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Papers by Sonam Choden

challenges orthodox views on the nature of poverty, how poverty is understood and how policy can ... more challenges orthodox views on the nature of poverty, how poverty is understood and how policy can best accelerate poverty reduction. Our work focuses on poverty and wellbeing through the lens of equity and inequality. Poverty is not only about 'poor ' people but also about the social and economic inequalities that compound and reproduce poverty.

PLOS ONE, Oct 7, 2022

Introduction Transgender persons experience health disparities and are marginalized in many socie... more Introduction Transgender persons experience health disparities and are marginalized in many societies worldwide. Even their numbers are unknown in many countries. We conducted the first effort to estimate the population size of transgender women (TGW) and transgender men (TGM) in Bhutan from November 2019 to January 2020. Methods Community-based surveys of TGW and TGM integrated several methods to estimate the size of hidden populations, including key informant mapping, wisdom-of-the-crowd, the service multiplier, and the unique object multiplier. Results of the several methods were synthesized using a Bayesian approach. Results Surveys included 34 TGW and 124 TGM. TGW was persons assigned to the male sex at birth and currently self-identified as "trans women" (91%), "women" (6%), or another gender (3%). TGM were persons assigned female sex at birth and self-identified as "trans men" (100%). Bayesian synthesis of the multiple methods estimated 84 TGW (credible interval 61-110) and 166 TGM (credible interval 124-211) in Bhutan. Conclusions Our study documented that TGW and TGM are part of Bhutanese society, with TGW constituting 0.03% of adult women and TGM 0.06% of adult men. Estimates can help advocate for resources and programs to address the health and well-being of these communities.

IARJSET

Due to the increase in the use of information system in daily activities of individuals, the nece... more Due to the increase in the use of information system in daily activities of individuals, the necessity and demand for such system has been continuously growing for the last few decades. Now, the time has come where such systems are readily available for one to use it. However, the quality of services and other software related issues must be solved within the short duration by the software developers or operators, otherwise the clients can choose the better option rather than the services of the former. Given that, the process and methods being applied during the software life cycle plays an important role in effectively delivering the services to the clients. The software company has to wisely choose the technology and methodology for their project so that their product can attract the current market as well as solve the trending problems. The research presents the finding and results of DevOps implementation across the software company of Bhutan that addresses the loophole of the conventional methods of software development life cycle.

BMC Cancer

Background Colposcopy is a tool for triaging screen positive women regardless of method used for ... more Background Colposcopy is a tool for triaging screen positive women regardless of method used for cervical cancer screening. The objective of this study was to evaluate the diagnostic performance of colposcopy in the diagnosis of histologic cervical intraepithelial neoplasia 2+ (CIN 2+) at Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Thimphu, Bhutan. Methods This cross-sectional study was conducted from March 2021 to August 2021 among 299 women who availed colposcopy services at the colposcopy clinic of JDWNRH, Bhutan. Women included in this study were either screen positive (Pap smear) or were suspected to have invasive cancer; they underwent colposcopy and a cervical biopsy irrespective of colposcopy impression. This histopathologic assessment was considered as the gold standard test for the diagnosis of cervical intraepithelial neoplasia (CIN) or invasive cancer. Results The mean age of the study participants was 43 years (ranges, 25–76 years). The sensitivity, speci...

Journal of South Asian Federation of Obstetrics and Gynaecology

Introduction: Hydatid cyst is a zoonotic infection caused by dog tapeworm Echinococcus species. T... more Introduction: Hydatid cyst is a zoonotic infection caused by dog tapeworm Echinococcus species. The liver and lungs are the most commonly affected organs with this disease. Rarely, pelvic organs are also involved. Case: A 36-year-old female presented with pain in the abdomen for a 1-week duration with a normal menstrual cycle. Ultrasound revealed a bilateral ovarian mass. Laparotomy revealed left broad ligament hydatid cyst and right-sided pelvic peritoneal hydatid cyst, which were confirmed by histopathological examination. After surgical excision, the patient was given albendazole for 6 months. Conclusion: Female pelvic hydatid cyst is a rare entity. In endemic settings, the possibility of a pelvic hydatid cyst should be kept as a differential diagnosis in an ovarian cyst in the presence of coexisting hepatic hydatid cyst and negative tumor markers.

