ABSTRACT
Nasopharyngeal carcinoma (NPC) is a multi-factorial disease caused by genetic, viral (Epstein Barr virus, EBV) and environmental factors. The elevation of IgA antibody titers against EBV viral capsid antigen (VCA) measured by indirect immunofluorescence assay (IFA) had been use as ‘gold standard’ for NPC diagnosis for over thirty years. However, IFA is unsuitable for mass screening among population since it is time-consuming, inconvenient to perform and difficult to standardize. To date, these difficulties of IFA have been solved by using recombinant protein-based enzyme-linked immunosorbent assay (ELISA). The EBV nuclear antigen 1 (EBNA1) is the only latent EBV antigen consistently expressed in NPC tissues. Recently, it has been found that IgA antibody against EBNA1 (IgA/EBNA1) measured by ELISA may be a useful marker for NPC and the early detection of this cancer. The purpose of this study is to evaluate the usefulness of IgA/EBNA1 from a commercial kit in Thai NPC cases. The concentration of serum IgA/EBNA1 was measured in 54 NPC patients and 122 age match healthy controls by using Sinoclone EBV IgA ELISA kit. The normal cut off value (mean+2SD) of serum IgA/EBNA1 showed a relative optical density (rOD) at 1.26 units. Serum IgA/EBNA1 level was positive in 52 (96.30%) out of 54 NPC patients and in 5 (4.10%) out of 122 healthy controls. NPC cases showed significantly higher serum IgA/EBNA1 level than healthy controls (P \< 0.001). In NPC patients, the serum IGA/EBNA1 level was increased with aggressiveness and advance stages of the disease. Detection of IgA/EBNA1 by Sinoclone EBV IgA ELISA kit in serum had a sensitivity, a specificity, positive predictive values and negative predictive values of 96.30, 95.90, 91.23 and 98.32%, respectively, for the diagnosis of NPC. The results of our study suggest that serum IgA/EBNA1 may be a suitable marker for diagnosis and prognosis of NPC in Thailand and that this test may be a useful addition to the panel of tests used for this purpose. Further studies are currently underway to evaluate the effectiveness of this marker as an early detection tool for NPC in Thailand.
ABSTRACT
<p><b>INTRODUCTION</b>Pre-hospital ambulance calls are not random events, but occur in patterns and trends that are related to movement patterns of people, as well as the geographical epidemiology of the population. This study describes the geographic-time epidemiology of ambulance calls in a large urban city and conducts a time demand analysis. This will facilitate a Systems Status Plan for the deployment of ambulances based on the most cost effective deployment strategy.</p><p><b>MATERIALS AND METHODS</b>An observational prospective study looking at the geographic-time epidemiology of all ambulance calls in Singapore. Locations of ambulance calls were spot mapped using Geographic Information Systems (GIS) technology. Ambulance response times were mapped and a demand analysis conducted by postal districts.</p><p><b>RESULTS</b>Between 1 January 2006 and 31 May 2006, 31,896 patients were enrolled into the study. Mean age of patients was 51.6 years (S.D. 23.0) with 60.0% male. Race distribution was 62.5% Chinese, 19.4% Malay, 12.9% Indian and 5.2% others. Trauma consisted 31.2% of calls and medical 68.8%. 9.7% of cases were priority 1 (most severe) and 70.1% priority 2 (moderate severity). Mean call receipt to arrival at scene was 8.0 min (S.D. 4.8). Call volumes in the day were almost twice those at night, with the most calls on Mondays. We found a definite geographical distribution pattern with heavier call volumes in the suburban town centres in the Eastern and Southern part of the country. We characterised the top 35 districts with the highest call volumes by time periods, which will form the basis for ambulance deployment plans.</p><p><b>CONCLUSION</b>We found a definite geographical distribution pattern of ambulance calls. This study demonstrates the utility of GIS with despatch demand analysis and has implications for maximising the effectiveness of ambulance deployment.</p>
Subject(s)
Ambulances , Geographic Information Systems , SingaporeABSTRACT
The long agonistic protocol for controlled ovarian hyperstimulation (COH) is effective and used most often, thus is considered the gold standard. Therefore any new regimen has to be compared in its results with those obtained with the long protocol. This report compares the efficacy of GnRH agonist and antagonist in a retrospective study of IVF/ICSI carried out in a tertiary teaching hospital from 2003 to 2006. Only the first COH cycle followed by IVF-ICSI from 200 couples (agonist = 120 and antagonist = 80) were analysed. The end points studied included the number of oocytes recovered, number of mature (MII) oocytes, fertilization, cleavage, morphology based embryo quality, pregnancy rate, quantity and cost of gonadotrophin. The average age of female subjects was 35.1 +/- 4.7 years with 50% being 35 years and above. Major infertility factors were tubal blockage, male factor and endometriosis altogether comprising 68%. GnRH agonist and antagonist cycle parameters were comparable except lesser amount of gonadotrophin was used with lower resultant costs (both p < 0.0005) in antagonistic regime. Antagonist regime produce somewhat more good quality embryos (p = 0.065), an insignificant difference. A clinical pregnancy rate per embryo transfer of 16.3% in agonist and 20.6% in antagonist regime was achieved respectively. In conclusion, GnRH antagonist protocol produced a COH response, embryonic development and pregnancy rates on par to GnRH agonist regime. Moreover GnRH antagonist protocol required a shorter stimulation period plus fewer complications. Hence GnRH antagonist regime provided means for a friendlier, convenient and cost effective protocol for patients.