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Juntongjin P, Abouelsaad S, Sugkraroek S, Taechakraichana N, Lungchukiet P, Nuallaong W. Awareness of vitiligo among multi-ethnic populations. J Cosmet Dermatol 2022; 21:5922-5930. [PMID: 35785468 DOI: 10.1111/jocd.15211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/16/2022] [Accepted: 06/30/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Vitiligo is a common acquired pigmentary disorder reported worldwide. Although asymptomatic, vitiligo negatively affects the patients' quality of life because it provokes psychological stigmatization and social discrimination. There are several misconceptions regarding vitiligo. OBJECTIVE This study aimed to evaluate the knowledge of and attitudes toward vitiligo in the general population and in different ethnic groups. METHODS A cross-sectional survey was conducted during which the participants were required to watch a brief video portraying a waitress affected by vitiligo and to fill a questionnaire related to the video content. Participants were recruited from among people who visited a private international hospital in Bangkok, Thailand, and who freely accepted to participate in the study. RESULTS Out of 405 participants who voluntarily participated in the study, approximately 30% were able to identify the condition as vitiligo. Approximately 66% and 88% of the participants had sufficient knowledge about and positive attitudes toward vitiligo, respectively. Those with sufficient knowledge scores significantly had more positive attitudes (p = 0.001). However, there were some differences among ethnic groups (p < 0.0001). Arabians had the highest knowledge and attitude scores. Regarding close-relationship attitudes, Asians tended to have perceptions that were different from that of others. CONCLUSION Knowledge of and attitudes toward vitiligo varied among ethnicities. Only 30% of the study population could identify this condition. Arabians had the highest knowledge score, whereas Caucasians had the highest prevalence of positive attitudes. Therefore, global awareness of vitiligo should be emphasized.
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Affiliation(s)
- Premjit Juntongjin
- Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Sara Abouelsaad
- Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | | | - Nimit Taechakraichana
- Department of Medical Education and Clinical Research Center, Bumrungrad International Hospital, Bangkok, Thailand
| | - Palita Lungchukiet
- Department of Medical Education and Clinical Research Center, Bumrungrad International Hospital, Bangkok, Thailand
| | - Winitra Nuallaong
- Department of Psychiatry, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
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Jittat N, Pongpirul K, Tepwituksakit B, Iammaleerat P, Heath J, Lungchukiet P, Taechakraichana N, Charukitpipat A. Effects of Oral Multi-Vitamin Multi-Mineral Supplement Formulations on Laboratory Outcomes and Quality of Life: A Quasi-Experimental Study. Front Nutr 2022; 9:889910. [PMID: 35832047 PMCID: PMC9271955 DOI: 10.3389/fnut.2022.889910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMulti-vitamin multi-mineral (MVMM) products often come in several single-substance capsules from different manufacturers. However, attempts to mix several vitamins and minerals into one MVMM product have been complicated and often involve legal concerns. This study aimed to comparatively investigate the changes in laboratory parameters and the quality of life (QOL) among individuals who received different MVMM formulations.MethodsThis three-arm non-randomized controlled trial was conducted at VitalLife Scientific Wellness Center (VSWC), Bangkok, Thailand. A total of 72 healthy adult individuals with total serum 25-(OH)D level of 20–29 ng/ml were invited to choose from the three available options, namely, (1) Hydro-Cell-Key (HCK®, Hepart AG, Switzerland) contains vitamin D3 2,000 IU, vitamin C 1,000 mg, vitamin E 166 mg, vitamin A 1 mg, coenzyme Q10 30 mg, natural carotenoids 8 mg, and citrus flavonoids 200 mg in granule formulation; (2) VTL-7 (VWSC) contains similar vitamins and minerals but in capsule formulation; and (3) placebo capsule (no supplement). The 36-Item Short-Form Health Survey (SF-36) was used to measure QOL at baseline, month 3 and 6. A generalized estimating equation (GEE) was used to compare the repeated-measure outcomes across the three groups. This study was registered at the Thai Clinical Trial Registration (TCTR20190205002) and approved by the Bumrungrad International Institutional Review Board (BI-IRB No.258-10-18PhFub).ResultsBoth VTL-7 and HCK saw a significantly higher increase in vitamin D than placebo at months 3 and 6, i.e., VTL-7 from 25.15 ± 2.13 to 35.53 ± 6.11 (p < 0.001) and 33.38 ± 6.89 (p < 0.001); HCK from 24.25 ± 3.08 to 28.43 ± 5.93 (p = 0.005) and 27.40 ± 5.24 (p = 0.012); and placebo from 24.00 ± 2.73 to 23.05 ± 4.39 (p = 0.273) and 22.30 ± 6.23 (p = 0.200), respectively. Similarly, β-carotenoids of VTL-7 vs. HCK groups significantly increased from 0.88 ± 0.68 vs. 0.94 ± 0.55 at baseline to 3.03 ± 1.79 (p < 0.001) vs. 1.09 ± 0.61 (p = 0.125) and 3.26 ± 1.74 (p < 0.001) vs. 1.15 ± 0.66 (p = 0.064), respectively. These findings were corroborated through the GEE analysis. Other micronutrients at months 3 and 6 did not increase significantly from baseline in any group. The overall QOL among the three groups in terms of physical (p = 0.560) and mental (p = 0.750) health increased but was not statistically significant.ConclusionThe supplements of MVMM in capsule formulation increased the serum levels of some micronutrients to a higher extent than that of granule formulation. Participant adherence remains a potential confounder and should be further explored.Clinical Trial Registrationidentifier: TCTR20190205002.
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Affiliation(s)
- Nawin Jittat
- Bumrungrad International Hospital, Bangkok, Thailand
| | - Krit Pongpirul
- Bumrungrad International Hospital, Bangkok, Thailand
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- *Correspondence: Krit Pongpirul
| | | | | | - Julia Heath
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Lee GY, Inthasorn P, Laowahutanont P, Lawpoolsri S, Kamolratanakul S, Lungchukiet P, Oh J, Termrungruanglert W, Taechakraichana N, Pitisuttithum P. Long-term effectiveness of human papillomavirus vaccines among adult women: A real-world scenario. Vaccine 2022; 40:1968-1976. [PMID: 35190207 DOI: 10.1016/j.vaccine.2022.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 01/26/2022] [Accepted: 02/09/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aimed to determine the real-world effectiveness of bi- or quadrivalent human papillomavirus (HPV) vaccines in Thai adult women ≥5 years post-vaccination in reducing HPV 16/18-associated low-grade squamous intraepithelial lesions or worse (LSIL+), atypical squamous cells of undetermined significance or worse (ASC-US+), and HPV 16/18 positivity. METHODS A retrospective cohort study was conducted among Thai women aged 20-45 years in Bangkok. The vaccinated and unvaccinated groups were matched according to baseline years. HPV/Pap test results were collected from the medical records and/or obtained by cervical sample collection at the study sites. Adjusted hazard ratios were measured using multivariable Cox regression analyses. RESULTS A total of 993 participants (493 vaccinated and 500 unvaccinated) were enrolled from 2018 to 2019. The median ages at baseline of the vaccinated and unvaccinated groups were 33 years (interquartile range [IQR] 27-38) and 34 years (IQR 30-38), respectively. The median follow-up periods were 7.3 years (IQR 6.1-8.6) and 7.2 years (IQR 5.8-8.9) for the vaccinated group and the unvaccinated group, respectively. More women in the vaccinated group were single (29.2% vs. 13.2%, P < 0.001) and university graduates (83.2% vs. 75.4%, P = 0.009). The vaccinated and unvaccinated groups had similar personal monthly incomes (>20,000 THB/month, 63.9% vs. 62.4%, respectively, P = 0.685). There were no cases of HPV 16/18-associated LSIL+ in the vaccinated group, whereas there were four cases in the unvaccinated group. HPV vaccine effectiveness was 88.0% (95% CI 2.0-98.5) in the reduction of HPV 16/18-associated ASC-US+, and 84.6% (95% CI 43.5-95.8) in the reduction of HPV 16/18 positivity. CONCLUSIONS HPV vaccine effectiveness was high in adult women in a real-world scenario in a developing country. Free HPV vaccination in adult women in this age group should be further explored when vaccine supplies are not limited. (HPV: human papillomavirus. LSIL+: low-grade squamous intraepithelial lesion or worse. ASC-US+: atypical squamous cells of undetermined significance or worse).
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Affiliation(s)
- Ga Young Lee
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok 10400, Thailand
| | - Perapong Inthasorn
- Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand
| | - Piyawat Laowahutanont
- National Cancer Institute of Thailand, 268/1 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand
| | - Saranath Lawpoolsri
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok 10400, Thailand
| | - Supitcha Kamolratanakul
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok 10400, Thailand
| | - Palita Lungchukiet
- Bumrungrad International Hospital, 33 Sukhumvit 3, Wattana, Bangkok 10110, Thailand
| | - Juhwan Oh
- Department of Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Wichai Termrungruanglert
- Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, 1873 Rama VI Road, Pathumwan, Bangkok 10330, Thailand
| | | | - Punnee Pitisuttithum
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok 10400, Thailand.
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Suwanvecho S, Suwanrusme H, Jirakulaporn T, Issarachai S, Taechakraichana N, Lungchukiet P, Decha W, Boonpakdee W, Thanakarn N, Wongrattananon P, Preininger AM, Solomon M, Wang S, Hekmat R, Dankwa-Mullan I, Shortliffe E, Patel VL, Arriaga Y, Jackson GP, Kiatikajornthada N. Comparison of an oncology clinical decision-support system's recommendations with actual treatment decisions. J Am Med Inform Assoc 2021; 28:832-838. [PMID: 33517389 PMCID: PMC7973455 DOI: 10.1093/jamia/ocaa334] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Indexed: 12/02/2022] Open
Abstract
Objective IBM(R) Watson for Oncology (WfO) is a clinical decision-support system (CDSS) that provides evidence-informed therapeutic options to cancer-treating clinicians. A panel of experienced oncologists compared CDSS treatment options to treatment decisions made by clinicians to characterize the quality of CDSS therapeutic options and decisions made in practice. Methods This study included patients treated between 1/2017 and 7/2018 for breast, colon, lung, and rectal cancers at Bumrungrad International Hospital (BIH), Thailand. Treatments selected by clinicians were paired with therapeutic options presented by the CDSS and coded to mask the origin of options presented. The panel rated the acceptability of each treatment in the pair by consensus, with acceptability defined as compliant with BIH’s institutional practices. Descriptive statistics characterized the study population and treatment-decision evaluations by cancer type and stage. Results Nearly 60% (187) of 313 treatment pairs for breast, lung, colon, and rectal cancers were identical or equally acceptable, with 70% (219) of WfO therapeutic options identical to, or acceptable alternatives to, BIH therapy. In 30% of cases (94), 1 or both treatment options were rated as unacceptable. Of 32 cases where both WfO and BIH options were acceptable, WfO was preferred in 18 cases and BIH in 14 cases. Colorectal cancers exhibited the highest proportion of identical or equally acceptable treatments; stage IV cancers demonstrated the lowest. Conclusion This study demonstrates that a system designed in the US to support, rather than replace, cancer-treating clinicians provides therapeutic options which are generally consistent with recommendations from oncologists outside the US.
