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Apichaya Sukpiriyagul,1 Ratiporn Chartchaiyarerk,1 Paluekpon Tabtipwon,1 Buppa Smanchat,1 Sinart Prommas,1 Kornkarn Bhamarapravatana,2 Komsun Suwannarurk3 1Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital, Royal Thai Air Force Bangkok Thailand; 2Department of Preclinical Science, Faculty of Medicine, Thammasat University Hospital, Pathum Thani, Thailand; 3Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University Hospital, Pathum Thani, ThailandCorrespondence: Ratiporn Chartchaiyarerk, Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital, Pathum Thani, Thailand, Tel +66814092569, Email ratiporn_c@rtaf.mi.thObjective: To evaluate the effects of tetrahydrocannabinol (THC):cannabinoid (CBD) (1:1) oil in reducing chemotherapy-induced nausea and vomiting (CINV) in gynecologic cancer patients who received moderate-to-high emetogenic chemotherapy.Material and Method: This was a randomized, double-blinded, crossover and placebo-controlled trial. The study was conducted at the Gynecologic Oncology Units, Bhumibol Adulyadej Hospital (BAH), Royal Thai Air Force, Bangkok, Thailand, between August and November 2022. Participants had gynecologic cancer and received moderate-to-high emetogenic chemotherapy. Subjects were randomized and divided into two groups (A and B) based on the block of four randomization method. In the first cycle, groups A and B received THC:CBD extract oil 1:1 (TCEO) and placebo before chemotherapy administration. In the second cycle, groups A and B received placebo and TCEO before chemotherapy administration. Both groups received per protocol antiemetic medication during chemotherapy. Nausea score and side effects were recorded.Results: A total of 60 cases were recruited. After exclusion, 54 cases were included in the study. The mean age of participants was 54.4 years. The mean body mass index (BMI) was 26.5 kg/m2. Fifty-nine (21/54) percent cases were the advanced stages of cancer. The nausea score of TCEO and placebo groups were 2.11 and 2.99, respectively (P < 0.05). More than half of the participants (36/54) reported dizziness and sedation side effects. Dry mouth, confusion, anxiety, and palpitation of both groups were comparable.Conclusion: The cannabinoid extract (THC:CBD) was an appropriate adjuvant agent to reduce CINV in patients with gynecologic cancer who received high-emetogenic chemotherapy. Dizziness and sedation were the major side effects.Keywords: CINV, THC, CBD, cannabis

Kobporn Sapanont,1 Wiyada Luangdansakul,1 Monyada Pleankong,1 Buppa Smanchat,1 Kornkarn Bhamarapravatana,2 Komsun Suwannarurk3 1Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, Thailand; 2Department of Preclinical Sciences, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand; 3Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathum Thani, ThailandCorrespondence: Wiyada Luangdansakul, Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, 10220, Thailand, Tel +66-2-5347314, Email nui.obgyn@gmail.comObjective: The aim was to demonstrate the prevalence of fetal myocardial hypertrophy (FMH) in diabetes mellitus (DM) pregnant women using spatio-temporal image correlation (STIC) M-mode.Material and Methods: This prospective descriptive study was conducted at Bhumibol Adulyadej Hospital (BAH) Royal Thai Air Force between April and December 2022. Participants were singleton DM pregnant women with gestational age (GA) between 18 and 40 weeks who had antenatal care and delivery at BAH. DM screening was randomized blood sugar obtained from all participants. All participants underwent fetal heart exams by four-dimension ultrasound with STIC M-mode.Results: One hundred and forty-five participants were recruited and classified as pregestational (PDM) and gestational DM (GDM) at 31 and 114 cases, respectively. The mean age of participants was 31.7 years old. Fasting blood sugar (FBS) of PDM was significantly higher than GDM (105.1 vs 87.0 mg%). GDMA2 had more elevated FBS than GDMA1 (p < 0.001). PDM had significantly greater FBS and two-hour postprandial blood sugar (2hr-PP) than GDM (105.1/87.0 and 151.5/117.9 mg%, respectively). FBS and 2hr-PP of GDMA2 were more than GDMA1 with statistical significance. Good glycemic control of GDM was significantly better than PDM. GDMA1 had better glycemic control than GDMA2 with statistical significance. Four-fifth (115/145) of participants had FMH. FMH and estimated fetal weight among PDM and GDM were comparable. Both good and poor glycemic control had similar FMH. Neonatal outcomes of FMH or non-FMH infants were similar.Conclusion: The prevalence of FMH in diabetic pregnant women was 79.3%. Glycemic control had no correlation to FMH.Keywords: STIC-M, gestational diabetes mellitus, pregestational diabetes mellitus, interventricular septal thickness

Sophapun Ekarattanawong,1 Chamnan Tanprasertkul,2 Charintip Somprasit,2 Pholasit Chamod,1 Rattana Tiengtip,1 Kornkarn Bhamarapravatana,1 Komsun Suwannarurk2 1Department of Preclinical Science, 2Department of Obstetrics and Gynaecology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand Objective: To study the possibility of using superoxide dismutase (SOD) and glutathione peroxidase (GPx) as combined preoperative biomarkers for endometriosis. Participants and methods: Female patients aged between 18 and 45 years old who came to the Gynecology outpatient clinic, Thammasat University Hospital, during September 2013–2016 with the complaint of gynecologic symptoms suspected of endometriosis, and who were positively diagnosed with endometriosis, were included in this study. All patients underwent conservative laparoscopic ovarian cystectomy with histopathological report. The control group consisted of healthy females of reproductive age who came to the outpatient clinic. The plasma SOD and GPx were measured from blood samples with commercial kits. A receiver operating characteristic curve was generated for plasma activity of SOD, GPx, and combined tests. The cutoff values were selected at the most appropriate sensitivity and specificity. Result: All 36 cases were included in this study. Mean ages of patients in the patient and control groups were 33.1 and 28.6 years old, respectively. SOD and GPx activities of disease and control group were 6.15 and 8.11, 463.9 and 472.34 nmole/min/mL unit, respectively. The sensitivity and 1–specificity of the combined test were calculated at 0.78, with sensitivity, specificity, accuracy, positive predictive value, and negative predictive value being 68.75, 80.77, 76.50, 69.23, and 80.33, respectively. Conclusion: A combination testing of SOD and GPx can possibly be used as preoperative biomarker for endometriosis. Keywords: superoxide dismutase, SOD, glutathione peroxidase, GPx, endometriosis, laparoscopy, endometriosis biomarker

Objectives: To investigate the relationship between preoperative inflammatory markers and recurrence of CIN after loop electrosurgical excision procedure (LEEP)., Methods: A retrospective historical cohort study was conducted at gynecologic oncology unit, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Thailand. Data was collected from medical records of CIN cases from year 2016 to 2021. Inclusion criteria were subjects who were diagnosed of CIN and underwent LEEP with pathologic confirmation and followed up for two years (at 6 months, 1 year, and 2 years). Preoperative complete blood count (CBC) was obtained within one month for calculation as systemic inflammatory values., Results: One hundred and ten cases of CIN were enrolled. Mean age of participants was 48.1 years old. Three-fourths (83/110) of the participants had histological confirmation as CIN2/3. Sixteen (18/110) and twenty (22/110) percentage of cases had recurrence of disease at 1 and 2 years, respectively. Monocytes /lymphocytes ratio (MLR) and systemic inflammation response index (SIRI) could predict recurrence of CIN within 2 years. MLR more than 0.16 and SIRI more than 0.57 gave the sensitivity and negative predictive value (NPV) at percentage of 77.3/ 81.8 and 91.8/ 90.2, respectively. Combination of MLR and SIRI had sensitivity and NPV at 90.5 and 95.4 percent, respectively. MLR and SIRI could not predict marginal involvement, glandular involvement, and LEEP confirmed CIN 2/3., Conclusion: Pretreatment MLR and SIRI were statistically significant in predicting the recurrence in CIN after post LEEP procedure within 2 years follow up.

