Displaying publications 1 - 20 of 105 in total

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  1. Participation and barriers to colorectal cancer screening in Malaysia
    Yusoff HM, Daud N, Noor NM, Rahim AA
    Asian Pac J Cancer Prev, 2012;13(8):3983-7.
    PMID: 23098504
    In Malaysia, colorectal cancer is the most common cancer in males and the third most common in females. Mortality due to colorectal cancer can be effectively reduced with early diagnosis. This study was designed to look into colorectal cancer screening participation and its barriers among average risk individuals in Malaysia. A cross sectional study was conducted from August 2009 till April 2010 involving average risk individuals from 44 primary care clinics in West Malaysia. Each individual was asked whether they have performed any of the colorectal cancer screening methods in the past five years. The barrier questions had three domains: patient factors, test factors and health care provider factors. Descriptive analysis was achieved using Statistical Program for Social Sciences (SPSS) version 12.0. A total of 1,905 average risk individuals responded making a response rate of 93.8%. Only 13 (0.7%) respondents had undergone any of the colorectal cancer screening methods in the past five years. The main patient and test factors for not participating were embarrassment (35.2%) and feeling uncomfortable (30.0%), respectively. There were 11.2% of respondents who never received any advice to do screening. The main reason for them to undergo screening was being advised by health care providers (84.6%). The study showed that participation in colorectal cancer screening in Malaysia is extremely low and multiple factors contribute to this situation. Given the importance of the disease, efforts should be made to increase colorectal cancer screening activities in Malaysia.
  2. Fulltext Gender differences in responses towards anti-smoking messages and policy implementation among future doctors in Malaysia
    Yasin SM, Ismail N, Noor NM, Mohd Azman MS, Taib H, Jusop JM, et al.
    Asian Pac J Cancer Prev, 2013;14(1):303-8.
    PMID: 23534742
    BACKGROUND: Medical students' views may provide some direction for future policy considerations.

    AIM: The aim of this study was to assess gender differences in future doctors' receptiveness to currently implemented anti-smoking messages and the effectiveness of those messages.

    MATERIALS AND METHODS: We administered a questionnaire to all students at a medical university in Malaysia, asking how frequently they noted anti- smoking policies, anti-smoking campaigns, and anti-smoking messages in schools. In addition, the questionnaire investigated most effective methods to convey these messages.

    RESULTS: A total of 522 (59.7%) students responded. Students were least likely to approve of total bans on cigarettes and increasing the price of cigarettes, and most likely to approve of bans on use of cigarettes in public places and sales to individuals less than 16 years old. Approval of total bans on cigarettes was more common in female students than in males OR=0.39 (95%CI: 0.18- 0.86). Furthermore, compared to the female students, the male students thought that printed media; OR=2.32 (95%CI: 1.31-4.10), radio; OR=1.93 (95%CI: 1.15-3.22) and the internet; OR=1.96 (95%CI: 1.15-3.33) were very effective at delivering anti-smoking messages.

