Biomedical subjects

K Limpaphayom

Publications and source records attributed to K Limpaphayom.

At least 19 recordsLinked to original sources

PubMed2005

Advocating for cervical cancer prevention.

Cervical cancer is a significant health problem among women in developing countries. Contributing to the cervical cancer health burden in many countries is a lack of understanding and political will to address the problem. Broad-based advocacy efforts that draw on research and program findings from developing-country settings are key to gaining program and policy support, as are cost-effectiveness analyses based on these findings. The Alliance for Cervical Cancer Prevention (ACCP) has undertaken advocacy efforts at the international, regional, national, and local levels to raise awareness and understanding of the problem (and workable solutions), galvanize funders and governments to take action, and engage local stakeholders in ensuring program success. ACCP experience demonstrates the role that evidence-based advocacy efforts play in the ultimate success of cervical cancer prevention programs, particularly when new screening and treatment approaches-and, ultimately, radically new approaches such as a human papillomavirus vaccine-are available.

Cost-Benefit Analysis↗

PubMed2003

Safety, acceptability, and feasibility of a single-visit approach to cervical-cancer prevention in rural Thailand: a demonstration project.

BACKGROUND: To increase screening and treatment coverage, innovative approaches to cervical-cancer prevention are being investigated in rural Thailand. We assessed the value of a single-visit approach combining visual inspection of the cervix with acetic acid wash (VIA) and cryotherapy. METHODS: 12 trained nurses provided services in mobile (village health centre-based) and static (hospital-based) teams in four districts of Roi-et Province, Thailand. Over 7 months, 5999 women were tested by VIA. If they tested positive, after counselling about the benefits, potential risks, and probable side-effects they were offered cryotherapy. Data measuring safety, acceptability, feasibility, and effort to implement the programme were gathered. FINDINGS: The VIA test-positive rate was 13.3% (798/5999), and 98.5% (609/618) of those eligible accepted immediate treatment. Overall, 756 women received cryotherapy, 629 (83.2%) of whom returned for their first follow-up visit. No major complications were recorded, and 33 (4.4%) of those treated returned for a perceived problem. Only 17 (2.2%) of the treated women needed clinical management other than reassurance about side-effects. Both VIA and cryotherapy were highly acceptable to the patients (over 95% expressed satisfaction with their experience). At their 1-year visit, the squamocolumnar junction was visible to the nurses, and the VIA test-negative rate was 94.3%. INTERPRETATION: A single-visit approach with VIA and cryotherapy seems to be safe, acceptable, and feasible in rural Thailand, and is a potentially efficient method of cervical-cancer prevention in such settings.

Acetic Acid↗

PubMed2001

The regulation of assisted reproductive technology in Thailand.

The Executive Board of the Medical Council of Thailand has set up an ad hoc committee to establish the regulations of practising of assisted reproductive technology. The committee assigned the Royal Thai College of Obstetricians and Gynecologists to supervise and take charge of the administration and formulate an annual report in accordance with the Thai Medical Council Declaration. The regulation was finally approved on October 9, 1997. It was announced in the Royal Gazette on December 26, 1997 and since then the prescription of standard measures for ART practice has been effected.

Female↗

PubMed2001

Difference in bone acquisition among hormonally treated postmenopausal women with normal and low bone mass.

This prospective analysis was conducted to compare the effects of hormone treatments on bone mineral density (BMD) of the lumbar spine, hip, and distal forearm in postmenopausal women with normal BMD and those with low bone mass. Eighty healthy women were randomly assigned to receive a cyclic regimen of standard hormone replacement therapy (HRT) or currently used low-dose oral contraceptive (OC). Women were categorized as normal BMD and low bone mass according to the Thai reference database. The results revealed that women with low bone mass gained more BMD than those with normal BMD. The difference in mean per cent bone acquisition was obvious at the spine. In addition, further subset analysis into OC and HRT groups revealed higher effects of OC on BMD when compared to HRT.

Adult↗

PubMed2000

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

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

Adult↗

PubMed2000

Comparison of norgestrel- versus cyproterone acetate-containing hormone replacement therapy on lipid-lipoprotein metabolism.