Background: Endometrial cancer (EC) is the most common gynecological cancer in developed countries and a standard treatment of surgery should be performed as expediently as possible. Delay time to surgery and survival was debated. The aim of this investigation was to evaluate the effect of time-interval between diagnosis and surgery (TDS) in EC patients with regards to prognosis and mortality rates., Methods: This retrospective study was conducted between January 2009 and May 2021 at Bhumibol Adulyadej Hospital, Thailand. Subjects were EC cases who underwent primary surgery during the study period. Cases with partial treatment were disqualified from the study. Subjects who underwent surgery before and after 6 weeks were classified as early and delayed surgery groups. Baseline and clinical characteristics were collected and analyzed., Results: During the study period, 419 EC cases were recruited. The mean age of participants was 56.8 years. Two-thirds (338/491) of subjects were menopausal. Endometrioid histology (406/491) was the most common histology subtype. Five years disease free survival (DFS) of early and delayed surgery groups were comparable at a percentage of 82.5 and 83.0, respectively. Among advanced stage and non-endometrioid EC cases, the delayed surgery group had significantly shorter DFS than the early group. Advanced stage, high grade and positive lympho-vascular space invasion (LVSI) were independent factors for poor DFS. Predictive factors for mortality were advanced stage and tumor recurrence., Conclusion: The TDS was not a prognostic factor for disease recurrence or overall mortality. Time to surgery equal to or more than 6 weeks gave worse prognosis for DFS among advanced stage or non-endometrioid histology EC.

Background: Endometrial thickness (ET) measurement was an alternative method for predicting abnormal endometrial pathology in postmenopausal bleeding. Cut-off value of ET measurement could not be use in perimenopausal bleeding., Objective: Aim of this study was to investigate appropriate ET cut-off value for perimenopause women with abnormal uterine bleeding (PEMB) and abnormal endometrial histopathology., Material and Methods: This was a cross-sectional study. PEMB at Bhumibol Adulyadej Hospital between July 2018 and June 2022 were recruited. Subjects who met inclusion criteria underwent ET measurement and endometrial biopsy via endometrial aspirator. Participants who had histopathology report of endometrial hyperplasia and more were classified as the study group. The Control group were subjects with no endometrial hyperplasia or cancer. Demographic and clinical character data were included. Correlation of ET and endometrial histopathology were calculated for statistical significance., Results: A total of 304 cases were included. After exclusion, 254 subjects were recruited for this study. There were 22 and 232 cases in the study and control groups, respectively. The mean age and body mass index (BMI) of participants were 44.7 years old and 27.5 kg/m2, respectively. Prevalence of endometrial hyperplasia and cancer in perimenopausal uterine bleeding were 7.5 (19/254) and 1.2 (3/254) percent, respectively. Endometrial thickness equal to and more than 8 mm was associated with abnormal endometrial histopathology with statistical significance. Age, BMI, nulliparity, anovulatory bleeding history, hypothyroidism, diabetes mellitus and anovulation state of both groups were comparable., Conclusions: Endometrial thickness equal or more than 8 mm were significantly associated with endometrial hyperplasia or more among perimenopausal women with abnormal uterine bleeding.

Objective: To compare the effectiveness of auricular acupressure with or without magnetic plates to routine post cesarean pain management., Methods: This randomized controlled trial was conducted at Obstetrics and Gynecology Department, Thammasat University Hospital, between January and June 2020. All participants were term primigravida pregnant women who underwent cesarean delivery during the study period. Participants were divided into three groups, namely control, placebo and study groups. Study (magnetic application) and placebo (non-magnetic application) groups received magnetic and non-magnetic auricular patches at both pinnas, respectively. Randomized assignments for each group were computer-generated, printed and kept in opaque sealed envelopes. The points in this study were Shenmen (TF4), Erzhong (HX1) and Penqiang (TF5). Visual analog scale (VAS) was immediately recorded up to 72 h after the operation., Results: A total of 195 cases were enrolled during the period of study. Each group had 65 participants. The mean participant's age was 31 years old. Demographic and clinical characters among the three groups were comparable. Pain scores within 12 h postoperative period of all three groups were comparable. Between 36 and 72 h post-operation, study groups had significantly lower VAS than the control group. One-quarter of participants had comparable nausea and vomiting side effects., Conclusions: Auricular acupressure at Shenmen (TF4), Penqiang (TF5) and Erzhong (HX1) with magnetic plate attachment could significantly relieve post cesarean pain between 18 and 72 h.

Objective: The aim of this study was to compare maternal and neonatal outcomes between sublingual misoprostol and oxytocin on stimulating labor in term premature rupture of membranes (PROM) in pregnant women. Materials and method . This randomized single-blind control trial was conducted at Bhumibol Adulyadej Hospital (BAH), Royal Thai Air Force, Bangkok, Thailand, between September 2020 and February 2021. Subjects were term pregnant women who had PROM and came to BAH for delivery. Participants were allocated into study (misoprostol) and control (oxytocin) groups. The study and control groups were, respectively, administered sublingual misoprostol and intravenous oxytocin to induce labor. Induction time and second stage of labor were recorded. Neonatal outcomes and maternal and fetal complications were also recorded and analyzed., Result: A total of 170 women were enrolled and equally divided into study and control groups. Mean maternal age, body mass index, parity, gestational age, and bishop score of both groups were comparable. Induction time of the study group was statistically shorter than the control group (338 and 399 min, respectively). Duration of active phase (450/427 min) and the second stage (19/21 min) of labor between study and control groups were not significantly different. Cesarean section delivery rate of study was lower than the control group (13.3 and 28.8%, p = 0.002). Intrapartum complications, neonatal outcomes, and intra- and postpartum complications among both groups were not significantly differentiated. There was no instance of postpartum hemorrhage or uterine rupture in the present study., Conclusion: Induction time and cesarean section rates of sublingual misoprostol group were significantly lower than the intravenous oxytocin group in full-term PROM pregnancy., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Suchada Unthanan et al.)