    CONCLUSIONS: Gender differences existed in the future doctors' perception of the effectiveness of anti-smoking initiatives. Taking this gender difference into account may increase the receipt of anti-smoking messages in adolescents.
  3. Cryopreservation of Garcinia cowa shoot tips by vitrification: the effects of sucrose preculture and loading treatment on ultrastructural changes in meristematic cells
    Yap LV, Noor NM, Clyde MM, Chin HF
    Cryo Letters, 2011 May-Jun;32(3):188-96.
    PMID: 21766148
    The effects of sucrose preculture duration and loading treatment on tolerance of Garcinia cowa shoot tips to cryopreservation using the PVS2 vitrification solution were investigated. Ultrastructural changes in meristematic cells at the end of the preculture and loading steps were followed in an attempt to understand the effects of these treatments on structural changes in cell membranes and organelles. Increasing preculture duration on 0.3 M sucrose medium from 0 to 3 days enhanced tolerance to PVS2 solution from 5.6 percent (no preculture) to 49.2 percent (3-day preculture). However, no survival was observed after cryopreservation. Examination of meristematic cells by transmission electron microscopy revealed the progressive accumulation of an electron-dense substance in line with increasing exposure durations to 0.3 M sucrose preculture. Treatment with a loading solution (2 M glycerol + 0.4 M sucrose) decreased tolerance of shoot tips to PVS2 vitrification solution and had a deleterious effect on the ultrastructure of G. cowa meristematic cells. This study suggests that G. cowa meristematic cells may lose their structural integrity due to exposure to glycerol present in the loading solution at a 2 M concentration, either due to its high osmotic potential, or due to its cytotoxicity.
  4. Fulltext Proteomic analysis of pitcher fluid from Nepenthes × ventrata
    Wan Zakaria WNA, Aizat WM, Goh HH, Noor NM
    Data Brief, 2018 Apr;17:517-519.
    PMID: 29876422 DOI: 10.1016/j.dib.2018.01.037
    The carnivorous plants of genus Nepenthes produce unique pitchers containing secretory glands, which secrete proteins into the digestive fluid. We investigated protein profile in the pitcher fluid during the first three days of opening to understand carnivory trait of Nepenthes × ventrata. The proteome analysis of pitcher fluid from N. × ventrata was performed by label-free quantitative liquid chromatography mass spectrometry (nLC-MS/MSALL). Raw MS data have been deposited to the ProteomeXchange with identifier PXD007251. This dataset allows the identification and quantification of proteins from pitcher fluids to elucidate proteins involved in carnivory physiology of Nepenthes species.
  5. Fulltext A Case Report of Steroid Withdrawal Syndrome
    Wahab F, Rahman RA, Yaacob LH, Noor NM, Draman N
    Korean J Fam Med, 2020 Sep;41(5):359-362.
    PMID: 32961047 DOI: 10.4082/kjfm.18.0181
    We report a case of steroid withdrawal syndrome in a 74-year-old woman who was suspected of having an occult exogenous Cushing's syndrome secondary to prolonged traditional complementary medicine use. She presented with non-specific symptoms of lethargy, malaise, and poor oral intake with weight loss for 1 month, and investigations showed suboptimal 9 AM cortisol level. She has responded well to steroid replacement.
  6. Use of denosumab in parathyroid carcinoma with refractory hypercalcemia
    Tong CV, Hussein Z, Noor NM, Mohamad M, Ng WF
    QJM, 2015 Jan;108(1):49-50.
    PMID: 25099611 DOI: 10.1093/qjmed/hcu166
  7. Lung disease stratification using amalgamation of Riesz and Gabor transforms in machine learning framework
    Than JCM, Saba L, Noor NM, Rijal OM, Kassim RM, Yunus A, et al.
    Comput Biol Med, 2017 10 01;89:197-211.
    PMID: 28825994 DOI: 10.1016/j.compbiomed.2017.08.014
