Displaying publications 81 - 100 of 245 in total

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  1. Lee YY, Tang TK, Phuah ET, Alitheen NB, Tan CP, Lai OM
    J Sci Food Agric, 2017 Mar;97(5):1379-1385.
    PMID: 27801514 DOI: 10.1002/jsfa.8124
    Non-enzymatic browning has been a wide and interesting research area in the food industry, ranging from the complexity of the reaction to its applications in the food industry as well as its ever-debatable health effects. This review provides a new perspective to the Maillard reaction apart from its ubiquitous function in enhancing food flavour, taste and appearance. It focuses on the recent application of Maillard reaction products as an inexpensive and excellent source of emulsifiers as well as superior encapsulating matrices for the entrapment of bioactive compounds. Additionally, it will also discuss the latest approaches employed to perform the Maillard reaction as well as several important reaction parameters that need to be taken into consideration when conducting the Maillard reaction. © 2016 Society of Chemical Industry.
  2. Adiiba SH, Chan ES, Lee YY, Amelia, Chang MY, Song CP
    J Sci Food Agric, 2022 Dec;102(15):6921-6929.
    PMID: 35662022 DOI: 10.1002/jsfa.12053
    BACKGROUND: Crude palm oil (CPO) is rich with phytonutrients such as carotenoids and tocols which possesses many health benefits. The aim of this research was to develop a methanol-free process to produce palm phytonutrients via enzymatic hydrolysis. In this work, triacylglycerol was hydrolyzed into free fatty acids (FFAs) using three different types of liquid lipases derived from Aspergillus oryzae (ET 2.0), Aspergillus niger (Habio) and Candida antartica (CALB).

    RESULTS: ET 2.0 was found to be the best enzyme for hydrolysis. Under the optimum condition, the FFA content achievable was 790 g kg-1 after 24 h of reaction with 1:1 water-to-oil mass ratio at 50 °C and stirring speed of 9 × g. Furthermore, with the addition of 2 g kg-1 ascorbic acid, it was found that 98% of carotenoids and 96% of tocols could be retained after hydrolysis.

    CONCLUSION: This work shows that enzymatic hydrolysis, which is inherently safer, cleaner and sustainable is feasible to replace the conventional methanolysis for the production of palm phytonutrients. © 2022 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

  3. Soo YT, Ng SW, Tang TK, Ab Karim NA, Phuah ET, Lee YY
    J Sci Food Agric, 2021 Aug 15;101(10):4161-4172.
    PMID: 33428211 DOI: 10.1002/jsfa.11054
    BACKGROUND: Palm pressed fibre (PPF) is a cellulose-rich biomass residue produced during palm oil extraction. Its high cellulose content allows the isolation of cellulose nanocrystal (CNC). CNC has attracted scientific interest due to its biodegradability, biocompatibility and low cost. The present study isolated CNC from PPF using a cation exchange resin, which is an environmentally friendly and less harsh hydrolysis method than conventional mineral acid hydrolysis. Isolated CNC was used to stabilise an oil-in-water emulsion and the emulsion stability was evaluated in terms of droplet size, morphology and physical stability.

    RESULTS: PPF was subjected to alkali and bleach treatment prior to hydrolysis, which successfully removed 54% and 75% of non-cellulosic components (hemicellulose and lignin, respectively). Hydrolysis conditions of 5 h, 15:1 (w/w) resin-to-pulp ratio and 50 °C produced CNC particles of 50-100 nm in length. CNC had a crystallinity index of 42% and appeared rod-like morphologically. CNC-stabilised emulsion had better stability when used in combination with soy lecithin (SL), a well-established, commonly used food stabiliser. Emulsion stabilised by the binary mixture of CNC and SL had droplet size, morphology and physical stability comparable to those of emulsion stabilised using SL.

    CONCLUSIONS: CNC was successfully isolated from PPF through a cation exchange resin. This offers an alternative usage for the underutilised PPF to be converted into value-added products. Isolated CNC was also found to have promising potential in the stabilisation of Pickering emulsions. These results provide useful information indicating CNC as a natural and sustainable stabiliser for food, cosmeceutical and pharmaceutical applications. © 2021 Society of Chemical Industry.