Aim: To construct the nomogram of fetal right portal vein (RPV) diameter at 30 to 35 weeks' gestation in Thai pregnant population and the use of RPV measurement to predicting small for gestational age (SGA) fetus., Methods: A prospective, cross-sectional study of singleton pregnancies at antenatal visit between 30 and 35 +6 weeks of gestation in single center, Bhumibol Adulyadej Hospital (BAH) was conducted from January to August 2020. Ultrasonography of fetal biometry and RPV diameter measurement were performed as well as immediate newborn birth weight measurement. The nomogram of fetal RPV was developed for standardization for Thai people., Results: A total of 219 singleton pregnant women were enrolled and ultrasonographic measurement of RPV and fetal biometry was obtained. Mean maternal age and gestational period were 29.4 years and 33.0 weeks, respectively. One third of participants were classified as obese. RPV diameter ranged from 1.85 to 6.07 mm and increased linearly with gestational age. The optimal threshold of RPV diameter for diagnosis SGA was less than 3.06 mm with area under ROC curve at a level of 0.613 (95%CI 0.496 to 0.731). Sensitivity and specificity were 38.46% and 83.94%, respectively. There was no fetal death or neonatal morbidity in the present study., Conclusion: RPV diameter increases in size depending on gestational age. RPV diameter at 30 to 35 +6 weeks gestation was a useful measurement for SGA prediction. RPV measurements greater than 3.06 mm strongly indicated normal fetal growth., (© 2021 Japan Society of Obstetrics and Gynecology.)

Background: Methamphetamine abuse has been a significant problem in Thailand. The methamphetamine abuse problem also affects pregnant women. The study of pregnancy outcomes among methamphetamine users during pregnancy is currently limited., Objective: To determine maternal and neonatal complications among methamphetamine-abusing parturients. Materials and method . This historical cohort study was conducted at Bhumibol Adulyadej Hospital (BAH), Bangkok, Thailand, between January 2017 and December 2019. The total number of women was 206 who were equally divided into a study and control group. Pregnant women who tested positive for methamphetamine in urine tests during the intrapartum period were compared to the control group with no history of drug abuse., Results: Maternal outcomes: gestational hypertension was found to be significantly increased in the study group compared to the control group at 14.6 vs. 1.0% (OR 17.4, 95%CI 2.5-134.3). Preeclampsia with and without severe features were found at higher rates in the study group without statistical significance. There were no eclamptic cases in this study. Neonatal outcomes: preterm birth rate of pregnant women who have tested positive in their urine methamphetamine test was significantly higher than in the control group (33.3%, 11.7%, OR 3.7, 95%CI 1.8-7.7). Average birth weight in the study and control group was 2779.1 ± 486.7 and 3049.5 ± 510 gm, respectively ( p value < 0.001). Low APGAR score rates of both groups also had no significant difference., Conclusion: Methamphetamine use during pregnancy increased both maternal and neonatal complications in terms of gestational hypertension, preterm birth, and average birth weight., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 Suthanud Premchit et al.)

The aim of this study was to identify the recurrence rate and risk factors for the recurrence of ovarian endometriosis (OE) after laparoscopic cystectomy. This was a retrospective cross-sectional study. Subjects were OE cases who underwent laparoscopic ovarian cystectomy at Bhumibol Adulyadej Hospital (BAH). The period of this study was from January 2008 to December 2017. Ovarian histopathology and at least one-year follow-up after surgery were the prerequisite requirements. A total of 106 OE cases were included in the study. Subjects were classified into recurrence and nonrecurrence groups. It comprised of 24 and 82 cases, respectively. The mean age of the participant was 32.4 years old. The demographic characters of both groups were comparable. The recurrence rate after laparoscopic OE surgery in the present study was 22.6% (24/106). The average largest diameter of OE in the present study was 54.5 mm. Postoperative medical treatment (OR 3.15, 95% CI 1.14-8.74, p = 0.02) and postoperative pregnancy (OR 2.86, 95% CI 1.03-7.93, p = 0.04) were associated factors for recurrence decrement. The recurrence rate of OE after laparoscopic cystectomy was 22.6%. Postoperative medical treatment and postoperative pregnancy were a significant factor that lowered OE recurrence., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Sornsittipong Wacharachawana et al.)

Background: This study aimed to survey quality of life (QoL) in endometrial cancer survivors between surgery with adjuvant therapy (radiation with or without chemotherapy) and surgery alone in Thammasat University Hospital, Thailand., Materials and Methods: This cross-sectional study was conducted at the Gynecologic Oncology clinic, Thammasat University hospital, Thailand between March 2011 and May 2019. Participants were endometrial cancer cases who underwent surgical staging with or without adjuvant treatment (study) and healthy women who came to gynecologic department for annual cervical screening (control). Assessment of QoL was investigated via the structural questionnaire designed by the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 (Thai version)., Results: During the period of the study, 94 participants who were diagnosed with endometrial cancer and underwent surgical staging were enrolled. There were 51, 43 and 51 cases in group A (surgery with adjuvant therapy), group B (surgery only) and group C (control), respectively. Control cases were participants who had comparable demographic characteristics and underwent gynecological checkup during the period of study. In part of physical functioning, group B had statistically better scores than group A. Participant in group B and C reported significantly better QoL in part of social functioning than group A. Symptom severity; appetite loss and constipation in group B was statistically less than in group A. Constipation problems in group A and C were comparable. Participants in group C had worse global health status than group A/B., Conclusion: Adjuvant treatment with either radiation or chemotherapy had negative impacts on QoL in endometrial cancer survivors. It impacted physical health, social function, appetite loss, and constipation. All endometrial cancer survivors had global health scores better than healthy peers. Thoroughly counseling to endometrial cancer survivors remains an important tool for increasing awareness of treatment complications and lowering psychological emotional stress., .

Background: The accuracy of intra-operative decision in confirming ovarian tumor malignancy during the operation is vital. Frozen sections are an important intra-operative tool to determine the provisional diagnosis and appropriate treatment of a tumor., Study Design: All records of diagnosed ovarian tumor patients who underwent exploratory laparotomy with intra-operative frozen sections request at Bhumibol Adulyadej Hospital (BAH) between January 2016 and June 2018 were reviewed., Main Outcome Measures: Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of intra-operative frozen and permanent sections were evaluated., Result: A total of 150 cases were recruited in this study. The mean age was 45.4 years. The number of benign, borderline and malignant ovarian tumors in this study were 97, 9 and 44 cases, respectively. The overall accuracy was 93.3%. Percentage of accuracy, sensitivity, specificity, PPV and NPV for benign, borderline and malignancy were 98.0/94.7/94.0, 100/88.9/79.6, 94.3/95.0/100, 97.0/55.3/100 and 100/99.3/92.2, respectively., Conclusion: The frozen section results yielded accurate diagnosis for rapid intraoperative evaluation of ovarian tumors. Its high accuracy allows for an appropriate surgical plan to be made in a timely manner. Large sizes and suspected mucinous borderline ovarian tumors reduced accuracy factors of frozen sections.

