Assessment of Prevalence, Adhesion and Surface Charges of Bifidobacterium spp. Isolated from Thai Women with Bacterial Vaginosis and Healthy Women

Background: Bifidobacterium spp. have been reported in women with bacterial vaginosis (BV), nevertheless data of prevalence and adhesion property of the vaginal bifidobacteria in Thai women with BV are still limited. Objective: To determine prevalence of Bifidobacterium spp. and to evaluate adhesion ability and cell surface properties of bifidobacterial isolates from Thai women with BV compared to healthy subjects. Material and Method: A total of 139 bifidobacterial isolates from 20 of 60 women with BV and 7 of 60 healthy women. The isolated strains were identified by molecular biology techniques and examined for adhesion property and surface charges. Results: The prevalence of vaginal bifidobacteria in women with BV (33.3%) was significantly (p<0.05) higher than healthy women (11.7%) with total counts of 8.9±3.4 Log CFU/ml and 5.7±2.9 Log CFU/ml, respectively. The frequent species of B. bifidum, B. longum, B. breve and B. dentium were found in women with BV, while healthy women harbored B. bifidum, B. longum and B. breve. All vaginal bifidobacteria from BV and healthy subjects were able to adhere cultured cells in vitro. The adhesion ability of B. bifidum and B. dentium from BV subjects showed high degree of adhesion property and was in correlation with cell surface characteristics. Conclusion: The prevalence of vaginal bifidobacteria occurred significantly higher in women with BV than healthy group. The strains of B. bifidum and B. dentium showed high adhesion property which implied as an important role of colonization in vaginas of women with BV.

Toxoplasma gondii infection: What is the real situation?

The prevalence of chronic Toxoplasma infections reported in the literature varies enormously. We hypothesize that one factor could be due to the different methods used in the evaluation of infections. Serological evidence of Toxoplasma infections in 450 pregnant women (PW) and 300 HIV-infected patients (HIV) were investigated by the Sabin-Feldman dye test and two other commercial ELISA kits (kit1 and kit2). Anti-Toxoplasma IgG antibodies obtained from the Sabin-Feldman dye test, ELISA kit1 and ELISA kit2 in the PW subjects were 14.7%, 29.6% and 38.7%, and in the HIV subjects were 13%, 34.7% and 36.3%, respectively. So there were significant differences in the seroprevalences when different diagnostic tests were used (P<0.05). Regarding Sabin-Feldman dye test as the gold standard for anti-Toxoplasma antibodies detection, we found that the sensitivity and specificity of the ELISA kit1 and kit2 was in the range of their specification. However as the two ELISA kits used in our study identified a much higher prevalence of Toxoplasma infections which indicated that false positive cases were being reported. Based on results obtained, it is therefore highly recommended that research workers should be aware that the reports of serological studies in terms of high positive results should be treated with some skepticism until additional precise diagnostic tools are developed.

Prevalence of lactobacilli in normal women and women with bacterial vaginosis.

OBJECTIVE: To study the prevalence and the number of lactobacilli in normal subjects and in women with bacterial vaginosis (BV). MATERIAL AND METHOD: The studied subjects consisted of 60 normal and 60 BV women. The diagnosis of BV was based on at least three of five indicators of Chandeying criteria. The vaginal specimens were collected and cultured on MRS plates for determination of lactobacilli counts. RESULTS: The number of lactobacilli was highly significant (p < 0.001) in the women with diagnosis of BK and the mean count of lactobacilli in BV was markedly decreased (5.3 +/- 1.8 log colony-forming unit--CFU/ml), compared with normal women (8.8 +/- 2.9 log CFU/ml). Among the treated BV group, follow-up vaginal specimen was encountered in 47 of 60 cases (78.3%). The proportion of lactobacilli isolation was slightly increased from 12 (25.5%) to 15 (31.9%) in 47 cases. Concordance with quantitative settlement of lactobacilli in BV was increased from 1.4 +/- 2.6 log CFU/ml, to 1.8 +/- 2.9 log CFU/ml in treated BV. Treated BV the lactobacilli had not restored significance (p = 0.5831), as well as the total bacteria. CONCLUSION: Lactobacilli dominantly occur in healthy women, and markedly decline in BV. However, the vaginal ecosystem is dynamically changed in the lactobacilli of either normal or BV women.

