Multilevel factors associated with physical activity participation among Thai university students.

This study investigated physical activity (PA) levels in Thai university students and their associated factors at multiple levels. Data of 3,930 university students age ≥18 years analyzed in this study were retrieved from a cross-sectional online survey, namely the ASEAN University Network - Health Promotion Network (AUN-HPN) health behavioral survey. The hierarchical generalized linear model considering clustering effects was applied to examine factors associated with sufficient PA across multiple levels. At the individual level, being female, underweight, and overweight had significantly lower odds of having sufficient PA. Sophomores had 22 % greater odds compared with freshmen. Students engaging in 1-3 and 4-6 sports activities had 3 and almost 4 times respectively higher odds of having sufficient PA. Students engaged in >8 h of sedentary time, and consumed adequate amounts of fruit/vegetables had 70 % and 59 % respectively higher odds of having sufficient PA. At the environmental level, students who traveled inactively to/from university, attended a university with private recreational facilities, and a university that adopted the healthy university framework (HUF) had significantly greater odds of having sufficient PA. A majority of university students were sufficiently physically active, despite gender disparity. When promoting PA among them, focus may be targeted at females and sophomores, and consider addressing the number of sports activities engaged, fruit/vegetable consumption, availability of private university recreational facilities, and adoption of the HUF. The results support the implementation of the AUN-HPN HUF, and future initiatives within the country and the wider network for health and PA promotion.

Patient satisfaction of breast reconstructive surgery following mastectomy in Brunei.

OBJECTIVE: To evaluate the impact of Breast Reconstructive Surgery (BRS) on patients' satisfaction and quality of life following mastectomy for breast cancer. METHODS: A multi-method design study comprising quantitative and qualitative research was conducted between October to December 2019. The quantitative component consisted of a cross-sectional study using the Breast-Q questionnaire and the qualitative component involved in-depth interviews with eligible patients (N = 16) who underwent BRS following mastectomy for breast cancer. Quantitative analysis was performed including Fisher's exact test and One-way Analysis of Variance where a p-value of <0.05 was regarded as statistically significant. Qualitative data was thematically analysed using Braun and Clarke's thematic analysis. RESULTS: 14 out of 16 eligible patients participated in the study. We observed the lowest-scale score was for 'satisfaction with nipples' (mean score 32.7), followed by 'physical well-being: abdomen' (mean score 69.5). Despite a median score of 70 for 'satisfaction with breasts', patients were satisfied with the overall outcome of BRS (median score 80.5). Thematic analysis yielded three themes i.e. "I feel beautiful again" that described patients' satisfaction with aesthetic outcome with autologous reconstruction; "Striving for normality" that indicated BRS established back a sense of normality and improve their self-confidence and lastly, "I was well taken care of" highlighted the importance of providing 'well-informed' care to ensure overall satisfaction of their BRS journey. CONCLUSION: The uptake of BRS remains low since its availability in 2012, despite an overall increase in breast cancer cases in Brunei annually. Patients who underwent BRS have shown an increase BREAST-Q scores in breast satisfaction, psychosocial and sexual well-being after breast cancer treatment. Delivering high-quality patient-centred services and providing adequate information can influence the level of satisfaction for overall outcome. BRS should be considered as an important healthcare priority in Brunei and routinely be offered in the management of breast cancer.

A survey of patient compliance with removable orthodontic retainer wear in Brunei Darussalam.

OBJECTIVE: To explore compliance with removable orthodontic retainer wear among patients who had completed fixed appliance orthodontic treatments. MATERIALS AND METHODS: A cross-sectional online survey was distributed to patients who had completed orthodontic treatment at the government orthodontic clinics. The response rate was 54.9%, 663 questionnaires were distributed and 364 responses were received. Demographic information was collected, and questions regarding types of retainers prescribed, instructed and actual wear times, satisfaction levels, and reasons for wearing and not wearing retainers. Chi Square, Fisher's Exact tests and Independent T-Test were used to detect significant associations between variables. RESULTS: Respondents under 20 years old and employed were the most compliant. The mean satisfaction levels of Hawley Retainer and Vacuum-Formed Retainer were reported to be 3.7 (P = 0.565). About 28% of those in both groups stated that they wear them to maintain their teeth straight. 32.7% of Hawley retainer wearers reported not wearing their retainers due to speech difficulties. CONCLUSION: Age and employment status were the variables that determined compliance. There was no significant difference in the satisfaction levels between the two retainer types. Most respondents wear their retainers to keep their teeth straight. Discomfort and forgetfulness were the primary reasons for not wearing retainers, besides speech difficulties.

