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Taking care of the diabatic patient’s feet

Looking after and taking care of the feet is necessary for people with diabetes, especially the elderly with diabetes There is a risk of exposure to opening chronic wounds or a more severe infection than common people. If they are not received good treatment, it may spread and result in losing toes or legs. These can be prevented by taking good care of your feet every day. In case of abnormal condition is spotted, it should be taken care of from the short term. Cause of diabatic patients having foot ulcers than common people 1. Those who has had diabetes for a long time, were found to have degeneration of the peripheral nerves that feed the hands and feet. Less of sensation, resulting in numbness, especially the toes. In particular, the toe has a chance to get injured and the wound may spread without knowing it or noticing it. As the nerves deteriorate, the muscles will flatten and cause the shape of the foot to be abnormal e.g. bent up toes, uneven weight of the feet, the areas that have been subjected to heavy loads or been pressed for a long time are thickened, or even get corns or ulcers. 2. Blood flow to the legs decrease due to the thickening of the artery walls, causing lack of nutrients and oxygen, the skin becomes thinner, the wound heals slower, and the calf pain occurs when walking. In case of blood clogged are spotted, the peripheral tissues will be dead, and the color will be darker, resulting in cutting off a toe or a dark dried toe may fall off itself. 3. Patients with high blood sugar levels for a long time can be easily infected, especially the skin fungus between the toes, causing the skin to peel and wound up and may follow with serious pathogens.   Prevention of peripheral nerve deterioration         Currently, there is no prevention, but the process could be gotten slower or less severe by controlling diabetes, keeping the sugar level within the criterion.

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How is diabetes diagnosed?

Diabetes means having blood sugar levels higher than the common people. For common people, by the time of intaking sugar before meals, the level of the sugar is in the range of 70 to 100 milligrams percent. Criteria for the diagnosis of diabetes stipulate that the level must be equal to or greater than 126 milligram percent. For an symptomatic person, the test must be re-coducted to ensure the result. For those whose level is around 101 – 125 milligram percent will be diagnosed as abnormal, having a great chance to get diabetes and a risk in complication of large blood vessel.   Diseases or conditions commonly found with diabetes. Diabetes is often found in obese people or with thier relatives and ancestors has been exposured to it. They tend to have high blood pressure and abnormal blood lipids as well. These two abnormal conditions contribute to the accelerated development of large vascular complications. Therefore, rigorous treatment is required along with controlling blood sugar levels.   high blood pressure and abnormal blood lipids are often found in conjunction with diabetes which act as catalyst in the progression of complications in large blood vessels.   Best wishes, Vibhavadi hospital

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Importance of Warming-up, A Tips for young golfer

Warming-up   Before the duel start!! do you know about this children? insufficient warm-up can cause injury while playing sports. Therefore, you should warm-up first before playing sports every time for safety, children should warm up first which is also do for the sport, namely "golf".   “Prevention is better than cure” by Col. Weerayut Chaopreecha, M.D., orthopedic surgeon Vibhavadi Hospital. Therefore, organizing a workshop "Anatomy for Golfers" provides advice to young golfers at North Park Golf Driving club (Prachachuen)   He stated that, bones are 5 times stronger than steel because of the bones of a living person contains living cells that constantly changing shape and being rebuilt. It can also repair itself when injured. Eating food from all 5 food groups, getting enough rest, and exercising. will help building strong bones.   Golf is a sport that uses all parts of the bone in which the player should exercise to stretch the joints and muscles every time. Due to the high-speed swing, most skilled golfers can speed their clubheads faster than 100 mph. If the muscle and ligaments was not stretched enough, it will often cause injury. In some cases, broken bones can lead to loss of balance for the rest of your life. Kind of terrifying isn’t it, therefore you must do exercise before playing golf.   Doctor said that the player should be prepared by warming up and stretching exercises before practicing or playing golf every time, starting from the neck muscles, rotate your shoulders around your spine, exercise the abdominal muscles, back and hips to maintain the spinal axis during the swing. Exercising and stretching of the thigh and calf muscles help in maintaining balance for transferring the body weight while playing golf.   That’s all, now you can play golf safely and happily.

