Background: Erectile dysfunction (ED) is suspected to be the symptom manifestation of COVID-19.However, scarce data was presented this day. Our study was conducted to determine the prevalence of ED and its associated factors among Thai patients with COVID-19.Methods: Sexually active males with COVID-19, hospitalized between May and July 2021 at one university hospital in Bangkok, were screened for erectile dysfunction by the International Index of Erectile Function 5 (IIEF-5). Demographic data and COVID-19 treatment history were collected. Mental health status, including depression and anxiety, was evaluated with the Thai Patient Health Questionnaire 9 (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7), respectively. The sample size was calculated, and logistic regression was used to analyze the association.Results: One hundred fifty-three men with COVID-19 were recruited. ED prevalence was 64.7%, of which severity was mostly mild. Logistic regression, adjusted for age, BMI, and medical comorbidities, portrayed a significant association between ED and mental health status. Higher risk of ED was found in participants with major depression [adjusted OR 8.45, 95% CI: 1.01-70.96, P=0.049] and higher GAD-7 total score [adjusted OR 1.15, 95% CI: 1.01-1.31, P=0.039].Conclusions: Thai patients with COVID-19 had high prevalence of ED, which was associated with mental disorders. Thus, screening for mental problems is recommended in individuals with COVID-19 and ED.

Background Spironolactone and cyproterone acetate are commonly used in feminizing hormone therapy to achieve the goal of female range testosterone level; however, the data on the efficacy comparing between these two anti-androgens are scarce. Aim To compare the anti-androgenic effects between spironolactone and cyproterone acetate as the component of feminizing hormone therapy among transgender women population. Methods The study was single-blinded randomized controlled trial involved 52 transgender women from two transgender health clinics. Each participant received oral estradiol valerate 4 mg/day combined with anti-androgen, spironolactone 100 mg/day or cyproterone acetate 25 mg/day, depending on which group they were randomized to. Clinical and biochemical variables were obtained at baseline and at 12 weeks of feminizing hormone therapy. Main Outcome Measures The change of testosterone level from baseline. Other changes including free testosterone, estradiol, prolactin and lipid profile after the therapy. RESULTS After a 12 weeks of feminizing hormone therapy, the change of testosterone level in the cyproterone acetate group [558.0 ng/dL (IQR 352.0 to 783.3)] was significantly higher than the spironolactone group [226.2 ng/dL (IQR,-4.3 to 480.1)](p value <0.001). Testosterone and calculated free testosterone in the cyproterone acetate group were significantly lower than the spironolactone group. Consequently, a proportion of the participants who achieved the female range testosterone (<50 ng/dL) was significantly higher in cyproterone acetate group (90%) compared to the spironolactone group (19%). Serious adverse effects observed in cyproterone acetate users were drug-induced liver injury and asymptomatic hyperprolactinemia. Clinical Implications The data on the differences between the two anti-androgen could be benefit for the transgender health-care providers in medication selection and adverse-effects counseling. Strengths & Limitations The study design was randomized controlled trial and controlled the estrogen component by prescribed the same type and dose for each participant. However, the study was suffered from the confound feminizing effects from previous hormone therapy and the high drop-out rate. CONCLUSION For feminizing hormone therapy, cyproterone acetate had a higher testosterone suppression efficacy than spironolactone.

Background and Aims Mental illness among medical students is common. Identifying at‐risk students can be beneficial in terms of prevention and treatment. This study examined the association between preadmission mental health evaluation and mental health service utilization among Thai medical students. Methods The authors collected data from all first‐ to sixth‐year students at one university hospital and three affiliated hospitals during the 2014 to 2019 academic year (n = 1642). Preadmission mental health was evaluated using the Thai Mental Health Indicators 66 (TMHI‐66) questionnaire. Data from mental health service utilization included the dates of service and the clinical diagnosis. Data were analyzed using Cox regression, adjusted for sex, hometown, and affiliated hospital. Results The prevalence of poor mental health was found to be 3.7% based on TMHI‐66 results. The proportion of all students who sought mental health services was 8.3%, and they were mostly diagnosed with depressive disorder (3%), adjustment disorder (1.9%), and anxiety disorder (1.9%). Students with positive TMHI‐66 results were more likely to seek out services at the faculty counseling center for one or more mental health problems (Hazard ratio [HR] = 2.11, 95% CI 1.11‐4.04, P = .024). Conclusion Preadmission mental health was found to be associated with mental health service utilization. Depressive disorder was the most frequent mental illness among Thai medical students utilizing the faculty counseling services. Still, the number was far lower than the reported prevalence of mental disorders due to various reasons. Further studies are needed to investigate risk and protective factors for mental disorders to better promote mental health and encourage mental health service utilization in targeted students throughout medical education.

