Displaying publications 81 - 100 of 301 in total

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  1. Fulltext Properties and Characterization of a PLA-Chitin-Starch Biodegradable Polymer Composite
    Olaiya NG, Surya I, Oke PK, Rizal S, Sadiku ER, Ray SS, et al.
    Polymers (Basel), 2019 Oct 11;11(10).
    PMID: 31614623 DOI: 10.3390/polym11101656
    This paper presents a comparison on the effects of blending chitin and/or starch with poly(lactic acid) (PLA). Three sets of composites (PLA-chitin, PLA-starch and PLA-chitin-starch) with 92%, 94%, 96% and 98% PLA by weight were prepared. The percentage weight (wt.%) amount of the chitin and starch incorporated ranges from 2% to 8%. The mechanical, dynamic mechanical, thermal and microstructural properties were analyzed. The results from the tensile strength, yield strength, Young's modulus, and impact showed that the PLA-chitin-starch blend has the best mechanical properties compared to PLA-chitin and PLA-starch blends. The dynamic mechanical analysis result shows a better damping property for PLA-chitin than PLA-chitin-starch and PLA-starch. On the other hand, the thermal property analysis from thermogravimetry analysis (TGA) shows no significant improvement in a specific order, but the glass transition temperature of the composite increased compared to that of neat PLA. However, the degradation process was found to start with PLA-chitin for all composites, which suggests an improvement in PLA degradation. Significantly, the morphological analysis revealed a uniform mix with an obvious blend network in the three composites. Interestingly, the network was more significant in the PLA-chitin-starch blend, which may be responsible for its significantly enhanced mechanical properties compared with PLA-chitin and PLA-starch samples.
  2. Fulltext Physicochemical characteristics and nutritional compositions of MR219 mutant rice and their effects on glycaemic responses in BALB/c mice
    Asma Ilyani, K., *Rafii, M. Y, Sobri, H., Anna, L. P. K., Rahim, A. H., Mahmud, T. M. M., et al.
    International Food Research Journal, 2019;26(5):1477-1484.
    MyJurnal
    The awareness of the general public on healthy foods has been a major concern and people are looking for the right variety of rice for diabetic patients. High amylose content rice with low glycaemic index (GI), which is an indicator of sugar release in the blood, is beneficial for human health. The present work was aimed to determine the physicochemical characteristics and nutritional compositions of MR219 mutant rice, and the effects of amylose content to blood glucose response and glycaemic index in field condition. A total of 31 M4 mutant lines (ML1 to ML31) were evaluated for physicochemical characteristics and nutritional compositions in comparison with the parental variety, MR219. In glycaemic response study, 48 female BALB/c mice were fed with glucose (a baseline), saline water, two check varieties (MR219 and MRQ74) and four selected mutant lines with different amylose contents. The physicochemical and proximate analysis revealed highly significant differences among the mutant lines. Some mutant lines improved amylose content and nutritional composition. Mutant ML3 had slightly higher amylose content than the parental variety and was recommended for glycaemic responses. However, the field experiment results showed two mutant lines namely; ML3 and ML30, having significantly lower glucose reading (5.49 mmol/L and 5.47 mmol/L, respectively) as compared to the parental variety and other mutant lines. The glucose level was found highest at 60 min after feeding but significantly dropped at 120 min. The normal glucose reading in ML3 and ML30 also resulted in moderate GI values (65% and 66%, respectively). As low and moderate GI foods are recommended for diabetic patients, ML3 and ML30 had high potential for their consumption, and can be suggested for further breeding program to develop low GI rice.
  3. The value of comparing mortality of Guillain-Barré syndrome across different regions
    Wong AH, Umapathi T, Shahrizaila N, Chan YC, Kokubun N, Fong MK, et al.
    J Neurol Sci, 2014 Sep 15;344(1-2):60-2.
    PMID: 24993467 DOI: 10.1016/j.jns.2014.06.021
    To study the clinical profile of Guillain-Barré syndrome (GBS) patients who died in 4 Asian countries in order to understand factors underlying any variation in mortality.
  4. Fulltext G2677T polymorphism can predict treatment outcome of Malaysians with complex partial seizures being treated with Carbamazepine
    Subenthiran S, Abdullah NR, Muniandy PK, Joseph JP, Cheong KC, Ismail Z, et al.
    Genet. Mol. Res., 2013;12(4):5937-44.
    PMID: 24338387 DOI: 10.4238/2013.November.26.3
