Development of an Assessment Tool of Menstrual-Cycle-Related Signs and Symptoms Based on Thai Traditional Medicine Principles for Evaluation of Women's Health.

BACKGROUND: Utilization of Thai traditional medicine (TTM) was considered in menstrual-cycle-related signs and symptoms (MCSs) to evaluate women's health. TTM clinicians diagnosed the MCSs by signs, symptoms, and associated factors of patients including a physical examination to find patterns of imbalance elements and the origin of the disorder to optimize treatment. Thus, the purpose of this study was to develop a new assessment tool, the menstrual-cycle-related signs and symptoms questionnaire (MCSQ) based on TTM principles for evaluation of women's menstrual health. METHODS: The items and components of the MCSQ were adjusted by TTM expert consensus using the Delphi technique. The content validity of the MCSQ was quantified by the content validity index (CVI). MCSQ were examined by construct validity and internal consistency reliability using exploratory factor analysis (EFA) and Cronbach's α coefficient, respectively. RESULTS: : All 19 experts (100%) responded to the questionnaires in the three rounds of the Delphi technique. The MCSQ showed high content validity of individual items (I-CVI = 0.83-1.00) and high overall content validity of the questionnaire (S-CVI/AVE = 0.98). Overall, 429 of 432 participants completed the questionnaire (99.31%). After factor analysis, the final MCSQ was divided into two sections, which consisted of 49 items. The first had 23 items focusing on the MCSs. And, the second had 14 items of personal and medical data including 12 items of associated factors. Cronbach's α coefficient of the final MCSQ was 0.87, and that of each component was between 0.32 and 0.82. CONCLUSIONS: This study reports a new MCS questionnaire tool, which was developed from TTM knowledge to evaluate women's health. This questionnaire showed an acceptable level of validity and reliability. Thus, it is also expected to be useful in clinical practice and ongoing research on evaluation of women's health.

Pharmacokinetics of piperine after oral administration of Sahastara remedy capsules in healthy volunteers.

BACKGROUND AND PURPOSE: To investigate the pharmacokinetics of piperine after single oral doses of capsules containing Sahastara (SHT) remedy dried ethanolic extracts in healthy Thai volunteers. EXPERIMENTAL APPROACH: Twenty-four healthy volunteers were divided into two dosage groups. They received a single oral dose of SHT remedy extract capsules of 100 or 200 mg. Blood was collected at time intervals of 0, 0.5, 1, 2, 4, 6, 8, 12, 24, and 48 h. Acute clinical safety was monitored by complete physical examination and laboratory tests during the study period. Piperine concentration in blood and urine was determined by liquid chromatography tandem-mass spectrometry. FINDINGS/RESULTS: No serious adverse events were detected, only one volunteer had abdominal pain that was self-limiting. The pharmacokinetics of piperine following SHT remedy extract capsule administration demonstrated a mean peak concentration (Cmax) of piperine of 3.77 µg/mL and 6.59 µg/mL after dosing with 100 and 200 mg, respectively. Interestingly, a secondary maximum concentration of piperine was observed in this study, which might be related to enterohepatic recirculation. Negligible amounts of unchanged piperine were detected in urine. CONCLUSION AND IMPLICATION: The systemic exposure of piperine after SHT remedy ethanolic extract demonstrated dose proportionality after single oral dosing of 100-200 mg. Piperine was detectable in plasma for at least 48 h with evidence of enterohepatic recirculation. Metabolism and excretion profiles of piperine after administration of SHT remedy extract capsule need to be further explored for phytopharmaceutical product development.