    Lung disease risk stratification is important for both diagnosis and treatment planning, particularly in biopsies and radiation therapy. Manual lung disease risk stratification is challenging because of: (a) large lung data sizes, (b) inter- and intra-observer variability of the lung delineation and (c) lack of feature amalgamation during machine learning paradigm. This paper presents a two stage CADx cascaded system consisting of: (a) semi-automated lung delineation subsystem (LDS) for lung region extraction in CT slices followed by (b) morphology-based lung tissue characterization, thereby addressing the above shortcomings. LDS primarily uses entropy-based region extraction while ML-based lung characterization is mainly based on an amalgamation of directional transforms such as Riesz and Gabor along with texture-based features comprising of 100 greyscale features using the K-fold cross-validation protocol (K = 2, 3, 5 and 10). The lung database consisted of 96 patients: 15 normal and 81 diseased. We use five high resolution Computed Tomography (HRCT) levels representing different anatomy landmarks where disease is commonly seen. We demonstrate the amalgamated ML stratification accuracy of 99.53%, an increase of 2% against the conventional non-amalgamation ML system that uses alone Riesz-based feature embedded with feature selection based on feature strength. The robustness of the system was determined based on the reliability and stability that showed a reliability index of 0.99 and the deviation in risk stratification accuracies less than 5%. Our CADx system shows 10% better performance when compared against the mean of five other prominent studies available in the current literature covering over one decade.
  8. Comparing the clinical effects of balanced electrolyte solutions versus normal saline in managing diabetic ketoacidosis: A systematic review and meta-analyses
    Tamzil R, Yaacob N, Noor NM, Baharuddin KA
    Turk J Emerg Med, 2023;23(3):131-138.
    PMID: 37529790 DOI: 10.4103/tjem.tjem_355_22
    The first-line treatment of diabetes ketoacidosis (DKA) involves fluid resuscitation with normal saline infusion to correct hypovolemia. Hyperchloremic metabolic acidosis from aggressive normal saline administration was associated with worse clinical outcomes in managing DKA. Other choices for normal saline include balanced electrolyte solutions (BESs). This study aimed to compare the clinical effects between BESs and normal saline in managing DKA. This study was a systematic review of probing articles published from inception to October 2021 in Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online, Google Scholar, and Scopus. Eight randomized controlled trials with a total of 595 individuals were included. The data were analyzed at 95% confidence level using random-effects models. For the primary outcomes, there was no difference in the duration of DKA resolution. (Mean difference [MD] -4.73, 95% confidence interval [CI] -2.72-4.92; I2 = 92%; P = 0.180). However, there was a significantly lower postresuscitation chloride concentration in the BES (MD 2.96 95% CI - 4.86 to - 1.06; I2 = 59%; P = 0.002). For the secondary outcomes, there was a significant reduction in duration for normalization of bicarbonate in the BES group (MD 3.11 95% CI - 3.98-2.23; I2 = 5%; P = 0.0004). There were no significant differences between groups in duration for recovery of pH, intensive unit admission, and adverse events (mortality and acute renal failure). Resuscitation with BES was associated with decreased chloride and increased bicarbonate values in DKA patients. It suggests that BES prevents DKA patients from hyperchloremic metabolic acidosis.
  9. Fulltext Maternal Vitamin D Supplementation for the Prevention of Respiratory Tract Infections in Offspring: A Meta-Analysis
    Sulaiman Z, Noor NM, Ismail SB, Mohd Lukman ASF, Irfan M, Hussain NHN
    Korean J Fam Med, 2022 May;43(3):174-182.
    PMID: 35610964 DOI: 10.4082/kjfm.21.0029
    BACKGROUND: Vitamin D may enhance immune system function and provide a protective effect against infections. Feto-maternal circulation plays an important role in supplying the developing fetus with nutrients and antibodies for its development and health during pregnancy and for its early years of life after birth. This meta-analysis aimed to determine the effectiveness of maternal vitamin D supplementation in preventing respiratory tract infections (RTIs) in children.

