Premature infants receiving delayed cord clamping with and without cord milking: a randomized control trial.

BACKGROUND: Preterm infants often have long hospital stays and frequent blood tests; they often develop anemia requiring multiple blood transfusions. Placental transfusion via delayed cord clamping (DCC) or umbilical cord milking (UCM) helps increase blood volume. We hypothesized umbilical cord milking (UCM), together with DCC, would be superior in reducing blood transfusions. OBJECTIVES: To compare the effects of DCC and DCC combined with UCM on hematologic outcomes among preterm infants. METHODS: One hundred twenty singleton preterm infants born at 280/7- 336/7 weeks of gestation at Thammasat University Hospital were enrolled in an open-label, randomized, controlled trial. They were placed into three groups (1:1:1) by a block-of-three randomization: DCC for 45 s, DCC with UCM performed before clamping (DCM-B), and DCC with UCM performed after clamping (DCM-A). The primary outcomes were hematocrit levels and number of infants receiving blood transfusions during the first 28 days of life. Intraventricular hemorrhage (IVH) and necrotizing enterocolitis (NEC) were secondary outcomes. Analyses were performed with an intent-to-treat approach. RESULTS: One hundred twenty preterm infants were randomized. There was no statistically significant difference in neonatal outcomes; hematocrit on admission 54.0 ± 5.5, 53.3 ± 6.0, and 54.3 ± 5.8 (p = 0.88), receiving blood transfusions 25%, 20%, and 12.5% (p = 0.24), incidence of NEC 7.5, 0 and 10% (p = 0.78) in the DCC, DCM-B and DCM-A groups, respectively. There were no preterm infants with severe IVH, polycythemia, maternal or neonatal death. CONCLUSION: The placental transfusion techniques utilized, DCC and DCC combined with UCM, provided the same benefits for preterm infants born at GA 28 and 33 weeks in terms of reducing the need for RBC transfusions, severities of IVH and incidence of NEC without increasing comorbidity. TRIAL REGISTRATION: TCTR20190131002 . Registered 31 January 2019-Retrospectively registered.

Real-life effectiveness of COVID-19 vaccine during the Omicron variant-dominant pandemic: how many booster doses do we need?

The surge in coronavirus disease 2019 (COVID-19) caused by the Omicron variants of the severe acute respiratory syndrome coronavirus 2 necessitates researches to inform vaccine effectiveness (VE) and other preventive measures to halt the pandemic. A test-negative case-control study was conducted among adults (age ≥18 years) who were at-risk for COVID-19 and presented for nasopharyngeal real-time polymerase chain reaction testing during the Omicron variant-dominant period in Thailand (1 January 2022-15 June 2022). All participants were prospectively followed up for COVID-19 development for 14 days after the enrolment. Vaccine effectiveness was estimated and adjusted for characteristics associated with COVID-19. Of the 7971 included individuals, there were 3104 cases and 4867 controls. The adjusted VE among persons receiving 2-dose, 3-dose, and 4-dose vaccine regimens for preventing infection and preventing moderate-to-critical diseases were 33%, 48%, 62% and 60%, 74%, 76%, respectively. The VE were generally higher among those receiving the last dose of vaccine within 90 days compared to those receiving the last dose more than 90 days prior to the enrolment. The highest VE were observed in individuals receiving the 4-dose regimen, CoronaVac-CoronaVac-ChAdOx1 nCoV-19-BNT162b2 for both preventing infection (65%) and preventing moderate-to-critical diseases (82%). Our study demonstrated increased VE along with an increase in number of vaccine doses received. Current vaccination programmes should focus on reducing COVID-19 severity and mandate at least one booster dose. The heterologous boosters with viral vector and mRNA vaccines were highly effective and can be used in individuals who previously received the primary series of inactivated vaccine.

Comparison of near vision in glaucoma patients using standard and reversed-contrast charts.

