Publications (16)32.3 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: To evaluate the safety of laparoscopic hysterectomy for young patients with intellectual disability and the postoperative satisfaction levels of their caregivers. A retrospective analysis was conducted of all patients with intellectual disability who underwent laparoscopic hysterectomy at a center in Thailand between January 5, 2004, and August 31, 2010. Information was retrieved about preoperative, intraoperative, and postoperative characteristics. Caregiver satisfaction levels were assessed 3months after surgery using a Likert-type scale. The mean age of the 74 included patients was 14.9±4.2years. The cause of intellectual disability was unknown for 30 patients (41%); 22 (30%) had Down syndrome. Total laparoscopic hysterectomy was performed among 66 (89%) patients. No major operative complications were noted. Overall, 72 (97%) caregivers were extremely satisfied with the surgical outcome; the remaining 2 (3%) reported being very satisfied. Laparoscopic hysterectomy was safe and had good outcomes among patients with intellectual disability. This procedure might be a feasible option to induce therapeutic amenorrhea among young patients with intellectual disability, especially in countries with limited resources. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
- [Show abstract] [Hide abstract] ABSTRACT: Background: Anogenital warts (AGWs) are common results of sexually transmitted infection (STI). Human papillomavirus (HPV) types 6 and 11, which are non-oncogenic types, account for 90% of the clinical manifestations. Although the quadrivalent HPV vaccine has been launched, AGW remains prevalent in some countries and shows association with abnormal cervical cytology. Objectives: To study the prevalence of abnormal cervical cytology (low grade squamous intraepithelial lesions or worse; LSIL+) in immunocompetent Thai women newly presenting with external AGWs. Materials and Methods: Medical charts of all women attending Siriraj STI clinic during 2007-2011 were reviewed. Only women presenting with external AGWs who were not immunocompromised (pregnant, human immunodeficiency virus positive or being on immunosuppressant drugs) and had not been diagnosed with cervical cancer were included into the study. Multivariate analysis was used to determine the association between the characteristics of the patients and those of AGWs and LSIL+. Results: A total of 191 women were eligible, with a mean age of 27.0±8.9 years; and a mean body mass index of 20.6±8.9 kg/m2. Half of them finished university. The most common type of AGWs was exophytic (80.1%). The posterior fourchette appeared to be the most common affected site of the warts (31.9%), followed by labia minora (26.6%) and mons pubis (19.9%). The median number of lesions was 3 (range 1-20). Around 40% of them had recurrent warts within 6 months after completing the treatment. The prevalence of LSIL+ at the first visit was 16.3% (LSIL 12.6%, ASC-H 1.1%, HSIL 2.6%). After adjusting for age, parity and miscarriage, number of warts ≥ 5 was the only factor associated with LSIL+ (aOR 2.65, 95%CI 1.11-6.29, p 0.027). Conclusions: LSIL+ is prevalent among immunocompetent Thai women presenting with external AGWs, especially those with multiple lesions.
- [Show abstract] [Hide abstract] ABSTRACT: Background Data on sexually transmitted infections (STI) prevalence among HIV-infected women in Thailand are limited. We studied, among HIV-infected women, prevalence of STI symptoms and signs; prevalence and correlates of having any STI; prevalence and correlates of Chlamydia trachomatis (CT) or Neisseria gonorrhoeae (GC) among women without CT and/or GC symptoms or signs; and number of women without CT and/or GC symptoms or signs needed to screen (NNS) to detect one woman with CT and/or GC overall, among pregnant women, and among women ≤25 years. Methods During October 2004–September 2006, HIV-infected women at 3 obstetrics and gynecology clinics were asked about sexual behaviors and STI symptoms, physically examined, and screened for chlamydia, gonorrhea, trichomoniasis, and syphilis. Multivariate logistic regression was used to identify correlates of infections. NNS was calculated using standard methods. Results Among 1,124 women, 526 (47.0%) had STI symptoms or signs, 469 (41.7%) had CT and/or GC symptoms or signs, and 133 (11.8%) had an STI. Correlates of having an STI included pregnancy and having STI signs. Among 469 women and 655 women with vs. without CT and/or GC symptoms or signs, respectively, 43 (9.2%) vs. 31 (4.7%), 2 (0.4%) vs. 9 (1.4%), and 45 (9.6%) vs. 38 (5.8%) had CT, GC, or “CT or GC”, respectively; correlates included receiving care at university hospitals and having sex with a casual partner within 3 months. NNS for women overall and women ≤25 years old were 18 (95% CI, 13-25) and 11 (95% CI, 6-23), respectively; and for pregnant and non-pregnant women, 8 (95% CI, 4-24) and 19 (95% CI, 14-27), respectively. Conclusions STI prevalence among HIV-infected women, including CT and GC among those without symptoms or signs, was substantial. Screening for CT and GC, particularly for pregnant women, should be considered.
