Combined vaginal administration of nystatin, diiodohydroxyquin, and benzalkonium chloride versus oral metronidazole for the treatment of bacterial vaginosis.

OBJECTIVE: To compare combined vaginal administration of nystatin, diiodohydroxyquin, and benzalkonium chloride versus oral metronidazole for the treatment of bacterial vaginosis (BV). METHODS: A randomized controlled trial was conducted among women diagnosed with BV using the Amsel criteria (n=90) at a university hospital in Khon Kaen, Thailand, between June 27, 2017, and April 30, 2018. The oral metronidazole group (n=44) received 400 mg of metronidazole, administered three times per day. The combined vaginal tablet group (n=46) received a vaginal suppository once daily, which comprised nystatin (100 000 U), diiodohydroxyquin (100 mg), and benzalkonium chloride (7 mg). Treatment was administered for 7 days in both groups. Follow-up visits at 14 and 42 days assessed treatment outcomes and adverse effects. RESULTS: Remission of BV occurred among 41 (93%) women in the oral metronidazole group and 39 (85%) women in the combined vaginal tablet group. The adjusted relative risk was 0.92 (95% confidence interval 0.80-1.06). The rate of nausea and/or vomiting was significantly higher in the oral metronidazole group than that in the combined vaginal tablet group. CONCLUSION: Treatment efficacy of the combined vaginal tablet versus oral metronidazole was equivalent. CLINICAL TRIAL REGISTRATION: TCTR20170627001 (www.clinicaltrials.in.th).

Difference in carotid intima-media thickness between pre and postmenopausal women.

OBJECTIVES: To examine whether carotid intima-media thickness (CIMT), the prevalence of increased CIMT, and the presence of carotid plaque differ according to menopausal status. METHODS: In this analytical cross-sectional study, we enrolled 61 premenopausal women and 61 postmenopausal women. We matched the two groups for age. Participants were classified as either premenopausal or postmenopausal according to menstrual history and follicular-stimulating hormone level. Two skilled radiologists measured CIMT and carotid plaque in all participants by using B-mode ultrasound. RESULTS: The mean age was 49.25 ±â€Š2.0 years. The mean number of years since menopause in the postmenopausal group was 1.9 ±â€Š0.92 years. After adjusted analysis, the mean CIMT of the common carotid artery of postmenopausal women was significantly higher than that of premenopausal women, with a mean difference of 0.068 mm (95% confidence interval 0.023, 0.113). There was no significant association between number of years since menopause and mean CIMT. Although the prevalence of increased CIMT and the presence of carotid plaque were significantly higher in the postmenopausal group than in the premenopausal group according to crude analysis, this difference was not statistically significant after adjusted analysis. Multiple linear regression analysis for assessing potential risk factors for the alteration of mean CIMT showed that only menopausal status and body mass index were independently associated factors. CONCLUSIONS: Our findings indicate that postmenopausal status is a significant factor of high mean CIMT. These findings add to the growing evidence showing that menopause transition is a critical period for subclinical atherosclerosis development.

Adequacy of calcium intake during pregnancy in a tertiary care center.

BACKGROUND: Calcium is an essential element for the body, which is taken through the dietary sources. Calcium supplements may be needed to achieve the dietary reference intake (DRI). Dietary calcium and supplemental calcium intake for calcium balance might be necessary. However, increasing evidence shows that calcium supplementation may enhance soft tissue calcification and cause cardiovascular diseases. Calcium requirement during pregnancy is markedly increased. If calcium supplementation depends on the dietary style of a region, then the adequacy of dietary calcium intake may guide the calcium supplementation. MATERIALS AND METHODS: A cross-sectional descriptive study was conducted among pregnant women who attended prenatal care at Srinagarind Hospital, Khon Kaen University. We used semiquantitative food frequency questionnaire (SFFQ) to evaluate the amount of daily calcium intake, and 3 days food record to assess the SFFQ reliability. We used the INMUCAL-N V.3.0, based on the Thai food composition table for nutritional calculation. RESULTS: Among 255 recruited pregnant women, the mean daily dietary calcium intake was 1,256.9 mg/day (SD: 625.1) and up to 1,413.4 mg/day (SD: 601.3) in daily milk consumed group. Based on Thai DRI for pregnant women, with 800 mg/day as adequate intake of calcium, 74.9% had adequate calcium intake, and majority of them had milk daily. CONCLUSION: The majority of pregnant women in a province of Northeast Thailand had adequate calcium intake, particularly those who had milk with their meal every day.