  4. Ooi EZH, Ab Karim NA, Chan ES, Wang Y, Tang TK, Tong SC, et al.
    J Sci Food Agric, 2024 May;104(7):3958-3970.
    PMID: 38284502 DOI: 10.1002/jsfa.13278
    BACKGROUND: As a by-product of the palm oil industry, palm stearin is often overlooked despite having several beneficial properties, such as excellent stability, which is critically essential to meet the demand of the global food trend in producing safer processed food. Specifically, deep frying of food is often associated with the production of toxic compounds that could potentially migrate into the food system when oils are degraded under continuous heating. The incorporation of palm stearin is regarded as a cost-effective and efficient method to modify the fatty acid composition of oils, enhance the frying qualities and lower the degradation rate.

    RESULTS: This study blended 5% and 10% palm stearin into palm oil to investigate the deep-frying performance and impact on food quality. Increasing the palm stearin content improved the frying oil's oxidative and hydrolytic stability, evidenced by reduction of total polar material, free fatty acid and total oxidation value. Addition of palm stearin increased the slip melting point which improved the oil's oxidative stability but no significant increase in oil content of instant noodles was observed. Scanning electron microscopy and fluorescence microscopy showed the formation of larger pores in the noodle structure that facilitated oil retention.

    CONCLUSION: Blending palm stearin into frying oil enhanced the frying stability and minimally affected the oil uptake in instant noodles. This article presents the viability of blending palm stearin into frying oils to develop longer-lasting frying oils. © 2024 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

  5. Aziz ZA, Lee YY, Ngah BA, Sidek NN, Looi I, Hanip MR, et al.
    J Stroke Cerebrovasc Dis, 2015 Dec;24(12):2701-9.
    PMID: 26338106 DOI: 10.1016/j.jstrokecerebrovasdis.2015.07.025
    Stroke remains a major health burden worldwide. The incidence and prevalence rates of stroke are decreasing in developed countries, an opposite trend is taking place in the Asia Pacific, where an increasing number of patients are being diagnosed with acute stroke. The results of the present study on acute stroke in multi-ethnic Malaysia will significantly contribute to the global stroke epidemiological data. We aimed to present epidemiological data of stroke including incidence and prevalence rates as well as associated risk factors from a prospective nationwide hospital-based registry from 2010 to 2014.
  6. Zahari Z, Lee CS, Ibrahim MA, Musa N, Mohd Yasin MA, Lee YY, et al.
    J Pharm Pharm Sci, 2016;19(1):127-36.
    PMID: 27096697 DOI: 10.18433/J3NS49
    PURPOSE: This study compared pain sensitivity among opioid dependent patients on methadone maintenance therapy (MMT) and opioid naive subjects.

    METHODS: The three hundred participants comprised 152 opioid naive subjects and 148 opioid dependent patients. Opioid naive subjects had not taken any opioids including morphine and methadone to their best knowledge and were presumed so after two consecutive negative urine screenings for drugs. All opioid dependent patients were stabilized in treatment, defined as having been enrolled in the program for more than one month with no change of methadone dosage over the past one month. Excluded from the study were individuals with chronic or ongoing acute pain and individuals with a history of analgesics ingestion within 3 d before the cold pressor test (CPT). Pain tolerance to CPT was evaluated at 0 h, and at 2, 4, 8, 12, and 24 h post-methadone dose.

    RESULTS: Patients exhibited a significantly shorter mean pain tolerance time of 34.17 s (95% CI 24.86, 43.49) versus 61.36 (52.23, 70.48) [p < 0.001] compared with opioid naive subjects. Time-dependent mean pain tolerance was also significantly different when naive subjects were compared to patients (p = 0.016).

    CONCLUSIONS: This study revealed hyperalgesia amongst patients on MMT, as manifested by their quicker hand withdrawal. The complaints of pain in this population should not be underestimated and the pain should be evaluated seriously and managed aggressively.