- [Show abstract] [Hide abstract] ABSTRACT: Cervical cancer is one of the most common AIDS-related malignancies in Thailand. To prevent cervical cancer, The US Public Health Service and The Infectious Disease Society of America have recommended that all HIV-infected women should obtain 2 Pap smears 6 months apart after the initial HIV diagnosis and, if results of both are normal, should undergo annual cytological screening. However, there has been no evidence in supporting whether this guideline is appropriate in all settings - especially in areas where HIV-infected women are living in resource-constrained condition. To determine the appropriate interval of Pap smear screenings for HIV-infected Thai women and risk factors for subsequent abnormal cervical cytology, we assessed the prevalence, cumulative incidence and associated factors of cervical cell abnormalities (atypical squamous cell of undetermined significance or higher grades, ASCUS+) among this group of patients. The prevalence of ASCUS+ was 15.4% at the first visit, and the cumulative incidence of ASCUS+ gradually increased to 37% in the first 3.5 years of follow-up appointments (first 7 times), and tended to plateau in the last 2 years. For multivariate correlation analysis, women with a CD4 count <350 cells/μL had a significant correlation with ASCUS+ (P = 0.043). There were no associations of subsequent ASCUS+ with age, pregnancy, contraceptive method, highly active anti-retroviral treatment, assumed duration of infection, or the CD4 count nadir level. There are high prevalence and cumulative incidence of ASCUS+ in HIV-infected Thai women. With a high lost-to-follow-up rate, an appropriate interval of Pap smear screening cannot be concluded from the present study. Nevertheless, the HIV-infected Thai women may require more than two normal semi-annual Pap smears before shifting to routinely annual cytologic screening.
- [Show abstract] [Hide abstract] ABSTRACT: To describe the treatment pattern of condyloma acuminata in female. The 5-year medical records of 449 women treated for genital condyloma acuminata at the Gynecologic Infectious Diseases and Female Sexually Transmitted Disease (GID-FSTD) unit were reviewed. Data included the distribution of age, client by category, anatomical site and size, serologically coexisting sexually transmitted infection (STI), and treatment modalities. About half, 50.1%, of treatment was the application of topical trichloroacetic acid; followed by podophylline in the proportion of 35.5%. While the electric cauterization and imiquimod applications were uncommon therapy. Two-fifth ofthe subjects, 40.7%, was completely cured, and the remaining cases required additional management. The present setting, the wide range of treatment available is reflection of the fact that there is no ideal management.
- [Show abstract] [Hide abstract] ABSTRACT: Background: Sertaconazole is a new imidazole fungicide introduced for vulvo-vaginal candidiasis. It has an azole group with benzothiophene that inhibits biosynthesis of ergosterol and brings about a massive leak of cytoplasm with consequent fungal cell death. Objective: Assess the safety and efficacy of Sertaconazole in the treatment of fungal vulvo-vaginitis for comparison with Fluconazole and Clotrimazole. Subjects and methods: One-hundred eighty-eight outpatients with fungal vulvo-vaginitis were recruited at Siriraj Hospital, Thailand between August 31, 2004 and January 30, 2006. The patients were given Sertaconazole, Fluconazole, or Clotrimazole, and received vaginal swab and culture for fungus at seventh and 28th days after treatment. Results: Out of 188 cases, 177 cases were followed-up completely. Sertaconazole group included 66 cases where 35 cure, 20 fail, and 7 recurrent cases. Fluconazole group included 60 cases and had 37 cure, six fail, and 20 recurrence cases. Clotrimazole group included 55 cases and had 32 cure, nine fail and 11 recurrent cases. There were risk factors of fungal vulvo-vaginitis, including frequent micturition and small toilet shower flushing. Conclusion: Sertaconazole had similar effectiveness and less side-effect as compared with Fluconazole and Clotrimazole. It appeared to work well with lowest recurrence.
