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Key Clinical Message: Rheumatic heart disease is a preventable disease. Patients may not present with a typical history of sore throat and polyarthritis but may present with Sydenham's chorea. We should not rely completely on clinical findings to rule out carditis. Echocardiography should be done to rule out subclinical carditis. Abstract: Sydenham's chorea is a major manifestation of rheumatic fever. It occurs primarily in children and is seen rarely after the age of 20 years. We describe a 16-year-old girl who presented with purposeless involuntary movements of her upper and lower limbs. Laboratory blood reports showed raised erythrocyte sedimentation rate and anti-streptolysin O. 2D Doppler Echocardiography confirmed subclinical carditis, thickened mitral and aortic valve with mild mitral regurgitation. She was managed as Acute Rheumatic Fever with oral Phenoxymethyl penicillin and Carbamazepine. At the latest follow-up interviewing the caregiver, the patient had no sequelae. Early diagnosis is key to preventing late consequences of acute rheumatic fever and rheumatic heart disease. Sydenham's chorea is a rare presentation of acute rheumatic fever. The absence of clinical carditis does not rule out carditis.

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A novel cost-effective disposable porous graphene electrode (P-GE) modified with bismuth nanoneedles (nano-BiNDs) is proposed as a "mercury-free" sensor for detecting heavy metals through smartphone-assisted electrochemical sensing. The P-GE was fabricated using screen-printing. Nano-BiNDs were generated on the P-GE by potentiostatic electrodeposition. Using an optimal potential of -1.20 V (vs. pseudo-Ag/AgCl) and a deposition time of 200 s, the nano-BiNDs had an average length and width of 189 ± 5 nm and 20 ± 2 nm, respectively. The analytical performances of the fabricated sensing platform were demonstrated by detecting Cd2+ and Pb2+ using square-wave anodic stripping voltammetry (SWASV) under optimized conditions. In the optimal conditions, the fabricated sensor exhibited sharp, well-defined stripping peaks for Cd2+ and Pb2+ with excellent peak-to-peak separation. The linear detection ranges were from 0.01 to 50 µg mL-1 for Cd2+ and 0.006-50 µg mL-1 for Pb2+. The detection limits for Cd2+ and Pb2+ were 3.51 and 2.10 ng mL-1, respectively. The developed portable sensor demonstrated high sensitivity, good repeatability, reproducibility, and anti-interference properties. The proposed portable sensor quantified Cd2+ and Pb2+ in commercial seaweed products with good accuracy, consistent with the results obtained using the standard ICP-OES method.

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Nitrite (NO2-) is widely used as an additive to extend the shelf life of food products. Excessive nitrite intake not only causes blood-related diseases but also has the potential risk of causing cancers. A disposable screen-printed electrode was modified with nano­palladium decorated bismuth sulfide microspheres (nanoPd@Bi2S3MS/SPE), and integrated with a smartphone-interfaced potentiostat to develop a portable, electrochemical nitrite sensor. NanoPd@Bi2S3MS was prepared by the hydrothermal reduction of a Bi2S3MS and Pd2+ dispersion and drop cast on the SPE. The nanoPd@Bi2S3MS/SPE was coupled with a smartphone-controlled portable potentiostat and applied to determine nitrite in food samples. The linear range of the sensor was 0.01-500 µM and the limit of detection was 0.0033 µM. The proposed system showed good repeatability, reproducibility, catalytic stability, and immunity to interferences. The proposed electrode material and a smartphone-based small potentiostat created a simple, portable, fast electrochemical sensing system that accurately measured nitrite in food samples.

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We present a highly sensitive and selective electrode of laser-induced graphene modified with poly(phenol red) (P(PhR)@LIG) for measuring zinc nutrition in rice grains using square wave anodic stripping voltammetry (SWASV). The physicochemical properties of P(PhR)@LIG were investigated with scanning electron microscopy (SEM), energy-dispersive X-ray (EDX), Fourier infrared spectroscopy (FT-IR) and Raman spectroscopy. The modified electrode demonstrated an amplified anodic stripping response of Zn2+ due to the electropolymerization of P(PhR), which enhanced analyte adsorption during the accumulation step of SWASV. Under optimized parameters, the developed sensor provided a linear range from 30 to 3000 µg L-1 with a detection limit of 14.5 µg L-1. The proposed electrode demonstrated good reproducibility and good anti-interference properties. The sensor detected zinc nutrition in rice grain samples with good accuracy and the results were consistent with the standard ICP-OES method.

