Kitirat Techatraisak

Postoperative levonorgestrel-releasing intrauterine system for pelvic endometriosis-related pain: a randomized controlled trial.

OBJECTIVES: To estimate the effectiveness of a postoperative levonorgestrel-releasing intrauterine system for relieving pelvic pain in patients with endometriosis. METHODS: A double-blind randomized controlled trial was conducted in 55 patients with endometriosis and moderate-to-severe dysmenorrhea (visual analog scale, greater than 50 mm) undergoing laparoscopic conservative surgery. After surgery, patients were randomized to a levonorgestrel-releasing intrauterine system (n=28) or expectant management (n=27) group. Primary outcome was the change of dysmenorrhea visual analog scale. Secondary outcomes included changes of pelvic pain and dyspareunia visual analog scale, Short Form-36 score, and adverse effects. RESULTS: The two groups were comparable in age, body mass index, parity, and baseline pain scores. At 12 months, the levonorgestrel-releasing intrauterine system group had a significantly lower median value of dysmenorrhea and noncyclic pelvic pain score. Compared with the control group, the levonorgestrel-releasing intrauterine system group had greater reduction in dysmenorrhea visual analog scale (−81.0 compared with −50.0 mm, P=.006) and pelvic pain visual analog scale (−48.5 compared with −22.0 mm, P=.038) but a comparable reduction in dyspareunia visual analog scale (−15.0 compared with −19.0 mm, P=.831). Two patients in levonorgestrel-releasing intrauterine system group (7.4%) and nine in the expectant management group (39.1%) had recurrent dysmenorrhea within 1 year postoperatively (P=.014). Number-needed-to-treat to prevent one case with recurrent dysmenorrhea within the first year was three cases. The Short Form-36 scores improved in the levonorgestrel-releasing intrauterine system group but did not change in the expectant management group. There was no serious adverse event during the study period. CONCLUSION: The levonorgestrel-releasing intrauterine system is effective and well accepted for long-term therapy after conservative surgery for patients with moderate to severe pain related to endometriosis. It can improve the patients quality of life, including physical and mental health. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00455845. LEVEL OF EVIDENCE: I

The induction of cyclooxygenase-2 by 17β-estradiol in endothelial cells is mediated through protein kinase C

Abstract:Objective and Design: We investigated whether estrogen affected COX isoform expressed in human umbilical vein endothelial cells (HUVEC).¶Materials and Methods: HUVEC were grown to confluence and replaced with fresh medium containing 17β-estradiol (0.001, 0.01, 0.1 and 1 nM) or 17β-estradiol (1 nM) plus staurosporine (0.1, 1 and 10 ng/ml) for 24 h, after which the supernatant medium was collected to measure 6-keto-PGF1α using enzyme immunoassay. To measure COX activity via exogenous substrates, the remaining cells were replaced with fresh medium containing arachidonic acid (10 μM for 10 min), and then the medium was removed to measure 6-keto-PGF1α. The COX isoform expressed in cells was detected by immunoblotting using specific antibody.¶Results: 17β-estradiol (0.001 to 1 nM) increased the production of 6-keto-PGF1α via either endogenous or exogenous substrate in a dose dependent manner. These increases were significantly inhibited when cells were coincubated with staurosporine. Interestingly, only COX-2 protein, but not COX-1 protein, was induced in 17β-estradiol treated HUVEC and was also inhibited by staurosporine.¶Conclusion: Our data showed that 17β-estradiol increased the release of PGI2 from HUVEC via the induction of COX-2 which was mediated through protein kinase C. The results suggested that COX-2 might have a role in the cardiovascular protective effect of estrogen.¶

Predictors for metabolic syndrome in perimenopausal and postmenopausal Thai women

Objective To determine the prevalence and predictors of metabolic syndrome in perimenopausal and postmenopausal Thai women. Materials and Methods The cross-sectional study was carried out in the Siriraj Menopause Clinic, Faculty of Medicine Siriraj Hospital, Mahidol University, a tertiary-care university hospital, from May 2006 to August 2009. Metabolic syndrome was diagnosed using the International Diabetes Federation (IDF) criteria for an Asian population, the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria with Asian waist circumference, and the NCEP-ATP III with body mass index cut-off value. The outcome measures were the prevalence and predictors of metabolic syndrome in perimenopausal and postmenopausal Thai women. Results There were 971 women classified into perimenopausal (n == 331), naturally postmenopausal (n == 442) and surgically postmenopausal (n == 198) groups. The overall prevalences (95%% confidence interval, CI) of metabolic syndrome were 16.0%% (15.1–24.3%%), 15.9%% (13.6–18.2%%), and 14.9%% (14.0–19.8%%) by IDF criteria, modified NCEP-ATP III criteria with Asian waist circumference, and with body mass index cut-off value, respectively. Focusing on the NCEP-ATP III criteria with Asian waist circumference, the prevalence was the highest in the surgically postmenopausal group (19.7%%, 95%% CI 15.1–24.3%%) followed by the perimenopausal (12.4%%, 95%% CI 9.4–15.4%%) and naturally postmenopausal (16.9%%, 95%% CI 14.0–19.8%%) groups, but without statistical significance. The prevalence increased with age, body mass index and family history of cardiovascular disease. Conclusion The overall prevalence of metabolic syndrome in perimenopausal and postmenopausal Thai women is 14.9–16.0%%, depending on diagnostic criteria, and its significant predictors include age, body mass index, and family history of cardiovascular disease.

