Teaching Hospital Kandy

Population-based cancer registry (PBCR) of Bhutan was established in Jigme Dorji Wangchuk National Referral Hospital (JDWNRH) in 2014 with the support of the Ministry of Health (Bhutan) and IARC Regional Hub, Tata Memorial Centre (TMC), Mumbai, India. This PBCR provides nationwide coverage (0.7 million population). We aim to present the cancer patterns in Bhutan for the years 2014-2022 using PBCR data. Trained registry staff collect cancer patient information by visiting various sources such as hospitals and diagnostic facilities. Data is entered into CanReg5 software. Data quality and consistency are checked by the IARC Regional Hub-TMC, Mumbai. The age-specific rate and age-adjusted rate were calculated using CanReg5 software. In the 9-year period (2014-2022), the PBCR registered 5906 incidence cancer cases, of which 2659 (45%) were males and 3247 (55%) were females. The age-adjusted incidence rate for males and females was 88.3 and 113.2 per 100,000 population, respectively. Age-adjusted mortality rates for males and females were 42.7 and 44.6 per 100,000 population, respectively. The leading cancer sites among males are stomach, esophagus, liver, lung, and rectum, and for females, cervix uteri, stomach, breast, lung, and thyroid. Cancer registry will play a pivotal role in boosting and monitoring screening program initiatives in Bhutan. Through effective linkages, it will build a robust database providing a cancer profile of the Bhutanese population which can be employed to devise effective cancer control activities in Bhutan.

Bhutan has achieved near-universal primary health care coverage, with eye health structurally integrated into its publicly financed health system. However, the extent to which existing resources enable equitable access to refractive error (RE) services has not been systematically evaluated. This study assesses the readiness of Bhutan’s RE service infrastructure, workforce distribution, and health technology and supply systems using the WHO Refractive Error Services Assessment Tool (RESAT). A nationwide cross-sectional situational analysis was conducted between March and July 2025 using a mixed-methods design guided by the WHO RESAT framework. The assessment covered all 36 public eye-care facilities and 33 licensed optical shops across 20 districts. Data were collected through structured facility questionnaires, targeted site verification, and key-informant interviews with stakeholders. Quantitative findings were summarized using descriptive statistics and triangulated with qualitative insights through framework analysis under three RESAT components: (1) service delivery, (2) human resources for eye health (HReH), and (3) health technology and supply. Data were obtained from all 36 public eye-care centres (100%) and 32 of 33 optical shops (97%) nationwide. RE services were available in 95% of districts but in only 14% of all health facilities, indicating limited primary-level integration. Optical shops operated in 65% of districts, with one-third concentrated in Thimphu, reflecting strong urban concentration. All public eye centres were equipped with essential refraction equipment; however, maintenance delays were reported due to the lack of biomedical capacity. The HReH comprised 102 professionals, of whom 89% were deployed in urban areas. Ophthalmologists and optometrists were exclusively urban-based, while only 17% of ophthalmic technicians served in rural hospitals. Optical services relied almost entirely (> 90%) on imported lenses and frames from India, with transport costs contributing to higher retail prices. Qualitative insights highlighted weak referral adherence, urban-rural inequities, and supply-chain vulnerability. Bhutan has made notable progress in integrating RE services within its universal health-care system. However, urban workforce concentration, absence of domestic optometry training, and reliance on imported optical supplies challenge equitable and sustainable service delivery. Strengthening workforce capacity, primary-level integration, and supply-chain resilience will be essential to achieving universal effective RE coverage by 2030. Not applicable.

1. IntroductionCystic echinococcosis (hydatidosis) in humans is caused by the larval stage of zoonotic cestodes of the genus Echinococcus . It is a widespread parasitic disease of significant public health importance [1-4]. Four distinct Echinococcus

Dengue is an arboviral fever. Weather modulates dengue transmission by influencing the life cycles of vector mosquitoes and the virus. Three teleconnections are known to affect the weather in Sri Lanka. Those are El Nino Southern Oscillation (ENSO), Indian Ocean Dipole (IOD) and ENSO Modoki. We studied correlations between dengue incidence (DI) in the Western Province (WP) of Sri Lanka as a whole and three districts of the province and indices of ENSO, IOD and ENSO Modoki. We used four indices of ENSO and one index each of IOD and ENSO Modoki. We acquired notified dengue cases in WP, population data and monthly indices of three teleconnections for the 2005–2019 period. We used wavelet time series analysis to determine correlations between indices of teleconnections and DI. Two indices of ENSO were correlated with the DI of the WP and all three districts of the WP individually. The other two indices were correlated with the DI of two districts. The index of IOD was correlated with DI of two districts. The index of ENSO Modoki was correlated with the DI of WP and one district of it. Both positive and negative extremes of at least one teleconnection index were followed by the rise of DI in all districts. We concluded that three teleconnections modulate DI of different districts of WP in different ways. Monitoring of indices of these teleconnections and escalating dengue preventive work after extremes of indices can potentially blunt impending dengue peaks.

