Screening of cancers is an important intervention in reducing the incidence and mortality related to cancers. Bhutan is one small country that is witnessing an increasing incidence and mortality related to cancers. The government implemented a time-bound population-level screening for gastric, cervical and breast cancers from 2020 to 2023 with an overall coverage of 91.2% of the eligible population. Among 370,225 individuals screened for H pylori, 32.4% tested positive; among 53,182 who underwent upper gastrointestinal endoscopy and biopsy, 255 (0.07%) had gastric cancer. Among 10,749 tested for HPV DNA, 9.3% were positive; among 9887 evaluated with colposcopy and biopsy, 154 (0.13%) had cervical cancer. For breast cancer screening, 72,283 underwent clinical breast examination, 845 mammography and cancer was detected in 73 (0.10%) individuals. In this article, we review how Bhutan implemented a population-level cancer screening programme with on boarding of multiple stakeholders and the participation of people across all districts.

Introduction: Postoperative nausea and vomiting (PONV) are common distressing symptoms experienced after laparoscopic cholecystectomy. We report the rate, and the factors associated with postoperative nausea and vomiting, the patterns of prophylactic antiemetic prescription, and the anesthetic techniques used among patients who underwent laparoscopic cholecystectomy at the Jigme Dorji Wangchuck (JDW) National Referral Hospital, Bhutan. Methods: A cross-sectional study was conducted at the JDW National Referral Hospital, from January to December 2018. All the patients who underwent laparoscopic cholecystectomy under general anesthesia were included in the study. The demographic variables, premedication, induction agents, muscle relaxants, inhalational agents for maintenance, opioid and adjuvant analgesics, the reversal agents used, and the occurrence of PONV within 24 h were recorded. Data were analyzed using SPSS (version 23). Continuous variables were compared using a t-test or Mann-Whitney test, categorical variables were tested using chi-square or Fisher’s exact tests. Binary logistic regression analysis was performed to determine the factors associated with postoperative nausea and vomiting. Results: 190 patients underwent laparoscopic cholecystectomy under general anesthesia. The rate of PONV after laparoscopic cholecystectomy was 31.1% (59/190). Over half (53.7%, 102/190) of the study population were within 21–40 years of age, over 80% (157/190) were female, and 2/3rd were overweight and obese. The most frequently used premedication was ranitidine (39%, 34/87) and metoclopramide (31%, 27/87). More than half (57.4%, 109/190) of the patients received morphine as an opioid analgesic before induction. Sodium thiopentone was a commonly used induction agent (65.8%, 125/190). Succinylcholine and atracurium were mostly preferred muscle relaxants. Isoflurane and air were the most used inhalational anesthetic agents for the maintenance of anesthesia. Ondansetron was the most preferred anti-emetics during the intraoperative period. Previous history of motion sickness (OR 5.8, 95%CI 2.9–11.2, p < 0.001), and use of sodium thiopental (OR 4.1, 95%CI 1.9–9.1, p < 0.001) were independent risk factors for PONV. The use of antiemetics (OR 0.1, 95%CI 0.0-0.4, p = 0.002), propofol (OR 0.2, 95%CI 0.1–0.5, p < 0.001), adjuvant analgesic paracetamol (OR 0.4, 95%CI 0.2–0.8, p = 0.026), and adequate hydration with IV fluids (OR 0.9, 95%CI 0.9-1.0, p = 0.042) were preventive factors for PONV. Conclusion: The rate of PONV after laparoscopic cholecystectomy was high. History of motion sickness and use of sodium thiopental for induction were independent risk factors of PONV. The use of multimodal prophylactic antiemetics was robust and superior to monotherapy in preventing PONV. This finding re-emphasizes the need for risk stratification and appropriate use of antiemetics and anesthetic agents to prevent PONV.