Outcome of adolescent pregnancy in different periods: Vachira Phuket Hospital.

OBJECTIVE: Determine an outcome of adolescent pregnancy in different periods. MATERIAL AND METHOD: The retrospective descriptive study was conducted during the first and second quarter of the fiscal year (FY) 2012. Outcome of adolescent pregnancy included hematocrit, antenatal visit, stillbirth, Apgar score, low birth weight, and maternal & neonatal complication were collected. RESULTS: There were 1,430/1,391 deliveries in the first/second quarter of FY 2012. The proportion of adolescent pregnancy of first/second quarter, less than 20 years old, was 182/155 cases (12.7/11.1%), respectively. The satisfactory antenatal visit, at least four visits, was achieved in the high proportion of 71.9/78.0%. However the first antenatal visit in the first trimester was quite low as 17.5/20.0%. Anemia was reported in about one-third as 30.7/28.3%, while low birth weight of less than 2,500 grams accounted for up to 13.7/13.5%. Severe asphyxia of Apgar score lees than 4for longer than 5 minutes was 2.1/1.2% CONCLUSION: Independent known confounding factors of adolescent pregnancy were associated with maternal anemia, and low birth weight neonate. Prenatal health care providers should pay special attention to this sensitive population.

Birth risk indicators for maternal and neonatal health among three different age groups: Betong Hospital perspective.

OBJECTIVE: Examine the maternal and neonatal birth risk indicator among three different age groups, and their relationship with the outcome of pregnancy. MATERIAL AND METHOD: This retrospective descriptive study was conducted between October 2010 and September 2011. The birth risk indicators of maternal and neonatal health were collected from the medical records of adolescent, elderly, and reproductive women maternal age (adult). RESULTS: There were 902 deliveries, and the proportion of teenage pregnancy/adult/elderly group was 16.5/71.5/12.0%. Most of the indicators, including delivered baby weight less than 2,500 grams, and hematocrit less than 30 volume% before admission, were not significant increases/decreased unless the antibiotic usage in the vaginal delivery for at least 24 hours was highly significant decreased/increased among adolescent/elderly group (0.6/75.0%), compared with adult group (8.3%). The cesarean section rate due to failure to progress was significant lower among adolescents (7.3%), compared with the adult group (14.5%). While the cesarean section due to previous cesarean section and delivered baby weight less than 2,500 grams were highly significant/significant lower among the elderly group (2.7/2.7%), compared with the adult group (12.7/7.9). CONCLUSION: The present study demonstrated that adolescent pregnancy even though it predisposed to maternal and neonatal complication, but when the teenagers receive optimal antenatal care, pregnancy outcome is comparable to that of other age groups.

Birth risk indicators for maternal and neonatal health: Songkla Center Hospital perspective.

OBJECTIVE: The aim of the present study was to examine the maternal and neonatal birth risk indicator and their relationship with the outcome of pregnancy. MATERIAL AND METHOD: This retrospective descriptive study was conducted in a selective month of 2008, 2009, and 2010. The birth risk indicators of maternal and neonatal health were collected from the medical records. RESULTS: There were 385, 349 and 334 deliveries in a selective month of 2008, 2009, and 2010. There was neither maternal mortality, nor cardiovascular failure in the present study period. Three main indication of inductions of labor were premature rupture of membrane (up to 4.0%), diabetes mellitus (up to 2.0%), and postdate (up to 1.3%). The first two conditions had statistical significance in September 2009 (p = 0.0334 and 0.0053 respectively). Whereas, the three major indications of cesarean section were previous cesarean section (12.5 to 21.9%), failure to progress due to protracted/arrest of labor pattern with/without rupture of membrane and augmented labor (2.4 to 7.5%), and fetal distress (1.1 to 4.2%). The rates of low birth weight, less than 2,500 grams, were varied from 5.2 to 6.9%. The respiratory distress syndrome (RDS) related to repeat cesarean section was encountered up to 3.6%, as well as the RDS related to induction of labor was up to 1.6%. CONCLUSION: The birth risk indicators reflect the outcome of pregnancy, however the development of additional key indicators for perinatal health care outcome are required.

