Exercise and associated features with low-level exercise among doctors

Abstract Background: Physical activity had been reported among doctors-in-training, with very few focusing on attending doctors. This study aimed to evaluate the physical activity, particularly exercise, of Thai doctors and features associated with low-level exercise. Materials and methods: Thai doctors who participated in the hospital's CSR service, which was conducted between Feb 14, 2022, to Oct 31, 2022, were verbally informed along with an information sheet about this parallel study. The doctors who consented to participate provided their personal data on diets, work hours, illnesses, health surveillance, stress, state of well-being, and exercise. To investigate the association with clinical features, the exercise level was categorized as low-level (≤ 2 days/week) or high-level (≥ 3 days/week). Results: The median age of 1187 doctors was 45.0 years. Slightly over half were female (55.4%) or worked ≤ 40 hours/week (55.3%). The presence of illnesses was found in 55.9%, irregular health surveillance in 29.0%, no/low fiber diet in 19.2%, overweight/obesity in 28.0%, and moderate/severe stress in 25.9%. Among the doctors who provided exercise data, 29.8% had a high-level of exercise and 49.0% had a low-level. Independent features associated with low-level exercise were no/low fiber diet (aOR = 3.01), irregular health surveillance (aOR = 2.41), age ≤ 60 years (aOR = 1.82), female gender (aOR = 1.79), and work > 40 hours/week (aOR = 1.76). Conclusions: Only 30% of Thai doctors had a high level of exercise. The significant independent factors for low-level exercise were younger age, female, working load, irregular health surveillance, and no/ low fiber diet.

Factors related to the achievement of the National License Examination Part 1 of medical students in Faculty of Medicine Vajira Hospital, Navamindradhiraj University.

Introduction: National License Examination (NLE) is organized by the Consortium of Thai Medical Schools to assess the competency of medical students. Part I-NLE involves an evaluation of basic science knowledge. Our objective was to evaluate factors associated with the results of part-I NLE. Methods: Learning attitude and behavior, preparation for and attitude towards the NLE were surveyed by a questionnaire given to all third to fifth year students (in 2010) at the institution. Additional data collected were: gender, admission and aptitude tests scores, cumulative grade point average (GPA) during the first two years, and the results of part-I NLE. Association of these factors and the results of the examination were studied. Results: Mean age of 206 participants was 21.1 + 0.74 years. 55% were female 45% male. Mean aptitude and admission scores were 18.9 + 2.64 and 51.4 ± 8.75, respectively while mean of GPA was 3.0 ± 0.33. From the questionnaire: mean scores of learning behavior, preparation and attitude towards the NLE were 3.3 ± 0.40, 3.1 ± 0.57, and 3.3 ± 0.61, respectively. There were174/ 206 students who passed the NLE. Factors significantly associated with achievement were: good GPA > 3.0, good learning behaviors (score > 3.0), and good preparation for the examination (score > 3.2). Conclusions: Recent academic effort and performance (represented as GPA and behaviors in learning and preparation for the examination) were more important than remote academic background (represented as aptitude and admission scores).Medical teachers should stimulate students to have continuous effort in learning and preparation for the examination.

Expression of cyclooxygenase-1 in epithelial ovarian cancer: a clinicopathological study.

OBJECTIVE: To determine immunohistochemical expression of cyclooxygenase-1 (COX-1) in epithelial ovarian cancer (EOC), and its association with clinical features and prognosis. METHODS: EOC patients treated in Bangkok Metropolitan Administration Medical College and Vajira Hospital during 1996-2003, and with available pathological tissue sections, were identified. Immunohistochemical staining was accomplished with antibodies to COX-1 and degree of expression was categorized into low and high for assessment of any. association with clinicopathological factors and survival. RESULTS: One-hundred and seven patients were included in the study, with a median age of 50 years. Most had stage I and III disease. The most common histologic subtype was serous carcinoma. Overall, we found COX-1 expression in 83.2 %. Non-mucinous lesions had significant higher levels of expression than mucinous tumors, but there was no link expression with other clinicopathological factors or survival. CONCLUSIONS: EOCs showed highexpression of COX-1, especially with a non-mucinous histology, but this appears to lack prognostic significance.