The Usefulness of Homeostatic Measurement Assessment-Insulin Resistance (HOMA-IR) for Detection of Glucose Intolerance in Thai Women of Reproductive Age with Polycystic Ovary Syndrome

Objectives. To study the cut-off point of Homeostatic Measurement Assessment-Insulin Resistance (HOMA-IR) as a screening test for detection of glucose intolerance in Thai women with polycystic ovary syndrome (PCOS). Study Design. Cross-sectional study. Setting. Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital. Subject. Two hundred and fifty Thai PCOS women who attended the Gynecologic Endocrinology Unit, during May 2007 to January 2009. Materials and Methods. The paitents were interviewed and examined for weight, height, waist circumference, and blood pressure. Venous blood samples were drawn twice, one at 12-hour fasting and the other at 2 hours after glucose loading. Results. The prevalence of glucose intolerance in Thai PCOS women was 20.0%. The mean of HOMA-IR was 3.53  ±  7.7. Area under an ROC curve for HOMA-IR for detecting glucose intolerance was 0.82. Using the cut-off value of HOMA-IR >2.0, there was sensitivity at 84.0%, specificity at 61.0%, positive predictive value at 35.0%, negative predictive value at 93.8%, and accuracy at 65.6%. Conclusion. HOMA-IR >2.0 was used for screening test for glucose intolerance in Thai PCOS women. If the result was positive, a specific test should be done to prove the diagnosis.

Causes of primary amenorrhea: A report of 295 cases in Thailand

Aims:  The aim of this study was to determine the prevalence of etiologic causes of primary amenorrhea in Thailand.

Prevalence and clinical predictors of insulin resistance in reproductive-aged thai women with polycystic ovary syndrome.

Objectives. To determine the prevalence of insulin resistance (IR) and its predictors in reproductive-aged Thai women with polycystic ovary syndrome (PCOS). Methods. A cross-sectional study was conducted from May 2007 to January 2009. Participants were 250 Thai women with PCOS. Information regarding medical history and physical examination and results of 75 gram OGTT were recorded. Results. The overall prevalence of IR was 20.0%, comprising the prevalence of impaired fasting glucose, impaired glucose tolerance, and diabetic mellitus of 3.2%, 13.6%, and 5.6%, respectively. Multiple logistic regression analysis showed that the independent predictors for IR were age of ≥30 years old, waist circumference (WC) of ≥80 cm, presence of acanthosis nigricans (AN), and dyslipidemia with odds ratios (95% confidence interval) of 2.14 (1.01–4.52), 3.53 (1.28–9.75), 2.63 (1.17–5.88), and 3.07 (1.16–8.11), respectively. Conclusion. The overall prevalence of IR in reproductive-aged Thai women with PCOS is 20.0%. Age ≥30 years old, WC ≥80 cm, the presence of AN, and dyslipidemia are the significant clinical predictors.

Cimicifuga racemosa extract for relieving menopausal symptoms: a randomized controlled trial

Abstract Objectives To evaluate the effectiveness of black cohosh extract 40 mg/day for relieving moderate to severe menopausal symptoms and improving quality of life in Thai women. Methods A randomized, double-blind, placebo-controlled clinical trial was conducted in a menopause clinic of a tertiary-care university hospital during 2011–2013. Participants were peri- or postmenopausal Thai women aged at least 40 years, who have moderate to severe menopausal symptoms evaluated using the Kupperman index (KI). Outcome measures included KI, frequency of hot flushes, Menopause-Specific Quality of Life (MENQOL) score, participants’ global satisfaction and safety outcomes. Results There were 54 participants assigned to treatment (black cohosh extract 40 mg/day, n = 27) or placebo group (n = 27). Both the treatment and placebo groups had comparable baseline KI scores (33.9 ± 7.9 vs. 31.3 ± 6.8), frequency of hot flushes (3.1 ± 2.0 vs. 2.8 ± 2.1), and MENQOL scores, all of which improved with time. Neither the improvements nor the global satisfaction were significantly different between the two groups; but the proportion of participants with moderate to severe symptoms seemed to be lower in the treatment group than in the placebo group (40% vs. 60%, p = 0.174). There was no serious adverse event or significant change in liver function tests. Conclusions A black cohosh extract of 40 mg/day is not superior to a placebo for relieving moderate to severe menopausal symptoms or improving quality-of-life scores in Thai women.