Objectives: To determine the effects of obesity in pre and postmenopausal women diagnosed with atypical squamous cells of undetermined significance (ASC-US) (in cases of remission, persistence, and progression of disease) after initial management and follow-up within 2 years to inform proper management for postmenopausal Thai women., Methods: This retrospective study was conducted at Bhumibol Adulyadej Hospital, Thailand between January 2013 and October 2018. Medical records of 506 patients whose cervical cytology reported of ASC-US were reviewed. Prevalence of silent high grade cervical intraepithelial neoplasia (CIN2/3) was evaluated. Cervical cytology after completed follow-up within 2 years were determined., Results: During the study period, there were 506 cases of ASC-US cytology reported. One quarter of cases were of post-menopausal status. Prevalence of CIN 2/3 in ASC-US cytology in pre and postmenopausal women were 9.9 and 7.2%, respectively. At 2-year follow-up appointments, around 90% of patients who completed follow-up remained in remission of the disease in both age groups. Menopausal status, body mass index (BMI), sexual activity, number of sexual partners, parity, smoking and hormone replacement therapy were not correlating factors to remission. Obese postmenopausal women had a lower remission rate of CIN, but this finding was not statistically significant., Conclusion: Obesity was not found to correlate strongly with the progression or remission of CIN. Obese postmenopausal women may still be affected by a persistence of the disease. Continuing cervical cytology monitoring should be recommended for such patients. Silent high grade cervical intraepithelial neoplasia (CIN2/3) in ASC-US cytology in this study were high. Colposcopy should be recommended for diagnosis and follow-up in this setting.

Objective: To examine the effectiveness of cryotherapy for reducing postoperative pain in patients who underwent exploratory laparotomy for gynecologic surgery., Materials and Methods: Patients who had indication for an exploratory laparotomy gynecologic procedure were selected by attending physicians to undergo abdominal surgery via low transverse skin incision. The participants were randomized into study and control groups with simple random sampling methods. Cold packs were applied at two hours after operation for 6 hours. The visual analog scale (VAS) score was recorded at two, 6, and 12 hours after operation., Result: One hundred cases were recruited and then divided into study and control groups equally. The mean age of both groups was 43 years. There was no difference in demographics data of both groups. Half of the participants in both groups underwent hysterectomies. At two hours after surgery, both groups had similar VAS scores. The study group had a lower VAS score at 6 and 12 hours after surgery than the control group with statistical difference. Morphine consumption within 24 hours after surgery in both the study and control groups was 2.8±3.4 and 3.0±4.4 mg, respectively, with no statistical difference. However the registration time of the first morphine requirement in the study group was statistically more prolonged than that of the control group. The lengths of hospital stay in both groups were similar. There was no complication reported in this study., Conclusion: Cryotherapy can reduce postoperative pain. In this presented study the patients who underwent gynecologic surgery had improved pain relief and prolonged time for the first dose of the analgesic drug.

Objective: This study proposes Facebook usage as a motivational vehicle for studying block subjects in Problem-Based Learning Curriculum. Facebook page engagement should allow self-motivated medical students the opportunity to review subject materials. Frequent use and practice resulted in better National Licensing Examination step 1 (NLE1) scores amongst frequent users of posted material., Methods: The scenarios and exercises were posted on a Facebook page every 2 months after completion of the relevant block. Participants were classified into four groups by frequency of Facebook page usage. Participants completed exit surveys after the NLE1 results were posted. The mean opinion scores of each group were compared using one-way ANOVA. The correlation coefficient of the percentage of the NLE1 success and frequency of page participation was calculated., Result: Most students spent excess of 3 months preparing for the NLE1. The most popular study aid was the MCQ bank. Frequent Facebook page users often preferred self-study and group work compared to "never" users ( p  < 0.05). Strong positive correlation ( r  = 0.956) was shown between the frequency of Facebook page usage and the success rate of the NLE1., Conclusion: Facebook study cases allowed self-motivated medical students to periodically review subject materials. Frequent users' regular practice resulted in better passing rates of the NLE1 exam., Competing Interests: Conflict of InterestThe authors declare that they have no conflict of interest., (© International Association of Medical Science Educators 2019.)

Abnormal uterine bleeding in women aged 35 years or over is an important clinical sign of many gynecological conditions. The diagnoses of these conditions require the pathological report of the endometrial tissue. Outpatient-based endometrial biopsy is an excellent option compared to standard fractional uterine curettage or hysteroscopy with endometrial biopsy in providing a definite diagnosis for abnormal uterine bleeding as it is less painful and does not require high potency anesthesia. This study evaluates the effect of intrauterine lidocaine on the patient's pain score during endometrial biopsy by the Novak curette. We included patients aged 35 years or more who had abnormal uterine bleeding between December 2016 and March 2018. The study was conducted at Thammasat University Hospital, Pathum Thani, Thailand. 250 patients were randomly allocated to either receive intrauterine lidocaine (study group) or normal saline (control group). Assessment of pain severity was evaluated using a visual analogue scale (VAS) score at 6 time-points, namely, before performing the procedure, when grasping the cervix by the tenaculum, during the intrauterine instillation of lidocaine or normal saline, during the uterine curettage, and then 15 minutes and 2 hours after the procedure. This study showed that there was significant pain reduction in patients who received intrauterine instillation of lidocaine compared to placebo, during uterine curettage, as well as 15 minutes and 2 hours after procedure ( p <0.0001). Patient satisfaction was not significantly different between the two groups, while physician satisfaction significantly improved in the lidocaine group. Serious complications were not found during this study. (This research project had been approved for registration at Thai Clinical Trials Registry. TCTR identification number is TCTR20161031003.).

Background: Colposcopy is the standard investigation for women with abnormal cervical cytology. Waiting time to colposcopy could impact to psychological distress. Data about anxiety and depression in eastern countries patients were limited. Aim of this investigation was to evaluate anxiety and depression status in Thai women who were waiting for colposcopy compared to women who attended gynecology clinic for cervical cancer screening. Materials and methods: This study was conducted at the outpatient gynecology clinic of Thammasat University Hospital between January 2017 to March 2018. A Total of 200 women were recruited into the study. The cases were divided into the study and control group. Study group consisted of one hundred women with abnormal cervical cytology referred to colposcopy. One hundred of women who attended gynecology clinic for cervical cancer screening was classified as control group. The Hospital Anxiety and Depression Scale (HADS) was used to determine anxiety in the participants. Results: Total of 200 women who met criteria of the study were recruited. The mean ages of both groups were 40 years old. Both groups were significantly different when it came to their education, 30 and 59 percent of study and control group had education level more than bachelor (p=0.003). The prevalence of anxiety was statistically significantly higher in study group than the control group (15% and 6%, respectively). There was only one case of depression in study. Waiting time and abnormal cervical cytology severity did not affected to anxiety level. Conclusions: Colposcopy and appointment caused anxiety. However anxiety was not associated with waiting time to colposcopy or Pap result’s severity., (Creative Commons Attribution License)

Abnormal vaginal bleeding is one of the most frequent problems found in gynecology. Endometrial histopathology is needed for definite diagnosis. It was obtained either from endometrial tissue sampling or from standard uterine curettage. Office endometrial tissue sampling is an easy and low morbid procedure. It is usually associated with pain and discomfort. Topical anesthetic agent is needed for pain relieving. This study was conducted in outpatient gynecology clinic, Thammasat University Hospital, Thailand. It was a double blind randomized controlled trial. A total of 140 participants were enrolled in study and control group. Each group consisted of 70 cases. Study group received topical spray of 10% lidocaine (40 mg) before endometrial aspiration. Topical spray of 0.9% normal saline was performed in control group. Novak curettage was an application for endometrial tissue obtaining in this study. Visual analog scale (10cm-VAS) was used for pain evaluation. Demographic character of both groups showed no statistical difference. The percentage of participants who had severe pain (VAS≥7) during tenaculum application and Novak curettage insertion and during procedure were 28.5% (20/70) versus 12.9% (9/70), 55.7% (39/70) versus 38.5% (27/70), and 78.5% (55/70) versus 60% (42/70) in control and study group, respectively. Both groups had no significant differences of postoperative pain at 15 minutes and 2 hours. This study indicates that topical lidocaine spray can relieve pain during endometrial tissue sampling.