    METHODS: We searched the Central and MEDLINE databases and went through all the reference lists in the related articles. We also searched for ongoing trials at http://www.who.int/ictrp/en/ and www.clinicaltrials.gov. Randomized controlled trials comparing vitamin D supplementation with a placebo or no treatment in pregnant women published in the English language up to March 2019 were included. Two reviewers extracted data independently using a predefined protocol and assessed the risk of bias using the Cochrane risk of bias tool, with differences agreed upon by consensus. The predefined primary outcome was the number of offspring who had RTIs. The secondary outcome was the presence of measurable serum immunoglobulin E levels.

    RESULTS: Three trials involving 3,224 participants (mother-child pairs) met the inclusion criteria and were included in this review. The present analysis reported that maternal supplementation with vitamin D had no effect on RTIs among children (n=1,486 offspring; risk ratio, 0.95; 95% confidence interval, 0.82-1.11; random effects; I2 statistics, 0%).

    CONCLUSION: Maternal vitamin D supplementation had no effect on RTIs in children. Therefore, consideration of other prevention methods in this regard is recommended.

  10. Fulltext Engineering the lactococcal mevalonate pathway for increased sesquiterpene production
    Song AA, Abdullah JO, Abdullah MP, Shafee N, Othman R, Noor NM, et al.
    FEMS Microbiol Lett, 2014 Jun;355(2):177-84.
    PMID: 24828482 DOI: 10.1111/1574-6968.12469
    Isoprenoids are a large, diverse group of secondary metabolites which has recently raised a renewed research interest due to genetic engineering advances, allowing specific isoprenoids to be produced and characterized in heterologous hosts. Many researches on metabolic engineering of heterologous hosts for increased isoprenoid production are focussed on Escherichia coli and yeasts. E. coli, as most prokaryotes, use the 2-C-methyl-d-erythritol-4-phosphate (MEP) pathway for isoprenoid production. Yeasts on the other hand, use the mevalonate pathway which is commonly found in eukaryotes. However, Lactococcus lactis is an attractive alternative host for heterologous isoprenoid production. Apart from being food-grade, this Gram-positive prokaryote uses the mevalonate pathway for isoprenoid production instead of the MEP pathway. Previous studies have shown that L. lactis is able to produce sesquiterpenes through heterologous expression of plant sesquiterpene synthases. In this work, we analysed the gene expression of the lactococcal mevalonate pathway through RT-qPCR to successfully engineer L. lactis as an efficient host for isoprenoid production. We then overexpressed the mvk gene singly or co-expressed with the mvaA gene as an attempt to increase β-sesquiphellandrene production in L. lactis. It was observed that co-expression of mvk with mvaA doubled the amount of β-sesquiphellandrene produced.
  11. Fulltext Overexpressing 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGR) in the lactococcal mevalonate pathway for heterologous plant sesquiterpene production
    Song AA, Abdullah JO, Abdullah MP, Shafee N, Othman R, Tan EF, et al.
    PLoS One, 2012;7(12):e52444.
    PMID: 23300671 DOI: 10.1371/journal.pone.0052444
    Isoprenoids are a large and diverse group of metabolites with interesting properties such as flavour, fragrance and therapeutic properties. They are produced via two pathways, the mevalonate pathway or the 2-C-methyl-D-erythritol-4-phosphate (MEP) pathway. While plants are the richest source of isoprenoids, they are not the most efficient producers. Escherichia coli and yeasts have been extensively studied as heterologous hosts for plant isoprenoids production. In the current study, we describe the usage of the food grade Lactococcus lactis as a potential heterologous host for the production of sesquiterpenes from a local herbaceous Malaysian