Development and Validation of a Predictive Score for Preoperative Diagnosis of Early Stage Epithelial Ovarian Cancer

Objective: To develop and validate a simplified multi-parameter risk-based scoring system for preoperative diagnosis of early stage epithelial ovarian cancer. Methods: All women presented with adnexal mass and were scheduled for operation at Phrapokklao hospital during September 2013 ­ December 2017 were included and categorized according to their histopathologic reports into early stage ovarian cancer groups and benign ovarian tumor groups. Multivariable logistic regression was used to explore for potential predictors. The selected logistic coefficients were transformed into risk-based scoring system. Internal validation was done with bootstrapping procedure. Results: A total of 270 participants were included in analysis and predictive model development, 54 in early stage ovarian cancer group and 216 in benign ovarian tumor group. Menopausal status, two abnormal ultrasound findings (presence of solid component or ascites), tumor size and serum CA-125 level were used for derivation of the scoring system. The score-based model showed area under ROC of 0.88 (95%CI 0.82-0.93). The developed scoring system ranged from 0 to 51 was classified into 3 subcategories for clinical practicability. The positive predictive values for the presence of early stage ovarian cancer were 2.07 (95%CI 0.43-6.05) for low risk patient, 29.13(95%CI 19.65-41.58) for moderate risk patient, and 95.45(95%CI 77.16-99.88) for high risk patient. Conclusion: This simplified risk-based scoring system for preoperative diagnosis of early stage ovarian cancer could aid general physicians or general gynecologists in evaluation of patients presenting with ovarian tumors and help gynecologic oncologists in management planning and prioritization of patients for operation.

Otorhinolaryngology surgery analysis in Japan and Thailand: Comparing Nihon University School of Medicine with Thammasat University Faculty of Medicine.

BACKGROUND/OBJECTIVE: We compared the surgery data of the department of otorhinolaryngology of the university hospitals in Japan and Thailand to make each feature and the differences of both otorhinolaryngology surgeries clear. There are some medical meetings and congresses between Japan and Thailand, but so far it has not reported about the comparison of surgery data. METHODS: Retrospectively, we analyzed the surgical statistics of department of otorhinolaryngology of Nihon University Itabashi Hospital (Japan) and Thammasat University Hospital (Thailand) between 2013 and 2014. RESULTS: In Japan, there were many surgeries involving the middle ear and paranasal sinuses whereas in Thailand, tracheotomy and tonsillectomy were more frequently performed. Statistical analysis of the surgical data revealed specific tendencies in the nature of the operations performed at each university. CONCLUSION: This study revealed that there are rather differences between two hospitals' surgeries features. It was thought that it would be beneficial to both institutions to gain a deeper understanding of the areas of expertise of each university in order to foster an environment conducive to increasing future international collaborations.

A Study of the Relationship between Pelvic Organ Prolapse and Positive Dipstick Urinalysis in Postmenopausal Women.

Objective: To study the relationship between pelvic organ prolapse and positive dipstick urinalysis in postmenopausal women. Material and Method: From April 2014 to August 2015, the postmenopausal women who attended the urogynecology clinic, Thammasat university hospital,were asked to join in the study. After signing the informed consent, the general characteristics data including the lower urinary tract symptoms (LUTS) were collected. The physical examination and evaluation of the quantitative measurement for POP were undergone. All women were asked to take the mid-streamed urine for dipstick urinalysis. Urinary tract infections were diagnosed by positive leukocyte esterase or nitrite test. Immediately after emptying the bladder, postvoid residual urine volume (PVR) was measured by using translabial ultrasound and calculated by the formula: height x depth x 5.6. Results: There were 221 postmenopausal women with POP and the incidence of the urinary tract infection in this group was 17.6%. Procidentia uteri were found in 39 women and 14 women had positive nitrite or leukocyte esterase tests with a significant correlation (p = 0.001). The anterior vaginal wall was the most common descending part and usually combined with other parts. Most women had prolapses at least grade II. The average postvoid residual urine was 35.0±24.4 ml. The total eversion of vaginal wall, procidentia uteri, was significantly associated with high PVR (p<0.001). And the women with high PVR had increased risk of positive urine dipstick test (p = 0.009). There was a correlation between anterior and posterior wall prolapses and UTI (p = 0.02). Conclusion: There were relationships between pelvic organ prolapse, especially procidentia uteri, anterior and posterior prolapses and UTI in postmenopausal women.