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This work introduces a 3D-printed portable electroplating device for the visualization of latent fingerprints (LFPs) on metallic substrates. An electroplating solution of Ag+-Cu2+ in a deep eutectic solvent (DES) is used. The electroplating is performed by two electrodes equivalent to an anode (+) and a cathode (-). The cathode is connected to the metal surface with the magnetic or alligator clip for carrying the LFP. The anode is connected to cotton dipped in the electroplating solution. The device was optimized in terms of the electroplating solution composition, and electroplating potential, current, and time. The device produced images with good resolution, revealing LFP ridges in minute detail of more than 12 points. The device also exhibited good repeatability and images were assessed against guidelines from the Centre for Applied Science and Technology (CAST) and the International Fingerprint Research Group (IFRG). The developed device could be applied to visualize LFPs in forensic investigations.

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Background: The National Action Plan on Antimicrobial Resistance in Bhutan promotes the rational use of antibiotics. It is important to establish baseline data on the use of antibiotics and the quality indicators of antibiotic prescriptions to identify where improvement efforts may need to be focused. Objectives: To describe the prevalence and patterns of antibiotic prescription and establish baseline data regarding quality indicators of antibiotic prescriptions in four major hospitals in Bhutan. Methods: This was a point prevalence survey of antibiotic use among inpatients in June 2022 conducted using the Australian National Antibiotic Prescribing Survey (NAPS). Results: There were 314 patients (41.5%) receiving at least one antibiotic on the audit day. Among prescriptions reviewed, 278 (88.5%) had indications for use documented, 102 (32.5%) had a review or stop date documented and 120 (38.2%) had microbiology samples collected prior to antibiotics. Ceftriaxone (68; 21.7%), cefazolin (41; 13.1%) and metronidazole (32; 10.2%), were the common antibiotics prescribed. The most common indications for use were surgical prophylaxis (42; 13.4%), community-acquired pneumonia (39; 12.4%) and sepsis (26; 8.3%). There were 125 prescriptions (39.8%) that were compliant with national/therapeutic antibiotic guidelines and 169 (53.8%) where antibiotic prescriptions were appropriate. Conclusions: This study identified key areas for targeted interventions in antimicrobial stewardship programmes in Bhutan. The prevalence of antibiotic use, indications for use, and drug choices were similar to data from other countries. Documentation plans for durations of use, prolonged surgical prophylaxis and concordance of choices with guideline recommendations present opportunities for improvement.

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Near-field communication (NFC) was used to control a portable glucose biosensor for diabetes diagnosis. The system comprised a smartphone and an NFC potentiostat connected to a screen-printed carbon electrode (SPCE) modified with Prussian blue-graphene ink and functionalized with gold nanoparticles-embedded poly (3,4ethylene dioxythiophene):polysulfonic acid coated with glucose oxidase (GOx-AuNPs-PEDOT:PSS/PB-G). GOx catalyzed the glucose redox reaction while the conductivity and sensitivity of the AuNPs-PEDOT:PSS composite enhanced electron transfer to the PB-G, which was used as a mediator. The fabrication process was characterized by scanning electron microscopy (SEM) with energy dispersibe x-ray analysis (EDX). The platform was electrochemically characterized by electrical impedance spectroscopy (EIS) and cyclic voltammetry (CV). The NFC biosensing device was then applied to quantify glucose in human blood serum by amperometry. The linear concentration range and detection limit for glucose were 0.5-500 µM and 0.15 µM, respectively. The accuracy of the device was good and results were in agreement with the results obtained from the standard hospital method. This NFC glucose sensing device can be a simple, sensitive, selective and portable platform for medical diagnosis.

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Black-necked Crane (Grus nigricollis) is a vulnerable Red list species whose populations are declining. However, little is known about Black-necked Cranes' habitat requirements or the causes of their population decline. We identified Black-necked Cranes' winter roost and foraging preferences of Black-necked Cranes in Bhutan during the winter of 2013-2014. Black-necked Cranes' roosts were recorded using Garmin GPSmap 60CSx, while foraging preferences and threats to the birds were identified based on a survey of household heads (n = 107) residing within a 3 km radius of roost sites. We grouped the threats identified by the communities into four major categories, viz. biological, social, political and natural threats based on the relevance. Of the four major threats, communities residing within the roosting and foraging habitat of the Black-necked Crane reported biological threat as major. Biological threats as reported by communities include loss of habitat, food shortage and competition from other animals. We recommend the present roosting areas be designated as part of the conservation areas for Black-necked Crane wintering in Bumthang district. In addition to preserving these areas, government should also encourage farming in foraging habitats of Black-necked Crane, because they mainly feed on barley, wheat, paddy, potatoes and buckwheat, besides roots, tubers and insects in the wetlands.