CLINICAL RELEVANCE: Reversed-contrast testing is easy to perform via electronic devices and may improve reading performance and the quality of life of most glaucoma patients. BACKGROUND: Electronic devices are becoming increasing popularity and most devices have easily adjustable contrast settings. This study investigated near vision acuity and preference between the standard visual acuity chart (black text on white background) and a reversed-contrast chart (white text on black background) in glaucoma patients with decreasing contrast sensitivity. METHODS: This cross-sectional study evaluated 177 eyes of 177 patients from a single glaucoma clinic. The better eye of primary glaucoma patients (visual acuity of 6/20 or better) was evaluated. Patients with any other condition affecting visual acuity or reading performance were excluded. Near visual acuity was measured using a device with an anti-glare screen at 40 cm distance for both standard and reversed-contrast charts. RESULTS: Glaucoma patients had a significantly better average near visual acuity using the reversed-contrast chart than using the standard chart (median best-corrected visual acuity, LogMAR = 0.12; interquartile range = 0.18 vs median best-corrected visual acuity, LogMAR = 0.2; interquartile range = 0.26; respectively; P < 0.01), with more prominent differences in the advanced glaucoma group (median best-corrected visual acuity of reversed contrast chart: median best-corrected visual acuity of standard chart = 0.12:0.2, 0.12:0.13, and 0.18:0.22 in the early, moderate, and severe groups, respectively, P < 0.01 in early and severe group and P = 0.02 in moderate group). One hundred and nine (109) out of 177 patients (61.58%) preferred the reversed contrast version. CONCLUSION: Reversed contrast materials may improve the reading performance and quality of life of patients with glaucoma, especially those with severe disease.

Evaluation and external validation of minor lymphatic pelvic pathway for distant metastases in cervical cancer patients treated with concurrent chemoradiotherapy.

To evaluate and validate the minor lymphatic pathway for distant metastases in cervical cancer. This is a retrospective cohort of cervical cancer patients underwent curative concurrent chemoradiotherapy. We used original dataset from 1 university hospital and validation dataset from 3 university hospitals. Lymphadenopathy status in CT imaging was reviewed by radiologist in either the obturator and external iliac nodes (major pathway) or the internal iliac and presacral nodes (minor pathway). We then used Cox regression to adjust for all potential confounders, including paraaortic nodes, T stage, histology, age, total treatment time, total number of nodes, total short axis of nodes. 397 and 384 patients were in the original and validation datasets (median follow-up period, 59.5 month's). The minor pathway was independent prognostic factor in multivariable analysis [HR=2.64; 95%CI=1.07-6.55; P = 0.036] and [HR=14.84; 95%CI=3.15-70.01; P= 0.001] in original and validation datasets, respectively. Whereas, the major pathway was statistically non-significant. Further validation showed that the minor pathway had the highest HR for distant metastases with both the EMBRACE (HR=6.05; 95% CI=1.30-28.08; P = 0.022) and the FIGO 2018 (HR=7.43; 95% CI=2.94-18.78; P<0.001) in the original dataset. A similar result was found with the validation dataset: EMBRACE, HR=30.91; 95% CI=2.78-343.62; P = 0.005; and FIGO 2018, HR=42.41; 95% CI=8.83-203.60; P<0.001.This is the first clinical study to validate that the minor lymphatic pathway was predominantly associated with distant metastases in cervical cancer. This finding should be validated in larger cohort to further integrate in standard staging for prediction of distant metastases.

Development and validation of a prognostic prediction model including the minor lymphatic pathway for distant metastases in cervical cancer patients.

To develop and validate a prognostic model, including the minor lymphatic pathway (internal iliac and presacral nodes). STUDY DESIGN: Retrospective cohort. PARTICIPANTS: Locally advanced cervical cancer underwent concurrent chemoradiotherapy. SAMPLE SIZE: 397 and 384 patients in the development and validation data set. PREDICTORS: Our new nodal staging system with the minor lymphatic pathway. OUTCOME: Distant metastases. STATISTICAL ANALYSIS: Cox regression; net reclassification improvement (NRI) and decision curve analysis (DCA). Our new nodal system was the strongest predictor. The predictors in the final model were new nodal system, tumor stage, adenocarcinoma, initial hemoglobin, tumor size and age. The nodal system and the pretreatment model had concordance indices of 0.661 and 0.708, respectively, with good calibration curves. Compared to the OUTBACK eligibility criteria, the nodal system showed NRI for both cases (22%) and controls (16%). The pretreatment model showed NRI for cases (31%) and controls (18%). DCA in both models showed threshold probability of 15% and 12%, respectively, when compared with 24% in OUTBACK eligibility criteria. Our new nodal staging system and the pretreatment model could differentiate between high-risk and low-risk patients, thus facilitating decisions to provide more aggressive treatment to prevent distant metastases.