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Affiliation(s)
| | - Harit Suwanrusme
- Bumrungrad International Hospital, Khlong Toei Nuea, Bangkok, Thailand
| | | | | | | | | | - Wimolrat Decha
- Bumrungrad International Hospital, Khlong Toei Nuea, Bangkok, Thailand
| | - Wisanu Boonpakdee
- Bumrungrad International Hospital, Khlong Toei Nuea, Bangkok, Thailand
| | - Nittaya Thanakarn
- Bumrungrad International Hospital, Khlong Toei Nuea, Bangkok, Thailand
| | | | | | | | - Suwei Wang
- IBM Watson Health, Cambridge, Massachusetts, USA
| | | | | | - Edward Shortliffe
- IBM Watson Health, Cambridge, Massachusetts, USA
- Columbia University, New York, New York, USA
| | - Vimla L Patel
- IBM Watson Health, Cambridge, Massachusetts, USA
- New York Academy of Medicine, New York, New York, USA
| | - Yull Arriaga
- IBM Watson Health, Cambridge, Massachusetts, USA
| | - Gretchen Purcell Jackson
- IBM Watson Health, Cambridge, Massachusetts, USA
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Narongsak Kiatikajornthada
- Bumrungrad International Hospital, Khlong Toei Nuea, Bangkok, Thailand
- Corresponding Author: Narongsak Kiatikajornthada, MD, Bumrungrad International Hospital, 33 Soi Sukhumvit 3, Khlong Toei Nuea, Watthana, Bangkok 10110, Thailand;
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Uaamnuichai S, Panyakhamlerd K, Suwan A, Suwajo P, Phanuphak N, Ariyasriwatana C, Janamnuaysook R, Teeratakulpisarn N, Vasuratna A, Taechakraichana N. Neovaginal and Anal High-Risk Human Papillomavirus DNA Among Thai Transgender Women in Gender Health Clinics. Sex Transm Dis 2021; 48:547-549. [PMID: 33534409 DOI: 10.1097/olq.0000000000001388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although human papillomavirus (HPV)-related lesions in the neovagina of transgender women have been well documented, information on high-risk HPV (hrHPV) in the neovagina has been very limited. The objective of this study was to determine hrHPV DNA detection rate in the neovagina of transgender women. METHODS Neovaginal and anal swab were collected in liquid-based cytology fluid from transgender women visiting Gender Health Clinic and Tangerine Community Health Clinic in Bangkok, Thailand. Samples were processed for hrHPV DNA (reported as subtypes 16 and 18 or the pooled result of subtypes 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 66) by automated real-time polymerase chain reaction and for neovaginal cytology according to the Bethesda system. Demographic data and sexual history were obtained, and physical examination was conducted. HIV status was obtained from existing medical records. RESULTS Samples were collected from 57 transgender women (mean age, 30.4 years [interquartile range, 8 years]). From 35 of 57 valid neovaginal samples, 8 (20%) tested positive for hrHPV DNA. From 30 of 57 valid anal samples, 6 (19.4%) tested positive for hrHPV DNA. HIV status was known for 52 transgender women, 1 of which were HIV infected; neovaginal hrHPV was invalid in that patient. CONCLUSIONS One of 5 transgender women visiting sexual health clinics in Bangkok was found to have hrHPV DNA in neovaginal and anal compartments. Studies are needed to look at incidence and persistence of hrHPV infection to inform anogenital precancerous and cancerous screening programs for transgender women.
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Affiliation(s)
- Sutira Uaamnuichai
- From the Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital
| | | | | | | | | | - Chai Ariyasriwatana
- From the Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital
| | | | | | - Apichai Vasuratna
- From the Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital
| | - Nimit Taechakraichana
- Department of Medical Education and Clinical Research center, Bumrungrad Hospital, Bangkok, Thailand
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Thammapiwan P, Suwan A, Panyakhamlerd K, Suwajo P, Phanuphak N, Taechakraichana N. The sexual function among transgender women who have undergone gender-affirming surgery using penile skin inversion vaginoplasty in Thailand. Eur J Plast Surg 2021. [DOI: 10.1007/s00238-021-01857-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bumphenkiatikul T, Panyakhamlerd K, Chatsuwan T, Ariyasriwatana C, Suwan A, Taweepolcharoen C, Taechakraichana N. Effects of vaginal administration of conjugated estrogens tablet on sexual function in postmenopausal women with sexual dysfunction: a double-blind, randomized, placebo-controlled trial. BMC Womens Health 2020; 20:173. [PMID: 32787848 PMCID: PMC7424993 DOI: 10.1186/s12905-020-01031-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/23/2020] [Indexed: 01/23/2023]
Abstract
Background Female sexual dysfunction (FSD) is prevalent in women with genitourinary syndrome of menopause (GSM). Vaginal estrogen is effective GSM treatment. This study was primarily aimed to evaluate the effects of vaginal administration of conjugated estrogens tablet on postmenopausal FSD using the Female Sexual Function Index (FSFI). Secondary aims were to evaluate vaginal pH, Vaginal Maturation Value (VMV), Normal Flora Index (NFI) and Most Bothersome Symptoms (MBS) changes. Methods A double-blind trial was conducted in postmenopausal women with FSD (FSFI ≤26.55). Sixty-seven participants were randomized into two arms; vaginally administered conjugated estrogens tablet (0.625 mg, daily for 3 weeks then twice weekly for 9 weeks, n = 33), or placebo (n = 34). Results There was no significant improvement of FSFI observed in estrogens arm compared to placebo in each domain and overall index (p = 0.182). The estrogens significantly improved vaginal pH and VMV, toward more acidity (p = < 0.001), higher VMV (p = < 0.001) and more superficial cells (p = < 0.001). We observed no significant difference in NFI and MBS between arms (p = 0.282, 0.182). Conclusion We found no significant changes in FSFI, NFI, and MBS, but significant improvement in vaginal pH and VMV in postmenopausal women with FSD treated with vaginally administered conjugated estrogens tablet. Few side-effects were reported. Trial registration Thai Clinical Trial Registry identification number TCTR20180219001, prospectively registered since 2018-02-19 11:33:21.
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Affiliation(s)
- Thanapob Bumphenkiatikul
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Bangkok, 10330, Thailand.
| | - Krasean Panyakhamlerd
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Bangkok, 10330, Thailand
| | - Thanittha Chatsuwan
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Chai Ariyasriwatana
- Division of Gynecologic Cyto-Pathology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Ammarin Suwan
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Bangkok, 10330, Thailand
| | - Charoen Taweepolcharoen
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Bangkok, 10330, Thailand
| | - Nimit Taechakraichana
- Department of Medical Education and Clinical Research Center, Bumrungrad International Hospital, Bangkok, 10110, Thailand
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Pongchaiyakul C, Charoensri S, Leerapun T, Wongsiri S, Songpatanasilp T, Taechakraichana N. Prevalence of asymptomatic radiographic vertebral fracture in postmenopausal Thai women. Arch Osteoporos 2020; 15:78. [PMID: 32447475 DOI: 10.1007/s11657-020-00762-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/18/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED We aim to investigate the nationwide prevalence of asymptomatic radiographic vertebral fracture in Thailand. We found 29% of postmenopausal women had at least one radiographic vertebral fracture. The prevalence was significantly higher among women with osteoporosis at the total hip (TH) region which implies that TH bone mineral density is a determinant of vertebral fracture risk. INTRODUCTION Radiographic vertebral fracture is associated with an increased risk of osteoporotic fracture and mortality in postmenopausal women. We designed a study to determine the prevalence of asymptomatic vertebral fractures in postmenopausal Thai women. METHODS The study was designed as a cross-sectional investigation at five university hospitals so as to achieve representation of the four main regions of Thailand. Radiographs were taken from 1062 postmenopausal women averaging 60 years of age. The presence of vertebral fracture was assessed by the Genant's semiquantitative method with three independent radiologists. Respective bone mineral density was measured by dual-energy X-ray absorptiometry (DEXA) at the lumbar spine (LS), femoral neck (FN), and total hip (TH). RESULTS Among the 1062 women, 311 were found to have at least one radiographic vertebral fracture-yielding a prevalence of 29% (95% CI 23.6-32.0%)-and 90 (8.5%, 95% CI 6.8-10.2%) had at least two fractures. The prevalence of vertebral fracture increased with advancing age. Most fractures occurred at one vertebra (71%) and only 29% at multiple vertebrae. The prevalence of vertebral fracture was significantly higher among women with osteoporosis compared with non-osteoporosis at the TH region. There was no significant difference in the prevalence among women with or without osteoporosis at the LS or FN. CONCLUSIONS Radiographic vertebral fractures were common among Thai postmenopausal women (~ 29%). These findings suggest that approximately one in three postmenopausal women has undiagnosed vertebral fracture. Radiographic diagnosis should therefore be an essential investigation for identifying and confirming the presence of vertebral fractures.
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Affiliation(s)
- Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
| | - Suranut Charoensri
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Taninnit Leerapun
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sunton Wongsiri
- Department of Orthopaedics and Physical Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Thawee Songpatanasilp
- Department of Orthopaedics, Phramongkutklao College of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Nimit Taechakraichana
- Menopausal Research Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Suwanvecho S, Suwanrusme H, Jirakulaporn T, Lungchukiet P, Thanakarn N, Taechakraichana N, Decha W, Boonpakdee W, Wongrattananon P, Preininger AM, Solomon M, Wang S, Hekmat R, Esquivel J, Dankwa-Mullan I, Patel VL, Shortliffe E, Arriaga YE, Jackson GP, Kiatikajornthada N. Associations between concordance with oncology clinical decision support and clinical outcomes in lung cancer patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e14114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14114 Background: Watson for Oncology (WfO) is an artificial intelligence-based clinical decision-support system which provides therapeutic options and associated scientific evidence to cancer-treating physicians. Oncologists at Bumrungrad International Hospital (BIH) have used WfO since 2015. We examined the association between concordance of WfO therapeutic options and BIH treatment decisions with short-term clinical outcomes for lung cancer patients. Methods: This study included lung cancer patients seen at BIH for treatment and follow-up care and for whom WfO was used from 2015 to 2018. Charts were reviewed for concordance with WfO, documentation of disease progression, response to treatment, and survival. We evaluated concordance between oncologists’ treatments and therapeutic options listed as “recommended” by WfO. We evaluated association between WfO concordance and partial or complete response rates over a 24-month period by comparison of proportions with odds ratio. Progression-free survival (PFS, time from diagnosis until progression or death) was evaluated by Kaplan-Meier log-rank test. Results: Seventy-nine lung cancer patients were included. We identified a trend towards higher response rates in concordant cases (59.2%, N = 32), as compared to discordant (48.0%, N = 12), with an odds ratio of 1.56 (see table). There was not a significant difference in PFS between concordant and discordant cohorts. Conclusions: In this small-cohort, retrospective study, lung cancer patients receiving treatments that are concordant with WfO recommended therapeutic options trended towards higher response rates than patients with discordant treatments. Use of a clinical decision-support system may help support cancer-treating physicians in delivering best practice and evidence-based care that may improve short-term outcomes. Prospective studies with larger samples and other cancer types are underway. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Vimla L Patel
- Columbia University Department of Biomedical Informatics, New York, NY
| | - Edward Shortliffe
- Columbia University, Department of Biomedical Informatics, New York, NY
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Suwanvecho S, Suwanrusme H, Issarachai S, Jirakulaporn T, Taechakraichana N, Lungchukiet P, Thanakarn N, Decha W, Boonpakdee W, Wongrattananon P, Preininger A, Arriaga YE, Solomon M, Wang S, Dankwa-Mullan I, Esquivel J, Patel VL, Shortliffe E, Jackson G, Kiatikajornthada N. Concordance between a clinical decision-support system and treatments selected by clinicians as a function of cancer type or stage. J Glob Oncol 2019. [DOI: 10.1200/jgo.2019.5.suppl.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
95 Background: Watson for Oncology (WFO) is an artificial intelligence (AI) based clinical decision-support tool trained by Memorial Sloan Kettering. This retrospective observational study of breast, lung, colon and rectal cancer examined the concordance of treatment options provided by WFO to treatments selected by clinicians at Bumrungrad International Hospital (BIH) as a function of stage or cancer type. Methods: Concordance between WFO treatment options and treatments selected by BIH clinicians (WFO-BIH concordance) was defined as identical or equally acceptable treatments, as determined by a panel of experts blinded to the source of treatment. Relationships between stage or type of cancer and WFO-BIH concordant treatments were evaluated by Chi-squared analysis. Results: Analysis revealed a statistically significant association ( P = 0.02) between cancer stage and concordance. For all 4 cancer types combined, stages I-III demonstrated higher concordance than stage IV. A highly significant association ( P < 0.001) between concordance and cancer type was identified. Colon cancer demonstrated the highest concordance, followed by rectal, lung and breast cancer. Reasons for discordance, when given, related to oncologist or patient preferences, and treatment availability. Conclusions: BIH clinicians tended to agree more with WFO therapeutic options for stage I-III cancers and colon cancer in general, as compared to relatively less agreement for stage IV cancers and breast cancer in general, suggesting the need to understand reasons for discordance among all cancer types and stages. An AI tool, trained by experts in the U.S., provides treatment options consistent with some therapies selected in international settings, but preferences and treatment availability may affect choices made in practice. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Vimla L Patel
- Columbia University Department of Biomedical Informatics, New York, NY
| | - Edward Shortliffe
- Columbia University, Department of Biomedical Informatics, New York, NY
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11
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Suwanvecho S, Suwanrusme H, Jirakulaporn T, Taechakraichana N, Lungchukiet P, Thanakarn N, Decha W, Boonpakdee W, Preininger A, Dankwa-Mullan I, Solomon M, Wang S, Jackson G, Patel V, Shortliffe E, Kiatikajornthada N. A blinded comparison of patient treatments to therapeutic options presented by an artificial intelligence-based clinical decision-support system. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz257.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Suwanvecho S, Shortliffe EH, Suwanrusme H, Issarachai S, Jirakulaporn T, Taechakraichana N, Lungchukiet P, Thanakarn N, Decha W, Boonpakdee W, Wongrattananon P, Preininger A, Kefayati S, Dankwa-Mullan I, Esquivel J, Patel VL, Jackson G, Kiatikajornthada N. A blinded evaluation of a clinical decision-support system at a regional cancer care center. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.6553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6553 Background: Clinical decision-support systems (CDSS) such as Watson for Oncology (WFO) may reduce treatment variation in oncology, provided options offered by the system are at least as acceptable as expert, evidence-based options. Deviation from expert consensus in practice is not well documented. In this blinded study, WFO therapeutic options and treatment decisions made by individual oncologists at Bumrungrad International Hospital (BIH) were evaluated by expert panel. Methods: Treatments selected by BIH that were labeled as either “for consideration” or “not recommended” by WFO were evaluated by a panel of 3 oncologists in 2018. The panel evaluated WFO options and previous BIH treatments for prospective cases from 2016-2018, blinded to the source of treatment option. Consensus of panel rated treatment pairs as: identical; both acceptable and roughly equivalent; both acceptable, but one preferred; one is acceptable and the other, unacceptable; neither is acceptable. The results of 321 treatment choices for breast, lung, colon and rectal cancers were analyzed, and McNemar’s test, a modified pairwise chi-square, was applied to identify differences between BIH and WFO. Results: 71% of both BIH and WFO treatments across all 4 cancer types were considered acceptable or identical by the panel. In 18 cases (5.6%), WFO treatments were preferred; in 14 cases (4.4%), BIH cases were preferred. Unacceptable treatments by either BIH or WFO were identified in 15% and 23% of treatments, respectively. Statistical analysis of treatment pairs revealed no significant difference between BIH and WFO treatments for breast, colon and rectal cancer. Treatment for lung cancer differed significantly ( p = 0.004); in 6% of cases, WFO was unacceptable and BIH acceptable; in 1% of cases, BIH was unacceptable and WfO was acceptable. Conclusions: This study is one of the first to compare therapeutic options from CDSS to treatment decisions made in practice, evaluated in a blinded fashion by an expert panel. 71% of treatments suggested by WFO CDSS were as acceptable as those selected by clinicians at the point of care, and some were considered superior. Decisions made in practice were unacceptable to the panel in 15% of cases, suggesting a role for CDSS.