Prevalence of high grade squamous intraepithelial lesions (HSIL) and invasive cervical cancer in patients with atypical squamous cells of undetermined significance (ASCUS) from cervical pap smears.

To determine the prevalence and factors associated with histologic diagnoses of High Grade Squamous Intraepithelial Lesions (HSIL) or invasive cervical cancer in women with a cytologic diagnosis of atypical squamous cells of undertermined significance (ASCUS), medical records of women with an ASCUS Pap smear from January 2003 to December 2006 were reviewed. Of 287 women with ASCUS Pap smears in whom data were available, 189 were annotated with "favoring a premalignant or malignant process", 74 with "favoring reactive", and 24 with "not otherwise specified". The prevalences of HSIL and invasive cervical cancer were 9.1% and 1.2%, respectively. Only subtypes of ASCUS were significantly associated with the detection of HSIL or invasive cancer, 12.7% with favoring premalignant or malignant process, 2.7% with favoring reactive, and 16.7% in with ASCUS-NOS (p=0.034).

Mixture of carbol fuchsin and alcian blue staining of gastric tissue for the identification of Helicobacter pylori and goblet cell intestinal metaplasia.

The purpose of this study was to evaluate the role of the mixture of carbol fuchsin and alcian blue stain in the diagnosis of Helicobacter pylori (HP) and goblet cell intestinal metaplasia (IM) in comparison to the more commonly used Giemsa and hematoxylin and eosin (H&E) stains. Pathological blocks of gastric tissues obtained from January 2006 to December 2007 were recut and processed for Giemsa and a mixture of carbol fuchsin and alcian blue stains. Clinical data regarding the patients were collected and previous slides stain with H&E from gastric tissues were reviewed. The Giemsa and the mixture of carbol fuchsin and alcian blue stains were studied by a pathologist who was blinded to the pathological and clinical data. Direct comparisons were made between the stains for diagnosis of HP. Of 423 cases studied the concordance rate was 97.8% (kappa value=0.947, p< 0.05). Using the mixture of carbol fuchsin and alcian blue stain, 4.3 % of goblet cell IM which were not detected by H&E stain were additionally identified. The prevalences of HP infection diagnosed by Giemsa, the mixture of carbol fuchsin and alcian blue, and H&E stains were 72.1%, 72.3%, and 71%, respectively. In conclusion, the mixture of carbol fuchsin and alcian blue stain can be used in place of Giemsa stain for the identification of HP, and is probably preferable because of its low cost and is less time-consuming. Carbol fuchsin and alcian blue which are commonly available dyes are more beneficial than Giemsa stain and aid in identifing goblet cell IM undiagnosed by conventional H&E stain.

Prognostic significance of microvessel density and mast cell density for the survival of Thai patients with primary colorectal cancer.