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Chronic Hepatitis C

Hepatitis C was first discovered in 1989. Worldwide prevalence is around 1.8% of blood donors. The population in Thailand is approximately estimated that 6 hundred thousand to a million people are infected with this disease. There are 6 genotypes of hepatitis C. In Thailand, 40-50% has been found to be genotype 3, followed by genotype 1 around 20% and genotype 6 for 15-20%. Hepatitis C virus transmitted by receiving contaminated blood or blood products, or from syringe, razors, tattoo or acupuncture equipment that is contaminated with patient’s blood. The disease transmission via sexual contact between husband and wife is very rare but the possibility is higher in people who are sexually promiscuous up to 0.4% per year. The chance of transmitting from mother to fetus is found at 4-7%.   As the disease progression continue after exposure to hepatitis C, 20% of acute hepatitis patients are found to have jaundice where more than 80% will go into chronic hepatitis with 20% of liver cirrhosis progression in 20 years and 20% of liver cancer incidence 5 years after cirrhosis. However, there are other factors that cause the disease to progress faster, including alcoholic drinking, gender (males), ages (over 4 years old), and concomitant infection with hepatitis B virus or HIV.   Diagnosis of chronic hepatitis C can be done by detecting Anti-HCV immunity which provides an accuracy of 92-99%. Therefore, it is commonly used in patient screening and can be confirmed by using HCV RNA for the amount of C virus in the blood. This is useful to tell the likelihood of response to treatment and see the trend of response during treatment.   Treatment of chronic hepatitis C aims to: 1. Eradicate hepatitis C virus to prevent transmission to other people. 2. Reduce inflammation in the liver, slow down fibrosis to reduce the incidence of cirrhosis and liver cancer. 3. Reduce the death rate from liver disease and increase quality of life   Currently, the drugs used to treat chronic hepatitis C are Pegylated Interferon and Ribavirin. The treatment takes around 6-12 months depending on the genotype. They are very expensive. The problem is that the costs associated with the drug have many side effects. They should be used under supervision and monitoring for side effects by a specialist from applying Interferon. The side effects include fever, aches, fatigue, weight loss, thyroid, and bone marrow suppression. Ribavirin is an oral drug that can cause hemolytic anemia, rash, cough, dizziness. In addition, patients must perform contraception during treatment until or after stop taking the drug for 6 months due to the effect of Ribavirin to the fetus.   Although the cost of treating chronic hepatitis C is very expensive, it is found that the treatment using Pegylated Interferon and Ribavirin can provide preventive benefits from cirrhosis liver failure and liver cancer. It also gives value in terms of life (quality and long-term living) and more cost-effective compared to hemodialysis in patients with chronic renal failure coronary artery surgery and long-term treatment of high blood pressure.

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The Fitness Guru

Dr. Somboon Roongpornchai American Board Antiaging Medicine - What is the difference between whey protein and casein protein shake? - Are there any foods with high in protein, easy to find without relying on ready-made products but equally valuable and foods that helps increase weight. Because I am a person who eats less but I want to gain 10 kg of weight, is that possible? Or is there any method that will work? I exercised and my weight was still normal. After eating protein, I didn't see any progress at all. I would like the most obvious method. - Ami silpa Everyone who exercises by fitness services, you’ve probably heard of protein supplements for exercisers. Recommended friends often say eat to get bigger muscles faster without wasting time or are you tired of lifting a lot of weight? This comment sounds reasonable because muscle protein is the main component. Therefore, eating extra protein should make our muscles grow faster, but there is a controversy. Because if you eat enough protein food, adding more protein will not benefit other than for psychological reasons. However, consider this, it will be a burden for our liver and kidneys to remove excess protein that is packed together as well.   Good news is most Thai foods contain less protein because our house mainly focuses on carbohydrates. As a result, Thai people are now obese in starch and sugar. Now, if you want to try supplementary protein with exercise as well. I feel that I have played for a long time but no muscle development have been spotted yet and the weight has remained constant. The next problem is how do we select the appropriate protein out of ten types that are being sold in the store, is there any principles for selection? For MH issued in November, I have already introduced whey protein. At this moment, let's get to know another type of supplementary protein.   In the field of athletes There are two main protein supplements: Casein and Whey, both of which are made mainly from milk. They differ in the methods and objectives of the users. If someone tells you which kind is better Shows that the person who advised, you still have a misunderstanding. Whey protein is classified as a fast-absorbing protein supplement, which is about 20-40 minutes. Most proteins are almost completely absorbed by the body. on the contrary Casein is a slow-absorbing protein that takes 3-4 hours to be absorbed and has a higher level in our blood for longer. Simply put, whey protein is focused on the body to build muscle. But casein will focus on preventing the breakdown of muscles to be used as energy. Do not eat both types of protein water together. because it will cause the absorption to be lost. The correct way is to take whey protein first. If taking casein, take it at least 3 hours apart.   Finally, I would like to emphasize that while building muscle is primarily protein, but other nutrients are needed. Major vitamins and minerals are also supplemented. Therefore, it is not recommended to use protein supplements as a staple diet for exercisers as you may be deficient in other essential nutrients. The correct advice is You should add protein to each main meal. But if you still can't eat much or can't prepare it in time Therefore, it is recommended to supplement with whey protein and casein again.  

