Experience on triple markers serum screening for Down's syndrome fetus in Hat Yai, Regional Hospital.

OBJECTIVES: To summarize the experience and evaluate the performance of the Hat Yai maternal serum screening (MSS) program. SETTING: The Hat Yai MSS program between 16 February 2003 and 11 March 2004. MATERIAL AND METHOD: The uptake of screening was 999 in 1,040 women (96.0%), between 14 to 20 weeks of gestation with the triple markers: Alpha-fetoprotein (AFP), human Chorionic Gonadotropin (hCG), and unconjugated Estriol (uE3) by Immulite chemiluminescent immunoassay system, Diagnostic Product Corporation (DPC). The risk cut-off for Down 's syndrome is one in 250 or greater, based on software for prenatal Down's syndrome risk calculation, by Prisca 3.5 DPC. RESULTS: There were 119 in 999 cases (11.9%) of the triple test positive. Amniocentesis had been performed on voluntary basis, and the uptake rate of amniocentesis following a positive Down's syndrome screening was 104 in 119 cases (87.3%). Based on clinical diagnosis of Down's syndrome in the newborns of non-amniocentesis mothers, assuming that normal looking babies were not Down's syndrome, the sensitivity (SENS), specificity (SPEC), positive predictive value (PPV), and negative predictive value (NPV) of all chromosomal abnormalities were 85.7%, 88.6%, 5.0%, and 99.8% respectively. The false positive rate was 113 in 992 cases (11.4%). Whereas, the SENS, SPEC, PPV and NPV of Down's syndrome were 100%, 88.4%, 3.4%, and 100% respectively. The false positive rate was 115 in 995 cases (11.6%). The mean level, median level, and multiple of median (MoM) of triple markers were demonstrated. CONCLUSION: The Down's syndrome screening is a systematic application of a test to identify subjects at increased risk of a specific disorder; of course it is not diagnostic, but to benefit making decision regarding further amniocentesis. The sensitivity of Prisca 3.5 software was satisfactory but false positive rate was remarkably high. It needs further standardization with adjusted MoM values.

Efficacy comparison of Pueraria mirifica (PM) against conjugated equine estrogen (CEE) with/without medroxyprogesterone acetate (MPA) in the treatment of climacteric symptoms in perimenopausal women: phase III study.

OBJECTIVE: To evaluate the efficacy comparison of Pueraria mirifica (PM), name in Thai is Kwao Kruea Khao, against conjugated equine estrogen (CEE) with/without medroxyprogesterone acetate (MPA) in the treatment of perimenopuasal women with climacteric symptoms. MATERIAL AND METHOD: Perimenopausal women attending the Menopausal clinic of Hat Yai Regional Hospital were voluntarily recruited. The vasomotor symptoms such as hot flushes and night sweats, as well as other unpleasant symptoms, urogenital and psychological symptoms, were also assessed. Patients were voluntarily enrolled and randomly received daily 50 mg raw material of PM, Group A, or daily 0.625 mg of conjugated equine estrogen (CEE) with/without 2.5 mg of medroxyprogesterone acetate (MPA), Group B, depend on non-hysterectomized/hysterectomized condition. RESULTS: Seventy-one patients were enrolled. Eleven of those were excluded for failing to complete the initial work-up and follow-up. Sixty cases were evaluated, 30 cases in Group A and 30 cases in Group B. After medication, the mean of modified Greene climacteric scale (MGCS) in Group A/Group B had decreased from 29.0/32.26 to 17.86/18.1, 12.56/9.57 and 9.9/8.16 at 1-, 3-, and 6- month respectively. The clinical satisfaction using MGCS was not statistically significant between PM (Group A) and CEE with/without MPA (Group B) in the alleviation of climacteric symptoms (p-value > 0.05). There were no statistically significant changes of three serum markers: estradiol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) between both groups. CONCLUSION: PM, containing phytoestrogens, has estrogenic effect as similar as CEE, and can alleviate the climacteric symptoms in perimenopausal women. PM demonstrates great promise in the treatment of climacteric symptoms. However, optimal doses should be clinically assessed to meet appropriate individual responses.

Challenges in the conduct of Thai herbal scientific study: efficacy and safety of phytoestrogen, pueraria mirifica (Kwao Keur Kao), phase I, in the alleviation of climacteric symptoms in perimenopausal women.

OBJECTIVE: To evaluate the preliminary efficacy and safety of Pueraria mirifica (Kwao Keur Kao), phytoestrogen, for the alleviation of climacteric symptoms. MATERIAL AND METHOD: Perimenopausal women attending with climacteric symptoms, such as hot flushes and night sweats, were invited to join the present study, conducted at the Menopausal Clinic, Hat Yai Regional Hospital. The patients were voluntarily enrolled and randomly received the raw material of Pueraria mirifica, oral 50 and 100 mg capsule, once daily for six months, as an open-label study. RESULTS: Of the 10 enrolled patients, 8 cases were completely evaluated. The modified Greene climacteric scale (MGCS) was satisfactorily decreased in both groups. The average scale declined from 44.1 at baseline, to be 26, 17, and 11.1 at 1-, 3-, and 6- month follow-up respectively. No other laboratory abnormalities, except one case had transiently increased the creatinine level, and one case of increased blood urea nitrogen. The mean serum estradiol was slightly increased, while the mean serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were nearly stable. CONCLUSION: Pueraria mirifica is relatively safe and preliminarily alleviates the climacteric symptoms in perimenopausal. women, but the data is insufficient to draw definite conclusions regarding the estrogenic effect.

