Human Papilloma Virus (HPV) Vaccine

Human Papilloma Virus (HPV) Vaccine   Currently, the incidence of cancer is continuously increasing in our population. In Thailand, we witness a daily average of 14 deaths and 28 new cases of the disease. In response to this alarming situation, there is now a vaccine available for the prevention of cervical cancer, oral cancer, ovarian cancer, female genital organ cancer, and head and neck cancer caused by the Human Papillomavirus (HPV). It is imperative that we take immediate action to address this issue.   Currently, there are two types of vaccines available for preventing cancer caused by the HPV virus:   1. The 4-strain vaccine protects against HPV strains 16 and 18, which are the main causes of cervical cancer (70%), as well as HPV strains 6 and 11, which prevent genital warts. Overall, this vaccine provides 70% protection against HPV-related cancer and also guards against genital warts.   2. The 9-strain vaccine provides 90% to 94% protection. It protects against HPV strains 16 and 18, which are the main causes of cervical cancer (70%), and also includes HPV strains 6 and 11 to prevent genital warts. Additionally, it offers protection against five more high-risk HPV strains: 31, 33, 45, 52, and 58. Overall, this vaccine provides 90% protection against HPV-related cancer, including prevention of genital warts.   Commencing vaccination in the non-dominant arm can begin at the age of 9, specifically targeting individuals aged 9 to 15. This vaccination regimen involves administering two doses. The first dose is administered on the initial day, followed by a second dose administered 6 to 12 months after the first. Subsequently, lifelong protection is achieved without the need for additional booster shots.   For individuals aged 15 and above, a total of three doses are administered, ensuring lifelong protection. The first dose is given initially, followed by the second dose two months after the first. The third dose is administered four months after the second, and lifelong immunity is established thereafter.

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Vulvar Cancer

Vulvar Cancer   Vulvar cancer, a condition affecting approximately 5% of gynecological cancers and around 0.6% of all cancers in women (1,2), is commonly found in women who have reached menopause.   The causes of vulvar cancer are multifactorial and include factors such as human papillomavirus (HPV) infection, prior presence of vulvar intraepithelial neoplasia (VIN), prior presence of cervical intraepithelial neoplasia (CIN), lichen sclerosus, smoking, alcohol consumption, obesity, compromised immune system, and a history of previous cervical cancer (3,4). Vulvar cancer can be classified into two types (5):   Type 1: Basaloid or Warty Type Type 2: Keratinizing Type     Type 1 Type 2 Age 36-65 years old 55-85 years old Traces of disease Many spots One spot Risk factors Immunodeficiency Abnormalities in cervical cells Pathology Basaloid or Warty types Keratinizing type HPV infection HPV types 16 and 33 Not related History of warts Commonly found Not related History of sexually transmitted diseases Commonly found Not related   Diagnostic Process:   The diagnostic process involves the extraction of tissue samples for pathological examination to determine the type of cancer in the oral and anal regions. Squamous Cell Carcinoma comprises approximately 90% of cases, followed by Melanoma at 2-4%, and Basal Cell Carcinoma at 2-3%.   Staging of Anal Cancer (6 Stages)   Stage 1: The disease is confined to the anal region.   Stage 1A: The tumor measures ≤ 2 centimeters and has spread into the superficial layer by ≤ 1 millimeter. Stage 1B: The tumor measures > 2 centimeters and has spread into the superficial layer by > 1 millimeter.   Stage 2: The tumor is unrestricted in size and has spread to adjacent organs (one of the lower third of the urethra, and/or one of the lower third of the anal canal, and/or perianal skin).   At stage 3, the disease marks are unrestricted in size and spread to adjacent organs (one-third of the lower portion of the urethra and/or one-third of the lower part of the birth canal and/or the bladder). Additionally, there is dissemination to the lymph nodes.   Stage 3A: Dissemination to one or more pelvic lymph nodes with a size of ≥ 5 millimeters or dissemination to 1-2 pelvic lymph nodes with a size of < 5 millimeters. Stage 3B: Dissemination to two or more pelvic lymph nodes with a size of ≥ 5 millimeters or dissemination to three or more pelvic lymph nodes with a size of < 5 millimeters. Stage 3C: Dissemination to pelvic lymph nodes and extra-capsular spread.   At stage 4: Stage 4A: Disease spread to the upper part of the urethra and/or the upper part of the birth canal, bladder lining, and the adjacent bones. Stage 4B: Dissemination to other organs.   References:   1. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017;67:7-30   2. U.S. Cancer Statistics Working Group. United States Cancer Statistics   3. Madsen BS, Jensen HL, et al. Risk factors for invasive squamous cell carcinoma of the vulva and vagina—population-based study in Denmark. Int J Cancer 2008;122:2827-2834   4. Brinton LA, Thistle JE, et al. Epidemiology of vulvar neoplasia in the NIH-AARP study. Gynecol Oncol 2017;145:298-304   5. Crum CP. Carcinoma of the vulva: epidermiology and pathogenesis. Obstet Gynecol 1992; 79:448-54   6. Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynecol Obstet 2009;105:103-4__     For more information, please contact the Obstetrics and Gynecology Department, located on the second floor of Building 2.   Visit https://www.vibhavadi.com/Center/Clinics/id/02  

