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Bangkok, Thailand

Wilailak S.,Mahidol University | Vipupinyo C.,Rajvithi Hospital | Suraseranivong V.,Bhumipol Hospital | Chotivanich K.,Mahidol University | And 12 more authors.
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2012

Objective To evaluate the effect of depot medroxyprogesterone acetate (DMPA) in protecting against epithelial ovarian cancer (EOC) and to evaluate factors associated with the risk of EOC. Design A multicentre, case-control study. Setting Twelve hospitals located across Thailand. Population Three hundred and thirty patients with EOC ('cases') and 982 matched controls were recruited from the 12 hospitals. Cases were newly diagnosed patients with EOC, demonstrated pathologically. Controls were age-matched patients admitted to different wards in the same hospital. Methods Cases and controls were interviewed by trained interviewers using a standardised pre-tested questionnaire. The factors associated with EOC were evaluated using univariate and multivariate analyses. Main outcome measures The odds ratio (OR) and 95% confidence interval (95% CI) were calculated to assess the relationship between DMPA and EOC. Results The use of DMPA was found to be associated with a 39% reduction in the risk of EOC with an OR of 0.61 and a 95% CI of 0.44-0.85 (P = 0.002). A significant risk reduction (83%) was observed when the duration of DMPA use was >3 years (OR 0.17; 95% CI 0.07-0.39; P < 0.001). Other factors associated with a reduced risk of EOC were the use of combined oral contraceptive pills and breastfeeding. A factor associated with an increased risk of EOC was a family history of gynaecological cancer. Conclusions The results suggest that DMPA may have a protective effect against EOC. If this effect is real, then it represents an important non-contraceptive benefit of DMPA. © 2012 RCOG.

Onpanna P.,Kuchinarai Crown Prince Hospital | Daosodsai P.,Khon Kaen University | Leelawat K.,Rajvithi Hospital | Porasuphatana S.,Khon Kaen University
Asian Biomedicine | Year: 2015

Background: Cross-sex hormone (CSH) use is widespread among transsexuals in Thailand. CSHs are used by male-to-female (MtF) transsexuals for feminization. Objectives: To determine effects of self-medication with CSH on cardiovascular risk biomarkers, C-reactive protein (CRP) and fibrinogen (Fb), in Thai MtF transsexuals. Methods: Data were collected from healthy MtF transsexual cabaret dancers in Pattaya city, Thailand, using a questionnaire and descriptive interview. Blood samples were collected to determine lipid profile, CRP, Fb, and sex hormone levels. ANOVA, Pearson correlation, and logistic regression were analyzed for effects of CSH on biomarkers; comparing CSH users with non-using controls. Results: We grouped 102 MtF transsexual participants (average age 28 years) as CSH (n = 66) and non-hormone using controls (n = 36). Several female and antimale hormonal products were used in CSH self-medication, with an average 12.5-year exposure. In the CSH group, significantly higher HDL with lower CRP levels and a negative correlation between total cholesterol, LDL, and 17β-estradiol were observed. Risk prevalence analysis exhibited lower prevalence of disease susceptibility in the CSH group. Logistic regression accordingly revealed the effect of CSH on CRP levels with odds ratios of 0.26 (CI 0.1-0.68) and 0.34 (CI 0.13-0.93) in crude and adjusted models, respectively. Conclusions: Moderate exposure to low doses of CSH use showed no serious risk or health problems in healthy MtF transsexuals in terms of cardiovascular risk biomarkers.

Laothavorn P.,Sirindhorn Cardiac Center | Hengrussamee K.,Chest Desease Institute | Kanjanavanit R.,Chiang Mai University | Moleerergpoom W.,Police General Hospital | And 4 more authors.
CVD Prevention and Control | Year: 2010

