The effect of online video-assisted teaching program on medical students learning procedure of fractional curettage.

OBJECTIVES: Since 2020, with the entire world in crisis over the coronavirus pandemic (COVID-19), medical students have adapted to hybrid and distance learning. This study aims to compare the learning outcomes of students learning the procedure of fractional curettage in an online video-assisted teaching program to those of students learning the procedure in a traditional class. METHODS: A quasi-experimental study was conducted among fourth-year medical students who rotated to Obstetrics and Gynecology courses between April 2021 and October 2021. Participants in the first two rotations were enrolled in traditional classes, and the online video-assisted teaching program was introduced in the subsequent two rotations. Both study groups took OSCEs (objective structured clinical examinations), a pre-test and post-test with MCQs (multiple choice questions), and a confidence and satisfaction level questionnaire. RESULTS: A total of 106 fourth-year medical students, 54 in the traditional group and 52 in the online video-assisted teaching program, were recruited. The online video-assisted group showed a statistically better mean OSCE score (85.67 ± 11.29 vs. 73.87 ± 13.01, p < 0.001) and mean post-test MCQ score than the traditional group (4.21 ± 0.87 vs. 3.80 ± 0.98, p = 0.0232). Moreover, the mean difference between the two groups' pre and post-test MCQ scores was significantly different (0.96 ± 1.37 vs. 1.79 ± 1.50 in traditional and online video-assisted teaching program groups, respectively, P = 0.0038). The participants in the experimental group reported significantly greater confidence (P < 0.001) in performing the fractional curettage procedure. However, the mean satisfaction score was significantly higher in the control group (p = 0.0053). CONCLUSION: The online video-assisted teaching program on the fractional curettage procedure, a necessary and skill-demanding procedure, is an effective and advantageous education tool that improves skills, knowledge, and confidence in fourth-year medical students. We recommend that the video-assisted teaching program is another effectively procedural teaching method for medical students.

Effects of intravenous tranexamic acid on ovarian reserve and intra-operative blood loss during laparoscopic cystectomy of endometriotic cyst: a pilot randomized controlled trial.

BACKGROUND: Strategies to preserve ovarian function after ovarian endometriotic cyst removal have been reported in many studies; however, no study has evaluated tranexamic acid administration during surgery. OBJECTIVE: To evaluate feasibility of conducting a definitive trial and assessing the potential efficacy of tranexamic acid on ovarian reserve and intra-operative blood loss by comparing mean differences in anti-Müllerian hormone (AMH) levels following laparoscopic ovarian cystectomy between tranexamic acid and control groups. MATERIALS AND METHODS: A parallel two-arm pilot trial was conducted with 40 participants with endometriotic cysts who underwent laparoscopic ovarian cystectomy. They were randomized 1:1 to either 1 g tranexamic acid (TXA) or no TXA (n = 20 per group). TXA was administered to the participants immediately after induction of general anesthesia and intubation. The primary outcome was the feasibility of conducting a definitive trial in terms of design and procedures (such as recruitment rate, retention, safety of intravenous 1 gm of TXA, sample size verification) and assess the efficacy of TXA on the ovarian reserve and intra-operative blood loss by comparing mean difference of AMH levels between TXA and control groups at pre- and 3 months post-surgery. RESULTS: The recruitment and successful completion rates were 95% and 100%. Baseline characteristics were similar in the two groups. The mean difference of serum AMH levels (pre- and 3 months post-surgery) between the TXA and control groups was not significantly different. When performing a subgroup analysis, the mean difference of AMH levels (pre- and 3 months post-surgery) seemed to be higher in the bilateral than in the unilateral ovarian cyst group but not significantly different. Operating time was significantly longer in bilateral than in unilateral cysts. No post-operative complications or adverse effects were found. CONCLUSION: The full randomized controlled trial for evaluating effects of TXA administration during laparoscopic cystectomy for endometrioma on ovarian reserve was shown to be feasible. Several modifications should be added for improving feasibility, for example, increasing the TXA dose, modifying TXA administration, focusing on either patients with unilateral or bilateral ovarian cysts, and exploring other outcome measures, e.g., surgeons' satisfaction. TRIAL REGISTRATION: Thai Clinical Trials Registry, TCTR20190424002 , Registered 24 April 2019.

Incidence of complete vaginal cuff wound healing at sixth and eighth week after total abdominal hysterectomy.