Bhutan Health Journal

Introduction: There is a wealth of literature on closed Achilles tendon injuries but open-lacerat... more Introduction: There is a wealth of literature on closed Achilles tendon injuries but open-lacerations are rarely reported. We aimed to assess the frequency of open Achilles tendon laceration in Bhutanese patients with a particular emphasis on age and sex distribution, mechanism of injury, and management provided to these patients. Methods: Retrospective study was conducted at department of orthopedic surgery, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Thimphu. All patients treated at JDWNRH for open-laceration of Achilles tendon between January 2018 to December 2020 were included. Data were analyzed for means and frequencies using SPSS software. Results: Of the 48 cases involved, 36 (75%) cases were male and 12 (25%) cases were female. The most affected age groups were between 21-60 years (70.8%). Majority of the cases inflicted injury following slip in squat-toilet (85.4%).Thirty-eight (79.2%) cases had a complete-laceration of the tendon and the remaining cases (20...

ECS Transactions

Fipronil is a member of phenylpyrazole insecticide, which was widely used in agriculture to kill ... more Fipronil is a member of phenylpyrazole insecticide, which was widely used in agriculture to kill pests [1-2]. It can also form metabolite, such as fipronil sulfone by oxidation process, which is more toxic than parent compound [3-4]. Fipronil sulfone can persist for longer duration, which can easily bind to lipid-rich matrices and get into food chain [5]. Its contamination in foods gained more concerned recently [6] and many agencies have restricted fipronil content in various food like vegetables, fruits, water, grains, edible oil, meat, eggs, etc. Fipronil could damage our liver, kidneys, and thyroid glands [6]. It is said that fipronil toxicity has no particular antidote and can be harmful to pregnant, weak, and old people [9]. Fipronil’s toxicity and risk to human health demands reliable and sensitive analytical method to monitor and reduce contamination. Many adsorbents previously used were commercially available and costly. Considering these limitations, a new sorbent can be d...

Bhutan Journal of Research and Development

The world today is facing a major crisis in energy, environment and climate. Human activities suc... more The world today is facing a major crisis in energy, environment and climate. Human activities such as building, transportation and industries have caused tremendous impact on the natural environment. The irreversible growth of cities is an indication of more cars on the road, more mobility and ultimately to more energy consumption. The expansion of urban areas leads to the development of transportation routes and increase in the number of vehicle ownership. Bhutan has opened its doors from being a landlocked country to an internationally recognized country. Trade and industry have become an important sector in building the country’s economy, with rapid infrastructure development. The realization of the energy crisis is as new as the urbanization trend although there is dire need to adopt green energy practices. This study explores various strategies based on the concept Green Urbanism, specified to the topic, Sustainable Transport. It presents the current transportation trend in one...

Bhutan Health Journal, 2021

ABSTRACTRetroperitoneal teratoma is a extragonadal germ cell tumor comprising 5% of all teratomas... more ABSTRACTRetroperitoneal teratoma is a extragonadal germ cell tumor comprising 5% of all teratomas in children, and the third most common retroperitoneal neoplasm in children. This is a case report of a 2 years old girl who presented with abdominal distension and palpable mass. The imaging findings of the mass was characteristic of retroperitoneal teratoma which was confirmed by histopathology report following complete excision. Retroperitoneal tumor is an uncommon tumor in children with characteristic imaging findings. Computed tomography is mainly used to evaluate the extent of the disease. Most of the retroperitoneal tumors are benign and curable with complete surgical excision.

SAGE Open Medical Case Reports, 2022

Malignant transformation in a mature cystic teratoma of the ovary is a rare complication. Herein,... more Malignant transformation in a mature cystic teratoma of the ovary is a rare complication. Herein, we report a case of a 62-year-old woman who was diagnosed with squamous cell carcinoma in a mature cystic teratoma of the ovary in the histopathology examination. This case report highlights the importance of suspecting malignant transformation in an elderly woman with a large mature cystic teratoma of the ovary with a thickened wall so that proper surgical and adjuvant treatments are planned.