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Affiliation(s)
- Suthida Suwanvecho
- Horizon Cancer Center, Bumrungrad International Hospital, Bangkok, Thailand
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Vimla L Patel
- The New York Academy of Medicine, Center for Cognitive Studies in Medicine and Public Health, New York, NY
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Perksanusak T, Panyakhamlerd K, Hirankarn N, Suwan A, Vasuratna A, Taechakraichana N. Correlation of plasma microRNA-21 expression and bone turnover markers in postmenopausal women. Climacteric 2018; 21:581-585. [DOI: 10.1080/13697137.2018.1507020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- T. Perksanusak
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - K. Panyakhamlerd
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - N. Hirankarn
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - A. Suwan
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - A. Vasuratna
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - N. Taechakraichana
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Suebthawinkul C, Panyakhamlerd K, Yotnuengnit P, Suwan A, Chaiyasit N, Taechakraichana N. The effect of vitamin D2 supplementation on muscle strength in early postmenopausal women: a randomized, double-blind, placebo-controlled trial. Climacteric 2018; 21:491-497. [PMID: 30095022 DOI: 10.1080/13697137.2018.1480600] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Low serum 25-hydroxyvitamin D [25(OH)D] has been shown to be associated with low muscle mass and loss of muscle strength, resulting in increased disability and frailty in older men and women. Vitamin D deficiency is common in postmenopausal women. The primary objective of the present study was to evaluate the effects of vitamin D supplementation on muscle strength in early postmenopausal women. The effects of vitamin D2 supplementation on muscle mass and muscle cross-sectional area (CSA) were secondarily investigated. METHODS A 12-week, prospective, randomized, double-blind, placebo-controlled trial was conducted in early postmenopausal women (45-60 years old) with vitamin D deficiency (serum 25(OH)D < 20 ng/ml). A total of 88 subjects were randomized into group I: vitamin D2 supplement 40 000 IU/week (n = 44), or group II: placebo (n = 44). Serum 25(OH)D level, muscle strength, muscle mass and muscle CSA were assessed at baseline and 12 weeks after the supplementation. RESULTS After 12 weeks of supplementation, 70% of women in group I achieved a sufficient level of serum 25(OH)D (>30 ng/ml). There were significant differences in changes of serum 25(OH)D levels between the two groups (p < 0.05). Muscle strength and muscle CSA in group I increased significantly after 12 weeks (p = 0.015, 0.045, respectively). However, there were no significant differences in the mean changes of muscle strength, muscle mass and muscle CSA between the two groups (p = 0.16, 0.89, 0.84, respectively). CONCLUSION In this study, we found no obvious effect of vitamin D supplementation on the changes in muscle strength, muscle mass and muscle CSA when compared to placebo. However, there were significant changes in muscle strength and muscle CSA from baseline in the vitamin D supplementation group.
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Affiliation(s)
- C Suebthawinkul
- a Reproductive Medicine Division, Department of Obstetrics and Gynecology, Faculty of Medicine , Chulalongkorn University , Bangkok , Thailand
| | - K Panyakhamlerd
- a Reproductive Medicine Division, Department of Obstetrics and Gynecology, Faculty of Medicine , Chulalongkorn University , Bangkok , Thailand
| | - P Yotnuengnit
- b Department of Rehabilitation Medicine, Faculty of Medicine , Chulalongkorn University , Bangkok , Thailand
| | - A Suwan
- a Reproductive Medicine Division, Department of Obstetrics and Gynecology, Faculty of Medicine , Chulalongkorn University , Bangkok , Thailand
| | - N Chaiyasit
- c Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Faculty of Medicine , Chulalongkorn University , Bangkok , Thailand
| | - N Taechakraichana
- a Reproductive Medicine Division, Department of Obstetrics and Gynecology, Faculty of Medicine , Chulalongkorn University , Bangkok , Thailand
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Songpatanasilp T, Sritara C, Kittisomprayoonkul W, Chaiumnuay S, Nimitphong H, Charatcharoenwitthaya N, Pongchaiyakul C, Namwongphrom S, Kitumnuaypong T, Srikam W, Dajpratham P, Kuptniratsaikul V, Jaisamrarn U, Tachatraisak K, Rojanasthien S, Damrongwanich P, Wajanavisit W, Pongprapai S, Ongphiphadhanakul B, Taechakraichana N. Thai Osteoporosis Foundation (TOPF) position statements on management of osteoporosis. Osteoporos Sarcopenia 2016; 2:191-207. [PMID: 30775487 PMCID: PMC6372784 DOI: 10.1016/j.afos.2016.10.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 01/07/2023] Open
Abstract
The adjusted incidence rate of hip fracture in Thailand has increased more than 31% from 1997 to 2006. Mortality and morbidity after hip fracture are also high. One year mortality after a hip fracture has increased from 18% in 1999 to 21% in 2007. The Thai Osteoporosis Foundation (TOPF) developed the first Clinical Practice Guideline (CPG) in 2002 and keeps updating the CPG since then. This latest version of the CPG is our attempt to provide comprehensive positional statement on the diagnosis, prevention and treatment of osteoporosis in Thailand. The study group who revised this position statement contains experts from the TOPF, Four Royal Colleges of Thailand, includes the Orthopaedic Surgeons, Gynecologists and Obstetricians, Physiatrists, Radiologists and 2 Associations of Endocrinologists and Rheumatologists which have involved in the management of patients with osteoporosis.
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Affiliation(s)
- T. Songpatanasilp
- Department of Orthopaedics, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - C. Sritara
- Nuclear Medicine Division, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - W. Kittisomprayoonkul
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - S. Chaiumnuay
- Rheumatology Division, Department of Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - H. Nimitphong
- Endocrinology and Metabolism Division, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - N. Charatcharoenwitthaya
- Endocrinology and Metabolism Division, Department of Medicine, Faculty of Medicine, Thammasat University, Bangkok, Thailand
| | - C. Pongchaiyakul
- Endocrinology and Metabolism Division, Department of Medicine, Faculty of Medicine, Khonkean University, Khonkean, Thailand
| | - S. Namwongphrom
- Department of Radiology, Faculty of Medicine, Chiangmai University, Chiangmai, Thailand
| | - T. Kitumnuaypong
- Rheumatology Division, Department of Medicine, Rajavithi Hospital, Bangkok, Thailand
| | - W. Srikam
- Department of Rehabilitation Medicine, Faculty of Medicine, Thammasat University, Bangkok, Thailand
| | - P. Dajpratham
- Department of Rehabilitation Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - V. Kuptniratsaikul
- Department of Rehabilitation Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - U. Jaisamrarn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - K. Tachatraisak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - S. Rojanasthien
- Department of Orthopaedics, Faculty of Medicine, Chiangmai University, Chiangmai, Thailand
| | - P. Damrongwanich
- Department of Orthopaedics, Police General Hospital, Bangkok, Thailand
| | - W. Wajanavisit
- Department of Orthopaedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S. Pongprapai
- Department of Rehabilitation Medicine, Vichaiyut Hospital, Bangkok, Thailand
| | - B. Ongphiphadhanakul
- Endocrinology and Metabolism Division, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - N. Taechakraichana
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Khrutmuang D, Panyakhamlerd K, Chatkittisilpa S, Jaisamrarn U, Taechakraichana N. Effect of multivitamin on serum 25-hydroxy vitamin D level in postmenopausal women: A randomized, double-blind, placebo-controlled trial. Osteoporos Sarcopenia 2016; 2:89-93. [PMID: 30775472 PMCID: PMC6372750 DOI: 10.1016/j.afos.2016.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 04/25/2016] [Accepted: 04/25/2016] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVES To determine the effects of multivitamin vitamin D 300 or 600 units on serum 25 hydroxyvitamin D (25(OH)D) level after 4 weeks of supplementation in postmenopausal women with vitamin D insufficiency. STUDY DESIGN Randomized double-blind, placebo-controlled trial. METHODS Postmenopausal women who had vitamin D insufficiency were recruited into the study. The participants were randomized to 3 groups of 4-week treatment period with multivitamin (GPO, Governmental Pharmacy Organization) 2 tablets (contained vitamin D2 amount 600 units), multivitamin 1 tablet (contained vitamin D2 amount 300 units) or placebo. At baseline and after 4 weeks of supplementation, serum 25(OH)D were determined with electrochemilumines-cence immunoassay (Cobas, Roche Diagnostics) and level change of 25(OH)D level were compared among the groups. RESULTS Out of 144 participants, 49.3% had vitamin D deficiency (<20 ng/ml) and 50.7% had vitamin D insufficiency (<30 ng/ml). However, after 4 weeks of the GPO oral multivitamin, serum 25(OH)D levels significantly increased from 19.4 ± 6.3 ng/ml at baseline to 22.2 ± 5.2 ng/ml (p = 0.01) and from 19.5 ± 5.0 ng/ml to 23.3 ± 5.2 ng/ml (p < 0.01) in the groups receiving vitamin D 300 IU and 600 IU/day, respectively. Approximately, 10% of those who took vitamin D had serum 25(OH)D level above the insufficiency level within 4 weeks. There was no significant changes of serum 25(OH)D after 4 weeks in the placebo group. CONCLUSIONS Daily supplementation of the generic multivitamin containing vitamin D2 300 and 600 IU daily for 4 weeks significantly increased mean serum 25(OH)D from baseline up above the deficiency level.
