Nikorn Dusitsin

The menopausal age and climacteric complaints in Thai women in Bangkok

Age at menopause, associated factors and related clinical symptoms were recorded in a sample of Thai women living in the Bangkok area. Interviews by trained nurses were offered to a sample of 2375 women aged 45-59 years selected at random in 19 of the 54 Bangkok Metropolis Administration health centers. Full reports were obtained from 2354 women. Fifty-six percent of the study population were classified as postmenopausal, i.e. having no vaginal bleeding during the last 12 months, 12% were perimenopausal, i.e. having irregular vaginal bleeding during the last 12 months and 31% were premenopausal, i.e. having regular vaginal bleeding during the last 12 months. The average age at menopause was 49.5 +/- 3.6 years and was not related to body weight, height, age at menarche, level of education, smoking or use of oral contraceptives. However, high parity was significantly correlated to delayed menopause. Clinical symptoms of oestrogen deficiency were reported at a significantly higher rate in the perimenopause group, but the premenopause and postmenopause groups did not differ in their complaints about any symptom, including hot flushes. The most striking effect of menopause was a dramatic loss of sexual desire in 86.9% of postmenopausal women. However, the situation did not induce any specific complaint or any request for medical support.

A new approach for the detection of cervical cancer in Thai women

OBJECTIVES The objective was to screen cervical cell samples of Thai women by using the Fourier-transform infrared (FTIR) spectrophotometry technique; the results were compared to the histologic diagnosis (gold standard). METHODS FTIR spectrophotometry is a new technology for cervical cancer screening. Instead of detecting the morphological changes as used in Pap smear test, this technique detects, at the molecular level, structural changes of functional groups through the changes of the infrared absorption spectrum. When the infrared light is passed through a cervical cell sample, a molecule absorbs infrared radiation of the appropriate frequency which excites it from one vibrational or rotational level to another. A graph of energy absorbed versus frequency is the absorption spectrum of the sample. The FTIR spectra can be interpreted as normal and abnormal results. First, significant changes in the intensity ratios and, second, significant shifts of the peak frequencies were detected. Two hundred seventy-five cervical cell specimens were received from patients undergoing hysterectomy at the Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University Hospital. Samples were collected, prepared, and analyzed by FTIR spectroscopy. RESULTS Histological examinations showed 108 abnormal cases and 167 normal cases. FTIR results versus histology showed sensitivity of 96.3% and specificity of 96.4%. False-negative and false-positive rates were 3.7 and 3.6%, respectively. CONCLUSIONS FTIR showed high sensitivity and yielded a good false-negative rate. Besides the cervical cancer detection, the FTIR spectroscopy technique can also elicit positive results from adenocarcinoma of the endometrium, sarcoma of the uterus, and ovarian malignancies.

A study of glucose tolerance, serum transaminase and lipids in women using depot-medroxyprogesterone acetate and a combination-type oral contraceptive

The metabolic effects of the 3-month injectable preparation depomedroxyprogesterone acetate (DMPA; Depo-Provera) 150 mg and of the combined oral contraceptive Ovral (d-norgestrel .05 mg plus ethinyl estradiol .05 mg) in a Thai population were assessed in a longitudinal study. Subjects were 2 groups of 16 women each from the Family Planning Clinic. A rapid intravenous glucose tolerance test (IVGTT) was done on both groups and at 1 2 3 6 9 and 12 months after drug administration. Plasma insulin levels were determined before and at 1 9 and 12 months posttherapy. Serum transaminase activity (SGOT and SGPT) triglyceride and total cholesterol levels were also determined. Results of the IVGTT are given as K values (disappearance rate of glucos e %/minute). In the DMPA group at 12 months the 1st significant decrease in mean fasting blood glucose levels was noted. The serum triglyceride levels tended to be lower throughout the 12 months of observation. Total cholesterol levels were significantly decreased after 9 and 12 months of DMPA use. SGOT AND SGPT and body weights remained the same. The K values were significantly increased during the observation period but less so toward the end of the period. Mean fasting plasma insulin was unchanged but some of the early plasma insulin responses were significantly increased. In the Ovral group the fasting blood glucose was significantly lower after 3 months of treatment. Serum triglyceride remained unchanged. Cholesterol levels tended to be lower during the first 6 months. SGOT and SGPT levels remained the same. Body weights were significantly increased. The mean K value did not change significantly but some were lower. Fasting plasma insulin remained the same but the plasma insulin responses to glucose load were significantly increased throughout the period particularly late during the observation period. Not all of the results agree with the works of some other investigators. It is concluded that DMPA caused a beneficial effect on carbohydrate metabolism without deterioration of lipid metabolism or liver function. Ovral did not induce any significant change in the K value although plasma insulin levels increased some during the test. Ovral did not induce any change in liver function or lipid metabolism except transient lowering of cholesterol values.

