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Adhikari TR, Jamtsho S, Tenzin K, Wangchuk P, Tshering P, Jamtsho S, Mukhia S, Penjor D. Special Sensory Function Deficit among Patients with Post-COVID-19 Visiting a Tertiary Care Centre. JNMA J Nepal Med Assoc 2023; 61:874-877. [PMID: 38289741 PMCID: PMC10725220 DOI: 10.31729/jnma.8321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Several patients who recover from COVID-19 infection continue to have persistent symptoms even after recovery from the disease. The special sensory functions such as taste, smell and hearing are affected by COVID-19 infection even after recovery from the illness. The aim of the study was to find out the prevalence of special sensory deficits among patients with post-COVID-19 visiting a tertiary care centre. Methods A descriptive cross-sectional study was conducted among adult patients who recovered from COVID-19 visiting a tertiary care centre from 1 January 2022 to 31 December 2022. After obtaining ethical approval from the Research Ethics Board of Health, data on patients who were diagnosed with COVID-19 one year ago was obtained from the surveillance register from the Ministry of Health. They were contacted by phone call and invited to the centre to participate in the study. Appropriate clinical examination and tests were carried out to assess the special sensory deficits. A convenience sampling technique was used. The point estimate was calculated at a 95% Confidence Interval. Results Among 271 patients, the prevalence of sensory function deficit was 39 (14.39%) (10.21-18.57, 95% Confidence Interval). Conclusions The prevalence of special sensory deficits after recovery from COVID-19 infections was found to be similar to the findings of other studies. Keywords anosmia; COVID-19; hearing loss.
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Affiliation(s)
- Tika Ram Adhikari
- Department of Otorhinolaryngology, Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
| | - Sonam Jamtsho
- Department of Otorhinolaryngology, Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
| | - Karma Tenzin
- Audiology Unit, Department of Otorhinolaryngology, Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
| | - Pelden Wangchuk
- Audiology Unit, Department of Otorhinolaryngology, Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
| | - Phub Tshering
- Department of Otorhinolaryngology, Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
| | - Sonam Jamtsho
- Department of Otorhinolaryngology, Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
| | - Sontosh Mukhia
- Department of Otorhinolaryngology, Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
| | - Dorji Penjor
- Department of Otorhinolaryngology, Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
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Adhikari TR, Jamtsho S. A rare case of abnormal epithelial migration in the external auditory canal secondary to cotton bud abuse. SAGE Open Med Case Rep 2023; 11:2050313X231183584. [PMID: 37389406 PMCID: PMC10302614 DOI: 10.1177/2050313x231183584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 06/05/2023] [Indexed: 07/01/2023] Open
Abstract
The outer third of external auditory canal is cartilaginous and contains pilosebaceous glands and hair follicles. The medial two third is bony, and the skin is devoid of these skin appendages and its secretions. It also has outward migratory property which makes the ear self-cleansing. Here we present an exceeding rare case of hair in the tympanic membrane causing distressing symptom of scratchy sensation, tinnitus, and otalgia. We hypothesize, it is the distortion of migratory pattern medially due to repeated otitis externa caused by abuse of cotton bud that led to presence of hair in the tympanic membrane.
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Affiliation(s)
| | - Sonam Jamtsho
- Sonam Jamtsho, Department of ENT, Jigme Dorji Wangchuk National Referral Hospital, P.O. Box 128, Menkhang lam, Thimphu, Bhutan.
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Monger A, Mahat K, Om N, Mongar P, Dorji T, Jamtsho S, Wangdi K, Wangdi C, Jamtsho T, Chettri V. Assessment of exposure to pesticides and the knowledge, attitude and practice among farmers of western Bhutan. PLoS One 2023; 18:e0286348. [PMID: 37252928 DOI: 10.1371/journal.pone.0286348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 05/13/2023] [Indexed: 06/01/2023] Open
Abstract
An estimated 69% of the population of Bhutan is engaged in agriculture. Farmers are exposed to a wide variety of pesticides during the preparation, transport, storage, mixing and application of pesticides posing a significant health risk. A controlled cross-sectional study of farmers in selected sites of Bhutan was conducted to characterize the level of exposure to pesticides and assess their knowledge attitude and practice on the safe handling of pesticides. A total of 399 participants were enrolled in the study comprising of 295 exposed farmers and 104 healthy and unexposed controls. A structured investigator administered questionaries was used to assess their Knowledge, Attitude and practice, and their blood samples were taken for measuring Acetyl Cholinesterase enzyme activity level. There was a significant difference between the Acetyl Cholinesterase enzyme inhibition of exposed and non-exposed control groups observed in the study (P < 0.001). Of the total of 295 farmers, 62 (21.01%) had severe enzyme inhibition of >30% as compared to the unexposed group. Safety practices of handling pesticides were low. The most common symptoms self-reported were headache (OR 1.08, 0.60-1.93) and neurological problems like forgetfulness, lack of concentration (OR 1.12, 0.50-2.48) and increased tiredness (OR 1.075, 0.52-2.19) that were significantly associated with the enzyme inhibition. In addition, we record a very low level of knowledge (17.0%), a fair attitude (63.0%) and poor practice (35.0%) on the safe handling and management of pesticides. This pilot study provides indication of exposure to pesticides in the selected sites of the country. Furthermore, it provides evidence for public health interventions by identifying the exposure patterns and pathways of individuals most at risk in the farming communities of the country. Surveillance and bio-monitoring programs are deemed necessary.