Comparison of condition specific indicators among illegal induced abortion: septic and non-septic abortion in Songkla Center Hospital.

OBJECTIVE: Determine the clinical indications of illegal induced abortion, comparison between septic and non-septic abortion. MATERIAL AND METHOD: The present retrospective descriptive study was conducted among pregnant women who were admitted in the hospital with the illegal induced abortion. The demographic data, gestational age, the method used, and personnel performing were gathered, as well as symptomatology, basic laboratory, condition progression, and medical and surgical intervention. RESULTS: There were 92 patients with illegal induced abortion between March 2009 and December 2010. The three main induced methods for termination of pregnancy was vaginal suppository, likely to be misoprostol-a synthetic prostaglandin E, analog (43.5%), oral Thai herbal medicine (19.6%) and combined medication (16.3%), respectively. Of septic/non-septic abortion, the first visit body temperature of 38.0 degrees Celsius or more (74.1/12.3%), heart rate of 100 per minutes or more (74.1/12.3%), fever index 3 degree-hours or more in the first 24 hours (81.5/12.3%) and fever index 5 degree-hours or more in the first 24 hours (59.3/1.5%), were statistically significant (all p-values of < 0.001). Overall, the most common type of termination of induced abortion was incomplete abortion 68 in 92 cases (73.9%). CONCLUSION: The first visit body temperature of 38.0 degrees C or more, heart rate of 100 per minutes or more and fever index of 3 and 5 degree-hours, are clinically helpful in the early diagnosis and treatment of septic abortion.

Validity evaluation of in-house preparation kit, vaginal pH paper test combined amine tube test, for the simple diagnosis of bacterial vaginosis.

OBJECTIVE: Determine the positive in-house preparation kit for suggested bacterial vaginosis (BV) for both elevated vaginal pH > 4.5 and positive amine test, as well as evaluate for validity of sensitivity, specificity, positive predictive value, and negative predictive value against Chandeying criteria for confirmed BV. MATERIAL AND METHOD: A cross-sectional study among the women who presented with an abnormal vaginal discharge (AVD) or asymptomatic annual cervical cytology screening was done. Each vaginal discharge was divided into two parts of investigation. The first part included the clinical criteria of confirmed BV, based on at least three out of five indicators, the vaginal pH > 4.5, homogeneous and thin discharge (milky discharge), positive sniff/amine test, clue cell > 20% of total vaginal epithelial cells, and scanty or absence lactobacilli. The second part included the in-house preparation kit of suggestive BV relied on elevated vaginal pH > 4.5 and positive amine tube test. RESULTS: Twenty-six women were enrolled. Of the complaint of AVD/asymptomatic had 2/10 of confirmed BV (12 cases), and 1/13 of confirmed non-BV (14 cases). The in-house preparation kit, compared with the clinical criteria, had sensitivity of 91%, specificity of 71%, positive predictive value of 73%, and negative predictive value of 90%. There were false negative of 1/12 cases (8.3%), and false positive of 4/14 cases (28.5%). CONCLUSION: The in-house preparation kit favorably compared with the clinical criteria and has the advantage of being simple, rapid, and easily performed in resource poor setting. Further development on sensitivity and specificity of the test is suggested.

Challenges in the conduct of Thai herbal scientific study: efficacy and safety of phytoestrogen, pueraria mirifica (Kwao Keur Kao), phase I, in the alleviation of climacteric symptoms in perimenopausal women.