Effects of sunlight exposure and vitamin D supplementation on vitamin D levels in postmenopausal women in rural Thailand: A randomized controlled trial.

BACKGROUND: Despite the abundant sunlight in Thailand, vitamin D deficiency is common in premenopausal and postmenopausal Thai women. Sunlight exposure is a natural way to increase one's intake of vitamin D. However, limited research has been conducted regarding natural exposure to sunlight as a strategy to improve vitamin D status in postmenopausal women. OBJECTIVE: This study aimed to determine the effects of sunlight exposure compared with oral supplementation with vitamin D2 (weekly 20,000 IU) in combination with sunlight exposure on 25(OH)D levels. METHODS: A 12-week randomized controlled trial was conducted in 52 postmenopausal women, age 50-70 years. The participants were randomized to either the sunlight exposure group or the sunlight exposure with vitamin D supplementation group. Serum 25(OH)D concentration and parathyroid hormone (PTH) were measured using standard assays at baseline and 12 weeks. RESULTS: After 12 weeks, mean serum 25(OH)D had decreased from 32.3 to 29.7 ng/ml in the sunlight exposure group, but significantly increased in the combination group (from 29.9 to 32.4 ng/ml). At the end of the study, 25(OH)D levels were significantly higher in the sunlight exposure with vitamin D supplementation group compared with the sunlight exposure group. However, this difference was not observed in women aged >60 years. Serum PTH had decreased in both groups, but not to a significant extent. CONCLUSION: A combination of weekly vitamin D2 supplementation at a dose of 20,000 IU with sunlight exposure is more effective than sunlight exposure alone in postmenopausal Thai women. Sunlight exposure alone is not sufficient to maintain 25-hydroxyvitamin D levels in this setting.

Rate and factors affecting non-exclusive breastfeeding among Thai women under the breastfeeding promotion program.

OBJECTIVE: The objective of this study was to assess the rate of non-exclusive breastfeeding and associated factors among Thai women under the Breastfeeding Promotion Program. METHODS: This was a prospective descriptive study that involved term postpartum women who attended the Breastfeeding Clinic at Srinagarind Hospital in Thailand, from April to December 2016. Abstracted data included baseline characteristics, obstetric history, breastfeeding history, problems in breastfeeding at day 3 and 2 weeks, and feeding status at 12 weeks postpartum. Univariate and multivariate logistic regression methods were used to determine significant factors predicting non-exclusive breastfeeding. RESULTS: Of the 500 postpartum women enrolled in this study, follow-up data at 12 weeks postpartum were available for 368 women (73.6%). The rate of non-exclusive breastfeeding assessed at 12 weeks postpartum was 26.4% (95% CI 21.9%-31.2%). Nipple problems and pain during the first 3 days postpartum and milk storage problems at 2 weeks postpartum were the major reasons for non-exclusive breastfeeding (69.4% and 59.1%, respectively). The significant independent factors that predicted these included patients not having confidence in their ability to breastfeed exclusively or not having any intention to do so (OR 7.22; 95% CI 3.26-14.24), no rooming-in (OR 2.31; 95% CI 1.04-5.12), and low milk quantity at 2 weeks postpartum (OR 3.75; 95% CI 1.70-8.29). CONCLUSION: The rate of non-exclusive breastfeeding in this study was ~26%, and significant associated factors included having lack of confidence/intention, no rooming-in, and low milk quantity reported at 2 weeks postpartum.

Premenstrual syndrome (PMS) among high school students.