  7. Hamid N, Muhamad R, Kueh YC, Zahari Z, Mohamad Nor N, Abdullah N, et al.
    J Pharm Bioallied Sci, 2020 10 08;12(4):444-448.
    PMID: 33679091 DOI: 10.4103/jpbs.JPBS_265_19
    Background: In Malaysia, the problem of marital distress is fast becoming an important public health concern. A major shortcoming is inadequate marital evaluation. There are, however, very few localized instruments for married women in Malaysia. The objective of this study was to translate the original version of the Revised Dyadic Adjustment Scale (RDAS) and to evaluate for its psychometric properties. Multiple aspects of validity and reliability were also assessed.

    Materials and Methods: The questionnaire was first translated into the Malay language (RDAS-M). In this cross-sectional study, healthy married Malay women in Kota Bharu, Kelantan, were recruited from January to April 2018. Participants were asked to complete the RDAS-M that consists of three domains, that is, dyadic consensus, dyadic satisfaction, and dyadic cohesion with a total of 14 items. The concept, content, and construct validity using exploratory factor analysis (EFA) and reliability of the RDAS-M were assessed.

    Results: Of the 164 recruited participants, 150 consented to participate. The mean age of the participants was 34.1 years (standard deviation [SD], 9.5 years), ranging from 20 to 57 years. All 14 items were considered comprehensible by more than 95% of the subjects. Based on EFA, total variance extracted was 69.08%, and the original three factors were retained. The Malay version of the RDAS was valid based on factor loadings for dyadic consensus, dyadic satisfaction, and dyadic cohesion, which ranged from 0.64 to 0.80, 0.79 to 0.98, and 0.37 to 0.78, respectively. The internal consistency was good with coefficient α of 0.87 for dyadic consensus, 0.93 for dyadic satisfaction, and 0.78 for dyadic cohesion.

    Conclusions: The Malay version of the RDAS is easy to understand, and is a reliable and valid instrument for married women. It is also comparable with the original version of the RDAS in terms of structure and psychometric properties.

  8. Zahari Z, Lee CS, Ibrahim MA, Musa N, Mohd Yasin MA, Lee YY, et al.
    J Pharm Bioallied Sci, 2020 Nov;12(Suppl 2):S787-S803.
    PMID: 33828379 DOI: 10.4103/jpbs.JPBS_248_19
    Introduction: Dopamine receptor D2 (DRD2) is one of the dopamine receptors that have been studied in relation to opioid dependence. It is possible, therefore, that DRD2 gene (DRD2) polymorphisms influence treatment outcomes of patients with opioid dependence. The objective of this study was to investigate the influence of DRD2 polymorphisms on the clinical outcomes of opioid-dependent patients on methadone maintenance therapy (MMT).

    Materials and Methods: Patients with opioid dependence (n = 148) were recruited from MMT clinics. Pain sensitivity, severity of the opiate withdrawal syndrome, and sleep quality were assessed using cold pressor test (CPT), Subjective Opiate Withdrawal Scale (SOWS-M), and Pittsburgh Sleep Quality Index (PSQI)-Malay, respectively. Deoxyribonucleic acid (DNA) was extracted from whole blood, and then was used for genotyping of Val96Ala, Leu141Leu, Val154Ile, Pro310Ser, Ser311Cys, TaqI A, -141C Ins/Del, and A-241G polymorphisms.

    Results: Among 148 patients, 8.1% (n = 12), 60.8% (n = 90), 27.7% (n = 41), and 29.1% (n = 43) had at least one risk allele for Ser311Cys, TaqI A, -141C Ins/Del, and A-241G polymorphisms, respectively. There were no significant differences in pain responses (pain threshold, tolerance, and intensity), SOWS, and PSQI scores between DRD2 polymorphisms.

    Conclusion: The common DRD2 polymorphisms are not associated with pain sensitivity, severity of the opiate withdrawal syndrome, and sleep quality in patients with opioid dependence on MMT. However, this may be unique for Malays. Additional research should focus on investigating these findings in larger samples and different ethnicity.