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Affiliation(s)
- Adeep Monger
- Royal Centre for Disease Control, Thimphu, Bhutan
| | - Kiran Mahat
- National Plant Protection Centre, Ministry of Agriculture and Forest, Thimphu, Bhutan
| | - Namgay Om
- National Plant Protection Centre, Ministry of Agriculture and Forest, Thimphu, Bhutan
| | - Pooja Mongar
- Royal Centre for Disease Control, Thimphu, Bhutan
| | | | | | - Karma Wangdi
- Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - Chador Wangdi
- Department of Public Health, Ministry of Health, Thimphu, Bhutan
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Dorji T, Yangchen, Wangmo S, Tenzin K, Jamtsho S, Pema D, Chhetri B, Nirola DK, Dhakal GP. Challenges in epilepsy diagnosis and management in a low-resource setting: An experience from Bhutan. Epilepsy Res 2023; 192:107126. [PMID: 36965308 DOI: 10.1016/j.eplepsyres.2023.107126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/09/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
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.
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Affiliation(s)
- Thinley Dorji
- Department of Internal Medicine, Central Regional Referral Hospital, Gelegphu, Bhutan.
| | - Yangchen
- Department of Internal Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | | | - Karma Tenzin
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Sonam Jamtsho
- Department of Surgery, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Dechen Pema
- Department of Radiodiagnosis and Imaging, Central Regional Referral Hospital, Gelegphu, Bhutan
| | - Bikram Chhetri
- Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Damber Kumar Nirola
- Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Guru Prasad Dhakal
- Department of Internal Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan; Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
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Tenzin T, Lhamo K, Rai PB, Tshering D, Jamtsho P, Namgyal J, Wangdi T, Letho S, Rai T, Jamtsho S, Dorji C, Rinchen S, Lungten L, Wangmo K, Lungten L, Wangchuk P, Gempo T, Jigme K, Phuntshok K, Tenzinla T, Gurung RB, Dukpa K. Evaluation of a rapid immunochromatographic test kit to the gold standard fluorescent antibody test for diagnosis of rabies in animals in Bhutan. BMC Vet Res 2020; 16:183. [PMID: 32513172 PMCID: PMC7281917 DOI: 10.1186/s12917-020-02405-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 06/02/2020] [Indexed: 11/12/2022] Open
Abstract
Background Rabies kills approximately 59,000 people each year worldwide. Rapid and accurate diagnosis of rabies is important for instituting rapid containment measures and for advising the exposed people for postexposure treatment. The application of a rapid diagnostic tests in the field can greatly enhance disease surveillance and diagnostic activities, especially in resource poor settings. In this study, a total of 179 brain tissue samples collected from different rabies suspect animal species (113 dogs, 50 cattle, 10 cats, 3 goats, 2 horses, and 1 bear) were selected and tested using both rapid immunochromatographic kit and the reference standard fluorescent antibody test (FAT). We evaluated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of a rapid antigen detection test kit produced by BioNote, Inc. (Hwaseong-si, Korea) relative to a FAT for its fit-for-purpose for confirmation of clinical cases of rabies for early response and enhancing rabies surveillance. Results Among 179 samples examined in this study, there was a concordance in results by the rapid test and FAT in 115 positive samples and 54 negative samples. Test results were discordant in 10 samples which were positive by FAT, but negative (false negative) by rapid kit. The rapid test kit showed a sensitivity of 92% (95% CI: 85.9–95.6) and specificity of 100% (95% CI: 93.4–100) using FAT as the reference standard. The positive and negative predictive values were found to be 100% (95% CI:96.7–100) and 84.4% (95% CI: 73.6–91.3), respectively. Overall, there was 94.4% (95% CI: 90–96.9) test agreement between rapid test and FAT (Kappa value = 0.874) with a positive percent agreement and negative percent agreement of 92 and 100%, respectively. Conclusions Our finding demonstrated that the rapid test kit (BioNote) can be used for rabies surveillance and confirming clinical case of rabies in animals for making rapid decisions particularly controlling rabies outbreaks in resource poor settings.
