Browse publications by year: 1994

Fulltext Detection and serotyping of dengue viruses by PCR: a simple, rapid method for the isolation of viral RNA from infected mosquito larvae

Chan SY, Kautner I, Lam SK

Southeast Asian J Trop Med Public Health, 1994 Jun;25(2):258-61.
PMID: 7855637

Dengue viruses pose a considerable global public health problem with an estimated 100 million cases of illness every year. This illustrates the need for rapid and reliable diagnostic methods for proper patient management and disease control. Currently, laboratory diagnosis depends on serology or virus isolation, with both methods having certain drawbacks. Alternatively, reverse transcription and polymerase chain reaction (RT-PCR) offers the potential for the rapid, highly sensitive and specific detection of dengue viruses. Since we occasionally encounter the problem of insufficient amounts of patient serum for the direct detection of dengue viruses, a method was developed for the extraction of viral RNA after biological amplification in mosquito larvae. Using this method, 15 of 19 clinical samples tested were correctly identified using RT-PCR.

MeSH terms: Animals; Dengue Virus/classification; Dengue Virus/isolation & purification*; Larva/virology; Culicidae/virology*; RNA, Viral/isolation & purification*; Sensitivity and Specificity; Serotyping; Transcription, Genetic; Polymerase Chain Reaction/methods*
Fulltext The prevalence and intensity of soil-transmitted helminths in some rural villages in northern peninsular Malaysia

Rahman WA

Southeast Asian J Trop Med Public Health, 1994 Jun;25(2):296-9.
PMID: 7855643

The prevalence and intensity of soil-transmitted helminths in five rural villages in northern peninsular were investigated. Generally the prevalence and intensity of infection were low in the 0-10- and above 50-year-old age groups when compared with other age groups. The prevalence and intensity of infection in the five villages were quite similar, because of similar socio-economic status. The highest intensity was observed for Ascaris lumbricoides, followed by hookworms and Trichuris trichiura.

MeSH terms: Adolescent; Adult; Aged; Child; Child, Preschool; Feces/parasitology; Female; Helminthiasis/epidemiology*; Helminthiasis/parasitology; Helminthiasis/transmission; Humans; Infant; Malaysia/epidemiology; Male; Middle Aged; Parasite Egg Count/statistics & numerical data; Rural Population/statistics & numerical data*; Soil; Prevalence; Age Distribution; Sex Distribution
Fulltext Reliability of two commercial serological kits for serodiagnosing Helicobacter pylori infection

Uyub AM, Anuar AK, Aiyar S

Southeast Asian J Trop Med Public Health, 1994 Jun;25(2):316-20.
PMID: 7855648

Two commercial serological kits, Pylori-set (Orion Diagnostica, Finland) and Helico-G (Cambridge Biomedical Ltd, UK), and an in-house ELISA were evaluated with sera from 24 Helicobacter pylori-positive and 146 H. pylori-negative dyspeptic patients. Sensitivity, specificity, positive and negative predictive values of Pylori-set were lower than that of Helico-G and in-house ELISA. Helico-G was more sensitive (91.7%) than in-house ELISA (83.3%) and both had comparable negative predictive values of 98.3% and 97.3%, respectively. However, specificity (97.9%) and positive predictive value (86.9%) of an in-house ELISA were much higher than specificity (80.1%) and positive predictive value (43.1%) of Helico-G. Kappa index of agreement between the three serological tests (Pylori-set, Helico-G or in-house ELISA) and the presence of H. pylori in antral biopsies was very low (k = 0.13; z = 1.9; p > 0.05), moderate (k = 0.49; z = 7.1; p < 0.0001), or substantial (k = 0.82; z = 10.8; p < 0.0001), respectively. Overall, statistical evaluations demonstrated that both commercial kits were not as reliable as the in-house ELISA for serodiagnosing H. pylori infection.

