Population-level cancer screening and cancer care in Bhutan, 2020-2023: a review

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.

Challenges in epilepsy diagnosis and management in a low-resource setting: An experience from Bhutan

Epilepsy is an important cause of morbidity and mortality especially in low- and middle-income countries. People with epilepsy (PWE) face difficulties in access to healthcare, appropriate diagnostic tests and anti-seizure medications (ASM). Bhutan is one such country in the Himalayas that has reported doubling of the prevalence of epilepsy from 155.7 per 100,000 population in 2017 to 312.4 in 2021. The country has one centre for electroencephalography and magnetic resonance imaging for a population of 0.7 million and does not have any neurologists as of 2023. There are 16 ASMs registered in the country but only selected medications are available at the primary level hospitals (phenobarbital, phenytoin and diazepam). There are challenges in the availability of these medicines all time round the year in all levels of hospitals. Neurosurgical treatment options are limited by the lack of adequate pre-surgical evaluation facilities and lack of trained human resources. The majority of PWE have reported facing societal stigma with significant impact on the overall quality of life. It is important to screen for psychiatric comorbidities and provide psychological support wherever possible. There is a need for a comprehensive national guideline that will cater to the needs of PWE and their caregivers within the resources available in the country. A special focus on the institutional and human resource capacity development for the study and care of epilepsy is recommended.

Eclampsia and postpartum onset of subarachnoid hemorrhage in dual setting of cerebral venous thrombosis and posterior reversible encephalopathy syndrome: A case report

Subarachnoid hemorrhage (SAH) can be an initial presentation of cerebral venous thrombosis. Eclampsia and postpartum onset of SAH should prompt physicians to identify possible causes and institute prompt management to avert irreversible cerebrovascular sequelae.

Radiation Dose from Computed Tomography Scanning in Patients at Songklanagarind Hospital: Diagnostic Reference Levels

Objective: To determine diagnostic reference levels (DRLs) of computed tomography (CT) radiation doses in terms of CT dose index volume (CTDIvol) and dose length product (DLP) of CT scans of the head, chest and abdomen for patients at Songklanagarind Hospital, Thailand. Material and Methods: This was a retrospective analysis of 463 randomly selected head, chest and abdominal CT stuides from 416 patients enrolled from July 1st to 31st 2017. The CTDIvol, DLP and clinical indication for each CT study were conducted. The median and third quartile values were analysed and compared to the standard international DRLs. The DRL was defined as the third quartile value. Results: The DRLs for CTDIvol, and DLP of head, chest and whole abdominal CT were 57.5, 11.6 and 13.1 milliGray (mGy), and 1,102.6, 474.7 and 624.4 milliGray x centimetre (mGy.cm), respectively. The most common clinical indications were stroke (29.1%) for head CT and malignancy for both chest (73.6%) and abdominal CTs (49.6%). Conclusion: The DRLs of each CT region were mostly below standard international DRLs of Australia, Europe, Japan, the United Kingdom and the United States. The clinical indication for malignancy had significant difference in the DLP values than other clinical indications in head and chest CT.