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Colposcopy

Colposcopy Dr. Utsanee Chatrichotikawong Specializing in gynecologic oncology   Every woman should receive annual screening for cervical cancer. In Thailand, cervical cancer is the second most common cancer among women, following breast cancer. On a daily basis, 14 Thai women lose their lives due to cervical cancer (1). If the test results show abnormal cells in the cervix, indicating a potential risk, further examination through colposcopy is recommended. The attending physician will schedule a colposcopy for the patient, which involves using a magnifying instrument to examine the cervix. Colposcopy refers to the use of a magnifying instrument with increased magnification levels to visualize an enlarged image of the cervix and assess any signs of abnormalities. It is a standard method for the care and treatment of patients with abnormal cervical cancer screening or those who test positive for high-risk human papillomavirus (HPV) strains, specifically types 16 and 18. During colposcopy, the cervix is stained with acetic acid, and the magnifying instrument is used to observe the cervix after staining. The principle behind this technique is that if the cells are exposed to a highly concentrated acid, the water inside the cell's cytoplasm will be drawn out, resulting in a clearer nucleus. In the case of abnormal cells, the nucleus will be enlarged, causing the water within the cell to be drawn out by the acid, resulting in the appearance of white patches. Therefore, if there are indications of abnormal cells in the cervix, further examination through colposcopy is necessary. The possible findings from colposcopy include low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), atypical squamous cells that cannot exclude HSIL (ASC-H), and atypical glandular cells (AGC) (2). Additionally, the detection of high-risk HPV strains, particularly types 16 and 18, increases the risk of developing cervical cancer.   How to Perform a Colposcopy:   Instruct the patient to assume a lithotomy position, similar to a gynecological examination. Insert a speculum into the vaginal canal to assess the cervix. Apply a 1% or 3% acetic acid solution to the cervix, leaving it for one minute or thirty seconds, respectively. Examine the cervical area for any abnormalities using the colposcope. Rotate the cervix for a thorough examination. If the transformation zone is not completely visible, gently scrape the cervical canal to obtain additional samples. This may cause slight discomfort for the patient. Apply Monsel's solution to stop any bleeding after colposcopy and cervical scraping. Avoid sexual intercourse for two weeks following the procedure. Refrain from taking baths, swimming, or lifting heavy objects for two weeks. It is normal to experience minor bleeding after the procedure. However, if there is excessive bleeding, seek immediate medical attention at the hospital. Schedule a follow-up appointment with the physician approximately seven days after the procedure to discuss the results of the cervical scraping and biopsy.   References   1. www.nci.go.th 2. The American College of Obstetricians and Gynecologists (ACOG) http://www.acog.org   For more information, please contact the Obstetrics and Gynecology Department, located on the second floor of Building 2.   Visit https://www.vibhavadi.com/Center/Clinics/id/02

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Uterine Cancer

Uterine Cancer   The foremost cause identified as the highest risk factor for developing uterine cancer is prolonged exposure to estrogen hormone stimulation alone (1).   Risk factors for uterine cancer (1)   Risk factors The likelihood of developing cancer when compared to the general population (times) Infertility 2-3 Irregular menstruation 2-4 Obesity 3-10 Diabetes 2-8 Prolonged exposure to estrogen hormone stimulation 4-8 Taking Tamoxifen medication 2-3 Slight abnormality in the endometrial tissue (Atypical endometrial hyperplasia) 8-29 Lynch II syndrome 20   Symptoms of cervical cancer:   Most commonly, abnormal bleeding from the vagina (1).   Diagnosis of the disease:   The diagnosis is typically made by examining tissue from the cervix. This can be done by a medical professional using a device similar to a suction tube inserted into the cervix to collect tissue for pathological examination, or by scraping the cervix to obtain tissue for pathological examination (1).   Complications of the procedure using a device similar to a suction tube inserted into the cervix to collect tissue for pathological examination are very rare. For example, cervical perforation is found in only 1-2 out of 1,000 individuals undergoing this procedure (1).   The reliability of the Pap test in detecting cervical cancer is not trustworthy. This is because 30-50% of cervical cancer patients have abnormal cells that have already shed and cannot be detected by the Pap test (2).   The accuracy of examining cervical tissue using a device similar to a suction tube inserted into the cervix for pathological examination is 90-98% when compared to scraping or excising the cervix for pathological examination in menstruating women (3).   Hysteroscopy, which involves visualizing three-dimensional images inside the cervix and introducing fluids into the cervix, and cervical scraping should be performed on patients with a tight cervix or patients who cannot tolerate the pain associated with these procedures or who do not have sufficient tissue obtained from suctioning the cervix for pathological examination (1).   The main standard treatment for cervical cancer is surgery to assess the extent of the disease, including removing the cervix, the cervical mouth, both ovaries, and sampling the yellow fluid in the cul-de-sac and the yellow fluid along the large blood vessels in the abdominal cavity for pathological examination (1).   Stages of Uterine Cancer (4 Stages):   Stage 1: Cancer is confined to the uterus and is divided into:   Stage 1A: Cancer has not spread to the muscular layer of the uterus or has spread but not beyond half of the thickness of the muscular layer. Stage 1B: Cancer has spread to half or more of the thickness of the muscular layer of the uterus.   Stage 2: Cancer has spread to the connective tissue of the cervix, known as the stroma.   Stage 3 is further divided into:   Stage 3A: Cancer has spread to the outermost layer of tissue surrounding the uterus, called the serosa, and/or the fallopian tubes. Stage 3B: Cancer has spread to the birth canal and/or the tissue adjacent to the uterine opening (parametrium). Stage 3C is divided into the following substages: Stage 3C1: Cancer has spread to the lymph nodes in the pelvic area. Stage 3C2: Cancer has spread to the lymph nodes beside the major blood vessels in the abdominal area (para-aortic lymph nodes).   Stage 4 is divided into:   Stage 4A: Cancer has spread to the bladder or the mucous lining of the intestinal wall. Stage 4B: Cancer has spread to other organs within or outside the abdominal cavity, or to the lymph nodes in the groin area.   The treatment for uterine cancer depends on the stage of the disease and the type of cancer cells. The doctor will recommend appropriate treatment options after evaluating the pathological findings and assessing the stage of the disease.   References:   1.            Berek and Novak's gynecology 16th edition 2.            Zucker PK, Kasdon EJ, Feldstein ML. The Validity of Pap smear parameters as predictors of endometrial pathology in menopausal women. Cancer 1985;56:2256-2263 3.            Van Hanegem N, Prins MM, Bongers MY, et al. The accuracy of endometrial sampling in women with postmenopausal bleeding: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2016; 197:147-155. 4.            FIGO Committee on Gynecologic Oncology. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynecol Obst 2009;105:103-104.   For more information, please contact the Obstetrics and Gynecology Department, located on the second floor of Building 2.   Visit https://www.vibhavadi.com/Center/Clinics/id/02