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Affiliation(s)
- Dithawut Khrutmuang
- Reproductive Medicine Division, Department of Obstetrics-Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok 10300, Thailand
| | - Krasean Panyakhamlerd
- Reproductive Medicine Division, Department of Obstetrics-Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok 10300, Thailand
| | - Sukanya Chatkittisilpa
- Reproductive Medicine Division, Department of Obstetrics-Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok 10300, Thailand
| | - Unnop Jaisamrarn
- Reproductive Medicine Division, Department of Obstetrics-Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok 10300, Thailand
| | - Nimit Taechakraichana
- Reproductive Medicine Division, Department of Obstetrics-Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok 10300, Thailand
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Tungmunsakulchai R, Chaikittisilpa S, Snabboon T, Panyakhamlerd K, Jaisamrarn U, Taechakraichana N. Effectiveness of a low dose testosterone undecanoate to improve sexual function in postmenopausal women. BMC Womens Health 2015; 15:113. [PMID: 26631095 PMCID: PMC4668626 DOI: 10.1186/s12905-015-0270-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 11/24/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Adding testosterone to hormonal therapy could improve sexual function and general well-being among women during climacteric. We evaluated the effectiveness of testosterone undecanoate on sexual function in postmenopausal women utilizing the standardized questionnaire FSFI score. METHODS Postmenopausal women with sexual complaints and Female Sexual Function Index (FSFI) ≤ 26.5 were enrolled in to this randomized, double-blinded, placebo-controlled trial. Participants were randomly assigned to 8-week treatment with either oral testosterone undecanoate 40 mg or placebo twice weekly with daily oral estrogen. The FSFI scores before and after treatment were compared to assess any improvement of sexual function. RESULTS Seventy women were recruited of which each group had 35 participants. The baseline characteristics and baseline FSFI scores were comparable between both groups. After 8 weeks of treatment, the FSFI scores significantly improved in both groups when compared to the baseline but the FSFI scores from the testosterone group were significantly higher than in the placebo group post-treatment (28.6 ± 3.6, 25.3 ± 6.7, respectively, p = 0.04). There was no difference in adverse effect between the two groups CONCLUSIONS The twice weekly addition of testosterone undecanoate to daily oral estrogen was associated with a significant improvement in sexual function among postmenopausal women than the use of the estrogen alone. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01724658 (February 17, 2012).
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Affiliation(s)
- Reuthairat Tungmunsakulchai
- Menopause Research Unit, Reproductive Medicine Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok, 10330, Thailand.
| | - Sukanya Chaikittisilpa
- Menopause Research Unit, Reproductive Medicine Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok, 10330, Thailand.
| | - Thiti Snabboon
- Endocrinology and Metabolism Unit, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok, 10330, Thailand.
| | - Krasean Panyakhamlerd
- Menopause Research Unit, Reproductive Medicine Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok, 10330, Thailand.
| | - Unnop Jaisamrarn
- Menopause Research Unit, Reproductive Medicine Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok, 10330, Thailand.
| | - Nimit Taechakraichana
- Menopause Research Unit, Reproductive Medicine Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok, 10330, Thailand.
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Akawatcharangura P, Taechakraichana N, Osiri M. Prevalence of premature ovarian failure in systemic lupus erythematosus patients treated with immunosuppressive agents in Thailand. Lupus 2015; 25:436-44. [PMID: 26621134 DOI: 10.1177/0961203315617539] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 10/20/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is an autoimmune disease that affects most women of reproductive age. The prevalence of premature ovarian failure (POF) in SLE patients is higher than that in the general population. However, the data on this condition are limited in Asian countries. OBJECTIVES To determine the prevalence and associated factors of POF in SLE patients who received immunosuppressive therapy. METHODS Women aged 18-40 years who were diagnosed with SLE according to the 1997 revised criteria for the classification of SLE or patients with biopsy-proven lupus nephritis were evaluated. All patients had received at least one of the following immunosuppressive agents: cyclophosphamide (CYC), azathioprine, mycophenolate mofetil, chlorambucil or cyclosporine for more than six months. POF was diagnosed in those who had sustained amenorrhea for more than six consecutive months, with a level of estradiol ≤ 110 pmol/L (30 pg/mL) and follicle stimulating hormone ≥40 IU/L. RESULTS Ninety two SLE patients were included in this study. Mean age at enrollment was 30 ± 6.9 years and disease duration was 103 ± 67.5 months. The mean Systemic Lupus International Collaborating Clinics/ American College of Rheumatology (SLICC/ACR) damage index was 1.7 ± 1.7. Seventy five patients (82%) had lupus nephritis. Sixty four patients (70%) received CYC. Eleven patients (12%) with POF were observed. For the binary logistic regression model, CYC cumulative dosage of more than 10 g was the only independent risk factor of POF (hazard ratio 17.0, 95% CI 1.96-147.72, p = 0.01). CONCLUSIONS From our data, 12% of SLE patients developed POF. A cumulative dose of CYC of more than 10 g was the only risk factor for POF. To prevent these events, systematic evaluation and early recognition of POF should be promoted in the care of SLE patients.
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Affiliation(s)
- P Akawatcharangura
- Department of Medicine, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand
| | - N Taechakraichana
- Menopause Research Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - M Osiri
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Uthaipaisanwong A, Rungruxsirivorn T, Roomruangwong C, Taechakraichana N, Chaithongwongwatthana S. Associated factors of prenatal depression among teenage pregnant women at King Chulalongkorn Memorial Hospital. J Med Assoc Thai 2015; 98:437-443. [PMID: 26058270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Depression during pregnancy is associated with deteriorating maternal health and increasing risk of preterm birth, fetal growth restriction, and suicidal attempt. The problems may be worse in adolescents who are more vulnerable. This study was conducted to determine the percentage of depression among teenage mothers and its associated factors. MATERIAL AND METHOD Two hundred teenage pregnant women aged between 13 and 19 years who visited King Chulalongkorn Memorial Hospital (KCMH) participated in the present study. They were asked to complete the validated Thai Edinburgh Postnatal Depression Scale (EPDS) questionnaire for depression screening. The cut-offscore of 11 was used for the diagnosis of prenatal depression. RESULTS Ninety-two (46%) teenage pregnant women were found to have prenatal depression using the EPDS cut-off score of 11. The mean age of participants was 17.5 years with the mean gestational ages of 23 weeks. Most of the participants (67%) resignedfrom school and 16% had history of attempted abortion during current pregnancy. There was no significant association between prenatal depression and unplanned pregnancy, unemployment, leaving school, or trimester at screening. Logistic regression analyses showed that history of attempted abortion and inadequate income were significantly associated with prenatal depression (odd ratio = 8.03, 95% CI 1.59 to 40.37 and 4.16, 95% CI 1.35 to 12.83, respectively). CONCLUSION Prenatal depression was common among teenage pregnant women who visited KCMH. Attempted abortion and inadequate income were found to be significantly associated with prenatal depression.
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Kengsakul M, Chaikittisilpa S, Hemrungrojn S, Panyakhamlerd K, Jaisamrarn U, Taechakraichana N. The factors associated with mild cognitive impairment (MCI) in surgical menopause women. J Med Assoc Thai 2015; 98:327-333. [PMID: 25958706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND OBJECTIVE As a sizeable proportion of persons with mild cognitive impairment will progress to frank dementia, early detection is an important strategy to prevent and decelerate the progression of cognitive decline. In Thailand, the prevalence of mild cognitive impairment in surgical menopause women has not been well established. The objectives of the present study were to determine the percentage and factors associated with mild cognitive impairment in women with surgical menopause. MATERIAL AND METHOD Between October 2013 and July 2014, 200 eligible women at King Chulalongkorn Memorial Hospital were enrolled. The self-reported questionnaires were used to obtain the demographic data and the Thai version of the Montreal Cognitive Assessment (MoCA) was used to detect mild cognitive impairment (MCI). The MCI was diagnosed when the MoCA score was less than 25. The data were statistically analyzed using SPSS version 17 for student t-test, Chi-square test, and multiple regression analysis. RESULTS The percentage of MCI in the present study was 43.5%. The univariate analysis showed that factors significantly related to MCI were marital status, educational levels, occupation, monthly income, and duration of hormone replacement therapy (HRT). Nevertheless, multiple regression analysis revealed that only older age at enrollment, marital status, low educational level, and low monthly income were significantly related to MCI. CONCLUSION Almost half of the surgical menopause women in the present study had MCI. Older age at enrollment, marital status, low educational level, and low monthly income were significantly related to MCI. Age at surgical menopause and HRT were not found to be associated with MCI in this study.
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Tuntiviriyapun P, Panyakhamlerd K, Triratanachat S, Chatsuwan T, Chaikittisilpa S, Jaisamrarn U, Taechakraichana N. Newly developed vaginal atrophy symptoms II and vaginal pH: a better correlation in vaginal atrophy? Climacteric 2014; 18:246-51. [PMID: 25374401 DOI: 10.3109/13697137.2014.981520] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The primary objective of this study was to evaluate the correlation among symptoms, signs, and the number of lactobacilli in postmenopausal vaginal atrophy. The secondary objective was to develop a new parameter to improve the correlation. STUDY DESIGN A cross-sectional descriptive study. METHODS Naturally postmenopausal women aged 45-70 years with at least one clinical symptom of vaginal atrophy of moderate to severe intensity were included in this study. All of the objective parameters (vaginal atrophy score, vaginal pH, the number of lactobacilli, vaginal maturation index, and vaginal maturation value) were evaluated and correlated with vaginal atrophy symptoms. A new parameter of vaginal atrophy, vaginal atrophy symptoms II, was developed and consists of the two most bothersome symptoms (vaginal dryness and dyspareunia). Vaginal atrophy symptoms II was analyzed for correlation with the objective parameters. RESULTS A total of 132 naturally postmenopausal women were recruited for analysis. Vaginal pH was the only objective parameter found to have a weak correlation with vaginal atrophy symptoms (r = 0.273, p = 0.002). The newly developed vaginal atrophy symptoms II parameter showed moderate correlation with vaginal pH (r = 0.356, p < 0.001) and a weak correlation with the vaginal atrophy score (r = 0.230, p < 0.001). History of sexual intercourse within 3 months was associated with a better correlation between vaginal atrophy symptoms and the objective parameters. CONCLUSION Vaginal pH was significantly correlated with vaginal atrophy symptoms. The newly developed vaginal atrophy symptoms II was associated with a better correlation. The vaginal atrophy symptoms II and vaginal pH may be better tools for clinical evaluation and future study of the vaginal ecosystem.
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Affiliation(s)
- P Tuntiviriyapun
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University , Bangkok , Thailand
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Tansupswatdikul P, Chaikittisilpa S, Jaimchariyatam N, Panyakhamlerd K, Jaisamrarn U, Taechakraichana N. Effects of estrogen therapy on postmenopausal sleep quality regardless of vasomotor symptoms: a randomized trial. Climacteric 2014; 18:198-204. [PMID: 25242569 DOI: 10.3109/13697137.2014.964670] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the effects of estrogen therapy on objective sleep quality in insomniac postmenopausal women without severe vasomotor symptoms and/or recognized hot flushes during sleep. Study design Randomized, double-blinded, placebo-controlled trial, parallel design (ClinicalTrials.gov Identifier: NCT01501422). METHODS Forty insomniac postmenopausal women with no severe vasomotor symptoms and/or recognized hot flushes during sleep were randomized into 2 months' treatment with a 50-μg transdermal estradiol patch or placebo. Sleep quality was determined objectively with wrist actigraphy. Sleep efficiency, total sleep time, wake up after sleep onset and number of awakenings were compared before and after treatment. The Insomnia Severity Index (ISI) and Epworth Sleepiness Scale (ESS) questionnaires were used for subjective sleep quality assessment before and after treatment. RESULTS The study showed no significant difference in sleep efficiency improvement between women having estrogen alone or placebo (median 85.7% vs. 85.2%, respectively, p = 0.71). Similarly, sleep quality scores assessed by ISI and ESS were not significantly different. CONCLUSION Estrogen therapy in insomniac postmenopausal women without severe vasomotor symptoms and/or recognized hot flushes during sleep was not found to improve sleep efficiency during the study period.