Background and Aims: When there is an immediate threat to maternal or fetal life, it is recommended to deliver within 30 min of the decision to have favorable perinatal outcomes. However, there is no data on the delivery intervals for Category‐I emergency cesarean section in Bhutan. The study evaluated the decision to delivery interval (DDI) and its effect on perinatal and maternal outcomes in Category‐I emergency cesarean section.Methods: A retrospective cross‐sectional study was conducted at the Phuentsholing General Hospital, Bhutan, from January 1, 2020 to December 31, 2020. Mothers who underwent Category‐I emergency cesarean section were included. The demographic variables, patient transfer time, anesthesia time, operation time, DDI, and maternal and perinatal outcomes were recorded in a standard proforma. The data were analyzed using SPSS version 23.Results: Of 78 Category‐I emergency cesarean sections, only 23 (29.5%) of the cases were able to perform within 30 min of the DDI. The median (interquartile range) DDI was 37 (30–44) min. More time was taken by anesthetists to administer anesthesia (20 [15–8] min). Fetal distress (40, 51.3%) was the commonest indication. The longest DDI was around 39 min for prolonged labor, and the shortest was 26 min for failed instrumental delivery. Over half of the newborns delivered more than 30 min of DDI had low APGAR scores (25, 32.1%) at 1 min and meconium was present (23, 29.5%). Intensive care was required in 11 (14.1%), of which there was 1 (1.3%) neonatal death.Conclusion: The Category‐I emergency cesarean sections performed within recommended DDI of 30 min were much less. The main delay was due to the longer time taken for the patient transfer and time taken by the anesthetists to administer anesthesia. Perinatal outcomes were favorable when the deliveries were conducted within 30 min of DDI.

Introduction: Excessive vaginal discharge is troublesome for females. The majority of the women seek gynecological consultation due to excessive vaginal discharge. The causes vary from physiological to pathological discharge. Unless the cause is identified and treated, women will remain in distress. The present study was thus carried out to determine the most common cause of the excessive vaginal discharge.Methods: A cross‐sectional study was conducted at the Phuentsholing General Hospital, Chukha, Bhutan, from May 1 to October 31, 2021. All females aged 18 years and older, irrespective of marital status, who presented with excessive vaginal discharge were recruited for the study. With due informed consent, a sterile speculum examination was performed and a high vaginal swab was collected and subjected to various tests. The data collected were analyzed using SPSS 23 software. Descriptive statistical tests were used for frequencies, percentages, mean, and standard deviations; the χ² test was used to determine associations, and a logistic regression test was performed to determine the effect of independent variables on dependent variables.Results: A total of 400 women were recruited for the study, of whom 362 (90.5%) women had infective causes for vaginal discharge. Trichomoniasis was the most common infection identified in 162 (40.5%) women, followed by bacterial vaginosis (91, 22.8%) and vulvovaginal candidiasis (52, 13.0%). In 38 (9.5%) women, infective cause was not found and categorized as physiological vaginal discharge. Malodorous, profuse discharge, vulval itching, dyspareunia, dysuria, and lower abdominal pain were significantly associated with infectious vaginal discharge.Conclusions: Excessive vaginal discharge was mainly caused by infections. The most commonly detected infection was trichomoniasis, followed by bacterial vaginosis and vulvovaginal candidiasis. Every female with vaginal discharge requires proper evaluations to identify the infection and treat it adequately.