  9. Lee YY, Hassan SA, Ismail IH, Chong SY, Raja Ali RA, Amin Nordin S, et al.
    J Paediatr Child Health, 2017 Dec;53(12):1152-1158.
    PMID: 29205651 DOI: 10.1111/jpc.13640
    The role of gut microbiota in early life and its impact on gut health and subsequent diseases remain unclear. There is a lack of research and awareness in this area, especially in the Asia-Pacific region, including Malaysia. This paper reports the position of a Malaysian Working Group on some key issues surrounding gut microbiota in early life and its role in gut health and diseases, as well as experts' stand on probiotics and prebiotics. The group reached a consensus that certain factors, including elective caesarean; premature deliveries; complementary feeding; use of antibiotics, prebiotics and/or probiotics; and exposure to the external environmental, have an impact on gut microbiota in early life. However, as evidence is lacking, especially from the Asia-Pacific region, further studies are needed to understand how gut microbiota in early life affects subsequent diseases, including allergy, inflammatory bowel disease, obesity and infantile colic. Lastly, although beneficial in acute diarrhoeal disease and probably allergic eczema, probiotics (and/or prebiotics) should be used cautiously in other gut dysbiotic conditions until more data are available.
  10. Muhammad HFL, Sulistyoningrum DC, Huriyati E, Lee YY, Manan Wan Muda WA
    J Nutr Metab, 2019;2019:9606054.
    PMID: 30719347 DOI: 10.1155/2019/9606054
    Background: Coffee is suggested as an alternative option for weight loss but the relationship between coffee consumption and adiposity in population-based studies is still controversial. Therefore, this study was aimed at evaluating the relationship between coffee intake and adiposity in adults and to test whether uncoupling protein 2 (UCP2) gene variation was able to affect this relationship.

    Methods: This was a cross-sectional study conducted in male and female adults living in the urban area of Yogyakarta, Indonesia. Adiposity was determined based on body weight, body mass index (BMI), percent body fat, and waist and hip circumference. Data on coffee consumption and other dietary components were collected using a semiquantitative food frequency questionnaire along with other caffeine-containing beverages such as tea, chocolate, and other beverages. The -866 G/A UCP2 gene variation was analyzed using polymerase chain reaction-restriction fragment length polymorphism. The correlation between coffee intake and adiposity was tested using linear regression test with adjustment for sex, age, energy intake, table sugar intake, and total caffeine intake.

    Results: In all subjects, coffee intake was inversely correlated with body weight (β = -0.122, p=0.028), BMI (β = -0.157, p=0.005), and body fat (β = -0.135, p=0.009). In subjects with AA + GA genotypes, coffee intake was inversely correlated with body weight (β = -0.155, p=0.027), BMI (β = -0.179, p=0.010), and body fat (β = -0.148, p=0.021). By contrast, in subjects with GG genotype, coffee intake was not correlated with body weight (β = -0.017, p=0.822), BMI (β = -0.068, p=0.377), and body fat (β = -0.047, p=0.504).

    Conclusion: We showed that coffee intake was negatively correlated with adiposity, and this was independent of total caffeine intake. Additionally, we showed that the -866 G/A UCP2 gene variation influences the relationship between coffee intake and adiposity.