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Affiliation(s)
- P Tansupswatdikul
- Menopause Research Unit, Division of Reproductive Medicine, Department of Obstetrics-Gynecology, Faculty of Medicine, Chulalongkorn University , Bangkok
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Puttapitakpong P, Chaikittisilpa S, Panyakhamlerd K, Nimnuan C, Jaisamrarn U, Taechakraichana N. Inter-correlation of knowledge, attitude, and osteoporosis preventive behaviors in women around the age of peak bone mass. BMC Womens Health 2014; 14:35. [PMID: 24588970 PMCID: PMC3942254 DOI: 10.1186/1472-6874-14-35] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 02/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As silent and preventable in nature, postmenopausal osteoporosis awareness should be raised among young women prior to an irreversible period of declining bone mass. We therefore decided to assess the inter-correlation of knowledge, attitude and osteoporosis preventive behaviors in women around the age of peak bone mass. METHODS A cross-sectional study was conducted in 430 women aged 20-35 years. The participants' knowledge, attitude and behaviors concerning osteoporosis prevention were assessed along with demographic data using a four-part questionnaire. The items in this questionnaire were established by extensive literature review, including the Guideline for Management of Osteoporosis of the Thai Osteoporosis Foundation (TOPF) 2010. The content was validated by experts in osteoporosis and reliability was obtained with a Cronbach's alpha score of 0.83. RESULTS The mean age of women in this study was 29.4 ± 4.6 years. Half of the participants (49.5%) had heard about osteoporosis, mostly from television (95.3%, n = 203/213) and the internet (72.8%, n = 155/213). Most women had certain knowledge (85.2%) and positive attitude towards osteoporosis (53.3%). Nevertheless, 80% of the studied population did not have appropriate osteoporosis behaviors. We found significant correlation between the level of attitudes and osteoporosis behaviors (adjusted odd ratio = 3.3 with 95% confidence interval of 1.9-5.7); attitude and educational level (adjusted odd ratio = 2.2 with 95% confidence interval of 1.4-3.4); and attitude and knowledge (adjusted odd ratio = 3.5 with 95% confidence interval of 1.8-6.8). CONCLUSION Despite having certain knowledge about osteoporosis, the young women did not seem to have appropriate osteoporosis preventive behaviors. Developing a right attitude towards osteoporosis may be a key determinant to improving health practices in order to prevent osteoporosis.
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Affiliation(s)
- Ploynin Puttapitakpong
- Menopause Research Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Sukanya Chaikittisilpa
- Menopause Research Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Krasean Panyakhamlerd
- Menopause Research Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Chaichana Nimnuan
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Unnop Jaisamrarn
- Menopause Research Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Nimit Taechakraichana
- Menopause Research Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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Jaisamrarn U, Triratanachat S, Chaikittisilpa S, Grob P, Prasauskas V, Taechakraichana N. Ultra-low-dose estriol and lactobacilli in the local treatment of postmenopausal vaginal atrophy. Climacteric 2013; 16:347-55. [PMID: 23347400 PMCID: PMC3786549 DOI: 10.3109/13697137.2013.769097] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective The aim of this study was to demonstrate the efficacy of an ultra-low-dose vaginal estriol 0.03 mg in combination with viable Lactobacillus acidophilus KS400 (Gynoflor® vaginal tablets) in the short-term therapy and to investigate the long-term maintenance dose in the treatment of vaginal atrophy. Methods This was a double-blind, randomized, placebo-controlled study (Controlled phase – initial therapy) followed by an open-label follow-up (Open phase – test medication initial and maintenance therapy). Included were postmenopausal women with vaginal atrophy symptoms and Vaginal Maturation Index (VMI) of ≤ 40%. The method of treatment was initial therapy with test medication (or placebo in first phase), one vaginal tablet daily for 12 days, followed by maintenance therapy, one tablet on two consecutive days weekly for 12 weeks. Results A total of 87 women completed the study. The Controlled phase results for a change in VMI demonstrated superiority of the 0.03 mg estriol–lactobacilli combination to placebo (p < 0.001). In the test group, the positive change in VMI was 35.2%, compared to 9.9% in the placebo group. In the Open phase after the initial therapy, the VMI was increased to 55.4% and, during maintenance therapy, it stayed at a comparable level (52.8–49.4%). The maturation of epithelium was followed by improvement of clinical symptoms and normalization of the vaginal ecosystem. Conclusions The ultra-low-dose, vaginal 0.03 mg estriol–lactobacilli combination (Gynoflor®) was superior to placebo with respect to changes in VMI after the 12-day initial therapy, and the maintenance therapy of two tablets weekly was sufficient to prevent the relapse of vaginal atrophy.
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Affiliation(s)
- U Jaisamrarn
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Bintvihok W, Chaikittisilpa S, Panyakamlerd K, Jaisamrarn U, Taechakraichana N. Cut-off value of body fat in association with metabolic syndrome in Thai peri- and postmenopausal women. Climacteric 2013; 16:393-7. [PMID: 23320744 DOI: 10.3109/13697137.2012.762762] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Pathophysiologic changes during the menopause transition may contribute to the risk of metabolic syndrome (MetS). Body fat composition, particularly visceral fat, is highly associated with increased insulin resistance, abnormal carbohydrate metabolism and high blood pressure. We purposefully wished to determine the optimal cut-off values of body fat composition, including visceral fat, in order to predict MetS and to assess the prevalence of MetS in peri- and postmenopausal women. METHODS This cross-sectional study was conducted in a population-based, prospective cohort at the Menopause and Gynecology clinics, King Chulalongkorn Memorial Hospital. Body fat percentage and visceral fat rating were measured by a bioelectrical impedance analyzer (Tanita SC 330). MetS was diagnosed using the Harmonizing criteria of A Joint Interim Statement of IDF/NHLBI/AHA/WHF/IAS/IASO 2009. Receiver operating characteristic analyses were performed to determine the optimal cut-off values of body fat, visceral fat, waist circumference and body mass index to identify peri- and postmenopausal women at risk of MetS. RESULTS Ninety-two perimenopausal and 446 postmenopausal women aged 40-60 years were recruited for the analyses. The optimal cut-off values for body fat percentage, visceral fat rating, waist circumference and body mass index for identifying women at risk of MetS were 34%, 7, 88 cm and 24 kg/m(2), respectively. The prevalence of MetS in this study was 27.9%. CONCLUSION The optimal cut-off values to predict MetS of body fat percentage, visceral fat and waist circumference were established. Using the Harmonizing 2009 criteria, we found that approximately one out of four peri- and postmenopausal women in this study had MetS.
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Affiliation(s)
- W Bintvihok
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Pongchaiyakul C, Leerapun T, Wongsiri S, Songpattanasilp T, Taechakraichana N. Value and validation of RCOST and TOPF clinical practice guideline for osteoporosis treatment. J Med Assoc Thai 2012; 95:1528-1535. [PMID: 23390783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To determine the percentage of postmenopausal women who need treatment using the various criteria as set out in clinical practice guideline published by the Royal College of Orthopaedic Surgeons of Thailand (RCOST) and the Thai Osteoporosis Foundation (TOPF). MATERIAL AND METHOD A cross-sectional investigation conducted at five university hospitals around Thailand, evaluated three categories of criteria according to the RCOST and the TOPF guideline for treatment in postmenopausal women, (1) bone mineral density (BMID) measured by DXA, (2) combined quantitative ultrasonography (QUS) measurement and clinical risk indices (CRI), and (3) FRAX or CRI plus spine radiography. RESULTS One thousand sixty two woman averaging 60 years of age were recruited for this study. Of those, women with osteoporosis according to DXA, osteopenia plus FRAX, or one major or two minor risk factors comprised between 1 and 22% (category I). Using the QUS T-score in combination with CRI (OSTA or KKOS score < or = -1) or nomogram criteria, between 11 and 14.4% needed treatment (category II). Using the BMI-based FRAX calculation or CRI (OSTA score of < -4 or KKOS probability of > or =80%) plus osteopenia by spine radiograph, between 2.6 and 15.7% needed treatment (category III). CONCLUSION Using the RCOST and TOPF clinical practice guideline, only one-fifth of postmenopausal Thai women would be eligible to receive treatment.
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Affiliation(s)
- Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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Chaikittisilpa S, Nimnuan C, Chirawatkul S, Jirapinyo M, Techatraisak K, Rattanachaiyanont M, Srisuparp S, Panyakhamlerd K, Jaisamrarn U, Taechakraichana N, Limpongsanurak S. Development and validation of the Menopause-specific Quality of Life Scale for menopausal Thai women. Climacteric 2012; 16:387-92. [PMID: 23017063 DOI: 10.3109/13697137.2012.707707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To develop a new instrument, the Menopause-specific Quality of Life Scale (MS-QoLS), for Thai women and to study the experience of menopausal aspects in peri- and postmenopausal Thai women. MATERIALS AND METHODS Item generation was developed from a focus group discussion and in-depth interview, and the content validity index (CVI) was computed, using item relevance ratings by content experts. Items with CVI values higher than 0.7 were selected. The draft questionnaire was tested for language, format and content. The final questionnaire was administered and the construct validity and reliability were then assessed. RESULTS Fifty-seven peri- and postmenopausal women participated in the focus group discussion and in-depth interview. Sixty-eight items across eight dimensions were generated based on content analysis result. The dimensions included Physical health, Psychological health, Sexual health, Daily activity, Family, Social, Treatment, and Economics. A total of 280 menopausal women were recruited from four collaborative hospitals for psychometric validation. After factor analysis, 22 items remained with six dimensions identified, that is, well-being, emotionality, anxiety/fear, family, social and sexual health. Cronbach's coefficient α of each domain was between 0.61 and 0.83. CONCLUSION The Thai MS-QoLS was systematically developed and validated for peri- or postmenopausal women. The initial assessment of the questionnaire showed an acceptable level of validity and reliability.
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Affiliation(s)
- S Chaikittisilpa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Kamondetdecha R, Panyakhamlerd K, Chaikittisilpa S, Chaiwatanarat T, Tepmongkol S, Taechakraichana N. Value of Osteoporosis Self-assessment Tools for Asians (OSTA) with or without Brown's clinical risk factors in detection of postmenopausal osteoporosis. Climacteric 2012; 16:127-32. [PMID: 22741522 DOI: 10.3109/13697137.2012.678913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the value of Osteoporosis Self-assessment Tools for Asians (OSTA) score, Brown's clinical risk assessment and their combination as screening tools for postmenopausal osteoporosis. METHODS Two hundred postmenopausal women were enrolled between August 2010 and January 2011. The weight and age of all participants were collected for the OSTA score. Clinical risk factors were collected for Brown's criteria. Bone mineral density was measured using dual-energy X-ray absorptiometry. RESULTS The mean age (± standard deviation (range)) of the studied population was 60.1 ± 7.8 (41-81) years. Twenty-one percent of the participants had either osteoporosis of the lumbar spine, or femoral neck or both, of which 8% had osteoporosis at the lumbar spine and 17% had osteoporosis at the femoral neck. The sensitivity and specificity for OSTA score cut-off values of ≤ -1 were 78.6% and 58.2% and for Brown's clinical risk factors were 57.1% and 71.5%, respectively. When the OSTA score of ≤ -1 and Brown's clinical risk factors were combined to screen participants with positive values for one or both test(s), the sensitivity increased from 78.6% to 81.0%, while the specificity decreased from 58.2% to 50.6%. The positive predictive values of the OSTA score, Brown's clinical criteria and the combined tools ranged between 30.4 and 70.6%. CONCLUSIONS An OSTA score of ≤ -1 seems to have higher sensitivity compared to Brown's clinical risk factor assessment. The combination of both tools provides a slight improvement in sensitivity but with a decline in specificity.