    Carbamazepine (CBZ) is used as the first line of treatment of complex partial seizures (CPS) in Malaysia. While this drug is known to be effective for the treatment of CPS, more than 30% of patients remain drug resistant to CBZ mono-therapy. We examined a possible relationship between patients' response to CBZ mono-therapy and the G2677T SNP of the ABCB1 gene. Three hundred and fourteen patients with CPS were recruited from the Neurology Department of the Kuala Lumpur Hospital, of whom 152 were responders and the other 162 were non-responders to CBZ mono-therapy. DNA was extracted from blood samples and real-time PCR was performed to detect the G2677T SNP of the ABCB1 gene. Results were described as genotype frequencies and compared by logistic regression analysis. Among the 152 responders, 74% had the GG genotype. However, among the 162 non-responders, 26.5% had the GT genotype and 39% had the TT genotype. There was a significant difference in genotype frequency (TT vs GG; odds ratio 4.70; 95% confidence interval, 2.70-8.20) between responders and non-responders. The presence of the T allele of the G2677T SNP appears to be a useful screening marker to determine if a patient is going to be resistant to CBZ as a single drug therapy in the treatment of CPS.
  5. Fulltext Screening of anti-dengue activity in methanolic extracts of medicinal plants
    Tang LI, Ling AP, Koh RY, Chye SM, Voon KG
    BMC Complement Altern Med, 2012;12:3.
    PMID: 22244370 DOI: 10.1186/1472-6882-12-3
    Dengue fever regardless of its serotypes has been the most prevalent arthropod-borne viral diseases among the world population. The development of a dengue vaccine is complicated by the antibody-dependent enhancement effect. Thus, the development of a plant-based antiviral preparation promises a more potential alternative in combating dengue disease.
  6. Fulltext Duodenal intussusception of Brunner's gland adenoma mimicking a pancreatic tumour
    Limi L, Liew NC, Badrul RH, Faisal MJ, Daniel YP
    Med J Malaysia, 2010 Dec;65(4):311-2.
    PMID: 21901954
    Brunner's gland adenoma is a rare benign tumour of the duodenum. It is usually asymptomatic but may occasionally present with gastrointestinal haemorrhage and obstruction. We report a 40-year old lady, presenting with upper gastrointestinal bleeding and was found to have prolapsed and intussuscepted Brunner's gland adenoma of the duodenum, which mimicked the appearance of a tumour in the head of pancreas.
  7. RecA mediated spontaneous deletions of the icaADBC operon of clinical Staphylococcus epidermidis isolates: a new mechanism of phenotypic variations
    Nuryastuti T, Henny C, Henk JB, Roel K, Abu TA, Bastiaan PK
    Med J Malaysia, 2008 Jul;63 Suppl A:97.
    PMID: 19025002
    Phenotypic variation in biofilm formation is common in clinical isolates of S. epidermidis. In the current study, nearly 5% of all clinical isolates analysed showed phenotypic variation in biofilm forming ability and electrophoretic mobility (EM). This is the first report of S. epidermidis strains irreversibly switching from biofilm-positive to biofilm-negative phenotype by spontaneous deletion of icaADBC genes which represents a new, possibly common mechanism of phenotypic variation.
  8. Randomized double-blind comparison of ketamine-propofol, fentanyl-propofol and propofol-saline on haemodynamics and laryngeal mask airway insertion conditions
    Goh PK, Chiu CL, Wang CY, Chan YK, Loo PL
    Anaesth Intensive Care, 2005 Apr;33(2):223-8.
    PMID: 15960405
    The aim of this prospective, double-blind, randomized, placebo-controlled clinical trial was to investigate whether the administration of ketamine before induction with propofol improves its associated haemodynamic profile and laryngeal mask airway (LMA) insertion conditions. Ninety adult patients were randomly allocated to receive either ketamine 0.5 mg x kg(-1) (n = 30), fentanyl 1 microg x kg(-1) (n = 30) or normal saline (n = 30), before induction of anaesthesia with propofol 2.5 mg x kg(-1). Insertion of the LMA was performed 60s after injection of propofol. Arterial blood pressure and heart rate were measured before induction (baseline), immediately after induction, immediately before LMA insertion, immediately after LMA insertion and every minute for three minutes after LMA insertion. Following LMA insertion, the following six subjective endpoints were graded by a blinded anaesthestist using ordinal scales graded 1 to 3: mouth opening, gagging, swallowing, movement, laryngospasm and ease of insertion. Systolic blood pressure was significantly higher following ketamine than either fentanyl (P = 0.010) or saline (P = 0.0001). The median (interquartile range) summed score describing the overall insertion conditions were similar in the ketamine [median 7.0, interquartile range (6.0-8.0)] and fentanyl groups [median 7.0, interquartile range (6.0-8.0)]. Both appeared significantly better than the saline group [median 8.0, interquartile range (6.75-9.25); P = 0.024]. The incidence of prolonged apnoea (> 120s) was higher in the fentanyl group [23.1% (7/30)] compared with the ketamine [6.3% (2/30)] and saline groups [3.3% (1/30)]. We conclude that the addition of ketamine 0.5 mg x kg(-1) improves haemodynamics when compared to fentanyl 1 microg x kg(-1), with less prolonged apnoea, and is associated with better LMA insertion conditions than placebo (saline).