- [Show abstract] [Hide abstract] ABSTRACT: World Health Organization guidelines for prevention of mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) recommend administration of zidovudine and single-dose nevirapine (NVP) for HIV-1-infected women who are not receiving treatment for their own health or if complex regimens are not available. This study assessed antiretroviral resistance patterns among HIV-infected women and infants receiving single-dose NVP in Thailand, where the predominant circulating HIV-1 strains are CRF01_AE recombinants and where the minority are subtype B. Venous blood samples were obtained from (1) HIV-infected women who received zidovudine from 34 weeks' gestation and single-dose NVP plus oral zidovudine during labor and (2) HIV-infected infants who received single-dose NVP after birth plus zidovudine for 4 weeks after delivery. HIV-1 drug resistance testing was performed using the TruGene assay (Bayer HealthCare). Most mothers and infants were infected with CRF01_AE. NVP resistance was detected in 34 (18%) of 190 women and 2 (20%) of 10 infants. There was a significantly higher proportion of NVP mutations in women with delivery viral loads of >50,000 copies/mL (adjusted odds ratio, 8.5; 95% confidence interval, 2.2-32.8, P = .002 for linear trend) and in those with subtype B rather than CRF01_AE infections (38% vs. 16%; adjusted odds ratio, 3.6; 95% confidence interval, 1.1-11.8; P = .038). The lower frequency of NVP mutations among mothers infected with subtype CRF01_AE, compared with mothers infected with subtype B, suggests that individuals infected with subtype CRF01_AE may be less susceptible to the induction of NVP resistance than are individuals infected with subtype B.
- [Show abstract] [Hide abstract] ABSTRACT: To determine the effect of adherence to a set of clinical practice guidelines (CPG) for the management of preterm contractions on health-care resource consumption and pregnancy outcomes. This prospective observational study was conducted in a tertiary care university hospital from January 2003 to December 2004. Comparisons were made between the cases receiving treatment according to the CPG (CPG group) and those receiving treatment deviating from the CPG (non-CPG group). There were 203 patients with preterm contractions. Compared with the CPG group, the non-CPG group had a higher rate of both tocolytic and steroid use, a longer maternal hospital stay, and a lower neonatal birthweight. Adherence to CPG in patients with preterm contractions at 28(+0)-36(+6) weeks' gestation consumes fewer health-care resources without compromising pregnancy outcomes.
- [Show abstract] [Hide abstract] ABSTRACT: To study the prevalence of bacterial vaginosis (BV) in pregnant women with preterm labor in Siriraj hospital. A cross-sectional study of 158 pregnant women with suspected preterm labor was performed between January and July 2005. The subjects enrolled in the present study were between 28+0 and 36+6 menstrual weeks. BV blue test was performed on the vaginal fluid collected from lower one- third of vagina. The prevalence of BV in women in the preterm labor group was 25.8% compared to 14.1% in the preterm contraction group (p = 0.07). Compared with preterm contractions a higher prevalence of BV was found in the pregnant women with preterm labor. Given that a quarter of pregnant women with preterm labor tested positive for BV, it might be appropriate to perform this test in the triage setting.
