Journal of Universal College of Medical Sciences <p>An official medical journal of the Universal College of Medical and Dental Sciences, Ranigaon, Bhairahawa, Nepal</p> Universal College of Medical Sciences en-US Journal of Universal College of Medical Sciences 2091-2846 <p>Authors have to give the following undertakings along with their article:</p> <ol> <li class="show">I/we declare that this article is original and has not been submitted to another journal for publication.</li> <li class="show">I/we declare that I/we surrender all the rights to the editor of the journal and if published will be the property of the journal and we will not publish it anywhere else, in full or part, without the permission of the Chief Editor.</li> <li class="show">Institutional ethical and research committee clearance certificate from the institution where work/research was done, is required to be submitted.</li> <li class="show">Articles in the Journal are Open Access articles published under the Creative Commons CC BY-NC License (<a href=""></a>)</li> <li>This license permits use, distribution and reproduction in any medium, provided the original work is properly cited, and it is not used for commercial purposes.</li> </ol> Continuing Professional Development (CPD) in Nepal and its Challenges <p>Not available.</p> Shatdal Chaudhary Nagendra Chaudhary ##submission.copyrightStatement## 2019-06-30 2019-06-30 7 1 1 2 10.3126/jucms.v7i1.24675 Intubating Conditions with Rocuronium Bromide and Suxamethonium in Elective Surgeries: A Randomized Comparative Study <p><strong>INTRODUCTION:</strong> Adequate&nbsp; intubating&nbsp; condition&nbsp; is&nbsp; required&nbsp; to&nbsp; avoid&nbsp; airway&nbsp; trauma&nbsp; and&nbsp; adverse&nbsp; sympathetic&nbsp; responses. Though, Succinylcholine is considered as ideal drug, it has many contraindications. In search of alternative, rocuronium is found to have similar responses in higher doses. Therefore, our aim was to compare the effect of different dosages of rocuronium with sucinylcholine for tracheal intubation and the haemodynamic variables.</p> <p>&nbsp;<strong>MATERIAL AND METHODS:&nbsp;</strong>A prospective randomized comparative study was conducted in Universal College of Medical Sciences (UCMS-TH) in 90 (American Society of Anaesthesiologists Physical Status I and II) patients with age between 18 to 60 years scheduled for elective surgeries under general anesthesia. They were divided into 3 groups of 30 each using lottery system. Groups 1 and&nbsp;2 received intravenous rocuronium 0.6mg/kg and 1mg/kg respectively whereas patients in group 3 received intravenous succinylcholine 1.5mg/kg. Under continuous monitoring, tracheal intubation attempt was done at 60 seconds after the administration of drug and intubating conditions were assessed according to Cooper et al four point scale.</p> <p>&nbsp;<strong>RESULTS:&nbsp;</strong>Only 26.7% of patients in group 1 exhibited excellent intubating condition whereas in groups 2 and 3, excellent intubating condition was exhibited in 100% when muscle relaxant was administered at 60 seconds with highly significant statistical difference between groups 1 and 3 with p value &lt;0.001 without any adverse effects in any of these patients.</p> <p><strong>CONCLUSION:&nbsp;</strong>This study concluded that intubating response with inj. succinylcholine 1.5mg/kg is similar to rocuronium 1.0mg/kg and is superior to inj rocuronium 0.6mg/kg, for intubating condition at 60 seconds following the drug administration while using Cooper et al. Score.</p> Kanchan Prakash Paudyal Pawan Puspa Baral Laxmi Pathak ##submission.copyrightStatement## 2019-06-30 2019-06-30 7 1 3 8 10.3126/jucms.v7i1.24676 Clinico-Pathological Study of Ocular Surface Squamous Neoplasia in a Tertiary Care Centre of Western Region of Nepal <p><strong>INTRODUCTION:&nbsp;</strong>Ocular surface squamous neoplasia (OSSN) consists of a wide range of conjunctival and corneal lesions ranging from dysplastic lesions to invasive squamous cell carcinoma. In recent times, the incidence of OSSN seems to be on the rise, especially in developing countries. The present study was aimed to analyse demographic pattern, clinical characteristics, and histopathology findings of OSSN in a tertiary care centre of western region of Nepal.</p> <p>&nbsp;<strong>MATERIAL AND METHODS:&nbsp;</strong>It was a retrospective study. We analyzed 94 cases of OSSN who presented to cornea department of Lumbini Eye Institute, Bhairahawa, Nepal over a period 1.5 years from 1st July 2017 to 31st December 2018. All the patients with OSSN, detailed clinical history and examination were recorded. Lesions were excised with a 3 mm margin clearance and sent for histopathological examination.