BACKGROUND: Premenstrual syndrome (PMS) is a common health problem among adolescents. OBJECTIVE: To assess the prevalence of PMS in Thai high school students. MATERIALS AND METHODS: This was a prospective study conducted among menstruating high school students in Khon Kaen, Thailand, from September to December, 2015. Participants were asked to prospectively complete an anonymous questionnaire, which included information about demographic data, menstrual patterns, and symptoms to be recorded on a daily calendar of premenstrual experiences according to the diagnostic criteria proposed by the American College of Obstetricians and Gynecologists. All of the data were prospectively recorded for 90 consecutive days. RESULTS: Of the 399 participants, 289 (72.4%) completed the self-report questionnaire. Eighty-six participants (29.8%; 95% CI, 24.5%-35.4%) reported having PMS. The most common somatic and affective symptoms among participants with PMS were breast tenderness (74.4%) and angry outbursts (97.7%). There were significant differences between the PMS and non-PMS groups, and PMS was associated with various problems related to educational activities, including lack of concentration and motivation, poor individual work performance, poor collaborative work performance, and low scores. However, there were no significant differences regarding interpersonal relationships between the PMS and non-PMS groups. CONCLUSIONS: PMS is a common menstrual disorder among Thai high school students. The most common symptoms reported in this study were angry outbursts and breast tenderness.

Prevalence of Vitamin D Insufficiency among Elderly Males Living in Rural Khon Kaen Province, Northeast Thailand.

BACKGROUND: Vitamin D is essential for bone strength. In our previous study of urban, elderly, males, the prevalence of vitamin D insufficiency was 48%, and they had a lower level of bone turnover marker than normal, young adult, Thai males. OBJECTIVE: To A) ascertain the prevalence of vitamin D insufficiency, B) to determine the bone turnover marker level in rural elderly males, and C) to compare urban and rural males with these parameters. RESULTS: The prevalence of vitamin D insufficiency among rural elderly males was 13.6%, while the level of bone turnover markers (P-CTx, and PINP) were in the normal Thai reference range. It was also found that rural elderly males had a significantly higher level of the calcidiol, iPTH, ß-CTx, and PINP than their urban counterparts. CONCLUSION: The prevalence of vitamin D insufficiency among rural elderly males was significantly lower than among urban males and rural males had a higher level of calcidiol, iPTH and bone turnover marker. The hypothesis was that differences in rural vs. urban lifestyle accounted for the discrepancy, possibly because elderly rural males performed strenuous outdoor labor while most urbanites stayed at home and/or had sedentary jobs.

Effects of the levonorgestrel-releasing intrauterine system plus estrogen therapy in perimenopausal and postmenopausal women: systematic review and meta-analysis.

OBJECTIVE: The objective of this study was to compare the effects of the levonorgestrel-releasing intrauterine system (LNG-IUS) with those of systemic progestogen in perimenopausal and postmenopausal women taking systemic estrogen therapy (ET). METHODS: We searched Medline (August 8, 2009), Embase (August 8, 2009), the Cochrane Central Register of Controlled Trials on the Cochrane Library Issue 3 (2009), the MetaRegister of Controlled Trials, and the reference lists of articles for relevant trials. Randomized controlled studies of LNG-IUS versus systemic progestogen in perimenopausal and postmenopausal women taking ET were included in the review. Two reviewers abstracted the trials independently. Any disagreement was resolved through discussion with the third reviewer. For dichotomous outcomes, a Peto odds ratio was calculated. For continuous outcomes, nonskewed data from valid scales were synthesized using a weighted mean difference or a standardized mean difference. RESULTS: Six trials with a total of 518 participants were included. The methodological limitation was an attrition bias. In perimenopausal and postmenopausal women taking ET, the incidence of a proliferative endometrium was comparable between the use of systemic progestogen and LNG-IUS, except for sequential medroxyprogesterone acetate, which had a higher incidence of proliferative endometrium. Descriptive data synthesis showed that ET combined with either LNG-IUS or systemic progestogen effectively relieved climacteric symptoms. Vaginal bleeding and spotting were common in the LNG-IUS group for the first 3 to 6 months of use. The discontinuation rate was not different. There was insufficient evidence to draw any conclusions about the other outcomes. CONCLUSIONS: The LNG-IUS was more effective than sequential medroxyprogesterone acetate but was comparable with other systemic progestogen regimens for endometrial protection in perimenopausal and postmenopausal women taking ET.