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Brown Carb VS White Carb Overcome obesity with carbohydrates

In the past, when they are talking about losing weight, people often encourage each other to abstain from low-fat foods. Each time they eat fried food, they will drain the oil until it dries out as much as possible or absorb the oil with a tissue until they are sure that it can be gently chewed in their mouths. One of my friends even buy a special ladle that scooped the soup without sticking to the fat on its surface. However, don’t you think that that my friends will be able to get rid of the belly as he wishes by investing this much because the more fat is eliminated, the more belly seems to constantly grow plump. Starch is our enemy, not fat!!!   During the past 5-7 years, nutritionists from many agencies said that the cause of obesity in today's era is not bad fat, but carbohydrates, or what we call for short, carbs, which are all starchy foods including sugar. The cause of diabetes for hundreds of years, most of the packaged foods are labeled fat-free and cholesterol-free which makes us understand that eating and not getting fat, but in fact, these foods still have a very high carb content and these carbs, when they enter into the body, can easily be converted into fat. So, it's not surprising that people who eat low-fat diets become fatter.   A better choice for health lover   Battle with fat around the belly this time might make the mistake by aiming at the wrong opponent. But this is still not late. Carbs are considered essential nutrients for energy. Therefore, abstaining from carbs is probably not a good choice for health lovers because you may have abnormalities in your body and results in weight loss at the end. The key point is to estimate the amount and choose the right type of carb. Good carbs are absorbed at a slow rate and high fiber content. Calories from good carbs will result in less fat being stored and energizes your body to be completely ready to handle daily tasks.   Brown carbs are a great source of vitamins.   Did you know that how many brown carbs do you need to consume to get a nutrient-rich mix of vitamins B, E, zinc, and folate. The brown intensity in a carb diet indicates that carbs contain a nutrient-rich mixture of seed skins and germ. only more useful fiber While white flour only contains the rice grains only.

