A case of 60 year old with anemia and splenomegaly that was confirmed to be CLL was discussed today. Clinical history, findings and a differential diagnosis was discussed by Dr Kesang, GDMO.
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About Me
- Dr. Puru
- Mongar Referral Hospital, Mongar, Bhutan
- I am a Pediatrician(With Special Interest in Pediatric Cardiology) at Mongar Hospital.
Welcome to my blog!
Hello everyone,
Welcome to my blog ! Let's share something interesting and something useful. I will make an attempt to update you on what is happening in and around Mongar Hospital . You are most welcome to contribute and comment in this blog!
Welcome to my blog ! Let's share something interesting and something useful. I will make an attempt to update you on what is happening in and around Mongar Hospital . You are most welcome to contribute and comment in this blog!
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MY CV IN SHORT
- O level: Punakha High School,1992
- A Level: Sherubtse college, 1994
- MBBS, Banaras Hindu University,2000
- Field Attachment, Punakha Hospital, 2000
- DMO Dagana 2001
- Superintendent, Riserboo Hospital,2002
- DMO, Trashiyangtse,2003-04
- Diploma in Child Health,PGIM Colombo,2007
- MD( Paediatrics)PGIM, Colombo, 2008
- Pediatrician , MRRH (2008-till date)
Quick Links
MRRH In Brief!
- 150 bedded Regional Referral Hospital
- Inagurated 2008, GOI funded.
- About 270 Staff in total
- Seven Units including OT and casualty
- 24 hours Casualty
- ICU and NICU with Ventilators
- All major specialities( Medicine,Psychiatry, Surgery,Gyn and Obs, Pediatric,Eye, ENT, Orthopedic, and Dental)
- Indegenous Unit with Steam/Herbal bath facilities
- Well Established Laboratory,X-ray,Endoscopy, Ultrasound, Basic Echocardiography,ECG and many other facilities.
- Fully Functional Dialysis Unit
MRRH Update
- Pediatrician and Medical Specialists conducted clinic at Lhuntse Hospital
- Orthopedic, Gynecologist and Radiologist to conduct clinic in S/jongkhar
- HAMT meeting done on 13th October
- Team from Burn Care USA visited MRRH
- Minister of Health visited MRRH and met with staff
- Team from JDW conducting Emergency Medical Course for medical officers at Mongar
- Eye Specialist Dr Bhim transferred to JDW
- Health Education Unit started adjacent to the maternity ward
- General Body Meeting conducted on 10th August
- External Consultant Reviews Under Five Deaths
- Accountant Tashi Wangmo transferred to Trade office, Mongar
- Seven fresh nurses to Join MRRH: No signs of separating NICU yet
- Hospital survives a potential fire threat at wee hours today 8th August
- Orientation to new nurses conducted today 8th August
- Specialists visit Lhuntse Hospital: 28th July
- Mortality meeting: case of a young female with acute liver failure
- Conference Hall now equipped with A/V equipment and new furniture
- A junior doctor from Burma doing attachment in Medicine Unit, MRRH
- Visitors card system initiated to control too many visitors
- Some new staff( Procurement Officer, Store Officer )to join MRRH
Clinical Case Conferences so far
- 1.Fanconii Anemia-Dr Puru
- 2. Chronic Eosinophilia-Dr Puru
- 3. Hypertension in the Young-Dr Kesang Namgyel
- 4. Henoch Shoenlin Purpura-Dr Kesang Namgyel
- 5. Clinical case of Thrombocytopenia-Dr Kesang Namgyel