Prevalence of vitamin D insufficiency among the elderly males living in the urban areas of Khon Kaen Province in the northeast of Thailand.

BACKGROUND: Vitamin D insufficiency among the elderly Thai women in the urban areas was higher than in the rural areas because of lifestyle differences. There are very few studies about vitamin D status among Thai elderly males. OBJECTIVE: To ascertain the vitamin D status in and prevalence of vitamin D insufficiency among the elderly Thai males living in the urban areas of Khon Kaen province, situated in Northeast, Thailand. RESULTS: The respective mean (SE) of calcidiol, beta-CTx and PINP level for the elderly Thai males were 42.04 (1.22), 0.26 (0.02) and 37.39 (2.19) ng/mL. A calcidiol level under 40 ng/mL indicated vitamin D insufficiency and the prevalence of the elderly Thai males living in urban area of Khon Kaen province, Thailand was 48%. The respective correlations between PTH and calcidiol, beta-CTx and PINP were -0.217, 0.640 and 0.393. The respective correlations between PTH and BMD of the trochanteric region and total femur were 0.198 and 0.199 (p < 0.05). CONCLUSION: The prevalence of vitamin D insufficiency among the elderly males in Khon Kaen remained high and the bone biochemical markers were at a low enough level to cause low bone turnover and low BMD.

Modified Singh index in diagnosing femoral neck osteoporosis.

The participants in the present study were 130 elderly women living in Khon Kaen, Thailand. All except one subject was undergone by both DEXA-BMD and AP radiographs of the left hip joints. The mean (SD) of age, weight, height and BMI of the 129 participants were 72.5 (5.3) years old, 49.8 (10.3) kg, 1.49 (0.06) m, and 22.21 (4.13) kg/m2, respectively. Poor intrapersonal reliability (kappa = 0.11 and 0.11) and poor interpersonal reliability (kappa = 0.15) for the modified Singh index with three grades were found. On the other hand the modified Singh index with two grades had high accuracy in diagnosing of femoral neck and total hip osteoporosis (0.74 and 0.81 respectively) when comparing with DEXA-BMD.

Using quantitative ultrasound and OSTA index to increase the efficacy and decrease the cost for diagnosis of osteoporosis.

According to the WHO criteria for diagnosing osteoporosis, DXA is presently the best method for measuring and diagnosing osteoporosis, but it is relatively expensive, non-portable and emits low-level radiation. Alternatively, the Osteoporosis Risk Assessment Tool for Asians (OSTA) and quantitative ultrasound (QUS) are simpler, less expensive and emit no radiation, but are less accurate. However, the use of OSTA index corroborated by QUS was proposed as an alternative method of diagnosing osteoporosis. The combined diagnostic strength of an OSTA index < or = -1 and a QUS T-score < or = -4.5 had comparably high accuracy relative to the gold standard DXA T-score < or = -2.5, especially for the femoral neck (80%) and total femur (89%). We conclude that the sequential use of the OSTA index followed by QUS is an efficacious alternative for diagnosing osteoporosis, especially in rural areas or in developing countries where resources are limited.

The prevalence of hypovitaminosis D in the elderly women living in the rural area of Khon Kaen Province, Thailand.

This study investigated the prevalence of hypovitaminosis D in the elderly women living in the rural area of Thailand. The subjects were 132 cases (but just 129 cases were used in the statistical analysis?) of the elderly women who were living in the rural area of Khon Kaen province. The mean (+/- SD) of age and the mean (+/- SD) of serum 25 (OH) D concentration of these elderly women were 71.55 (+/- 5.26) years and 44.9 (+/- 11.02) ng/ml respectively. There was a significant inverse relationship (or correlation? Notice your analysis.) between the serum 25 (OH) D and the PTH concentration. The serum PTH concentration increased significantly when the serum 25 (OH) D concentration was at < or = 35 ng/ml. As a result, the prevalence of hypovitaminosis D in these selected elderly women was 17.4 per cent.