Predicting Factors for Pelvic Lymph Node Metastasis in Patients with Apparently Early-Stage Endometrial Cancer.

BACKGROUND: Performing lymphadenectomy in all patients with early-stage endometrial cancer (EC) is debatable because the procedure may expose patients to unnecessary risks of postoperative complications. Aim of this study was to evaluate the prevalence and risk factors of pelvic lymph node metastasis (PLNM) in patients with apparently early-stage EC. MATERIALS AND METHODS: Two hundred and two patients with apparently early-stage EC who underwent surgical staging at Thammasat University Hospital between the years 2013 and 2020 were included in this retrospective study. Clinicopathological data and preoperative laboratory results were obtained from computer-based medical records. All data were statistically analyzed to determine the prevalence of PLNM and risk factors for developing PLNM. RESULTS: PLNM was detected in 22 (10.9%) patients. Univariate analysis demonstrated that having grade 3 tumor, myometrial invasion of 50% or greater, vaginal involvement, cervical involvement, adnexal involvement, lower uterine segment involvement, lymphovascular space invasion (LVSI), and positive peritoneal cytology were associated with higher risk for developing PLNM. In addition, lower preoperative hemoglobin level and higher preoperative white blood cell count were significantly associated with PLNM. Multivariate analysis demonstrated that myometrial invasion of 50% or greater and LVSI were independent risk factors for developing PLNM (odds ratio (OR) 9.31, 95% confidence interval (CI) 2.58-33.55, p = 0.001, and OR 3.73, 95%CI 1.39-10.02, p = 0.009, respectively). CONCLUSIONS: Myometrial invasion of 50% or greater and LVSI were independent risk factors for developing PLNM in patients with apparently early-stage EC and thus lymphadenectomy in these patients should be provided.

Comparing real-life effectiveness of various COVID-19 vaccine regimens during the delta variant-dominant pandemic: a test-negative case-control study.

Data on real-life vaccine effectiveness (VE), against the delta variant (B.1.617.2) of the severe acute respiratory syndrome coronavirus 2 among various coronavirus disease 2019 (COVID-19) vaccine regimens are urgently needed to impede the COVID-19 pandemic. We conducted a test-negative case-control study to assess the VE of various vaccine regimens for preventing COVID-19 during the period when the delta variant was the dominant causative virus (≥ 95%) in Thailand (25 July 2021-23 Oct 2021). All individuals (age ≥18 years) at-risk for COVID-19, presented for nasopharyngeal real-time polymerase chain reaction (RT-PCR) testing, were prospectively enrolled and followed up for disease development. Vaccine effectiveness was estimated with adjustment for individual demographic and clinical characteristics. Of 3353 included individuals, there were 1118 cases and 2235 controls. The adjusted VE among persons receiving two-dose CoronaVac plus one BNT162b2 booster was highest (98%; 95% confidence interval [CI] 87-100), followed by those receiving two-dose CoronaVac plus one ChAdOx1 nCoV-19 booster (86%; 95% CI 74-93), two-dose ChAdOx1 nCoV-19 (83%; 95% CI 70-90), one CoronaVac dose and one ChAdOx1 nCoV-19 dose (74%; 95% CI 43-88) and two-dose CoronaVac (60%; 95% CI 49-69). One dose of CoronaVac or ChAdOx1 nCoV-19 had a VE of less than 50%. Our study demonstrated the incremental VE with the increase in the number of vaccine doses received. The two-dose CoronaVac plus one BNT162b2 or ChAdOx1 nCoV-19 booster regimens was highly effective in preventing COVID-19 during the rise of delta variant.

Effect of staining methods on human sperm morphometrics using HT CASA II.