MeSH terms: Adolescent; Adult; Aged; Aged, 80 and over; Antibodies, Bacterial/blood; Biopsy; Dyspepsia/diagnosis; Female; Humans; Male; Middle Aged; Pyloric Antrum/microbiology; Pyloric Antrum/pathology; Reagent Kits, Diagnostic*; Sensitivity and Specificity; Serologic Tests/instrumentation; Reproducibility of Results; Helicobacter Infections/diagnosis*
Fulltext Spirometric volumes in Malaysian males

Singh R, Singh HJ, Sirisinghe RG

Southeast Asian J Trop Med Public Health, 1994 Jun;25(2):341-8.
PMID: 7855654

Spirometry was performed on 1,485 male subjects ranging in age from 13 years to 78 years and comprising of all the main ethnic groups in Malaysia. They were divided into six age categories. Mean forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were 3.45 +/- 0.02 and 3.10 +/- 0.02, respectively. Both FVC and FEV1 correlated negatively with age. Regression analysis revealed an age-related decline in FVC of 295 ml per decade of life. Multiple stepwise regression of the data for the prediction of an individual's FVC above the age of 20 years gave the equation FVC (1) = 0.0404 (height in cm)-0.0295 (age in years)-2.2892. Predicted FVC values derived from equations based on other populations were considerably higher than the observed mean in this study. This study therefore, reemphasises the need to be cautions when applying formulae derived from one population to another. Grossly erroneous conclusions may be reached unless predicted equations for lung-function tests for a given population group are derived from studies based upon the same population group.

MeSH terms: Adolescent; Adult; Aged; Aging/physiology; Analysis of Variance; Forced Expiratory Volume; Humans; Lung/physiology*; Malaysia; Male; Middle Aged; Reference Values; Sex Characteristics*; Spirometry/statistics & numerical data; Vital Capacity; Linear Models
Fulltext Monitoring resistance gene frequencies in Malaysian Culex quinquefasciatus Say adults using rapid non-specific esterase enzyme microassays

Lee HL, Tadano T

Southeast Asian J Trop Med Public Health, 1994 Jun;25(2):371-3.
PMID: 7855659

The ability to identify the occurrence of different resistance genotypes in field populations of mosquito is considered important for the purpose of optimising chemical control operations. The recent development of rapid microassays of enzymes responsible for resistance has provided a means for rapidly assessing the genetic background of target mosquito populations. This concept is the topic of investigation in this study. Non-specific esterase activity, which is responsible for the resistance to organophosphates in Malaysian Culex quinquefasciatus Say adults, was determined in 3 field populations from Kuala Lumpur City using rapid enzyme assay. The optical density results were used to estimate the genotypic frequencies of the populations. Subsequently, time-dependent changes in the various frequencies were determined. Such techniques allowed rapid assessment of resistance genotypes for decision-making and its possible use in insect control merits further investigation.

MeSH terms: Animals; Biological Assay/methods; Colorimetry/methods; Culex/enzymology; Culex/genetics*; Esterases/analysis*; Esterases/genetics; Female; Gene Frequency*; Genotype; Insecticide Resistance/genetics; Malathion/antagonists & inhibitors*; Malaysia; Time Factors
Fulltext Studies on adult mosquito vectors of Japanese encephalitis in a pig farm in Selangor, Malaysia

Vythilingam I, Mahadevan S, Zaridah MZ, Ong KK, Abdullah G, Ong YF

Southeast Asian J Trop Med Public Health, 1994 Jun;25(2):383-6.
PMID: 7855662

Mosquito collections were carried out for a period of one year from January to December 1992 in a pig farm in Sungai Pelek, Selangor, Malaysia. A total of 41,022 mosquitos belonging to 52 species and 20 genera were collected. Culex tritaeniorhynchus and Cx. gelidus, the important vectors, comprised 63% of all mosquitos collected. Both these species were collected in large numbers during the wet months of May and December. The other predominant species in that area were Cx. fuscocephala, Cx. quinquefasciatus, Cx. sitiens, Aedes butleri, and Armigeres subalbatus.

MeSH terms: Animals; Animal Husbandry*; Encephalitis Virus, Japanese*; Insect Vectors/virology*; Malaysia; Culicidae/classification; Culicidae/virology*; Population Density; Rain; Seasons; Swine
Fulltext Absence of plasmid in mosquitocidal Clostridium bifermentans serovar malaysia

Seleena P, Lee HL

Southeast Asian J Trop Med Public Health, 1994 Jun;25(2):394-6.
PMID: 7855665
MeSH terms: Animals; Clostridium/classification; Clostridium/genetics*; Clostridium/growth & development; DNA, Bacterial/analysis; DNA, Bacterial/isolation & purification; Electrophoresis, Agar Gel; Culicidae*; Pest Control, Biological*; Plasmids/analysis; Plasmids/isolation & purification*; Serotyping
Bone marrow transplantation in Malaysia