OBJECTIVE: To evaluate the preliminary efficacy and safety of Pueraria mirifica (Kwao Keur Kao), phytoestrogen, for the alleviation of climacteric symptoms. MATERIAL AND METHOD: Perimenopausal women attending with climacteric symptoms, such as hot flushes and night sweats, were invited to join the present study, conducted at the Menopausal Clinic, Hat Yai Regional Hospital. The patients were voluntarily enrolled and randomly received the raw material of Pueraria mirifica, oral 50 and 100 mg capsule, once daily for six months, as an open-label study. RESULTS: Of the 10 enrolled patients, 8 cases were completely evaluated. The modified Greene climacteric scale (MGCS) was satisfactorily decreased in both groups. The average scale declined from 44.1 at baseline, to be 26, 17, and 11.1 at 1-, 3-, and 6- month follow-up respectively. No other laboratory abnormalities, except one case had transiently increased the creatinine level, and one case of increased blood urea nitrogen. The mean serum estradiol was slightly increased, while the mean serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were nearly stable. CONCLUSION: Pueraria mirifica is relatively safe and preliminarily alleviates the climacteric symptoms in perimenopausal. women, but the data is insufficient to draw definite conclusions regarding the estrogenic effect.

Experience on triple markers serum screening for Down's syndrome fetus in Hat Yai, Regional Hospital.

OBJECTIVES: To summarize the experience and evaluate the performance of the Hat Yai maternal serum screening (MSS) program. SETTING: The Hat Yai MSS program between 16 February 2003 and 11 March 2004. MATERIAL AND METHOD: The uptake of screening was 999 in 1,040 women (96.0%), between 14 to 20 weeks of gestation with the triple markers: Alpha-fetoprotein (AFP), human Chorionic Gonadotropin (hCG), and unconjugated Estriol (uE3) by Immulite chemiluminescent immunoassay system, Diagnostic Product Corporation (DPC). The risk cut-off for Down 's syndrome is one in 250 or greater, based on software for prenatal Down's syndrome risk calculation, by Prisca 3.5 DPC. RESULTS: There were 119 in 999 cases (11.9%) of the triple test positive. Amniocentesis had been performed on voluntary basis, and the uptake rate of amniocentesis following a positive Down's syndrome screening was 104 in 119 cases (87.3%). Based on clinical diagnosis of Down's syndrome in the newborns of non-amniocentesis mothers, assuming that normal looking babies were not Down's syndrome, the sensitivity (SENS), specificity (SPEC), positive predictive value (PPV), and negative predictive value (NPV) of all chromosomal abnormalities were 85.7%, 88.6%, 5.0%, and 99.8% respectively. The false positive rate was 113 in 992 cases (11.4%). Whereas, the SENS, SPEC, PPV and NPV of Down's syndrome were 100%, 88.4%, 3.4%, and 100% respectively. The false positive rate was 115 in 995 cases (11.6%). The mean level, median level, and multiple of median (MoM) of triple markers were demonstrated. CONCLUSION: The Down's syndrome screening is a systematic application of a test to identify subjects at increased risk of a specific disorder; of course it is not diagnostic, but to benefit making decision regarding further amniocentesis. The sensitivity of Prisca 3.5 software was satisfactory but false positive rate was remarkably high. It needs further standardization with adjusted MoM values.

Efficacy comparison of Pueraria mirifica (PM) against conjugated equine estrogen (CEE) with/without medroxyprogesterone acetate (MPA) in the treatment of climacteric symptoms in perimenopausal women: phase III study.