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Objectives Several studies confirm multiple complications after COVID-19 infection, including men’s sexual health, which is caused by both physical and psychological factors. However, studies focusing on long-term effects among recovered patients are still lacking. Therefore, we aimed to investigate the erectile function at three months after COVID-19 recovery along with its predicting factors. Methods We enrolled all COVID-19 male patients, who were hospitalized from May to July 2021, and declared to be sexually active within the previous two weeks. Demographic data, mental health status, and erectile function were collected at baseline and prospectively recollected three months after hospital discharge. To determine changes between baseline and the follow-up, a generalized linear mixed effect model (GLMM) was used. Also, logistic regression analysis was used to identify the associating factors of erectile dysfunction (ED) at three months. Results One hundred fifty-three men with COVID-19 participated. Using GLMM, ED prevalence at three months after recovery was 50.3%, which was significantly lower compared with ED prevalence at baseline (64.7%, P = 0.002). Declination of prevalence of major depression and anxiety disorder was found, but only major depression reached statistical significance (major depression 13.7% vs. 1.4%, P < 0.001, anxiety disorder 5.2% vs. 2.8% P = 0.22). Logistic regression, adjusted for BMI, medical comorbidities, and self-reported normal morning erection, showed a significant association between ED at three months and age above 40 years and diagnosis of major depression with adjusted OR of 2.65, 95% CI 1.17–6.01, P = 0.02 and 8.93, 95% CI 2.28–34.9, P = 0.002, respectively. Conclusion Our study showed a high ED prevalence during the third month of recovery from COVID-19. The predicting factors of persistent ED were age over 40 years and diagnosis of major depression during acute infection.

Purpose: Donepezil, a drug frequently used to treat dementia, is mainly metabolized by cytochrome P450 2D6 (CYP2D6). This study investigated the relationships between CYP2D6 genotype and activity scores as well as predicted phenotype of plasma donepezil concentrations in 86 Thai dementia participants. Materials and Methods: CYP2D6 was genotyped using bead-chip technology (Luminex xTAG ® v.3). Steady-state trough plasma donepezil concentrations were measured using highperformance liquid chromatography. Results: Sixteen genotypes were found but the most frequent genotypes detected among our participants were CYP2D6*10/*10 (27.9%) and *1/*10 (26.7%). One-third of the participants had an activity score of 1.25 which predicted that they were normal metabolizers. The overall median (interquartile range) of plasma donepezil concentration was 51.20 (32.59-87.24) ng/mL. Normal metabolizers (NMs) had lower plasma donepezil concentrations compared to intermediate metabolizers (IMs) (41.15 (28.44-67.65) ng/mL vs 61.95 (35.25-97.00) ng/mL). Multivariate analysis showed that CYP2D6 activity score (r 2 = 0.50) and the predicted phenotype (independent of dose) could predict the plasma donepezil concentration (r 2 = 0.49). Conclusion: Plasma donepezil concentration in NMs was lower compared to IMs. Additional studies with larger sample size and use of next-generation sequencing as well as its outcomes are warranted to confirm the benefit of using pharmacogenetic-guided treatment for donepezil.

Background and Aims In Thailand, suicide is the leading cause of death among middle‐aged adults. We believe suicide characteristics depend on different cultural/socioeconomic status. This study aimed to describe the characteristics and associated factors of suicidal attempts by self‐poisoning in Bangkok, the metropolitan city of Thailand. Methods Records of all patients visiting the emergency department of King Chulalongkorn Memorial Hospital, Bangkok, Thailand, with self‐poisoning suicidal attempts throughout 2021 were collected and analyzed. Results Self‐poisoning accounted for 110 attempts (by 74 patients). Females aged 11–30 were the most prevalent group. Pharmaceutical agents were commonly used. Most patients (86.4%) had underlying psychiatric illness(es), mostly major depressive disorder. Female, history of psychiatric illness and follow‐ups, personality comorbid, and previous attempts reached statistical significance by univariate regression for factors associated with reattempting suicide, but only personality comorbid was significant from multivariable study ( p = 0.02). Reattempting mostly recurred within 8 days after the prior attempt. Conclusion Majority of self‐poisoned patients in Bangkok were young adults taking medications, which differs from the overall Thai population where most instances involve patients of older patients (30–50 years) and ingestion of agricultural substances. Appropriate strategies are needed for specific psychosocial/socioeconomic contexts and within the critical period after previous nonfatal attempts.

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