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Obesity is becoming a universal healthcare problem. The role of endoscopic bariatric and metabolic therapies is emerging in the management of obesity and its related conditions. The endoscopic treatment can be used as a primary weight loss procedure and a revision procedure after bariatric surgery. While the prevalence of obesity has been rising over the past two decades in Thailand, the treatment options have been limited to diet and exercise, pharmacological treatment, and bariatric surgery until recently. In 2020, an endoscopic full-thickness suturing device was introduced to Thailand, leading to successful endoscopic bariatric therapy using a suturing device in Thai patients. This article intends to report the first successful endoscopic sleeve gastroplasty and transoral outlet reduction in Thailand with a mini-review focusing on these two procedures' outcomes.

Familial hypercholesterolemia (FH) is inherited as an autosomal dominant. It is an important clinical condition leading to hypertension, atherosclerosis, and premature coronary artery disease. Atherosclerosis is rarely reported in children. We report here 2 children with familial hypercholesterolemia and early atherosclerosis. The first case is a 4 year-old Thai boy who presented with yellowish papules in the skin creases which had been present for 2 years. His grandfather and father had been diagnosed with diabetes mellitus and hypercholesterolemia, respectively. Physical examination revealed his weight for height to be 125% and planar xanthomas. The remaining examination was unremarkable. Plasma lipid profiles showed a total cholesterol level of 674 mg/dl, a triglyceride level of 261 mg/dl, a high-density lipoprotein cholesterol (HDL-C) level of 39 mg/dl, and a low-density lipoprotein cholesterol (LDL-C) level of 583 mg/dl. The results of a carotid duplex scan showed atherosclerotic plaques in both carotid arteries. The second case is a 10 year-old Thai boy who had no symptoms, but his mother and uncle had been diagnosed with coronary heart disease and diabetes mellitus, respectively. Physical examination revealed a weight for height of 112%, but the remaining examination was unremarkable. Plasma lipid profiles showed a total cholesterol level of 328 mg/dl, a triglyceride level of 59 mg/dl, and HDL-C level of 54 mg/dl, and an LDL-C level of 262 mg/dl. A carotid duplex scan showed atherosclerotic plaques in both carotid arteries. Atherosclerosis is rarely reported in children and it usually correlates with ischemic heart disease. The finding of atherosclerotic plaques in the large arteries may reflect deposition of atheroma in their coronary arteries. We suggest that this investigation is an important procedure in the screening of early atherosclerosis in order to primarily and secondarily prevent premature coronary artery disease.

Objective: To evaluate the estrogenic effect on the maturation index of hormonal replacement therapy (HRT) in postmenopausal women (PMW). Methods: The maturation indexes (MI) were evaluated based on vaginal cytology which was classified into no, low, moderate and high MI. Results: There were 70 PMW who were not on HRT evaluated for controls. There were 66%, 23%, 7% and 4% of them had no, low, moderate and high MI. There were 18 PMW who used transdermal estrogen patch or gel. It was found that 0%, 66%, 17% and 17% of them had no, low, moderate and high MI. There were 42 PMW who were given oral hormonal tablets. It was found that 7%, 33%, 53% and 7% of them had no, low, moderate and high MI. Conclusion: Hormonal replacement therapy whether via patch, gel or oral intake resulted in changes in maturation index in postmenopausal women.

Objective: This study was to compare the pulmonary function, respiratory muscle strength, and physical activity level between obese and non-obese children and to determine the correlation between pulmonary function, respiratory muscle strength and physical activity level in both child groups. Methods: Thai healthy children aged between 10-12 years participated in this study. They were classified into an obese group with body weight > +3 standard deviations and a non-obese group with body weight between ± 1.5 standard deviations of children who have the same height. Children in both groups were measured for pulmonary function, forced vital capacity (FVC), and forced expiratory volume in one second (FEV1 ), FEV1 /FVC ratio, vital capacity (VC), inspiratory muscle strength (MIP), expiratory muscle strength (MEP), and physical activity level. Results: The results showed that FVC, FEV1 and VC of the obese group were statistically higher than the non-obese group (p 0.05). Physical activity levels were not significantly different between the groups (p>0.05). Moreover, the results demonstrated that physical activity level in the obese group had no correlation with FVC, FEV1 , FEV1 /FVC ratio and VC (r = 0.203, 0.170, -0.067 and 0.133 respectively; p > 0.05) and similarly the non-obese group showed no correlation with FVC, FEV1 , FEV1 /FVC ratio and VC (r = 0.225, 0.168, -0.207 and 0.168 respectively; p > 0.05). Additionally, the results demonstrated that physical activity level in the obese group had no correlation with MIP and MEP (r = 0.151 and 0.355 respectively; p > 0.05) and similarly the non-obese group showed no correlation with MIP and MEP (r = 0.202 and 0.006 respectively; p > 0.05). Conclusion: This study provides information about the pulmonary function and respiratory muscle strength in Thai obese children. FVC, FEV1 and VC of the obese group were higher than the non-obese group. In addition, FEV1 /FVC ratio of the obese group was lower than the non-obese group. Although, all parameters including pulmonary function of both groups were in the normal range. However, obese children tend to observe airway obstruction higher than non-obese children. Moreover, respiratory muscle strength and physical activity level were not different between groups. Additionally, physical activity level had no correlation with pulmonary function and respiratory muscle strength in both groups.