Gynecologic tumors during childhood and adolescence.

The majority of genital tumors are similar in almost all of the cell types but the frequency is different between children, adolescents, and female adults. The primary site of tumor is similar to the adults, however, the potential of malignant occurrence is higher among children and adolescents. The outline of this article covers clinical manifestation, differential diagnosis, investigation, and management in the particular disease/condition. The challenges of gynecology in children and adolescents are the complexity of physical and mental health, so the approach needs delicate skill and reasoning. Because they are not in full adulthood but in the transitional stage, the multidisciplinary and meticulous approach and management is a substantial issue. Balance and flexibility are the main key of this medical care. Extreme surgical intervention leading to over treatment or ignorance and carelessness leading to under quality of care are challenges facing the doctor.

Efficacy and safety of Pueraria mirifica (Kwao Kruea Khao) for the treatment of vasomotor symptoms in perimenopausal women: Phase II Study.

OBJECTIVES: To evaluate the preliminary efficacy and safety of Pueraria mirifica in the treatment of vasomotor symptoms. DESIGN: Open-label study. SETTING: Hat Yai Regional Hospital, Thailand. SUBJECTS: Pre and postmenopausal women with vasomotor symptoms, such as hot flushes and night sweats. Other unpleasant symptoms, urogenital and psychological symptoms, were also evaluated. MATERIAL AND METHOD: Patients were enrolled voluntarily and randomly received 50 mg or 100 mg of Pueraria mirifica in capsules, once daily for six months. RESULTS: Of the 48 enrolled patients, 11 cases were excluded for failing to complete the initial work-up. Thirty-seven cases were evaluated. 20 of 37 (54.1%) randomly received a dose of 50 mg/day of Pueraria mirifica (Group A), and 17 of 37 (45.9%) received 100 mg/day of Pueraria mirifica (Group B). The mean of the modified Greene climacteric scale decreased from 35.6 to 26.6, 17.2 and 15.1 in group A, while group B, declined from 32.6 to 21.0, 14.8 and 13.6 at 1-, 3- and 6-month respectively. The mean serum estradiol, fluctuated from the baseline of 76.6 to 55.4, 56.7, 72.5, 69.2, 114.2 and 74.5 pg/ml at 1-, 2-, 3-, 4-, 5- and 6-month respectively. Whereas the mean serum follicle-stimulating hormone (FSH)/luteinizing hormone (LH) was stable in the range of; 27.1/12.6, 28.3/12.9 and 22.5/11.4 mIU/ml at baseline, 3- and 6-month respectively. CONCLUSIONS: Pueraria mirifica, containing phytoestrogens, relatively alleviated the climacteric symptoms in perimenopausal women. The transient negative profiles occurred in a small number of subjects that included anemia, and liver profiles. While there was a slight decrease in lipoproteins and an increase in hormonal profiles, Pueraria mirifica demonstrates great promise in the treatment of climacteric symptoms among perimenopausal women. However, optimal doses should be clinically assessed, to meet appropriate individual responses.

Efficacy, safety and acceptability of a seven-day, transdermal estradiol patch for estrogen replacement therapy.

OBJECTIVES: To evaluate the efficacy, safety and acceptability of a seven-day, transdermal estradiol patch, in the treatment of menopausal symptoms. DESIGN: Open-label trial. SETTING: Hat Yai Regional Hospital, Thailand. SUBJECTS: Hysterectomized women with surgical or natural menopause. METHOD: The clients received a 12.5 cm2 matrix patch, containing 3.9 mg of estradiol delivering 0.05 mg/day, once a week for six months. The efficacy, safety, and acceptability were evaluated at the end of 1-, 3- and 6-months. RESULTS: Six-month responses were analyzed among 50 enrolled patients. The mean estradiol level/Follicle Stimulating Hormone/Lutienizing Hormone were 27.88/70.03/31.19, 44.08/53.37/26.86, and 42.43/48.53/24.39 pg/ml, mIU/L, mIU/L at admission, 1- and 3-months, respectively. The average climacteric score was 27.18, 16.60, 12.78, and 12.18 at admission, 1-, 3- and 6-month, respectively. At least 94 per cent of patches were not dislodged more than one quarter. The most common skin irritation was itching, followed by erythema, vesicle, and burning sensation. The patches were generally well tolerated, and acceptability was satisfactory. CONCLUSION: Transdermal estradiol patch effectively reduced the severity of menopausal symptoms, measured by modified climacteric score. Adhesion was found to be excellent. In actual clinical practice, the transdermal patch should be appropriately introduced to tolerant users.