plant, Persicaria minor (synonym Polygonum minus). A sesquiterpene synthase gene from P. minor was successfully cloned and expressed in L. lactis. The expressed protein was identified to be a β-sesquiphellandrene synthase as it was demonstrated to be functional in producing β-sesquiphellandrene at 85.4% of the total sesquiterpenes produced based on in vitro enzymatic assays. The recombinant L. lactis strain developed in this study was also capable of producing β-sesquiphellandrene in vivo without exogenous substrates supplementation. In addition, overexpression of the strain's endogenous 3-hydroxy-3-methylglutaryl coenzyme-A reductase (HMGR), an established rate-limiting enzyme in the eukaryotic mevalonate pathway, increased the production level of β-sesquiphellandrene by 1.25-1.60 fold. The highest amount achieved was 33 nM at 2 h post-induction.
  12. Fulltext Simple Orthodontic Correction of Rotated Malpositioned Teeth Using Sectional Wire and 2 × 4 Orthodontic Appliances in Mixed-Dentition: A Report of Two Cases
    Sockalingam SNMP, Zakaria ASI, Khan KAM, Azmi FM, Noor NM
    Case Rep Dent, 2020;2020:6972196.
    PMID: 32695527 DOI: 10.1155/2020/6972196
    The correction of rotated malpositioned tooth/teeth into the dental arch alignment in the mixed-dentition is often a challenging task for paediatric dentists. Failure in addressing this issue can bring about detrimental effect to the developing dentition and increases the probability of a complex orthodontic treatment in later years. Factors such as severity of the malpositioned teeth, patient's treatment compliance, limitation in specific functions of the selected appliance, availability of bone and space may dictate the success of the treatment. The combined use of a simple sectional orthodontic wire appliance and a 2 × 4 orthodontic appliance has been shown to produce a positive effect. The appliances resulted in derotation of the rotated malpositioned teeth and bringing them into arch alignment in two cases. This treatment option had eliminated the detrimental effects to the developing dentition and helped patients to enhance their smile and dental aesthetics.
  13. Recent advancement of engineering microbial hosts for the biotechnological production of flavonoids
    Shah FLA, Ramzi AB, Baharum SN, Noor NM, Goh HH, Leow TC, et al.
    Mol Biol Rep, 2019 Dec;46(6):6647-6659.
    PMID: 31535322 DOI: 10.1007/s11033-019-05066-1
    Flavonoids are polyphenols that are important organic chemicals in plants. The health benefits of flavonoids that result in high commercial values make them attractive targets for large-scale production through bioengineering. Strategies such as engineering a flavonoid biosynthetic pathway in microbial hosts provide an alternative way to produce these beneficial compounds. Escherichia coli, Saccharomyces cerevisiae and Streptomyces sp. are among the expression systems used to produce recombinant products, as well as for the production of flavonoid compounds through various bioengineering approaches including clustered regularly interspaced short palindromic repeats (CRISPR)-based genome engineering and genetically encoded biosensors to detect flavonoid biosynthesis. In this study, we review the recent advances in engineering model microbial hosts as being the factory to produce targeted flavonoid compounds.
  14. Effect of miscentering and low-dose protocols on contrast resolution in computed tomography head examination
    Shaffiq Said Rahmat SM, Abdul Karim MK, Che Isa IN, Abd Rahman MA, Noor NM, Hoong NK
    Comput Biol Med, 2020 08;123:103840.
    PMID: 32658782 DOI: 10.1016/j.compbiomed.2020.103840
    BACKGROUND: Unoptimized protocols, including a miscentered position, might affect the outcome of diagnostic in CT examinations. In this study, we investigate the effects of miscentering position during CT head examination on the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR).