University students' overall and domain-specific physical activity during COVID-19: A cross-sectional study in seven ASEAN countries.

This research investigated the overall and domain-specific physical activity (PA) of university students in the coronavirus disease 2019 (COVID-19) pandemic. A cross-sectional study was applied to socioeconomic (SE) and PA online data collected from 15,366 students across 17 universities in seven Association of Southeast Asian Nations (ASEAN) countries. Statistical analyses using logistic regressions established SE-PA relationships. Over half (60.3%) of ASEAN university students met age-span specific PA guidelines. Students participated in recreational PA the most, followed by study-related activities and 44.1% of students engaged in >8 hrs/day of sedentary time (ST). Compared to students with a normal body mass index (BMI), students who were underweight (UW), overweight (OW), and obese (OB) respectively, had a 14% (UW odds ratio (OR) = 1.14, p = 0.005), 25% (OW OR = 1.25, p < 0.001), and 24% (OB OR = 1.24, p = 0.005) greater probability of meeting PA guidelines. Those who engaged in active transport and belonged to a sports club (SC) had 42% (SC OR = 0.58, p < 0.001, for both) less probability of meeting the PA guidelines, compared with those who travelled inactively and did not belong to a sports club, respectively. Students who participated in 4-6 sport or exercise activities had ten times more likelihood of meeting PA guidelines (OR = 10.15, p < 0.001), compared with those who did not play any sport or do any exercise. Students who spent >8 hrs/day of ST had 32% (ST OR = 0.68, p < 0.001) less probability of meeting PA guidelines, compared with those who spent <3 hrs of ST. These data showed that over half of ASEAN university students achieved PA guidelines and were highly sedentary during the COVID-19 pandemic. Recreational and study-related activities were important for students to maintain sufficient PA and should be actively promoted within the restrictions imposed during periods of the COVID-19 pandemic lockdowns.

Evaluation of cardiovascular diseases risk calculators for CVDs prevention and management: scoping review.

BACKGROUND: Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality globally. This review aimed to summarise evidence on the key features, usability and benefits of CVD risk calculators using digital platforms for CVDs prevention and management in populations. METHODS: We used search engines and thematic analyses to conduct a scoping review. As the reporting guideline for this review, we used Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). RESULTS: A total of 17 studies meeting eligibility criteria were included in the analysis, from which about 70% of the studies have prognostic level I (n = 8) and level II (n = 4) evidence. The review found that various guidelines are recommending different algorithms for CVD risk prediction. The QRISK® was the most accurate CVD risk calculator for several study populations, whereas World Health Organization/International Society of Hypertension (WHO/ISH) risk scores were the least accurate. The key features of CVD risk calculators are variables, predictive accuracy, discrimination index, applicability, understandability, and cost-effectiveness. CONCLUSION: For the selected risk prediction tool, development and validation research must be done, which considers a mix of stroke-specific risk and CVD risk to establish its usability in the local community and advantages to the particular health-care environment. To get healthcare professionals more involved in preventing and treating CVDs, each healthcare setting should use an online CVD risk assessment tool that is more useful, accurate, and easy to use, based on the population and health system.

Prevalence of Health-Risk Behaviors and Mental Well-Being of ASEAN University Students in COVID-19 Pandemic.

The prevalence of epidemiological health-risk behaviors and mental well-being in the COVID-19 pandemic, stratified by sociodemographic factors in Association of South East Asian Nations (ASEAN) university students, were examined in the research. Data were collected in March-June 2021 via an online survey from 15,366 university students from 17 universities in seven ASEAN countries. Analyzed data comprised results on physical activity, health-related behaviors, mental well-being, and sociodemographic information. A large proportion of university students consumed sugar-sweetened beverages (82.0%; 95%CI: 81.4, 82.6) and snacks/fast food daily (65.2%; 95%CI: 64.4, 66.0). About half (52.2%; 95%CI: 51.4, 53.0) consumed less than the recommended daily amounts of fruit/vegetable and had high salt intake (54%; 95%CI: 53.3, 54.8). Physical inactivity was estimated at 39.7% (95%CI: 38.9, 40.5). A minority (16.7%; 95%CI: 16.1, 17.3) had low mental well-being, smoked (8.9%; 95%CI: 8.4, 9.3), and drank alcohol (13.4%; 95%CI: 12.8, 13.9). Country and body mass index had a significant correlation with many health-risk behaviors and mental well-being. The research provided important baseline data for guidance and for the monitoring of health outcomes among ASEAN university students and concludes that healthy diet, physical activity, and mental well-being should be key priority health areas for promotion among university students.