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Affiliation(s)
- Tenzin Tenzin
- Department of Livestock, National Centre for Animal Health, Serbithang, Thimphu, Bhutan.
| | - Kelzang Lhamo
- Department of Livestock, National Centre for Animal Health, Serbithang, Thimphu, Bhutan
| | - Purna B Rai
- Department of Livestock, National Centre for Animal Health, Serbithang, Thimphu, Bhutan
| | - Dawa Tshering
- Department of Livestock, National Centre for Animal Health, Serbithang, Thimphu, Bhutan
| | - Pema Jamtsho
- District Veterinary Hospital, Trashigang, Bhutan
| | | | - Thrinang Wangdi
- Regional Livestock Development Centre, Kanglung, Trashigang, Bhutan
| | - Sangay Letho
- Regional Livestock Development Centre, Kanglung, Trashigang, Bhutan
| | - Tuku Rai
- City Veterinary Hospital and Satellite Veterinary Laboratory, Phuentsholing, Bhutan
| | - Sonam Jamtsho
- City Veterinary Hospital and Satellite Veterinary Laboratory, Phuentsholing, Bhutan
| | - Chendu Dorji
- Regional Livestock Development Centre, Tshimasham, Chukha, Bhutan
| | - Sangay Rinchen
- Regional Livestock Development Centre, Tshimasham, Chukha, Bhutan
| | - Lungten Lungten
- Satellite Veterinary Laboratory, Deothang, Samdrup Jongkhar, Bhutan
| | | | | | - Pema Wangchuk
- Regional Livestock Development Centre, Zhemgang, Bhutan
| | - Tshewang Gempo
- Satellite Veterinary Laboratory, Gelephu, Sarpang, Bhutan
| | - Kezang Jigme
- Satellite Veterinary Laboratory, Gelephu, Sarpang, Bhutan
| | | | - Tenzinla Tenzinla
- Department of Livestock, National Centre for Animal Health, Serbithang, Thimphu, Bhutan
| | - Ratna B Gurung
- Department of Livestock, National Centre for Animal Health, Serbithang, Thimphu, Bhutan
| | - Kinzang Dukpa
- Department of Livestock, National Centre for Animal Health, Serbithang, Thimphu, Bhutan
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Dorji K, Lestari T, Jamtsho S, Mahendradhata Y. Implementation fidelity of hospital based directly observed therapy for tuberculosis treatment in Bhutan: mixed-method study. BMC Public Health 2020; 20:533. [PMID: 32306977 PMCID: PMC7168849 DOI: 10.1186/s12889-020-08666-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/06/2020] [Indexed: 11/30/2022] Open
Abstract
Background Direct observed treatment (DOT) has been implemented in Bhutan since 1997 and currently, it is offered in various model of delivery including a combination of hospital based, home based DOT and ambulatory DOT. Overall, treatment success rate for tuberculosis cases is higher than the global target; however, it is still need to be improved. Evaluation to the implementation fidelity of DOT is important to identify potential rooms for improvement. This study aimed to assess two major components of the program’s implementation fidelity: to assess patient’s adherence to DOT and explore factors for adherence; to assess provider’s compliance with DOT guideline and explore factors for compliance. Methods This research used a sequential explanatory mixed method. The conceptual framework of implementation fidelity was adopted to guide this study design. The cross-sectional study of TB patients was enrolled in two hospitals with highest TB load, between September to November 2017 in Bhutan. Interviewer assisted survey was conducted with 139 TB patients who visited the hospital in continuation phase. In-depth interview was then conducted with nine TB patients and four health staffs to explore the barriers and enablers of DOT. Results Total of 61.9% (86/139) of patients has received DOT at intensive phase. Proportion was higher among MDR-TB cases (100%), and smear sputum positive TB cases (84.7%). In the continuation phase, 5.8% of patients took medicine at hospital, 48.9% at home and the rest 45.3% no longer practiced DOT. More than 90% of patient received correct dosage and standard regimen of anti-TB drugs according to the guideline. The key factors affecting poor adherence to DOT as perceived by patients were; lack of willingness to visit the clinic on daily basis due to long distance, financial implications and family support. However, patient’s satisfaction to the quality of TB treatment service delivery was high (98.6%). Providing incentives to the patient was most agreed enabler felt by both health workers and patients. Conclusion In the selected hospital sites, the patient’s adherence to DOT and provider’s compliance with DOT guideline is partially implemented; the coverage and the duration of DOT is very low, therefore, need to revise and improve DOT model and structure.
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Affiliation(s)
- Kunzang Dorji
- International Master program in Public Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia. .,Present Address: Royal Centre for Disease Control, Department of Public Health, Ministry of Health, Thimphu, Bhutan.
| | - Trisasi Lestari
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Yodi Mahendradhata
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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