  9. Fulltext Field evaluation of a rapid diagnostic test to detect antibodies in human toxocariasis
    Lim PK, Yamasaki H, Mak JW, Wong SF, Chong CW, Yap IK, et al.
    Acta Trop, 2015 Aug;148:32-7.
    PMID: 25910623 DOI: 10.1016/j.actatropica.2015.04.011
    Human toxocariasis which is caused mainly by the larvae of Toxocara canis and Toxocara cati, is a worldwide zoonotic disease that can be a potentially serious human infection. The enzyme-linked immunosorbent assay (ELISA) using T. canis excretory-secretory (TES) antigens harvested from T. canis larvae is currently the serological test for confirming toxocariasis. An alternative to producing large amounts of Toxocara TES and improved diagnosis for toxocariasis is through the development of highly specific recombinant antigens such as the T. canis second stage larva excretory-secretory 30 kDa protein (recTES-30). The aim of this study was to evaluate the sensitivity and specificity of a rapid diagnostic kit (RDT, named as iToxocara kit) in comparison to recTES-30 ELISA in Serendah Orang Asli village in Selangor, Malaysia. A total of 133 subjects were included in the study. The overall prevalence rates by ELISA and RDT were 29.3% and 33.1%, respectively, with more positive cases detected in males than females. However, no association was found between toxocariasis and gender or age. The percentage sensitivity, specificity, positive predictive value and negative predictive value of RDT were 85.7%, 90.1%, 80% and 93.2%, respectively. The prevalence for toxocariasis in this population using both ELISA and RDT was 27.1% (36/133) and the K-concordance test suggested good agreement of the two tests with a Cohen's kappa of 0.722, P<0.01. In addition, the followed-up Spearman rank correlation showed a moderately high correlation at R=0.704 and P<0.01. In conclusion, the RDT kit was faster and easier to use than an ELISA and is useful for the laboratory diagnosis of hospitalized cases of toxocariasis.
  10. A potential resource for bioconversion of domestic wastewater sludge
    Molla AH, Fakhru'l-Razi A, Abd-Aziz S, Hanafi MM, Roychoudhury PK, Alam MZ
    Bioresour Technol, 2002 Dec;85(3):263-72.
    PMID: 12365494
    Twenty seven filamentous fungal strains representing five genera; Aspergillus, Penicillium, Trichoderma, Myriodontium and Pleurotus were isolated from four sources; domestic wastewater sludge cake (SC) from IWK (Indah Water Konsortium) wastewater treatment plant, palm oil mill effluent compost from Sri Ulu palm Oil Processing Mill, compost of plant debris, and fungal fruiting bodies from a rotten wood stump. Thirty-three strains/isolates were tested for their ability to convert domestic wastewater sludge into compost by assessing biomass production and growth rate on sludge enriched media. The strains/isolates Aspergillus niger, SS-T2008, WW-P1003 and RW-P1 512 produced the highest dry biomass at higher sludge supplemented culture media from their respective group (Aspergillus, Trichoderma, Penicillium and Basidiomycetes, respectively). This implied these strains are better adapted for growth at higher sludge rich substances, and subsequently may be efficient in bioconversion/biodegradation of sludge. The fungi isolated from ecological closely related sources were more amendable to adaptation in a sludge rich culture media.
  11. The spectrum of ocular involvement in patients with systemic lupus erythematosus without ocular symptoms
    Soo MPK, Chow SK, Tan CT, Nadior N, Yeap SS, Hoh HB
    Lupus, 2000;9(7):511-4.
    PMID: 11035416 DOI: 10.1177/096120330000900706
    The aim of the study was to determine the spectrum of clinical ocular involvement in patients with inactive systemic lupus erythematosus (SLE) who have no ocular symptoms. Patients with a diagnosis of SLE based on the 1982 revised American College of Rheumatology criteria and with no ocular complaints were recruited from the SLE clinic. Clinical data regarding their systemic disease and disease activity were recorded and a full ophthalmic examination carried out. 52 patients of mixed ethnicity comprising of 75% Chinese, 19% Malays and 6% Indian patients were recruited. Of these, 51 (98%) were female with a mean age of 34+/-11 (range 16-74 y). 16 (31%) patients had dry eyes while corticosteroid induced glaucoma and cataract was detected in 1 (2%) and 7 (14%) patients, respectively. No patients were found to have sight-threatening ocular conditions such as cotton wool spots, vasculitis, optic neuropathy or uveitis. Patients with clinically inactive disease were found not to have sight-threatening ocular diseases that are known to be associated with SLE. Although they have no ocular complaints, nearly one-third of these patients have dry eyes. Ocular examination may be unnecessary when the disease is clinically inactive and in the absence of ocular symptoms.