Znet: Deep Learning Approach for 2D MRI Brain Tumor Segmentation.

BACKGROUND: Detection and segmentation of brain tumors using MR images are challenging and valuable tasks in the medical field. Early diagnosing and localizing of brain tumors can save lives and provide timely options for physicians to select efficient treatment plans. Deep learning approaches have attracted researchers in medical imaging due to their capacity, performance, and potential to assist in accurate diagnosis, prognosis, and medical treatment technologies. METHODS AND PROCEDURES: This paper presents a novel framework for segmenting 2D brain tumors in MR images using deep neural networks (DNN) and utilizing data augmentation strategies. The proposed approach (Znet) is based on the idea of skip-connection, encoder-decoder architectures, and data amplification to propagate the intrinsic affinities of a relatively smaller number of expert delineated tumors, e.g., hundreds of patients of the low-grade glioma (LGG), to many thousands of synthetic cases. RESULTS: Our experimental results showed high values of the mean dice similarity coefficient (dice = 0.96 during model training and dice = 0.92 for the independent testing dataset). Other evaluation measures were also relatively high, e.g., pixel accuracy = 0.996, F1 score = 0.81, and Matthews Correlation Coefficient, MCC = 0.81. The results and visualization of the DNN-derived tumor masks in the testing dataset showcase the ZNet model's capability to localize and auto-segment brain tumors in MR images. This approach can further be generalized to 3D brain volumes, other pathologies, and a wide range of image modalities. CONCLUSION: We can confirm the ability of deep learning methods and the proposed Znet framework to detect and segment tumors in MR images. Furthermore, pixel accuracy evaluation may not be a suitable evaluation measure for semantic segmentation in case of class imbalance in MR images segmentation. This is because the dominant class in ground truth images is the background. Therefore, a high value of pixel accuracy can be misleading in some computer vision applications. On the other hand, alternative evaluation metrics, such as dice and IoU (Intersection over Union), are more factual for semantic segmentation. CLINICAL IMPACT: Artificial intelligence (AI) applications in medicine are advancing swiftly, however, there is a lack of deployed techniques in clinical practice. This research demonstrates a practical example of AI applications in medical imaging, which can be deployed as a tool for auto-segmentation of tumors in MR images.

Perceived sleep quality: a comparison between hospital nurses and student nurses.

BACKGROUND: The prevalence of poor sleep quality is high among nurses, and affects them physically and psychologically as well as organisational functioning. However, evidence on equipping student nurses with good sleep practices that could mitigate poor sleep as they transition into the nursing workforce is lacking. AIM: This study compared the prevalence and quality of good sleep among hospital nurses and student nurses. METHODS: A descriptive cross-sectional study of 130 hospital nurses and 130 student nurses in Brunei was carried out. Sleep quality was assessed using the Pittsburgh Sleep Quality index. Multiple logistic regression was applied. RESULTS: Hospital nurses were 4.29 times more likely to experience poor sleep than student nurses. Those who were overweight were 2.35 times more likely to have poor sleep quality than those with a healthy weight. Although students had significantly good sleep latency, needing less time to fall asleep, they experienced significantly more sleep disturbances, shorter sleep duration and less sleep efficiency. CONCLUSION: The prevalence of poor sleep quality among nurses in Brunei is higher than global estimates. Stakeholders such as nursing leaders, nursing educators and healthcare policymakers should prepare student nurses and help existing nurses by formulating strategies to promote working schedules and rosters that minimise circadian disruption.

Salivary cortisol, perceived stress and coping strategies: A comparative study of working and nonworking women.

