Introduction:The existence of baseline data on the spectrum of thyroid nodules in Bhutanese patients is unknown. Fine-needle aspiration cytology (FNAC) is regarded as the gold standard diagnostic test for pre-op assessment of thyroid lesions. Materials and Methods:We conducted a retrospective study, involving 765 patients who underwent FNAC of the thyroid gland, at Jigme Dorji Wangchuck National Referral Hospital, Thimphu, between January-2018 to December-2020. We aimed to assess the cytomorphological spectrum of thyroid nodules, classify them as per The Bethesda system for reporting thyroid cytopathology (TBSRTC), assess risk of malignancy (ROM), and evaluate the accuracy of FNAC in diagnosing thyroid malignancy.Results: Colloid nodule (37.4%) and papillary thyroid carcinoma (4.2%) constituted the majority of benign and malignant cytological diagnoses, respectively. According to TBSRTC, majority of the cases (82.0%) fell under the Bethesda II category.Bethesda III was the least common (1.4%) category. As compared to histopathological diagnosis; the sensitivity, specificity, positive and the negative predictive values of FNAC in diagnosing thyroid malignancy were 90.0%, 93.3%, 93.10%, and 90.32% respectively. The ROM increased concurrently with the grade of the Bethesda category and was more or less close to the ROM reference range, published in the TBSRTC. Conclusion:Benign thyroid nodules (82.0%) constituted a majority of thyroid nodules in Bhutanese patients. FNAC was found to be reliable in detecting thyroid malignancy. From the literature, TBSRTC was found to be a more convenient method for reporting thyroid cytology. Henceforth, as most institutes, we plan to implement TBSRTC for reporting thyroid cytopathology. K E Y W O R D Sfine-needle aspiration cytology, the Bethesda system, thyroid malignancy, thyroid nodule | INTRODUCTIONThyroid gland is the largest endocrine organ in the human body that is affected by both neoplastic and non-neoplastic diseases, leading to diffuse and/or nodular enlargement. Depending on the screening approaches, the prevalence of thyroid nodules ranges from 20% to 60%. 1,2 Although non-neoplastic lesions are relatively more common, thyroid malignancy is the most serious clinical condition behind a
Objective: To explore the factors influences on childhood obesity in Mongar, Bhutan to notify and alert future improvement of a childhood obesity interventions for children in Bhutan. Study design: Qualitative study. Methods: Interviews of a purposeful sample with primary health workers and school health coordinator in one district in Bhutan were arranged to explore their perceptions related to the factors contributing to childhood obesity. 11 Primary healthcare workers and two school health coordinators were included. All the discussions were transcribed verbatim in English and iterative thematic approach was used for data analysis. Results: In general, the causes of childhood obesity were perceived to relate to macro-level policy influences, the school environment, sociocultural factors, and family and individual behavioral factors, acting in combination. Conclusion: The findings suggest that primary healthcare workers and school health coordinators have their own views on the causes of childhood obesity which involved behavioral, structural and social causes. A prominent emerging theme was the need for interventions like health workers and public awareness and support for a healthy environment. Any local initiatives in Mongar Bhutan are unlikely to be successful without such support.
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. Methods: 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. Results: 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%). Conclusions: 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.
The paper reviews the existing e-learning system implemented in Bhutan and discuses some problems of existing solution. A new system for lifelong learning specifically for education of Bhutanese people is presented. The paper discusses the objectives and the accomplished features of a new lifelong e-learning prototype-Bhutanese e-learning system. It is a prototype that can be customized to perform versatile functionalities to engage students and improve their participation. The system also serves as a basic student information system providing details of student, however, development and integration of other functionalities like result management system can be an asset.
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