Background: COVID‐19 pandemic has derailed health care services. The health resources and manpower were prioritized and diverted to curb the COVID‐19 infections at the cost of routine medical services to the people. The impact of the COVID‐19 pandemic on maternal and child health is unknown. This study aimed to assess the impact of the Covid‐19 pandemic on maternal and child health care services in Phuentsholing General Hospital.Methods: A descriptive retrospective study was conducted at Phuentsholing General Hospital from January 1 to June 30, 2022. The patient medical records were reviewed for the prepandemic years 2018, and 2019, and the pandemic years 2020, and 2021. The medical records of all the female patients and newborns who came to the Maternal and Child Health Unit (MCH), those who were admitted to the gynecology ward, and who underwent obstetrical and gynecological surgeries were reviewed. The data were analyzed using SPSS version 23. Descriptive statistics such as frequencies and percentages were used to describe the study variables. The line graph and bar graph were used to determine the trends and to compare the impact of COVID‐19 on MCH services between the pre‐pandemic and pandemic years.Results: During the COVID‐19 pandemic, the total admission dropped by 10% to 14.4%; the total deliveries dropped by 16.1%; Cesarean section rate dropped to 12.9%; and fewer gynecological surgeries were performed (13.9% from 20.6%). There was a significant drop in antenatal and postnatal follow‐up visits (31.5% and 24.51%) respectively; Pap smear dropped by 93% and colposcopy by 52%. The overall immunization coverage has dropped drastically during the pandemic period.Conclusion: The pregnant mothers and newborn babies missed antenatal and postnatal follow‐up visits, missed immunization, and women were not able to be screened for cervical cancers during the pandemic. These negative impacts of the COVID‐19 pandemic on maternal and child health care were profound.

Coronary artery disease is the most prevalent heart condition and a leading cause of mortality worldwide. Acute coronary syndrome (ACS) encompasses ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina (UA). ACS has become an increasingly concerning health issue in Bhutan. Currently, no baseline data exists on ACS in the country. This study aims to assess the burden of ACS by analyzing the clinical characteristics and outcomes of patients diagnosed with ACS who presented to the National Referral Hospital in Bhutan. A prospective cohort study was conducted at the Emergency Department of Jigme Dorji Wangchuk (JDW) National Referral Hospital from October 1, 2022, to September 30, 2023. All patients diagnosed with ACS who presented to the Emergency Department were included in the study. Demographic and clinical presentations were recorded. Electrocardiogram (ECG) recordings were performed for all patients with ACS and categorized into STEMI, NSTEMI, and UA. Appropriate treatments were initiated, and patients were closely monitored. Depending on the severity, patients were either admitted to the medical ward or intensive care unit, while some were discharged home. All data were recorded using a standard pro forma developed for the study. Data analysis was performed using SPSS version 23. During the study period, 67 patients were diagnosed with ACS. Of these, over 58% (39/67) had NSTEMI, while approximately 33% (22/67) had STEMI. The mean age ± SD of ACS patients was 63.5 ± 16.8 years, with the majority being male (67.2%, 45/67). More than half of the ACS patients presented to the hospital within 24 h of symptom onset, with chest pain (29.7%) and shortness of breath (26.4%) being the most common complaints. Among STEMI patients, over 60% exhibited ST elevation in the anterior and septal leads on ECG, and more than two-thirds required thrombolytic therapy (77.3%, 17/22). Among thrombolytic agents, alteplase was the most commonly used (70%), followed by streptokinase (17.6%). Of the 67 ACS patients, over 46% (31/67) developed complications, with more than one-fourth experiencing heart failure (26.9%). Complications were significantly more common in STEMI patients compared to those with NSTEMI (p < 0.001). The majority (61.2%, 41/67) were discharged home after improvement, while one-third required referral overseas for cardiac interventions. Older age (≥ 60 years) was independently associated with ACS (OR 9.5, 95% CI 1.1–86.9, p = 0.046). Other medical conditions, including hypertension, diabetes, dyslipidemia, and smoking, increased the likelihood of ACS; however, these associations were not statistically significant (p > 0.05). Among the cases of acute coronary syndrome, 58% were classified as NSTEMI and 33% as STEMI. A majority of patients presented to the hospital within 24 h, expressing complaints of chest pain and shortness of breath, and received essential thrombolytic therapy. Approximately 48% of these patients developed complications, and over one-third were referred overseas for additional treatment. This study indicates that acute coronary syndrome is an emerging public health concern in Bhutan, underscoring the urgent necessity for the establishment of percutaneous coronary intervention (PCI) within the country to mitigate the need for overseas referrals.