Objective: To study dietary patterns of secondary-school students at Grade VII and Grade X. Methods: Students both male and female at Grade VII and Grade X were taught about food exchange lists. Then the investigators asked them to fill their food intakes during the past 7 days by using food frequency. Also, the investigators measured their bodyweight and heights, then classified them by BMI into 3 groups which were normal weight (group I) overweight (group II) and obese (group III). Results: The male students in normal bodyweight groups at Grade VII drank more milk than the females of the same group. The energy, carbohydrate, protein and fat intakes were not different between male and female students and among the 3 groups at Grade VII. In contrast, the male students at Grade X in normal bodyweight group and overweight group had more intakes of energy, protein and fat. Also the boys of the normal bodyweight group at Grade X drank more milk. Conclusion: There were no differences in energy intakes among students of the same Grade of different BMI. Female students drank less milk than male students in the normal weight group. The male students in normal bodyweight and overweight groups at Grade X consumed more foods than the female students.

Objective: Familial hypercholesterolemia (FH) is associated with atherosclerosis coronary artery disease (CAD). The aim of this study is to identify a mutation in the LDL receptor gene that underlined the FH phenotype in a female patient and her family. Methods: The LDL receptor gene was screened by Polymerase Chain Reaction-Single Strand Conformation Polymorphism (PCR-SSCP), direct DNA sequencing and was subsequently confirmed by PCR-RFLP. Results: The screening of the entire LDL receptor gene revealed a 5' donor splice site mutation of the first base of intron 3, i.e., 313+1G➔T mutation in one allele. This mutation was previously reported in a Danish patient with severe hypercholesterolemia. Conclusion: This case report illustrates the use of DNA diagnosis of a female heterozygous FH case and her family members, which is more accurate than clinical diagnosis especially when clinical phenotype is variable or when the individual who is at high risk is still a normolipidemic at his/ her young age. DNA diagnosis is now used as a tool to find or diagnose FH. Accurate and/or early diagnosis is important for prevention and treatment of FH patients in order to avoid the development of CAD in these patients.

Objective: To determine the association between reductions of fat from subcutaneous, intermuscular and subfascial compartment at thighs and improvement of serum insulin level. Methods: A longitudinal, clinical intervention study of restricted energy with exercise was performed in 20 healthy, overweight teenagers (age: 10-15 y, BMI: 26-40 kg/m2). Fat distribution parameter (by dual-energy X-ray absorptiometry and computerized axial tomography at thigh), serum insulin, body weight were assessed at baseline and after 4 weeks. Results: There are significant reductions in bodyweight, BMI, serum insulin, FGIR subfascial fat and intermuscular fat after 4 weeks. Loss of subfascial fat at thighs is significantly associated with decreasing levels of serum insulin in those who have initially abnormal high levels. Conclusion: Losses of subfascial fat at thighs is associated with improvement of insulin levels in obese teenagers who are on 4 weeks of dietary restriction and moderate exercise.Â

Obesity is a condition that can play a very significant role on the health of children who are growing up into maturity. The effects of obesity include increased risk of heart disease, diabetes, and hypertension. Its major causes are excessive eating, lack of restraint, and easily gratifying their desire for tasty food. If an adjustment can be made to their perception and behavior so that they can define the volume of food consumed then these obese children are capable of monitoring their weight and are able to reduce the risk of illness as a consequence of obesity without needing weight control pills which can be detrimental to their health. The most important factor that can help to change obese children's behavior is their perceived self-efficiency in monitoring their weight by self-control practiced by dieting and balanced exercise using the support of other members of the obese children group. Â Â Â Participation in the summer camp for obese children has the following objectives to promote their perceived self-efficacy; to make an adjustment to their consumption and exercise behavior, and to make them aware of the effects of obesity. The activities of the project comprised of education relating to obese children and their parents, restriction of energy intake to 800 Kcal/d, participation in group activities and exercise e.g. swimming, aerobics, and visual education without administration of weight control tablets for 4 weeks, 5 days/week. After completing of the summer camp, group meetings were held occasionally to assess their perceived self-efficacy. The results of monitoring the behavior of 20 obese children participating in project with BMI ranging from 26-41 Kg/m2, with age range of 10-15 years, were assessed by data collection by questionnaires concerning perceived self-efficacy, a BMI Assessment Form, and the data analysed using paired t-test. The results of the assessment on the last day of the summer camp and 12 weeks after the late day found that obese children had an increased perceived self-efficacy at a statistically significant level of P