To evaluate the effect of paclitaxel and platinum-based chemotherapy (PT) on micturition symptoms.
All gynecologic cancer patients who were assigned to receive the PT regimen and understood the Thai ...language were invited to participate in this study. The exclusion criteria were as follows: abnormal urinary symptoms, retained urinary catheter or percutaneous nephrostomy, anticholinergic drug use, or scheduled to receive radiation therapy after the completion of chemotherapy. The participants were interviewed using three Thai validated questionnaires, the incontinence impact questionnaire-short form, urogenital distress inventory short form, and Sandvik score, on the day before receiving the first cycle of chemotherapy (pre-treatment), on the day before receiving the 4th cycle (mid-treatment), and 46 weeks after completing 69 cycles (post-treatment). The scores at the three time points were compared. Patients who received less than three cycles were not included in the analysis.
One hundred and ten patients were included in this study. There were significant differences in the median questionnaire scores at the three time points for both carboplatin plus paclitaxel and cisplatin plus paclitaxel. However, when using a pairwise difference between the two treatment protocols, there were no significant changes in the score from pre-treatment to post-treatment.
The PT regimen has an impact on micturition symptoms during chemotherapy which recover after treatment completion.
To investigate the prevalence and predictive factors of malnourishment in patients with gynecologic cancer during chemotherapy.
A total of 101 patients treated with chemotherapy between April 2020 ...and February 2021 were interviewed using the patient-generated subjective global assessment (PG-SGA). Clinical and laboratory data were also collected. The total number of lymphocytes per cubic milliliter (total lymphocyte count, TLC) and serum albumin were calculated to provide an optimal cut-off point using receiver operating characteristic curves. Clinicopathological variables were compared using univariate and multivariate analyses to identify the independent predictive factors for malnourishment.
The prevalence of good, moderate, and severe nourishment was 73.3%, 18.8%, and 7.9%, respectively. The optimal cut-off points for TLC and albumin were 1,450 cells/μL and for albumin was 3.9 g/dL. Univariate analysis indicated that the number of chemotherapy cycles ≤3, albumin level ≤3.95 g/dL, body mass index ≤25 kg/m2, TLC <1,450 cells/μL, anemia, and no neutropenia were significantly associated with malnutrition. However, only a serum albumin level ≤3.95 g/dL was independently associated with malnourishment.
Patients with gynecologic cancer treated with chemotherapy were occasionally found to be malnourished, with the independent predictive predictor being a blood albumin level less than or equal to 3.95 g/dL.
The study of prevalence and risk factors of postoperative lower limb deep vein thrombosis (DVT) in Thai gynecologic patients was limited. The present study was conducted to evaluate this issue.
The ...patients were age > 15 years old without a history of DVT or pulmonary emboli (PE) scheduled for laparotomy or vaginal gynecologic surgery between May and November 2020 were invited to participate. All of these patients were scheduled for a complete duplex ultrasound to detect lower limb DVT 72 h before and within 14 days after the operation. The patients without DVT were scheduled for an interview by telephone about DVT symptoms 30 days after the operation. The clinical variables were compared using univariate and multivariate analysis to identify the independent factors related to the development of DVT.
One hundred and twelve patients met the inclusion criteria. Of these patients, 44 cases (39.3%) were diagnosed as malignancy and 102 patients underwent a hysterectomy. Post-operative DVTs were detected in six patients (5.4%) and all except one had a malignancy. Thus, the prevalence of DVT in malignancy cases was five in 44 patients (11.4%). The independent risk factors for postoperative DVT were age > 60-year-old and receiving a perioperative blood transfusion. Five of six DVT patients received low molecular-weight heparin for treatment of DVT and none developed PE. The rest of the participants reported no symptom-related DVTs from the interview 30 days after the operation.
The prevalence of postoperative DVT in gynecologic patients was 5%, and the independent risk factors were elderly patients and receiving a perioperative blood transfusion.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
This study aimed to investigate the potential predictive factors for platinum resistance and poor prognosis in epithelial ovarian, fallopian tube, and primary peritoneal cancer treated with ...platinum-based chemotherapy.
Medical records of 306 patients with the above mentioned cancers treated with platinum-based chemotherapy between 2007 and 2017 were retrospective reviewed. Clinical data, preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platinum-free interval, and survival time were recorded. NLR, PLR, and cancer antigen 125 (CA125) levels were calculated for an optimal cutoff point using receiver operating characteristic curves. The clinicopathological variables were compared using univariate and multivariate analyses to identify independent predictive factors for platinum resistance and poor survival outcomes.