Adsorption of basic dye Crystal Violet (CV) from aqueous solution by two low cost adsorbents Grou... more Adsorption of basic dye Crystal Violet (CV) from aqueous solution by two low cost adsorbents Ground Nut shell powder (GNSP) and Ground nut shell ash (GNSA) has been investigated through batch mode adsorption process. The study involves the removal of CV using operational parameters; initial concentration (100-600 mg/L), different contact time, adsorbent dose (0.1-0.5 g/100mL) and p H (3-10). It has been found that percentage removal of dye improve with reduction in original concentration, intensification in time of contact and adsorbent dose. Basic p H of the dye solution show better adsorption capacity as compared to acidic dye solution. FTIR analysis reveals the presence of favourable alcoholic and carboxylic groups on the surface of the adsorbent. SEM analyses show irregular morphology with particles in micrometer range. Langmuir isotherm fit better than Freundlich adsorption isotherm and to Lagergren second order kinetic model fitted better than first order for both the adsorben...

Bhutan Health Journal, 2021

Introduction: The presence of functional endometrial tissue in the surgical scar, which commonly ... more Introduction: The presence of functional endometrial tissue in the surgical scar, which commonly follows caesarean section is called scar endometriosis. It is a very rare condition which is commonly misdiagnosed. Case report: We report two cases of scar endometriosis which developed after caesarean section. One case was misdiagnosed as a keloid for a long duration (12 years) and other one was not diagnosed despite the characteristic presenting symptoms. Both the cases underwent surgical excision with free resection margins and histopathological confirmation of diagnosis. Conclusions: Clinicians must be aware of varying presentations of scar endometriosis to ensure timely diagnosis and treatment.

Introduction: Intraosseous lipoma is a very rare neoplasm accounting for < 0.1 % of primary bo... more Introduction: Intraosseous lipoma is a very rare neoplasm accounting for < 0.1 % of primary bone tumors. Pain is the leading symptom in majority of the reported cases but it can be asymptomatic. There is slight male predominance in occurrence of this lesion. The plain radiological findings are not specific and requires differential diagnosis. The lesion is mostly diagnosed by histopathological examination. Case report: A 31-year-old male presented with localized pain around the medial aspect of right ankle joint for one week. Examination revealed mild tenderness over the distal part of the right tibia over the medial aspect. Plain radiograph of the right leg showed well-defined expansile osteolytic lesion with sclerotic rim and calcified matrix at metaphysis of distal tibia. MRI showed enhancing T1-weighted hypo intense and T2-weighted hyperintense lesion. For this case, radiological impression was giant cell tumor with differential diagnosis of aneurysmal bone cyst and fibrous d...

ACR Open Rheumatology, 2021

Patient‐reported outcomes (PROs) are an integral part of treat‐to‐target approaches in managing r... more Patient‐reported outcomes (PROs) are an integral part of treat‐to‐target approaches in managing rheumatoid arthritis (RA). In clinical practice, however, routine collection, documentation, and discussion of PROs with patients are highly variable. The RISE LC (Rheumatology Informatics System for Effectiveness Learning Collaborative) was established to develop and share best practices in PRO collection and use across adult rheumatology practices in the United States

Sexually Transmitted Diseases, 2021

A study of female sex workers in Bhutan estimated their numbers nationally at 597 (417–777). Fema... more A study of female sex workers in Bhutan estimated their numbers nationally at 597 (417–777). Female sex workers not employed at entertainment centers report a higher risk of sexually transmitted diseases. Background Knowing the number of persons at risk for sexually transmitted diseases (STDs) and their risk behaviors are needed to allocate limited resources, set targets for prevention and care activities, gauge the reach of programs, and assess their impact. Female sex workers (FSWs) are a population at high risk for STD worldwide; little is known about FSW in Bhutan. Methods We conducted a community-based survey and population size exercise of FSW in Bhutan. The survey used a hybrid venue-based/peer-referral sampling method. Population size estimation methods were key informant mapping, census and enumeration, unique object multiplier, and capture-recapture. Results Of 517 women surveyed, 67.5% provided sex for money in the last year. Compared with FSWs at venues, FSWs referred by peers were more likely to have sex with alcohol (80.1% vs. 51.5%, P < 0.001) and more paying partners (mean, 3.5 vs. 2.0; P = 0.001), and less likely to have tested for an STD (28.3% vs. 51.0%, P < 0.001) or have outreach worker contact (27.6% vs. 41.5%, P = 0.007). The estimated number of FSWs in the 9 districts was 353 (95% confidence interval, 345–362). Extrapolation to the whole country projected 597 (417–777) FSWs nationally. Conclusions Our estimate of the number of FSW in Bhutan corresponds to 0.71% of adult urban women, a figure in line with other countries in South and Southeast Asia. Our data highlight the need for outreach beyond venues where women are employed to reach FSW at higher risk for STD but who have less access to interventions.