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Snacks

For six-pack By Dr. Somboon Roongpornchai For gentlemen who have been following Men's Health for a long time would have already known that abdominal muscles come from the right training, along with eating. For young people, who sit up every day, It is guaranteed that the six pack abs must be in the abdomen for sure but It just doesn't come out of the fat. Therefore, you should try this out, using the fat extraction plan that I am about to introduce here.   Kanom Jeen or snacks are forbidden for those who are being in shape or weight loss. However, some people can't help it but it's still good that they don't dare to beat a lot like having protein.  You may have noticed that some people eat so much but their stomachs are still hard as a board. Techniques for choosing snacks wisely will allow you to maintain your shape comfortably. Eating food often increase strength as well, speed-up metabolism, reduces hunger and clears the brain. Some doctors say that the mood will even improve. We often find that there are two types of people.   Type 1: Those who do not eat at all or eat very little (Which will be followed by symptoms of calories falling into some range or hungry until they have no energy to workout) Type 2: Those who don’t know what to eat, taking starchy, high-sugar snacks which result in a belly that protrudes through the belt.   I have encountered this problem every day since I was in America. I can say that everyone has faced this problem as well. Therefore, you should prepare snacks in advance. They can be prepared from home or work. It's up to you. It's easy, not too hard for your health and fitness goals. Some people who don't have this knowledge might be discouraged and ended-up without knowing nothing about what and how much they can eat.  Let's take a look at how I am going to manage my snacks. I guarantee that this is going to work on you, delicious, getting fit and get you a six pack rewards whether you like snacks or not.   Old snack: chocolate milk Old snack: Bua-loy (Thai glutinous rice balls with coconut milk) Smart snack: banana shake (190 calories) Half cup sliced bananas topped with low-fat yogurt with 1-2 pills of omega-3 oil. This will cut the calories in half but still add protein and fiber which helps you feel full longer.   Old snack: Rich Chocolate Ice Cream with Peanut Butter (640 calories) Smart snack: Frozen Ripe Bananas, sprinkle with 20 peanuts. By this method, fat and sugar is cut-off by 300 calories, plus nearly doubles of fiber and vitamins (220 calories)   Smart snack: 1 stick of meatballs with sweet and sour sauce, eaten with fresh cabbage and cucumbers, will get almost half the calories in the form of protein and fiber from fresh vegetables. At least some of it flows into our muscles, but we must choose a shop that looks good and without borax.   Old snack: 150 grams of biscuits or potato chips (320 calories)   Smart snack: 100 grams (or a bit more) of whole-wheat bread or high-fiber biscuits, topped-up with cucumber or cantaloupe and honey or a little salad dressing. This will reduce both calories, prevent high blood pressure from consuming too much salt. plus 2-3 times more fiber, minerals and vitamins.   Old snack: 1-piece hot fried chicken (300-400 calories) Smart snack: 1 skewer of grilled chicken meat with a small salad without any salad dressing or pound fruit. It is delicious and healthy due to the calories that are reduced by more than half, reducing of fat accumulation with lots of vitamins from fruits and vegetables Old snack: 1 normal size of fries (382 calories plus almost 20 grams of fat without any protein or fiber) Smart snack: Homemade fries or sliced potatoes (your choice). It must be dry fried with a little oil. sprinkle a little salt, pepper, and then bake or put in the microwave. Served with carrots cut into sticks.   Old snack: 1 piece of pizza (300 – 400 calories) Smart snack: Cracker bread, topped up with tomato sauce or spaghetti sauce and sprinkled with a little cheese. Put it in the microwave for a short period of time. This is like giving back 50 percent of your calories to the pizza restaurant.   Old snack: 2 apples Smart snack: 1 apple with nuts. This method will supply the protein and reduce sugar in the same amount of calories. it helps to full the stomach better and longer. Old snack: Patongo with 1 serving of sweetened condensed milk or banana (710 calories) Smart snack: Crispy bread sticks served with guava or fresh carrots dipped in low-fat yogurt. a slice or two of sweet watermelon can be added. Now it's a 100-calorie snack that's low in fat and sodium.   Healthy Six – pack Snacking   Easy snacks to boost your fitness. For the young in this modern age, convenience is important. Occasionally, you just have to choose some snacks that help you build your muscles. The following list of snacks can help you. •          The smallest pack of almonds •          The smallest peanut butter crackers •          Soy milk, less sweet or no sugar •          low fat yogurt or natural flavor •          Compressed fiber snack bars, low fat, less sweet. In case of none can be found, you can have crispy pork. a piece of pounded pork with hot green tea.   Tips for Six-pack Snacks:   Hunger Quotient: you should observe on how much is your ability to endure hunger in different period by what time of day that you are hungry. Don't endure it, try to listen to your body, take a small snack to feed your body enough to satisfy your hunger. You don't have to be full. (If your Hunger Satisfaction Scale is of 0 to 10, you'll need to stay on a 4-6 level throughout the day.) and continue with your daily life. This will allow you to know when your body needs calories, how many times a day, which is the most accurate too. Try to stop eating anytime you want to see how many meals your body wants you to eat and at what time.   Eat Proportionately: Observe the portion of the eaten food. Challenge yourself on how much portion of protein, carbohydrates, and fats you have got in each meal then try portioning your food according to your body's needs. You'll see that it's not difficult to try to choose carbohydrates from whole wheat, brown rice, unpolished rice or flour. As for protein, choose pure meat such as fish, chicken (removing the skin). As for fat, focus on fat from fish, olive oil and try to exercise more.   Nutrient-dense Foods: Choosing nutritious food is the most important. It is key to a good health. To aids your exercise, some foods are almost unhealthy, such as sweet jelly. Try to switch to eating nuts, fresh fruits, your stomach, brain, body will be full.