To compare the effects on the lipid profile of estradiol valerate with norgestrel to a regimen of estradiol valerate with cyproterone acetate. Sixty-four healthy women in their perimenopause or early postmenopause, aged between 40-55 years, were randomized to one of the two 21-day sequential regimens: estradiol valerate 2 mg/day for 21 days and combined with either norgestrel 0.5 mg/day or cyproterone acetate 1 mg/day from day 12 to 21, with 7 days of drug-free interval, for 12 cycles. Lipid profiles were followed at baseline, 6 and 12 cycles. Sixty-one subjects completed the study, 30 in the norgestrel group and 31 in the cyproterone group. During 12 cycles of study, serum HDL cholesterol levels decreased significantly in the norgestrel group (p < 0.01) and were unchanged in the cyproterone group. The levels were significantly lower in the norgestrel group than in the cyproterone group (p < 0.05). No differences were found between groups as regards LDL cholesterol and total cholesterol levels. Triglyceride levels decreased significantly in the norgestrel group (p < 0.01), remained unchanged in the cyproterone group and the levels were significantly different between groups (p < 0.01). In conclusion, the study demonstrated that sequential regimen of estradiol valerate with norgestrel produced less favorable HDL cholesterol but more favorable triglyceride levels than the regimen of estradiol valerate with cyproterone acetate.

Adult↗

PubMed1999

Estradiol and follicle-stimulating hormone levels in oophorectomized women applying percutaneous 17 beta-estradiol over the medial surface of the left arm.

To assess the changing estradiol (E2) and follicle stimulating hormone (FSH) level in oophorectomized women applying percutaneous 17 beta estradiol over the medial surface of the left arm. Thirty-nine women, who had undergone total abdominal hysterectomy and bilateral oophorectomy after 4 weeks, were enrolled into the study. All subjects received a daily dose of 1.5 mg percutaneous 17 beta-estradiol in 2.5 g of the gel, applied over the medial surface of the left arm in the limited area of 150 cm2. Serum E2 and FSH were measured before and after commencing the study at weeks 4, 8 and 12. The measurement was performed 12-14 hours after the gel application, using time-resolved fluoroimmunoassay (FIA) method. Serum E2 significantly increased from the baseline value at weeks 4, 8 and 12 (Median of E2 value at weeks 0, 4, 8 and 12 = 47.30, 86.78, 128.00 and 163.15 pmol/L, respectively, P < 0.05). While the serum FSH level significantly decreased. (Median of FSH value at weeks 0, 4, 8 and 12 = 66.05, 60.40, 53.35 and 48.40 IU/L, respectively, P < 0.05). In conclusion, this dose, duration and route of estrogen administration increased the serum E2 level close to the early to mid-follicular phase of the normal menstrual cycle. While FSH level significantly decreased but did not reach the premenopausal range.

Arm↗

PubMed1999

The predictive value of skin thickness in the diagnosis of osteopenia.

Skin and bone share a similar organic constituent (type I collagen) which decreases with time after menopause due to hypoestrogenism. The interdependence of skin and bone atrophy has been reported. This study was conducted to assess the predictive value of an ultrasonographic measurement of skin thickness in the diagnosis of osteopenia (BMD below -1.5 SD.) in perimenopausal and early postmenopausal women. All patients had skin thickness measured by the same radiologist and had a dual-energy X-ray absorptiometry (DEXA) scan of the lumbar spine and the femoral neck. Of the 77 women studied, the mean age was 50.9 +/- 3.0 years. Thirty patients were in perimenopause and 47 in early postmenopause. Mean skin thickness was 2.1 +/- 0.4 mm. Women with a skin thickness of < or = 1.7 mm carried a higher risk for developing osteopenia at the lumbar spine (odds ratio 8.41, 95% confidence interval 2.19-32.35) and the femoral neck (odds ratio 3.88, 95% CI 1.14-13.17). Patients with a skin thickness of > or = 2.4 mm had a lower probability of osteopenia at the lumbar spines (odds ratio 0.17, 95% CI 0.035-0.845) and the femoral neck (odds ratio 0.22, 95% CI 0.055-0.899). In conclusion, a low skin thickness measurement by ultrasonography may be used as an indicator for osteopenia in perimenopausal and early postmenopausal women.