Factors Affecting Successfulness of Vaginal Pessary Use for the Treatment of Pelvic Organ Prolapse.

BACKGROUND: Pelvic organ prolapse can cause adverse events affecting the lives of the women. Vaginal pessary is a conservative treatment, which is not expensive and safe. For the patient with medical condition, vaginal pessary would be the first choice of treatment. OBJECTIVE: To study the factors those affect the success of the vaginal pessary use for treatment ofpelvic organ prolapse. MATERIAL AND METHOD: Historical data ofpatients who visited urogynecology clinic, Thammasat University hospital from January 2009 through December 2013, were collected. The SPSS program was used for statistical analysis with p-value < 0.05. RESULTS: Of 252 women with pelvic organ prolapse, median age was 67 years (range 29-92 years). Most patients, 78.2%, had severe POP (stage 3-4). 194 women were treated with vaginal pessary. 83.5% of these patients could use continuously more than 3 months. The open ring was the most common using pessary. 48.1% of the patients who could use pessary continuously can self-remove and insert the device. Anterior vaginal wall and the vaginal length were significantly higher with the successful users. The most common complication was the presence of abnormal vaginal discharge, and more common in the patient with donut pessary. CONCLUSION: The open ring is the device that can be used easily and has fewer complications,followed by ring with support. Short vaginal length is afactor that cannot use the pessary. It seems that relaxed anterior wall and longer vaginal length might help hold the pessary in the vagina.

Effect of pelvic floor muscle training (PFMT) during pregnancy on bladder neck descend and delivery.

BACKGROUND: Pelvic floor muscle exercises (PFME) are commonly recommended during pregnancy and after birth for both prevention and treatment of lower urinary tract symptoms (LUTS). Stress urinary incontinence has long been presumed to be associated with urethral hypermobility. Pregnancy and delivery are known cause of increasing bladder neck descent (BND). OBJECTIVE: The present study aimed to determine the effect of antenatal PFME on bladder neck descent in nulliparous pregnancy. MATERIAL AND METHOD: 219 nulliparous women pregnant between 8-12 weeks were interviewed and then underwent transperineal ultrasound. Of the total, 108 women were randomly assigned to a PFMT group, while 111 women to a control group. The latter group received routine antenatal care. For the intervention group, patients were taught about PFMT using visual biofeedback by transperineal ultrasound. The PFMT regimen comprised a series of 15 contractions, and each contraction was heldfor 5 seconds, with 5 seconds rest between each contraction. Patients were asked to repeat this regimen for 3 times after each meal. At second trimester, third trimester, 3-month postpartum and 6-month postpartum, the subjects in both groups were interviewed and then underwent another ultrasound assessment. Transperineal ultrasound was performed after bladder emptying, with the patient in the supine position. Bladder neck position was measured at rest and on maximal valsava, and the differences yielded a numerical valueforBND. The sample size was calculated with apower of80% p<0.05 was considered significant. SPSS 15. Ofor windows (SPSS Inc., Chicago, Illinois) was used for statistical analyses. RESULTS: Demographic characteristics did not differ significantly between PFMT and control groups, showing effective randomization. Mean age was 26.95±3.94 and 26.51±5.41 years for PFMT and control group, respectively (p = 0.49). There were no significant differences in bladder symptoms between the two groups at the first visit. In the first trimester, the average BND of the PFMT group was slightly higher than BND of the control group (14.1±6.9 mm and 12.2±6.7 mm respectively (p = 0.04)). When comparing delivery mode by using Pearson's Chi-square test, there was no statistically significant difference between two groups (p = 0.35). The mean fetal birth weight of women in the PFMTgroup was 3,084 grams and in the control group was 3,093 grams (p = 0.88). At 6 monthspostpartum, 80 women of the PFMT group and 65 women of the control group returned for follow-up. There were no differences regarding the prevalence ofL UTS between the groups at 6 months after delivery. Women in the control group had a higher BND (16.4±6.6 mm) than those in the PFMT group (13.9±7.3 mm, p = 0.03). This difference was also found in the subgroup of the women who delivered vaginally (BND = 17.5±6.7 mm in the control group and 13.2±7.4 mm in the PFMTgroup, p = 0.006). CONCLUSION: Although postpartum prevalence of LUTS was no different between groups, this study has demonstrated that antenatal pelvic floor muscle exercises may reduce bladder neck mobility at 6 months after childbirth. The significance of such an effect remains to be determined.