</p> <p>&nbsp;<strong>RESULTS:&nbsp;</strong>Mean age of our patients with OSSN was 48.89±17.955 years ranging from 17 to 85 years. There were 52 (55.32%) male and 42 (44.68%) female. Mean duration of presentation was 6.34±6.17 months. A solitary nodule at the limbus was the commonest presentation. Right eyes were involved more than left eyes. Lesions were found most commonly on temporal site 52 (55.32%) followed by nasal 36 (38.30%). On histopathological examination benign lesions were found in 31 (32.98%) eyes, preinvasive lesion in 50 (53.19%) eyes and invasive lesions in 13 (13.83%) eyes.</p> <p>&nbsp;<strong>CONCLUSION:&nbsp;</strong>OSSN were seen more commonly in young adults with male predominance. Benign and pre invasive lesions are found more commonly than invasive lesions.</p> Sushila Patel Binita Bhattarai Pokharel Anita Shah Manita Sunam Goda Saraswati Khadka Thapa ##submission.copyrightStatement## 2019-06-30 2019-06-30 7 1 9 13 10.3126/jucms.v7i1.24677 Prevalence of Acute Abdomen Admission in Surgery Ward at Tertiary Care Center of Nepal <p><strong>INTRODUCTION:&nbsp;</strong>Abdominal pain is one of the most common reasons for an emergency department visit, accounting to about 8% of all emergency visits in United States. There are very few data available regarding the emergency admission of acute abdomen in Nepal. The aim of this study is to determine the prevalence of acute abdomen admission and their frequency according to the age, sex and month of admission in hospital.</p> <p>&nbsp;<strong>MATERIAL AND METHODS:&nbsp;</strong>This was a retrospective descriptive study carried out in Universal College of Medical Sciences, Bhairahawa, Nepal. Admission registers of surgery ward from July 2017 to June 2018 were reviewed. Data regarding the diagnosis, age, sex and month of admission of the patients were collected. Descriptive analyses were done regarding the frequency of disease, distribution of the diseases according to the age, sex and month of occurrences.</p> <p>&nbsp;<strong>RESULTS:&nbsp;</strong>Total of 675 patients with acute abdomen were analyzed. Acute appendicitis was the most common cause for acute abdomen accounting for 52% of total admission. It was followed by intestinal obstruction (13%) and acute cholecystitis (11%). Median age of presentation of acute appendicitis was 23 years. Median age of presentation of acute cholecystitis was 42 years. Acute abdomen occured most frequently on April, May and December. Overall, spring season had highest number of admission (31.5%) followed by winter (25.6%).</p> <p>&nbsp;<strong>CONCLUSION:&nbsp;</strong>Acute abdomen incidence varies according to age, most commonly found in young adults. Male has higher prevalence of acute abdomen when compared to female with exception of acute cholecystitis.</p> Rajesh Poudel Kailash Chandra Santosh Shah Naveen Mahasheth Santosh Mishra Kumar Paudel ##submission.copyrightStatement## 2019-06-30 2019-06-30 7 1 14 16 10.3126/jucms.v7i1.24678 Comparison of Central Obesity with Overall Obesity in Predicting the Risk of Type 2 Diabetes Mellitus <p><strong>INTRODUCTION:&nbsp;</strong>Many studies have shown the association of waist circumference, waist hip ratio and body mass index with type 2 diabetes mellitus. Waist circumference and waist hip ratio have been used as measures of central obesity and body mass index has been used as a measure of general obesity. Objective of this study is to find out which type of obesity is better for prediction of risk of type 2 diabetes mellitus.</p> <p>&nbsp;<strong>MATERIAL AND METHODS:</strong>Total 100 participants with confirmed diagnosis of type 2 DM with age group 35-80 years were selected for the study. Anthropometric measurements like height, weight, waist circumference (WC) and hip circumference were measured and body mass index (BMI) and waist hip ratio (WHR) were calculated. Area under receiver operating characteristic (ROC) curve was used for correlating the parameters with type 2 diabetes mellitus in both male and female patients.</p> <p>&nbsp;<strong>RESULTS:&nbsp;</strong>Area under ROC curve, a measure of performance of the indices in predicting diabetes in total subjects, was found to be highest for waist hip ratio (0.840) followed by waist circumference (0.688) and BMI (0.608). Similarly, area under ROC curve was found maximum for waist hip ratio followed by waist circumference and body mass index in case of male and female patients.</p> <p>&nbsp;<strong>CONCLUSION:&nbsp;</strong>The present study concludes that anthropometric indicators of central obesity (WHR and WC) are more predictive for type&nbsp;2 DM than anthropometric indicator of general obesity (BMI).