- 6. Case of Anasarca-Dr Kesang MD
- 7. Case of Gynecomastia: Surgical Specialist
Unit Heads:MRRH
- Casualty: Mrs Neelima Chhetri
- Unit I: Br Pema
- Unit II: Br Norden Lepcha
- Unit III: Kuenzang Thinley
- ICU/NICU: Br Hem Kumar
- Dialysis: Br Karma Tenzin
- OT: Sis Sangay
CME topics covered so far
- 22. Neonatal Resuscitation-Sis Sonam Choden and Br Thinley
- 21. ECG for nurses-Dr Kesang
- 1. Scrub Typhus-Dr P. Bhandari
- 2. Basics of Chemotherapy-Dr Ugen Tshomo
- 3. Blood Transfusion in Clinical practice-Dr B.M. Dhungel
- 4. Chronic Eosinophilia-Dr P. Bhandari
- 5. Advances in Infertility -Dr Sonam Gyamtsho
- 6.Baby Friendly Hospital Initiative-Kesang Wangmo
- 7. Clinical case of Hemolytic anemia-Dr Kesang, Medical Specialist
- 8.Recent advances in Labour Management
- 9.Where there is no Orthopedic Surgeon, Dr Ugen Thinley
- 10.Ophthalmological Emergencies-Dr BB Rai
- 11. Clinical Case of Kala-azar-Dr Namsa
- 12. Basic and Adanced Life Support, Dr Min
- 13. Management of Head Injuries-Dr Myat
- 14.Disaster Preparedness-Dr Hoffman
- 15. Approach to Coma-Dr Kesang ,MD
- 16.ENT Emergencies
- 17. Case of Leukemia, Dr Kesang, GDMO
- 18. Maternal Collapse-Dr Sonam Gyamtsho
- 19. Reduced Fetal Movements: Dr Sonam Gyamtsho
- 20.Evidence Based Medicine-Dr Min
Updated list of doctors at Mongar Hospital
1.Dr .......................Medical Superintendent(post vacant)
2.Dr Kesang Namgyel, MBBS, MD-Medical Specialist
3.Dr.Sonam Gyamtsho, MBBS, MD, Fellow(infertility)-Gynecologist
4.Dr Krishna Sharma, MBBS,MD, Fellow(Cytopathology),Pathologist
5.Dr P.Bhandari, MBBS, DCH, MD-Pediatrician
6.Dr. B.B Rai, MBBS,D. Ophth,DNB-Eye Specialist/Vitreo Retina Specialist.
7.Dr Ugen Thinley, MBBS, MD-Orthopedic Surgeon
8. Dr. Nidup, MBBS, MD,Radiologist
9.Dr Maung Maung Than, Surgeon.
10.Dr. Kyaw Htut Win, ENT specialist
11.Dr Tin Tin Aye, Psychiatrist
12.Dr Kyi Kyi Aye, Anaesthesiologist.
13. Dr Manjunath, Prosthodontist
14. Dr Suneeta, Periodontist
15. Dr Sangay Dorji, GDMO
16. Dr Aiye, GDMO on attachment.
2.Dr Kesang Namgyel, MBBS, MD-Medical Specialist
3.Dr.Sonam Gyamtsho, MBBS, MD, Fellow(infertility)-Gynecologist
4.Dr Krishna Sharma, MBBS,MD, Fellow(Cytopathology),Pathologist
5.Dr P.Bhandari, MBBS, DCH, MD-Pediatrician
6.Dr. B.B Rai, MBBS,D. Ophth,DNB-Eye Specialist/Vitreo Retina Specialist.
7.Dr Ugen Thinley, MBBS, MD-Orthopedic Surgeon
8. Dr. Nidup, MBBS, MD,Radiologist
9.Dr Maung Maung Than, Surgeon.
10.Dr. Kyaw Htut Win, ENT specialist
11.Dr Tin Tin Aye, Psychiatrist
12.Dr Kyi Kyi Aye, Anaesthesiologist.
13. Dr Manjunath, Prosthodontist
14. Dr Suneeta, Periodontist
15. Dr Sangay Dorji, GDMO
16. Dr Aiye, GDMO on attachment.
Recent Nominations for Trainings/Workshop/Conference for Mongar Hospital
- Br Phuntsho to attend Infection Control workshop at Gelephu
- Bro Pema atteneded IMNCI monitoring workshop in Paro
- Some nurses from indoor and MCH attended breastfeeding worksho at Gidakom
- Dr Puru, Telemedicine Conference, Singapore
- Dr Puru and Dr Ugyen, IMTRAT Update at Thimphu
- ACO Thering, Mental Health Workshop, Paro
- Dr Puru, Sis Sonam Deki and Sis Pema JDWNRH
- Dr Sangay GDMO for ECCD in Paro
- Dr Puru, Meeting on Congenital Birth Defects, Bangkok
- Dr Sonam Gyamtsho, PMTCT, Bangkok
Current patient list-NICU and ICU
- 2101;Premature, Low birth weight, apnea of prematurity.
