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Background:The Postgraduate Medical Education globally has transited from traditional cognitive based to more competency-based learning. Bhutan’s only medical university, Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB) introduced Competency Based curriculum (CBC) through implementation of workplace-based assessment (WPBA) in June 2018. The proposed competency-based curriculum (CBC) was aimed at developing appropriate competencies in the learners through workplace-based assessment. A programmatic evaluation of the trainees and trainer’s perception on implementation of workplace-based assessment for three years at KGUMSB was conducted in July-Sept 2021. Methods: The evaluation was conducted in July-Sept, 2021. The mixed methods design was utilized such as survey, review of student portfolios and focus group discussion. A total of 62 participants (46 residents in clinical training and 16 faculty members) participated in this evaluation. Results: After three years of implementation of WPBA, it was perceived as a good system of assessing learners with a high level of acceptability among both the students and faculty members. The practice of providing immediate feedback was well appreciated by students. Conclusions: These findings support that WPBA is a good assessment system in postgraduate education. However, it was also evident that issues such as perceived time constraints, overburdened students and lack of faculty capacity were possible obstacles to proper implementation of WPBA.

Background Hydatid cysts are caused by Echinococcus granulosus infection, and hydatidosis is recognized as a re-emerging zoonotic disease globally. While the liver is the most commonly affected organ, other organs can also be affected, including the heart. Because of the low sensitivity and specificity of serologic diagnostic tests, ultrasound and echocardiography are increasingly used to make the diagnosis of cardiac hydatid cyst. Case report We report the case of a cardiac hydatid cyst, detected by point-of-care ultrasound (POCUS), in a 79-year-old woman who presented with shortness of breath and was in ventricular tachycardia. The diagnosis was further confirmed with a computed tomography scan. Although cases of alveolar and liver hydatid cysts are seen, this is the first case of a cardiac hydatid cyst in Bhutan. Why Should an Emergency Physician Be Aware of This? This case illustrates the importance of POCUS in reaching a diagnosis, particularly in resource-poor areas where other sophisticated diagnostic tools are not easily available. A cardiac hydatid cyst must be in the differential for structural causes of dysrhythmias. This is especially so because treatment of unstable dysrhythmias in the acute setting of an emergency department has to be modified from the usual algorithm in the presence of a cardiac hydatid cyst, due to the potentially fatal risk of cyst rupture and anaphylaxis.

Single-phase spinel cobalt oxide (Co3O4) and copper-substituted cobalt oxide (Co2.8Cu0.2O4) nanomaterials were synthesized via a co-precipitation route. To explore the potential applicability of the Co3O4 and Co2.8Cu0.2O4 materials for gas sensor fabrication, their SO2 gas sensing characteristics were studied at three different temperatures using the gas concentration of 3 ppm. Unsubstituted Co3O4 sample exhibits poor response towards SO2 gas whereas the Cu-substituted sample showed superior gas sensing characteristics such as gas response, response time and recovery time at all three temperatures. Among the three studied temperatures, the maximum gas response of 7.5% was found at 200 °C with recovery and response times of 26 sec, indicating an optimal temperature. Our results demonstrate that the nanostructured Co2.8Cu0.2O4 material could be a potential candidate to design SO2 gas sensor for detection of low concentration gas.

Hemorrhagic stroke accounts for a significant proportion of mortality and confers a poor quality of life with high dependency among survivors. Surgical evacuation of hematoma has the advantage of rapidly controlling the increased intracranial pressure, halting the ongoing herniation syndrome, and mitigating the secondary cascades of events mediated by the inflammatory and blood degradation products. The advantage is hindered by the concurrent insult to the healthy brain tissue while passing through the normal brain tissue. Therefore, minimally invasive approaches to evacuate the hematoma are employed, but the need for an expensive surgical armamentarium and the expert multidisciplinary team is the bottleneck for their application, particularly in low-income nations. We herein performed a study upon the role of mini craniotomy open surgical method of evacuating hematoma in selected patients with supratentorial intracerebral hemorrhage. We found a significant reduction in the surgery length, minimized risk of post-surgery complications, shortened intensive care unit stay, and reduced mortality compared to the full-fledged craniotomy and endoscopy-guided surgery. There is a need for a large-scale randomized multicenter prospective study to verify the advantages of minimally invasive approaches in the management of symptomatic supratentorial intracerebral hemorrhages.

Hemorrhagic stroke accounts for a significant proportion of mortality and confers a poor quality of life with high dependency among survivors. Surgical evacuation of hematoma has the advantage of rapidly controlling the increased intracranial pressure, halting the ongoing herniation syndrome, and mitigating the secondary cascades of events mediated by the inflammatory and blood degradation products. The advantage is hindered by the concurrent insult to the healthy brain tissue while passing through the normal brain tissue. Therefore, minimally invasive approaches to evacuate the hematoma are employed, but the need for an expensive surgical armamentarium and the expert multidisciplinary team is the bottleneck for their application, particularly in low-income nations. We herein performed a study upon the role of mini craniotomy open surgical method of evacuating hematoma in selected patients with supratentorial intracerebral hemorrhage. We found a significant reduction in the surgery length, minimized risk of post-surgery complications, shortened intensive care unit stay, and reduced mortality compared to the full-fledged craniotomy and endoscopy-guided surgery. There is a need for a large-scale randomized multicenter prospective study to verify the advantages of minimally invasive approaches in the management of symptomatic supratentorial intracerebral hemorrhages.

Objective The Bhutan Emergency Aeromedical Retrieval (BEAR) Team is the only helicopter emergency medical service in Bhutan. This study was performed to review the clinical cases cared for by the BEAR Team, ascertain the types of interventions that were performed, and determine the outcomes of patients evacuated in its first year of operations. Methods This is a retrospective observational study in which medical evacuations performed in the first year of operations were analyzed. The number of airlifts activated during the study period determined the sample size (171). Data were obtained from case logs and trip sheets. Results The BEAR Team provided services to all regions of the country in its first year. The overall survival rate was 73.1%. The most common intervention required was securing a definitive airway (n = 24). The top 3 conditions requiring air medical retrieval were sepsis, acute mountain sickness, and trauma. Conclusion Helicopter emergency medical services are known to decrease the time to definitive treatment. This is particularly pertinent in Bhutan, given the scattered population distribution, long transport times, and distribution of medical resources and specialty care. This study is the first of its kind in Bhutan, and this can pave way to conduct more studies involving patients transported by air ambulance.