BACKGROUND: Angiogenesis has been found to be a reliable prognostic indicator for several types of malignancies. In colorectal cancer, however there has been controversy as to whether there is a correlation between this feature and the tumors' behavior. OBJECTIVE: Determine the correlation between microvessel density (MVD) and mast cell density (MCD) in order to evaluate these factors in terms of their prognostic relevance for primary colorectal carcinoma in Thai patients. MATERIAL AND METHOD: One hundred and thirty colorectal carcinoma patients diagnosed between January 2002 and December 2004 were identified. Eleven patients were excluded from the present study due to recurrence of colorectal carcinoma in eight cases whereas pathologic blocks were not found in three cases. One hundred and nineteen patients met all inclusion criteria and were included in the present study. Representative paraffin sections obtained by the tissue micro-array technique (9 x 5 arrays per slide) from areas of highest vascular density (hot spots) were prepared. Sections were immuno-stained by monoclonal anti CD 31 for microvessel and antibody mast cell tryptase for mast cell detections, respectively. Three readings at different periods of time under a microscopic examination of high power magnification were examined by a pathologist who was blinded to clinical data. The highest microvessel and mast cell counts were recorded as MVD and MCD. Patients were then divided into groups of high and low MVD and high and low MCD by median values (20.5 and 14.5, respectively). Overall survival of the patients in each group was estimated by the Kaplan-Meier Method while a multivariate Cox regression backward stepwise analysis was employed to find out independent prognostic factors. RESULTS: Significant positive correlation was found to exist between MVD and MCD in the hot spots (R = 0.697, p < 0.0001). Regarding their prognostic role, patients with tumors of low MVD (hypovascular) and low MCD (low mast cell counts) had significantly longer survival rates than those with hypervascular and high mast cell counts (p < 0.0001). The Multivariate Cox hazard showed that MVD and distance metastasis of cancer were independent poor prognostic factors to survival (p = 0.036 and p = 0.024, respectively). The patients with high MVD (hypervascular) tumors and with presence of distant metastasis had 1.9 and 2.5 times higher death rates than the corresponding hypovascular and non-metastatic groups, respectively during the period from January 2002 to September 2007. CONCLUSION: Assessment of microvessel density in the invasive front of primary colorectal carcinoma could serve as useful prognosis tool of primary colorectal carcinoma in Thai patients.

Prevalence of high grade squamous intraepithelial lesion (HSIL) and invasive cervical cancer in patients with low grade squamous intraepithelial lesion (LSIL) at cervical pap smear.

OBJECTIVE: To assess the prevalence and factors associated with a histologic diagnosis of high grade squamous intraepithelial lesion (HSIL) and invasive cervical cancer in patients with low grade squamous intraepithelial lesion (LSIL) cervical pap smear findings. METHODS: Medical records (including cytology reports, colposcopic impression, and pathologic results from cervical biopsy, endocervical curetting, cervical conization or hysterectomy) of 226 women with LSIL from conventional cervical pap smears during January 2001 to December 2005, who subsequently underwent colposcopic evaluation at our institution, were reviewed. RESULTS: Mean age of the patients was 39.0 years. The incidences of LSIL, HSIL, microinvasive cervical cancer were 58.8%, 15.0%, 1.3% respectively. No associations were found between age, parity, contraception, anti-HIV or menstrual status and the detection of HSIL/invasive cervical cancer. CONCLUSION: Approximately 16.3 % of LSIL pap smear cases turn out to be HSIL or invasive cervical cancer from histologic diagnosis.

Chemotherapy in patients with recurrent or refractory epithelial ovarian cancer.

OBJECTIVES: To evaluate the response rates, progression-free survival, and overall survival of patients with epithelial ovarian carcinoma who were treated with chemotherapy after being resistant to or had recurrence after first-line chemotherapy. MATERIAL AND METHOD: Clinical and pathological data of all patients with epithelial ovarian carcinoma who received chemotherapy in the second-setting at the Department of Obstetrics and Gynecology, Bangkok Metropolitan Administration Medical College and Vajira Hospital from January 1994 to December 2005 were reviewed. RESULTS: During the study period, 61 ovarian carcinoma patients met the inclusion criteria. All patients had primary surgery, not responded to or had recurrence after first-line chemotherapy, and received subsequent chemotherapy. Thirty-seven cases (60. 7%) were considered as platinum-resistant and 24 cases as platinum-sensitive (39.3%). The overall response rate (RR) to subsequent chemotherapy was 23.0% (14 patients): complete response 18.0% (11 patients) and partial response 5.0% (three patients). Stable disease was achieved as the best response in 11 patients (18.0%). Thirty-six patients (59.0%) experienced disease progression. Median progression-free survival (PFS) of all 61 patients was 5.7 months (95%CI, 4.7-6.7 months) while median overall survival (OS) was 18.3 months (95%CI, 2.7-34.0 months). Some prognostic factors were studied and found that patients with platinum-sensitive had a better response rate, longer PFS and OS than those with platinum-resistant diseases. CONCLUSION: Response rate of ovarian carcinoma to subsequent chemotherapy for resistant or recurrent diseases was modest. Median PFS and OS of the patients were less than and slightly longer than a year respectively. The patients who had platinum-sensitive diseases had a better prognosis in terms of RR, PFS, and OS than those with platinum-resistant disease.