Hypovitaminosis D in Thailand.

The hypovitaminosis D in the premenopausal women and the postmenopausal elderly women in Thailand was investigated. One hundred and six cases of the elderly women living in the urban area of Khon Kaen province, one hundred and thirty-two cases of the elderly women living in the rural area of Khon Kaen province, ninety-eight cases of the postmenopausal women who attended Menopausal Clinic, Srinagarind Hospital, Khon Kaen province, and 357 premenopausal women from the multicenters in Thailand were the subjects. The serum level of 25(OH)D < or = 35 ng/ml was used as the cut-off point of hypovitaminosis D. The prevalence of hypovitaminosis D in these selected groups of women was 65.4, 15.4, 60.2, and 77.8 percent respectively. The premenopausal female group had the highest prevalence of hypovitaminosis D and the lowest level of 25 (OH) D whereas the group of the postmenopausal elderly women in the rural area had the lowest prevalence of hypovitaminosis D and the highest 25 (OH) D level.

Vitamin D status of Thai premenopausal women.

Vitamin D insufficiency of Thai elderly women in urban area were higher than in rural area because of the difference in life style. Until now there are no any evidences about vitamin D status in Thai premenopausal women. This study was the multicenters study from 5 provinces of Thailand which cover all region of Thailand except southern area. The mean (SE) of calcidiol level of Thai premenopausal women was 29.09 (0.42) ng/ml, and with the cut point of < or = 35 ng/ml; the prevalence of vitamin D insufficiency was 77.81%. Chiang Mai had lowest calcidiol level (25.09 ng/ml) and had highest PTH, and bone resorption markers. The prevalence of vitamin D insufficiency was highest in Khon Kaen (88.78%) and Chiang Mai (84.62%) province respectively. Life style modification to expose more sunlight should be advised for increasing the serum vitamin D and lowering the risk of osteoporosis.

Prevalence and risk factors of urinary incontinence in Khon Kaen menopausal women.

OBJECTIVE: To determine the prevalence and risk factors of urinary incontinence in menopausal women. STUDY DESIGN: Prospective Descriptive study. SETTING: Menopausal clinic and gynecological outpatient unit, Department of Obstetrics and Gynecology, Srinagarind Hospital, Faculty of Medicine Khon Kaen University. STUDY POPULATION: Menopausal women attending the menopausal clinic and gynecological outpatient unit. MATERIAL AND METHOD: Between April 23 and July 15, 2004, 229 menopausal women were interviewed by pre-validated questionnaire and in-depth interview to determine the prevalence and risk factors of urinary incontinence. RESULTS: The average age of the study group was 55.8 years. The prevalence of urinary incontinence was 38.86%, the most common type was mixed urinary incontinence (82.02%) followed by stress urinary incontinence (12.36%), and urge urinary incontinence (5.62%). The risk factors of urinary incontinence were vaginal delivery, menopause before 50 years old, and postmenopausal women who had never used hormone therapy. CONCLUSION: The prevalence of urinary incontinence in menopausal women was 38.86%. Mixed urinary incontinence was the most common type. Associated risk factors were vaginal delivery, menopause before 50 years old, and postmenopausal women who had never used hormone therapy.

Preoperative vaginal preparations for abdominal hysterectomy for the prevention of febrile morbidity: savlon douching vs povidone-iodine painting.

