Search

Human papillomavirus (HPV) E2 and L1 proteins are expressed in cervical cells during the lytic stage of infection. Overexpression of p16INK4A is a biomarker of HPV-associated cervical neoplasia. This study investigated antibodies to HPV16 E2, HPV16 L1, and p16INK4A in sera from women with no squamous intraepithelial lesion (No-SIL) of the cervix, low-grade SIL, high-grade SIL, and cervical squamous cell carcinoma (SCC). HPV DNA was detected by polymerase chain reaction. Anti-E2, -L1, and -p16INK4A antibodies in sera were determined by western blot. Among 116 samples, 69 (60%) were HPV DNA-positive. Percentages seropositive for anti-E2, -L1, and -p16INK4A antibodies were 39.6, 22.4, and 23.3%, respectively. Anti-E2 antibody was significantly correlated with HPV DNA-positive cases. Eighty-seven women (75%) were regarded as infected with HPV, having at least one positive result from HPV DNA, L1, or E2 antibody. Antibody to p16INK4A was associated with HPV infection (odds = 5.444, 95% CI 1.203-24.629, P = 0.028) and precancerous cervical lesions (odds = 5.132, 95% CI 1.604-16.415, P = 0.006). Interestingly, the concurrent detection of anti-E2 and -p16INK4A antibodies was significantly associated with HPV infection (odds = 1.382, 95% CI 1.228-1.555, P = 0.044). These antibodies might be good candidate biomarkers for monitoring HPV-associated cervical lesion development to cancer. [ABSTRACT FROM AUTHOR]

Background: Adolescent pregnancy is a major health problem in many developing countries., Objective: To assess contraceptive practices and pregnancy intendedness in pregnant adolescents., Materials and Methods: This study was prospectively conducted from September 2013 to June 2014. All consecutively pregnant women between 15 and 19 years old attending the Antenatal Clinic at Srinagarind Hospital and the Khon Kaen Branch of the Planned Parenthood Association of Thailand were invited for participation. Face-to-face interviews by trained interviewers using standardized questionnaires were carried out. Logistic regression was used to determine an adjusted odds ratio (aOR) and 95% confidence interval (CI) of independent predictors., Results: Two hundred participants were enrolled. Mean age was 17.2 years. One hundred and eighteen (59.0%) were currently in school. Seventy-five (37.5%) participants had never used any contraceptive methods. Of the 125 participants who had ever used contraception, regular use of contraceptives was reported in only 21 participants (16.8%). Only two participants (1.0%) had ever used an intrauterine device or implant. Participants' age was a significant independent factor associated with non-use of contraceptives (aOR, 6.42; 95% CI, 2.94-14.04). Of the 200 participants, 132 (66.0%) declared that the pregnancy was unintended. Significant independent factors predicting unintended pregnancy were educational status (aOR, 6.17; 95% CI, 3.27-13.75) and participants' age (aOR, 5.76; 95% CI, 2.42-13.70)., Conclusion: Non-use and use of contraceptive methods with high failure rates were major reasons leading to adolescent pregnancies. Participants' age was an independent factor predicting non-use of contraceptives. Educational status and age of the participants were significant factors predicting unintended pregnancy.

Background: The purpose of this study was to assess the incidence of and risk factors for postoperative febrile morbidity after laparoscopic-assisted vaginal hysterectomy (LAVH)., Methods: This retrospective study was carried out using the medical records of women with benign gynecologic conditions who underwent LAVH between June 2007 and May 2012 at Srinagarind Hospital in Thailand. Data were collected to assess baseline patient characteristics, occurrence of body temperature ≥38°C on two occasions at least 6 hours apart in the 24 hours following the surgical procedure, and possible risk factors related to postoperative febrile morbidity., Results: In total, 199 women underwent LAVH during the study period. They had a mean age of 46±6 years, a mean body mass index of 24.0±3.2 kg/m(2), a mean surgical duration of 134±52 minutes, median estimated blood loss of 200 mL, a mean total hospital stay of 5±2 days, and a mean postoperative hospital stay of 3±2 days. Postoperative febrile morbidity was documented in 31 cases (15.6%). The cause of postoperative fever was unknown in most cases, with only two cases having an identifiable cause. The risk of postoperative febrile morbidity was highest in women treated with more than two antibacterial agents and with a regimen of more than 3 days., Conclusion: This study shows a moderately high rate of febrile morbidity after LAVH, for which the main risk factors were use of multiple drugs and doses for antibiotic prophylaxis.

This study was conducted to establish whether the preoperative platelet to lymphocyte ratio (PLR) is predictive of survival of women with ovarian clear cell carcinoma (OCCC). A PLR > 300 was deemed elevated. Progression-free survival (PFS) was estimated using the Kaplan-Meier method. Cox proportional hazard analysis was used to determine the independent effect of PLR. Thirty-six patients were reviewed. Elevated PLRs were more commonly noted in patients with an advanced vs an early stage of disease (88.9% vs 11.1%). Women with elevated PLR carried a higher rate of disease progression during primary therapy than that those in the normal PLR group (44.4 vs 22.2%). The median PFS for patients with elevated PLR was notably worse than that for patients with normal PLR (10 vs 34 months). Despite the impact of elevated PLR on PFS, it was found to be marginally significant when controlling for commonly applied prognostic markers. It, however, trended toward significance (HR=4.76; 95%CI, 0.95-23.8). In conclusion, an elevated PLR appears to be directly associated with adverse survival rather than being a surrogate for other indicators of a poor prognosis. PLR may be a useful biomarker for predicting survival of women with OCCC and merits further large-scale studies.