    Study site: SLE clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
  12. The effect of mivacurium pretreatment on intra-ocular pressure changes induced by suxamethonium
    Chiu CL, Lang CC, Wong PK, Delilkan AE, Wang CY
    Anaesthesia, 1998 May;53(5):501-5.
    PMID: 9659028
    Forty patients without eye disease, undergoing elective nonophthalmic surgery, were studied in a double-blind, randomised, placebo-controlled study evaluating the efficacy of mivacurium pretreatment in attenuating the rise in intra-ocular pressure in response to suxamethonium administration, laryngoscopy and intubation. The patients were randomly allocated to receive either mivacurium 0.02 mg.kg-1 or normal saline as pretreatment 3 min before a rapid sequence induction technique using alfentanil, propofol and suxamethonium. Suxamethonium induced a significant increase in intra-ocular pressure in the control group but not in the mivacurium pretreatment group (mean (SEM) increase = 3.5 (1.2) mmHg vs. 0.4 (0.8) mmHg, p < 0.05). There was a decrease in intra-ocular pressure in both groups after laryngoscopy and intubation with no significant difference between the two groups. These results show that mivacurium pretreatment is effective in preventing the increase in intra-ocular pressure after suxamethonium administration.
  13. Identification of crossbred buffalo genotypes and their chromosome segregation patterns
    Harisah M, Azmi TI, Hilmi M, Vidyadaran MK, Bongso TA, Nava ZM, et al.
    Genome, 1989 Dec;32(6):999-1002.
    PMID: 2628159
    Chromosome analysis on different breed types of water buffaloes (Bubalus bubalis) was undertaken to identify their karyotypes and to determine the pattern of chromosome segregation in crossbred water buffaloes. Altogether, 75 purebred and 198 crossbred buffaloes including 118 from Malaysia and 80 from the Philippines, were analyzed in this study. The diploid chromosome number of the swamp buffalo from both countries was 48 and that of the river buffalo was 50, while all F1 hybrids exhibited 49 chromosomes. The F2 hybrids consisted of three different karyotype categories (2n = 48, 2n = 49, and 2n = 50), whereas the backcrosses included two different karyotype categories each, with 2n = 48 and 2n = 49 in the three quarters swamp types and 2n = 49 and 2n = 50 in the three quarters river types. Chi-square tests on pooled data from Malaysia and the Philippines indicated that the distribution of different karyotype categories of F2 animals did not deviate significantly from the 1:2:1 ratio expected if only balanced gametes with 24 and 25 chromosomes were produced by the F1 hybrids. In the three quarters swamp and three quarters river types, the respective karyotypic categories were in ratios approximating 1:1. The distribution of chromosome categories among the F2 hybrids and backcrosses suggests that only genetically balanced gametes of the F1 hybrids are capable of producing viable F2 and backcross generations.
  14. Maternal age-specific incidence of Down's syndrome in Malaysian neonates
    Boo NY, Hoe TS, Lye MS, Poon PK, Mahani MC
    J Singapore Paediatr Soc, 1989;31(3-4):138-42.
    PMID: 2534718
    Over an 18 month period, 34,495 livebirths were delivered in the Kuala Lumpur Maternity Hospital. 36 neonates (1.044 per 1000 livebirths) had Down's syndrome. The observed rates of Down's syndrome per 1000 livebirths by single year intervals of maternal age were calculated. By using the discontinuous slope model, our study showed that the incidence of Down's syndrome among the Malaysian liveborns increased markedly when the maternal age exceeded 35 years. This study also suggested that the Malay mothers had increased risk of producing babies with Down's syndrome at a later age than the Chinese and the Indians. However, a larger number of babies in each racial group needs to be studied to confirm this.
  15. Morphological analysis of various rugae patterns among Dravidian population
    Selvamani M, Bindiya PK, Bhojaraju N, Bastian TS, Suhana HS, Mathew M
    J Oral Maxillofac Pathol, 2019 9 14;23(2):295-299.
    PMID: 31516240 DOI: 10.4103/jomfp.JOMFP_277_18
    Aim: The aim of this study was to analyze and identify differences in the palatal rugae patterns and genderwise distributions in three different populations (Kerala, Mahe and Puducherry).