Gland Surgery, 2020

Background: Papillary thyroid carcinoma (PTC) accounts for the majority of diagnoses of thyroid c... more Background: Papillary thyroid carcinoma (PTC) accounts for the majority of diagnoses of thyroid carcinoma. BRAF V600E mutation is the most common genetic alteration in PTC, which has diagnostic and prognostic significance. The rate of BRAF V600E mutation in PTC from Thailand has not been reported. Our purpose was to estimate the prevalence of BRAF mutation in a large institutional series using an affordable approach, which combined mutation-specific immunohistochemistry (IHC) with VE1 antibody and tissue microarray (TMA). Methods: A total of 476 PTC cases plotted on TMA were employed for determining the mutation status in this study. The cancer tissue of initial 100 cases (pilot study) were analyzed for BRAF V600E mutation by using both direct sequencing and VE1 immunostaining. For the subsequent PTC cases, VE1 IHC was used as an alternative to direct sequencing for the detection of mutation. Univariate and multivariate analyses were done to determine the association of clinicopathological variables with BRAF V600E mutation. Results: In the pilot study, VE1 IHC showed excellent analytical performance (κ=0.884) for detecting BRAF V600E mutation in PTC TMA as compared to direct sequencing. The prevalence of BRAF V600E in the whole cohort was 60.9% by using VE1 IHC. The mutation was commonly seen in tall cell (92.9%) and classic (70.2%) variants of PTC. Multivariate analysis (P<0.05) showed association of BRAF V600E with histological type of tumor, extrathyroidal extension, and absence of Hashimoto's thyroiditis. Conclusions: In conclusion, BRAF V600E mutation was detected in 60.9% of Thai PTC and it was associated with several aggressive clinicopathological variables of thyroid cancer. VE1 IHC proved as a reliable method able to replace direct sequencing for detection of the mutation. A combination of mutation-specific IHC and TMA allows conducting large cohort studies more labor-saving and cost-efficiently.

Cancers, 2020

Detection of BRAFV600E is useful for making diagnosis and risk stratification of papillary thyroi... more Detection of BRAFV600E is useful for making diagnosis and risk stratification of papillary thyroid carcinoma (PTC). Molecular testing, however, is not always available for routine clinical use. To assess the clinical utility and reliability of VE1 immunohistochemistry (IHC) for detecting BRAFV600E mutation in PTC, VE1 IHC was performed on the tissue microarrays of 514 patients with PTC and was compared with Sanger sequencing results. Of 514 PTC cases, 433 (84.2%) were positive for VE1 expression. Among 6 discordant cases between VE1 IHC and Sanger sequencing, 3 initial VE1-false negative cases turned out to be true false negative on repeat testing, and 3 VE1-false positive cases showed BRAFV600E mutation using digital PCR analysis. PTCs with low variant allele fraction were positive for VE1 IHC but were not detected using sequencing. VE1 IHC showed 99.3% sensitivity, 100% specificity, 100% positive predictive value, and 96.4% negative predictive value. The BRAFV600E mutation was sig...

Current Osteoporosis Reports, 2019

Purpose of Review The aims of this review are to summarize current performance for osteoporosis q... more Purpose of Review The aims of this review are to summarize current performance for osteoporosis quality measures used by Centers for Medicare and Medicaid (CMS) for pay-for-performance programs and to describe recent quality improvement strategies around these measures. Recent Findings Healthcare Effectiveness Data and Information (HEDIS) quality measures for the managed care population indicate gradual improvement in osteoporosis screening, osteoporosis identification and treatment following fragility fracture, and documentation of fall risk assessment and plan of care between 2006 and 2016. However, population-based studies suggest achievement for these process measures is lower where reporting is not mandated. Performance gaps remain, particularly for post-fracture care. Elderly patients with increased comorbidity are especially vulnerable to fractures, yet underperformance is documented in this population. Gender and racial disparities also exist. As has been shown for other areas of health care, education alone has a limited role as a quality improvement intervention. Multifactorial and systems-based interventions seem to be most successful in leading to measurable change for osteoporosis care and fall prevention. Summary Despite increasing recognition of evidence-based quality measures for osteoporosis and incentives to improve upon performance for these measures, persistent gaps in care exist that will require further investigation into sustainable and valueadding quality improvement interventions.

challenges orthodox views on the nature of poverty, how poverty is understood and how policy can ... more challenges orthodox views on the nature of poverty, how poverty is understood and how policy can best accelerate poverty reduction. Our work focuses on poverty and wellbeing through the lens of equity and inequality. Poverty is not only about 'poor ' people but also about the social and economic inequalities that compound and reproduce poverty.