Adverse skin reactions to transdermal oestradiol in tropical climate. A comparative study of skin tolerance after using oestradiol patch and gel in Thai postmenopausal women

A crossover randomized comparison between two different transdermal oestradiol delivery systems has been performed in post-menopausal women of the Bangkok area. Clinical benefits were identical with the use of either a gel, applied once/day on 800 cm2 of skin and which totally evaporated within 3 min, or a patch applied for 3-5 days on 20 cm2 of skin. There was no evidence of pharmacokinetic advantage with the patch, and the day to day intra-individual variations were even greater with patch than with gel. There were no cutaneous side effects with the gel, but unacceptable skin reactions, including itching, vesicular rash and residual pigmentation, were present in 58% of patients during patch use. Therefore a combination, in a small skin area, of adhesive, occlusive effect and high oestradiol concentration does not appear appropriate in hot and humid climate.

A randomized trial of oral contraceptive and hormone replacement therapy on bone mineral density and coronary heart disease risk factors in postmenopausal women

Objective To identify the effects of oral contraceptive (OC) and hormone replacement therapy (HRT) on bone mineral density and coronary heart disease risk factors in postmenopausal women. Methods Eighty healthy postmenopausal women were randomly assigned to a cyclic regimen of OC containing 30 μg of ethinyl estradiol and 150 μg of desogestrel or HRT containing 0.625 mg of conjugated equine estrogens 21 days per cycle and 5 mg of medrogestone 10 days per cycle for 12 months. Bone mineral density of lumbar spine and hip, biochemical markers of bone turnover, lipid-lipoprotein profiles, coagulation profiles, fasting plasma glucose, and blood pressure were evaluated. Results Both regimens caused significant increase in bone mineral density of lumbar spine, trochanter, intertrochanteric region, total hip, and Ward triangle. Only OC therapy was associated with a significant increase in femoral neck bone mineral density (mean score ± standard error 2.5% ± 0.7%, P < .01). Biochemical markers of bone turnover, total cholesterol, and low-density lipoprotein cholesterol decreased significantly in both groups. Posttreatment levels of those bone markers and lipid-lipoprotein were significantly lower after OC therapy than HRT. Fasting plasma glucose and systolic blood pressure decreased significantly in both groups; however, only the OC group showed a significant decrease in diastolic blood pressure. Conclusion Both OC and HRT increased bone mineral density of lumbar spine and hip, but OC suppressed bone turnover more than HRT. Both methods favorably affected lipid-lipoprotein metabolism, fasting plasma glucose, and blood pressure during the 12 months of treatment.

The use of two estrogen preparations (a combined contraceptive pill versus conjugated estrogen cream) intravaginally to treat urogenital symptoms in postmenopausal Thai women: a comparative study.

To determine whether the combined contraceptive pill used intravaginally was as effective as the standard conjugated estrogen cream for the treatment of urogenital symptoms in postmenopausal Thai women.

Shift in FTIR spectrum patterns in methomyl-exposed rat spleen cells

Methomyl is a highly toxic carbamate insecticide which is widely used in many agricultural countries. We have applied the Fourier-transformed infrared (FTIR) spectroscopic method to study the toxicity of methomyl on cytoskeletal protein and the nucleic acid of rat spleen cells. Rats were given methomyl by gavage at 2, 6 and 8 mg/kg in single doses. Colchicine, a microtubule-disrupting agent, was given to rats at 2, 4, and 6 mg/kg in single doses and mitomycin C, an alkylating agent which acts as a DNA-cross-linking agent, was given by an intraperitoneal route to rats at 1 mg/kg. It was shown that the wavenumber of FTIR spectra at amide I and amide II in both methomyl- and colchicine-exposed rats shifted in dose response manner when compared with the control (P < 0.05). The amide I and II shifts in these regions have been proposed to be the result of an alpha-helix protein conformational change. Toxic doses of mitomycin C, a DNA-cross-linking agent, did not result in this pattern. Moreover, all exposed rats showed an increase in the absorbance ratios that were related to the vibrational mode of the phosphodiester group in nucleic acid (P < 0.05).

