Postgraduate medical education in Bhutan began in 2014 which marked a new era in the medical education in the country. From a mere handful of surgeons in 2003 to the numbers today, general surgical services have come a long way in Bhutan. Medical education has progressed tremendously to adoption of modern medical educational methods promoting objectivity in all aspects. This article dwells with the historical perspective as well as the state of the general surgical education and the services in Bhutan. It is the first of its kind of article to be written.

Introduction: Helicobacter pylori (H. pylori) is a bacterium causing chronic gastric infection and may cause gastric cancer. It was necessary to see the trend of infection, especially in symptomatic patients. This retrospective descriptive study was aimed to describe the characteristics of H. pylori infection in Bhutanese patients referred for an endoscopy to the National Referral Hospital, Thimphu. Methods: The sample of the study was randomized 380 medical records of the patients who underwent upper gastrointestinal endoscopy and Rapid Urea Test for symptomatic dyspepsia and peptic ulcer. Data was collected using a survey form designed by the researchers. Data analysis was done using descriptive statistics and either Chi-square or Fisher’s exact test. Results: The prevalence of H. pylori infection was very high (76.6%). The mean age of the infection was 42 with a range from 15 to 84 years. The highest prevalence of infection was observed in the age group 20-29 years (82.7%) and lowest in the oldest age group 70-84 years (66.7%). The analysis showed no significant difference in infection amongst age groups, gender, and endoscopic findings to the positive results at 5% significant level except for monthly prevalence (p<0.001). Gastritis was the commonest endoscopy finding (153/380) and gastro-duodenitis had the highest positivity rate (88.9%). Conclusion: The prevalence of infection was relatively high compared with previous studies. Young and middle-aged adults had a high prevalence and this group needs to be given priority for screening and eradication treatment considering limited resources to prevent associated gastric cancer in Bhutan.

The purpose of this article includes is to identify the factors that will determine the quality of academic performance of students and to assess teachers’ perceptions on factors that influence the quality of academic performance. In light of the deteriorating education quality and poor academic performance in high schools, it became important more than ever before to study the factors influencing the performance. The research focused mainly on educational article, thus, it was convenient to adopt descriptive research and follow the mixed method as a research design. The quantitative data was collected from 100 school teachers through e-mail and four principals for in-depth study. The interviews were recorded using the mobile device and then transcribed to analyze and develop themes. The research found that there is insufficient resources in school that has deteriorated the quality of academic performance, lack of professional development training. It was also evident that school culture contributes to improve the quality of academic performance. Therefore, the study recommends the  concerned agencies need to allocate enough resources, improve social ambience, conduct frequent in-service workshops for the teachers and as well act as change agent for further improvement of conducive environment in all the levels of schools across the country.

A 56 year old woman referred from a district hospital for a liver mass on initial evaluation was found to have perforation of gas-containing hollow viscus. Emergency exploratory laparotomy revealed a burst appendix. She did well post op and was discharged in a healthy state. This case report was done to highlight the importance of proper history taking and clinical examination in order to prevent delay in implementing appropriate treatment.