 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 Result: 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. Conclusion: Total abdominal hysterectomy was the common approach despite vaginal hysterectomy being performed under regional anesthesia with shorter duration of surgery and shorter hospital stays.

Burden and outcome of community-acquired pneumonia in adult patients admitted to National Referral Hospital, Bhutan

ABSTRACT Introduction: 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. Methods: 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. Results: 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. Conclusion: 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.

Managing essential healthcare services during the first nationwide lockdown: experiences from a Regional Referral Hospital in Bhutan

The current COVID -19 pandemic has brought unprecedented burden on healthcare system throughout the world. While the pandemic has hijacked all attention and priorities, there is a significant concern that non-COVID essential healthcare services may be negleccted. Lockdowns have become an important public health measure to contain local outbreaks. We describe our experiences in ensuring the provision of essential healthcare services during the first nationwide lockdown. Adequate preparations with a well-thought of contingency plan , identification of roles, good communication system, 24 -hour hotline and a mobile clinic with the most essential services, form important components of essential healthcare services.

Incidental diagnosis of Herlyn-Werner-Wunderlich Syndrome in a nulliparous woman: a case report in Bhutan

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.

Clinical profile of pathological Jaundice among neonates admitted in the National Referral Hospital, Bhutan

Background: Neonatal jaundice is a common condition especially in the first week of life. There are various maternal and neonatal clinical characteristics that have been associated with pathological jaundice. Objectives: To describe clinical profile of pathological jaundice and to estimate its prevalence among newborns admitted at the National Referral Hospital. Methods: A cross-sectional descriptive study design was used to study pathological jaundice cases admitted at the Gyaltsuen Jetsun Pema Neonatal Intensive Care Unit (NICU) of Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) from 7th November 2018 till 6th November 2019. Data was collected using a predesigned case proforma, entered and analyzed in Epidata after obtaining ethical clearance from the Research Ethics Board of Health (REBH), Bhutan. Results: Facility based prevalence rate of pathological neonatal jaundice was found to be 63.66% in our setting. The median age on presentation was 4 days. Blood group ABO incompatibility and neonates less than one week of age were found to be most common neonatal profile in this study. Significant association was found between primiparous mothers and excessive weight loss. Conclusion: The prevalence of pathological jaundice was high in our setting. ABO incompatibility, neonates less than one week of age, primigravida mothers with feeding issues should be closely followed or screened for pathological jaundice especially during the first one week of life. Keywords: Pathological jaundice, Prevalence, ABO incompatibility, feeding issues, excessive weight loss

Characteristics of people who died by suicide: record review of two and half years from the National Referral Hospital, Bhutan

Introduction To address the suicide issue in the country, the Royal Government of Bhutan implemented a three year suicide prevention action plan from 1st July 2015 to 30th June 2018. As part of that action plan a national suicide registry was established under the Ministry of Health in January 2016 to collect comprehensive national data on suicide. The purpose of this study is to generate national information on suicide by analysing the suicide cases investigated and reported to suicide registry by the Forensic Department during the first two and half years. Methodology The study is a descriptive, retrospective and quantitative analysis of the suicide cases investigated by the Forensic Department from 1st January 2016 to 30th June 2018. The variables included the characteristics of the suicide victims. Result Majority of the victims were young adults with no or low education and were either unemployed or employed with less income. 56.7% of the victims were women. Majority of them did not have physical illness or disability. About 45% had some form of mental health issues. Majority of them experienced some form of acute stressful event prior to committing suicide. Conclusion Improved socioeconomic conditions through gainful employment, easily accessible mental health services and social support networks as well as population with good social and emotional skills will contribute to prevention of suicide in the country.

Effectiveness of different ways of presenting neuroanatomy illustration in powerpoint slides on nursing student’s short -term learning memory

Introduction: Neuroanatomy is considered as difficult subject as it consists mostly of complicated microscopic structures. However, understanding of the subject structure is very important for nursing students to know its functions and dysfunctions for enhancing nursing practices. To date, teaching neuroanatomy relies heavily on illustrations and the most common way is by using PowerPoint slides, but teachers are often faced with dilemma on how to use illustrations effectively. Therefore, this study was conducted to assess the effectiveness of different ways of presenting neuroanatomy illustrations in PowerPoint slides on nursing students’ short[1]term learning memory. Methods: The quasi-experimental study was conducted at Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan between June 2020 and November 2020 by comparing an Experimental (n= 70) and a Control group (n= 69) of first year nursing students for their ability to answer questions based on those seven-way slides. Independent sample t-test was used for statistical analysis. Results: Significant difference was found at 95% CI between the performance of the Experimental and Control groups regarding Way 1 (Sequencing of labels) and Way 6 (Magnifying from the original structure) of presentation (tWay 1(135.99) = 2.695, p= .008, d = .458, 95% CI = [0.059, .385]; tWay 6(135.61) = 2.351, p= .020, d = .399, 95% CI = .031, .355], respectively). Conclusions: The use of different ways like sequencing the labels and magnifying from the original structure of presenting illustration in PowerPoint slides are found to be helpful in increasing short[1]term memory in students.

Knowledge, Attitude and Practice of nurse-midwives on the use of partograph in health care centres of Bhutan

Introduction: World Health Organization recommends using partograph to reduce maternal and neonatal deaths due to obstetric complications. Proper utilization of partograph by health care providers was noted to be good when it is associated with better knowledge and a positive attitude towards partograph. There is a paucity of scientific study about knowledge, attitude and practice on the use of partograph among healthcare providers in Bhutan. Therefore, this study aimed to assess the knowledge, attitude and practice of nurse-midwives on the use and completeness of partograph in seven hospitals and one Basic Health Unit grade I. Methods: A descriptive study was carried out from September 2017 to February 2018. Non-probability sampling method was used to survey all nurse-midwives who attended deliveries in the selected health facilities using a standard semi-structured questionnaire. All partographs filled three months before the data collection was selected purposefully and reviewed using a checklist. Results: A total of 96 participants consisting of 66 (68.8%) females and 30(31.3%) males consented for the survey. Good knowledge of partograph was reported among 48(50%) of the participants with a mean score of 12.1 (SD: ± 1.52). Attitude on the usage of partograph was found to be favorable with a median of 42 (range 32-48). Partograph usage was reported by 86 (89.6%) while only 10.4% reported having received in-service training on partograph. Out of 426 partographs reviewed, only 68 (16.0%) were found to be complete. Conclusions: Despite the encouraging findings on the use of partograph, completeness of the partograph was very low. This study therefore, recommends the reinforcement of knowledge and practice through periodic continuous medical education and auditing of the partographs.