PLOS ONE, Oct 7, 2022

Introduction Transgender persons experience health disparities and are marginalized in many socie... more Introduction Transgender persons experience health disparities and are marginalized in many societies worldwide. Even their numbers are unknown in many countries. We conducted the first effort to estimate the population size of transgender women (TGW) and transgender men (TGM) in Bhutan from November 2019 to January 2020. Methods Community-based surveys of TGW and TGM integrated several methods to estimate the size of hidden populations, including key informant mapping, wisdom-of-the-crowd, the service multiplier, and the unique object multiplier. Results of the several methods were synthesized using a Bayesian approach. Results Surveys included 34 TGW and 124 TGM. TGW was persons assigned to the male sex at birth and currently self-identified as "trans women" (91%), "women" (6%), or another gender (3%). TGM were persons assigned female sex at birth and self-identified as "trans men" (100%). Bayesian synthesis of the multiple methods estimated 84 TGW (credible interval 61-110) and 166 TGM (credible interval 124-211) in Bhutan. Conclusions Our study documented that TGW and TGM are part of Bhutanese society, with TGW constituting 0.03% of adult women and TGM 0.06% of adult men. Estimates can help advocate for resources and programs to address the health and well-being of these communities.

IARJSET

Due to the increase in the use of information system in daily activities of individuals, the nece... more Due to the increase in the use of information system in daily activities of individuals, the necessity and demand for such system has been continuously growing for the last few decades. Now, the time has come where such systems are readily available for one to use it. However, the quality of services and other software related issues must be solved within the short duration by the software developers or operators, otherwise the clients can choose the better option rather than the services of the former. Given that, the process and methods being applied during the software life cycle plays an important role in effectively delivering the services to the clients. The software company has to wisely choose the technology and methodology for their project so that their product can attract the current market as well as solve the trending problems. The research presents the finding and results of DevOps implementation across the software company of Bhutan that addresses the loophole of the conventional methods of software development life cycle.

BMC Cancer

Background Colposcopy is a tool for triaging screen positive women regardless of method used for ... more Background Colposcopy is a tool for triaging screen positive women regardless of method used for cervical cancer screening. The objective of this study was to evaluate the diagnostic performance of colposcopy in the diagnosis of histologic cervical intraepithelial neoplasia 2+ (CIN 2+) at Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Thimphu, Bhutan. Methods This cross-sectional study was conducted from March 2021 to August 2021 among 299 women who availed colposcopy services at the colposcopy clinic of JDWNRH, Bhutan. Women included in this study were either screen positive (Pap smear) or were suspected to have invasive cancer; they underwent colposcopy and a cervical biopsy irrespective of colposcopy impression. This histopathologic assessment was considered as the gold standard test for the diagnosis of cervical intraepithelial neoplasia (CIN) or invasive cancer. Results The mean age of the study participants was 43 years (ranges, 25–76 years). The sensitivity, speci...

Journal of South Asian Federation of Obstetrics and Gynaecology

Introduction: Hydatid cyst is a zoonotic infection caused by dog tapeworm Echinococcus species. T... more Introduction: Hydatid cyst is a zoonotic infection caused by dog tapeworm Echinococcus species. The liver and lungs are the most commonly affected organs with this disease. Rarely, pelvic organs are also involved. Case: A 36-year-old female presented with pain in the abdomen for a 1-week duration with a normal menstrual cycle. Ultrasound revealed a bilateral ovarian mass. Laparotomy revealed left broad ligament hydatid cyst and right-sided pelvic peritoneal hydatid cyst, which were confirmed by histopathological examination. After surgical excision, the patient was given albendazole for 6 months. Conclusion: Female pelvic hydatid cyst is a rare entity. In endemic settings, the possibility of a pelvic hydatid cyst should be kept as a differential diagnosis in an ovarian cyst in the presence of coexisting hepatic hydatid cyst and negative tumor markers.