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The screening for ovarian cancer

The screening for ovarian cancer   Ovarian cancer is an unfortunate occurrence in Thailand, with a rate of 6.6 cases per 100,000 women. It affects approximately 1 in 70 women and ranks as the 6th most common cancer among Thai women (1).   Screening for ovarian cancer involves internal examinations and ultrasound scans, along with testing for cancer markers such as CA-125, CA19-9, and HE-4. It is recommended to undergo these screenings annually.   There are several risk factors associated with ovarian cancer, including advancing age, a history of breast cancer, smoking, nulliparity, infertility, endometriosis, menstrual pain, early onset of menstruation, late onset of menopause, a family history of ovarian or breast cancer, and individuals with genetic mutations such as BRCA1 and BRCA2 (2).   Since ovarian cancer often presents with minimal symptoms, such as frequent urination, constipation, bloating, and abdominal discomfort, the diagnosis is often made at an advanced stage when fluid accumulation in the abdomen becomes apparent. Therefore, screening for ovarian cancer is of utmost importance.   Ovarian cancer has four stages, namely:   Stage 1: Cancer is confined to the ovaries without evidence of spreading to the abdominal cavity or the lesser sac.   Stage 2: Cancer has spread to the fallopian tubes and organs within the abdominal cavity.   Stage 3: Cancer has spread to the abdominal cavity, the peritoneal lining, the outer surface of the small intestine, the omentum, and the lymph nodes surrounding major blood vessels in the abdomen.   Stage 4: Cancer has spread to distant organs outside the abdominal cavity, such as the lungs, brain, liver, and cervical lymph nodes.   The treatment options for ovarian cancer include surgical intervention, targeted therapy using specific drugs, and chemotherapy. Early detection of the disease in the initial stages increases the chances of successful treatment compared to the later stages.   For more information, please contact the Obstetrics and Gynecology Department, located on the second floor of Building 2.   Visit https://www.vibhavadi.com/Center/Clinics/id/02  

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Q&A: Insights on Covid-19 in Pregnant Women