Objective: To determine any association between the menopausal status and epithelial ovarian cancer coexisting with endometriosis (EOC-E). In addition, the prevalence and possible risk factors were assessed. Methods: Medical records of 172 women with epithelial ovarian cancer between January 2011 and December 2016 at Prapokklao Hospital were reviewed and divided into two groups: EOC-E defined as the case group and without endometriosis (EOC-NE) as the control group. Results: The proportion of EOC-E was 18% (31/172). There were no significant differences between the two groups in baseline clinical characteristics and presenting symptoms except for history of smoking and abnormal uterine bleeding found more often in EOC-E cases. Most EOC-E were of clear cell histological type followed by endometrioid and serous types (35.5, 25.8 and 22.6 %; respectively). The clear cell type was 8 times more likely in the EOC-E than in the EOC-NE (OR 8.0, 95% CI 2.97-21.89, p-value <0.001) group. Nulliparity and smoking increased risk of EOC-E 2 and 7 times, respectively (OR 2.3, 95%CI 1.03-5.00, p-value 0.041 and OR 7.4, 95%CI 1.18-46.63, p-value 0.032). Conclusions: EOC-E are relatively common. Abnormal uterine bleeding is the only significant presenting symptom in the EOC-E as compared with the EOC-NE group. Endometriosis was a predictive factor for clear cell and endometrioid type I EOC. Menopausal status and age were not associated with a presentation of endometriosis with EOC, (Creative Commons Attribution License)

Objectives: To determine the prevalence of abnormal Papanicolaou (Pap) smear, cervical intraepithelial neoplasia (CIN) 2 or higher and cancer between conventional Pap smear (CPP) and liquid based Pap smear (LBP). Methods: This retrospective study was conducted at Bhumibol Adulyadej Hospital, Bangkok, Thailand between January 2011 and December 2016. Data was collected from medical records of participants who attended for cervical cancer screening test. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for detecting CIN 2 or higher were evaluated by using the most severity of histopathology reports. Results: A total of 28,564 cases were recruited. Prevalence of abnormal Pap smear from CPP and LBP were 4.8 % (1,092/22,552) and 5.7 % (345/6,012), respectively. Percentage of unsatisfactory smears in CPP (52.3%) was higher than LBP (40.5%). From CPP and LBP, cervical cancer percentages were 0.2 and 0.1, respectively. Sensitivity, specificity, PPV, NPV and accuracy of CPP and LBP for detection cancer were 42.5 vs 26.1%, 99.9 vs 100.0%, 69.8vs 75.0%, 99.7 vs 100.0 % and 99.7 vs 99.7%, respectively. Conclusion: Prevalence of abnormal cervical cytology and cancer from CPP and LBP were 4.8/0.2 and 5.7/0.1 percent, respectively. Unsatisfactory smear of LBP was less than CPP. Sensitivity, specificity, PPV, NPV and accuracy of CPP and LBP for detection CIN 2 or higher and cancer were comparable., (Creative Commons Attribution License)

Background: Endometriosis has a significant effect on many aspects of women’s lives, also increasing the risk of ovarian cancer. Although endometriosis is considered as a benign condition, it sometimes behaves like cancer. Methods: All medical records of epithelial ovarian cancer patients during January 2011 to December 2016 were reviewed. Recurrent cases were excluded. Data collected included age at diagnosis, parity, marital status, familial history of cancer, menopausal status, weight, height, smoking histroy, contraception, CA 125 level, result of surgery and pathological report. Results: One hundred and seventy-two medical records of patients with epithelial ovarian cancer (EOC) were included. Average age at diagnosis was 52.3 years. Epithelial ovarian cancer coexisting with endometriosis (EAOC) was found in nearly one-fifth of cases. Nullipara and smoking were associated with 2.3 and 8.3 fold higher risk of EAOC development (aOR 2.349, 95%CI 1.012-5.451; aOR 8.26, 95%CI 1.234-55.278; respectively). Age, familial history of cancer and coexistence with endometriosis were factors related to surgical outcome. More of EAOC group had optimal surgery compared to the non-EAOC group (61.3% and 41.8%) with statistical significance. Conclusion: Younger age, familial history of cancer and coexistence of endometriosis were factors related to optimal surgery. Success of optimal surgery is greater in EAOC than in non-EAOC patients. Coexistence of endometriosis does not hinder successful ovarian cancer debulking surgery., (Creative Commons Attribution License)

Background : To determine a baseline quality of life (QoL) in cervical cancer survivors compared to that of healthy subjects in the tertiary Thammasat University Hospital, Thailand. Materials and Methods: The investigation was conducted at the outpatient gynecological department of Thammasat University Hospital between January and June 2016. A total of 192 women were entered into the study (97 cervical cancer survivors; 37 after radical hysterectomy (RH), 43 with concurrent chemoradiation (CRT), and 17 featuring both RH and CRT; and 95 control subjects from the same outpatient department with no history of malignancy). Participant QoL was assessed using a Thai version of the EORTC-QLQ-C30 (European Organization for Research Treatment of Cancer Quality-of-Life) and a general survey for the assessment of sociodemographic data was also conducted. Results: There were significant differences in physical, role, emotional and social functions between cervical cancer survivor and control groups. Global health, fatigue, pain, appetite loss, and financial difficulties also demonstrated statistically significant variation. Cervical cancer survivors treated by RH had higher scores for emotional and social function and global health than the control group. Moreover, they had less appetite loss, fatigue and financial difficulties. However, patients treated with CRT experienced more pain than the control group. All cervical cancer survivors had lower physical function scores than the control group. Conclusion: Quality of life in cervical cancer survivors is better than in healthy peers in some domains. Cervical cancer survivors treated with RH may have a better QoL than healthy peers. Early detection for early stage cervical cancer remains most important because treatment in early stages does not cause lowering of the QoL., (Creative Commons Attribution License)

Background: Adnexal torsion results in ischemia of structures distal to twisted pedicle and acute onset of pain is responsible for about 3% of all gynecologic emergencies. Ovarian torsion classically occurs in a pathological enlarged ovary, as with cancer, but diagnosis remains a challenge. Objective: Our purpose was to evaluate clinical risk factors predictive of torsion with gangrenous adnexa. Material and methods: A retrospective descriptive study and chart review of surgically proven ovarian torsion/adnexal torsion cases at the Obstetrics and Gynecology Department of Prapokklao Hospital, Chanthaburi, Thailand between January 2011 and December 2015 was conducted. Result: Seventy-eight cases were identified. Mean age at presentation was 35.5 years. The average maximum diameter of the ovarian tumors was 10.8 cm. The percentage of gangrenous ovarian cysts in this study was 46.2 (36/78). The precision to determine the pathological site by patient, physician and ultrasonography was 8.5, 24.2 and 83.3 percent, respectively with statistically significant variation. Conclusion: Ovarian/adnexal torsion remains a challenge condition especially in young nulliparous women. Sophisticated investigation does not guarantee ovary preservation. Combining clinical acumen, appropriate tests and detailed consideration may be the best practice at the present time., (Creative Commons Attribution License)

