Seasonal Hyperacute Panuveitis (SHAPU) in Bhutan.

PURPOSE: To report the first series of Seasonal Hyperacute Pan Uveitis (SHAPU) from Bhutan. METHODS: We retrospectively analyzed the patients with clinically diagnosed SHAPU treated in the referral center in the last 5 years. Data included demographics (age, sex, laterality), region, time of presentation (year, season) and treatment received. RESULTS: The series included 3 males and 2 females. The mean age was 16 years. Three patients had presented in autumn of 2021, and two in autumn of 2019. Four patients presented within 2 weeks of the onset of symptoms. All patients had either exposure or contact with white moths. All patients presented with unilateral sudden painless reduction in vision and low Intraocular pressure. Four patients required vitrectomy. The final visual acuity of 3 patients was >6/36, and one patient was 6/60. CONCLUSIONS AND IMPORTANCE: The time of presentation and early treatment intervention are crucial in achieving good visual prognosis in SHAPU.

Intravitreal Bevacizumab in Management of Persistent Secondary Macular Hole with Epiretinal Proliferation.

BACKGROUND: Aetiology for non-closure of full-thickness macular hole (FTMH) becomes crucial in determining the method of effective mode of intervention. Association of epiretinal proliferation (ERP) along with full-thickness macular hole (FTMH) have shown poorer anatomic and visual outcomes after surgical intervention. Various surgical techniques have been described in literature for treatment of persistent MH. CASE: We report a A 60-year-old female patient with FTMH secondary to branched retinal vein occlusion (BRVO) initially associated with ERP. OBSERVATIONS: She was successfully managed by treating with combination of intravitreal injection of off label bevacizumab (Avastin) (1.25 mg/0.05 ml) and pure gas of SF6 (1 cc) under topical anaesthesia after an initial surgical intervention. CONCLUSION: Presence of ERP in retinal vein occlusion cases needs closer and frequent follow up. IVB can be used as an adjunct in treating secondary MH.

The nutritional status of children in Bhutan: results from the 2008 National Nutrition Survey and trends over time.

BACKGROUND: There are few reports on the nutritional status of Bhutanese children. The objective of this paper is to summarize results from the 2008 National Nutrition Survey and to describe progress achieved during the last two decades. METHODS: A cross-sectional survey of 2376 children aged 6 to 59 months was conducted during November-December 2008 to provide national and regional estimates. A multi-stage cluster sampling method was applied and 40 gewogs/thromdes were selected from each region (Western, Central, Eastern). Guidelines on how to measure length/height and weight followed WHO standardized procedures. Data were analysed for consistency and validation using the software WHO Anthro and the WHO SPSS macro. Underweight, stunting, overweight, wasting and thinness were defined based on the WHO Child Growth Standards. Data from 1986-88 and 1999 national surveys were reanalysed using the WHO standards to describe trends in nutritional status. RESULTS: Nationally, 34.9% Bhutanese preschool children are stunted and 10.4% are underweight. Wasting is 4.7%, with severe wasting close to 2% in rural areas, while overweight affects 4.4% of preschool children. While underweight rates are similar across regions, wasting is substantially more prevalent in the Western region and stunting in the Eastern region. Stunting shows a steep rise during the first two years of life, as high as 40%, and levels off thereafter, while wasting is greatest among children aged 6-24 months and subsequently decreases. The prevalence of stunting fell from 60.9% in 1986-88 to 34.9% in 2008, and underweight declined from 34.0% to 10.4% during same period. The percentage of wasted children dropped from 5.2% in 1986-88 to 2.5% in 1999 but then increased to 4.7% in 2008. CONCLUSIONS: There have been major improvements in the nutritional status of Bhutanese children over the past two decades, however, linear growth retardation remains a significant concern. Early identification of growth faltering is essential for improving the effectiveness of public health programs to prevent stunting. Similarly, wasting rates indicate the need for a system to identify children with severe malnutrition in the isolated communities so that they can receive appropriate care.