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VEGETARAIN FITNESS FOR MEN

Make your body firm by vegetarian. By Dr. Somboon Roompornchai   Currently, eating vegetables is a global trend and tends to increase more and more. It is obviously noticeable that many people begin to stop eating meat and turn to vegetarian diets. The reason is they think that vegetables are useful and healthy, keeping the body strong, don't get sick easily. I am quiet surprised when I ask those who get their firm muscles about how did they make it and the answer was so simple that they are vegetarian. I used to think the firm body must only be obtained by having protein. However, many people support the idea that eating vegetable helps in body buildup and weight increase.   Ask The Fitness Guru Dr. Somboon Roompornchai American College of Anti-aging Sports medicine Professionals (ACASP)   I just became interested in body workout after reading Men's Health. Once I have registered for fitness membership, the trainer took me for many measurement which I do understand some and some may not.  Could you please explain about those measurement and how is it important to me.   For those men who think about who is fat or thin, most people probably think of the body weight and set it as a criterion. In the past, I and some doctor thought of the same way. For today, I have to say that body weight is just rough physique criteria in which we do not use it to evaluate your body strength and healthy.   I am explaining to you that 2 of my patients came to me to consult about the anti-aging program. Both of them had the same weight and height. They both had got problems with their body mass index (IBM), which indicates they are overweight. However, when I met them, one looks really fat, but another person is big due to the weight training. Therefore, I think that the weight may not tell the body level of a man.   In this case, body fat mass and waist circumference measurements will provide better information because most Thai men have a fat mass between 12 -15 percent. In case of the fat mass is more than 18 percent, it must be considered that you are not firm, have a belly, or accumulated fat. Don't wait for the weight to warn you, you must control and keep your fat mass at a lower level. Most of them must not exceed 9 percent.   In addition to fat mass measuring, muscle mass measuring is also useful because it indicates whether the fitness program you are playing is suitable. The only way to tell if a particular program is right for you is by looking at changes in your muscle mass (Most of workout programs focus on losing fat mass and increasing muscle mass, so your weight may not change or may even increase, in term of muscle while fat mass must be reduced). We are able to decide our fate, but for the shape, you can define it. Take action on diet and exercise regularly and your desired body and health is no longer a dream.       For more information, please contact us via [email protected]