The optimal cutoff points for NLR, PLR, and CA125 were 3.38, 210, and 365 IU/L, respectively. Univariate analysis indicated that NLR >3.38, PLR >210, CA125 >365, advanced stage, suboptimal disease, serous type, and ascites were significant predictive factors for platinum resistance. However, only NLR >3.38 and advanced stage were independent predictive factors with an adjusted odds ratio of 1.880 and 3.333, respectively. Regarding factors associated with poor survival outcomes, only PLR >210 and advanced stage were independent factors, with a hazard ratio of 1.578 and 3.994, respectively.
High NLR and advanced stage were potential independent predictive factors for platinum resistance, whereas high PLR and advanced stage were potential independent predictive factors for poor survival outcomes.
Background and Aim: During the Covid-19 pandemic, the knowledge, attitudes, and practices about COVID-19 infection in gynecologic cancer patients were still limited. This study aimed to explore these ...issues.Methods: Gynecologic cancer patients who attended our gynecologic oncology unit between February and June 2022 were invited to a cross-sectional survey using a WHO survey tool. Results: 363 patients participated with 20.9% undergoing treatment and receiving the COVID-19 vaccine significantly less than the surveillance participants (85.4% vs.57.9%, P < 0.01). Forty-eight participants developed a COVID-19 infection. The most common vaccine used for the two first doses was AstraZeneca. Regarding attitudes issues, most participants felt health literacy was obtained easily. They considered that they had a moderate probability to have severe symptoms of COVID-19 infection and almost all knew the proper behavior for prevention. The participant reported little stress and most trusted healthcare workers and family doctors. They agreed with lifting regular rules to control the COVID-19 pandemic. The other opinions that were significantly higher in participants who did not receive the vaccine versus those who received the vaccine, were as follows: “If everyone is vaccinated, no need for me to vaccinate”, “the stress made me not want to vaccinate”, “no need to vaccine due to rare disease” and “the vaccine is unsafe”. Conclusion: Gynecologic cancer patients who were under treatment received the COVID-19 vaccine less than those under surveillance. Most participants revealed a good attitude toward this pandemic. However, unvaccinated participants were concerned about the severe side effects of the vaccine.
: The objective of this study was to evaluate the efficacy of lidocaine spray in reducing the pain during colposcopy-directed cervical biopsy (CDB).
: From December 2017 to February 2019, 312 women ...undergoing CDBs were enrolled. The participants were randomized to three groups: group 1 (lidocaine spray), in which lidocaine spray was applied thoroughly to the cervix; group 2 (placebo), in which normal saline was applied thoroughly to the cervix; and group 3 (control), in which no anesthetic agent was applied to the cervix. Each woman completed a 10 cm visual analog scale to classify the subjective pain experience at three time points: baseline, immediately after biopsy, and 10 min after the procedure. The primary outcome of this study was the biopsy pain score.
: The 312 enrolled women were randomly assigned to the three groups, amounting to 104 women per group. The clinical and pathological characteristics of the participants in all groups were comparable. The baseline, the biopsy, and the post-procedure pain scores were comparable among the three groups. There was a significant increase in the pain score from baseline to biopsy and from baseline to post-procedure in each group. The pain-score changes from baseline to biopsy in the lidocaine spray group significantly decreased when compared with the normal saline group (<0.001), and tended to decrease, though not significantly (
= 0.06), when compared with the control group. No complication with the intervention was observed.
: The application of lidocaine spray to the cervix has the benefit of reducing the pain associated with CDBs by a small amount. However, the intervention is safe and may be considered in nulliparous and/or overly anxious women undergoing the procedure.
Testing for high-risk human papillomavirus DNA (HPV test) has gained increasing acceptance as an alternative method to cytology in cervical cancer screening. Compared to cytology, HPV test has a ...higher sensitivity for the detection of histologic high-grade squamous intraepithelial lesion or worse (HSIL+), but this could lead to a large colposcopy burden. Genotyping for HPV16/18 has been recommended in triaging HPV-positive women. This study was aimed to evaluate the screening performance of HPV testing and the role of genotyping triage in Northern Thailand.
A population-based cervical screening program was performed in Chiang Mai (Northern Thailand) using cytology (conventional Pap test) and HPV test (Hybrid Capture 2). Women who had abnormal cytology or were HPV-positive were referred for colposcopy. Cervical samples from these women were genotyped using the Linear Array assay.