Lin HP, Chan LL, Tan A, Ariffin WA, Lam SK

Bone Marrow Transplant, 1994 Jun;13(6):725-9.
PMID: 7920303

The sole BMT centre in Malaysia caters only for children. Since 1987, 89 transplants have been performed using reverse barrier nursing techniques. The overall survival rate is 73% with the majority of survivors leading normal lives. The early and late infection rates of 46% and 13%, respectively, are comparable to those of other centres. Although the early septicaemia rate is 36% the immediate mortality rate is < 10%. GVHD is less frequent and severe and the interstitial pneumonitis rate lower than that in the West. The average cost of US $8000 per transplant is much lower than the cost of a transplant performed overseas. Thus we believe that our paediatric BMT programme is simple and cost-effective.

MeSH terms: Adolescent; Child; Child, Preschool; Female; Graft vs Host Disease/mortality; Graft vs Host Disease/epidemiology; Humans; Infant; Malaysia/epidemiology; Male; National Health Programs; Incidence; Bone Marrow Transplantation*
An unusually medial axillary arch muscle

Dharap A

J Anat, 1994 Jun;184 ( Pt 3):639-41.
PMID: 7928652

In the left upper limb of an adult male cadaver a triangular muscular slip, 3.5 cm long and 2.5 cm wide, arose from the lower border of latissimus dorsi just proximal to its tendon of insertion. It was inserted by a slender 6 cm long tendon mainly into the coracoid process of the scapula. Three short fibrous strands radiated from this slender tendon to gain attachments to pectoralis minor and the common tendon of origin of the short head of biceps brachii and coracobrachialis. In addition 2 flat tendinous bands attached the margin of this muscular slip to teres major. The thoracodorsal nerve entered the main bulk of latissimus dorsi close to the muscular slip but did not supply a separate branch to the latter. This is an axillary arch muscle in an unusually medial location.

MeSH terms: Axilla/anatomy & histology*; Humans; Male; Muscles/anatomy & histology*
Contraceptive efficacy of the Copper T380A and the Multiload Cu250 IUD in three developing countries

Farr G, Amatya R

Adv Contracept, 1994 Jun;10(2):137-49.
PMID: 7942261

The clinical performance of the Copper T380A (TCu380A) and the Multiload 250 (MLCu250) intrauterine devices (IUDs) were evaluated for 12 months in a group of women who had one of the two IUDs inserted. Results are from a randomized clinical trial conducted at four collaborating research sites located in three developing countries. The gross cumulative life-table pregnancy rate of the TCu380A IUD was significantly lower than the rate with the MLCu250 IUD at 12 months (0.5 and 1.2, respectively, p < 0.01). No statistically significant differences between the two study IUDs were found with regard to IUD expulsion or IUD removal due to bleeding/pain, personal reasons, medical reasons, or planned pregnancy. TCu380A IUD users were more likely to report experiencing increased dysmenorrhea (p < 0.01) or intermenstrual pelvic pain (p < 0.01) than were MLCu250 IUD users. However, few of these users discontinued use of their assigned IUD because of having experienced menstrual bleeding disturbances or intermenstrual pelvic pain. These data indicate that the TCu380A IUD may be a better option than the MLCu250 IUD for women wishing to practice highly effective long-term birth control without having to resort to hormonal methods.

MeSH terms: Adult; Developing Countries*; Female; Humans; Malaysia; Menstruation Disturbances/etiology; Sri Lanka; Thailand; Life Tables; Treatment Outcome
Infectivities of four isolates of Taenia taeniaeformis to various rodents

Nonaka N, Iwaki T, Okamoto M, Ooi HK, Oku Y, Ohbayashi M, et al.

J Vet Med Sci, 1994 Jun;56(3):565-7.
PMID: 7948394

Taenia taeniaeformis were isolated from Norway rats captured at Sapporo (SRN isolate) and Kuala Lumpur, Malaysia (KRN) and from Bedford's gray red-backed voles at Toubetsu (TCR) and Abuta (ACR). SRN, KRN and TCR isolates showed similar degree of infectivity to various rodents in which cysticerci with hooks were obtained in laboratory rats, white tuberous lesions in mice and no cysts or lesions in Mongolian gerbils and voles. Contrary to this, inoculation with ACR isolate eggs resulted in strobilocerci formation in the liver of voles, but no cysts were observed in rats, mice or gerbils. This host specificity of ACR isolate to voles suggests that it might be a new species of Taenia.