OBJECTIVE: To utilize computer-assisted semen analysis (CASA) for comparison of sperm morphometrics between fresh sperm and three different staining methods METHODS: Semen samples from 140 volunteers were stained with Diff-Quik (DQ), SpermBlue (SB), and black glutinous rice extract (BR). Morphometry by automatic CASA evaluated head defects, width, length and presence of normal sperm and acrosomes. RESULTS: Comparison of width and length between fresh sperm heads and those stained by the three methods found that DQ produced averages that were higher (p<0.05), whereas results obtained from SB and BR dyes were consistent with those of fresh sperm. Parameter measurements between SB and BR did not statistically significantly differ. In contrast, sperm head defects were found to be significantly varied among all techniques. Also, percentages of normal sperm and normal acrosomes were significantly different (p<0.05), with the exception that percentage of normal acrosomes from DQ were consistent to those from SB and BR. CONCLUSION: The implemented stains will impact sperm morphometrics. This dilemma can be mitigated if specific criteria of CASA parameters are defined for each stain; this would be particularly applicable for evaluation of novel dyes.

Development of clinical prediction rule for diagnosis of autistic spectrum disorder in children.

PURPOSE: This study aims to develop a clinical prediction rule for the diagnosis of autistic spectrum disorder (ASD) in children. DESIGN/METHODOLOGY/APPROACH: This population-based study was carried out in children aged 2 to 5 years who were suspected of having ASD. Data regarding demographics, risk factors, histories taken from caregivers and clinical observation of ASD symptoms were recorded before specialists assessed patients using standardized diagnostic tools. The predictors were analyzed by multivariate logistic regression analysis and developed into a predictive model. FINDINGS: An ASD diagnosis was rendered in 74.8 per cent of 139 participants. The clinical prediction rule consisted of five predictors, namely, delayed speech for their age, history of rarely making eye contact or looking at faces, history of not showing off toys or favorite things, not following clinician's eye direction and low frequency of social interaction with the clinician or the caregiver. At four or more predictors, sensitivity was 100 per cent for predicting a diagnosis of ASD, with a positive likelihood ratio of 16.62. ORIGINALITY/VALUE: This practical clinical prediction rule would help general practitioners to initially diagnose ASD in routine clinical practice.

Predictors of Absent High-grade Cervical Intraepithelial Neoplasia (CIN) in Loop Electrosurgical Excision Procedure Specimens of Patients with Colposcopic Directed Biopsy-Confirmed High-Grade CIN

Objective: To determine predictors of having cervical intraepithelial neoplasia (CIN) 1 or less in loop electrosurgical excision procedure (LEEP) specimens of patients with colposcopic directed biopsy-confirmed CIN 2-3. Methods: Two hundred and eighty patients with colposcopic directed biopsy-confirmed CIN 2-3 who subsequently underwent LEEP were enrolled in the retrospective study. Related clinical data were collected to determine the predictors of CIN 1 or less in LEEP specimens. Results: CIN 1 or less in LEEP specimens was found in 71 (25.4%) of 280 patients. Multivariate logistic regression analyses demonstrated that nulliparity [OR (95% CI) = 3.375 (1.245-9.150)], low grade Papanicolaou (Pap) results [OR (95% CI) = 6.410 (2.877-14.280)] and low grade colposcopic impression [OR (95% CI) = 16.506 (5.844-46.632)] were significant risk factors of having CIN 1 or less in LEEP specimens. Neither persistent nor recurrent CIN 2-3 was detected in 71 patients who had CIN 1 or less in LEEP specimens. However, persistent or recurrent CIN 2-3 developed in 3 out of 209 (1.4%) patients with CIN 2-3 found in LEEP specimens. Conclusion: Approximately 25% of patients with CIN 2-3 in colposcopic directed biopsy specimens had CIN 1 or less found in LEEP specimens. Predicting factors of having CIN 1 or less in LEEP specimens were nulliparity, low grade Pap results and low grade colposcopic impression.

Possibility of using superoxide dismutase and glutathione peroxidase as endometriosis biomarkers.