Background: Postoperative pain has many adverse effects for the patients with laparotomy operation. There are few studies that compare between Maylard and Pfannenstiel incision in term of pain and wound complication after operation., Objective: To compare the postoperative pain and wound complications between the muscle-cutting Maylard incision and the Pfannenstiel incision in women who needed benign gynecologic surgery., Material and Method: This randomized controlled trial study compared two laparotomy techniques, Maylard and Pfannenstiel method. Ninety cases of benign gynecologic conditions were recruited and randomly assigned to receive either Maylard or Pfannenstiel incision from August 2014 to October2015 at Thammasat University Hospital, Thailand. Visual analogue scale (VAS) was applied to measure postoperative pain. Baseline characteristics of the study groups and postoperative outcomes were analyzed., Results: From the planned 90 recruited cases, there were 81 cases for complete analysis, 41 in Maylard and 40 in Pfannenstiel group. There were no difference in age, body mass index, education level, previous abdominal surgery and type of operation between Maylard and Pfannenstiel group. Duration of operation, type of anesthesia and dosage of analgesic drug were not statistically significant between both groups. Length of surgical wound was longer in Maylard than in Pfannenstiel group (17.27±0.6 vs. 14.13±0.8 cm, p = 0.04). Postoperative pain score (VAS) at 3, 6, 12, 24 and 48 hours were not statistically different between two groups. Pain score at 72 hours and 7th day in Maylard group showed significantly less than in Pfannenstiel group (0.51±0.5 vs. 1.10±1.0 p = 0.04, 0.12±0.3 vs. 0.23±0.4, p = 0.01, respectively). The numbers of participants with moderate to severe pain (VAS >4) in Maylard group were less than in Pfannenstiel group at 3, 6, 12 and 24 hours but after that there was no statistically difference. There were no postoperative wound complications such as disruption, infection or hematoma in all participants in this study., Conclusion: Postoperative pain up to 48 hours in both Maylard and Pfannenstiel group showed similar VAS but after 48 hours; the Maylard group showed less pain. Even though the surgical wound length in Maylard group was longer than Pfannenstiel group, numbers of cases with VAS >4 within 24 hours in Maylard were less than in Pfannenstiel group. Postoperative pain up to 48 hours in both Maylard and Pfannenstiel group showed similar VAS but after 48 hours; the Maylard group showed less pain. Even though the surgical wound length in Maylard group was longer than Pfannenstiel group, numbers of cases with VAS >4 within 24 hours in Maylard were less than in Pfannenstiel group.

Background: Mature cystic teratoma is the most common benign germ cell ovarian tumor. Malignant transformation is uncommon. The pathology is mostly composed of squamous cell carcinoma. Mucinous cystadenocarcinoma should be differentiated between malignant transformation and the coincidental occurrence., Case Report: A case of an early stage mucinous ovarian cancer co-existing with mature cystic teratoma at the same ovarian side was reported. A 57-year-old woman presented with incidental palpable pelvic mass for two weeks. Right ovary consisted of multiloculated cyst and mature cystic teratoma. The patient underwent an exploratory laparotomy for a large ovarian cyst evaluation. Mucinous ovarian cancer was diagnosed as FIGO stage IC3 after operation. Histopathology report showed mucinous cystadenocarcinoma and mature cystic teratoma of the right ovary. There was no additional abdominal abnormality. Immunohistochemistry staining supported the diagnosis of metastatic adenocarcinoma of colon or intestinal type of mucinous ovarian cancer. Further investigation for locating other primary cancer site was then performed. The result was negative. The intestinal-type mucinous ovarian cancer co-existing with mature cystic teratoma of the right ovary was the final histopathological reading. The patient was then started on carboplatin/paclitaxel combination chemotherapy for 6 cycles after surgery. The patient showed complete remission at the end of the chemotherapy treatment., Conclusion: This was a rare case of mucinous ovarian cancer co-existing with mature cystic teratoma. Clinical acumen, immunochemistry staining and metastatic survey investigation played important roles for the final diagnosis.

Background: Premature neonates are susceptible to anemic problems with low iron storage. Delayed cord clamping (DCC) has been studied and its beneficial value has been supported by existing research in newborns with very low birth weights. But there were only few data pertinent to late preterm infants., Objective: To investigate the effect of delayed cord clamping (DCC) as compared with immediate cord clamping (ICC) on the hematocrit level at 48 hours in late preterm neonates after vaginal delivery., Material and Method: The design consisted of a randomized controlled trial. One hundred pregnant women who were admitted because of preterm labor (GA 34-36(+6) week) in active phase were recruited and allocated into two groups, designated as the ICC and DCC groups. The DCC were defined as the case in which patients underwent the umbilical cord clamping at 120 seconds after birth. At 48 hours after delivery, both the hematocrit (Hct) and microbilirubin (MB) levels of newborns were determined. Also, neonatal and maternal complications were recorded., Result: Eighty-six neonates were analyzed. There were no statistical differences in the baseline data of maternal symptoms and newborns between the two groups. Neonates in the DCC group had a significantly higher hematocrit level than the ICC group (55.4% and 47.6%, respectively: p = 0.02). The MB level in the DCC group was also significantly higher than in the ICC group (9.4% and 8.6 mg %, respectively: p = 0.04). However, phototherapy and length of hospitalization in both groups were not different. There were no serious maternal and fetal complications in either group., Conclusion: The DCC procedure could raise the Hct level in the late preterm newborns without serious adverse effects. But more evidence is needed to explore the possible benefit of this procedure.

Objective: To assess the effect of the different scheduled gestational age for a repeat elective cesarean section (CS) on emergency cesarean section rate and adverse pregnancy outcomes in pregnant women with history of previous CS., Material and Method: A prospective cohort study of singleton pregnant women who had a history of CS and were scheduled for a repeat elective CS to be performed. The cases were divided into two groups of which the elective CS was appointed at 38 or 39 weeks of gestation as study and control groups, respectively. Emergency cesarean section rate, maternal and neonatal complications were defined as main outcomes., Results: Of 415 scheduled elective repeat cesarean deliveries performed at 38 weeks of gestation or later, 209 were scheduled between 38 0/7 and 38 6/7 weeks (study group), and 206 were scheduled between 39 0/7 and 39 6/7 weeks (control group). Most of the cases had one previous cesarean delivery. The emergency CS rate before schedule in the study group was significantly less than in the control group (15.3% vs. 51%, p<0.001). Spontaneous labor pain was a major factor to have unplanned delivery. The maternal intra-operative complications were significantly increased in women who had emergency cesarean before schedule compared to elective CS on scheduled in 38 weeks group (25% vs. 12.9%, p<0.001) and 39 weeks group (31.4% vs. 14%, p<0.001). The major intra-operative complication was uterine atony. There were no statistically significant differences in maternal post-operative and neonatal complications in scheduled elective CS in 38 and 39-week group. Transient tachypnea of the newborn (TTNB) was higher in elective CS at 38 week compared to emergency CS., Conclusion: The emergency CS rate in 39 weeks gestation group was significantly higher than 38 weeks group. The incidence of adverse maternal intra-operative complications was statistically difference with emergency CS when compared to elective CS in case and control groups. Recommendation of elective repeated CS at GA39 weeks may be suitable only under some circumstances. The number of prior CS is one of factors that should be considered.