Q&A: Insights on Covid-19 in Pregnant Women   Pregnancy Stage   1. Does pregnancy increase the risk of contracting COVID-19?   Answer: Pregnancy does not increase the risk of contracting COVID-19.   2. Do the symptoms of COVID-19 differ in pregnant women compared to non-pregnant women?   Answer: The symptoms of COVID-19 in pregnant women do not differ from those in non-pregnant women. Common symptoms include fever, cough, headache, muscle pain, loss of smell, and nasal congestion. It has been found that around 90% recover without requiring hospitalization. However, pregnant women, especially those with risk factors such as age >= 35 years, obesity, diabetes, or high blood pressure, may experience more severe illness.   3. Are there increased complications for both the mother and the fetus if a pregnant woman contracts COVID-19?   Answer: Pregnant women with COVID-19 may experience the following increased complications:   Preterm birth, especially in cases of severe pneumonia or illness. Cesarean delivery. Pre-eclampsia. Increased risk of stillbirth or fetal death.   4. Is there a risk of COVID-19 transmission to newborns from infected mothers?   Answer: There is no clear evidence that COVID-19 can be transmitted through the placenta and infect the fetus. However, there have been some reports of approximately 2% of newborns testing positive for COVID-19 after being born to infected mothers in the third trimester.   5. In the current situation with a high prevalence of COVID-19, are there any changes in the approach to prenatal care to reduce the risk of infection for pregnant women?   Answer: Healthcare providers will adjust the care provided based on the individual risk of each pregnant woman. Steps that can help reduce the risk of infection include:   Telehealth consultations. Reducing the frequency of prenatal visits. Decreasing the duration of in-person visits to healthcare facilities. Limiting the number of people in waiting areas and maintaining physical distancing. Consolidating laboratory testing into fewer appointments. Conducting targeted ultrasound examinations. Adjusting the timing and frequency of prenatal health assessments for the fetus.   Labor and Delivery Stage   1. Should pregnant women infected with COVID-19 but asymptomatic delay induction of labor or opt for cesarean delivery if there are medical indications such as pre-eclampsia or fetal growth restriction?   Answer: It is not recommended to delay induction of labor or opt for cesarean delivery solely based on COVID-19 infection in pregnant women without symptoms. However, medical indications such as pre-eclampsia or fetal growth restriction may pose greater risks to both the mother and the fetus, warranting appropriate medical advice.   2.What is an appropriate method for relieving pain during labor for pregnant women with COVID-19 infection?   The answer is administering epidural anesthesia, which has several advantages: It helps reduce the stress on the cardiovascular and respiratory systems caused by pain and anxiety. It eliminates the need for general anesthesia in emergency cesarean sections. Nitrous oxide should not be used, as it is an inhalation-type analgesic used during labor, and there is insufficient information regarding cleaning, filtering, and the potential for aerosolization.   3. Should individuals staying with pregnant women during labor be screened for COVID-19?   The answer is that individuals in the labor room should undergo COVID-19 screening (though specific requirements may vary in different locations). The following individuals should not be allowed in the labor room: Spouses who have tested positive for COVID-19 but are asymptomatic. Individuals with a history of contact with COVID-19 patients within the past 14 days.   4. Is it necessary for pregnant women with COVID-19 infection to undergo cesarean section?   The answer is no. Cesarean section is not necessary as it increases the maternal risk without improving the neonatal outcomes. However, it may be necessary in cases where the mother experiences severe exhaustion, severe symptoms, or obstetric complications that require cesarean delivery.   Postpartum Period   1. How are infants born to mothers with COVID-19 cared for in hospitals?   Answer: Infants born to mothers infected with COVID-19 receive care following infection control precautions. They are separated from other infants, and nasopharyngeal swabs are taken to test for COVID-19 infection. The care provided is based on the test results.   2. How should infants be cared for if their mother is infected with COVID-19?   Answer: Infants can stay in the same room as their mother, but they should be kept at least 6 feet away. The mother must wear a face mask and clean her hands before touching the infant.   3. How long should a mother infected with COVID-19 maintain distance (isolation) and follow infection prevention guidelines from their newborn?   Answer: In mothers with symptoms, the isolation and infection prevention guidelines should be followed for at least: 10 days from the onset of symptoms 20 days in case of severe symptoms or compromised immune system 24 hours without using fever-reducing medications Improvement of other symptoms In asymptomatic mothers, at least 10 days after testing positive for the infection.   4. Can infants breastfeed from a mother infected with COVID-19?   Answer: Although there is no evidence of COVID-19 transmission through breast milk, considering the benefits of breastfeeding, it is recommended that infants receive breast milk.   5. What should a mother infected with or suspected of having COVID-19 do when breastfeeding her newborn?   Answer: Clean hands, breasts, and wear a face mask (face mask) while breastfeeding to prevent droplet transmission. Alternatively, the mother can clean hands, breasts, wear a face mask, and express milk for others to feed the infant.   COVID-19 Vaccine for Pregnant Women and Breastfeeding Women   1. What recommendations are there regarding the administration of the COVID-19 vaccine for women who are planning to become pregnant?   Answer: Since there is no evidence showing that the spread of the disease increases complications during pregnancy, it is not recommended to postpone pregnancy. However, it is advisable to receive the vaccine before getting pregnant, if possible. The vaccine does not affect fertility, and there is no need to delay pregnancy after vaccination.   2. Is the vaccine safe for pregnant women?   Answer: The vaccine does not contain components of the virus that can replicate, so it does not cause the disease. Adjuvants such as aluminum salts used in vaccines are safe, and they have been administered widely in pregnant women, such as the Tdap (Tetanus, Diphtheria, and Pertussis) vaccine. However, it is recommended to receive the vaccine after 12 weeks of gestation. In the case of pregnant women who have already received the first dose, they should receive the second dose at the same time as women who are not pregnant.   3. Does the administration of the vaccine in pregnant women lead to different side effects and complications compared to non-pregnant women?   Answer: The vaccine may have similar side effects as those experienced by non-pregnant women due to the stimulation of the immune system. However, the specific side effects may vary depending on the type of vaccine administered.   4. What is the effect of the vaccine on the fetus during pregnancy?   Answer: Available data shows that the rates of miscarriage, fetal abnormalities, growth restriction, preterm birth, and stillbirth are not increased in pregnant women who received the vaccine.   5. What is the effectiveness of the vaccine in pregnant women?   Answer: The vaccine helps reduce the severity of the disease in pregnant women who are infected with COVID-19. Additionally, some vaccines have been found to induce cross-reactive immune responses in pregnant women, and antibodies have been detected in breast milk, potentially providing immune protection to newborns from vaccinated mothers.   6. Can pregnant women receive the COVID-19 vaccine along with other recommended vaccines during pregnancy?   Answer: Pregnant women can receive other vaccines such as TdaP (Tetanus, Diphtheria, and Pertussis) and influenza vaccines concurrently with the COVID-19 vaccine.   7. Can breastfeeding women receive the COVID-19 vaccine?   Answer: Antibodies generated from the vaccination of mothers can be passed through breast milk and may provide protection against infection in infants.   Article by Dr. Piraphan Phanphakdeekul, Obstetrician-Gynecologist at Vibhavadi Hospital, President of the PCT Obstetrics and Gynecology Subcommittee.   For inquiries, please contact the Obstetrics and Gynecology Department at 02-561-1111 / 02-058-1111 ext. 2219-20.     Word count: 1317

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Signs to Look Out For If You Have Irregular Menstruation and Have Been Internally Examined

Signs to Look Out For If You Have Irregular Menstruation and Have Been Internally Examined                   If a patient has irregular menstruation and has been inspected internally with no abnormal symptoms found, the condition is referred to as Dysfunctional Uterine Bleeding. Dysfunctional Uterine Bleeding (DUB) is a condition caused by the hormonal system that regulates menstruation which may cause no ovulation. Although this condition is not harmful to the body, it can be bothersome if it occurs frequently or differently than other women's cycles.   Treatment If you are not married or not ready to have children, contraceptive pills can be used. If you have been taking the pills for an extended period of time (6 months to 1 year), and your menstrual cycle has not returned to normal, additional tests such as blood hormone tests and ultrasound may be recommended.   If you wish to have children, treatment can use drugs to induce ovulation and make it easier for you to get pregnant. If you are not pregnant, your menstrual cycle will continue as normal.     by Dr. Chumpol Chinniyompanich Obstetrics and Gynecologist Vibhavadi Hospital