OBJECTIVE: To study the possibility of using superoxide dismutase (SOD) and glutathione peroxidase (GPx) as combined preoperative biomarkers for endometriosis. PARTICIPANTS AND METHODS: Female patients aged between 18 and 45 years old who came to the Gynecology outpatient clinic, Thammasat University Hospital, during September 2013-2016 with the complaint of gynecologic symptoms suspected of endometriosis, and who were positively diagnosed with endometriosis, were included in this study. All patients underwent conservative laparoscopic ovarian cystectomy with histopathological report. The control group consisted of healthy females of reproductive age who came to the outpatient clinic. The plasma SOD and GPx were measured from blood samples with commercial kits. A receiver operating characteristic curve was generated for plasma activity of SOD, GPx, and combined tests. The cutoff values were selected at the most appropriate sensitivity and specificity. RESULT: All 36 cases were included in this study. Mean ages of patients in the patient and control groups were 33.1 and 28.6 years old, respectively. SOD and GPx activities of disease and control group were 6.15 and 8.11, 463.9 and 472.34 nmole/min/mL unit, respectively. The sensitivity and 1-specificity of the combined test were calculated at 0.78, with sensitivity, specificity, accuracy, positive predictive value, and negative predictive value being 68.75, 80.77, 76.50, 69.23, and 80.33, respectively. CONCLUSION: A combination testing of SOD and GPx can possibly be used as preoperative biomarker for endometriosis.

Quality of Life in Cervical Cancer Survivors and Healthy Women: Thai Urban Population Study

Background : To determine a baseline quality of life (QoL) in cervical cancer survivors compared to that of healthy subjects in the tertiary Thammasat University Hospital, Thailand. Materials and Methods: The investigation was conducted at the outpatient gynecological department of Thammasat University Hospital between January and June 2016. A total of 192 women were entered into the study (97 cervical cancer survivors; 37 after radical hysterectomy (RH), 43 with concurrent chemoradiation (CRT), and 17 featuring both RH and CRT; and 95 control subjects from the same outpatient department with no history of malignancy). Participant QoL was assessed using a Thai version of the EORTC-QLQ-C30 (European Organization for Research Treatment of Cancer Quality-of-Life) and a general survey for the assessment of sociodemographic data was also conducted. Results: There were significant differences in physical, role, emotional and social functions between cervical cancer survivor and control groups. Global health, fatigue, pain, appetite loss, and financial difficulties also demonstrated statistically significant variation. Cervical cancer survivors treated by RH had higher scores for emotional and social function and global health than the control group. Moreover, they had less appetite loss, fatigue and financial difficulties. However, patients treated with CRT experienced more pain than the control group. All cervical cancer survivors had lower physical function scores than the control group. Conclusion: Quality of life in cervical cancer survivors is better than in healthy peers in some domains. Cervical cancer survivors treated with RH may have a better QoL than healthy peers. Early detection for early stage cervical cancer remains most important because treatment in early stages does not cause lowering of the QoL.

Clinical Factors Associated with Specimen Adequacy for Conventional Cervical Cytology in Thammasat University Hospital, Thailand.

PURPOSE: To study clinical factors related to adequacy of transformation zone (TZ) components in cervical smears. MATERIALS AND METHODS: Medical and Papanicolaou (Pap) smear reports from Thammasat University Hospital, Thailand during January to December 2015 were collected. Demographic data was reviewed by attending physicians and impact of clinical factors onTZ adequacy was primary outcome. A total of 3,251 smears were reviewed. Finally, 2,098 smears met The inclusion criteria and enrolled into this study. RESULTS: Average age and bodyweight of participants in this study were 43.0 years and 60.0 kg, respectively. Ninety seven percent of smears were classified as satisfactory for evaluation according to the Bethesda system 2001. Adequacy (group A) and inadequacy (group B) of TZ were equal in percentage (50.9/46.0). Prevalence of abnormal cervical cytology was 4.4%. Percentages of abnormal Pap smears in group A and B were 7.3 and 1.4, respectively (p<0.001). Factors associated with increased adequacy of TZ were old-age (≥ 50 yr), nulliparity, within 3-months postpartum, history of TZ inadequacy and abnormal smears. Sexually transmitted disease (STD), hormonal usage, previous cryotherapy and smears collected by staff were associated with inadequacy of TZ. CONCLUSIONS: Collection of cervical specimens should be carefully performed. STD history, hormonal usage and previous cryotherapy are risk factors for TZ inadequate specimens.