Pregnancy and miscarriage rates in 3978 donor insemination cycles: Effect of age, parity and partner's infertility status on pregnancy outcome

The effects of age, parity and male infertility status on pregnancy outcome were studied in a cohort of 720 women receiving donor insemination (DI) treatment. Twenty-two percent of women failed to complete the treatment, leaving 562 women receiving 3202 cycles of DI for assessment. Of the 321 of pregnancies achieved, 57 (17.8%) ended in a mis-carriage. After further DI treatments, 64.7% of mothers who had miscarried succeeded in giving birth. There was some evidence to indicate a trend of decreasing pregnancy rate with increasing maternal age, although this result was not significant (log rank trend statistics = 3.44, P > 0.05). The pregnancy rates of multiparous and primiparous women were significantly different, irrespective of their partners infertility status (azoospermia: log rank statistics = 3.74, P ˇ- 0.05; oligozoospermia: log rank statistics = 4.71, P < 0.03). Furthermore, multiparous women were more likely to become pregnant than primiparous women (azoospermia: hazard ratio = 1.29; oligozoospermia: hazard ratio = 1.50). There was no significant association between miscarriage rate and maternal age (log rank trend statistics = 0.99, P > 0.05). The small number of older women (> 35 years) may confound this result. The mean (± sd) sperm donor age was 23.6 years (± 3.5 years). The implications of these observations are discussed.

Measures of body adiposity and visceral adiposity index as predictors of metabolic syndrome among Thai women with PCOS

Abstract Aim: To evaluate the relationship between measures of body adiposity and visceral adiposity index (VAI) and risk of metabolic syndrome (MS) and to identify the optimal cut-off points of each measurement in Thai polycystic ovary syndrome (PCOS). Methods: A cross-sectional study was completed physical examination, fasting plasma glucose, lipid profiles of 399 PCOS and 42 age-matched normal controls. Body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and VAI were calculated. Associations between different measures and MS were evaluated and the receiver-operating characteristic (ROC) curve was performed to determine appropriate cut-off points for identifying MS. Results: Percentage of MS in PCOS was 24.6%, whereas none MS in controls. Previously recommended cut-off values for body adiposity and VAI were significantly associated with MS. ROC curve analysis of the only PCOS showed newly obtained optimal cut-off points for BMI and VAI of ≥28 kg/m2 (AUC = 0.90) and >5.6 (AUC = 0.94), respectively. Values found to be more accurate than the original ones. VAI was the best predictor, followed by BMI and WHtR. Conclusion: All body adiposity and VAI parameters can predict the risk of MS. Optimal values for Thai PCOS were ≥28 kg/m2 for BMI, ≥0.85 for WHR, ≥0.5 for WHtR and >5.6 for VAI.

Effects of Preeclamptic Plasma on Potassium Currents of Human Umbilical Vein Endothelial Cells

Endothelial cell (EC) dysfunction in preeclampsia (PE) may be mediated by humoral factors secreted by placenta, thereby affecting the EC vasoactive compound production. Possible targets of these factors include potassium channels, which are important in EC membrane potential control, calcium influx, and vasoactive compound release. Alterations in potassium channel function may thus contribute to the pathogenesis of PE. The present study compared the effects of 10% plasma from PE, normal pregnant (NP), or nonpregnant women (NS) on potassium currents of human umbilical vein ECs (HUVECs), using whole-cell patch clamp technique, with HUVECs in conventional culture medium (10% fetal bovine serum) as controls. Cells of all groups were similar in morphology and whole-cell capacitance. The fraction of cells with inward rectifier potassium channel (IRK) current in PE plasma (41.2%) was significantly lower than those in NP and NS plasmas (76.9% and 59.1%, respectively), although the IRK current density was similar among groups. The outward current components included the calcium-sensitive potassium channels (KCa) and were partially blocked by 100 nmol/L apamin and 200 nmol/L iberiotoxin. The fraction with outward current in PE plasma (100%) was significantly higher than those in NP and NS plasmas (76.9% and 81.8%). The findings indicate inhibition of IRK expression by PE plasma in HUVEC culture, while KCa expression may be facilitated probably as a compensatory response to diminished IRK. These data suggest that potassium channels may be a target of the pathogenic factor/factors in the plasma of patients with PE and may play roles in the pathogenesis of this condition.