Congenital myasthenic syndromes (CMS) are a group of rare inherited neuromuscular disorders caused by defects in neuromuscular transmission. Unlike autoimmune myasthenia gravis, CMS typically presents in childhood with variable severity and symptoms, and does not involve autoantibodies. This report presents the management of a primigravida diagnosed with CMS who was generally stable on pyridostigmine therapy but experienced a severe exacerbation during pregnancy. The diagnosis of CMS was made on clinical grounds, but the genetic testing for confirmation of the exact mutation was not available. The patient experienced intermittent mild exacerbations before pregnancy, managed with short courses of prednisolone. A severe exacerbation at 20 weeks of gestation required intensive care unit admission for respiratory support. Despite plans for a vaginal delivery, she developed exhaustion and desaturation during labour, followed by foetal distress, necessitating emergency caesarean section. Postpartum, the patient returned to her baseline functional status, and the neonate showed no signs of neuromuscular weakness.This case highlights that pregnancy in women with CMS can be safely managed with careful monitoring, multidisciplinary planning, and readiness to escalate care when needed. Delivery plans should be flexible, and management should be tailored to the individual’s clinical course. Since the neonatal outcome is unpredictable in the absence of genetic testing, follow-up care is necessary in all cases.

ABSTRACT To ensure the survival of threatened species, identifying biodiversity hotspots is essential for determining where and how conservation should be prioritized. Sri Lanka along with Western Ghats of India is a global biodiversity hotspot, with reptiles among its most threatened taxa. Agamid lizards in Sri Lanka are both threatened and evolutionarily distinct, with 19 of 22 species endemic to the island. We assessed the distribution of 14 threatened agamid lizard species using Species Distribution Modeling (SDM). The generated distribution maps were used to identify highly diverse target areas for agamid conservation, both within and outside protected areas. We assigned conservation priority ranks for species using different criteria such as IUCN status, the number of occurrence records, and the size of the estimated range. Our results indicated that agamid hotspots are primarily concentrated in the wet zone of Sri Lanka; specifically, Sinharaja Forest Reserve, the Peak Wilderness Sanctuary, and the Knuckles Mountain Range emerged as high priority conservation targets. Although all species targeted in our SDM had some portion of their range within protected areas, over 40% of high‐priority agamid habitats remain unprotected. We advocate for the expanded use of SDM for hotspot identification and conservation planning, particularly for threatened and endangered species with poorly documented population status and geographic distribution.

BackgroundMedicinal plants and herbal preparations have been used in Ayurveda medicine to treat diabetes for centuries. Link Gluconorm (LG) is a standardized solid formulation comprising seven medicinal herbs that have been used as herbal ingredients in Ayurveda for treating type 2 diabetes mellitus (T2DM). This study evaluated the efficacy and safety of the solid form of LG, and its effect on the quality of life (QoL) in T2DM patients.Materials and methodsAn observational study was conducted on 37 newly diagnosed uncomplicated T2DM patients aged between 35 and 65 years, whose fasting blood glucose levels ranged between 110 and 160 mg/dL. They were being treated for diabetes using the LG herbal formulation as the sole treatment. Laboratory tests for assessing glycemic control and safety were done at baseline and repeated at 4-weekly intervals for 24-weeks. A validated diabetes-specific QoL inventory was administered every 2 weeks.ResultsThe mean age was 48 ± 9y, and the mean body mass index was 25.0 ± 4.4 kg/m2 and 25.2 ± 4.2 kg/m2 for females and males, respectively. Statistically significant reductions in mean fasting blood glucose (153.85 mg/dL ± 15.62 to 129.01 mg/dL ± 12.88, p = 0.006), postprandial blood glucose (191.27 mg/dL ± 21.40 to 140.72 mg/dL ± 8.92, p < 0.001), glycosylated hemoglobin (8.51%±0.44 to 7.43%±0.40, p < 0.001) and improved QoL scores (1.93 ± 0.22 to 1.55 ± 0.08, p < 0.01) were observed at 24 weeks. There were no adverse changes in the hematological, liver and renal function safety parameters assessed using laboratory investigations. No adverse events or hypoglycemia were reported.ConclusionsThe polyherbal formulation LG significantly improved the QoL and glycaemic parameters and appeared safe after 24 weeks of treatment. Due to the small sample size, unblinded nature of this preliminary study, and the lack of a control arm, a randomized double-blinded controlled clinical trial on a larger group of patients is recommended.