- [Show abstract] [Hide abstract] ABSTRACT: To assess the results of Pap smear at postpartum scheduled visit, especially the prevalence of squamous cell abnormalities including association with CD4(+) T-lymphocyte count (CD4(+) count) levels at delivery among HIV-infected women between the years 1996 and 2004. As part of the research and implementation programs of short course antiretroviral regimens for the prevention of mother to child perinatal HIV transmission in HIV-infected pregnant women delivered at Siriraj hospital, CD4(+) count at delivery and Pap smear at postpartum were evaluated. Among 636 women, 13.3% had squamous cell abnormalities. Seventy-seven cases (90.6%) of squamous cell abnormalities were low grade squamous intraepithelial lesions. The prevalence of squamous epithelial cell abnormalities detected by Pap smear, was higher in women whose CD4(+) count at delivery was < 200 cells/microL than in women whose CD4(+) count at delivery was > or = 200 cells/microL, with a significant difference (21.2%vs 12.2%). All HIV-infected pregnant women should be evaluated for clinical and immunological status during the antepartum period. Pelvic examination and Pap smear should be considered as a part of this evaluation. They should receive comprehensive health-care services that continue after pregnancy, including postpartum gynecologic examination and Pap smear. Women with normal cervical cytological findings but low CD4(+) count should be offered an antenatal Pap smear and long-term follow-up including a 6-monthly Pap smear.
- [Show abstract] [Hide abstract] ABSTRACT: We have previously described a selective increase in HIV-DNA content in CCR5-negative lymphocytes from late stage HIV-infected patients. Here, we show that this increase occurred even in the absence of viral phenotypic switching from CCR5- to CXCR4-tropic. This leads us to hypothesize that early and late CCR5-tropic viruses might be different in the ability to infect CCR5-low or -negative cells. We compared a set of early CCR5-tropic viruses with low viral DNA content in CCR5-negative cells to a set of late CCR5-tropic viruses with high viral DNA content in CCR5-negative cells. We could not find any significant differences between the two sets of viruses in the aspects of relative infectivity in CCR5-low cells and the level of inhibition by beta-chemokine. This suggested that there may be some changes in cellular phenotype or environment that allows an expansion of susceptible cell population in late stages HIV infection. Understanding these changes may provide a novel approach for HIV therapy.
- [Show abstract] [Hide abstract] ABSTRACT: This cross sectional type sub-study was established to assess the potential risk factor associated with human papillomavirus (HPV) cervical infection in Human immunodeficiency virus (HIV)-seropositive women. The series of 178 HIV-seropositive women was enrolled in the Department of Obstetrics & Gynecology, Siriraj Hospital. Demographic, obstetrical and behavioral risk factors were interviewed. Laboratory results were recorded. Clinical gynecologic examination was performed including Pap smear. The patients were assigned into two groups, HPV and non-HPV group. The comparison of the potential risk factors between the groups was calculated statistically. It was found that the prevalence of HPV infection was reported in 17 patients (9.6%). HIV-seropositive women, who were infected with HPV, had a significantly more probability to have a single partner in their lifetime than those who were not infected. It could be that HPV cervical infection and HIV-seropositive women share common potential risk factors, as well as, the recognition of sexual intercourse as the important route of HPV transmission.
- [Show abstract] [Hide abstract] ABSTRACT: The case of an obese 12-year-old girl with a huge and mobile pelvic cystic mass is presented. After ultrasonography and determination of tumor markers, a right huge benign adnexal mass was suspected. In order to avoid exploratory laparotomy because severe pain and a large operative scar were expected, an operative laparoscopy was performed. No intra-operative and post-operative complications were observed. With the uneventful recovery, only a one-day hospital stay was needed. Neither residual nor recurrent evidence was suspected after 2-, 6-, 12-, 18- and 24-months follow-up. With proper case selection, good pre-operative counseling and the operation performed under familiarity and good training in laparoscopy, laparoscopic management of a huge suspected benign adnexal mass is technically feasible. The benefits are reducing hospital stay, lowering morbidity, especially less pain and cosmetic acceptance of the operative scar.