Antiemetic effect of ondansetron and dexamethasone in gynecologic malignant patients receiving chemotherapy.

OBJECTIVES: To evaluate the antiemetic effect of a single dose of ondansetron and dexamethasone as a prophylaxis for chemotherapy induced acute nausea and emesis and factors associated with the control of acute nausea and emesis. MATERIAL AND METHOD: Patients who received single dose of 8 mg ondansetron and 20 mg dexamethasone as a prophylaxis for chemotherapy induced nausea and emesis at Department of Obstetrics and Gynecology, Bangkok Metropolitan Administration Medical College and Vajira Hospital, between October 2004 and April 2006 were identified. The assessment record of the drug efficacy had been evaluated in the first 24 hours after the start of chemotherapy in terms of control of vomiting, and nausea. Age of the patients, history of alcohol intake, type of cancer, regimen of chemotherapy and course of chemotherapy were analysed as possible factors associated with the control of nausea and emesis. RESULTS: Seventy-eight gynecologic-cancer patients receiving 353 cycles of chemotherapy were evaluated in this study. Completed control of acute vomiting and nausea were 68% and 57.2% respectively. Complete control of acute vomiting and nausea were 56.9% and 45.4% in patients of < or = 45 years compared to 78.8% and 68.7% in those with > 45 years. Complete control of acute vomiting and nausea were 59.2% and 48.7% in those receiving cisplatin-containing regimens compared to 86.7% and 75.2% in non-cisplatin containing regimens. Univariable and multivariable analysis showed that younger patients and those who received cisplatin-containing regimens had significant lower rates of complete control of both nausea and emesis. Patients receiving the first three courses of chemotherapy had significantly higher rate of complete control of nausea but not emesis as compared to those receiving chemotherapy after the third course. CONCLUSION: A single intravenous dose of 8 mg of ondansetron and 20 mg of dexamethasone had good control of acute nausea and vomiting only in those who received non-cisplatin containing regimens and those older than 45 years.

Granulocyte-colony stimulating factors for secondary prevention of leucopenia in patients receiving chemotherapy.

OBJECTIVE: To evaluate the effectiveness of GCSF as a secondary preventive adjunct to chemotherapy in the gynaecologic cancer patients who previously had grade 3-4 neutropenia or leucopenia from chemotherapy. MATERIAL AND METHOD: We retrospectively reviewed the medical records of 94 chemotherapeutic cycles with GCSF as secondary prophylaxis in 29 patients with gynaecologic malignancy between January 1996 and April 2005. RESULTS: The median age of the patients was 51 years (21-75). Most of the patients had ovarian cancers (19 cases, 65.6%). From secondary GCSF, grade 4 neutropenia was developed in 12 of 94 cycles (12.8%), and grade 4 leucopenia was developed in 5 of 94 cycles (5.3%). There were no patients developing febrile neutropenia after GCSF support. CONCLUSION: Secondary GCSF prophylaxis was effective in preventing grade 4 leucopenia, grade 4 neutropenia, and febrile neutropenia.

Tumor persistence in high grade squamous intraepithelial lesion patients with positive surgical margin post loop electrosurgical excision procedure.