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Affiliation(s)
- R Kamondetdecha
- Menopause Research Unit, Reproductive Medicine Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Rithirangsriroj K, Panyakhamlerd K, Chaikittisilpa S, Chaiwatanarat T, Taechakraichana N. Osteoporosis in different age-groups and various body mass index (BMI) ranges in women undergoing bone mass measurement at King Chulalongkorn Memorial Hospital. J Med Assoc Thai 2012; 95:644-649. [PMID: 22994022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To determine percentage of osteoporosis at femoral neck and lumbar spine (L1-L4) in women with different age group and various BMI ranges. MATERIAL AND METHOD The present study was conducted in 4528 women of > or =40 years who underwent first BMD measurement at King Chulalongkorn Memorial Hospital between 2000 and 2010. Bone mineral density (BMD) of femoral neck (nondominant side) and lumbar spine (Li-L4) was measure by Dual-energy x-ray Absorptiometer (DXA). The percentage of osteoporosis was determined by WHO cutoff value using Thai nationwide reference database. RESULTS The percentages of osteoporosis at femoral neck (FN) in age group of 40 to 49, 50 to 59, 60 to 69, and > or =70 years were 6.2%, 7.4%, 24.4%, and 51.8% respectively The corresponding figures for lumbar spine (LS) were 3.4%, 5.6%, 12.7%, and 20.9% respectively. The percentage of osteoporosis seems to increase strikingly after 60 years at both sites. The percentage of osteoporosis at FN in underweight, normal weight, overweight and obesity were 52.1%, 20.3%, 15.7%, and 9.4% respectively. The corresponding figures for LS were 22.8%, 12%, 4.8%, and 5.9% respectively. Over 30% of women of age > or =60 years with BMI of less than 23 kg/m2 had osteoporosis by the studied criteria. CONCLUSION The percentage of osteoporosis seemed to be increasing with age and declining with BMI. Using the WHO cutoff value and Thai reference database, the percentage of femoral neck osteoporosis appeared to be higher than the lumbar spine. In the present study, the authors found that women of > or =60 years with BMI of less than 23 kg/m2 posed a substantial percentage of osteoporosis.
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Affiliation(s)
- Kunthida Rithirangsriroj
- Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
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Luengratsameerung S, Panyakhamlerd K, Treratanachat S, Taechakraichana N. Systemic effects of conjugated equine estrogen vaginal cream on bone turnover markers in postmenopausal women. Climacteric 2012; 16:133-40. [PMID: 22515801 DOI: 10.3109/13697137.2012.662252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the systemic effect of therapy with conjugated equine estrogen (CEE) vaginal cream on bone turnover markers in postmenopausal women. METHODS This study was conducted in 40 spontaneously menopausal women aged 40-60 years who complained of vulvovaginal symptoms. Subjects were instructed to self-administer 1 g CEE vaginal cream (CEE 0.625 mg) once daily for 12 weeks (continuous phase), then twice weekly for the next 12 consecutive weeks (intermittent phase). Serum levels of bone turnover markers and estradiol and the vaginal maturation index were evaluated at baseline, 12 and 24 weeks after treatment initiation. RESULTS Levels of C-terminal cross-linked telopeptide of type I collagen (CTx) were significantly decreased at 12 weeks and 24 weeks when compared to baseline values (median (range) 0.435 (0.171-0.859) and 0.391 (0.122-0.714) vs. 0.562 (0.250-1.290) ng/ml (p < 0.001 and < 0.001), respectively), but there was no significant difference between the levels at 12 and 24 weeks. Levels of procollagen type I N-terminal propeptide (P1NP) and osteocalcin levels were significantly decreased after 24 weeks when compared to pretreatment levels (mean (standard deviation) 41.74 (11.76) vs. 50.02 (17.71) ng/ml (p = 0.002) for P1NP and 23.91 (7.11) vs. 27.54 (8.67) ng/ml (p < 0.001) for osteocalcin, respectively). Estradiol levels were significantly increased and the vaginal maturation index was significantly improved after 12 and 24 weeks when compared to baseline. CONCLUSIONS CEE vaginal cream significantly decreased the bone resorption marker (CTx) in postmenopausal women after completion of the continuous-treatment phase. There was no significant further decrease after the intermittent phase. The effects on the markers of bone formation and bone turnover (P1NP and osteocalcin) were apparent only at 24 weeks. The two treatment phases moderately increased serum estradiol levels and significantly improved the vaginal maturation index.
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Affiliation(s)
- S Luengratsameerung
- Menopause Research Unit, Reproductive Medicine Division, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Chaikittisilpa S, Angsuwathana S, Chaovisitsaree S, Jirapinyo M, Wilawan K, Panyakhamlerd K, Jaisamrarn U, Techatraisak K, Morakote N, Suchartwatnachai C, Kongmephol W, Taechakraichana N. Clinical responses to the combination of estradiol and drospirenone in symptomatic postmenopausal Thai women. J Med Assoc Thai 2011; 94:1019-1025. [PMID: 21970189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To investigate the efficacy and tolerability of the oral hormone replacement therapy (HRT) containing 1 mg estradiol (E2) plus 2 mg drospirenone (DRSP) in Thai women with postmenopausal symptoms. MATERIAL AND METHOD Fifty-five Thai women with postmenopausal symptoms participated in this multicenter, open-label, non-comparative Phase IV study. The primary endpoint was the reduction of hot flushes after 12 weeks of treatment. Secondary endpoints included changes infrequency and intensity of menopausal symptoms as well as safety assessments after 4, 8, and 12 weeks of treatment. RESULTS Treatment with 1 mg E2 plus 2 mg DRSP reduced the frequency of hot flushes in 94.6% of women at the end of the 12-week treatment period. In 60% of women, the frequency of hot flushes was reduced to 10% or less, compared to baseline findings and 49.1% of women had no remaining hot flushes. Other postmenopausal symptoms such as vaginal dryness, urinary incontinence, dysuria, and dyspareunia improved The most common adverse events were vaginal bleeding or spotting and breast tenderness. CONCLUSION The oral HRT of 1 mg E2 plus 2 mg DRSP was effective and well tolerated by Thai women suffering from postmenopausal symptoms.
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Affiliation(s)
- Sukanya Chaikittisilpa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Songpatanasilp T, Chailurkit LO, Chantprasertyothin S, Ongphiphadhanakul B, Taechakraichana N. Effect of GGCX gene polymorphism on the responses of serum undercarboxylated osteocalcin and bone turnover markers after treatment with vitamin K2 (menatetrenone) among postmenopausal Thai women. J Bone Miner Metab 2011; 29:606-14. [PMID: 21344298 DOI: 10.1007/s00774-011-0263-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 01/12/2011] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to evaluate the influence of gamma-glutamyl transferase (GGCX) gene polymorphisms on the response of serum undercarboxylated osteocalcin (ucOC) and bone turnover markers 3 months after treatment with menatetrenone. One hundred and forty postmenopausal Thai women were enrolled and assigned to receive 45 mg/day treatment of menatetrenone (MK-4) concurrently with calcium 1.2 g and vitamin D 400 IU for 3 months. Demographic characteristics, GGCX genotyping, serum bone turnover markers and ucOC levels were obtained from all participants at baseline. We evaluated the reduction of ucOC at 3 months and the reduction of beta-CTx and P1NP at 1 and 3 months. The responses were compared between the different genotypes of GG and GA + AA groups. There was a significant reduction of serum ucOC, beta-CTx and P1NP from the baseline at 3 months (p < 0.001) though there was no significant difference between genotypes (GG vs. GA + AA; p > 0.05). Nonetheless, a subgroup analysis of postmenopausal women who 65 years of age or over (N = 37) revealed a significant difference between the two groups in the reduction of ucOC. Menatetrenone significantly reduced serum ucOC as well as beta-CTX and P1NP from the baseline. GGCX polymorphism appeared to have an influence over the reduction of ucOC especially in older women (age ≥65). Furthermore, the groups which have "A" allele trend to being more efficient in reducing the serum ucOC level than the group which does not have it.
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Affiliation(s)
- Thawee Songpatanasilp
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Rajthevee, Bangkok, Thailand.
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Tan D, Darmasetiawan S, Haines CJ, Huang KE, Jaisamram U, Limpaphayom KK, Lin SQ, Ling YS, Nguyen TNP, Park KH, Shah D, Subramaniam R, Taechakraichana N, Xing SM. Guidelines for hormone replacement therapy of Asian women during the menopausal transition and thereafter. Climacteric 2009; 9:146-51. [PMID: 16698661 DOI: 10.1080/13697130600655852] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
These Guidelines summarize the position of an Expert Panel on Menopause in Asian Women regarding the use of hormone replacement therapy (HRT) during the menopausal transition and thereafter. They are intended to aid gynecologists, family physicians and other health-care professionals in providing optimal care to menopausal Asian women who desire HRT.
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Affiliation(s)
- D Tan
- United Doctors' Medical Center, Mabuhay Rotonda, Quezon City 11 13, The Philippines
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Pongchaiyakul C, Songpattanasilp T, Taechakraichana N. Osteoporosis: overview in disease, epidemiology, treatment and health economy. J Med Assoc Thai 2008; 91:581-594. [PMID: 18556872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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Pongchaiyakul C, Songpattanasilp T, Taechakraichana N. Burden of osteoporosis in Thailand. J Med Assoc Thai 2008; 91:261-267. [PMID: 18389994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Taechakraichana N, Holinka CF, Haines CJ, Subramaniam R, Tian XW, Ausmanas MK. Distinct lipid/lipoprotein profiles and hormonal responsiveness in nine ethnic groups of postmenopausal Asian women: the Pan-Asia Menopause (PAM) study. Climacteric 2007; 10:225-37. [PMID: 17487649 DOI: 10.1080/13697130701352375] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Lipid/lipoprotein profiles, among other factors, are associated with risk of cardiovascular disease. Because cardiovascular disease varies in Asian countries, we hypothesized that lipid profiles differ in ethnic groups of postmenopausal Asian women. To add to the limited body of information currently available, we also investigated the effects of estrogen/progestin therapy on lipid/lipoprotein profiles in postmenopausal Asian women. METHODS The Pan-Asia Menopause (PAM) study was a prospective, randomized, double-blind clinical trial evaluating 1028 postmenopausal women at 22 investigational centers in 11 Asian countries/territories. Subjects were randomly assigned to one of three doses of continuous combined conjugated estrogens (CE)/medroxyprogesterone acetate (MPA): CE/MPA (in mg/day) = 0.625/2.5, 0.45/1.5 or 0.3/1.5. The treatment period, following baseline evaluations, consisted of six continuous 28-day cycles. Analysis of lipid profiles was a secondary objective of the PAM study. Total cholesterol, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), very low density cholesterol (VLDC-C), triglycerides and lipoprotein(a) were analyzed at a central laboratory by state-of-the-art methods. RESULTS Mean concentrations of total cholesterol, LDL-C, VLDL-C and triglycerides differed significantly among the nine ethnic groups of postmenopausal women. This difference was independent of body mass index and age, two factors that also influenced lipid/lipoprotein profiles. Mean HDL-C concentrations also differed, but this difference was influenced by body mass index in a weak interaction. All three doses of CE/MPA significantly lowered total cholesterol. Treatment with the high and middle doses significantly lowered LDL-C, and increased HDL-C, VLDL-C and triglycerides. The high dose produced a significant decrease in lipoprotein(a). CONCLUSIONS The different lipid/lipoprotein profiles in the nine ethnic groups of postmenopausal Asian women evaluated here suggest a relationship to differences in the prevalence of cardiovascular disease reported for different regions in Asia. However, the reported prevalence data on cardiovascular disease morbidity and mortality in the regions corresponding to the nine ethnic groups are insufficient to allow qualitative comparisons with the lipid profiles shown in our study. The lipid/lipoprotein changes in response to estrogen/progestin therapy observed here are consistent with those reported for Western women.