Background: Heart Failure (HF) is the one of the malignant cardiac syndromes which has a high morbidity and mortality rate. In Thailand, HF is one of the major cardiovascular health problems and economic burdens disease. Thai ADHERE is the first HF registry in Thailand. Objective: To assess patient with HF in Thailand in terms of patients' characteristics, clinical presentation, causes of heart failure, and precipitating causes of heart failure, hospital course, management, and in-hospital outcomes. Material and methods: Thai Acute Decompensated Heart Failure Registry or Thai ADHERE registry is a Phase IV, multicenter, observational, and open-label registry in 18 cardiac centers in Thailand using the US ADHERE protocol. Medical records of hospitalized patients with the principal discharge diagnosis of HF from March 2006 to November 2007 were validated and registered via an electronic web based system. Results: There were 2041 HF admissions in 1612 patients with a median age of 67 years (mean 64 ± 14 years). Age >75 years was found in 24%, 49.6% were male patients, and 67% of these admissions had prior heart failure. Underlying diseases were hypertension [(HT) = 65%], coronary artery disease [(CAD) = 47%], dyslipidemia (50%), diabetes mellitus (47%), atrial fibrillation (24%) and chronic kidney disease (19%). Clinical features at presentation were dyspnea (97%), edema (60%), pulmonary rales (85%) and pulmonary congestion by chest X-ray (93%). Sixty-nine percent (69%) were in NYHA functional class IV and 44% had a left ventricular ejection fraction (LVEF) less than 40%. Common causes of heart failure were CAD (45%), valvular heart diseases (19%), cardiomyopathy (14%) and HT (12%). Precipitating causes of heart failure were heart disease itself 54% and 20% were related to inadequate diuretics and poor patient compliance with medications. Neurohormonal blockers (NHB) [angiotensin converting enzyme inhibitors (ACEI), angiotensinoge receptor blocker (ARB), aldosterone blocker (AA) and beta blockers (BB)], were given prior to hospitalization in comparison to at discharge in 26% vs. 35%, 12% vs. 12%, 13% vs. 17% and 26% vs. 24% respectively. In-hospital mortality rate was 5.5% and the median length of hospitalization was 7.5 days. Major causes of death were sepsis, worsening of heart failure, arrhythmic arrest and acute coronary syndrome. There was a higher mortality rate in those with poor LV systolic function compared to those with preserved LV systolic function (8.2% vs. 4.1%; p = .008). At discharge, 23% of the patients were asymptomatic while 69% had symptomatic improvement. Conclusion: Thai ADHERE registry revealed that Thai patients hospitalized for heart failure are younger and sicker than European and American patients. There is a high prevalence of HF with preserved ejection fraction. CAD was the most common cause of HF while HT was the most common underlying disease. There was a 5.4% mortality rate, which was higher in those with poor LV systolic function. There was underutilization of NHB (ACEI, ARB, BB and AA). © 2010 Published by Elsevier Ltd. on behalf of World Heart Federation.

Kongsengdao S.,Rajvithi Hospital
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2012

Hemifacial spasm (HFS) is a common movement disorder presented with unilateral, intermittent, irregular tonic or clonic contraction of facial expression muscles without any identifiable etiology. Comparison of quality of life (QoL) between Dysport and Neuronox has not been studied in HFS patients. To evaluate the QoL after treatment with botulinum toxin A (Dysport and Neuronox) injection in HFS patient. A 24-week, double-blind, randomized, cross-over comparison of QoL in HFS patients after being treated with botulinum toxin A (Dysport) and botulinum toxin A (Neuronox) was performed. Assessment of QoL composed of hemifacial spasm-30 (HFS-30), medical outcome study short form 36 items (SF-36), abnormal involuntary movement scale (AIMS) and center for epidemiologic studies-depression (CES-D) questionnaire, were performed at week 0, week 12, and week 24. The 24-hour HFS diary, recorded for 4 weeks after treatment was also evaluated. Total of 26 HFS patients were enrolled between May 2010 and January 2011. The mean HFS-30, AIMS and CES-D were reduced after treatment without any difference between the two groups. The mean SF-36 was not changed in both groups. However mean HFS-30 (p = 0.09), AIMS (p = 0.02) and CES-D (p < 0.001) of all treated patients were reduced across the treatment period. Total intensity score of HFS, duration of facial muscles spasm per day and duration of functional impairment per day in Dysport group were significantly lower than the Neuronox group (p < 0.001). There was no difference between Dysport and Neuronox in the aspect of QoL in HFS patients. However, there was improvement of QoL after multiple botulinum toxin A injection.

Intragumtornchai T.,Chulalongkorn University | Bunworasate U.,Chulalongkorn University | Siritanaratkul N.,Mahidol University | Khuhapinant A.,Mahidol University | And 10 more authors.
Leukemia and Lymphoma | Year: 2013

The impact of health insurance with inequitable rituximab coverage on the survival of patients with diffuse large B-cell lymphoma (DLBCL) has never been reported. We conducted a nationwide multicenter analysis on the outcome of 553 adult patients consecutively diagnosed with DLBCL between July 2003 and June 2006, in whom treatment cost was reimbursed under the Civil Servant Medical Benefit Scheme (CSMBS) (n =201) or the Universal Coverage Scheme (UCS) (n =352). The international prognostic index was comparable between the two payment groups. Rituximab-based therapy was administered in 45.3% and 3.1% of CSMBS and UCS patients, respectively (p <0.001). With a median follow-up of 24.6 months, the 6-year progression-free survival (PFS) was superior for CSMBS patients (34.2 vs. 23.2%, p =0.005). "Not treated with rituximab-based therapy" was the strongest adverse prognostic feature indicating a short PFS (hazard ratio 2.1, p <0.001). It is concluded that lack of access to rituximab is the principal factor accounting for the inferior PFS observed in Thai patients with DLBCL who are treated under the UCS. © 2013 Informa UK, Ltd.

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