AIM: To assess the incidence and risk factors of complete vaginal cuff wound healing at sixth and eighth week after total abdominal hysterectomy (TAH). METHODS: A retrospective chart review of women who underwent TAH for benign conditions from January 2015 to December 2015 at Ramathibodi Hospital was conducted. The primary outcome was the incidence of complete vaginal cuff healing at 6 and 8 weeks after operation as determined by complete vaginal mucosal approximation without the presence of suture material or granulation tissue. RESULTS: The medical records of 235 patients who underwent TAH for benign conditions were reviewed. The incidence of complete vaginal cuff wound healing at 6 and 8 weeks after operation were 189 and 225 cases, respectively (80.4% vs 95.7%, P value <0.001). Forty-six (19.6%) patients had incomplete vaginal cuff healing at 6 weeks after operation. Of those, 33 patients had vaginal cuff granulation. Spontaneous regression of lesions had occurred in 69.7% at 8 weeks. Independent risk factors of delay vaginal cuff healing were the used of electrosurgery for vaginal incision (adjusted odds ratio 13.4, 95% confidence interval 2.63-67.74) and suturing cuff with continuous technique (adjusted odds ratio 9.1, 95% confidence interval 2.12-39.01). CONCLUSION: The incidence of complete vaginal cuff wound healing was significantly higher at 8 weeks than at 6 weeks after TAH for benign conditions. Therefore, 8 weeks after operation would be an appropriate time for the first vaginal cuff examination.

Limited Impact of Music Therapy on Patient Anxiety with the Large Loop Excision of Transformation Zone Procedure - a Randomized Controlled Trial.

BACKGROUND: Many studies have pointed to strategies to cope with patient anxiety in colposcopy. Evidence shows that patients experienced considerable distress with the large loop excision of transformation zone (LLETZ) procedure and suitable interventions should be introduced to reduce anxiety. This study aimed to investigate the effects of music therapy in patients undergoing LLETZ. MATERIALS AND METHODS: A randomized controlled trial was conducted with patients undergoing LLETZ performed under local anesthesia in an out patient setting at Ramathibodi Hospital, Bangkok, Thailand, from February 2015 to January 2016. After informed consent and demographic data were obtained, we assessed the anxiety level using State Anxiety Inventory pre and post procedures. Music group patients listened to classical songs through headphones, while the control group received the standard care. Pain score was evaluated with a visual analog scale (VAS). Statistical analysis was conducted using Pearson Chi-square, Fisher's Exact test and T-Test and p-values less than 0.05 were considered statistically significant. RESULTS: A total of 73 patients were enrolled and randomized, resulting in 36 women in the music group and 37 women in the non-music control group. The preoperative mean anxiety score was higher in the music group (46.8 VS 45.8 points). The postoperative mean anxiety scores in the music and the non-music groups were 38.7 and 41.3 points, respectively. VAS was lower in music group (2.55 VS 3.33). The percent change of anxiety was greater in the music group, although there was no significant difference between two groups. CONCLUSIONS: Music therapy did not significantly reduce anxiety in patients undergoing the LLETZ procedure. However, different interventions should be developed to ease the patients' apprehension during this procedure.

Vaginal Stump Characteristics after Total Abdominal Hysterectomy Using Electrosurgery versus Scalpel or Scissors for Vaginal Incision: A Randomized Controlled Trial.

Objective: To compare the vaginal stump characteristics following total abdominal hysterectomy between two vaginal incision techniques, electrosurgery versus scalpel or scissors. Material and Method: A randomized single-blind controlled trial was performed in 80 patients scheduled to undergo total abdominal hysterectomy for benign conditions. Either sharp instrument (scalpel or scissors) or electrosurgery was used for vaginal incision following standard surgical technique for total abdominal hysterectomy. The main outcome measures were the vaginal stump characteristics determined by the degree of vaginal mucosal approximation and the presence of vaginal granulation at 6-week postoperatively. Results: Six weeks after surgery, the number of patients with incomplete mucosal approximation following electrosurgical technique was 11 (27.5%), as compared to 8 (20%) (p = 0.43) in the scalpel/scissors technique group. The incidences of vaginal granulation in the scalpel/scissors group and electrosurgical group were 10% and 22.5%, respectively. Conclusion: The vaginal stump characteristics at six weeks following total abdominal hysterectomy between two vaginal incision techniques were not statistically significantly different.

LINE-1 Methylation Patterns as a Predictor of Postmolar Gestational Trophoblastic Neoplasia.