Adult↗

PubMed1999

Skin thickness in different menopausal status.

It is well known that skin thickness will decrease in the years after menopause. Women may have climacteric symptoms including those associated with skin alterations as early as during the perimenopausal period. This study was performed to compare the skin thickness of women in their premenopause (N = 31), perimenopause (N = 35) and early postmenopause (N = 46). The mean skin thickness in each group was 2.28 +/- 0.39 mm., 2.18 +/- 0.35 mm. and 2.02 +/- 0.36 mm. respectively. The skin thickness of women in the early postmenopausal group was significantly lower than those in the premenopausal group, but no difference was found between premenopausal and perimenopausal group nor between perimenopausal and early postmenopausal group. Furthermore, we found no correlation between skin thickness and chronological age. In conclusion, the decline in skin thickness of women entering menopause requires a period of time to undergo significant alterations and the study revealed a significant reduction of skin thickness as early as in the course of the early postmenopausal period.

Adult↗

PubMed1999

Dyslipidemia among healthy postmenopausal Thai women.

A prospective analysis was conducted to assess the prevalence of dyslipidemia among 80 healthy postmenopausal Thai women who were not more than five years after menopause. Serum total cholesterol, triglycerides and high-density lipoprotein (HDL) cholesterol were measured using enzymatic procedures. Low-density lipoprotein (LDL) cholesterol concentration was estimated by Friedewald formula. The results showed that 91.25 per cent, 10.00 per cent, 38.75 per cent and 48.75 per cent of the studied population had total cholesterol > or = 200 mg/dl, triglycerides > or = 150 mg/dl, HDL < 50 mg/dl, and LDL > or = 190 mg/dl respectively. Of all the women, 77.50 per cent and 10.00 per cent had total cholesterol / HDL ratio of > or = 4 and had triglyceride levels of > or = 150 mg/dl with HDL < 50 mg/dl, respectively. This unexpected high prevalence of dyslipidemia in this healthy postmenopausal group should be taken into account in considering health promotion strategies for postmenopausal Thai women particularly those in the high risk group.

Adult↗

PubMed1998

Similarity of bone mass measurement among hip, spines and distal forearm.

From January-December 1995, bone mineral density (BMD) of lumbar spine, hip and distal forearm were studied in 325 healthy women visiting the menopause clinic, Chulalongkorn Hospital. This retrospective analysis was conducted to assess the correlation of BMD among various measurement sites. Bone mass measurement at hip and spine were performed utilizing dual energy X-ray absorptiometer (DEXA), Hologic QDR 2000 and at distal forearm by single energy X-ray absorptiometer (SEXA), Hologic DTX 100. By canoconical correlation, the results revealed a significant correlation of BMD of distal and ultra-distal part of forearm with various sites of hip (r = 0.602, p < 0.001). There was also significant correlation of distal and ultra-distal part of forearm with various sites of spines (r = 0.619, p < 0.001). Though there is some heterogeneity of bone mass density among different measurement sites, practically with this fairly good level of correlation, bone mass measurement of distal forearm might be used to predict the BMD of hip and spine in Thai women. The accuracy of predicting the BMD of hip and spine by BMD of distal forearm in the mass screening programme in Thailand is now going on. The results will be followed.

Absorptiometry, Photon↗

PubMed1998

Postmenopausal osteoporosis: what is the real magnitude of the problem in the Thai population?

To assess the prevalence of osteoporosis, bone mass measurement was performed on 1,047 women attending a menopause clinic at Chulalongkorn Hospital, Bangkok. The mean age of the population was 50.5 +/- 5.7 years. The bone density was measured at lumbar spines (LS) (L1-L4) and the non-dominant femoral neck (FN) site utilizing a Hologic QDR 2000 dual energy X-ray absorptiometer. According to the World Health Organization's (WHO) definition a value of bone mineral density (BMD) that is more than 2.5 standard deviation (SD) below the young adult mean is considered diagnostic of osteoporosis. In this study, Thai and American cut-off values of BMD for osteoporosis were used to compare the prevalence of osteoporosis. Using Thai's cutoff value, the results showed a lower prevalence of osteoporosis of both LS and FN (15.7% and 9.5%, respectively). Considering the subgroups of the studied population, the prevalence of osteoporosis of LS and FN utilizing Thai's cutoff value was significantly higher in postmenopausal than in premenopausal women. (Premenopause vs postmenopause, LS: 4.7% vs 21.4%; FN: 4.7% vs 11.9%, respectively, P < 0.05) WHO's definition of osteoporosis (the cutoff value of 2.5 SD below the young adult mean) is based on the rationale that this cutoff value identifies approximately 30 per cent of postmenopausal white women as having osteoporosis which is approximately equivalent to the lifetime risk of fracture at the spine, hip and forearm of white women at age 50 years. The prevalence of osteoporosis obtained in this study might not represent the true magnitude of the problem in Thailand. Until we have our own lifetime fracture risk which will enable us to have an appropriate cutoff value to diagnose osteoporosis, this prevalence might be used as an approximate figure or initial information for further research in this field.