AIMS: This study investigated stress levels and coping strategies among working and nonworking women in the United Arab Emirates. BACKGROUND: Stress levels in working and nonworking women have previously been studied, but few studies used cortisol to measure stress or examined how coping strategies affect stress levels. METHODS: We employed a cross-sectional design with a convenience sample of women aged 20-65 years. Information on women's sociodemographic characteristics, perceived stress (using the Perceived Stress Scale) and coping strategies (using the Brief-COPE) was collected. Participants' morning (07:00-08:00) and evening (19:00-20:00) cortisol levels were measured using unstimulated saliva samples. RESULTS: In total, 417 working and 403 nonworking women participated in this study. More nonworking women reported high stress levels than working women (14.1% vs. 4.1%, p = .001). Working women reported more use of informational support and venting to cope with stress compared with nonworking women (94.0% vs. 88.1%, p = .001). More nonworking women had impaired morning (<0.094 mg/dl) and evening (>0.359 mg/dl) cortisol compared with working women (58.1% vs. 28.5% and 41.7% vs. 18.0%, respectively). Compared with working women, nonworking women had 3.25 (95%CI: 2.38, 4.47) and 3.78 (95%CI: 2.65, 5.43) times the odds of impaired morning and evening cortisol, respectively. CONCLUSION: Nonworking women exhibited higher levels of stress than working women. There is an urgent need to support nonworking women to manage stress through appropriate awareness campaigns and public health policies. IMPLICATIONS FOR MANAGEMENT: Policymakers and community leaders should consider the mental health of nonworking women as a priority in planning public health policies and programmes. Nurse managers must have a voice in reforming public health policy to support early assessment and management of stress among nonworking women.

Prediction Modeling of Mental Well-Being Using Health Behavior Data of College Students.

Background: Since the onset of the COVID-19 pandemic in early 2020, the importance of timely and effective assessment of mental well-being has increased dramatically. Due to heightened risks for developing mental illness, this trend is likely to continue during the post-pandemic period. Machine learning (ML) algorithms and artificial intelligence (AI) techniques can be harnessed for early detection, prognostication and prediction of negative psychological well-being states. Objective: Studies using machine learning classification of mental well-being are scarce in Asian populations. This investigation aims to develop reliable machine learning classifiers based on health behavior indicators applicable to university students in South-East Asia. Methods: Using data from a large, multi-site cross-sectional survey, this research work models mental well-being and reports on the performance of various machine learning algorithms, such as generalized linear models, k-nearest neighbor, naïve-Bayes, neural networks, random forest, recursive partitioning, bagging, and boosting. Prediction models were evaluated using various metrics such as accuracy, error rate, kappa, sensitivity, specificity, Area Under the recursive operating characteristic Curve (AUC), and Gini Index. Results: Random forest and adaptive boosting algorithms achieved the highest accuracy of identifying negative mental well-being traits. The top five most salient features associated with predicting poor mental well-being include body mass index, number of sports activities per week, grade point average (GPA), sedentary hours, and age. Conclusions: Based on the reported results, several specific recommendations and suggested future work are discussed. These findings may be useful to provide cost-effective support and modernize mental well-being assessment and monitoring at the individual and university level.

Academic experiences, physical and mental health impact of COVID-19 pandemic on students and lecturers in health care education.

BACKGROUND: In keeping with nation-wide efforts to contain the spread of COVID-19, Universiti Brunei Darussalam (UBD) transformed fully its pedagogical delivery to online mode, where we investigated teaching and learning experiences, physical and mental health of undergraduate students and lecturers during the COVID-19 pandemic. METHODS: We conducted a cross-sectional study on undergraduate students and lecturers in a health science faculty using a self-developed pretested questionnaire through anonymous online data collection method. RESULTS: Fifty-six lecturers (100% response rate) and 279 students (93.3% response rate) participated. The positive experiences reported by students include becoming independent (72.8%) and adapting to online learning (67.4%), while lecturers learned new teaching techniques (50.0%) and became more innovative (50.0%) by learning new tools (48.2%). However, studying at home caused students to feel more distracted (72.0%) with a feeling of uncertainty towards examinations (66.7%), while lecturers felt that students' laboratory skills were compromised (44.6%). Even though online delivery of assessments enabled lecturers to explore all options (50.0%), they found it difficult to maintain appropriate questions (41.1%) and fair assessments (37.5%). Majority of students missed eating out (68.8%) and felt a lack of participation in extracurricular activities (64.9%), while lecturers reported more time for exercise (51.8%), despite having more screen time (50.0%) and computer-related physical stress (44.6%). In terms of mental health, increased stress in students was reported (64.9%), though they had more time for self-reflection (54.8%). Although lecturers reported a closer relationship with family (44.6%), they also felt more stressed due to deadlines, unexpected disruptions and higher workloads (44.6%) as well as concerns related to work, family and self (39.3%). CONCLUSION: In this abrupt shift to online teaching, students and lecturers in our study identified both positive and negative experiences including the impact on their physical and mental health. Our findings are important to provide the evidence for online pedagogical benefits and can serve to promote the enhancement and adaptation of digital technology in education. Our findings also aim to promote the importance of addressing physical and mental health issues of the university community's well-being through provision of emotional and mental health support and appropriate programs.