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Chaikittisilpa S, Jirapinyo M, Chaovisitsaree S, Wipatavit V, Bunyaviroch S, Kanluan B, Panyakhamlerd K, Jaisamrarn U, Taechakraichana N. Impact of women's health initiative study on attitude and acceptance of hormone replacement therapy in Thai women attending menopause clinics. J Med Assoc Thai 2007; 90:628-35. [PMID: 17487115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To assess the attitude and acceptance of Thai women attending menopause clinics on hormone replacement therapy (HRT) after the Women's Health Initiative (WHI) publication. MATERIAL AND METHOD A standardized questionnaire was used to assess attitude and acceptance of HRT in 1,206 women who visited menopause clinics in six hospitals between September 2005 and February 2006. RESULTS Of the total respondents, 92% were in the age of 40-70 years, 75% were in their peri- and post menopause, 25% were current users and the average duration of hormone use was 5.6 +/- 5.3 years. The women's perception of hormone benefits on osteoporosis prevention, skin improvement, and hot flashes treatment were 39.1%, 31.7%, and 28.9%, respectively. The most common concern of hormone use was malignancy. Hormone side effects were found to be the most common reason for switching hormone regimen. Of all the past users, 85% stopped HRT because they changed to another treatment regimen. Only 3.7% had been aware the WHI, of which 43.5% were influenced by its results. The most common source of HRT information was from doctors. For the ever users, 72.3% had some knowledge about HRT. CONCLUSION The present survey revealed that very few women had been aware of the WHI study. Nevertheless, the prevalence of HRT current users was lower compared to a prior survey before the WHI publication. Doctors appeared to be the important source of HRT information, which may indirectly have an influence over women's attitude and acceptance on HRT.
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Affiliation(s)
- Sukanya Chaikittisilpa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University Bangkok, Thailand.
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Rungruxsirivorn T, Panyakamlerd K, Trerattanachart S, Taechakraichana N. Randomized comparison of lower and standard dosages of transdermal estradiol on serum estradiol levels and vaginal maturation index. J Med Assoc Thai 2006; 89:1362-7. [PMID: 17100370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To evaluate serum estradiol (E2) in postmenopausal women who received 0.025 mg/d or 0.05 mg/d transdermal estradiol, in an equivalent trial. MATERIAL AND METHOD One hundred and eight postmenopausal women were randomized into 0.025 mg/d and 0.05 mg/d of transdermal E2 matrix patch. After 12 weeks, serum E2 and vaginal maturation index (VMI) were checked in both groups. Adverse effects, such as breast tenderness, application site reaction, weight gain, and headache, were also assessed. RESULTS Serum E2 in 0.025 mg/d and 0.05 mg/d groups were 42.43 +/- 35.11 and 48.41 +/- 22.36 pg/mL, respectively. There was no statistically significant difference between the groups. Equivalence was found under CI of +/- 14 pg/mL. Mean value of superficial cells and vaginal maturation index (VMI) were comparable between both groups. Adverse effects seem to be less in the lower dosage group compared to the standard dosage group. CONCLUSION The lower dosage (0.025 mg/d) of the transdermal E2 matrix system is probably an appropriate treatment option for postmenopausal women who need minimal effective and minimal adverse effects.
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Affiliation(s)
- Tassawan Rungruxsirivorn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
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Chuenchompoonut V, Bunyavejchevin S, Wisawasukmongchol W, Taechakraichana N. Prevalence of genital prolapse in Thai menopausal women (using new standardization classification). J Med Assoc Thai 2005; 88:1-4. [PMID: 15960208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND There is an increasing number of menopausal women in Thailand (estimation of 5 million women). There is no published data on the prevalence of genital prolapse among Thai menopausal woman. So the authors created this hospital based study to identify the magnitude of this problem in Thai menopausal women. OBJECTIVE To study the prevalence and symptoms of genital prolapse in Thai menopausal women attending the menopausal clinic in King Chulalongkorn Memorial Hospital. STUDY DESIGN Descriptive study (Cross-sectional study). MATERIAL AND METHOD Two hundred and fifteen Thai menopausal women attending the menopause clinic at King Chulalongkorn Memorial Hospital from the 1st of January to the 28th of February 2004 were recruited. Urinary symptoms history taking and pelvic examination were done. The severity of any prolapse was classified using International Continence Society classification. RESULTS Prevalance of Thai menopausal women having any type of genital prolapse was 43.3%. Anterior vaginal wall prolapse and superior vaginal prolapse were the two highest prevalences of genital prolapse (29.3% and 14.9%). The prevalence of genital prolapse increased by the menopausal age. The two leading symptoms were stress incontinence and vaginal outlet relaxation (89.3% and 51.6%). CONCLUSION From the present study, the authors found the prevalence of any genital prolapse (43.3%) and stress incontinence(89.3%) among Thai women attending menopausal clinic in King Chulalongkorn Memorial Hospital. The authors strongly recommend pelvic examination and urinary-symptoms history taking to evaluate the severity of genital prolapse.
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Affiliation(s)
- Vorachai Chuenchompoonut
- Department of Obstetric and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Taechakraichana N, Witoonpanich P. Osteoporosis: latest innovation in therapy. J Med Assoc Thai 2004; 87 Suppl 3:S126-S131. [PMID: 21213509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Postmenopausal osteoporosis has been found to be a health threat in most developed countries and is an emerging problem of countries in Asia Pacific region. It is estimated that half of all hip fractures worldwide will occur in this region by 2050. The consequences of osteoporosis are fractures which may have a highly impact on quality of daily life. The current conceptual understanding of osteoporosis is emphasized on bone strength. It is defined as an integration of bone density and bone quality. Assessment of treatment efficacy is more accurate by looking at fracture risk reduction over an increase of bone mineral density. The premature termination of the Women's Health Initiative study in July 2002 has limited the osteoprotective role of hormone replacement therapy (HRT). It is a general recommendation to give HRT to symptomatic women in their perimenopause or climacteric midlife. Non-HRTanti-osteoporotic medication eg., raloxifene, bisphosphonates, calcitonin, and intermittent PTH is considered to be the first line therapy in asymptomatic women over 60 years. Other innovative anti-osteoporotic regimens are being under research development.
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Affiliation(s)
- Nimit Taechakraichana
- Department of Obstetrics and Gynecology Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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Kung AWC, Chao HT, Huang KE, Need AG, Taechakraichana N, Loh FH, Gonzaga F, Sriram U, Ismail NMN, Farooqi A, Rachman IA, Crans GG, Wong M, Thiebaud D. Efficacy and safety of raloxifene 60 milligrams/day in postmenopausal Asian women. J Clin Endocrinol Metab 2003; 88:3130-6. [PMID: 12843154 DOI: 10.1210/jc.2002-021855] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
In healthy Caucasian postmenopausal women, raloxifene increases bone mineral density (BMD), decreases biochemical markers of bone turnover, and lowers low-density lipoprotein (LDL) cholesterol, without effects on high-density lipoprotein (HDL) cholesterol and triglycerides. This randomized, double-blind study examines the effects of raloxifene 60 mg/d (n = 483) or placebo (n = 485) in healthy postmenopausal Asian women (mean age 57 yr) from Australia, Hong Kong, India, Indonesia, Malaysia, Pakistan, Philippines, Singapore, Taiwan, and Thailand. Serum osteocalcin, serum N-telopeptide, total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides were assessed at baseline and 6 months. Lumbar spine BMD was measured at baseline and 1 yr in 309 women from 4 countries. Clinical adverse events were recorded at each interim visit. At 6 months, raloxifene 60 mg/d significantly decreased osteocalcin, N-telopeptide, total cholesterol, and LDL cholesterol by medians of 15.9%, 14.6%, 5.3%, and 7.7%, respectively, from placebo. Changes in HDL cholesterol and triglycerides were similar between raloxifene and placebo. Raloxifene 60 mg/d increased mean lumbar spine BMD (1.9%) from placebo at 1 yr (P = 0.0003). The incidences of hot flashes (placebo 3.5%, raloxifene 5.6%, P = 0.12), and leg cramps (placebo 2.7%, raloxifene 4.3%, P = 0.16) were not different between groups. No case of venous thromboembolism was reported. The effects of raloxifene 60 mg/d on bone turnover, BMD, and serum lipids in healthy postmenopausal Asian women were similar to that previously reported in Caucasian women.
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Affiliation(s)
- Annie W C Kung
- Department of Medicine, The University of Hong Kong, Division of Endocrinology, Queen Mary Hospital, Hong Kong, People's Republic of China
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Taechakraichana N, Wilawan K, Wipatavit V, Maitrisathit S, Thamanavat N, Jaisamrarn U, Panyakhamlerd K, Havanond P, Limpaphayom KK. Hormone replacement therapy: attitude and acceptance of Bangkokian women. J Med Assoc Thai 2003; 86 Suppl 2:S385-98. [PMID: 12930015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVE To conduct a hospital-based survey to assess women's attitude and acceptance towards menopause and hormone replacement therapy (HRT). METHOD The authors conducted a survey in women who visited the menopause clinic in 5 university and public hospitals in Bangkok. A group of 615 women who lived in those catchment areas and voluntarily cooperated in responding to a set of standardized questionnaires was randomly selected. RESULTS Of the total respondents, 97.0 per cent were in the age range between 40-70 years, 51.7 per cent were in the peri- and postmenopausal period, 65.7 per cent believed that menopause is a natural change but some may need medical treatment, 53.9 per cent were current users of which the average duration of HRT use was 4.70 +/- 3.36 years. The most common reasons for HRT initiation were osteoporosis, hot flashes, and vaginal dryness. The most common side effects found in the current users were breast pain, headache, and vaginal bleeding. Of all the current users, 43.2 per cent wanted to switch from HRT. Most of the respondents (95.4%) based their decision on the choices of treatment on medical advice. Of the total respondents, 62.0-74.7 per cent reported not having enough clear information on menopause and HRT. CONCLUSION According to the present study, most of the women regarded menopause as a natural change of life although some need treatment. The most common indications for HRT were osteoporosis, hot flashes and vaginal dryness. Nearly half of the current users wanted to switch from HRT. Most of the respondents based their treatment decision on medical advice.
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Affiliation(s)
- Nimit Taechakraichana
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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Taechakraichana N, Jaisamrarn U, Panyakhamlerd K, Chaikittisilpa S, Limpaphayom KK. Climacteric: concept, consequence and care. J Med Assoc Thai 2002; 85 Suppl 1:S1-15. [PMID: 12188398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Climacteric is the period of life starting from the decline in ovarian activity until after the end of ovarian function. According to the definition, the period includes peri-menopause, menopause and post-menopause. Climacteric is considered to be a natural change of life which may be accompanied by various health consequences i.e., menopausal symptoms, osteoporosis, coronary heart disease, or Alzheimer's disease. The key concept is that women enter menopause with different menopausal status for instances, natural menopause, surgical menopause, early menopause or even premature ovarian failure. Women may experience various health consequences due to the difference in genetic and environmental interaction. The prevalence and incidence of menopausal problems vary according to ethnic groups. For instance, Asian women seem to have less problems after menopause than their occidental counterparts. Nevertheless, the problems do exist and seem to be increasing due to the longer life expectancy and lifestyle changes of people in the region. Clinical decision in menopausal therapy can be determined according to health risk stratification. Appropriated menopausal therapeutic strategies include medical and non-medical modalities. The non-medical modalities are mainly focussed on lifestyle modification, while the medical modalities are classified as hormone replacement therapy (HRT) and non-HRT. Those in the high risk group will probably benefit most from medication besides lifestyle modification. There are various types, doses, routes and regimens of medication which need to be appropriately matched with the proper women's characteristics. Those who have contraindications to HRT or can not tolerate its side effects may choose other alternatives eg, selective estrogen receptor modulators, bisphosphonates, calcitonin or calcium and vitamin D. The success of menopausal therapy is to give an appropriate therapeutic option to the right woman. The future direction of research will remain focussing on the development in diagnosis and menopausal therapy particularly the main three areas of health promotion, disease prevention and treatment. The trend of research and development will probably be concentrated on new pharmaceutical agents with more specific action and high selectivity in an attempt to maximize its efficacy and safety. Attention may be paid more on the convenience of drug administration to increase its compliance. Alternative medicine and appropriated technologies are also the fields of special interest of which research is underway.