    Materials and Methods: Ninety maxillary study models (30 from each group including males and females) were examined in the age group ranging from 18 to 25 years. The palatal rugae pattern was analyzed for shape.

    Results: After analyzing the rugae patterns among the groups, the most common pattern was the wavy pattern (53.57%) followed by curved (18.22%) and straight (13.66%). The least was circular (1.3%). When compared between sex, the most common pattern was found to be wavy (male - 54.3% and female - 53.09%), while the curved pattern was more common among the females (21.09%) than males (13.97%). The straight pattern was more common among the males (18.8%) than females (10.18%). The least common pattern was found to be the circular in both sexes which accounted for around 1%.

    Conclusion: This study shows no two palates are identical in terms of their rugae pattern. Palatal rugae possess unique characteristics as they are absolutely individualistic. Study also confirms that the "wavy" type of palatal rugae pattern was the most predominant among these three populations.

  16. Application of a new system for classifying tooth, root and canal morphology in the primary dentition
    Ahmed HMA, Musale PK, El Shahawy OI, Dummer PMH
    Int Endod J, 2020 Jan;53(1):27-35.
    PMID: 31390075 DOI: 10.1111/iej.13199
    Knowledge of root and canal morphology is essential for the effective practice of root canal treatment. Paediatric endodontics aims to preserve fully functional primary teeth in the dental arch; however, pulpectomy procedures in bizarre and tortuous canals encased in roots programmed for physiologic resorption are unique challenges. A new coding system for classifying the roots and main canals (https://doi.org/10.1111/iej.12685), accessory canals (https://doi.org/10.1111/iej.12800) and developmental anomalies (https://doi.org/10.1111/iej.12867) has been introduced recently. This paper discusses challenges for describing root and canal morphology in primary teeth and describes the potential application of the new classification system for root canals in the primary dentition.
  17. Orientation and verbal fluency in the English Longitudinal Study of Ageing: modifiable risk factors for falls?
    Smith TO, Neal SR, Peryer G, Sheehan KJ, Tan MP, Myint PK
    Int Psychogeriatr, 2019 10;31(10):1491-1498.
    PMID: 30522546 DOI: 10.1017/S1041610218002065
    OBJECTIVES: To determine the relationship between falls and deficits in specific cognitive domains in older adults.

    DESIGN: An analysis of the English Longitudinal Study of Ageing (ELSA) cohort.

    SETTING: United Kingdom community-based.

    PARTICIPANTS: 5197 community-dwelling older adults recruited to a prospective longitudinal cohort study.

    MEASUREMENTS: Data on the occurrence of falls and number of falls, which occurred during a 12-month follow-up period, were assessed against the specific cognitive domains of memory, numeracy skills, and executive function. Binomial logistic regression was performed to evaluate the association between each cognitive domain and the dichotomous outcome of falls in the preceding 12 months using unadjusted and adjusted models.