A Comparative Study of the Spontaneous Labor Rate in Scheduled Elective Cesarean Section at 38 Weeks versus 39 Weeks of Gestation in Parturient with Previous Cesarean Section.

Objective: To assess the effect of the different scheduled gestational age for a repeat elective cesarean section (CS) on emergency cesarean section rate and adverse pregnancy outcomes in pregnant women with history of previous CS. Material and Method: A prospective cohort study of singleton pregnant women who had a history of CS and were scheduled for a repeat elective CS to be performed. The cases were divided into two groups of which the elective CS was appointed at 38 or 39 weeks of gestation as study and control groups, respectively. Emergency cesarean section rate, maternal and neonatal complications were defined as main outcomes. Results: Of 415 scheduled elective repeat cesarean deliveries performed at 38 weeks of gestation or later, 209 were scheduled between 38 0/7 and 38 6/7 weeks (study group), and 206 were scheduled between 39 0/7 and 39 6/7 weeks (control group). Most of the cases had one previous cesarean delivery. The emergency CS rate before schedule in the study group was significantly less than in the control group (15.3% vs. 51%, p<0.001). Spontaneous labor pain was a major factor to have unplanned delivery. The maternal intra-operative complications were significantly increased in women who had emergency cesarean before schedule compared to elective CS on scheduled in 38 weeks group (25% vs. 12.9%, p<0.001) and 39 weeks group (31.4% vs. 14%, p<0.001). The major intra-operative complication was uterine atony. There were no statistically significant differences in maternal post-operative and neonatal complications in scheduled elective CS in 38 and 39-week group. Transient tachypnea of the newborn (TTNB) was higher in elective CS at 38 week compared to emergency CS. Conclusion: The emergency CS rate in 39 weeks gestation group was significantly higher than 38 weeks group. The incidence of adverse maternal intra-operative complications was statistically difference with emergency CS when compared to elective CS in case and control groups. Recommendation of elective repeated CS at GA39 weeks may be suitable only under some circumstances. The number of prior CS is one of factors that should be considered.

Nomogram of Intracranial Translucency in the First Trimester Ultrasound of Pregnant Women at Thammasat University Hospital.

Objective: The aim of the study was to determine normative values of intracranial translucency (IT) by ultrasonography in singleton pregnant women patient at Thammasat University Hospital during the first trimester. Material and Method: The first trimester singleton pregnant women (11-13 weeks) underwent routine ultrasonography screening. The gestational age was calculated by measuring the length of the embryo or fetus from the top of its head to bottom of the buttocks (crown-rump length; CRL) and IT of the brain region in the mid-sagittal planefetal face position. Repeated ultrasonography was performed in the second trimester period as well as after birth infant check-up for disability. Results: One hundred and ninety one singleton pregnant women were examined by an ultrasonography to measure CRL, GA and IT. The average age was 29.71±5.09 years (16-39 years). All participants were healthy without a history of anomaly in previous pregnancies. Half of cases were nulliparity. Participants were followed until birth. There was no open neural tube defect baby in this study. Median GA, CRL and IT in this study were 12.6+0.7 weeks, 64.0±10.2 (40.0-80.9) and 1.3±0.3 (0.5-2.5) mm, respectively. IT measurement value increased in correlation with increasing CRL and advancing GA (p<0.05). Conclusion: IT values increased significantly with CRL and GA increasing.

Efficacy of Delayed versus Immediate Cord Clamping in Late Preterm Newborns following Normal Labor: A Randomized Control Trial.