    METHOD: We simulate the CT head examination using a water phantom with a standard protocol (120 kVp/180 mAs) and a low dose protocol (100 kVp/142 mAs). The table height was adjusted to simulate miscentering by 5 cm from the isocenter, where the height was miscentered superiorly (MCS) at 109, 114, 119, and 124 cm, and miscentered inferiorly (MCI) at 99, 94, 89, and 84 cm. Seven circular regions of interest were used, with one drawn at the center, four at the peripheral area of the phantom, and two at the background area of the image.

    RESULTS: For the standard protocol, the mean CNR decreased uniformly as table height increased and significantly differed (p 

  15. Fulltext Successful Modified Desensitization Therapy with Analog Insulin in an Individual with Severe Allergy to Multiple Insulin Preparations: A Case Report
    Seman WJW, Nasruddin AB, Noor NM
    J ASEAN Fed Endocr Soc, 2018;33(1):53-56.
    PMID: 33442111 DOI: 10.15605/jafes.033.01.09
    We present a case of a 27-year-old female with T2 DM who developed allergic reactions after commencement of insulin therapy. Trial with different types of insulin resulted in a series of allergic reactions ranging from urticarial rash to development of angioedema, bronchospasm and anaphylactic shock. She was successfully treated with a modified insulin desensitization protocol using rapid-acting insulin.
  16. Fulltext Dataset of Fourier transform-infrared coupled with chemometric analysis used to distinguish accessions of Garcinia mangostana L. in Peninsular Malaysia
    Samsir SA, Bunawan H, Yen CC, Noor NM
    Data Brief, 2016 Sep;8:1-5.
    PMID: 27257614 DOI: 10.1016/j.dib.2016.04.062
    In this dataset, we distinguish 15 accessions of Garcinia mangostana from Peninsular Malaysia using Fourier transform-infrared spectroscopy coupled with chemometric analysis. We found that the position and intensity of characteristic peaks at 3600-3100 cm(-) (1) in IR spectra allowed discrimination of G. mangostana from different locations. Further principal component analysis (PCA) of all the accessions suggests the two main clusters were formed: samples from Johor, Melaka, and Negeri Sembilan (South) were clustered together in one group while samples from Perak, Kedah, Penang, Selangor, Kelantan, and Terengganu (North and East Coast) were in another clustered group.
  17. Fulltext Dataset of SSR markers for ISSR-Suppression-PCR to detect genetic variation in Garcinia mangostana L. in Peninsular Malaysia
    Samsir SA, Bunawan H, Yen CC, Noor NM
    Data Brief, 2016 Sep;8:1438-42.
    PMID: 27617279 DOI: 10.1016/j.dib.2016.08.016
    In this dataset, we present 15 Simple Sequence Repeat (SSR) markers with the motifs (AC)n, (GA)n, and (AC)n(AG)n using a ISSR-Suppression-PCR technique in order to discriminate Garcinia mangostana from diverse geographical origins in Peninsular Malaysia. A few loci showed differences between 3 and 6 bp in allele size, indicating that there are some polymorphisms between individuals correlating to the number of SSR repeats that may be useful for differentiate of genotypes. Collectively, these data show that the ISSR-Suppression-PCR is a valuable method to illustrate genetic variation of selected G. mangostana in Malaysia.
  18. Fulltext Regulation of terpenoid biosynthesis by miRNA in Persicaria minor induced by Fusarium oxysporum
    Samad AFA, Rahnamaie-Tajadod R, Sajad M, Jani J, Murad AMA, Noor NM, et al.
    BMC Genomics, 2019 07 16;20(1):586.
    PMID: 31311515 DOI: 10.1186/s12864-019-5954-0
    BACKGROUND: Persicaria minor (kesum) is an herbaceous plant with a high level of secondary metabolite compounds, particularly terpenoids. These terpenoid compounds have well-established roles in the pharmaceutical and food industries. Although the terpenoids of P. minor have been studied thoroughly, the involvement of microRNA (miRNA) in terpenoid regulation remains poorly understood and needs to be explored. In this study, P. minor plants were inoculated with the pathogenic fungus Fusarium oxysporum for terpenoid induction.

    RESULT: SPME GC-MS analysis showed the highest terpenoid accumulation on the 6th day post-inoculation (dpi) compared to the other treatment time points (0 dpi, 3 dpi, and 9 dpi). Among the increased terpenoid compounds, α-cedrene, valencene and β-bisabolene were prominent. P. minor inoculated for 6 days was selected for miRNA library construction using next generation sequencing. Differential gene expression analysis showed that 58 miRNAs belonging to 30 families had significantly altered regulation.
    Among these 58 differentially expressed genes (DEGs), 27 [corrected] miRNAs were upregulated, whereas 31 [corrected] miRNAs were downregulated. Two putative novel pre-miRNAs were identified and validated through reverse transcriptase PCR. Prediction of target transcripts potentially involved in the mevalonate pathway (MVA) was carried out by psRobot software, resulting in four miRNAs: pmi-miR530, pmi-miR6173, pmi-miR6300 and a novel miRNA, pmi-Nov_13. In addition, two miRNAs, miR396a and miR398f/g, were predicted to have their target transcripts in the non-mevalonate pathway (MEP). In addition, a novel miRNA, pmi-Nov_12, was identified to have a target gene involved in green leaf volatile (GLV) biosynthesis. RT-qPCR analysis showed that pmi-miR6173, pmi-miR6300 and pmi-nov_13 were downregulated, while miR396a and miR398f/g were upregulated. Pmi-miR530 showed upregulation at 9 dpi, and dynamic expression was observed for pmi-nov_12. Pmi-6300 and pmi-miR396a cleavage sites were detected through degradome sequence analysis. Furthermore, the relationship between miRNA metabolites and mRNA metabolites was validated using correlation analysis.