The effect of injectable norethisterone oenanthate on ovarian hormones in Thai women.

The ovarian hormones, progesterone and estradiol, as well as norethisterone concentrations were studied in 15 subjects receiving a single intramuscular injection of norethisterone oenanthate. Three treatment groups were studied. The 5 subjects of group A had no additional treatment, the 5 subjects of group B received ethynylestradiol and the 5 subjects of group C received combined ethynylestradiol and norgestrel orally. Additional treatment was for 5 consecutive days 6 weeks after the injection. Blood samples were obtained weekly for 12 weeks post-treatment. All subjects showed a similar pattern of norethisterone concentrations with a range of 3.5-19.5 ng/ml 1 week after injection, declining to levels of less than 0.02 ng/ml at the end of treatment period. Progesterone concentrations of greater than 4 ng/ml indicated that ovulation had occurred in 2 subjects of group A, 5 subjects of group B and 2 subjects of group C during the study period. Serum estradiol concentrations reached pre-ovulatory levels (greater than 200 pg/ml) in 4,3 and 2 subjects of group A,B and C, respectively, during the treatment period. With the other subjects, serum estradiol showed lesser increases. Among the 15 Thai women in the study, the median time of ovulation was 11 weeks, with the earliest occurring at 6 weeks. Three women receiving NET-OEN and no other treatment had ovulated by 6 weeks. Thai women in this study appear to be more resistant to the antiovulatory effect of NET-OEN as compared to women in other published studies.

A comparative study of the safety, effectiveness and acceptability of two foaming vaginal tablets (nonoxynol-9 versus menfegol) in Thai women

Two foaming vaginal tablets containing nonoxynol-9 (OVT-n) or menfegol (OVT-m) were studied to evaluate safety, effectiveness and acceptability. The study was conducted at the Chulalongkorn University, Institute of Health Research, Bangkok, Thailand. One-hundred-two women randomly assigned to one of the two types of tablets were scheduled for follow-up visits at 1, 3, 6 and 12 months. Although there were differences between the two groups in the gross cumulative 12-month life table rates and 12-month continuation rates, these differences were not statistically significant. Twelve-month discontinuation rates for accidental pregnancy were 31.7 per 100 women for OVT-n group and 25.3 per 100 women for the OVT-m group. Seventeen of the total 22 pregnancies occurred due to use failure. This study indicates that the regular and proper use of OVT-n or OVT-m tablets are comparable and are a safe means of birth control. Although a few product-related (burning) or medical complaints were reported by both groups of tablet users, it seems that the vaginal contraceptive is an acceptable method for fertility control in a suitable population who will use it regularly and properly.

A rapid method for the determination of 5α-dihydrotestosterone in Thai males receiving medroxyprogesterone acetate

A rapid method for the determination of DHT (5 alpha-dihydrotestosterone) in serum was established, utilizing potassium permanganate as an oxidising agent to convert the double bond at position 4-5 of testosterone to dihydroxy alcohols. DHT was then extracted with diethyl ether and measured directly using radioimmunoassay technique. The precision of the assay was determined at three levels of DHT added into pooled serum and found to be 4.4-5.1% for between assay percentage coefficient of variation. The sensitivity of the standard curve was found to be 4.2 pg/0.5 ml sample. The accuracy was determined in pooled serum with added standard DHT in the range of 80-800 pg. The percentage recovery of the assay was found to be 92.93-98.35%. The antisera used for DHT assay exhibited no significant cross-reaction with various steroids tested except testosterone which showed a 91.3% cross-reaction. The method was applied to measure the level of DHT in serum of Thai males receiving medroxyprogesterone acetate (MPA) as an oral contraceptive. Twenty-five subjects were divided into 5 groups. Group 1 received an oral placebo with monthly sesame oil injection. Groups 2, 3 and 4 received 5 mg, 10 mg and 20 mg MPA, respectively, with the addition of monthly injection of 250 mg testosterone enanthate (TE). Group 5 received 20 mg MPA daily with the addition of monthly injection of 500 mg TE. Blood specimens were obtained monthly. The first 4 months were used as a control period. After the 4-month period, each subject received treatment as mentioned above for 6 months, then follow-up study was resumed for another 6 months. The results revealed that subjects receiving 20 mg MPA with the addition of 250 mg TE showed a significant decrease of DHT levels (p less than 0.001).