Background: Premature neonates are susceptible to anemic problems with low iron storage. Delayed cord clamping (DCC) has been studied and its beneficial value has been supported by existing research in newborns with very low birth weights. But there were only few data pertinent to late preterm infants. Objective: To investigate the effect of delayed cord clamping (DCC) as compared with immediate cord clamping (ICC) on the hematocrit level at 48 hours in late preterm neonates after vaginal delivery. Material and Method: The design consisted of a randomized controlled trial. One hundred pregnant women who were admitted because of preterm labor (GA 34-36(+6) week) in active phase were recruited and allocated into two groups, designated as the ICC and DCC groups. The DCC were defined as the case in which patients underwent the umbilical cord clamping at 120 seconds after birth. At 48 hours after delivery, both the hematocrit (Hct) and microbilirubin (MB) levels of newborns were determined. Also, neonatal and maternal complications were recorded. Result: Eighty-six neonates were analyzed. There were no statistical differences in the baseline data of maternal symptoms and newborns between the two groups. Neonates in the DCC group had a significantly higher hematocrit level than the ICC group (55.4% and 47.6%, respectively: p = 0.02). The MB level in the DCC group was also significantly higher than in the ICC group (9.4% and 8.6 mg %, respectively: p = 0.04). However, phototherapy and length of hospitalization in both groups were not different. There were no serious maternal and fetal complications in either group. Conclusion: The DCC procedure could raise the Hct level in the late preterm newborns without serious adverse effects. But more evidence is needed to explore the possible benefit of this procedure.

Recurrence of Endometrioma Following Conservative Ovarian Endometrioma Cystectomy: Laparoscopy versus Laparotomy.

OBJECTIVE: To investigate the recurrence rate and disease-free interval between laparoscopy versus laparotomy for the conservative surgery of endometrioma. MATERIAL AND METHOD: A retrospective cohort study was conducted. The medical records of reproductive women who underwent conservative ovarian cystectomy surgery (laparoscopy or laparotomy) for endometrioma at Thammasat University Hospital were retrieved. The patients were followed through 24 months to evaluate the recurrence of endometrioma. Propensity scoring was used to adjust for confounding by indication and confounding by contraindication. Model for competing time to event was used in analysis. RESULTS: One hundred and twenty-eight and 114 patients were enrolled in laparoscopy and laparotomy groups, respectively. Mean age and body weight in laparotomy group were statistically higher than those in the other group were. Mean height and body mass index were, however not statistically different in either groups. In addition, the stage of disease and bilaterality in both groups were comparable. Diameter ofendometrioma in laparotomy group was significantly larger than that in laparoscopy group (7.0 ± 2.5 vs. 6.2 ± 1.8 cm, respectively; p = 0.004). After adjusting for propensity scoring, the endometrioma recurrence rate was significantly higher in laparoscopy group as compared to laparotomy group (27.3% vs. 14.9%, respectively; p = 0.02). However, the cumulative rate of pregnancy after surgery was not statistically different (4.7% vs. 4.4%, respectively; p = 1.0). CONCLUSION: The present study has demonstrated that the surgical technique has a strong impact on the recurrence or disease-free interval. Laparoscopy might not eradicate the disease pathology as effectively as open laparotomy in some situations, such as in cases with complexity of disease.

Postoperative Pain Relief in Major Gynaecological Surgery by Perioperative Parecoxib Administration: Thammasat University Hospital Study.

OBJECTIVE: To study postoperative pain relief in major gynaecological surgery by perioperative parecoxib administration in Thammasat University Hospital. MATERIAL AND METHOD: This double-blind randomized controlled clinical trial was conducted in Thammasat University Hospital, Pathumthani, Thailand from October 2013 to May 2014. One hundred and twenty patients who underwent elective gynaecological surgery were randomized assigned to study and control groups. Study group (n = 60) received 40 mg parecoxib and control group (n = 60) received placebo at 1 hour before surgery. The postoperative visual analog scale (VAS) at 3, 6, 12 and 24 hours, frequency of meperidine consumption in 24 hours and side effects of parecoxib were recorded. RESULTS: VAS of study group after operation at 3, 6, 12 and 24 hours was significantly lower than control group. Meperidine consumption in placebo group was significantly higher than study group (27.50 ± 19.36 and 48.75 ± 28.15 mg, respectively; p < 0.001). There was no side effect from parecoxib in this study. CONCLUSION: Intravenous postoperativeparecoxib injection could relief pain and reduced meperidine consumption. Parecoxib could be safely used in gynaecological surgery for postoperative pain relief

High pre-pregnancy body mass index and the risk of poor obstetrics outcomes among Asian women using BMI criteria for Asians by World Health Organization Western Pacific Region (WPRO): a large cohort study.