Bhutan Health Journal

Introduction: There is a wealth of literature on closed Achilles tendon injuries but open-lacerat... more Introduction: There is a wealth of literature on closed Achilles tendon injuries but open-lacerations are rarely reported. We aimed to assess the frequency of open Achilles tendon laceration in Bhutanese patients with a particular emphasis on age and sex distribution, mechanism of injury, and management provided to these patients. Methods: Retrospective study was conducted at department of orthopedic surgery, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Thimphu. All patients treated at JDWNRH for open-laceration of Achilles tendon between January 2018 to December 2020 were included. Data were analyzed for means and frequencies using SPSS software. Results: Of the 48 cases involved, 36 (75%) cases were male and 12 (25%) cases were female. The most affected age groups were between 21-60 years (70.8%). Majority of the cases inflicted injury following slip in squat-toilet (85.4%).Thirty-eight (79.2%) cases had a complete-laceration of the tendon and the remaining cases (20...

ECS Transactions

Fipronil is a member of phenylpyrazole insecticide, which was widely used in agriculture to kill ... more Fipronil is a member of phenylpyrazole insecticide, which was widely used in agriculture to kill pests [1-2]. It can also form metabolite, such as fipronil sulfone by oxidation process, which is more toxic than parent compound [3-4]. Fipronil sulfone can persist for longer duration, which can easily bind to lipid-rich matrices and get into food chain [5]. Its contamination in foods gained more concerned recently [6] and many agencies have restricted fipronil content in various food like vegetables, fruits, water, grains, edible oil, meat, eggs, etc. Fipronil could damage our liver, kidneys, and thyroid glands [6]. It is said that fipronil toxicity has no particular antidote and can be harmful to pregnant, weak, and old people [9]. Fipronil’s toxicity and risk to human health demands reliable and sensitive analytical method to monitor and reduce contamination. Many adsorbents previously used were commercially available and costly. Considering these limitations, a new sorbent can be d...

Bhutan Journal of Research and Development

The world today is facing a major crisis in energy, environment and climate. Human activities suc... more The world today is facing a major crisis in energy, environment and climate. Human activities such as building, transportation and industries have caused tremendous impact on the natural environment. The irreversible growth of cities is an indication of more cars on the road, more mobility and ultimately to more energy consumption. The expansion of urban areas leads to the development of transportation routes and increase in the number of vehicle ownership. Bhutan has opened its doors from being a landlocked country to an internationally recognized country. Trade and industry have become an important sector in building the country’s economy, with rapid infrastructure development. The realization of the energy crisis is as new as the urbanization trend although there is dire need to adopt green energy practices. This study explores various strategies based on the concept Green Urbanism, specified to the topic, Sustainable Transport. It presents the current transportation trend in one...

Bhutan Health Journal, 2021

ABSTRACTRetroperitoneal teratoma is a extragonadal germ cell tumor comprising 5% of all teratomas... more ABSTRACTRetroperitoneal teratoma is a extragonadal germ cell tumor comprising 5% of all teratomas in children, and the third most common retroperitoneal neoplasm in children. This is a case report of a 2 years old girl who presented with abdominal distension and palpable mass. The imaging findings of the mass was characteristic of retroperitoneal teratoma which was confirmed by histopathology report following complete excision. Retroperitoneal tumor is an uncommon tumor in children with characteristic imaging findings. Computed tomography is mainly used to evaluate the extent of the disease. Most of the retroperitoneal tumors are benign and curable with complete surgical excision.

SAGE Open Medical Case Reports, 2022

Malignant transformation in a mature cystic teratoma of the ovary is a rare complication. Herein,... more Malignant transformation in a mature cystic teratoma of the ovary is a rare complication. Herein, we report a case of a 62-year-old woman who was diagnosed with squamous cell carcinoma in a mature cystic teratoma of the ovary in the histopathology examination. This case report highlights the importance of suspecting malignant transformation in an elderly woman with a large mature cystic teratoma of the ovary with a thickened wall so that proper surgical and adjuvant treatments are planned.

