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.

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).

Prevalence of exclusive breastfeeding at 3, 4 and 6 months in Bangkok Metropolitan Administration Medical College and Vajira Hospital.

OBJECTIVE: To determine the prevalence of exclusive breastfeeding at 3, 4, and 6 months postpartum in women who delivered at Bangkok Metropolitan Administration Medical College and Vajira Hospital, and to evaluate the potential factors for continuation of exclusive breastfeeding. MATERIAL AND METHOD: A prospective descriptive study was performed in 210 mothers who delivered in the authors' institution between December 1, 2006 and February 28, 2007. All eligible subjects were interviewed before discharge from the hospital. The successive postpartum interviews were then conducted via telephone at 3, 4, and 6 months after delivery. RESULTS: Average maternal age was 27 years and over half (54.3%) were primipara. Rates of exclusive breastfeeding at 3, 4, and 6 months were 48%, 26%, and 11% respectively. Significant factors for exclusive breastfeeding were duration allowed for work absence and intended time to breastfeed. CONCLUSION: Approximately half of the mothers in the present study provided exclusive breastfeeding to their babies in the first 3-month postpartum. The prevalence of exclusive breastfeeding at 6 months was lower than the 30% goal of the 9th National Economic and Social Development Plan. The need to return to work and intended time to breastfeed were the significant factors affecting duration of exclusive breastfeeding.

Prognostic value of p53 expression in early stage cervical carcinoma treated by surgery.

OBJECTIVE: To evaluate the prognostic significance of p53 protein expression in patients with early stage cervical carcinoma treated by surgery alone in a well-controlled study. METHODS: A matched case-control study was performed in patients with stage Ib-IIa cervical carcinoma who underwent radical hysterectomy with pelvic lymphadenectomy. Patients had neither lymph node metastasis nor involvement of the parametrium and surgical margins, and did not receive any adjuvant treatment. Cases included 30 patients who had tumor recurrence within 5 years after surgery; controls included 60 patients who were disease-free for at least 5 years after surgery. Cases and controls were within 10 years of age, had the same stage and tumor type, and underwent surgery on as close to the same date as possible. The tumor sizes of cases and controls were within 1 cm of each other. Expression of p53 protein was studied by immunohistochemistry. Expression was considered positive when at least 10% of tumor cells showed nuclear staining. RESULTS: No significant difference of p53 expression was observed between the case group and the control group (33% versus 40%). High histologic grade of tumors and lymphovascular space invasion were significantly associated with tumor recurrence in multivariable analysis (p=0.012 and 0.014, respectively). CONCLUSION: In this study, expression of p53 did not correlate with tumor recurrence. Immunohistochemistry for p53 protein appears to provide no prognostic information in the patients with early stage cervical cancer treated by surgery.

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.

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.

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.

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%.

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.

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.