- [Show abstract] [Hide abstract] ABSTRACT: To evaluate the efficacy and safety of short-course therapy with zidovudine plus lamivudine for reduction of perinatal transmission of human immunodeficiency virus type 1 (HIV-1), a single-arm, open-label, prospective, nonrandomized study was conducted. One hundred six treatment-naive pregnant women received zidovudine (300 mg) plus lamivudine (150 mg) twice daily from week 34 of gestation until the onset of labor. During labor, zidovudine and lamivudine were given every 3 h. Neonates received zidovudine syrup for 4 weeks and were bottle fed. The median maternal virus load and CD4+ cell count at weeks 32–34 of gestation were 4.33 log10 copies/mL and 274 cells/mm3, respectively. At delivery, the mothers' mean decrease in virus load was 1.55 log10 copies/mL and the mean increase in CD4+ cell count was 93 cells/mm3, compared with enrollment levels. Three neonates were HIV-1 infected, for a transmission rate of 2.83% (95% confidence interval, 1%–8%). There were no serious adverse events in the mothers. Adverse events noted in neonates were anemia (in 6 neonates), elevated transaminase levels (in 1), and thrombocytopenia (in 3). Short-course therapy with zidovudine plus lamivudine appeared to be safe and effective for prevention of perinatal transmission of HIV-1.
- [Show abstract] [Hide abstract] ABSTRACT: The main barrier to implementation of antiretroviral drugs in HIV-infected pregnant women is the lack of antenatal care (ANC). From April 1999 to December 2001, the prevalence of pregnant women not receiving ANC and coming for delivery in Siriraj Hospital was 7.3 per cent (2,152/29,484) and the prevalence of HIV infection among this group was 5.7 per cent, substantially higher than that of 27,332 pregnant women receiving ANC in Siriraj Hospital (2.2%). Besides developing interventions to increase use of ANC, the test for diagnosis of HIV infection during the intrapartum period should be rapid, inexpensive, highly sensitive and specific, easy to perform and results should be easy to interpret. The Determine Rapid Test for detection of HIV fulfills these criteria with 100 per cent sensitivity, 99.85 per cent specificity, 97.54 per cent positive predictive value, 100 per cent negative predictive value and 0.14 per cent false positive. To improve prevention of mother-to-child HIV transmission (PMTCT), the authors believe that this uncomplicated rapid HIV testing should be used during the intrapartum period to Thai-pregnant women who did not receive antenatal care and antiretroviral drugs might be offered as soon as possible for those testing HIV-positive and for their baby as chemoprophylaxis.
- [Show abstract] [Hide abstract] ABSTRACT: Objective To determine the percentage of various adnexal masses and to evaluate the feasibility, safety, advantages and awareness associated with laparoscopic management in patients who had suspected benign adnexal masses. Design Retrospective study Setting Endoscopic Unit of the Department of Obstetrics and Gynecology, Siriraj Hospital Subjects Medical and laparoscopic surgical records of 292 patients with various clinical diagnoses, who had suspected benign-adnexal masses and underwent laparoscopy from January 1998 to December 2000 Results Patients ages ranged from 17 to 76 years, with a mean of 33.1±14.6 years. The most common pre-operative diagnosis was endometriosis (54.1% of all the cases), 25.3% was other benign ovarian tumors in which functional cyst was the most common (31.1%), endometrioma was found in 23% of cases and 20.3% of cases had dermoid cyst. Overall, benign pathologic conditions were found in 99.7% (291 / 292) of patients. The mean sizes of functional cyst, other masses and neoplastic cyst were 3.1±2.3 cm, 3.9±3.0 cm, and 4.3 ±2.8 cm respectively. The size of neoplastic cyst was significantly greater than non-neoplastic mass. Only one malignant cyst was found in this study. Conclusion Diagnostic laparoscopy to confirm the diagnosis and further management can be performed in the same setting, with low rate morbidity and short hospital stay. Unless symptoms are severe and acute, expectant management for 3 months of apparently benign ovarian tumor does not seem to cause significant risks for the patients and may allow spontaneous regression of functional cyst. Although laparoscopy is an microinvasive surgery, re-evaluation of the patient just prior to surgery is a must.
Siayuthia, Bangkok, Thailand
- Department of Obstetrics and Gynecology