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Ask the fitness guru

Ask the fitness guru Easy trick For fitness people who like to eat vegetarian food.   A good vegetarian must choose protein along with it.   Vegetarians often worry about protein deficiencies because they were told that protein only comes from meat, milk, eggs, etc. Nowadays, people who exercise choose to eat vegetarian food without worrying about lack of protein. Nowadays, there are many protein-rich vegetarian foods to choose from. For example, milk, eggs, cereals, nuts are all protein-rich nutrients. If you are still not sure, you can have whey protein like isolate type as supplement. Of course, these proteins may not be sufficient as meat proteins but consuming alternately can ensures that the recommended amounts of key proteins are met. Please make sure you have at least 200 grams of protein per day.   Choose the right nutrients and prepare your own food.   A popular question that scares many people whether they should have vegetarian food or not is that the body does not get enough nutrients because some knowledgeable people really protested. If you want to eat vegetarian food, you must know how to choose the right diet. Vegetarians will have to spend some time to prepare their own meals because they can select their desired food. The watch-out list of nutrients and often deficient in vegetarian diets include iron, zinc, and vitamin B12.   Iron is an important component in red blood cells which is the key to unlock muscles growing at a fast rate. Most people get this substance primarily from meat because the iron from plant (Found in green leafy vegetables such as spinach, cassia leaves, cereals) can be absorbed in less amount and may lead to lack of nutrient at the end. This issue can be simply solved by adding bit more vitamin C to your diet. Vitamin C will help absorb iron from plants better. Importantly, vegetarians should avoid drinking tea, coffee with or after meals due to it reduce the absorption of iron from the food you eat. If you like to drink, you should drink it 1-2 hours before meals or 4 hours after meals. More importantly, dairy products and bone nourishing calcium will also block the absorption of iron. Therefore, it must be taken separately with meals. Iron-rich vegetarian foods include beans, grains, tofu, and eggs.   Zinc-rich vegetarian foods include grains (don't boil too much water). or very decomposed because it will lose the nutritional value. If you can drink boiled water (it's good to drink), nuts, seeds, and tofu. However, meat eaters are also often deficient in zinc. The recommended dosage is 25 milligrams per day. Most vegetarians get vitamin B12 from dairy and eggs. People get from fish, fish sauce, which this vitamin is lacking a lot of young vegetarians. It should be added better. Because this vitamin is water soluble and does not accumulate in the body. excreted through urine.   How to strengthen your body by eating   For those skinny guys who exercise a lot but no different could be spotted or even gain weight and grow of belly (especially at age thirties), this is caused by decrease in the metabolism rate. Despite the decreased metabolism rate, you can become a muscular man by adjusting your diet. Muscles can grow faster as you choose an appropriate supplement nutrition. For instance, one of my colleagues who works out regularly have taken a supplement nutrition as he turns to have vegetarian diet. On the day of weight training, he takes 30 grams of whey protein with 25 grams of dextrose with water and drink 15-30 minutes before weight training. This is a wise option because the protein and dextrose can be easily absorbed into the body. Glucose can provide source of energy in the first 5 minutes of your workout then protein will take care of the rest. In addition, consumption of glucose before doing exercise causes high levels of the hormone insulin which in turn helps the glucose to enter muscle cells better, resulting in faster muscle development. If your muscle strength are low, legume foods such as soybeans or tofu which is an excellent plant-based source of protein could solve your issue.   Eating vegetarian with no energy running out   In fact, meat lovers may experience more fatigue than vegetarians. For people who choose to eat only, will get less energy, fatigue, and feel sleepy because they eat a lot of protein which causes body to use all energy to digest food, resulting in easily lacking energy.   Strength comes from a perfect and balanced body. A balanced diet will be our perfect source of energy. Strong muscles come from effective loading. Basically, if you want to load your muscles strong, the first thing you need to do is generate muscle power. Because it needs strength to do workout and lead to strong and well-balanced muscles. Exercise without energy may cause injury and make muscle get weaken. The other factors that affect the muscle strength may include bad hormones, deficiency of iron, irregular calorie levels, hard work out without sufficient rest. This problem can be simply solved by having meal on-time, properly, regularly, and be wise.   What does Muscle building diet look like?   You can choose to eat vegetarian food along with building up your muscle strength. A good technique is to serve sufficient calories and balance diet as you need. Therefore, the nutrient should be served from various sources to ensure that you will received them all. Even though, Vegetarian diet can be obtained from various source, you may end-up lack of nutrient but are still able to sustainably achieve your body build-up.   In general, vegetarians are healthier than other people. They are typically safe from heart disease, less fat, lower risk of cancer and diabetes, blood pressure is maintained. Now, you have got the right option, just balance it, serve yourself a proper nutrient and you will be extremely strong.

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10 things you should know before HPV vaccination to prevent cervical cancer