OBJECTIVE: To determine the rates of persistent and recurrent tumors in patients with High Grade Squamous Intraepithelial Lesion (HSIL) who had positive surgical margin from Loop Electrosurgical Excision Procedure (LEEP). MATERIAL AND METHOD: Clinical and pathological data of all women who underwent LEEP procedures and revealed HSIL lesions with positive surgical margin between July 1997 and December 2004 were recorded. RESULTS: Histologic diagnoses of HSIL with positive surgical margin were found in 95 cases during the study period. Residual diseases were identified at ectocervical margins in 46 cases (48.4%), endocervical margin in 26 cases (27.4%), and both margins in 23 cases (24.2%). Subsequent hysterectomy was performed in 58 cases (61.0%). The remaining 37 cases (38.9%) underwent periodic follow-up with the median follow up period of 11 months (range, 1-74 months). Persistent diseases were identified in 18 of 58 hysterectomized cases but none in 37 follow-up cases. Recurrent disease was identified in only one case in the follow-up group. Overall the rates of persistent and recurrent disease were found in 18.9% and 1.1% respectively. CONCLUSION: In HSIL patients with positive surgical margin from LEEP the rate of persistent disease was 18.9%, while the rate of recurrence was 1.1%.

Vitamin B12 status of Thai women with neoplasia of the cervix uteri.

The vitamin B12 statuses of Thai women with high- and low-grade cervical dysplasia were studied and compared with women with normal cytological smears. Serum vitamin B12 and vitamin B12 intakes were assessed, as well as demographic characteristics, sexual behavior, reproductive and menstrual history, exogenous hormone use, personal and familial medical history, smoking habit, and other risk factors. The presence or absence of genital HPV DNA was determined by polymerase chain reaction (PCR). Serum vitamin B12 levels in women with normal cytological smears were significantly higher than those with both high- and low-grade cervical dysplasia (p<0.001). Low vitamin B12 serum levels were significantly statistically associated with increased low-grade (OR = 4.08; 95% CI = 1.41-11.79; p < 0.05) and increased high-grade cervical dysplasia risk (OR = 3.53; 95% CI = 1.24-10.04; p< 0.05) for the highest vs lowest quartiles of serum vitamin B12. This study indicated a relationship between low vitamin B12 status and increased risk of cervical cancer.

Comparison of ultrasound score, CA125, menopausal status, and risk of malignancy index in differentiating between benign and borderline or malignant ovarian tumors.

OBJECTIVES: To evaluate the diagnostic performances of ultrasound score (US), CA 125, menopausal status, risk of malignancy index (RMI)-- in differentiating between benign and borderline or malignant ovarian tumors. MATERIAL AND METHOD: Women with ovarian masses who were scheduled to have elective surgery at the Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital between May 1999 and December 2001 were included in the study. Ultrasonographic study and CA 125 were examined preoperatively. The RMI was obtained from the ultrasound score, CA 125, and menopausal status. The diagnostic values of each parameter and the RMI were determined. RESULTS: From 175 women, 35 women (20%) had malignant ovarian tumors. RMI yielded better diagnostic performance to differentiate between benign and borderline or malignant ovarian tumors than US score, CA 125, and menopausal status in respective order The optimal RMI to predict malignancy was 0.135 with the sensitivity of 88.6% (95% CI; 81.1%-96.1%), specificity of 90.7% (95% CI; 83.9%-97.6%), positive and negative predictive value of 70.5% (95% CI; 59.7%-81.2%) and 97.0% (95% CI; 92.9%-100.0%) respectively. CONCLUSION: RMI yielded better diagnostic performance than the individual parameter of ultrasound score, CA 125, or menopausal status in differentiation of benign from borderline or malignant ovarian tumors.

Histopathologic consistency between endometrial hyperplasia diagnosis from endometrial curettage and pathologic diagnoses from hysterectomy specimens.