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Zika Virus: A Villain for Unborn Children

Zika Virus: A Villain for Unborn Children Mosquitoes are more dangerous than tigers… who agrees? Listen to this story about why mosquitoes are worse than tigers. The Zika virus disease is a well-known disease, but it's not actually new. It was first discovered in 1947 when the virus was detected in monkeys from the Zika forest in Uganda, and named Zika virus. The disease then became a worldwide epidemic. Thailand reported its first confirmed case in 2012, with an average of five cases per year. In 2015, it was found that Zika virus infection in pregnant mothers was associated with small birth defects. This is really scary! From the start of 2016 until the start of September, there have been 279 cases reported. However, there have been no cases reported in Thailand of babies born with small heads to mothers who have been infected with the Zika virus. How is the Zika virus transmitted? A member of the RNA virus group, the Zika virus is transmitted through Aedes mosquitoes, which also carry other diseases like Dengue Fever, Encephalitis Virus, Yellow Fever, and West Nile Fever. This is why mosquitoes are worse than tigers! Most cases of Zika virus infections occur through mosquito bites, and the virus can also be transmitted through sexual intercourse. Research shows that the virus can be present in semen for up to 180 days, which means abstaining from sex for that period is necessary for those with Zika. The virus can also be contracted through exposure to infected blood and can even be transmitted from mother to fetus. Symptoms of Zika Virus Rewritten: Of those infected with the Zika virus, 80% do not display symptoms, while the remaining 20% experience various symptoms. The most common symptom, affecting about 90% of symptomatic patients, is a rash known as maculopapular rash. Other symptoms include a low-grade fever (37.8C-38.7C), conjunctivitis (without eye discharge), joint pain, headache, and, in rare cases, neurological signs and muscle weakness. The majority of these symptoms are mild and resolve on their own, so there is generally no need for concern if Zika develops in the general population. However, if contracted by pregnant women, the virus may cause microcephaly in the fetus. Furthermore, infection at a younger gestational age can result in smaller fetuses with more severe brain abnormalities than those infected later in pregnancy. Which pregnant women are eligible for testing for Zika virus infection? The following symptoms in pregnant women should be noted: 1. Maculopapular rash with at least one of the following symptoms: fever, joint pain, and red eyes. 2. Fever with at least two of the following symptoms: headache, joint pain, and red eyes. 3. Presence of maculopapular rash in a person who has lived or traveled to an area where confirmed Zika virus cases have been reported and is still in the disease control period (28 days). For examination, blood and/or urine samples must be taken according to the duration of symptoms and sent to the Department of Medical Sciences. How is this disease treated? The current situation is that there are no vaccines or specific drugs for treating Zika virus infection. Treatment is focused on relieving symptoms. For instance, if you have a fever, you can take paracetamol to reduce it, or use calamine for a rash. The symptoms typically resolve on their own within 5-7 days. In terms of treating pregnant women infected with Zika virus, the approach is generally similar to that for non-pregnant individuals, depending on the symptoms. However, it is important to monitor fetal head size with ultrasound. Even if the fetus is found to have a small head size, there are currently no drugs or treatments available. For babies diagnosed with abnormalities, the best option is to offer prayers and hope for a healthy birth. If neurological symptoms are absent after birth, pediatricians will have to continue monitoring the baby's development. Important to protect yourself! Rewritten: "As there is no specific treatment or vaccine available for Zika virus, the following measures can be taken: 1. Mosquito eradication: The Department of Disease Control's 3-step method, including cleaning up the house, collecting garbage, and collecting stagnant water, should be followed. 2. Prevent mosquito bites: Pregnant women should apply mosquito repellent, with a focus on herbal remedies such as lemongrass. 3. Abstinence from sex: Individuals with Zika virus infection should abstain from sex for six months, as the virus can be detected in semen for up to 180 days. Alternatively, they should use a condom during sexual activity. It is crucial for any pregnant woman experiencing symptoms such as fever, rash, joint pain, or red eyes not to neglect seeking medical attention. It is essential to be aware of the severity of the situation, but there is no need to panic when asked, "Are mosquitoes worse than tigers?" Best wishes Dr. Ruchirek Ketthong, Obstetrician and Gynecologist (Maternal Fetal Medicine)

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How Well Do You Know Folic Acid?

How Well Do You Know Folic Acid? Folic Acid Folate, also known as folic acid, is a vital B vitamin that plays a significant role in the creation of new cells within the body. While "folic acid" refers to the synthetic form of this vitamin, "folate" is the naturally occurring form. These terms are often used interchangeably. Natural sources of folate include green leafy vegetables, citrus fruits, nuts, and other foods. Some countries fortify certain foods like rice, bread, pasta, and cereals with folic acid. It is important to ensure an adequate intake of folate, especially from pre-pregnancy to early pregnancy, as it can help prevent neural tube defects in babies. What are neural tube defects in babies?   During the first trimester of pregnancy, a crucial period of development, the neural tube forms and closes to give rise to the baby's brain and spinal cord. It is important to note that many women may not be aware of their pregnancy during this early stage. Neural tube defects, therefore, pose a significant concern during this time. These defects are severe congenital anomalies that affect the brain and spinal cord. The two most common types of neural tube defects are spina bifida, characterized by an incomplete closure of the neural tube in the spinal cord, and anencephaly, which involves an incomplete closure of the neural tube in the brain and skull.   How can neural tube defects be prevented? Folic acid plays a crucial role in the development of the fetal neural tube. However, since many pregnancies are unplanned, neural tube defects can occur before a woman realizes she is pregnant, usually around 3-4 weeks after conception. Therefore, it is important for women to ensure adequate folic acid supplementation both before and during pregnancy to reduce the risk of such birth defects. While folate is naturally found in various foods, it is often insufficient to meet the necessary levels for pregnant women, necessitating folic acid supplementation. It is recommended to take a daily supplement of 400 micrograms of folic acid in addition to consuming folate-rich foods. Waiting until the first prenatal visit, typically between 6-12 weeks of gestation, to start taking folic acid may not be as effective in preventing neural tube defects.   For women with a history of neural tube defects in previous pregnancies, it is advised to begin taking 400 micrograms of folic acid daily before conception. When planning to conceive, it is recommended to consult a healthcare professional and take a higher dose of 4,000 micrograms of folic acid daily for at least one month before conception and continue until the end of the first trimester of pregnancy.   While taking folic acid at the appropriate time and dosage is important, it does not guarantee a 100% prevention of neural tube defects, as there can be other underlying causes for such conditions. By Dr. Parit Vajasitthisilp, M.D.   Specialist in Female Pelvic Medicine and Reconstructive Surgery