Background: Cervical cancer is the second most common of malignancy found in Thai women. Human papillomavirus (HPV) infection is a major cause. The objective of the present study was to evaluate the prevalence of HPV infection and association with abnormal cervical cytology in Thai women., Materials and Methods: This study was conducted at the Gynecologic Clinic, Thammasat University, Pathum Thani, Thailand. A total of 2,144 cases who underwent annual cervical cancer screening by co-testing (liquid based cytology and HPV testing, DNA versus mRNA) during the priod from July 2013 to June 2016 were recruited in this study., Results: Prevalence of positive high risk (HR) HPV DNA and mRNA test were 19.7 and 8.4%, respectively with a statistically significant difference. Majority of cases of abnormal cytology in this study were atypical squamous cells of undetermined significance (ASC-US). In patients with ASC-US, positive HR HPV DNA was greater than in the mRNA group (10.1 and 4.5%, p<0.001). Nonetheless, there was no significant difference in participants with cervical intraepithelial neoplasia (CIN). HPV mRNA test had slightly lower sensitivity but higher negative predictive value (NPV) than the DNA test to detect abnormal cytology during cervical cancer screening (p<0.001). Both HPV test (DNA and mRNA) had equally efficacy to detect high grade precancerous lesion or higher (CIN 2+)., Conclusions: Prevalence of HR HPV DNA and mRNA were 19.7 and 8.4 percent, respectively. NPV of HPV mRNA was higher than DNA test. Both tests had equal efficacy to detect CIN 2+ with sensitivity and specificity of 63% vs 55.7% and 83% vs 92%, respectively.

Purpose: To study the prevalence of CIN2+ diagnosis in women with atypical Papaniculoau (Pap) smears to suggest appropriate management option for Thai health care., Materials and Methods: Data from all patients with liquid based cytology with human papillomavirus (HPV) testing between May 2013 - May 2016 were collected from medical records. Women with atypical cervical Pap smears were recruited. Results for age, HPV testing, HPV 16, 18, 45 and other genotypes tested, colposcopic examination and histopathological assessment were all collected. Atypical smears were defined as atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells cannot be exclude high grade squamous intraepithelial lesion (ASC-H)., Results: A total of 2,144 cases were recruited. Twenty six women with ASC-US on cytology had high risk (HR) HPV detection while eight cases with ASC-H had HR-HPV (40.0% VS 72.7%, p=0.005). Among the 26 women with ASC-US cytology and positive HR-HPV, HPV type 16 (n=8, 30.8%), type 18 (n=1, 3.8%), type 45 (n=1, 3.8%) and other HPV types (n=17, 65.4%) were found. Eight women with ASC-H and positive HR-HPV demonstrated type 16 (n=6, 75%) and other HPV types (n=2, 25%). Fifty seven women with ASC-US had normal colposcopy, CIN1 and CIN2+ at percentages of 80.7 (46/57), 14.0 (8/57) and 5.3 (3/57), respectively. In the ASC-H group, 7 out of 10 women had normal colposcopy and three (30%) had CIN2+ results., Conclusions: In women with ASC-US cytology, immediate colposcopy is highly recommended. HPV testing can be performed if colposcopy is not an available option because there was high prevalence (5.3%) of CIN2+ in our findings. ASCCP recommendations for ASC-H that colposcopy should be performed on all ASC-H cases regardless of HPV result are thereby supported by the findings of this investigation.

Background: Cervical cancer is the second most common in Thailand, but the mortality rate may be rising yearly. It is a cancer that can be prevented by early screening for precancerous lesions, several methods being available., Objective: To identify the prevalence of abnormal Papanicolaou (Pap) smears and lesions with visual inspection with acetic acid (VIA) in pregnant women and assess risk factors for this group., Materials and Methods: This prospective study was performed at Prapokklao Hospital, Thailand during April-July 2016. All pregnant women of gestational age between 12-36 weeks who attended an antenatal clinic were recruited. All participants were screened for cervical cancer by Pap smear and VIA. If results of one or both were abnormal, colposcopic examination was evaluated by gynecologic oncologist., Results: A total of 414 pregnant women were recruited. Prevalence of abnormal Pap smear and VIA were 6.0 and 6.7 percent, respectively. The most common abnormal Pap smear was low grade intraepithelial lesion (LSIL, 44%). Factors associated with abnormal Pap smear in pregnant women were low BMI, multiple partners and being a government officer. In pregnancy, Pap smear had higher sensitivity and specificity than VIA for detection of precancerous cervical lesion. Patients with young coitarche or more than 25 years of active sexual activity were high risk groups., Conclusions: Prevalence of abnormal Pap smear and VIA in pregnant women was 6.0 and 6.7 percent, respectively. Factors associated with abnormal Pap smear were coitarche, years of sexual activity, low BMI, multiple partners and being a government officer.

Purpose: To study clinical factors related to adequacy of transformation zone (TZ) components in cervical smears., Materials and Methods: Medical and Papanicolaou (Pap) smear reports from Thammasat University Hospital, Thailand during January to December 2015 were collected. Demographic data was reviewed by attending physicians and impact of clinical factors onTZ adequacy was primary outcome. A total of 3,251 smears were reviewed. Finally, 2,098 smears met The inclusion criteria and enrolled into this study., Results: Average age and bodyweight of participants in this study were 43.0 years and 60.0 kg, respectively. Ninety seven percent of smears were classified as satisfactory for evaluation according to the Bethesda system 2001. Adequacy (group A) and inadequacy (group B) of TZ were equal in percentage (50.9/46.0). Prevalence of abnormal cervical cytology was 4.4%. Percentages of abnormal Pap smears in group A and B were 7.3 and 1.4, respectively (p<0.001). Factors associated with increased adequacy of TZ were old-age (≥ 50 yr), nulliparity, within 3-months postpartum, history of TZ inadequacy and abnormal smears. Sexually transmitted disease (STD), hormonal usage, previous cryotherapy and smears collected by staff were associated with inadequacy of TZ., Conclusions: Collection of cervical specimens should be carefully performed. STD history, hormonal usage and previous cryotherapy are risk factors for TZ inadequate specimens.

