Saipin Pongsatha

Pharmacokinetics of isoflavones, daidzein and genistein, after ingestion of soy beverage compared with soy extract capsules in postmenopausal Thai women

BackgroundIsoflavones from soybeans may provide some beneficial impacts on postmenopausal health. The purpose of this study was to compare the pharmacokinetics and bioavailability of plasma isoflavones (daidzein and genistein) after a single dose of orally administered soy beverage and soy extract capsules in postmenopausal Thai women.MethodsWe conducted a randomized two-phase crossover pharmacokinetic study in 12 postmenopausal Thai women. In the first phase, each subject randomly received either 2 soy extract capsules (containing daidzin : genistin = 7.79 : 22.57 mg), or soy beverage prepared from 15 g of soy flour (containing daidzin : genistin = 9.27 : 10.51 mg). In the second phase, the subjects received an alternative preparation in the same manner after a washout period of at least 1 week. Blood samples were collected immediately before and at 0.5, 1, 2, 4, 6, 8, 10, 12, 24 and 32 h after administration of the soy preparation in each phase. Plasma daidzein and genistein concentrations were determined by using high performance liquid chromatography (HPLC). The pharmacokinetic parameters of daidzein and genistein, i.e. maximal plasma concentration (Cmax), time to maximal plasma concentration (Tmax), area under the plasma concentration-time curve (AUC) and half-life (t1/2), were estimated using the TopFit version 2.0 software with noncompartmental model analysis.ResultsThere were no significant differences in the mean values of Cmax/dose, AUC0–32/dose, AUC0-∝/dose, Tmax, and t1/2 of genistein between both preparations. For pharmacokinetic parameters of daidzein, the mean values of Cmax/dose, Tmax, and t1/2 did not significantly differ between both preparations. Nonetheless, the mean AUC0–32/dose and AUC0-∝/dose after administration of soy extract capsules were slightly (but significantly, p < 0.05) higher than those of soy beverage.ConclusionThe bioavailability of daidzein, which was adjusted for the administered dose (AUC/dose), following a single oral administration of soy beverage was slightly (but significantly) less than that of soy extract capsules, whereas, the bioavailability adjusted for administered dose of genistein from both soy preparations were comparable. The other pharmacokinetic parameters of daidzein and genistein, including Cmax adjusted for the dose, Tmax and t1/2, were not different between both soy preparations.

Misoprostol for second trimester termination of pregnancies with prior low transverse cesarean section

Recently, misoprostol has become a major method used for pregnancy interruption in our institute because of its low cost, effectiveness and drug stability. However, although misoprostol use in women with a scarred uterus at term has been reported several times, only very few case reports of its use in the second trimester have been publishedw1,2x. The purpose of this study was to see if misoprostol could be used as an alternative for such use. This case series consisted of pregnancies with previous low transverse cesarean section with unfavorable cervix indicated for second trimester termination with various indications, including hemoglobin Bart’s disease(42.9%), aneuploidy (19.0%), dead fetus(23.8%) and others(14.3%). Each patient was counseled and closely attended in labor unit with extreme precaution for uterine rupture. Vital signs, uterine contraction and adverse outcomes of misoprostol were recorded at at least 1-h intervals. Terbutaline sulfate 250 mg intravenously or subcutaneously was used in case of hyperstimulation. Oxytocin intravenous infusion was allowed for augmentation of labor as needed

Transvaginal ultrasound in threatened abortions with empty gestational sacs

Objective: To determine whether transvaginal ultrasound criteria alone can distinguish viable from non‐viable gestational sacs at a single examination. Method: A prospective descriptive study was undertaken and analysis performed on 211 pregnancies complicated by threatened abortion and empty gestation sacs diagnosed by transvaginal ultrasound. The main outcome measure was the final diagnosis of viable or non‐viable gestation on subsequent transvaginal sonography. Results: The study shows that a single transvaginal ultrasound examination is useful in differentiating viable from non‐viable gestation sacs. The mean sac diameter (MSD) was found to be the most useful criterion for determining non‐viability. An MSD of ≥ 17 mm that lacked an embryo and an MSD of ≥ 13 mm without visible yolk sac were reliable predictors of non‐viable gestation sacs at a single examination with 100% specificity and 100% positive predictive value. An MSD ≥ 13 mm without visible yolk sac was the most sensitive criterion. Using MSD criteria, 73% of non‐viable gestations could be reliably identified without any false‐positive diagnoses. Deformed shape, low position and thin decidual reaction are strong indicators of non‐viable gestations but are not 100% accurate. There is still a significant proportion of empty sacs, where no accurate distinction between viable and non‐viable can be made according to one criterion at a single examination and in these cases serial examinations should be carried out before any active management is advocated. Conclusion: In most cases, transvaginal sonographic criteria alone can distinguish viable from non‐viable empty gestational sacs at a single examination.