OBJECTIVE: To evaluate the efficacy comparison of Pueraria mirifica (PM), name in Thai is Kwao Kruea Khao, against conjugated equine estrogen (CEE) with/without medroxyprogesterone acetate (MPA) in the treatment of perimenopuasal women with climacteric symptoms. MATERIAL AND METHOD: Perimenopausal women attending the Menopausal clinic of Hat Yai Regional Hospital were voluntarily recruited. The vasomotor symptoms such as hot flushes and night sweats, as well as other unpleasant symptoms, urogenital and psychological symptoms, were also assessed. Patients were voluntarily enrolled and randomly received daily 50 mg raw material of PM, Group A, or daily 0.625 mg of conjugated equine estrogen (CEE) with/without 2.5 mg of medroxyprogesterone acetate (MPA), Group B, depend on non-hysterectomized/hysterectomized condition. RESULTS: Seventy-one patients were enrolled. Eleven of those were excluded for failing to complete the initial work-up and follow-up. Sixty cases were evaluated, 30 cases in Group A and 30 cases in Group B. After medication, the mean of modified Greene climacteric scale (MGCS) in Group A/Group B had decreased from 29.0/32.26 to 17.86/18.1, 12.56/9.57 and 9.9/8.16 at 1-, 3-, and 6- month respectively. The clinical satisfaction using MGCS was not statistically significant between PM (Group A) and CEE with/without MPA (Group B) in the alleviation of climacteric symptoms (p-value > 0.05). There were no statistically significant changes of three serum markers: estradiol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) between both groups. CONCLUSION: PM, containing phytoestrogens, has estrogenic effect as similar as CEE, and can alleviate the climacteric symptoms in perimenopausal women. PM demonstrates great promise in the treatment of climacteric symptoms. However, optimal doses should be clinically assessed to meet appropriate individual responses.

Gynecologic tumors during childhood and adolescence.

The majority of genital tumors are similar in almost all of the cell types but the frequency is different between children, adolescents, and female adults. The primary site of tumor is similar to the adults, however, the potential of malignant occurrence is higher among children and adolescents. The outline of this article covers clinical manifestation, differential diagnosis, investigation, and management in the particular disease/condition. The challenges of gynecology in children and adolescents are the complexity of physical and mental health, so the approach needs delicate skill and reasoning. Because they are not in full adulthood but in the transitional stage, the multidisciplinary and meticulous approach and management is a substantial issue. Balance and flexibility are the main key of this medical care. Extreme surgical intervention leading to over treatment or ignorance and carelessness leading to under quality of care are challenges facing the doctor.

Efficacy and safety of Pueraria mirifica (Kwao Kruea Khao) for the treatment of vasomotor symptoms in perimenopausal women: Phase II Study.

OBJECTIVES: To evaluate the preliminary efficacy and safety of Pueraria mirifica in the treatment of vasomotor symptoms. DESIGN: Open-label study. SETTING: Hat Yai Regional Hospital, Thailand. SUBJECTS: Pre and postmenopausal women with vasomotor symptoms, such as hot flushes and night sweats. Other unpleasant symptoms, urogenital and psychological symptoms, were also evaluated. MATERIAL AND METHOD: Patients were enrolled voluntarily and randomly received 50 mg or 100 mg of Pueraria mirifica in capsules, once daily for six months. RESULTS: Of the 48 enrolled patients, 11 cases were excluded for failing to complete the initial work-up. Thirty-seven cases were evaluated. 20 of 37 (54.1%) randomly received a dose of 50 mg/day of Pueraria mirifica (Group A), and 17 of 37 (45.9%) received 100 mg/day of Pueraria mirifica (Group B). The mean of the modified Greene climacteric scale decreased from 35.6 to 26.6, 17.2 and 15.1 in group A, while group B, declined from 32.6 to 21.0, 14.8 and 13.6 at 1-, 3- and 6-month respectively. The mean serum estradiol, fluctuated from the baseline of 76.6 to 55.4, 56.7, 72.5, 69.2, 114.2 and 74.5 pg/ml at 1-, 2-, 3-, 4-, 5- and 6-month respectively. Whereas the mean serum follicle-stimulating hormone (FSH)/luteinizing hormone (LH) was stable in the range of; 27.1/12.6, 28.3/12.9 and 22.5/11.4 mIU/ml at baseline, 3- and 6-month respectively. CONCLUSIONS: Pueraria mirifica, containing phytoestrogens, relatively alleviated the climacteric symptoms in perimenopausal women. The transient negative profiles occurred in a small number of subjects that included anemia, and liver profiles. While there was a slight decrease in lipoproteins and an increase in hormonal profiles, Pueraria mirifica demonstrates great promise in the treatment of climacteric symptoms among perimenopausal women. However, optimal doses should be clinically assessed, to meet appropriate individual responses.