- 2102:Neonatal Jaundice
- 2103:
- 2104:Pneumonia in young infant
- 2109:
Current Patient List :Pediatric Ward
- Cabin:
- P1:
- P2:
- P3:Meniingitis
- P4: Pneumonia
- P5 : LRTI
- P6: Lobar Pneumonia
- P7: Cerebral Palsy with Pneumonia and rib osteomyelitis
- P8:
- P9:
- P10:
- P11:
- P12;Acute Glomerulonephritis
- P13: Nephrotic Syndrome
- P14:
- P15:Miliary TB
- P16-18: Medical patients
Pediatric/Neonatal Referrals to JDWNRH
- 80. Meningitis with acute hydrocephalous
- 79. Abdominal mass? TB
- 78.Cyanotic heart disease
- 77. Conjugated Hyperbilirubinemia(referred to In)dia
- 76. Downs with PDA( own transport)
- 75. TB suspect, but no focus
- 74. ASD and PS for Further referral to India
- 73. Ex premature with developmental delay secondary to hearing impairement
- 72.Seven year old with large PDA
- 71.Neonate with congenital Diaphragmatic hernia
- 70. Severe wasting with Recurrent abdominal pain
- 69. Autism suspect
- 68. Neuroblastoma in a neonate
- 67.Mucopolysaccharidoses?
- 66. Congenital HD( Severe PS and PDA) and Hydrocephalous
- 65. Prolonged Jaundice with acholic stools
- 64. Recurrent Wheezing, for further referral to Kolkotta
- 63. Hemolytic jaundice?
- 62. Burns with major GI Bleeding
- 61. Pelvi-Calyceal dilatation in an 8 year old
- 60. Diabetes Insipidus
- 59. 8 years with altered behavior( History of Head Injury)
- 58. 8 years RHD,AR( to cardiologist): seen and sent back
- 57. 8 year old with large VSD,PHT,FTT( OPD basis for further referral to India)
- 56. RHD, MR, AR
- 55. 1 month ofld with? gut malrotation/volvulus
- 54. 8 years old with ? ICSOL/ Neurodegenerative Disorder
- 53. Severe anemia, pale stools: Neonatal hepatitis? from NICU
- 52. Suspected Gastric Outlet Obstruction
- 51. Complex Congenital Heart Disease( again sent back saying no budget and need 12 kg!)
- 50. Meningits with raised ICT, and possible brain abcess( had a subdural empyema on CT)
- 49.Complex Partial Seizures with Developmental Delay
- 48. Child with a very thick bladder wall
- 47. 14 months old with multiple cysts in the liver and jaundice
- 46.Anasarca and Bicytopenia
- 45.Ebstein"s anomaly(Referred to India)
- 44. Bilateral hydronephrosis( seen by urologist, Ped surgeon and sent back on follow up)
- 43. Zygomatic Swelling( Refused Bone marrow and further referral from JDW)
- 42. Ig A nephropathy
- 41. Focal Seizures( has neurocysticercosis)
- 40. Cholecystitis
- 39. 3 year old with large ASD and failure to thrive( Operated)
- 38. Neonate with Wilms Tumor/Neuroblastoma(turned out to be adrenal hemorrhage)
- 37. Pancytopenia with Organomegaly
- 36.Child with acquired speech problem
- 35. Recurrent RTI for HRCT chest( normal CT)
- 34.Hemolytic anemia( sent back with plan to refer later to india)
- 33.Hemophilia Suspect( confirmed from Kolkotta)
- 32. Developmental Delay( OPD basis)
- 31. Downs Syndrome with Sepsis and Bilious NG aspirates( Died at MRRH)
- 30. CHD( VSD,PS, SA membrane)( Operated at Durgapur for VSD, SA membrane)
- 29. Congenital hydrocephalous( OPD basis)
- 28. Two cases of CHD: VSD,ASD, PDA and another one with Pulmonary atresia, VSD
- 27. 5 year old with Chronic Cough(OPD basis)
- 26. Ex-Premature with Retinopathy of Prematurity
- 25. Suspected Meningoencephalitis
- 24.Acquired Immunodeficiency(expired at JDW)
- 23.Pyloric Stenosis/Volvulus
- 22. Meningitis with focal signs
- 21. Meconium Ileus
- 20. Pyopericardium( second case in a month)
- 19. Cyanotic Heart Disease
- 18. Wilms Tumor
- 17. Purulent pericardial effusion( Went to Durgapur and had an anterior pericardiotomy)
- 16. Steroid reisistant Nephrotic syndrome
- 15. 7 year old with eosinophilia, pulmonary infiltrates and hemiparesis
- 14. 2 month old with Pyloric Stenosis( Had a band in stomach)
- 1. Prolonged Unconjugated Hyperbilirubinemia
- 2. Chronic Renal Failure
- 3. Psoriasis Vulgaris( diagnosed chronic Eczema)
- 4. Post Kasai with Portal Hypertension
- 5. PUO
- 6. Chronic Headache with Neurological Signs
- 7.Febrile UTI with Left sided Pelvi calyceal dilatation
- 8. One year old with Meningoencephalitis
- 9. Neonate with seizure Disorder
- 10. 7 year old with Pink Fallots
- 11.7 year old with hemiplegia
- 12. Child with cyanotic heart disease(TOF), brain abcess and CTEV
- 81. Khuru Injury with Raised ICT
Top three morbidities in the Neonatal Unit, MRRH,2011
- 1. Neonatal Jaundice
- 2. Prematurity and associated conditions
- 3. Sepsis Neonatorum
Top three causes of death in Neonatal Unit 2011
- 1.Prematurity and associated conditions.