</p> Bishal Joshi Laxmi Shrestha Kushal Bhattarai Nilu Manandhar Narayan Bahadur Mahotra ##submission.copyrightStatement## 2019-06-30 2019-06-30 7 1 17 21 10.3126/jucms.v7i1.24680 Cystic Meningiomas: A Radiological and Histological Study and Pre Operative Diagnostic Errors <p><strong>INTRODUCTION: </strong>Meningiomas are solid neoplasms, cysts are extremely rare, diagnostically elusive, and behave differently. Therefore, a study was initiated comparing our cases with various series. This is the second largest series so far reported. We tried to hypothesize how to eliminate diagnostic errors in this study, while few interesting points were discovered.</p> <p>&nbsp;<strong>MATERIAL AND METHODS:&nbsp;</strong>All meningiomas operated in the last seventeen years were reviewed. It was a retrospective study. Diagnostic errors, clinical behaviour and histopathology were reviewed. Planning of surgery and prognostication demands that the diagnosis be established pre-operatively and since these tumours may mimic other brain tumour types on radiology , factors that may lead to better diagnostic accuracy were tried to be established. Categorization of the tumours with different cyst types according to various classifications was done. The follow up period was two months to ten years.</p> <p>&nbsp;<strong>RESULTS:&nbsp;</strong>Out of 530 meningiomas, we found 20 with cystic changes.. There mean age was 47.5 years. The commonest symptoms were raised intra cranial pressure, hemiparesis, memory loss, behavioral changes, vision loss, &nbsp;papilloedem and cranial nerve palsies. The most common histological variety was meningothelial meningioma. The incidence of high grade or malignant tumors was 30 %. Based on radiology, the highest diagnostic accuracy was achieved in 62.5% cases only.</p> <p>&nbsp;<strong>CONCLUSION:&nbsp;</strong>Cystic meningiomas continue to pose diagnostic challenges. &nbsp;Multi-planar contrast magnetic resonance imaging (MRI) will help in establishing accurate diagnosis, it reveals cysts missed on computed tomography (CT) scans. This would lead to accurate prognostication and better surgical planning with the aim of preventing recurrences.</p> Jaideep Chandra Raj Kumar KC ##submission.copyrightStatement## 2019-06-30 2019-06-30 7 1 22 26 10.3126/jucms.v7i1.24681 Comparative Study on Efficacy of Ketorolac and Pethidine for Postoperative Pain Management <p><strong>INTRODUCTION:&nbsp;</strong>Postoperative pain management is essential for early mobilization and rehabilitation to enhance recovery and to reduce morbidity. Ketorolac and pethidine are two most common analgesics used in the postoperative setting for pain management.</p> <p><strong>MATERIAL AND METHODS:&nbsp;</strong>Sixty patients (n=60) of age group 18-60 years who undergone various surgical procedures were divided randomly into two groups (T1 and T2). T1 group received inj. ketorolac 5 mg/kg IM and T2 group received pethidine 1.5 mg/kg IM body weight respectively on 6 hourly basis for 48 hours postoperatively. Patients were assessed in the recovery room for pain according to Visual Analogue Scale (VAS), Verbal Rating Scale (VRS) and Sedation Score after 1, 6, 12, 18, 24 and 48 hours of drug administration. Analgesic efficacy was measured using VAS and VRS. Safety of the drugs was assessed by using Sedation Score.</p> <p><strong>RESULTS:&nbsp;</strong>Ketorolac showed equianalgesic effect as pethidine estimated by VAS score at 18th &nbsp;and 48th &nbsp;hour. In other periods of observation, pethidine exhibited better analgesic effects than ketorolac. However, ketorolac shows less incidence of sedation compared to pethidine.</p> <p><strong>CONCLUSION:&nbsp;</strong>This study showed that postoperative pain during the first 48 hours can be relieved by either ketorolac or pethidine. Ketorolac appeared safer than pethidine while pethidine appeared more effective analgesic than ketorolac in the management of postoperative pain.</p> Laxmi Shrestha Bishal Joshi Anjan Palikhey Kushal Bhattarai ##submission.copyrightStatement## 2019-06-30 2019-06-30 7 1 27 32 10.3126/jucms.v7i1.24682 Prevalence of Absence of Palmaris Longus Tendon in Nepalese Population <p><strong>INTRODUCTION:&nbsp;</strong>The palmaris longus (PL) is a tendinous superficial flexor of forearm. It basically, anchor skin and fascia of hand resist the horizontal shear force in distal direction. It also helps in tightening of palmar aponeurosis. Along with other flexor muscle it also helps in flexion of wrist joint. The incidence of absence of palmaris longus is in great variation from 1.5 to 63.9%. Its variation of absence has attracted many researchers globally. The aim of the present study is to know occurrence of absence of PL in Nepalese population.