Introduction: Tibetan medicine (TM) is a whole systems medical approach that has had growing interest in the West. However, minimal research, particularly with cancer, has been conducted. The purpose of this article is to provide an overview of TM and describe a clinical case review study to obtain preliminary evidence of TM's safety and effect on patients treated for cancer or hematologic disorders. Methods: A retrospective case review was conducted in India and cases met the following inclusion criteria: (a) confirmed diagnosis of cancer or hematologic disorder by standard Western biomedical diagnostic tests, (b) either treated exclusively with TM or received insufficient Western treatment followed by TM and (c) were in remission or had stable disease at least 2 years after start of TM. Results: Three cases were identified, 1 solid tumor and 2 hematologic diseases: Case 1-poorly to moderately differentiated adenocarcinoma of the stomach, positive lymph nodes and mucosal infiltration, with clear scans and excellent quality of life 29 months later ; Case 2-chronic myelogenous leukemia with normalization of hematologic labs within 3 months of starting TM and stable 4 years later; and Case 3-red cell aplasia improved significantly and reversed dependence on blood transfusions with TM. None of the cases experienced demonstrable adverse effects from TM. Conclusions: This limited case review found TM to be safe and have positive effects on quality of life and disease regression and remission in patients with cancer and blood disorders. Further exploration and investigation using rigorous methods is warranted.

Multidrug-resistant tuberculosis (MDR-TB) is a well-identified raising public health concern worldwide. However, the data available on MDR-TB in children and particularly in the neonate age group are limited. Congenital tuberculosis (TB) is rare, and its diagnosis is challenging because of non-specific manifestations. The choice of anti-tubercular drugs is difficult because of the lack of international consensus as a consequence of the scarcity of evidence-based data on this age group. We hereby present a case from Bhutan of a 23-day-old male neonate with congenital MDR-TB. His mother was diagnosed with disseminated TB, and treatment was commenced 11 days post-partum. Congenital transmission of TB was suspected, as direct postnatal transmission was unlikely and thorough screening of contacts for TB was negative. In this case, the mother's MDR-TB status was revealed only after her newborn's MDR-TB diagnosis.

Background: Enteric fever (EF) continuous to be a serious health threat in Nepal and children are mostly affected from this systemic illness with gruesome complications if left untreated. Accurate diagnosis and appropriate antimicrobial therapy still remain a challenge here. Though ceftriaxone is used as the drug of choice in hospitalized patients, there are concerns on emerging cephalosporin resistance in adults, though not reported in children yet. The objectives of this study were to assess the defervescence time and outcomes of children hospitalized with EF treated with ceftriaxone.Methods: This prospective observational study was conducted at Kathmandu tertiary hospital, Nepal for 12 consecutive months. Children (5-16 years) diagnosed with enteric fever using WHO or validated clinical diagnostic criteria were eligible for recruitment. After taking written informed consent, enrolled children were treated as per the institutional treatment protocol with a same brand of ceftriaxone of standard daily dose and duration of 7 days for uncomplicated and 10 days for complicated. Data on defervescence time, treatment outcomes and their clinical and laboratory profile were collected in the predesigned proforma and analyzed.Results: Of 106 enrolled children, the predominant manifestations were headache (95.3%), loss of appetite (94.3%) and abdominal pain (90.6%). The main laboratory findings were positive Widal test (74%) and thrombocytopenia (50%). Nine children (8.5%) showed blood culture positivity. Salmonella typhi with nalidixic acid resistant strains and Salmonella paratyphi A were isolated (2:1) and were sensitive to ceftriaxone (100%). The defervescence mean time was 3.94 days (± 0.96 SD). Children with positive blood culture had significantly longer defervescence time than those with negative culture (4.56 versus 3.89 days; p=0.04). One child developed complication (pneumonia). No children died or encountered treatment failure. Thrombophlebitis (38.7%) was the only adverse effect of ceftriaxone. Conclusion: Ceftriaxone of once daily dosing regimen exhibited safe and satisfactory treatment outcomes with approximate four days to defervescence. Ceftriaxone can still be drug of choice for the treatment of EF in hospitalized children. Further studies with a greater number of isolates for the classical clinical profile of EF and cephalosporin susceptibility in children may confirm or refute these findings.

Background: Neonatal jaundice is a common condition especially in the first week of life. There are various maternal and neonatal clinical characteristics that have been associated with pathological jaundice. Objectives: To describe clinical profile of pathological jaundice and to estimate its prevalence among newborns admitted at the National Referral Hospital. Methods: A cross-sectional descriptive study design was used to study pathological jaundice cases admitted at the Gyaltsuen Jetsun Pema Neonatal Intensive Care Unit (NICU) of Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) from 7th November 2018 till 6th November 2019. Data was collected using a predesigned case proforma, entered and analyzed in Epidata after obtaining ethical clearance from the Research Ethics Board of Health (REBH), Bhutan.  Results: Facility based prevalence rate of pathological neonatal jaundice was found to be 63.66% in our setting. The median age on presentation was 4 days. Blood group ABO incompatibility and neonates less than one week of age were found to be most common neonatal profile in this study. Significant association was found between primiparous mothers and excessive weight loss. Conclusion: The prevalence of pathological jaundice was high in our setting. ABO incompatibility, neonates less than one week of age, primigravida mothers with feeding issues should be closely followed or screened for pathological jaundice especially during the first one week of life. Keywords: Pathological jaundice, Prevalence, ABO incompatibility, feeding issues, excessive weight loss

Introduction: The epidemiology of kidney diseases in children can vary widely across geographic regions. The main purpose of this study was to determine the pattern and short-term outcome of kidney disease among children hospitalized at the national referral hospital in Bhutan. Methods: All admitted children aged one month to 12 years with kidney disease, from January to December 2018, were included in the study. Diagnostic criteria were applied to all the patients on admission to determine study eligibility and subsequent demographic and clinical data were collected using a structured interviewer administered pro forma. Results: A total of 128 (7.8%) children met diagnostic criteria for kidney disease among 1648 hospitalized children during the study period. The median age at presentation was 2.5 years (interquartile range 0 to 8). The commonest disease was acute kidney injury (48, 37.5%) followed by acute glomerulonephritis (37, 28.9%), urinary tract infection (37, 28.9%), congenital anomalies of kidney and urinary tract (11, 8.6%) and nephrotic syndrome (11, 8.6%). Median duration of hospital stay was 8 days (IQR 4 to 14.8). Four (3.1%) patients were referred to India for specialist care, 5 (3.9%) underwent dialysis and 28 (21.9%) died. Of the 28 patients who died, 26 (92.9%) had acute kidney injury and 2 (7.1%) had chronic kidney disease. Conclusions: Pediatric kidney diseases comprise a significant proportion of disease burden at the national referral hospital. Education of primary healthcare providers about the epidemiologic burden of pediatric kidney diseases is needed to reduce kidney-related morbidity and mortality.