Efficacy, safety and acceptability of a seven-day, transdermal estradiol patch for estrogen replacement therapy.

OBJECTIVES: To evaluate the efficacy, safety and acceptability of a seven-day, transdermal estradiol patch, in the treatment of menopausal symptoms. DESIGN: Open-label trial. SETTING: Hat Yai Regional Hospital, Thailand. SUBJECTS: Hysterectomized women with surgical or natural menopause. METHOD: The clients received a 12.5 cm2 matrix patch, containing 3.9 mg of estradiol delivering 0.05 mg/day, once a week for six months. The efficacy, safety, and acceptability were evaluated at the end of 1-, 3- and 6-months. RESULTS: Six-month responses were analyzed among 50 enrolled patients. The mean estradiol level/Follicle Stimulating Hormone/Lutienizing Hormone were 27.88/70.03/31.19, 44.08/53.37/26.86, and 42.43/48.53/24.39 pg/ml, mIU/L, mIU/L at admission, 1- and 3-months, respectively. The average climacteric score was 27.18, 16.60, 12.78, and 12.18 at admission, 1-, 3- and 6-month, respectively. At least 94 per cent of patches were not dislodged more than one quarter. The most common skin irritation was itching, followed by erythema, vesicle, and burning sensation. The patches were generally well tolerated, and acceptability was satisfactory. CONCLUSION: Transdermal estradiol patch effectively reduced the severity of menopausal symptoms, measured by modified climacteric score. Adhesion was found to be excellent. In actual clinical practice, the transdermal patch should be appropriately introduced to tolerant users.

Toxoplasma infection in pregnant women: a current status in Songklanagarind hospital, southern Thailand.

BACKGROUND: Toxoplasmosis, being one of the TORCH's infections in pregnant women, is caused by Toxoplasma gondii, an obligate intracellular protozoan parasite. This parasitic infection in pregnancy congenitally causes severe outcomes to their fetus and newborn. This study aimed to determine the seroprevalence and stages of Toxoplasma infection in pregnant women and its associated risks exposures. METHODS: The study was conducted within the pregnant women attending the antenatal clinic (ANC) at Songklanagarind hospital, Hat Yai, Songkhla province, Thailand. The sera of a total of 760 consecutive pregnant women were screened using standard commercial ELISA kits for detection of anti-Toxoplasma IgG and IgM antibodies. IgG avidity in the seropositive for both anti-Toxoplasma IgG and IgM antibodies were also assessed. The pregnant women's socio-demographic, obstetrics and risk factors associated with Toxoplasma seropositivity data were analyzed using univariate and multivariate analyses. RESULTS: From the total 760 pregnant women, 190 (25%, 95% CI = 22.05-28.20) were positive for anti-Toxoplasma antibodies. Of these, 167 (22.0%, 95% CI = 19.0-25.0) were positive for only anti-Toxoplasma IgG antibody and 23 (3.0%, 95% CI = 2.0-4.0) were positive for both anti-Toxoplasma IgG and IgM antibodies. All these samples were high avidity, indicated the infection occured prior to four to five months. By applying statistical univariate analysis, age group, occupation and sources of drinking water showed a significant association with Toxoplasma seropositivity (p < 0.05). Multivariate logistic regression analysis further indicated that the significant factors associated with Toxoplasma seropositivity are age ≥26 (OR = 1.65, 95% CI = 1.11-2.44), working as laborer (OR = 1.57, 95% CI = 1.13-2.18) and drinking unclean (piped/tap/rain) water (OR = 1.75, 95% CI = 1.08-2.84). CONCLUSION: The pregnant women in the active age group, working as laborers and exposure to unclean drinking water from various sources were at higher risk of Toxoplasma infection. Therefore, health education and the awareness of risk exposures regarding this parasitic disease are required to minimize the effects of this parasitic infection in pregnant women as well as in the general population.