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Insights from Health Talk FM.102's Happy&Healthy Program: Understanding Pelvic Organ Prolapse

Insights from Health Talk FM.102's Happy&Healthy Program: Understanding Pelvic Organ Prolapse   Prolapsed pelvic organs   The pelvic floor is a cup-shaped area in the body, surrounded by robust pelvic bones, muscles, and connective tissue. It houses the pelvic organs, including the urinary bladder, uterus, vagina, and rectum in women. These organs can become displaced or "slack" due to the deterioration or injury of the connective tissues that support them. Factors like age, heredity, pregnancy, childbirth (especially multiple or assisted deliveries), obesity, and conditions that increase abdominal pressure (such as coughing, sneezing, and chronic constipation) can contribute to the weakening of these tissues.   Pelvic organ prolapse most commonly affects the female reproductive organs, namely the uterus and vagina, due to structural differences between men and women. Pelvic prolapse refers to the protrusion of pelvic organs into the vagina, such as the descent of the uterus or the anterior/posterior vaginal wall. The severity of this condition can be classified using the POP-Q system, which distinguishes between four grades. Grades 1-2 indicate mild prolapse, where the organs are still mostly contained within the vagina and may not cause noticeable symptoms. In more severe cases (grades 3-4), a visible lump may protrude from the vaginal opening, potentially accompanied by symptoms like abnormal vaginal bleeding, urinary retention, kidney issues, and abnormal bowel movements. In addition to the female reproductive organs, pelvic organ prolapse can also affect the rectum (the last part of the colon) in both men and women, although it is less commonly discussed. Treatment for rectal prolapse requires the expertise of a colorectal surgeon and differs from the management of prolapse involving the female reproductive organs.   The treatment approach for pelvic organ prolapse in women depends on the severity of the condition and the presence of symptoms. Here are several treatment options:   1. Risk factor management: It is crucial to avoid or address risk factors that contribute to pelvic organ prolapse, such as weight loss in overweight individuals, avoiding heavy lifting, managing chronic coughing and sneezing, and addressing constipation. These measures help reduce abdominal pressure, an important factor in the effectiveness of treatment.   2. Pelvic floor muscle training: For patients in the early stages of prolapse, pelvic floor muscle training is the primary treatment. This approach aims to strengthen the muscles supporting the pelvic organs, potentially reducing vulvar size. Similar to training other muscles, regular and disciplined practice is essential. It is recommended to practice at least 3-4 days a week, with approximately 30-40 repetitions per day. However, for patients with advanced pelvic organ prolapse, pelvic floor muscle training alone may not provide significant benefits or resolve all symptoms.   3. Pessary use: A pessary is a device inserted into the vagina to support specific parts and prevent their movement, alleviating symptoms. It is a convenient, non-surgical option that can be fitted to each patient's individual needs. Pessaries offer immediate symptom relief without the need for hospital visits or surgical wounds. However, it is important to note that wearing a pessary does not correct the underlying anatomical issue. Continuous use is necessary to prevent symptoms.   4. Corrective surgery: Surgical intervention may be considered for pelvic organ prolapse. Procedures aim to restore the vaginal area close to its original position or close the vagina entirely. It is a misconception that both the uterus and vagina can be completely removed in most cases of advanced pelvic organ prolapse. Only the uterus can be removed, as the vagina remains essential for its connections to the bladder and rectum. It also acts as a protective barrier between internal organs and external elements like air.   The main cause of prolapsed pelvic organs is the deterioration of the connective tissue structure. Therefore, the primary method of prevention is to minimize risk factors. This includes maintaining a healthy weight, addressing chronic cough and chronic constipation. Pelvic floor muscle training can be initiated from a normal age of maturity. Additionally, for women who do not experience symptoms, it is advised to undergo annual health check-ups that include internal examinations, cervical cancer screenings, and ultrasounds. If any symptoms arise, such as changes in urinary patterns or stool, it is important to seek immediate medical attention for proper treatment or further investigation into the underlying cause.   Dr. Parit Vajasitthisilp, Obstetrician and Gynecologist, Specialist in Medicine

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Understanding Urinary Incontinence in Women: Exploring Causes, Including Congenital Factors and Medication Side Effects