MeSH terms: Animals; Arvicolinae; Gerbillinae; Male; Mice, Inbred ICR; Species Specificity; Taenia/isolation & purification; Taenia/pathogenicity*; Taeniasis/physiopathology*; Rats, Wistar; Mice; Rats/parasitology*
Endometriosis and infertility: raised iron concentration in the peritoneal fluid and its effect on the acrosome reaction

Arumugam K

Hum Reprod, 1994 Jun;9(6):1153-7.
PMID: 7962392

Endometriosis and infertility are commonly associated. This study investigated the role of accelerated lipid peroxidation of spermatozoa by the peritoneal fluid of patients with endometriosis as a cause for this association. It proposes that the increased iron concentration present in the fluid of these patients acts as a catalyst for the process. Peritoneal fluid from 25 patients with endometriosis and 25 matched controls was obtained at laparoscopy. Spermatozoa were incubated in the fluid from both groups and the subsequent acrosome reaction rates analysed. The relationship between these results and iron concentration in the fluid was examined. A significant decrease in the acrosome reaction rate was seen in the endometriotic group (P = 0.034). Overall, a decrease in the acrosome reaction rate was associated with an increased iron concentration in the fluid (18 of the 25 pairs). In mild disease, (six of 11 pairs), the relationship was not as marked as that in severe disease (12 of 14 pairs). These results suggest that the peritoneal fluid in patients with endometriosis has a detrimental action on the acrosome reaction of spermatozoa in vitro.

MeSH terms: Calcimycin/pharmacology; Acrosome/drug effects; Acrosome/physiology*; Ascitic Fluid/metabolism*; Endometriosis/complications; Endometriosis/metabolism*; Female; Humans; Infertility, Female/complications; Infertility, Female/metabolism*; Iron/metabolism*; Male
A longitudinal study of alveolar bone loss around maxillary central incisors in patients with leprosy in Malaysia

Subramaniam K, Nah SH, Marks SC

Lepr Rev, 1994 Jun;65(2):137-42.
PMID: 7968186

The loss of alveolar bone supporting the maxillary central incisors and the general periodontal conditions were evaluated after 14 years in the 12 patients remaining from an original group of 47 under treatment in Malaysia. Alveolar bone loss was minimal during this period even in the presence of periodontal inflammation. These data suggest that treatment protects patients with leprosy from alveolar bone loss and suggests that other skeletal deformities might respond similarly.

MeSH terms: Adult; Aged; Follow-Up Studies; Humans; Incisor; Leprosy/complications*; Leprosy/drug therapy; Leprosy/pathology; Longitudinal Studies; Maxillary Diseases/etiology*; Maxillary Diseases/pathology; Middle Aged; Periodontium/pathology; Alveolar Bone Loss/etiology*; Alveolar Bone Loss/pathology
Control of haemonchosis in Malaysian goats with closantel

Dorny P, Vercruysse J, Jalila A, Sani R, Symoens C

Vet Parasitol, 1994 Jun;53(3-4):233-41.
PMID: 7975118

The therapeutic and prophylactic effects of closantel on natural infections with Haemonchus contortus were studied in goats in Peninsular Malaysia. Closantel was highly effective against H. contortus, either at a subcutaneous (s.c.) injection of 5.0 mg kg-1 body weight (100%), or in an oral drench mixture with mebendazole at a dose of 10.0 mg kg-1 (99.2%), as indicated by faecal egg counts. H. contortus larvae were absent from faecal cultures for 5, 6 and 7 weeks following treatment with s.c. injections of closantel at doses of 2.5 mg kg-1, 5.0 mg kg-1 and 10.0 mg kg-1 respectively, and for 6 weeks after treatment with closantel at 10.0 mg kg-1, given orally. Through its sustained activity, closantel not only prevented reinfection with H. contortus but also caused a dramatic reduction in pasture contamination. The potential utility of closantel in the strategic control of haemonchosis in goats, and as an alternative treatment for benzimidazoles and levamisole resistant H. contortus strains, is discussed.