Effect of pregnancy on urinary functions in Thai nulliparous pregnant women.

BACKGROUND: Many epidemiological studies have shown that lower urinary tract symptoms (LUTS) are common during the first pregnancy. Both prevalence and severity ofLUTSseem to increase through out pregnancy. It also compromised daily life of pregnant women. Both anatomical change and hormonal change during pregnancy can disrupt the normal urinary tract function. OBJECTIVE: The aim of the present study is to identify the effect ofpregnancy in different trimesters ofpregnancy on urinary function of Thai nulliparous women by using free uroflowmetry. MATERIAL AND METHOD: A prospective study of 111 Thai nulliparous pregnant women at 8-12, 24-28 and 32-38 gestational weeks. They attended the antenatal clinic in Thammasat Hospital. All women were interviewed about their urinary symptoms such as hesitancy, frequency, nocturia, stress incontinence, urge incontinence and difficulty in passing urine. The severity of each symptom was clarified as none, mild, moderate and severe. Free uroflowmetry was performed using a special-setting toilet in the clinic. Maximum flow rate (Qmax), average flow rate (Qavg), voided volume (VV) and residual urine volume were measured. RESULTS: Mean age of 111 women was 26.6±5.4 years and the mean body weight was 52.4±9.4 kilograms. The average gestational age was 8.6±1.9 weeks at first visit, 26.1±1.3 weeks at second visit and 34.1±1.6 weeks at last visit. The symptom ofurinary frequency and nocturia increased throughoutpregnancy. Only two women at 24-28 weeks and one woman at 34- 38 weeks reported moderate to severe stress incontinence. No women had moderate to severe urge incontinence. Maximum and average flow rates slightly increased toward the end ofpregnancy. But voided volume was slightly decreased in the second and third visits. Residual urine of less than 50 ml was found in all women and allperiods. CONCLUSION: Urinary frequency and nocturia were common in Thai nulliparous pregnancy. Most of them did not complain of stress nor urge incontinence. Maximum and average flow rate seem to increase consistently while gestational age increase and average voided volume were reduced in late pregnancy.

Normal value of bone mineral density of lumbar spine, proximal femur, and distal forearm of women in different age groups.

The cross sectional, descriptive study was conducted to find the reference data for bone mineral density (BMD) in normal women in the area around Thammasat University Hospital. The study population consisted of 806 women aged 15-80 years. BMD of different parts of the body were measured by dual energy photon absorptiometer. The results showed that mean (+/- SD) BMD of the lumbar spine 2, 3, 4, neck of femur, Ward's triangle of femur, greater trochanter of femur, ultradistal part of radius, and distal ulnar averaged from all age groups were 0.954 +/- 0.144, 1.027 +/- 0.151, 1.059 +/- 0.147, 0.898 +/- 0.114, 0.774 +/- 0.165, 0.777 +/- 0.103, 0.412 +/- 0.073, and 0.585 +/- 0.096 g/cm2 respectively. Overall, the peak BMD was between the age of 40-44 years old. It started decreasing from the age of 45 and decreased remarkably after the age of 50. The data is shown to be a database for our hospital's health policy, but the authors believe that it could also be used as reference data for future studies in Thailand. It is suggested that normal values in different areas should be available in the future in order to provide more specific and better health care according to demographic variation.