Urinary incontinence is a prevalent condition, particularly among older women, where urine involuntarily seeps or flows out without control. It significantly impacts the quality of life for patients, causing feelings of embarrassment and shame within their families and society. Many individuals affected by this condition attempt to conceal it, which hinders them from seeking necessary treatment. Women can experience various types of urinary incontinence, and some cases may be complicated by pelvic organ prolapse. Therefore, it is crucial for women with urinary incontinence to consult their healthcare provider for a thorough evaluation and appropriate treatment.   Types of Urinary Incontinence There are three primary types of urinary incontinence: 1. Stress urinary incontinence: This occurs when there is an increased pressure on the abdomen, leading to urine leakage. In healthy women, the urethra is supported by connective tissues that prevent urine flow during activities such as coughing, sneezing, laughing, or exercising. However, if these tissues are damaged or weakened, stress urinary incontinence can occur. 2. Urgency incontinence: Also known as overactive bladder, this type is characterized by a sudden, intense urge to urinate, followed by involuntary leakage. The urge to urinate can be triggered by various factors, such as removing clothing, opening a bathroom door, hand washing with cold water, or even unlocking house keys. Patients with urgency incontinence may experience frequent urination (more than 7 times a day) and nocturia (waking up to urinate more than once at night). 3. Mixed urinary incontinence: This is a combination of stress urinary incontinence and urgency incontinence. Patients with mixed urinary incontinence experience both urine leakage during activities that increase abdominal pressure and sudden, uncontrollable urges to urinate.             There are also other types of urinary incontinence, although they may be less common. These include positional urinary incontinence (leakage when changing positions), bedwetting (involuntary urination during sleep), continuous urinary incontinence, unconscious urinary incontinence, and urinary incontinence during sexual activity.   Assessment of Patients during Doctor's Visit The assessment of patients during a doctor's visit is crucial for accurate diagnosis and treatment. Your doctor will conduct a detailed inquiry about your urinary incontinence symptoms, including a comprehensive medical history, information about your fluid intake, chronic diseases, and regular medications. A general physical examination will be performed, followed by a detailed internal examination that includes an assessment of pelvic organ prolapse. Additionally, your doctor may recommend specific additional tests or laboratory investigations, which may include: 1. Urinary Diary: Keeping a record of your urinary habits, known as a bladder diary, is essential for the assessment process. This diary tracks the amount of urine, timing of urination, fluid intake, and activities that trigger urinary incontinence. It provides valuable information to identify the underlying cause and guide treatment decisions. 2. Basic Tests: These may include measuring the amount of urine in the bladder using ultrasound, performing a cough stress test to simulate urinary incontinence by increasing abdominal pressure, and measuring the residual urine volume in the bladder after urination using ultrasound. 3. Urine Analysis: A urinalysis is conducted to check for other potential causes of urinary incontinence, such as urinary tract inflammation or the presence of stones. 4. Urodynamic Study: This test mimics the actual events occurring in the bladder, starting from urine filling to the bladder's capacity and simulating urinary incontinence to observe the associated events during urination. It is typically performed for patients with complicated diagnoses or those planning to undergo surgery.   Treatment Options for Urinary Incontinence 1. General Treatment for Urinary Incontinence 1.1 Behavior Modification/Lifestyle Modification: - Weight reduction: Overweight or obese patients may experience improvement in symptoms with weight loss. - Treatment of constipation: Addressing chronic constipation can help alleviate symptoms. - Appropriate fluid intake: Balancing fluid intake is crucial. Patients with excessive fluid intake and frequent urination or urinary incontinence should reduce their intake to around 1.5-2 liters per day. However, patients with frequent urination and low fluid intake should not restrict their fluid intake further, as it may lead to dehydration. - Avoiding certain beverages and foods: Some beverages like coffee, tea, soft drinks, soda, fruit juice, and alcoholic beverages, as well as sour or spicy foods, should be avoided. 1.2 Pelvic Floor Muscle Training: - Strengthening the pelvic floor muscles through consistent and disciplined exercises for at least 3 months can effectively treat urinary incontinence. It is important to learn the correct technique under the guidance of a healthcare professional, as many patients initially perform these exercises incorrectly. 2. Specific Treatment for Stress Urinary Incontinence (related to coughing, sneezing, etc.) 3. Specific Treatment for Urge Urinary Incontinence 3.1 Bladder Training: - This method aims to increase the bladder's capacity by gradually extending the time between voiding and attempting to delay urination when the urge arises. Bladder training should be practiced under the supervision of a healthcare professional. 3.2 Medications: - Certain medications can relax the bladder muscles, helping to hold urine for longer and reducing urinary incontinence. However, patients may experience side effects such as dry mouth, dry eyes, or constipation. Different medications may need to be tried before finding the most effective one. Medications are usually used as adjunctive therapy and prescribed for about 3 months. 3.3 Botulinum Toxin Injection: - This procedure involves endoscopically injecting botulinum toxin into the bladder wall to relax the bladder muscles, reducing urgency and increasing urine retention. The effect typically lasts for 6-9 months and may require repeated injections. Some patients may experience temporary difficulty urinating or urinary retention and may need catheterization for a period. 3.4 Other Treatment Methods: - For patients with severe symptoms despite previous treatments, alternative options like Tibial Nerve Stimulation or Sacral Nerve Stimulation may be considered. However, these treatments are not widely available in Thailand due to their complexity, high cost, and potential complications.   Best wishes from Dr. Prit Vajasitthisilp, Obstetrician at Vibhavadi Hospital Specialist in Female Pelvic Medicine and Reconstructive Surgery

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ไขข้อข้องใจทำไมต้องฉีดวัคซีนป้องกันมะเร็งปากมดลูก ?