OBJECTIVE: To study the potential of long interspersed element-1 (LINE-1) methylation change in the prediction of postmolar gestational trophoblastic neoplasia (GTN). METHODS: The LINE-1 methylation pattern from first trimester placenta, hydatidiform mole, and malignant trophoblast specimens were compared. Then, hydatidiform mole patients from 11999 to 2010 were classified into the following 2 groups: a remission group and a group that developed postmolar GTN. Specimens were prepared for a methylation study. The methylation levels and percentages of LINE-1 loci were evaluated for their sensitivity, specificity, and accuracy for the prediction of postmolar GTN. RESULTS: First, 12 placentas, 38 moles, and 19 malignant trophoblast specimens were compared. The hydatidiform mole group had the highest LINE-1 methylation level (p = 0.003) and the (u)C(u)C of LINE-1 increased in the malignant trophoblast group (p ≤ 0.001). One hundred forty-five hydatidiform mole patients were classified as 103 remission and 42 postmolar GTN patients. The %(m)C(u)C and %(u)C(m)C of LINE-1 showed the lowest p value for distinguishing between the two groups (p < 0.001). The combination of the pretreatment ß-hCG level (≥100,000 mIU/mL) with the %(m)C(u)C and %(u)C(m)C, sensitivity, specificity, PPV, NPV, and accuracy modified the levels to 60.0%, 92.2%, 77.4%, 83.8%, and 82.3%, respectively. CONCLUSIONS: A reduction in the partial methylation of LINE-1 occurs early before the clinical appearance of malignant transformation. The %(m)C(u)C and %(u)C(m)C of LINE-1s may be promising markers for monitoring hydatidiform moles before progression to GTN.

PTEN and MDM2 expression in the prediction of postmolar gestational trophoblastic neoplasia.

OBJECTIVE: To investigate the role of PTEN and MDM2 expression in hydatidiform mole in the prediction of postmolar gestational trophoblastic neoplasia (GTN). STUDY DESIGN: A total of 145 cases of hydatidiform mole were diagnosed at the King Chulalongkorn Memorial Hospital from 1999 to 2010. Patients were classified into 2 groups: spontaneous remission and patients with postmolar GTN. Clinicopathologic features and immunohistochemical staining by PTEN and MDM2 were reviewed. The results were analyzed in correlation to the clinical characteristics and outcomes. RESULTS: Of 145 recruited cases, 128 (88.3%) cases were complete hydatidiform mole (CHM) and 17 (11.7%) cases were partial hydatidiform mole (PHM). Postmolar GTN was clinically diagnosed in 42 cases (28.9%). The incidences of postmolar GTN following CHM and PHM were 29.7% and 23.5%, respectively. Mean age of the postmolar GTN group was significantly older than that of the remission group (31.2 vs. 27.8, p = 0.04). There was no significant difference of pathologic features between cases with remission and postmolar GTN. Immunoreactivity of PTEN and MDM2 were similarly present in trophoblastic cells of both CHM and PHM groups without significantly different patterns. CONCLUSION: Immunohistochemical expression of PTEN and MDM2 in hydatidiform mole cannot predict molar malignant transformation.

Inhibin A levels and severity of preeclampsia.

OBJECTIVE: To evaluate the use of third trimester inhibin A levels to assess the severity of preeclampsia. MATERIALS AND METHODS: Blood samples were taken from women diagnosed with mild and severe preeclampsia during the third trimester of pregnancy. Blood samples were collected in plain tubes, centrifuged and stored at -80 degrees C until analyzed. All serum samples were measured for inhibin A levels by enzyme-linked immunosorbent assays. RESULTS: Inhibin A levels were greater in the severe (1,435.9 +/- 603.2 pg/mL) than in the mild preeclampsia group (1,021.9 +/- 438.8 pg/mL, P = 0.014). CONCLUSION: Inhibin A levels rise with increasing severity of disease. However, there is considerable overlap of serum inhibin A levels in women with mild and severe preeclampsia. Inhibin A is therefore not a useful adjunct for the classification of preeclampsia.

Serum inhibin A level in preeclampsia and normotensive pregnancy.

OBJECTIVE: To compare serum inhibin A levels in pregnancy complicated by preeclampsia and in normotensive pregnancy. MATERIALS AND METHODS: Blood samples were taken from 60 women. Thirty women were diagnosed with preeclampsia, and 30 women had normotensive pregnancies. Both groups were matched for gestational age. Blood samples were collected in plain tubes, centrifuged, and stored at -80 degrees C until analyzed. All serum samples were measured for inhibin A level by enzyme-linked immunosorbent assay (ELISA). RESULTS: Inhibin A levels were greater in the preeclampsia group (1229.7 +/- 537.5 pg/mL) than in the normotensive group (839.1 +/- 370.0 pg/mL, p = 0.002). CONCLUSIONS: Levels of inhibin A in the preeclampsia group were greater than in the normotensive group.