</p> <p><strong>MATERIAL AND METHODS:&nbsp;</strong>This is a&nbsp;&nbsp; cross sectional&nbsp;&nbsp; descriptive observational study conducted among 270 medical students (MBBS, BDS) at Universal College of Medical Science, Bhairawaha in year the &nbsp;2018-2019. Ethical approval for study was taken from institutional review committee (IRC). Four tests-Schaeffer's Test, Thompson's Fist, Mishra's Test and Puspa Kumar's two finger sign were used to see the absence/presence of Palmaris longus. A semi-structured proforma was used to collect the data.</p> <p><strong>RESULTS:&nbsp;</strong>Out of 270 students, there were 145 (53.7%) females and 125 (46.3%) males. Age of the subject range from 19-23 years with a mean age of 19.91 &nbsp;years. The overall absence of palmaris longus was seen in 40 students (14.8%) which included&nbsp;18 males (14.4%) and 22 females (15.2%). Bilateral absence of palmaris longus was seen in 10 students (3.7%) whereas unilateral absence of palmaris longus was seen 14 males (11.2%) and 16 females (11.03%).</p> <p><strong>CONCLUSION:&nbsp;</strong>This present study concluded that overall absence of palmaris longus was seen in 14.8% subjects. Gender wise distribution showed that 14.4% males and 15.2% &nbsp;had the absence of palmaris longus. Thus, sound knowledge about this variation is important in planning graft surgeries.</p> Nitasha Sharma Bikash Parajuli Niraj Pandey Ram Prakash Shah ##submission.copyrightStatement## 2019-06-30 2019-06-30 7 1 33 36 10.3126/jucms.v7i1.24683 An Experience with Management of Hemoperitoneum in Blunt Injury of Abdomen at Tertiary Care Center of Western Nepal <p><strong>INTRODUCTION:&nbsp;</strong>Blunt abdominal trauma results in huge burden of morbidity and mortality among all age groups caused mainly by road traffic accident, fall from height and physical assault. This study was designed to evaluate the outcome of management of hemoperitoneum in blunt injury of abdomen.</p> <p><strong>MATERIAL AND METHODS:&nbsp;</strong>This is a prospective observational study involving 100 cases of blunt abdominal injury during the period from 1st December, 2014 to 13th &nbsp;March 2016 in UCMS-TH, Bhairahawa, Nepal. Documentation of the patients which included identification, history, clinical findings, diagnostic tests, operative findings, operative procedures, complications during hospital-stay was done. The decision regarding operative or non- operative management was made by specialist surgeon.</p> <p><strong>RESULTS:&nbsp;</strong>The majority of the patients belonged to 21- 30 years age group. 72 cases were male while 28 were female. 93 patients were managed conservatively while 7 patients were operated. Most common mode of injury was road traffic accident (RTA) (74%) followed by fall form height (20%). Most common organ to be injured was spleen (65%) followed by liver (26%).&nbsp;93 % patients underwent non-operative management while 7 % were operated. Mortality rate was 0% among the &nbsp;non- operative and 14.29% in operative cases.</p> <p><strong>CONCLUSION:&nbsp;</strong>Non operative management in patient with hemoperitoneum with regular monitoring of vitals and repeated clinical assessment can reduce the operative need , morbidity and length of hospital stay. Non-operative Management (NOM) for blunt abdominal injuries was found to be highly successful in 93% of the patients in this study.</p> Santosh Mishra Kailash Chandra Kumar Paudel ##submission.copyrightStatement## 2019-07-02 2019-07-02 7 1 37 41 10.3126/jucms.v7i1.24689 Assessment of Students' Attitude towards Learning Communication Skills: An Exploratory Study <p><strong>INTRODUCTION:&nbsp;</strong>Good communication skills can increase the health-care providers' diagnostic efficiency and decision making ability, as well as lead to improved patient satisfaction. The aim of this study is to determine the attitude associated with learning communication skills among dental and medical students.</p> <p><strong>MATERIAL AND METHODS:&nbsp;</strong>A descriptive study was conducted among 231 students, studying in Universal College Of Medical Sciences (UCMS), College of Dental Surgery, Bhairahawa, Nepal using a standardized pro forma which consisted of questions on general information and of communication skills using validated &nbsp;Communication Skills Attitude Scale. For statistical analysis, Mann-Whitney U test and Kruskal-Wallis test were applied.</p> <p><strong>RESULTS:&nbsp;</strong>Students indicate high levels of positive attitudes and low levels of negative attitudes. Attitudinal scores differ insignificantly in relation to gender.