Toxoplasmosis-serological evidence and associated risk factors among pregnant women in southern Thailand.

Toxoplasma gondii is an important parasite in pregnant women. This case-controlled study assessed the seroprevalence of toxoplasmosis in 640 pregnant women in southern Thailand and identified their associated risk factors. The overall seroprevalence of toxoplasmosis was 181 (28.3%). Of this, 138 (21.6%) were positive for only anti-Toxoplasma immunoglobulin G (IgG) antibody, 43 (6.7%) were positive for both IgG and IgM antibodies, and none were positive for IgM antibody. Multivariate analysis revealed that increasing age (adjusted odds ratio [OR] = 1.64, 95% confidence interval [CI] = 1.01-2.67), living outside Songkhla province (adjusted OR = 1.56, 95% CI = 1.08-2.24), parity (adjusted OR = 1.65, 95% CI = 1.01-2.68), contact with cats (adjusted OR = 1.70, 95% CI = 1.20-2.43), and drinking of unclean water (adjusted OR = 1.70, 95% CI = 1.08-2.68) were factors associated with Toxoplasma seroprevalence. On the basis of the results obtained, a health surveillance program should be initiated as a primary preventive measure for congenital toxoplasmosis and focus on educating women of the child-bearing age group to avoid contact with cats and to strictly practice personal hygiene.

Prevalence and typing of human papilloma virus (HPV) among female sex workers and outpatient women in southern Thailand.

BACKGROUND: Thai sex workers (SW) have high rates of sexually transmitted infections (STIs); however, detection and treatment is often complicated by accessibility to sensitive and accurate diagnostic tests. Self-sampling of women combined with molecular amplification techniques could help in accurate diagnosis, treatment and follow-up of such women. Detection of persistent high-risk human papilloma virus (HPV) in such populations could also be beneficial in identifying women who may need more frequent follow-up for cervical cytology screening. The current study aimed to examine the prevalence of HPV in this population and compare this with the lower-risk outpatient women (OPW) in Thailand. METHODS: Four hundred and thirty OPW and 524 Thai SW were sampled by a self-administered tampon collection. Cells were extracted from tampons and, subsequently, women underwent routine vaginal examination for detection of other STIs. Detection of HPV was performed by polymerase chain reaction (PCR) using the L1 consensus primers, followed by L1 consensus probe using an in-house PCR-enzyme-linked immunosorbent assay (ELISA). All positive samples were typed using PCR-ELISA and type-specific oligonucleotide probes. RESULTS: Overall, HPV was detected in 20/430 (4.6%) and 120/524 (22.9%) in OPW and SW respectively. Over 98% of samples produced a beta-globin signal, indicating adequately collected samples. Human papilloma virus typing probes detected HPV16 or 18 in 14% and 26% of the positive samples from OPW and SW respectively. HPV31, 33, 35 or 39 were detected in 19% and 12% and HPV45, 51 or 52 in 9.5% and 4% of positive OPW and SW patients respectively. Low risk HPV6 or 11 were detected in 1% and 4.9% of OPW and SW respectively. CONCLUSION: There was a significantly higher HPV prevalence in Thai SW than OPW, with the majority (21%) of positive samples containing the oncogenic HPV16 or 18 DNA. The results indicate that PCR could serve as a rapid and easy method for identification of women who require more frequent screening for cervical cancer.

Sexual health promotion in Thailand.

Sexuality and power are at the root of most sexual and reproductive health problems in Thailand, including reproductive tract infections, fertility and population control, unwanted pregnancy and abortion, unsafe abortion, unsafe motherhood and violence against women, as well as issues emerging from the mobile and migrant population, including the spreading of HIV/AIDS. In the past three decades, reproductive health services in Thailand have been established and strengthened. Since 1995, reproductive health has become a priority of the Ministry of Public Health. Health system reform in 2000 led to strategies and actions of health performance improvement. Ongoing multisectoral programmes include: (1) political and social involvement; (2) training for professionals; (3) multidimensional services; and (4) research.