Intravaginal misoprostol for pregnancy termination

Misoprostol is one of the most popular products used for pregnancy termination because of its high efficacy, low cost and stability at room temperature. It was found that a dosage of 400 mcg of intravaginal misoprostol is optimal for secondtrimester termination [1–3]; however, the optimal time interval between doses has not been established. We conducted this study to compare the efficacy of intravaginal misoprostol, 400 mcg, administered every 3 and 6 h. Pregnant women with live fetus and unfavorable cervix at accurate gestational age of 14–28 weeks with indications for pregnancy termination were allocated into either group of 3-h interval or 6-h interval by block randomization. A Bishop score was obtained for cervical assessment just before initiating misoprostol. Exclusion criteria

Bone mineral density in women using the subdermal contraceptive implant Implanon for at least 2 years

To compare the effect of the long‐term use of a subdermal single‐rod contraceptive implant on bone mineral density (BMD) between users and a control group.

Randomized comparison of dry tablet insertion versus gel form of vaginal misoprostol for second trimester pregnancy termination

Aim:  To compare the effectiveness of vaginal misoprostol between dry tablet insertion and gel form for second trimester pregnancy termination.

Prenatal sonographic diagnosis of Larsen syndrome.

Larsen syndrome, first described by Larsen1 in 1950, is an inherited condition of collagen formation that leads to multiple joint dislocations, abnormal facies, spine abnormalities, and neck instability. Some cases have been familial, with both autosomal dominant and recessive patterns of inheritance. Although some cases are lethal, generally the prognosis can be relatively good after aggressive orthopedic management. Because of the wide clinical variation and the lack of a known metabolic defect, delineation between the various forms of Larsen syndrome is difficult. Prenatal diagnosis is essential for proper management, either by termination of pregnancy when diagnosed very early or by preparation for anticipated perinatal complications when diagnosed late. However, only a few cases of Larsen syndrome have been diagnosed prenatally.2–4 The objective of this study is to demonstrate the potential role of ultrasonography in the prenatal diagnosis of Larsen syndrome. CASE REPORT

Transvaginal sonographic features in diagnosis of ectopic pregnancy

OBJECTIVES: To evaluate the efficacy of pelvic transvaginal sonography (TVS) in patients with clinical presentation of extrauterine pregnancy (EUP) and positive β‐hCG. METHODS: Three hundred and twenty‐one patients with clinical suspicion of EUP were subjected to TVS at Maharaj Nakorn Chiang Mai Hospital. The criteria for entry to the study were (1) clinical suspicion of EUP, with stable hemodynamic condition, (2) correct final diagnosis must be known, (3) serum β‐hCG must be determined, by assay sensitivity of 10 mlU/ml (4) TVS was examined by the same sonographer. Frequencies of each TVS feature in EUP and IUP were determined. Among the patients with positive β‐hCG and empty uterus, the accuracy indices of various TVS features in predicting EUP were calculated. RESULTS: Patients with measurable β‐hCG were divided into two main groups, namely those with demonstrable typical intrauterine gestational sac (52/201), and those without (149/201). None of the subjects in the first group had EUP. Among the latter group of patients, with empty uterus, TVS signs could be further divided into 3 subgroups: (1) Direct sign, clear evidence of extrauterine gestational sac. This group had positive predictive value 100%, but low sensitivity (26%). (2) Indirect signs of EUP, i.e. adnexal mass and pelvic fluid, especially echogenic fluid. Echogenic fluid, adnexal mass and their combination had positive predictive value for EUP 92.3%, 92.8% and 95.0%, respectively. Complex adnexal mass gave the highest sensitivity (85.7%). (3) No positive sign on TVS, which is very, unlikely to be EUP, and was found in only 2.8% of EUP. CONCLUSIONS: The results of this study indicate that TVS can help to facilitate the diagnosis of EUP in most cases. EUP can be confidently diagnosed by demonstration of adnexal ring, and excluded by visualization of intrauterine sac. Complex adnexal mass and echogenic fluid are extremely helpful in making the diagnosis.

Therapeutic termination of second trimester pregnancies with intrauterine fetal death with 400 micrograms of oral misoprostol

Objective: To assess the efficacy and maternal side‐effects of oral misoprostol for second trimester termination of pregnancies with intrauterine fetal death.

Randomized controlled study comparing misoprostol moistened with normal saline and with acetic acid for second-trimester pregnancy termination. Is it different?

Objective:  To compare the efficacy and adverse effects of 400 µg intravaginal misoprostol for second‐trimester pregnancy termination in live fetuses between two groups: one in which misoprostol was moistened with normal saline solution (NSS) and the other in which misoprostol was moistened with acetic acid.