MeSH terms: Administration, Oral; Animals; Anthelmintics/administration & dosage; Anthelmintics/therapeutic use; Feces/parasitology; Female; Goats; Haemonchiasis/drug therapy; Haemonchiasis/prevention & control; Haemonchiasis/veterinary*; Injections, Subcutaneous; Levamisole/therapeutic use; Malaysia; Male; Mebendazole/administration & dosage; Parasite Egg Count; Salicylanilides/administration & dosage; Salicylanilides/therapeutic use*; Time Factors; Goat Diseases/drug therapy*; Goat Diseases/parasitology; Goat Diseases/prevention & control
Fulltext Malaysian children with: "benign epilepsy of childhood with centrotemporal spikes"

Manonmani V, Tan CT

Singapore Med J, 1994 Jun;35(3):247-9.
PMID: 7997896

Benign epilepsy of childhood with centrotemporal spikes (BECT) was studied in Malaysian children, and was observed in Chinese, Malay and Indian children in the ratio 10:6:5. There were 12 boys and 9 girls. Fit frequency varied from almost daily to a single fit. The age of onset ranged from 2-13 years and BECT was not noted in any child over 13 years old. There was a strong circadian rhythm and fits occurred mainly in sleep. Generalised seizures were more common than partial seizures. During the 3-year study from April 1989 to April 1992, 21 children with BECT were identified from the EEG records done at the University Hospital and it was found that this genetic epilepsy which is autosomal dominant with age dependent penetrance occurs in approximately 4.8% of our epileptic children. In addition there were 3 children in whom petit mal co-existed with a BECT EEG trait.

MeSH terms: Adolescent; Child; Child, Preschool; Electroencephalography; Epilepsies, Partial/drug therapy; Epilepsies, Partial/ethnology; Epilepsies, Partial/physiopathology*; Epilepsy, Temporal Lobe/drug therapy; Epilepsy, Temporal Lobe/ethnology; Epilepsy, Temporal Lobe/physiopathology*; Female; Genes, Dominant; Humans; Malaysia/epidemiology; Male; Prognosis
Fulltext An outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit in Singapore: a 20-month study of clinical characteristics and control

Tan KW, Tay L, Lim SH

Singapore Med J, 1994 Jun;35(3):277-82.
PMID: 7997904

Methicillin resistant Staphylococcus aureus (MRSA) is a major infection control problem in many countries. There have been many reports of outbreaks in neonatal nurseries including, in our part of the world, Australia, Hong Kong and Malaysia. A recent outbreak of MRSA in the neonatal intensive care unit in the Kandang Kerbau Hospital, Singapore, presented us with the opportunity to study the clinical characteristics of the outbreak and the effects of infection control measures. Neonates admitted to the neonatal intensive care unit were studied over a 20-month period. They were all screened for nasal colonisation on admission and weekly thereafter. Infections were documented. Over this period there were altogether 2,576 admissions of which 85 infants had nasal colonisation with MRSA (3.3%) and 28 developed infections (1%). Although the majority of infants colonised by MRSA suffered no ill effects, 3 had septicaemia and 2 had septicaemia with osteomyelitis. There were no deaths. Standard infection control measures with barrier nursing and the use of mupirocin nasal ointment were ineffective, and control was achieved only after strict cohorting together with the use of mupirocin was instituted. This was done without additional costs to the department and without additional nurses or doctors.

MeSH terms: Cross Infection/prevention & control; Disease Outbreaks*; Humans; Infant, Newborn; Intensive Care Units, Neonatal*; Patient Isolation; Singapore; Staphylococcal Infections/epidemiology*; Staphylococcal Infections/prevention & control; Staphylococcus aureus/drug effects*; Methicillin Resistance*
Fulltext Renal tubular acidosis in Kelantan, Malaysia--a case review

Zainal D

Singapore Med J, 1994 Jun;35(3):303-5.
PMID: 7997910

Renal tubular acidosis (RTA) is a defect in urinary acidification in the absence of renal failure. All records of patients admitted to adult medical wards at the University Hospital USM (HUSM), Kelantan between 1986 to 1990 with the diagnosis of renal tubular acidosis were reviewed. Sixteen (16) patients were identified and fulfilled the diagnostic criteria. Their mean age at presentation was 28.9 +/- 0.74 years. The triad of muscle weakness, hypokalaemia and systemic metabolic acidosis were the characteristic features at presentation. Normal serum alkaline phosphatase and skeletal X-rays were noted. Their prognosis were generally good. Their mean serum bicarbonate and potassium on follow up were 17.84 +/- 0.35 and 3.82 +/- 0.05 mmol/L respectively. The importance of regular follow-up and long-term management is emphasised.

