Comparison of osteoporosis self assessment tool for Asian (OSTA) and standard assessment in Menopause Clinic, Chiang Mai.

OBJECTIVE: To compare osteoporosis self assessment tool for Asian (OSTA) with the standard measurement of bone mineral density (BMD) by dual energy x-rays absorptiometry (DXA) in- identifying the prevalence of osteopenia and osteoporosis in Thai menopausal women who attended the Menopause Clinic, Faculty of Medicine, Chiang Mai University. MATERIAL AND METHOD: The data was retrospectively collected from the medical records of women who had lumbar femoral neck and radius BMD t-score measurement by DXA (Hologic, QDR-4500C) between January 2004 and December 2005. The body weight and age ofpatients were calculated for the OSTA index score. The women with OSTA score < -1 and > or = -1 were classified as "moderate to high risk" and "low risk" for fracture, respectively. The BMD T-scores of < -1 and > or = -1 were classified as "osteopenia to osteoporosis " and "normal" respectively. RESULTS: Three hundred and fifteen menopausal women of the age of 45-87 years were included. The BMD T-scores assessment revealed that more than half of the subjects had osteopenia to osteoporosis (T-score < or = -1), 196 women (62%) at lumbar spine, 133 women (42.2%) at femur and a third, 114 women (36.2%) at radius respectively. The OSTA index at the standard cut-point of < -1 had a sensitivity and specificity of 36.2% and 71.4% respectively for the lumbar spine and 40.6% and 72.0% respectively for the neck of the femur in predicting osteopenia to osteoporosis status. CONCLUSION: The OSTA index score had a low sensitivity (36-48%) but a high specificity (71-75%) for identifying osteopenic to osteoporotic women among population of menopausal period Nevertheless, it is a useful screening tool in old age women (> 65 years).

One year study of Implanon on the adverse events and discontinuation.

OBJECTIVE: To determine adverse events and discontinuation of Implanon in healthy Thai women between 16 and 45 years of age. DESIGN: Prospective descriptive study. SETTING: Family Planning Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University. SUBJECTS: Ninety-two female volunteers with eligible criteria, no contraindication for hormonal contraceptive and wished to have long-term contraception were recruited. MAIN OUTCOME MEASURES: Determination of adverse events was done three months after Implanon insertion. Discontinuation of Implanon use was reviewed during the study period of one year RESULTS: Amenorrhea (40.2%) and infrequent bleeding (39.1%) were the most menstrual adverse events. While most non-menstrual adverse events were headache/dizziness (27.2%) and lower abdominal pain (23.9%). Severe non-menstrual side effect was rare (1-2%). Seven subjects (7.6%) discontinued using Implanon during the one year period of study. CONCLUSION: Implanon demonstrated a high continue rate at the first year of insertion. It produced similar adverse events like other progestin-only contraceptives. Counseling before insertion is important for increased client satisfaction and a higher continuation rate.

Immediate complications of laparoscopic tubal sterilization: 11 years of experience.

OBJECTIVE: To evaluate the complications of laparoscopic tubal sterilization. METHOD: A retrospective study of laparoscopic tubal sterilization performed at Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai, Thailand was conducted. The details of the operation, including complications and operation time were collected from the operative and family planning registry. RESULTS: Between January 1987 and December 1997, 948 cases of laparoscopic tubal sterilization were performed as an outpatient setting. The combination of intravenous sedation and local anesthesia was employed in all cases. Minor intra-operative complications were found in 4.6% of cases. The most frequent complications were meso-salphingeal and meso-ovarian bleeding. No serious complication was found in this study. The mean operation time was 19.3 minutes (range 5-75 minutes). CONCLUSION: The present study suggested that out-patient laparoscopic tubal sterilization under the combination of intravenous sedation and local anesthesia is a convenient and relatively safe procedure.

Symptoms of estrogen deficiency in nursing personnel in Maharaj Nakorn Chiang Mai Hospital.

OBJECTIVE: To determine the self-reported prevalence and severity of climacteric symptoms of estrogen deficiency in nursing personnel working in Maharaj Nakorn Chiang Mai Hospital during the year 2002. DESIGN: Cross-sectional descriptive study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University. SUBJECT: Six-hundred and eight nursing personnel, including professional nurses and practical nurses, aged 40-60 years, working in Maharaj Nakorn Chiang Mai Hospital. MATERIAL AND METHOD: The same sets of questionnaires were provided and distributed to each subject. Subjects had self assessment under individual decision with written consent and data was prospectively collected. The data were analyzed using software SPSS version 10 and presented in frequencies and percentage. MAIN OUTCOME MEASURE: The prevalence and severity of each climacteric symptoms. RESULTS: Five-hundred and seventy five of 608 subjects (94.6%) responded to the questionnaires, 62.6% of them were in normal reproductive period, while the remainder (37.4%) were in the menopausal period. The latter group was divided into 4 subgroups of pre/peri-menopause, post menopause, surgical menopause and premature ovarian failure. The prevalence of climacteric symptoms was systematically classified as follows, vasomotor instability 40.7% (severe cases, 5.4%), psychosomatic symptoms 50.9% (severe cases, 3.9%), lower urinary tract symptoms 29.1% (severe cases, 2.4%), lower genital tract symptoms 34.0% (severe cases, 2.7%), and other symptoms 50.7% (severe cases, 4.3%). The first five most common symptoms were as follows, forgetful 84.1% (severe cases, 7.9%), myalgia 74.3% (severe cases, 10.6%), anxious 71.0% (severe cases, 5.3%), tired 70.0% (severe cases, 4.1%), headache 68.3% (severe cases, 8.3%). The least common symptom was needle pain, the prevalence was 19.7% (severe cases, 1.3%). The overall prevalence of women using hormone replacement therapy was 13.1%, only 8.9% were current users. CONCLUSION: Focusing on each symptom of climacteric symptoms, the authors found high prevalence in psychosomatic symptoms and other symptoms such as forgetful, myalgia, anxious, tired and headache. While the classic symptom (vasomotor instability) was found to be low in the present study which was different from the previous reports. This may be due to the racial or cultural and educational factors among different populations.