Survival analysis in advanced epithelial ovarian carcinoma in relation to proliferative index of MIB-1 immunostaining.

AIM: To evaluate the survival of patients with advanced epithelial ovarian carcinoma in relation to MIB-1 immunostaining, to determine the association between MIB-1 and clinicopathologic variables, and to identify an appropriate cut-off point for MIB-1 immunostaining as a prognostic marker. METHODS: We retrospectively reviewed the medical records of women diagnosed with advanced epithelial ovarian carcinoma during 1987-1998. The paraffin-embedded tissue of recruited women was stained with MIB-1 immunostaining for review. RESULTS: The records of 105 patients were included. The percentage staining of MIB-1 ranged from 0.3 to 100%, with a median of 11.9%. MIB-1 staining was generally higher in serous tumors than in other types (P = 0.048), but was not associated with other potential prognostic indicators. The 5-year survival rate among advanced epithelial ovarian carcinoma patients was 25.7%, while that in the high MIB-1 (greater than or equal to median) and low MIB-1 (less than median) patients was 15.1% (95% confidence interval [CI] = 7.1-26.0) and 36.5% (95% CI = 23.8-49.4), respectively. Median survival times in the two groups were 1.8 years and 3.0 years, respectively (P < 0.008). Division of the MIB-1 staining percentage into quartiles showed that the risk of death increased from the first to the second quartile (>/=7.6 to <11.9%, hazard ratio = 2.36, 95% CI = 1.22-4.54) with no further increase in higher quartiles. CONCLUSION: Among patients with advanced epithelial ovarian carcinoma, MIB-1 immunostaining was higher in serous than in other histologic types. Levels of MIB-1 staining above the cut-off point of 7.6% had significantly poorer survival.

Effectiveness of COL-1492, a nonoxynol-9 vaginal gel, on HIV-1 transmission in female sex workers: a randomised controlled trial.

BACKGROUND: Nonoxynol-9 (rINN, nonoxinol-9) is an over-the-counter spermicide that has in-vitro anti-HIV-1 activity. Results of studies of its effectiveness in prevention of HIV-1 infection in women have been inconclusive. We aimed to assess effectiveness of this vaginal gel. METHODS: We did a randomised, placebo-controlled, triple-blinded, phase 2/3 trial with COL-1492, a nonoxynol-9 vaginal gel, in 892 female sex workers in four countries: Benin, Côte d'Ivoire, South Africa, and Thailand. 449 women were randomly allocated nonoxynol-9 and 443 placebo. Primary endpoint was incident HIV-1 infection. Secondary endpoints included Neisseria gonorrhoeae and Chlamydia trachomatis infections. Analysis was by intention to treat. FINDINGS: 765 women were included in the primary analysis. HIV-1 frequency in nonoxynol-9 users was 59 (16%) of 376 compared with 45 (12%) [corrected] of 389 in placebo users (402.5 vs 435.0 woman-years; hazard ratio adjusted for centre 1.5; 95% CI 1.0-2.2; p=0.047). 239 (32%) women reported use of a mean of more than 3.5 applicators per working day, and in these women, risk of HIV-1 infection in nonoxynol-9 users was almost twice that in placebo users (hazard ratio 1.8; 95% CI 1.0-3.2). 516 (68%) women used the gel less frequently than 3.5 times a day, and in these, risk did not differ between the two treatments. No significant effect of nonoxynol-9 on N gonorrhoeae (1.2; 0.9-1.6) or C trachomatis (1.2; 0.8-1.6) infections was reported. INTERPRETATION: This study did not show a protective effect of COL-1492 on HIV-1 transmission in high-risk women. Multiple use of nonoxynol-9 could cause toxic effects enhancing HIV-1 infection. This drug can no longer be deemed a potential HIV-1-prevention method. Assessment of other microbicides should continue.