OBJECTIVES: To evaluate the consistency between histopathology of endometrial hyperplasia (EMH) from endometrial curettage and those from the subsequent hysterectomy specimen. The co-incidental finding of endometrial carcinoma in patients with EMH was also studied. MATERIAL AND METHOD: All patients who had a diagnosis of EMH from the curettage procedure and underwent hysterectomy, between January 1995 and December 2004, were identified. The histopathology of the curettage specimens were compared to those of the hysterectomy specimens. RESULTS: The histopathologic subtypes of EMH from the curettage specimens of 46 patients included in the study were: simple or complex hyperplasia in 30 cases and atypical simple or complex hyperplasia in 16 cases. The consistency rate of endometrial tissue from curettage and hysterectomy specimens was 41.3%. The consistency rates were 62.5% and 30.0% in patients with atypical EMH and EMH without atypia respectively. Eight cases (17.4%) of EMH also had co-incident endometrial carcinoma. CONCLUSION: The consistency rate of endometrial tissue from curettage and hysterectomy specimens was only modest. This rate was lower in EMH without atypia.

Efficacy of platinum plus cyclophosphamide in patients with epithelial ovarian cancer.

OBJECTIVES: To determine the response rate (RR), 5-year progression-free survival (PFS), and the 5-year survival rate (SVR) of epithelial ovarian cancer patients who received platinum plus cyclophosphamide as adjuvant postoperative chemotherapy. MATERIAL AND METHOD: Epithelial ovarian cancer patients who underwent tumor debulking surgery and received platinum plus cyclophosphamide as adjuvant chemotherapy at Vajira Hospital from January 1995 to December 2003 were identified. All clinical and pathological data were reviewed RESULTS: Among 114 patients included in the present study, 101 patients were evaluable for response. Overall response rate was 79.2%. The 5-year PFS and 5-year SVR were 60.3% (95% confidence interval [95% CI]; 50.5, 70.1%) and 60.7% (95% CI; 50.9, 70.5%) respectively. Subgroup analysis showed better RR, PFS, and SVR in early stage than advanced stage disease. CONCLUSION: The overall RR, 5-year PFS, and 5-year SVR of patients of the whole group were modest. These outcomes were significantly better in the early stage than the advanced stage.

Cost effectiveness of concurrent chemoradiation in comparison with radiation alone in locally advanced cervical cancer.

INTRODUCTION: Concurrent chemoradiation has been advocated to be more effective than radiation alone in the treatment of cervical cancer. However, it certainly has more side effects. Hence, it is worthwhile to investigate the cost-effectiveness (CE) of concurrent chemoradiation in comparison with radiation alone in locally advanced cervical cancer. MATERIAL AND METHOD: The treatment of cervical cancer was modeled using the decision tree where the treatment option would be either concurrent chemoradiation or radiation alone. Patients receiving each treatment had different risks of tumor recurrence. Costs in this analysis were separated into four major categories: costs for treatment of cervical cancer, costs for treatment of major side effects, costs for follow up cancer patients, and costs for diagnosis including supportive care of recurrent cervical cancer Charges were used for the costs of chemotherapy, radiotherapy, drugs, and accessories. Unit cost was used for the costs of laboratory investigations, in-patient and out-patient services. Costs incurred after the first year were discounted at an annual rate of 5%. The benefit was measured as months of life survived. The present study evaluated the patients to 5 years after complete treatment. RESULTS: The CE ratio in the concurrent chemoradiation group was 2,855 and 1,835 Baht/month survived if the chemotherapy was given as in-patient and out-patient respectively. The CE ratio in the radiation group equaled 2,366 Baht/month survived. For the sensitivity analysis, in the situation that chemoradiation was not much better than radiation alone in terms that the recurrent rate from chemoradiation group was not more than 20% lower than the radiation group, radiation therapy alone would be more cost effective even if chemotherapy was given as an out-patient basis. CONCLUSION: Radiation alone was more cost effective than chemoradiation in the treatment of cervical cancer. Nevertheless, if chemotherapy was administered on an out-patient basis, chemoradiation will be more cost effective only if the recurrent rate from the chemoradiation group was more than 20% lower than the radiation group.