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Affiliation(s)
- Nimit Taechakraichana
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Sueblinvong T, Taechakraichana N, Phupong V. Prevalence of climacteric symptoms according to years after menopause. J Med Assoc Thai 2001; 84:1681-91. [PMID: 11999814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To study the prevalence of menopausal symptoms of women attending the menopause and gynecology clinics at Chulalongkorn Hospital. STUDY DESIGN A descriptive study was conducted at the menopause and gynecology clinics at Chulalongkorn Hospital. After inclusion and exclusion were done, four hundred and twenty seven participants with premenopause, perimenopause and postmenopause were studied. All the women were classified into seven groups of premenopause, perimenopause and one, two, three, four and > or =five years after menopause. The interview was performed by well-trained social workers using standardized questionnaires. RESULTS The average age at menopause of the postmenopausal women was 49.46 + 3.30 years. Prevalence of vasomotor symptoms eg. hot flushes in premenopause, perimenopause and one, two, three, four and > or =five years after menopause were 4.4 per cent, 25 per cent, 27.3 per cent, 38.8 per cent, 40 per cent, 11.1 per cent and 10.3 per cent, respectively. Prevalence of psychological symptoms eg. moodiness were 26.5 per cent, 25 per cent, 54.6 per cent, 38.7 per cent, 32.2 per cent, 11.2 per cent and 11.8 per cent, respectively. But the prevalence of headache in this category was 29.4 per cent, 23.3 per cent, 23.7 per cent, 22.6 per cent, 25.0 per cent, 11.1 per cent and 13.2 per cent, respectively. Prevalence of urinary symptoms seemed to increase continuously after menopause. Prevalence of genital symptoms eg. vaginal dryness were 5.9 per cent, 13.3 per cent, 25.5 per cent, 25.8 per cent, 15.0 per cent, 16.7 per cent and 20.6 per cent, respectively. Prevalence of other symptoms eg. muscle and joint pain were 22.1 per cent, 43.3 per cent, 56.4 per cent, 58.0 per cent, 45.0 per cent, 27.8 per cent and 28.0 per cent, respectively. CONCLUSION The prevalence of menopausal symptoms in this postmenopausal group appeared to increase during the first and second years after menopause and tended to decrease afterwards. The prevalence of other symptoms eg. dry eyes and headache appeared to be unchanged after menopause.
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Affiliation(s)
- T Sueblinvong
- Department of Obsetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Taechakraichana N, Jaisamrarn U, Panyakhamlerd K, Chaikittisilpa S, Limpaphayom K. Difference in bone acquisition among hormonally treated postmenopausal women with normal and low bone mass. J Med Assoc Thai 2001; 84 Suppl 2:S586-92. [PMID: 11853286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
This prospective analysis was conducted to compare the effects of hormone treatments on bone mineral density (BMD) of the lumbar spine, hip, and distal forearm in postmenopausal women with normal BMD and those with low bone mass. Eighty healthy women were randomly assigned to receive a cyclic regimen of standard hormone replacement therapy (HRT) or currently used low-dose oral contraceptive (OC). Women were categorized as normal BMD and low bone mass according to the Thai reference database. The results revealed that women with low bone mass gained more BMD than those with normal BMD. The difference in mean per cent bone acquisition was obvious at the spine. In addition, further subset analysis into OC and HRT groups revealed higher effects of OC on BMD when compared to HRT.
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Affiliation(s)
- N Taechakraichana
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Chotnopparatpattara P, Panyakhamlerd K, Taechakraichana N, Tantivatana J, Chaikittisilpa S, Limpaphayom KK. An effect of hormone replacement therapy on skin thickness in early postmenopausal women. J Med Assoc Thai 2001; 84:1275-80. [PMID: 11800301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND It is well known that dermal thickness, the major component of skin thickness, will decrease progressively after menopause. Bone and dermis share a similar organic constituent (collagen type I). The effect of hormone replacement therapy on bone has been established, whereas, its effects on skin are less well-described. This study was performed to determine the effect of combined estrogen-progestin replacement therapy in a sequential regimen on skin thickness in women during the early postmenopausal period. METHOD One hundred early postmenopausal women who met the eligibility criteria and had already signed a consent form were non-randomly allocated in two groups. Group A; sixty women who received cyclic hormone replacement therapy in each 28-day cycle for 6 cycles. Group B; forty women who received 1,000 mg of calcium carbonate daily. Skin thickness was measured by ultrasonography before and after treatment and the Student's t-test was used to compare the results. RESULTS A statistically significant increase in skin thickness over baseline was noted after combined estrogen-progestin replacement therapy had been administered for 24 weeks compared to the control and baseline groups. The skin thickness was also significantly decreased after calcium had been administered for 24 weeks when compared to baseline. CONCLUSION Skin thickness was increased in early postmenopausal women subjected to hormone replacement therapy with an alternating dose of estrogen and progestin.
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Affiliation(s)
- P Chotnopparatpattara
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Limpaphayom KK, Taechakraichana N, Jaisamrarn U, Bunyavejchevin S, Chaikittisilpa S, Poshyachinda M, Taechamahachai C, Havanond P, Onthuam Y, Lumbiganon P, Kamolratanakul P. Prevalence of osteopenia and osteoporosis in Thai women. Menopause 2001; 8:65-9. [PMID: 11201518 DOI: 10.1097/00042192-200101000-00011] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the age-specific and age-adjusted prevalence of osteopenia and osteoporosis in pre- and postmenopausal Thai women. METHODS This was a descriptive study of 1,935 Thai women ranging in age from 40 to 80 years, with randomly selected strata using multistage sampling and stratifying from six representative provinces of the country. After recruiting, all the women were interviewed by a well-trained interviewer using structured questionnaires. Bone mineral density (BMD) of lumbar spine 1-4 and nondominant hip was measured by a dual energy photon absorptiometer. The investigators were trained and standardized; inter- and intraobserver variations were measured periodically. Every BMD outcome was re-examined by the specialist. Age-specific prevalence of osteoporosis and osteopenia were determined using both Thai and Western standard BMD values. Age-adjusted prevalence of osteopenia and osteoporosis was calculated using the age-adjusted direct method. RESULTS Using the Thai BMD reference, the age-specific prevalence of osteoporosis among Thai women rose progressively with increasing age to more than 50% after the age of 70. The age-adjusted prevalence of osteoporosis also rose progressively. It was 19.8%, 13.6%, and 10% for lumbar spine, femoral neck, and intertrochanteric. The age-adjusted prevalence of osteoporosis indicates the overall magnitude of that condition in the population or country. In our study, using a Western BMD reference resulted in a misleadingly high prevalence of osteoporosis in the population of Asian countries. CONCLUSION It is important to calculate the age-adjusted prevalence of osteopenia and osteoporosis to address the overall magnitude of the problem in Thai women. This will allow us to predict the socioeconomic impact of preventable chronic conditions such as osteoporosis. The results obtained from this study are important data for public health policy: maximizing bone mass throughout life as well as detection of important risk factors is essential.
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Affiliation(s)
- K K Limpaphayom
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Panyakhamlerd K, Limpaphayom K, Taechakraichana N, Chaikittisilpa S, Pasatrat S, Pojanasopanakun S. Comparison of norgestrel- versus cyproterone acetate-containing hormone replacement therapy on lipid-lipoprotein metabolism. J Med Assoc Thai 2000; 83:764-70. [PMID: 10932511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
To compare the effects on the lipid profile of estradiol valerate with norgestrel to a regimen of estradiol valerate with cyproterone acetate. Sixty-four healthy women in their perimenopause or early postmenopause, aged between 40-55 years, were randomized to one of the two 21-day sequential regimens: estradiol valerate 2 mg/day for 21 days and combined with either norgestrel 0.5 mg/day or cyproterone acetate 1 mg/day from day 12 to 21, with 7 days of drug-free interval, for 12 cycles. Lipid profiles were followed at baseline, 6 and 12 cycles. Sixty-one subjects completed the study, 30 in the norgestrel group and 31 in the cyproterone group. During 12 cycles of study, serum HDL cholesterol levels decreased significantly in the norgestrel group (p < 0.01) and were unchanged in the cyproterone group. The levels were significantly lower in the norgestrel group than in the cyproterone group (p < 0.05). No differences were found between groups as regards LDL cholesterol and total cholesterol levels. Triglyceride levels decreased significantly in the norgestrel group (p < 0.01), remained unchanged in the cyproterone group and the levels were significantly different between groups (p < 0.01). In conclusion, the study demonstrated that sequential regimen of estradiol valerate with norgestrel produced less favorable HDL cholesterol but more favorable triglyceride levels than the regimen of estradiol valerate with cyproterone acetate.
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Affiliation(s)
- K Panyakhamlerd
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Limpaphayom KK, Taechakraichana N, Jaisamrarn U, Bunyavejchevin S, Chaikittisilpa S, Poshyachinda M, Taechamahachai C, Havanond P, Onthuam Y, Lumbiganon P, Kamolratanakul P. Bone mineral density of lumbar spine and proximal femur in normal Thai women. J Med Assoc Thai 2000; 83:725-31. [PMID: 10932505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To find the reference data for age-specific normal bone mineral density in a Thai female population. STUDY DESIGN Cross-sectional, Descriptive study. MATERIAL AND METHOD 1773 Thai women aged between 11-80 years were recruited, using multistage cluster sampling and stratifying from six represented provinces in the country, each strata was randomly selected. After recruiting, the women were interviewed by well-trained personnel using structured questionnaires. Bone mineral density of the lumbar spine 1-4 and nondominant hip were measured by Dual Energy Photon Absorptiometer. The scientists, X-rays technician were trained and standardized inter and intra observers variation. Quality control of examination was measured periodically. Every BMD outcome was re-examined by a specialist. RESULTS The peak bone mineral density of both spines and hips was between the age of 30 to 34 years old. Mean Value for spine and femoral neck was 0.957 and 0.814 g/cm2 respectively. The BMD of spine and hip was significantly decreased after the age of 35 and the loss was accelerated at age 50. Osteoporosis for spine and femoral neck is considered when BMD are below 0.682 and 0.569 g/cm2 respectively. CONCLUSION The results are important data for public health policy, by maximizing bone mass during skeletal growth before menopause and minimizing bone loss throughout life as well as for detection of important risk factors.
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Affiliation(s)
- K K Limpaphayom
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Tanawattanacharoen S, Panyakhamlerd K, Chaikittisilpa S, Taechakraichana N, Limpaphayom KK. Uterine blood flow response to hormonal replacement therapy in asymptomatic postmenopausal women: a transvaginal Doppler study. J Med Assoc Thai 2000; 83:368-73. [PMID: 10808696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
To evaluate the effect of continuous hormonal replacement therapy (HRT) on Doppler parameters of uterine blood flow in asymptomatic postmenopausal women. Thirty-eight asymptomatic postmenopausal women were recruited into the study from the outpatient menopause clinic, Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University. The study population was divided into 20 cases without any HRT (group 1) and 18 cases using continuous conjugated equine estrogen 0.625 mg/day combined with medroxyprogesterone acetate 2.5 mg/day (group 2). The duration of HRT was 21.3 +/- 9.5 (13-56) months. A transvaginal colour flow imaging system (ALOKA SSD-2000 MultiView, Tokyo, Japan) was used to assess uterine blood flow. Quantitative data from areas of colour were evaluated by pulsed Doppler spectrum analysis. Resistance indices (RI) were measured as indicators of uterine perfusion. Both groups were statistically similar with respect to age, parity, age at menopause, height and weight. The endometrial thickness in group 1 and 2 were 3.8 +/- 0.8 and 4.1 +/- 0.6 millimetres, respectively. The left uterine artery RIs of group 1 and 2 were 0.86 +/- 0.08 and 0.84 +/- 0.07, respectively (p = 0.33). The right uterine artery RIs of group 1 and 2 were 0.87 +/- 0.07 and 0.83 +/- 0.06, respectively (p = 0.06). In conclusion, continuous HRT had a non-significant influence on uterine blood flow in the postmenopausal women.
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Affiliation(s)
- S Tanawattanacharoen
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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