Adsorption of basic dye Crystal Violet (CV) from aqueous solution by two low cost adsorbents Grou... more Adsorption of basic dye Crystal Violet (CV) from aqueous solution by two low cost adsorbents Ground Nut shell powder (GNSP) and Ground nut shell ash (GNSA) has been investigated through batch mode adsorption process. The study involves the removal of CV using operational parameters; initial concentration (100-600 mg/L), different contact time, adsorbent dose (0.1-0.5 g/100mL) and p H (3-10). It has been found that percentage removal of dye improve with reduction in original concentration, intensification in time of contact and adsorbent dose. Basic p H of the dye solution show better adsorption capacity as compared to acidic dye solution. FTIR analysis reveals the presence of favourable alcoholic and carboxylic groups on the surface of the adsorbent. SEM analyses show irregular morphology with particles in micrometer range. Langmuir isotherm fit better than Freundlich adsorption isotherm and to Lagergren second order kinetic model fitted better than first order for both the adsorben...

Bhutan Health Journal, 2021

Introduction: The presence of functional endometrial tissue in the surgical scar, which commonly ... more Introduction: The presence of functional endometrial tissue in the surgical scar, which commonly follows caesarean section is called scar endometriosis. It is a very rare condition which is commonly misdiagnosed. Case report: We report two cases of scar endometriosis which developed after caesarean section. One case was misdiagnosed as a keloid for a long duration (12 years) and other one was not diagnosed despite the characteristic presenting symptoms. Both the cases underwent surgical excision with free resection margins and histopathological confirmation of diagnosis. Conclusions: Clinicians must be aware of varying presentations of scar endometriosis to ensure timely diagnosis and treatment.

Introduction: Intraosseous lipoma is a very rare neoplasm accounting for < 0.1 % of primary bo... more Introduction: Intraosseous lipoma is a very rare neoplasm accounting for < 0.1 % of primary bone tumors. Pain is the leading symptom in majority of the reported cases but it can be asymptomatic. There is slight male predominance in occurrence of this lesion. The plain radiological findings are not specific and requires differential diagnosis. The lesion is mostly diagnosed by histopathological examination. Case report: A 31-year-old male presented with localized pain around the medial aspect of right ankle joint for one week. Examination revealed mild tenderness over the distal part of the right tibia over the medial aspect. Plain radiograph of the right leg showed well-defined expansile osteolytic lesion with sclerotic rim and calcified matrix at metaphysis of distal tibia. MRI showed enhancing T1-weighted hypo intense and T2-weighted hyperintense lesion. For this case, radiological impression was giant cell tumor with differential diagnosis of aneurysmal bone cyst and fibrous d...

ACR Open Rheumatology, 2021

Patient‐reported outcomes (PROs) are an integral part of treat‐to‐target approaches in managing r... more Patient‐reported outcomes (PROs) are an integral part of treat‐to‐target approaches in managing rheumatoid arthritis (RA). In clinical practice, however, routine collection, documentation, and discussion of PROs with patients are highly variable. The RISE LC (Rheumatology Informatics System for Effectiveness Learning Collaborative) was established to develop and share best practices in PRO collection and use across adult rheumatology practices in the United States

Sexually Transmitted Diseases, 2021

A study of female sex workers in Bhutan estimated their numbers nationally at 597 (417–777). Fema... more A study of female sex workers in Bhutan estimated their numbers nationally at 597 (417–777). Female sex workers not employed at entertainment centers report a higher risk of sexually transmitted diseases. Background Knowing the number of persons at risk for sexually transmitted diseases (STDs) and their risk behaviors are needed to allocate limited resources, set targets for prevention and care activities, gauge the reach of programs, and assess their impact. Female sex workers (FSWs) are a population at high risk for STD worldwide; little is known about FSW in Bhutan. Methods We conducted a community-based survey and population size exercise of FSW in Bhutan. The survey used a hybrid venue-based/peer-referral sampling method. Population size estimation methods were key informant mapping, census and enumeration, unique object multiplier, and capture-recapture. Results Of 517 women surveyed, 67.5% provided sex for money in the last year. Compared with FSWs at venues, FSWs referred by peers were more likely to have sex with alcohol (80.1% vs. 51.5%, P < 0.001) and more paying partners (mean, 3.5 vs. 2.0; P = 0.001), and less likely to have tested for an STD (28.3% vs. 51.0%, P < 0.001) or have outreach worker contact (27.6% vs. 41.5%, P = 0.007). The estimated number of FSWs in the 9 districts was 353 (95% confidence interval, 345–362). Extrapolation to the whole country projected 597 (417–777) FSWs nationally. Conclusions Our estimate of the number of FSW in Bhutan corresponds to 0.71% of adult urban women, a figure in line with other countries in South and Southeast Asia. Our data highlight the need for outreach beyond venues where women are employed to reach FSW at higher risk for STD but who have less access to interventions.