MeSH terms: Acid-Base Equilibrium; Adult; Bicarbonates/blood; Bicarbonates/urine; Female; Humans; Hydrogen-Ion Concentration; Malaysia; Retrospective Studies; Incidence
Fulltext Radiological diagnosis of accidental oesophageal intubation

Chan YK

Singapore Med J, 1994 Jun;35(3):327-8.
PMID: 7997918

Oesophageal intubation is rapidly fatal if not recognised. We report a patient who not only survived an oesophageal intubation but who had chest X-rays taken which showed an oesophageal intubation which was initially recognised by the attending physician.

MeSH terms: Accidents; Aged; Aged, 80 and over; Esophagus/radiography*; Humans; Intubation, Intratracheal/adverse effects*; Male; Respiratory Sounds
Arsenic and trace metals in commercially important bivalves, Anadara granosa and Paphia undulata

Mat I

Bull Environ Contam Toxicol, 1994 Jun;52(6):833-9.
PMID: 8019077
MeSH terms: Animals; Arsenic/analysis*; Food Contamination/analysis; Malaysia; Mollusca/chemistry*; Shellfish/analysis*; Trace Elements/analysis*; Water Pollutants, Chemical/analysis
Squamous cell carcinoma antigen as an adjunct tumour marker in primary carcinoma of the lung

Cheah PL, Liam CK, Yap SF, Looi LM

J Clin Pathol, 1994 Jun;47(6):535-7.
PMID: 8063936

AIMS: To determine (1) the detection rate of primary carcinoma of the lung by serological assay of CEA (carcinoembryonic antigen); and (2) whether addition of seroassay of squamous cell carcinoma related antigen before treatment improves detection sensitivity.
METHODS: A prospective study spanning 27 months was conducted at the University Hospital, Kuala Lumpur. Serum CEA (Abbott IMx) and serum squamous cell carcinoma antigen (Abbott IMx) from patients clinically suspected of having primary carcinoma of the lung, were assayed using the microparticle enzyme immunoassay method.
RESULTS: Thirty seven cases of histologically confirmed primary lung carcinoma were studied. Of these, 17 were squamous cell carcinomas, 10 adenocarcinomas, nine small cell carcinomas, and one large cell carcinoma. The patients' ages ranged from 34-82 years. The male:female ratio was 3.6:1. Squamous cell carcinoma antigen was raised above the cutoff value of 1.5 ng/ml in 94.1% of squamous cell carcinomas, 20.0% of adenocarcinomas, and 11.1% of small cell carcinomas. By comparison, CEA was raised above the cutoff value of 3.0 ng/ml in 70.6% of squamous cell carcinomas, 77.8% of small cell carcinomas, and 100% of adenocarcinomas. CEA and squamous cell carcinoma antigen were not raised in the patient with large cell carcinoma and in 14 healthy volunteers. None of 15 patients with a variety of benign lung diseases showed a rise of CEA, while two patients--a 25 year old Indian woman with pneumonia and a 64 year old Malay man with bronchial asthma--had raised squamous cell carcinoma antigen values above the cutoff. Serum CEA and squamous cell carcinoma antigen values did not seem to correlate with stage or degree of differentiation of the tumours.
CONCLUSIONS: The findings suggest that CEA is a good general marker for carcinoma, particularly adenocarcinoma. In contrast, squamous cell carcinoma antigen is more specific for squamous carcinoma.

MeSH terms: Adenocarcinoma/diagnosis; Adult; Aged; Aged, 80 and over; Antigens, Neoplasm/blood*; Carcinoembryonic Antigen/blood; Carcinoma, Squamous Cell/diagnosis; Female; Humans; Lung Neoplasms/diagnosis; Lung Neoplasms/immunology*; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity; Biomarkers, Tumor/blood*; Serpins*; Carcinoma, Small Cell/diagnosis

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