    RESULTS: Of the 5197 participants included in the analysis, 1308 (25%) reported a fall in the preceding 12 months. There was no significant association between the occurrence of a fall and specific forms of cognitive dysfunction after adjusting for self-reported hearing, self-reported eyesight, and functional performance. After adjustment, only orientation (odds ratio [OR]: 0.80; 95% confidence intervals [CI]: 0.65-0.98, p = 0.03) and verbal fluency (adjusted OR: 0.98; 95% CI: 0.96-1.00; p = 0.05) remained significant for predicting recurrent falls.

    CONCLUSIONS: The cognitive phenotype rather than cognitive impairment per se may predict future falls in those presenting with more than one fall.

  18. Guidelines for reporting the quality of clinical case reports in Endodontics: a development protocol
    Nagendrababu V, Chong BS, McCabe P, Shah PK, Priya E, Jayaraman J, et al.
    Int Endod J, 2019 Jun;52(6):775-778.
    PMID: 30586165 DOI: 10.1111/iej.13067
    Case reports are used to communicate interesting, new or rare condition/s, innovative treatment approaches or novel techniques. Apart from informing readers, such information has the potential to contribute towards further scientific studies and the development of newer management modalities. In that context, it is important that case reports are presented accurately and deliver all the necessary and pertinent information to the reader. Reporting guidelines are used to inform authors of the quality standards required to ensure their manuscripts are accurate, complete and transparent. The aim of this project is to develop and disseminate new guidelines - Preferred Reporting Items for Case reports in Endodontics (PRICE). The primary aim is to aid authors when constructing case reports in the field of Endodontics to ensure the highest possible reporting standards are adopted. The project leaders (PD and VN) formed a steering committee comprising six additional members. Subsequently, a five-phase consensus process will be used. The steering committee will develop the PRICE guidelines (PRICE checklist and flow chart) by identifying relevant items (quality standards) derived from the CAse REport guidelines and Clinical and Laboratory Images in Publications principles, focussing on the content of case reports. Following this, the steering committee will identify a PRICE Delphi Group (PDG) consisting of 30 members including academicians, practitioners, and members of the public. The individual items (components) of the PRICE checklist will be evaluated by the PDG based on a 9-point Likert scale. Only items scored between 7 and 9 by 70% or more members will be included in the draft checklist. The Delphi process will be continued until a consensus is reached and a final set of items agreed by the PDG members. Following this, a PRICE Face-to-Face meeting group (PFMG) will be formed with 20 members to achieve a final consensus. The final consensus-based checklist and flow chart will be evaluated and approved by selected members of the PDG and PFMG. The approved PRICE guidelines will be published in relevant journals and disseminated via contacts in academic institutions and national endodontic societies, as well as being presented at scientific/clinical meetings.
  19. Gene symbol: APC. Disease: colorectal cancer
    Tan LP, Ng BK, Balraj P, Poh BH, Lim PK, Peh SC
    Hum Genet, 2005 Dec;118(3-4):539-40.
    PMID: 16521263
  20. Comparison of two case difficulty assessment methods on cohorts of undergraduate dental students - a multi-centre study
    Shah PK, Duncan HF, Abdullah D, Tomson PL, Murray G, Friend TM, et al.
    Int Endod J, 2020 Nov;53(11):1569-1580.
    PMID: 32748456 DOI: 10.1111/iej.13377
    AIM: To compare the educational benefits and user friendliness of two anonymized endodontic case difficulty assessment (CDA) methods.

    METHODOLOGY: A cohort (n = 206) of fourth-year undergraduate dental students were recruited from four different Dental Schools and divided randomly into two groups (Group A and B). The participants assessed six test endodontic cases using anonymized versions of the American Association of Endodontists (AAE) case difficulty assessment form (AAE Endodontic Case Difficulty Assessment Form and Guidelines, 2006) and EndoApp, a web-based CDA tool. Group A (n = 107) used the AAE form for assessment of the first three cases, followed by EndoApp for the latter. Group B (n = 99) used EndoApp for the initial three cases and switched to the AAE form for the remainder. Data were collected online and analysed to assess participants' knowledge reinforcement and agreement with the recommendation generated. Statistical analysis was performed using the two-way mixed model anova, Cohen's Kappa (κ) and independent t-tests, with the levels of significance set at P P = 0.001) after assessment of the first three test cases. However, this increase was not significant (P = 0.842) between the CDA methods. Overall, the AAE form and EndoApp had slight (κ = 0.176, P P P 

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