</p> <p><strong>CONCLUSION:&nbsp;</strong>Medical and dental students in our study show basically a positive approach. Further investigation is necessary to explore and understand attitudes towards communication skills of medical and dental undergraduates.</p> Rupam Tripathi Navin Tripathi Malati Tripathi Rubina Shrestha Dheeraj Kesari Pradip Chhetri ##submission.copyrightStatement## 2019-07-02 2019-07-02 7 1 42 45 10.3126/jucms.v7i1.24690 Knowledge, Attitude and Practice Regarding Immunization among Medical Students <p><strong>INTRODUCTION:&nbsp;</strong>Prevention of disease is the necessity of today's life. Immunization is the most important component of preventive medicine. Knowledge and attitude of health professionals have significant role in increasing the acceptance of immunization. This study is aimed to determine the association between knowledge and attitude towards immunization and its practice among medical students and emphasis on the need of immunization education intervention among medical students.</p> <p><strong>MATERIAL AND METHODS:&nbsp;</strong>Institutional based cross-sectional study among 397 medical students studying Bachelor in Medicine and Bachelor in Surgery (MBBS) was conducted in Universal College of Medical Sciences, Bhairahawa, Nepal. Purposively 1st to 4th year medical students were selected.</p> <p><strong>RESULTS:&nbsp;</strong>Among 397 students, 59% had good knowledge regarding immunization, 63% had positive attitude and 47% had applied the knowledge and attitude in practice. Level of knowledge, attitude as well as practice regarding immunization was found statistically significant among medical students with their year of study. The analysis found that level of knowledge was more with 4th year students 89.47±7.92 and least with 1st year students 62.82±13.01. Third year and 4th year students had good attitude with mean score of 85.66±9.13 and 85.49 ± 9.51 respectively. Similarly, practice level was found more among 3rd &nbsp;and 4th &nbsp;year student, while least among 1st year students 39.89±21.16. There is statistically weekly positive correlation between knowledge, attitude and practice in overall among the medical students.</p> <p><strong>CONCLUSION:&nbsp;</strong>The acceptance of immunization can be increased by increasing the level of knowledge and attitude regarding immunization thus providing a foundation to include a comprehensive immunization education to medical students.</p> Rubina Shrestha Pradip Chhettri Chet Kant Bhusal Rajendra Ruchal Saneep Shrestha Bipan Shrestha ##submission.copyrightStatement## 2019-07-02 2019-07-02 7 1 46 50 10.3126/jucms.v7i1.24692 Awareness Regarding Patient Rights among Hospitalized Patients in a Hospital of Rupandehi <p><strong>INTRODUCTION:&nbsp;</strong>Patients' rights is recently introduced term in health sciences literature and practice and has become an important part of modern health care practice. Patients now are much more aware of what they expect from health care professionals, when they enter the health care environment. The aim of the study was to find out the knowledge regarding patient rights among hospitalized patients.</p> <p><strong>MATERIAL AND METHODS:&nbsp;</strong>Descriptive study was conducted to find out the knowledge regarding patients' rights among hospitalized patients. Seventy two respondents were selected by using convenience sampling technique. Semi-structured interview schedule was used to collect the data and collected data were analyzed by using descriptive statistics with Statistical Package for Social Science software (SPSS) version 20.</p> <p><strong>RESULTS:&nbsp;</strong>The findings of the study revealed that 59.72% of the respondents had high knowledge regarding patient rights. Cent percent of the respondents had knowledge that being treated with respect, equitable treatment, decide to participate in human experiment are patient rights. Ninety three percent, 92% and 31.90% respondents had knowledge that right to informed consent, right to confidentiality, right to privacy and right to leave against medical advice are patients' rights respectively.</p> <p><strong>CONCLUSION:&nbsp;</strong>Based on the findings of the study, it is concluded that nearly three fourth of the respondents have high knowledge regarding patients' rights. It is recommended that management of hospital should conduct orientation program regarding human rights to health care providers to deliver health care in human right aspect.