Adult↗

PubMed1997

Dengue hemorrhagic fever during pregnancy: antepartum, intrapartum and postpartum management.

Dengue hemorrhagic fever is a common tropical disease in Thailand that nowadays has an increasing incidence during adulthood. We managed three cases of dengue hemorrhagic fever during pregnancy which developed during the antepartum, intrapartum and postpartum periods. We diagnosed dengue hemorrhagic fever during pregnancy with clinical pictures of fever, hemoconcentration and thrombocytopenia with serological proof in all cases. All cases were treated conservatively except for the second one, in which cesarean delivery was inevitable due to severe preeclampsia with unfavorable cervix. All patients and their babies were in good condition before discharge. With increasing incidence during adulthood, more cases of dengue hemorrhagic fever in pregnancy can be found. Conservative treatment should be conducted in all cases. We believe that this is the first case report of intrapartum dengue hemorrhagic fever during pregnancy.

Adult↗

PubMed1997

Estradiol and follicle-stimulating hormone levels in oophorectomized women using vaginal estrogen.

To assess the changing estradiol (E2) and follicle-stimulating hormone (FSH) level in oophorectomized women using vaginal estrogen. Serum estradiol and FSH were evaluated in 32 oophorectomized women using a daily dose of 2 g base of 1.25 mg vaginal conjugated equine estrogen (CEE) cream. The blood sample for hormone assay was collected 8-10 hours from the time of vaginal application. E2 and FSH levels were measured in the serum sample before and after commencing the study at 4, 8 and 12 weeks using the time-resolved fluoroimmunoassay method. Serum estradiol significantly increased from baseline value at 4, 8 and 12 weeks. (Mean +/- SD of E2 value at 0, 4, 8, 12 weeks: 9.97 +/- 12.13, 249.83 +/- 170.46, 299.38 +/- 190.65, 322.82 +/- 218.31 pmol/L, respectively, P < 0.05) On the other hand, serum FSH significantly decreased from baseline value at 4, 8 and 12 weeks. (Mean +/- SD of FSH value at 0, 4, 8, 12 weeks: 77.64 +/- 27.24, 40.33 +/- 21.64, 38.84 +/- 22.33, 30.90 +/- 24.32 IU/L, respectively, P < 0.05) In conclusion, a daily dose of 2 g vaginal CEE cream raised the serum estradiol level close to the normal level in the follicular phase of the normal menstrual cycle. However, even though FSH significantly decreased it did not reach the premenopausal level.

Administration, Topical↗

PubMed1997

Correlation of bone mineral density among various measurement sites.

Bone mineral density (BMD) of the lumbar spine and hip was studied in 1,047 women visiting the menopause clinic, to assess the correlation of BMD among various measurement sites. Bone mass measurement was performed utilizing dual energy X-ray absorptiometer (DEXA), Hologic QDR 2000. The results revealed a significantly high correlation of BMD of total hip and spine. (r = 0.7021, P < 0.001) Nevertheless, BMD of the spine was mostly correlated with BMD of trochanteric site (r = 0.7235, P < 0.001) and least correlated with BMD of intertrochanteric region. (r = 0.2426, P < 0.001) In conclusion, BMD of spine and hip is highly correlated. However, there was some heterogeneity of correlation in different specific measurement sites.

Absorptiometry, Photon↗

PubMed1997

Climacteric complaints of paramedical personnel.