Work-family conflict, health status and job satisfaction among nurses.

OBJECTIVE: Research studies have demonstrated that nurses face difficulty balancing family roles and responsibilities with work. This study aimed to explore the relationship between work-family conflict and health status and job satisfaction among nurses. METHODS: This was a cross-sectional study of 426 nurses working in high-dependency and general settings in a large referral hospital in Brunei Darussalam. RESULTS: Work-family conflict inversely affects health status and job satisfaction for nurses working in high-dependency and general settings. However, general nurses experienced higher work-family conflict albeit better job satisfaction and health status compared to high-dependency nurses. Older, single and non-smoker nurses reported higher job satisfaction. CONCLUSION: This study further informs healthcare and nursing administrators and policymakers, who should foster effective strategies and interventions to support the balance of nurses' work and family life.

Free sugar intake and dietary sources among adult population in Brunei: The national health and nutritional status survey.

High sugar consumption is associated with increased risk of noncommunicable diseases. This study identifies the dietary sources of free sugars and explores association of sugar intake with related factors among adult population in Brunei. Data from the National Health and Nutritional Status Survey 2010, of 1559 adult residents of Brunei, aged 18-75 years, were extracted and analyzed. The results revealed that mean daily free sugar intake was 55.5 g/day (standard deviation [SD] -51.4), contributing to 14.5% of total energy intake. The prevalence of free sugar intake of <10% and 5% among the adult population was 60.1% (95% confidence interval [CI]: 57.6, 62.5) and 82.6% (95% CI: 80.6, 84.4), respectively. Free sugar from sugar-sweetened beverages was sourced from beverages prepared with sugar (17.9%), cordial and syrup (15.1%), and carbonated drinks (14.6%). Free sugar consumption was significantly higher in men (66.6 g/day, SD - 61.2) than women (46.2 g/day, SD - 39.1) (P < 0.001). Younger participants had significantly higher free sugar intake and percentage of energy from free sugar compared to older participants. This study provides justification for addressing sugar intake as a component of strengthening nutrition policy in Brunei.

Psychosocial factors and burnout among oncology nurses in Brunei Darussalam: A pilot study.

Background: Existing evidence showed that adverse psychosocial factors contribute to burnout in oncology nurses and impose profound implications to nursing practice. Due to the complexity of this relationship, more studies are still needed. Objective: To investigate the prevalence and relationship between burnout and psychosocial factors among oncology nurses. Methods: A descriptive cross-sectional study design was conducted in 2018 using the Maslach Burnout Inventory and the Copenhagen Psychosocial Questionnaire to measure burnout and psychosocial factors, respectively. Descriptive and multivariate regression using maximum likelihood procedures were used for analysis. Results: Out of three burnout variables, emotional exhaustion demonstrated a highly significant relationship towards psychosocial factors, particularly quality of leadership (p <0.001), justice and respect (p <0.001), and rewards (p <0.001) - congruent to a high prevalence of emotional exhaustion reported. Conclusion: Improvement in leadership quality, rewards, justice and respect could minimise emotional exhaustion among oncology nurses. These findings further inform management and policymakers to target these specific psychosocial factors in addition to using other interventions to counter the harmful effects of burnout. A positive psychosocial workplace would consequently decrease the risk of nurses' intention to leave, reduce nurse shortages, and increase the quality of patient care.

Strategies used to cope with stress by emergency and critical care nurses.