Objective: To study postoperative pain relief in major gynaecological surgery by perioperative parecoxib administration in Thammasat University Hospital., Material and Method: This double-blind randomized controlled clinical trial was conducted in Thammasat University Hospital, Pathumthani, Thailand from October 2013 to May 2014. One hundred and twenty patients who underwent elective gynaecological surgery were randomized assigned to study and control groups. Study group (n = 60) received 40 mg parecoxib and control group (n = 60) received placebo at 1 hour before surgery. The postoperative visual analog scale (VAS) at 3, 6, 12 and 24 hours, frequency of meperidine consumption in 24 hours and side effects of parecoxib were recorded., Results: VAS of study group after operation at 3, 6, 12 and 24 hours was significantly lower than control group. Meperidine consumption in placebo group was significantly higher than study group (27.50 ± 19.36 and 48.75 ± 28.15 mg, respectively; p < 0.001). There was no side effect from parecoxib in this study., Conclusion: Intravenous postoperativeparecoxib injection could relief pain and reduced meperidine consumption. Parecoxib could be safely used in gynaecological surgery for postoperative pain relief

Background: Bevacizumab, a humanized monoclonal antibody targeting vascular endothelial growthfactor (VEGF), has been approvedfor concurrent treatment with first line chemotherapy in advanced epithelial ovarian cancer., Case Report: A case of an advanced stage epithelial ovarian cancer (EOC) receiving a combination of bevacizumab, carboplatin andpaclitaxel chemotherapy was reported. A 44-year-old woman was presented with abdominal discomfort and distention for 4 months. Bilateral 12 cm diameter ovarian tumors were diagnosed as FIGO stage IIIc after surgical staging operation. Histopathology report showed the mixed type of serous and endometriod adenocarcinoma. The patient was then started on carboplatin/paclitaxel combination chemotherapy for 6 cycles after surgery every 3 weeks. Bevacizumab (7.5 mg/ m2) was concurrently administered with chemotherapy every 3 weeks startingfrom the 2nd cycle. A complete remission was achieved after the end of the chemotherapy treatment. Bevacizumab was continued for one year after the completion of the standard chemotherapy. Bone marrow suppression, hypertension and proteinuria were not found during Bevacizumab treatment. At bevacizumab treatment completion, a platinum-sensitive recurrent ovarian cancer was diagnosed at the two weeks postprogram routine check-up. The patient was counseled to start second line chemotherapy treatment and has yet to come back with her decision., Conclusion: Combination of bevacizumab, carboplatin and paclitaxelfor first line chemotherapy in advanced EOC in this case had no serious side effects and need further study.

Background: In the years 2014, coverage rates of cervical cancer screening in Nakornnayok province accounted to 76.5%. This was lower than the government's specified goal of 80%. Community health volunteers are members of a Thai healthcare alliance established to help promoting healthcare service communication and collaboration at the primary level. Such village health volunteers (VHVs) are established in most villages., Objective: To assess the knowledge and attitudes of cervical cancer screening among VHVs., Materials and Methods: The subjects were 128 VHVs from four Nakornnayok sub-districts; namely KlongYai, Chomphol, Buangsan and Suksara, Thailand. The study was conducted from December 2014 to January 2015. The questionnaire was designed to assess the knowledge and attitude of cervical cancer screening provided by the VHVs. In addition, cervical cancer screening coverage rates of each area were collected. The demographic data, scores of knowledge, attitudes, practices and the cervical cancer screening coverage rates were analyzed by one-way ANOVA., Results: The questionnaire reliability was assessed as 0.81. The total knowledge and attitude scores were 10 and 15 points. The mean knowledge scores of KlongYai, Chomphol, Buangsan and Suksara were 6.8, 7.0, 6.5 and 9.0 points, respectively. The VHVs had a high level of overall knowledge about cervical cancer screening. The mean attitude scores were 12.4, 13.2, 13.4 and 13.1 points. VHVs had a positive attitude to the promotion of cervical cancer screening at the overall level. The percentages of VHVs promoting cervical cancer information in respective districts were 72.2, 94.3, 94.9 and 50.0. However, the cervical cancer screening coverage rates were 62.4%, 34.7%, 80.3% and 47.3% respectively., Conclusions: The knowledge, attitudes and percentages of promoting information of cervical cancer screening among VHVs in the four sub-districts were high but did not correlate with the cervical screening coverage rates for each area. VHVs needed to understand socio-cultural beliefs of the women in the target population and design suitable strategies to encourage higher cervical screening coverage.

Background: ASC-US cases are managed according to the current American Society for Colposcopy and Cervical Pathology (ASCCP) guideline in which a human papillomavirus (HPV) test and repeat Pap smear are performed in the next 1 year. Colposcopy in cases of positive high risk HPV and persistent ASC-US or more in subsequent Pap smear is recommended. The HPV test is more expensive and still not currently a routine practice in Thailand., Objective: To identify the risk factors of persisted abnormal Pap smear and the colposcopic requirement rate in women with ASC-US., Materials and Methods: During 2008-2013, this study was conducted in Prapokklao Hospital, Chanthaburi, Thailand. Participants were women who attended gynaecology clinic for cervical cancer screening. Women who had cytological reports with ASC-US were recruited. During the study period, 503 cases were enrolled. Colposcopic requirement was defined as those who were detected with an ASC-US or more in subsequent Pap smears up to 1 year follow-up., Results: The colposcopic referral rate was 23.2 (85/365) percent at 12 months. Prevalence of cervical intraepithelial neoplasia (CIN) 2/3 was 3.3 (12/365) percent. Loss follow-up rate of subsequent Pap smear and colposcopic appointment were 27.4 (138/503) and 48.2 (41/85) percent, respectively. There was no invasive cancer. High risk factors for persisted abnormal Pap smears in subsequent test were premenopausal status, HIV infected patients and non-oral contraceptive pills (COC) users., Conclusions: Referral rate for colposcopy in women with ASC-US reports was rather high. Loss to follow-up rate was the major limitation. Immediate colposcopy should be offered for women who had high risk for silent CIN.

Background: Anal intraepithelial lesions (AIL) are likely to represent a precursor for anal cancer. Women infected with human immunodeficiency virus (HIV) may be at higher risk of anal cancer but a screening program for AIL still is not routinely recommended. We here studied the relationship of dysplastic cells from cervical and anal cytology in HIV-infected women., Materials and Methods: This prospective study was conducted in Prapokklao Hospital, Thailand during 2013-2014. Five hundred and ninety nine HIV-infected women were recruited. Participants who had cytological reports of equally or over "abnormal squamous/glandular cells of undetermined significance" (ASC-US) were classified as abnormal cervical or anal cytology. Descriptive statistics and logistic regression analysis were used to evaluate correlations between groups., Results: HIV-infected women with abnormal cervical cytology had 3.8 times more risk (adjusted odd ratio 3.846, 95% confidence interval 1.247-11.862, p-value. 019) for abnormal anal cytology. The major problem of the anal Pap test in this study was the inadequacy of the collected specimens for evaluation (34.4%, 206/599). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of cervical and anal Pap tests were 93.9/12.0, 87.3/96.9, 39.7/21.4, 99.4/94.1 and 88.1/91.4 percent, respectively., Conclusions: Abnormal cervical cytology in HIV-infected women indicates elevated risk for abnormal anal cytology. The sensitivity of the anal Pap test for detection of AIL 2/3 in HIV-infected women was quite low while specificity was excellent. Inadequacy of specimen collection for evaluation was a major limitation. Improvement of sample collection is recommended for future investigations.