    CONCLUSION: Our findings suggest that six studied miRNAs post-transcriptionally regulate terpenoid biosynthesis in P. minor. This regulatory behaviour of miRNAs has potential as a genetic tool to regulate terpenoid biosynthesis in P. minor.

  19. Fulltext Correction to: Regulation of terpenoid biosynthesis by miRNA in Persicaria minor induced by Fusarium oxysporum
    Samad AFA, Rahnamaie-Tajadod R, Sajad M, Jani J, Murad AMA, Noor NM, et al.
    BMC Genomics, 2019 08 01;20(1):627.
    PMID: 31370802 DOI: 10.1186/s12864-019-5994-5
    Following publication of the original article [1], the authors reported a number of errors, which are listed in this Correction article. The corrections are marked in bold.
  20. Inter-observer Variability Analysis of Automatic Lung Delineation in Normal and Disease Patients
    Saba L, Than JC, Noor NM, Rijal OM, Kassim RM, Yunus A, et al.
    J Med Syst, 2016 Jun;40(6):142.
    PMID: 27114353 DOI: 10.1007/s10916-016-0504-7
    Human interaction has become almost mandatory for an automated medical system wishing to be accepted by clinical regulatory agencies such as Food and Drug Administration. Since this interaction causes variability in the gathered data, the inter-observer and intra-observer variability must be analyzed in order to validate the accuracy of the system. This study focuses on the variability from different observers that interact with an automated lung delineation system that relies on human interaction in the form of delineation of the lung borders. The database consists of High Resolution Computed Tomography (HRCT): 15 normal and 81 diseased patients' images taken retrospectively at five levels per patient. Three observers manually delineated the lungs borders independently and using software called ImgTracer™ (AtheroPoint™, Roseville, CA, USA) to delineate the lung boundaries in all five levels of 3-D lung volume. The three observers consisted of Observer-1: lesser experienced novice tracer who is a resident in radiology under the guidance of radiologist, whereas Observer-2 and Observer-3 are lung image scientists trained by lung radiologist and biomedical imaging scientist and experts. The inter-observer variability can be shown by comparing each observer's tracings to the automated delineation and also by comparing each manual tracing of the observers with one another. The normality of the tracings was tested using D'Agostino-Pearson test and all observers tracings showed a normal P-value higher than 0.05. The analysis of variance (ANOVA) test between three observers and automated showed a P-value higher than 0.89 and 0.81 for the right lung (RL) and left lung (LL), respectively. The performance of the automated system was evaluated using Dice Similarity Coefficient (DSC), Jaccard Index (JI) and Hausdorff (HD) Distance measures. Although, Observer-1 has lesser experience compared to Obsever-2 and Obsever-3, the Observer Deterioration Factor (ODF) shows that Observer-1 has less than 10% difference compared to the other two, which is under acceptable range as per our analysis. To compare between observers, this study used regression plots, Bland-Altman plots, two tailed T-test, Mann-Whiney, Chi-Squared tests which showed the following P-values for RL and LL: (i) Observer-1 and Observer-3 were: 0.55, 0.48, 0.29 for RL and 0.55, 0.59, 0.29 for LL; (ii) Observer-1 and Observer-2 were: 0.57, 0.50, 0.29 for RL and 0.54, 0.59, 0.29 for LL; (iii) Observer-2 and Observer-3 were: 0.98, 0.99, 0.29 for RL and 0.99, 0.99, 0.29 for LL. Further, CC and R-squared coefficients were computed between observers which came out to be 0.9 for RL and LL. All three observers however manage to show the feature that diseased lungs are smaller than normal lungs in terms of area.
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