Gland Surgery, 2020

Background: Papillary thyroid carcinoma (PTC) accounts for the majority of diagnoses of thyroid c... more Background: Papillary thyroid carcinoma (PTC) accounts for the majority of diagnoses of thyroid carcinoma. BRAF V600E mutation is the most common genetic alteration in PTC, which has diagnostic and prognostic significance. The rate of BRAF V600E mutation in PTC from Thailand has not been reported. Our purpose was to estimate the prevalence of BRAF mutation in a large institutional series using an affordable approach, which combined mutation-specific immunohistochemistry (IHC) with VE1 antibody and tissue microarray (TMA). Methods: A total of 476 PTC cases plotted on TMA were employed for determining the mutation status in this study. The cancer tissue of initial 100 cases (pilot study) were analyzed for BRAF V600E mutation by using both direct sequencing and VE1 immunostaining. For the subsequent PTC cases, VE1 IHC was used as an alternative to direct sequencing for the detection of mutation. Univariate and multivariate analyses were done to determine the association of clinicopathological variables with BRAF V600E mutation. Results: In the pilot study, VE1 IHC showed excellent analytical performance (κ=0.884) for detecting BRAF V600E mutation in PTC TMA as compared to direct sequencing. The prevalence of BRAF V600E in the whole cohort was 60.9% by using VE1 IHC. The mutation was commonly seen in tall cell (92.9%) and classic (70.2%) variants of PTC. Multivariate analysis (P<0.05) showed association of BRAF V600E with histological type of tumor, extrathyroidal extension, and absence of Hashimoto's thyroiditis. Conclusions: In conclusion, BRAF V600E mutation was detected in 60.9% of Thai PTC and it was associated with several aggressive clinicopathological variables of thyroid cancer. VE1 IHC proved as a reliable method able to replace direct sequencing for detection of the mutation. A combination of mutation-specific IHC and TMA allows conducting large cohort studies more labor-saving and cost-efficiently.

Cancers, 2020

Detection of BRAFV600E is useful for making diagnosis and risk stratification of papillary thyroi... more Detection of BRAFV600E is useful for making diagnosis and risk stratification of papillary thyroid carcinoma (PTC). Molecular testing, however, is not always available for routine clinical use. To assess the clinical utility and reliability of VE1 immunohistochemistry (IHC) for detecting BRAFV600E mutation in PTC, VE1 IHC was performed on the tissue microarrays of 514 patients with PTC and was compared with Sanger sequencing results. Of 514 PTC cases, 433 (84.2%) were positive for VE1 expression. Among 6 discordant cases between VE1 IHC and Sanger sequencing, 3 initial VE1-false negative cases turned out to be true false negative on repeat testing, and 3 VE1-false positive cases showed BRAFV600E mutation using digital PCR analysis. PTCs with low variant allele fraction were positive for VE1 IHC but were not detected using sequencing. VE1 IHC showed 99.3% sensitivity, 100% specificity, 100% positive predictive value, and 96.4% negative predictive value. The BRAFV600E mutation was sig...

Current Osteoporosis Reports, 2019

Purpose of Review The aims of this review are to summarize current performance for osteoporosis q... more Purpose of Review The aims of this review are to summarize current performance for osteoporosis quality measures used by Centers for Medicare and Medicaid (CMS) for pay-for-performance programs and to describe recent quality improvement strategies around these measures. Recent Findings Healthcare Effectiveness Data and Information (HEDIS) quality measures for the managed care population indicate gradual improvement in osteoporosis screening, osteoporosis identification and treatment following fragility fracture, and documentation of fall risk assessment and plan of care between 2006 and 2016. However, population-based studies suggest achievement for these process measures is lower where reporting is not mandated. Performance gaps remain, particularly for post-fracture care. Elderly patients with increased comorbidity are especially vulnerable to fractures, yet underperformance is documented in this population. Gender and racial disparities also exist. As has been shown for other areas of health care, education alone has a limited role as a quality improvement intervention. Multifactorial and systems-based interventions seem to be most successful in leading to measurable change for osteoporosis care and fall prevention. Summary Despite increasing recognition of evidence-based quality measures for osteoporosis and incentives to improve upon performance for these measures, persistent gaps in care exist that will require further investigation into sustainable and valueadding quality improvement interventions.