ไขข้อข้องใจทำไมต้องฉีดวัคซีนป้องกันมะเร็งปากมดลูก ?   “เรื่องน่ารู้ที่จะช่วยให้สาว ๆ หายสงสัยว่าทำไมควรป้องกันเชื้อ HPV สาเหตุของมะเร็งปากมดลูก”   หนูยังหาแฟนไม่ได้เลยแล้วจะรีบฉีดทำไมแต่งงานแล้วค่อยฉีดดีกว่าไหมคะ ?              1.มะเร็งปากมดลูกเกิดจากการติดเชื้อ HPV ซึ่งติดต่อได้ง่ายมากจากการมีเพศสัมพันธ์หรือการสัมผัสทางผิวหนังบริเวณอวัยวะเพศ เพศสัมพันธ์แม้เพียงครั้งเดียวก็อาจทำให้ติดเชื้อ HPV ได้              2.เพราะส่วนใหญ่เพศสัมพันธ์ครั้งแรกเกิดจากความไม่ตั้งใจ เราคงคาดเดาไม่ได้ว่าจะมีเมื่อไรถึงตอนนั้นจะป้องกันก็คงไม่ทันแล้ว               3.การฉีดวัคซีนตั้งแต่ยังไม่มีเพศสัมพันธ์หรือยังไม่ติดเชื้อ จะทำให้ได้ประโยชน์มากกว่า               ข้อมูลทางการแพทย์ล่าสุดพบว่า วัคซีนป้องกันมะเร็งปากมดลูกบางชนิดสามารถป้องกันได้มากกว่า 90% ผู้หญิงที่ยังไม่เคยติดเชื้อและการฉีดตั้งแต่อายุยังน้อย จะทำให้มีภูมิคุ้มกันสูงกว่าและอยู่ได้นานกว่าฉีดตอนที่มีอายุมากขึ้น ดังนั้นการฉีดเมื่ออายุน้อยและยังไม่เคยมีเพศสัมพันธ์เป็นการป้องกันที่ดีที่สุด ดิฉันมีแฟนคนเดียวค่ะ เขารับประกันว่าชัวร์มั่นใจไม่นอกใจแน่นอนค่ะ? - จะแน่ใจได้อย่างไร? เพราะผู้ชายอาจติดเชื้อมาก่อนที่จะมีเพศสัมพันธ์กับเรา และแม้เราจะมีแฟนคนเดียวแต่แฟนอาจไม่ได้มีเราเป็นคนแรกหรือคนเดียว เขาอาจติดเชื้อมาโดยไม่รู้ตัวเพราะเชื้อโรคนี้เป็นไวรัสที่ติดต่อง่าย   ต้องตรวจมะเร็งปากมดลูกก่อนฉีดหรือไม่กลัวฉีดไปแล้วไม่ได้ช่วยอะไรเลย?   - โดยไม่ต้องกังวลว่าจะต้องตรวจภายในเพื่อหาเชลล์มะเร็งปากมดลูกก่อนเพราะการฉีดวัคซีนเป็นการป้องกันการติดเชื้อในอนาคตส่วนการตรวจภายในเป็นการตรวจหาเซลล์ผิดปกติที่เกิดจากการติดเชื้อมาก่อนทำได้ควบคู่กันไปก็จะดีที่สุด    ฉันอายุมากแล้ว จะฉีดไปทำไมให้เด็ก ๆ สาว ๆ เขาฉีดน่าจะดีกว่า ?   - “ฉีดช้า ยังดีกว่าไม่ได้ฉีด” เพราะมะเร็งเกิดได้ทุกวันและทุกช่วงวัย การศึกษาทางการแพทย์พบว่าวัคซีนสามารถป้องกันได้แม้ในผู้หญิงอายุมาก นอกจากนี้วัคซีนยังมีความปลอดภัย ดังนั้นจึงไม่มีเหตุผลอะไรที่จะไม่ฉีดวัคซีนป้องกันมะเร็งไว้ล่วงหน้า     วัคซีนป้องกันมะเร็งปากมดลูกฉีดที่ตรงไหนกลัวเจ็บจนทนไม่ไหวค่ะ ?   - ฉีดบริเวณต้นแขนข้างใดข้างหนึ่งเหมือนการฉีดวัคซีนทั่ว ๆ ไป ไม่ได้ฉีดบริเวณปากมดลูกหรืออวัยวะอื่นใดเลย วัคซีนป้องกันมะเร็งปากมดลูกจำนวน  3  เข็ม  เข็มที่ 2 ห่างจากเข็มแรก 1-2 เดือน และเข็มที่สุดท้ายห่างจากเข็มแรก  6  เดือน ฉีดวัคซีนแล้วจะมีอันตรายไหม มีผลข้างเคียงหรือไม่คะ ? องค์การอนามัยโลก( WHO ) ได้รับรองวัคซีนนี้แล้วว่าปลอดภัยทั่วโลกมีการฉีดไปแล้วกว่า 50 ล้านโด๊ส อาทิ อเมริกา ยุโรป กลุ่มสแกนดิเนเวีย ญี่ปุ่น ออสเตรเลีย ฯลฯ ดิฉันกำลังจะแต่งงานคิดว่าจะมีลูกเลยฉีดได้หรือไม่คะ ? - ฉีดได้ค่ะ ไม่ต้องคุมกำเนิดหลังฉีดเพราะวัคซีนไม่ได้สังเคราะห์จากเชื้อไวรัสโดยตรงถ้าตั้งครรภ์แล้วยังฉีดไม่ครบ  3 เข็ม ก็แนะนำให้ฉีดเข็มที่เหลือหลังคลอดได้   รักตัวเอง ก่อนจะสายเกินไป ชวนผู้หญิงไทยตรวจคัดกรองเป็นประจำพร้อมทั้งฉีดวัคซีน HPV   ข้อมูลโดย : พญ.สุนีย์  ศักดิ์ศรี สูตินรีแพทย์ประจำ รพ.วิภาวดี  

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