- 2. Sepsis
- 3.Birth Asphyxia
- OUR NEONATAL MORTALITY RATE(MRRH only) is 9.98/1000 LIVE BIRTHS-2010
Top 5 diagnosis in admitted Pediatric Patients( Indoor Morbidity)2010
- 1.Pneumonia (238 cases)
- 2.Diarrhoea/Dysentry ( 35 cases)
- 3.Scrub Typhus( 32 cases)
- 4.Heart Diseases( Congenital and Aquired) 26 cases
- 5. Meningitis(20 cases)
MRRH VITAL STATISTICS
- Neonatal Mortality Rate: 9.98 per 1000 Live Births
- Low Birth Weight Rate 6%
- Prematurity Rate: 5 %
- Average Birth weight: 3.07 kg
- Total Live Births 505
My areas of Interest
- PEDIATRIC CARDIOLOGY
- SCRUB TYPHUS
- KAWASAKI DISEASE
- EMERGENCY PEDIATRICS
My Research Topics( Currently underway)
- Prospective Study on Pediatric Scrub Typhus
- Surveillance of Congenital Anomalies/Birth Defects
- Meningits /Acute Encephalitis Surveillance
Completed Research Activity
- Incidence of Congenital heart diseases in children born at Mongar Hospital( Approved by Health Ethics and Research Bureau, MoH)-2010 and presented at Annual Medical Conference,2011, Thimphu
- Pattern of Cardiac lesions in children attending Mongar Hospital-2009
- Clinico-Laboratory Profile of Children with Scrub Typhus-2009 AND presented at the Annual Medical Conference, 2011
- Nursing Shortage: A Nurse's Perspective-2009
Interesting clinical cases under follow up
- Bardeit Biedel Syndrome (Obesity)
- Chronic Eosinophilic Pneumonia
- Eosinophilic Purpura
- Fanconii Anemia
- Fraser Syndrome
- Freeman Sheldon Syndrome(Whistling Face Syndrome)
- Infantile Hypertrophic Cardiomyopathy
- Kawasaki Vasculitis Syndrome
- Klippel Feil Syndrome
- Marfans Syndrome
- Solitary kidney
- Werdnig Hoffman Type 2
If I could change something
- I would change the attitude of our health workers!
Unbelievable things some people do!
- Amother recently came to me with a sick baby. When i asked what was wrong , she said :" Moe gotpa kabnee Pneumonia khiwala yigla"
- A mother left the hospital with her baby saying that her father died that day, which was later found out not to be true!!
- Another mother left the hospital saying her mother died, which was also not true!
Blog Archive
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2010
(186)
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May
(14)
- Inviting CME Proposals
- Pentavalent gets a green signal
- Nurse Assistants
- CME: Maternal Collapse
- EMOC Workshop
- Mongar Hospital staff selected for training
- Neonatal Equipment through JICA
- Clinical Discussion: CLL
- Away at Paro
- CME: Approach to Coma
- Clinical Meeting: HSP
- First Phase HPV Vaccination
- Making Mongar Hospital Academically Active!
- HPV Vaccination Awareness
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May
(14)
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