OBJECTIVE: To compare the effectiveness between savlon solution was douching and povidone-iodine solution painting for reducing febrile morbidity after total abdominal hysterectomy. STUDY DESIGN: Clinical trial. MATERIAL AND METHOD: One hundred and fifty patients at Srinagarind Hospital were scheduled for total abdominal hysterectomy (TAH). All subjects were non-randomly allocated to receive either savlon (1:1000 solutions) douching or povidone-iodine (1% solution) painting as pre-operative vaginal preparations. They also received Cefazolin 1 gm. intravenously before the operation. The principal outcome of the study was febrile morbidity. RESULTS: The overall rate of febrile morbidity was 21 percent. The incidence of febrile morbidity in the savlon vs. povidone-iodine groups was 16 (12/75) and 25 (19/75) percent, respectively. No statistically significant difference was found between the two groups (p-value = 0.16). The odds ratio was 1.78 (95%CI 0.79 to 3.99) and adjusted odds ratio was 2.09(95%CI 0.86 to 5.10) CONCLUSION: The effectiveness between savlon solution douching and povidone-iodine solution painting in conjunction with a prophylactic antibiotic before TAH for reducing febrile morbidity was not significant different.

Effect of hormone therapy on lipid profile in menopausal women.

OBJECTIVE: To study lipid profile of menopausal women with hormone therapy. MATERIAL AND METHOD: Two hundred and sixty eight menopausal women in good health conditions, separated into natural and surgical menopause group, received service at Menopausal clinic in Srinagarind Hospital, Faculty of Medicine, Khon Kaen University since 1996-2004. They regularly took a single type of hormone therapy for about 12 months and obtained blood cholesterol levels for pre- and post-hormone therapy of about 12 months period. The data were analyzed with SPSS v. 10.0.5. RESULTS: The average age of the sample groups were 50.91 +/- 5.93 years and 52.83 +/- 5.28 respectively. Both sample groups have similar mean level of cholesterol levels during pretreatment period. Surgical menopausal group has greater HDL level than the naturally menopausal group with the average level of 64.24 +/- 15.32 mg/ dl. and 58.80 +/- 17.20 mg/dl. respectively. However after taking hormone therapy, blood cholesterol level was significantly changed in both groups. The mean level of LDL decreased (8.59% and 11.49% respectively) and mean level of HDL increased (15.43% and 6.89% respectively). CONCLUSIONS: Hormone therapy in menopausal women can improve cholesterol levels by decreasing LDL and increasing HDL with statistical significance (p < 0.05).

Singh index screening for femoral neck osteoporosis.

The present study included 130 elderly women living in Khon Kaen, Thailand, and all but one underwent both DEXA-BMD and AP radiographs of the left hip joint. The mean (SD) of age, weight, height and BMI of the 129 participants was 72.5 (5.3) years, 49.8 (10.3) kg, 1.49 (0.06) m, and 22.21 (4.13) kg/m2, respectively. The authors found both poor sensitivity and a positive predictive value for a Singh grade of < or = 4 or < or = 3 (viz. 58 and 29 or 19 and 43 percent, respectively). The ROC curve showed the poor diagnostic value of the Singh index since the area under the curve was approximately 40% the Singh index is therefore a poor screening tool for femoral neck osteoporosis.

Serum concentration of undercarboxylated osteocalcin and the risk of osteoporosis in thai elderly women.

The elevation of undercarboxylated osteocalcin (ucOC) means vitamin K insufficiency is significantly increased in elderly women, and is associated with high skeletal turnover, low BMD, and increased risk of osteoporotic fracture. The objective of the present study was to find out the level of ucOC and the prevalence of vitamin K deficiency in elderly Thai women. The upper limit of normal premenopausal ucOC level was 2.314 ng/ml, represented the cut-off level for vitamin K deficiency, 39.1% of elderly women had serum ucOC concentration above this level. Women with high serum ucOC level had a significantly lower BMD of ultradistal radius, distal 1/3 of radius and 25(OH)D level, higher serum PTH and alkaline phosphatase activity than women with a normal ucOC (p<0.05). Serum ucOC was correlated positively with PTH (r = 0.411, p< 0.001), modest negatively with serum 25(OH)D (r = -0.17, p= 0.013). The ucOC level of urbanized elderly was higher than that of rural elderly. It was concluded that vitamin K deficiency is one of the risks of osteoporosis with high prevalence in the Thai elderly especially urbanized ones, the supplement of vitamin K should be recommended in Thai osteoporotic patients especially the urbanized elderly.