10 things you should know before HPV vaccination to prevent cervical cancer   1.How HPV vaccine can prevent us from cervical cancer Cervical cancer is caused by viral infection, namely HPV (Human Papillomavirus) which can be infected via sexual intercourse. The virus will interrupt the cervical cell and cause them to become tumor or cancer. Receiving HPV vaccination can effectively prevent us from cervical cancer at a success rate of 70%.   2.Do we need to be tested for HPV before vaccination? According to the recommendations of the US Immunization Board, no abnormal condition can be detected for young women who go for a regular cervical screening test called a Pap Smear Test. They do not need to receive any more HPV testing prior to vaccination. In the present, the tools are still limited as similar as the ready hospitals that can provide services for HPV infection testing which make identifying the strain of the virus become difficult and costly which is not worth, compared to the cost of getting vaccinated. In case of an abnormal Pap smear result is detected, the doctor will give advice on how to cure it before getting vaccinated. It is still necessary to check the "Pap smear" regularly because the HPV vaccine cannot provides comprehensive protection against all other types of HPV that can cause cervical cancer.   3.Is HPV vaccine able to effectively protect us from cervical cancer at 100% success rate? In fact, We have discovered that 99.7% of cervical cancer is caused by HPV, a virus that transmitted mainly through sexual contact. This led to the development of the HPV vaccine, which can effectively prevent at 70% success rate of the major infections that cause cervical cancer. There are some HPV that this vaccine is ineffective against. However, vaccine work very well for those who have not been exposed to the virus contained in the vaccine. The first successfully produced HPV vaccine and has been used in more than 80 countries around the world, covering HPV types 16 and 18 which are the major species that cause vaginal cancer and cervical cancer about 70% success rate and can also prevent infection with HPV types 6 and 11, which causes of genital warts at 90% success rate.   4.Are those women who have had sex still able to get the HPV vaccine? For women who have had sex can still get vaccinated, but it may not be effective at maximum protection compared to those who have never had sex before. However, It can still provide protection against infection with some of the other HPV strains included in the vaccine.   5.Which age is recommended to get vaccinated? Because HPV vaccine show the most effect in cases where there has never been contact with the pathogens. So it is recommended to be injected in girls or teenage girls. This is a precaution before having sex for the first time. According to the recommendation of the Immunization Committee, the United States has approved its use in girls and young women ages between 9-26 that the vaccine can effectively prevent cervical cancer caused by the main HPV-16 and 18 strains in those who have never been infected. as mentioned before. In many other leading countries, the vaccine is considered compulsory in girls and adolescent girls ages around 11-12 years as a pre-exposure protection. Due to the statistics  record of HPV infection around the world, it was found that the a group of 18 – 28 years old is commonly got infected and the HPV can take up to 10 years to form before it shows abnormal symptoms and cancerous which is the solid reason for explaining that patients with this disease whose age current between 35 – 50 years may actually have the onset of this disease since youth.   6. Is it safe to get the girl vaccinated? The research results have confirmed that this vaccine type is very safe because it is a synthetic vaccine mimics the structure of HPV without bringing any component of its strain used for vaccine production. It can create immunity against HPV as soon as it enters body. The serious side effects are very rare. The results also showed that vaccination in girls had a higher immunization response than in adults.   7.Can we still get vaccinated after we have got over 26 years old? Theoretically, the HPV vaccine works at its most effectiveness as you have never been exposed to the virus or never have had sex. The immunity level is even higher if the vaccine is given in childhood while making decision whether to get vaccinated or not is up to personal judgment in terms of the cost-effectiveness or lower the risk of cervical cancer through vaccination because the benefits that will be obtained from the vaccine depend on the individual's preexisting HPV infection condition. Generally, the infection can be spread individually. Not all species can infect the host at the same time. Therefore, being vaccinated can still protect against infection with other HPV strains in the uninfected vaccine. However, it is reccomended to consult your doctor for further information for a clear understanding before considering vaccination.   8.Can pregnant woman or breastfeeding women get vaccinated? Those women are strictly not recommended to get vaccinated. .For instance, If you become pregnant during the second or third dose of vaccination, the injection should be stopped immediately and come back for the 2nd of 3rd  dose right after giving birth without starting it again. However, regarding to reports, the vaccine is not harmful to babies born to mothers who were vaccinated during pregnancy. Consequently, those women who are being under breastfeeding period can get vaccinated.   9.Which body part will get vaccinated and is there any side effect or not? The vaccination is injected into the upper arm muscle. Harmful side effects are minimal. Most of them are common symptoms such as pain, swelling, slight redness at the injection spot or may have a fever in some cases After the injection, it is advisable to sit down and observe the symptoms for about 30 minutes before going home.   10.How many doses of this vaccine should be taken and how long will it be effective? 3 dose in Total must be taken within 6 months. According to the present, for a period of 5 years, it was found that the efficiency of the immune system was high. Currently, the study of the duration of prevention is ongoing. It is likely found that the HPV vaccine stimulates the immune system to recognize and build immunity to the HPV strains present in the vaccine. This is like the hepatitis B vaccine where the duration of immunity is still unknown at the early stages. But later it was found that the immune system can last a lifetime without booster injections.   Authored by Assoc. Prof. Dr. Wichai Termrungruanglert, M.D. Department of Obstetrics and Gynecology, Faculty of Medicine Chulalongkorn University  

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