This study was conducted from October 1995 to January 1996, to assess the prevalence of climacteric complaints of paramedical personnel in Chulalongkorn Hospital. Data collection was performed using a standardized questionnaire, comprised of population characteristics, items and severity of climacteric complaints. All the participants filled up the questionnaire by themself after receiving a clear explanation of the meaning of each symptom. Two hundred and ninety women aged 40-59 years participated in the study. Their mean age was 47.72 +/- 4.77 years. Forty six per cent of the study population were classified as premenopausal, i.e. having regular vaginal bleeding during the last 12 months, 18 per cent were perimenopausal, i.e. having irregular vaginal bleeding during the last 12 months and 35 per cent were postmenopausal, i.e. having no vaginal bleeding during the last 12 months. The mean time since menopause of the last group was 4.71 +/- 3.75 years. The results revealed that the prevalence of vasomotor symptoms, urogenital symptoms and other symptoms i.e. numbness, forgetfulness, etc, were reported at a significantly higher rate in the postmenopause than in the perimenopause and premenopause women respectively (P < 0.05). However, there was no significant difference in the prevalence of psychological symptoms among the three groups (P > 0.05). In conclusion, except for psychological symptoms, the reported prevalence of climacteric complaints in paramedical personnel was associated with menopausal status.

Adult↗

PubMed1997

Serum estradiol and gonadotropins level in postmenopausal women with or without hormone replacement.

Serum follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) was measured in 49 menopausal women, to assess the changing serum level in women with or without hormone replacement. Women in the study group (N = 25) received estrogen with or without progestin. The control group (N = 24) did not receive any hormone regimen. Serum hormone measurement was done at 0, 6 and 12 month, using time-resolved fluoroimmunoassay method. The results revealed no significant change of FSH, LH and E2 at 0, 6 and 12 month in the control group. (FSH at 0, 6, 12 month: 55.14 +/- 22.82, 63.90 +/- 24.54, 72.81 +/- 29.58 IU/L, P = 0.09; LH at 0, 6, 12 month: 35.54 +/- 19.86, 33.02 +/- 16.30, 32.33 +/- 17.37 IU/L, P = 0.83; E2 at 0, 6, 12 month: 49.28 +/- 48.54, 37.29 +/- 39.93, 25.63 +/- 23.58 pmol/L, P = 0.17). However, in the study group, FSH and LH significantly decreased but E2 significantly increased at 6 and 12 months. (FSH at 0, 6, 12 month: 59.33 +/- 22.30, 27.23 +/- 16.31, 29.74 +/- 19.45 IU/L, P < 0.05; LH at 0, 6, 12 months: 41.4 +/- 17.02, 19.62 +/- 13.66, 15.65 +/- 8.77 IU/L, P < 0.05; E2 at 0, 6, 12 months: 47.33 +/- 41.25, 280.94 +/- 174.11, 270.70 +/- 198.65 pmol/L, P < 0.05). In conclusion, hormone replacement decreased serum gonadotrophin, though not reaching the premenopausal level. However, serum E2 value was significantly increased close to the level in the follicular phase of normal menstrual cycle.

Estradiol↗

PubMed1997

Symptoms and problems of menopausal women in Klong Toey slum.

This study was conducted to assess the symptoms and problems of postmenopausal Thai women in Klong Toey slum. The interview was randomly performed according to the home number by well-trained social workers and a standardized questionnaire was used. One hundred and nineteen postmenopausal women were eligible for the study. The women were of low socioeconomic and educational background. Their mean age was 58.9 +/- 6.9 years. The mean time since menopause was 7 years. The prevalence of the climacteric symptoms was as follows: vasomotor symptoms 72.3 per cent, urological symptoms 80.7 per cent, genital symptoms 87.4 per cent and psychological symptoms 98.3 per cent. However, the prevalence of severe vasomotor, urological, genital and psychological symptoms which these women recognized as problems was 29.4 per cent, 19.3 per cent, 15.1 per cent and 75.6 per cent, respectively. In conclusion, the prevalence of climacteric symptoms of postmenopausal women in Klong Toey slum were high but the symptoms which these women recognized as problems were low. These women probably perceived these symptoms as a natural change of life.

Aged↗