Objective: To determine the accuracy of colposcopically directed biopsy (CDB) in diagnosis of precancerous or cancerous lesion of the uterine cervix as a quality index of the institute., Materials and Methods: We retrospectively reviewed the medical records of the women who had colposcopic examination at the Department of Obstetrics and Gynecology, Srinagarind Hospital from January, 2005 to December, 2010. The women with satisfactory colposcopic examination who had CDB and further interventions such as loop electrosurgical excision procedure (LEEP)/conization, and/or hysterectomy were included in study. The pathological reports of the specimens from CDB were analyzed comparing with LEEP/conization or hysterectomy according to the highest degree of abnormalities. Pathological reports of HSIL (high grade squamous intraepithelial lesion) or more severe were classified as positive, while LSIL (low grade squamous intraepithelial lesion) or less severe were classified as negative., Results: There were 320 patients included, 259 having highest pathological reports of HSIL or more. The accuracy of CDB to detect HSIL or more of the uterine cervix was 87.8% with sensitivity, specificity, PPV and NPV of 84.9%, 100%, 100%, and 61%, respectively., Conclusions: The accuracy of CDB in diagnosis of cervical pathology in our institute was acceptable and comparable to those of others. CDB is a reliable method to obtain the pathological diagnosis in women with abnormal cervical cytologic screening.

Objectives: To evaluate treatment response and acute treatment-related toxicity of concurrent chemoradiotherapy with cisplatin 20 mg/m2 , compared to 40 mg/m2 as the standard, in locally advanced cervical cancer., Study Design: A prospective randomized controlled trial in Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen., Subjects: 140 patients, >60 years old with biopsy-proven previously untreated invasive carcinoma of cervix, FIGO stage IB2-IVA, undergoing concurrent chemoradiotherapy with adequate bone marrow, renal and liver functions, between April and December 2009., Methods: All patients were randomly assigned (half in each group)to receive weekly cisplatin at a dose of 40 mg/m2 compared to 20 mg/m2, concurrent with radiotherapy for 6 cycles. Main outcome measures included clinical response, cytological response, and acute treatment-related toxicity., Results: All 140 patients completed 6 cycles of weekly cisplatin. 80% had squamous cell carcinomas; about half were FIGO stage IIIB. The 40 mg/m2 group showed unplanned interruptions in 13/70 (18.6%), which was significantly different from the 5/70 (7.1%) in the 20 mg/m2 group (p=0.02), resulting in prolonged treatment time (p=0.026). Complete responses were found in 69/70 (98.6%) and 68/70 (97.1%), respectively, with no significant difference. Hematological and gastrointestinal toxicities were most frequently observed. Acute toxicities in the first group was significantly higher when compared to the second group (p<0.05) as follows; grade 1-2 leukopenia (14.8% vs. 6.4%), grade 1-2 neutropenia (9.3% vs. 2.6%), grade 2 N/V (3.8% vs. 1%), grade 2 diarrhea (2.4% vs. 0.7%), and grade 1 sensory neuropathy (4.5% vs. 1.2%). No treatment related deaths were encountered., Conclusion: This prospective trial has sufficient data to support the conclusion that concurrent chemoradiotherapy with weekly cisplatin 40 mg/m2 in locally advanced cervical cancer gives good treatment outcomes. When reducing the cisplatin dose to 20 mg/m2, treatment responses were still comparable to the standard, but acute toxicity could be reduced. However, there are insufficient data to assess long term treatment outcomes and late treatment related toxicity, because of the short follow-up time.

Objectives: To determine the prevalence and predictive factors of residual disease in the specimens from cold knife conization (CKC) or the loop electrosurgical excision procedure (LEEP) and complication rates of these procedures., Design: Descriptive analytical study in Srinangarind Hospital, Khon Kaen, Thailand, of a total of 463 patients with abnormal Pap smears who underwent LEEP or CKC during 2002-2007., Methods: The medical records of 463 women were retrospectively reviewed to ascertain the prevalence, associated factors of positive surgical margin, and complications of LEEP and CKC. The patients' characteristics and pathologic parameters were collected and analyzed. Univariate analysis was based with the chi-square test and the Student's t-test. Multiple logistic regression models were employed to investigate factors associated with cone margin involvement., Results: Of the 463 patients, 124 cases had a positive cone margin (26.8%). 53 patients had complications (11.4%), such as bleeding (25) and infection (28). The margin involvement was significantly associated with type of conization, purpose of conization, skill of surgeon, and histological diagnosis., Conclusion: The prevalence of a positive cone margin is rather high. Physicians who perform conization should take into account risk factors in management of cases with abnormal cytological screening for cervical cancer.

Our objective was to assess the efficiency of an appointment-letter intervention aimed to increase uptake of cervical cancer screening in women between 35 and 65 years of age. From January, 2007, we randomly recruited 320 women, not screened for at least 5 years, from the Samliem inner-city community, Khon Kaen, Northeast Thailand. A total of 150 women 35, 40, 45, 50, 55, 60 and 65 years of age were assigned to the intervention group according to Thai National Cancer Institute's ( TNCI) strategy. A further 170 women between 36-39, 41-44, 46-49, 51-54, 56-59 and 61-64 years of age were assigned to the control group. Baseline interviews were conducted for all women in both groups by one of the researchers in January, who also provided culturally-sensitive health education emphasizing the need for screening. Then appointment letters were sent only to women in the intervention group in February, with the last date for an appointment being March 31st. In April of 2007, immediately post-intervention, screening-coverage interviews were performed in both groups for comparison. There was a significant increase in the Pap smear screening-coverage rate in the intervention group compared with the control group (44.67% vs. 25.88%, p=0.001). Therefore, the appointment-letter intervention produced a significant effect on increasing Pap smear coverage in this group of women.