&nbsp;</p> Saraj Gurung Ritika Sapkota ##submission.copyrightStatement## 2019-07-02 2019-07-02 7 1 51 54 10.3126/jucms.v7i1.24693 Impact of Physical Health Status of Antenatal Mothers on their Neonates <p><strong>INTRODUCTION:&nbsp;</strong>Newborn health is closely related to that of their mothers. The simple indicators of the mother like haemoglobin level, height, weight, gestational age of the mother will give the first hand information of deviated health of the neonates.</p> <p><strong>MATERIAL AND METHODS:&nbsp;</strong>Descriptive correlation study was conducted to assess the impact of physical health status of antenatal mothers on their neonates, 170 antenatal mothers and their born neonates were selected by using purposive sampling. Semi-structured interview schedule, observation of record review and measurement of physical health parameters were used for data collection. &nbsp;A descriptive and inferential statistics were used to investigate the relationships between the variables of antenatal mothers with their neonates with SPSS software version 16.</p> <p><strong>RESULTS:&nbsp;</strong>The study findings revealed that the weight of the neonates has statistically significant correlation with the maternal weight, height, hemoglobin and maternal gestational weeks; length of the neonates has statistically significant correlation with the maternal height, maternal weight and maternal age; Gestational age (Ballard score) with the maternal gestational weeks and neonates birth weight; neonates head circumference has statistically significant with the maternal height, gestational weeks and maternal weight; chest circumference of the neonates has statistically significant with the maternal height and maternal weight.</p> <p><strong>CONCLUSION:&nbsp;</strong>The study concluded that there was a significant correlation between the selected maternal weight, height, hemoglobin and gestational weeks with neonatal weight; maternal height, weight, age with neonatal length, head circumference, chest circumference and maternal gestational weeks with neonate gestation age by Ballard score.</p> Anuja Kachapati Badri Kumar Gupta ##submission.copyrightStatement## 2019-07-02 2019-07-02 7 1 55 58 10.3126/jucms.v7i1.24694 Transgenic Mosquitoes Fight against Malaria: A Review <p>Malaria control with transgenic mosquitoes will be challenging; however, recent advances suggest that it may be a possibility in the foreseeable future. Progress towards discovering refractory genes for rodent malaria and gene drive systems for Drosophila provide hope that similar advances may be made for human malaria in mosquito vector species. That said, the African malaria burden has proved exceptionally difficult to diminish by all means tried thus far; and it is unlikely that transgenic mosquitoes will provide an all-in-one solution. Transgenic mosquitoes should be considered within the context of an integrated vector management strategy which should also include insecticide-treated bed-nets, indoor residual spraying with insecticides and treatment of infected individuals with antimalarial drugs. Integrated strategies will be a necessity for any successful african malaria control program and transgenic mosquitoes should be considered as a potential ingredient in the future goal of continent-wide disease control.</p> Amit Kumar Shrivastava Laxmi Shrestha Shraddha Prakash Roshan Kumar Mehta ##submission.copyrightStatement## 2019-07-02 2019-07-02 7 1 59 65 10.3126/jucms.v7i1.24695 Current Status of Internship Training in Nepal <p>This is a perspective article about the status of undergraduate medical internship training in Nepal based on the learned experience and reflections on current practices on medical education in Nepal. The medical education in Nepal is facing myriad challenges. In order to keep up with the current demands and advances in medical education, adaptation and changes in current curriculum and its modalities are crucial. Current medical curriculum, specifically needs to focus on promoting communication skills, community based learning and medical ethics which may help to garner skills and motivate students for innovations and research in the field.</p> Santosh Shah Anand Kumar Kailash Chandra ##submission.copyrightStatement## 2019-07-02 2019-07-02 7 1 66 69 10.3126/jucms.v7i1.24696 Bimaxillary Protrusion - A Case Report <p>Correction of a severe bimaxillary protrusion with maximum anchorage can be challenging. This case report describes the treatment of a girl with a bimaxillary protrusion. Orthodontic treatment included extraction of her 4 first premolars. The total treatment time was 18 months. Her dental proclination and facial appearance was significantly improved.</p> Hemant Kumar Halwa Sumit Kumar Yadav Kishor Dutta Sandeep Kumar Gupta Raju Shrestha Anish Kumar Shah ##submission.copyrightStatement## 2019-07-02 2019-07-02 7 1 70 73 10.3126/jucms.v7i1.24697