Of 5,456 women, 2.0% had abnormal Pap test results and 6.5% tested positive with Hybrid Capture 2. Of 5,433 women eligible for analysis, 355 with any positive test had histologic confirmation and 57 of these had histologic HSIL+. The sensitivity for histologic HSIL+ detection was 64.9% for Pap test and 100% for Hybrid Capture 2, but the ratio of colposcopy per detection of each HSIL+ was more than two-fold higher with Hybrid Capture 2 than Pap test (5.9 versus 2.8). Genotyping results were available in 316 samples. HPV52, HPV16, and HPV58 were the three most common genotypes among women with histologic HSIL+. Performance of genotyping triage using HPV16/18/52/58 was superior to that of HPV16/18, with a higher sensitivity (85.7% versus 28.6%) and negative predictive value (94.2% versus 83.9%).
In Northern Thailand, HPV testing with genotyping triage shows better screening performance than cervical cytology alone. In this region, the addition of genotyping for HPV52/58 to HPV16/18 is deemed necessary in triaging women with positive HPV test.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The clear-cell variant of epithelioid mesothelioma is an extremely rare neoplasm of the peritoneum. It shares histomorphologic features overlapping with a wide variety of tumors including carcinomas ...and other non-epithelial neoplasms. The diagnosis of peritoneal clear-cell mesothelioma is not always straightforward, despite known immunohistochemistry (IHC) markers. Due to its rarity, this entity may be diagnostically confused with other clear-cell neoplasms, particularly in intraoperative frozen sections. Here, we present a case of clear-cell mesothelioma originating in the uterine serosa that was initially misdiagnosed as clear-cell adenocarcinoma in the intraoperative frozen section. Microscopically, the tumor showed diffuse tubulocystic spaces of variable size lined by clear cells with moderate nuclear atypia. Immunohistochemical staining confirmed the diagnosis of clear-cell mesothelioma. Recognition of this entity, albeit rare, is important as the diagnosis may significantly affect the management considerations. The judicious use of an IHC panel helps to distinguish this tumor from other mimickers.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
To investigate the efficacy of listening to music on pain reduction during colposcopy-directed cervical biopsy (CDB).
: From June 2020 to November 2021, 240 women undergoing CDB were enrolled. The ...participants were randomized into three groups: Group 1, colposcopic examination while wearing headphones and listening to music; Group 2, colposcopy while wearing headphones but not listening to music; Group 3 (control group), colposcopy while neither listening to music nor wearing headphones. All participating women completed a 10 cm visual analog scale for subjective pain at three time points: baseline, immediately after cervical biopsy, and 15 min after the procedure. The primary endpoint was the biopsy pain score.
: Of the 240 women, a sample size of 80 was randomly assigned per group. The clinical-pathological and procedure-related characteristics of the participants in all groups were similar. The mean baseline pain score between each group was not significantly different (2.83 in the music group, 2.54 in group 2, and 2.94 in the control group,
= 0.47). There were no significant differences between each group in terms of mean biopsy pain score (4.21 in the music group, 4.24 in group 2, and 4.30 in the control group,
= 0.98). The differences in changes between the baseline pain score and the biopsy pain score were not statistically significant (1.39 in the music group, 1.70 in group 2, and 1.36 in the control group,
= 0.69). In the multiple comparison analysis, the differences in changes between the biopsy pain score and the baseline pain score between each group were also not statistically significant. There were no complications with the intervention observed.
: This study demonstrated that there was no beneficial effect of listening to music on pain reduction during colposcopy-directed cervical biopsies.
Objective. To determine the percentage of rising serum cancer antigen (CA-125) in singleton pregnant women whose ultrasonographical findings were normal. Methods. Singleton pregnant women who ...received antenatal care at our institute with a normal ultrasonographical examination in their first and/or second trimester were invited to participate in blood testing for CA-125. The conditions that might affect the CA-125 level were excluded. The normal level of CA-125 was defined as ≤35 U/ml. Results. 136 pregnant women met the inclusion criteria. Of these cases, 87 cases received a blood test for CA-125 in both their first and second trimesters while 46 and 3 cases received a blood test for CA-125 in only the first and second trimester, respectively. The median serum CA-125 levels in the first and second trimester were 16.44 (range 5.94–77.54) U/ml and 16.76 (range 5.26–35.81) U/ml, respectively. Only 9.1% of the studied patients showed an abnormal CA-125 level in the first trimester period and only one case showed an abnormal CA-125 level in the second trimester period. Conclusion. Few of normal pregnancies showed rising CA-125. Therefore, when it elevated in pregnant women, other causes such as the adnexal lesion should be investigated.
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FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
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