BACKGROUND:: developing coping strategies to use in stressful situations is an essential nursing skill. Prolonged and constant stress is harmful to nurses' health and leads to organisational inefficiency, high staff turnover and decreased job satisfaction. AIM:: to identify nurses' stress coping strategies and determine the relationship between coping strategies and sociodemographic factors. METHOD:: a descriptive cross-sectional study using a self-administered questionnaire was undertaken at an emergency department and critical care units at the largest referral hospital in Brunei. RESULTS:: problem-solving and positive reappraisal were the predominant positive coping strategies identified. Those working in medical intensive care employed escape-avoidance behaviours more frequently. Married participants exhibited higher levels of confrontative coping behaviours. CONCLUSION:: to the authors' knowledge, this is the first study to examine job-stress coping strategies among nurses in Brunei. The authors examined the different strategies and the poor health outcomes associated with using negative coping styles. Future stress management interventions should target staff who employ negative coping strategies to promote positive strategies, enabling them to provide better quality care.

High-dependency care: experiences of the psychosocial work environment.

AIM: to explore high-dependency care nurses' experiences of their psychosocial work environment. METHODS: four focus groups were conducted with 23 emergency and critical care hospital nurses in Brunei. All sessions were recorded, transcribed verbatim and analysed using inductive-approach thematic analysis. FINDINGS: three major themes were identified. 'Specialisation/specific skills' explained a fundamental requirement for the high-dependency care nurses to work effectively and efficiently in their workplace. 'Task completion' narrated the pressure they experienced to complete their tasks within time constraints exacerbated by a reduced number of staff. 'Acknowledgement' signified their need for fair and adequate reward for their hard work through career progression and promotion. CONCLUSION: this study facilitates the design of future interventions and policies that promote a healthy psychosocial work environment by ensuring nurses working in these areas have the required specialisation skills, there is a balance of workload and nurse-to-patient ratios, and they are offered fairness and equity in career progression and promotion.

A study into psychosocial factors as predictors of work-related fatigue.

OBJECTIVE: To explore and determine relationship between psychosocial factors and work-related fatigue among emergency and critical care nurses in Brunei. METHODS: Cross-sectional study conducted on all emergency and critical care nurses across Brunei public hospitals from February to April 2016. RESULTS: 201 nurses participated in the study (82% response rate). A total of 36% of the variance of chronic fatigue was explained by stress, trust in management, decision latitude, self-rated health, and work-family conflict. Burnout, self-rated health, commitment to workplace, and trust in management explained 30% of the variance of acute fatigue. Stress, work-family conflict and reward explained 28% of the variance of intershift recovery after controlling for significant sociodemographic variables. Smoking was identified as an important sociodemographic factor for work-related fatigue. CONCLUSIONS: Psychosocial factors were good predictors of work-related fatigue. A range of psychosocial factors were established, however more research is required to determine all possible causation factors of nurses' work-related fatigue.

Management of male H-type anorectal malformations.

PURPOSE: H-type anorectal malformations (ARM) are extremely rare in males. Herein, we have described our experience of managing this variety. METHODS: From September 1993 to February 2009, seven boys with H-type ARM were managed in the Department of Pediatric Surgery, Chittagong Medical College and Hospital, Chittagong, Bangladesh. Clinical features, operative procedures and outcomes were analyzed. RESULTS: Age ranged from 1 day to 4 years. The passage of meconium was seen in urine of four boys, through ectopic openings in the perineum in three boys. One patient had a round worm passing through an ectopic opening. Three boys' perineum showed meconium dots/streak along scrotal raphe. Anus was absent in all. Two patients had rectopenilurethral (RPU) and rectoscrotal (RS) fistula; two boys had anoscrotal and anoperineal fistula; one boy had pinhole anus with RS and RPU fistula. One boy had rectoperineal and RS fistula. One patient had rectobulbar urethral fistula with meconium filled chamber between the two hemiscrotum. Two boys had associated anomalies. Five boys had primary procedure with anterior sagittal approach-anoplasty (ASAP) and anorectoplasty (ASARP). Two patients had pelvic colostomy and ASARP in one and PSARP in one. One patient died postoperatively. One boy developed anal stenosis and needed redo. Five children have regular bowel movements and they are growing well. CONCLUSION: Thorough clinical examination may identify the anatomical variations of male H-type ARM, and for the treatment of which primary ASAP or ASARP gives good results.

Medical education in Bangladesh.

Bangladesh shares many socio-cultural, financial, and health issues typical of developing countries. Despite some encouraging developments in health measures at grass-roots level, medical education in Bangladesh faces many challenges. This article provides a snapshot of the current situation of undergraduate and post-graduate medical education with particular emphasis on pedagogical issues, highlighting challenges faced and suggesting an immediate five-point action plan.