Alcoholic liver disease (ALD) is one of the major public health problems in Bhutan. The incidence of alcohol liver diseases (per 10,000 populations) in the year 2016 was 46.The burden of mortality associated with it is alarming, going by the size of the population of the country. It is one of the all-time top five killer diseases in the country. In 2016, the mortality attributable to alcohol liver disease was 184 corresponding to 97% of deaths due to reported liver diseases. The ALD is responsible for 15% of all deaths on an average in the last 3 years.How to cite this article: Wangchuk P. Burden of Alcoholic Liver Disease: Bhutan Scenario. Euroasian J Hepato-Gastroenterol 2018;8(1):81-82.

Introduction: The Postgraduate Medical Education has witnessed transition from traditional cognitive based to more competency-based learning globally. Khesar Gyalpo University of Medical sciences of Bhutan introduced Competency Based Medical Education (CBME) through implementation of work place-based assessment (WPBA) in June 2018. The primary objective of this initiative was to produce specialist of highest quality and cultivate competency and outcome based, yet learner centered curricula. Methods: The evaluation was conducted in June, 2019. The mixed methods of data collection techniques were utilized such as survey, interview, and review of the documents and focus group discussion. It was to provide understanding of local challenges and needs in implementation of WPBA. Results: A total of 90% of the faculty members and 40% of administrators evaluated were aware of the implementation of WPBA. Majority of the faculty felt that WPBA is beneficial to both faculty and the residents and all residents felt that it’s beneficial in terms of learning. OBGYN residents have been exposed to maximum numbers of WPBA at 20. The maximum numbers of WPBA activities were performed by residents of general practice department which stood at 56. Lack of time as hindrance of practice of WPBA was implicated by 28% of the faculty and 61% residents. Conclusions: Despite WPBA being implemented for a short duration there is a high level of awareness and acceptability among both the residents and faculties as an effective teaching and learning tool.

Introduction: Exposure to any type of noise has a potential risk. Higher the level of noise and longer duration of exposure, the more the risk for the hearing sensitivity and health as a whole. The objective of the study is to determine the prevalence of Occupational Noise Induced Hearing Loss (ONIHL) among the industrial workers in Bhutan and to ascertain high risk establishment and vulnerable occupations. Methods: The hearing assessment was conducted among 1638 workers considering different types of industries and occupations to ascertain the prevalence of occupational noise induced hearing loss and vulnerable group amongdifferent industries and occupations. Descriptive statistics and binary logistic regression were performed to test the significance of ONIHL among the various independent variables. Results: The study found that the prevalence of ONIHL stands at 27.9% among industrial workers in Bhutan. 42.45% of candidates who had ONIHL reported with tinnitus in either or both ears. This study founda significant association between the exposure duration and the severity of ONIHL among the industrial workers. Considering the type of industry, wood based industry, hydro services, cement and polymer were found to have a higher prevalence of ONIHL and similarly, higher prevalence of ONIHL were found among occupations such as blaster, chipper, carpenters, dryer (knife grinder) and crusher operators. Conclusions: This study conduces that prevalence of ONIHL among industrial workers is found to be at the higher side and some of the occupations and industries impose higher risk. The study suggests that there is need for intervention such as strict enforcement of the permissible exposure limit, monitor and evaluate hearing conservation programs, and providing advice and recommendation to address such issues by the relevant agencies and industries

Background Hearing impairment due to ototoxicity is one common cause adding to global burden of disability. Amikacin and kanamycin are two common Aminoglycosides used to treat multidrug resistant tuberculosis which results in ototoxicity. The mean prevalence rate of multidrug resistant tuberculosis in Bhutan stood at 16%. Objective The study is aimed to establish prevalence rate of hearing impairment due to ototoxicity and secondary side effects which may ascertain specific early intervention. Method A total of 42 Patients undergoing multidrug resistant tuberculosis treatment participated in the study conducted at Jigme Dorji Wangchuk National Referral Hospital and Gidakom Hospital over a period of one year. Audiological tests were conducted once every month. The severity of ototoxicity was being graded using Brock's hearing loss grades. Result The study found 45.23% participants with some degree of hearing loss consequent to multidrug resistant tuberculosis treatment. Around 9.5% of the total participants developed potential disabling hearing loss. Around 30.09% of participants had experienced subjective tinnitus during the course of treatment. Study found no significant association (p-value 0.88, 95%CI 0.93–1.00) between referred test result of DPOAE (distortion product Otoacoustic emission) screener and the ototoxicity. Conclusion Study showed with significant prevalence of ototoxicity. Since hearing impairment have negative impact on psychosocial wellbeing and communication abilities, it is paramount importance to put in place the various preventative measures. With current guidelines by World Health Organisation on replacement of second-line injectable by oral regimens while treating patients with MDR-TB, it is expected to address ototoxicity and related issues.

There is no international reporting of SARS-CoV-2 infections in health care workers (HCWs). Estimates suggest that a HCW dies every thirty minutes from COVID-19. This worsened the shortages and burnout of HCWs worldwide. Twenty months into the pandemic, Bhutan recorded over 2600 COVID-19 positive cases and three deaths. About 906 HCWs were directly involved in managing these laboratory confirmed cases but no infections occured amongst this group. This zero infection was possible through the clustered management of positive cases in four national COVID-19 centers, strategic deployment of HCWs, the uninterrupted provision of quality personal protectiPPE and repeated training on the correct use of PPE. This is an exemplary achievement for a small country with limited expertise and resources.