OBJECTIVE: To evaluate the effects of high pre-pregnancy body mass index (BMI) on the risk ofpoor obstetric outcomes among Asian women using BMI criteria by Regional Office for the Western Pacific Region of WHO (WPRO). MATERIAL AND METHOD: The present study was a retrospective cohort. Subjects of live birth singletons who had full term delivered atfour tertiary care centers, teaching university hospitals between January and December 2012 were enrolled. All pregnant women with pre-pregnancy BMI 18.5 kg/m2 or over were recruited and categorized into two groups, normal BMI and high BMI Level of BMI at 18.5-22.9 kg/m2 was defined normal BMI, and level at or over than 23 kg/M2 was defined as high BMI, respectively. The association between high pre-pregnancy BMI and poor adverse pregnancy outcomes were evaluated. RESULTS: Two thousands seven hundred and thirty-three pregnant women were recruited. Normal and high pre-pregnancy BMI women were 1,840 and 893, respectively. The average age was 2 7.81 +/- 5.67 and 29.48 +/- 13.03 years old respectively. Most ofsubject were primigravida. Mean BMI of normal group and high BMI group were 20.2 7 +/- 1.42 and 26.66 +/- 3.45 kg/ m2, respectively. In multivariate analysis, high pre-pregnancy BMI pregnant women have significantly higher adjusted risk ratio for gestational diabetes mellitus and preeclampsia, induction of labor prolong second stage of labor, including, caesarean delivery or obstetrics procedures (RR 1.54, 95% CI 1.30-1.84, RR 1.17, 95% CI 1. 12-1.23, RR 1.41, 95% CI 1. 04- 1.90, RR 1.28, 95% CI 1.11-1.48 and RR 1.17, 95% CI 1.05-1.27, respectively). In addition, the adjusted risk ratio of postpartum hemorrhage and neonatal macrosomia were significantly increased (RR 1.86, 95% CI 1.01-3.43 and RR 1.46, 95% CI 1.28-1.65, respectively). CONCLUSION: This evidence strongly suggested that high pre-pregnancy BMI using WPRO criteria increased the risk of pregnancy complications and adverse pregnancy outcomes. This study was one of the largest studies among Asian populations.

The effects of systematic management on maternal and neonatal complications in gestational diabetes subjects.

OBJECTIVE: To compare maternal and neonatal complications ofgestational diabetes mellitus (GDM) between conservative and systematic management. MATERIAL AND METHOD: This retrospective cohort study was conducted at Thammasat University Hospital, Thailand. GDM subjects who were diagnosed and treated from October 2004 to March 2007 were classified as the conservative management group (CMG). The participants who were diagnosed and treated from April 2007 to September 2009 were classified as the systematic management group (SMG). SMG was ambulatory-managed per standard protocol by a multidisciplinary team (physician, diabetes nurse case manager nutritionist and pharmacologist). RESULTS: There were 87 and 118 subjects in CMG and SMG, respectively. Mean age and body mass index before pregnancy in CMG and SMG were not statistical different. Oral glucose tolerance tests (50 and 100 gram) were similar in both groups. The prevalence of GDM A2 was 57.5 and 55.1% in CMG and SMG, respectively. Mean gestational age at DM clinic consultation and number of hospital admission of SMG was less than CMG (p < 0.001). Neonatal hypoglycemic episode in SMG was less than CMG (1.7 vs. 10.3; p = 0.007). Postpartum 75-gram glucose tolerance test appointments and percentages of underwent in SMG were more than CMG (p < 0.001). Other composite maternal and neonatal outcomes were not different in either group. CONCLUSION: Systematic management by a multidisciplinary team conducted according to a practical guideline has the benefit of neonatal hypoglycemia reduction and hospital admission included postpartum DM surveillance increments.