  11. Lawenko RM, Lee YY
    J Neurogastroenterol Motil, 2016 Jan 31;22(1):25-30.
    PMID: 26717929 DOI: 10.5056/jnm15151
    Gastroesophageal reflux disease (GERD) is a disease predominantly seen in the West but there is a rising trend in Asia. Ambulatory 24-hour catheter-based pH monitoring has been the de facto gold standard test for GERD that correlates symptoms with acid reflux episodes. However, drawbacks such as patients' discomfort, and catheter displacement render the test as cumbersome and error-prone. The Bravo pH wireless system is designed to be user-friendly and has an added advantage of prolonged pH monitoring. The system is comparable to the catheter-based pH monitoring system in terms of diagnostic yield and symptom-reflux association. Indications include evaluation of patients with refractory GERD symptoms and prior to anti-reflux surgery. Bravo utilizes a wireless pH-sensing capsule with a complete prepackaged system, and a data processing software. The capsule may be positioned indirectly using endoscopic or manometric landmarks or under direct endoscopic guidance. Optimal threshold cut-off values are yet to be standardized but based on available studies, for the Asian population, it may be recommended for total % time pH < 4 of 5.8 over 48 hours. Cost is a limitation but capsule placement is relatively safe although technical failures may be seen in small percentage of cases.
  12. Lee YY, Erdogan A, Rao SS
    J Neurogastroenterol Motil, 2014 Oct 30;20(4):547-52.
    PMID: 25230902 DOI: 10.5056/jnm14056
    Management of chronic constipation with refractory symptoms can be challenging. Although new drugs and behavioral treat-ments have improved outcome, when they fail, there is little guidance on what to do next. At this juncture, typically most doc-tors may refer for surgical intervention although total colectomy is associated with morbidity including complications such as recurrent bacterial overgrowth. Recently, colonic manometry with sensory/tone/compliance assessment with a barostat study has been shown to be useful. Technical challenges aside, adequate preparation, and appropriate equipment and knowledge of co-lonic physiology are keys for a successful procedure. The test itself appears to be safe with little complications. Currently, colon-ic manometry is usually performed with a 6-8 solid state or water-perfused sensor probe, although high-resolution fiber-optic colonic manometry with better spatiotemporal resolutions may become available in the near future. For a test that has evolved over 3 decades, normal physiology and abnormal findings for common phenotypes of chronic constipation, especially slow transit constipation, have been well characterized only recently largely through the advent of prolonged 24-hour ambulatory colonic manometry studies. Even though the test has been largely restricted to specialized laboratories at the moment, emerg-ing new technologies and indications may facilitate its wider use in the near future.(J Neurogastroenterol Motil 2014;20:547-552).
  13. Lee YY, Erdogan A, Rao SS
    J Neurogastroenterol Motil, 2014 Apr 30;20(2):265-70.
    PMID: 24840380 DOI: 10.5056/jnm.2014.20.2.265
    Assessment of transit through the gastrointestinal tract provides useful information regarding gut physiology and patho-physiology. Although several methods are available, each has distinct advantages and limitations. Recently, an ingestible wire-less motility capsule (WMC), similar to capsule video endoscopy, has become available that offers a less-invasive, standardized, radiation-free and office-based test. The capsule has 3 sensors for measurement of pH, pressure and temperature, and collec-tively the information provided by these sensors is used to measure gastric emptying time, small bowel transit time, colonic transit time and whole gut transit time. Current approved indications for the test include the evaluation of gastric emptying in gastroparesis, colonic transit in constipation and evaluation of generalised dysmotility. Rare capsule retention and malfunc-tion are known limitations and some patients may experience difficulty with swallowing the capsule. The use of WMC has been validated for the assessment of gastrointestinal transit. The normal range for transit time includes the following: gastric empty-ing (2-5 hours), small bowel transit (2-6 hours), colonic transit (10-59 hours) and whole gut transit (10-73 hours). Besides avoiding the use of multiple endoscopic, radiologic and functional gastrointestinal tests, WMC can provide new diagnoses, leads to a change in management decision and help to direct further focused work-ups in patients with suspected disordered motility. In conclusion, WMC represents a significant advance in the assessment of segmental and whole gut transit and mo-tility, and could prove to be an indispensable diagnostic tool for gastrointestinal physicians worldwide.
  14. Lee YY, Erdogan A, Yu S, Dewitt A, Rao SSC
    J Neurogastroenterol Motil, 2018 Jul 30;24(3):460-468.
    PMID: 29879762 DOI: 10.5056/jnm17081
    Background/Aims: Whether high-resolution anorectal pressure topography (HRPT), having better fidelity and spatio-temporal resolution is comparable to waveform manometry (WM) in the diagnosis and characterization of defecatory disorders (DD) is not known.

    Methods: Patients with chronic constipation (Rome III) were evaluated for DD with HRPT and WM during bearing-down "on-bed" without inflated rectal balloon and "on-commode (toilet)" with 60-mL inflated rectal balloon. Eleven healthy volunteers were also evaluated.

    Results: Ninety-three of 117 screened participants (F/M = 77/16) were included. Balloon expulsion time was abnormal (> 60 seconds) in 56% (mean 214.4 seconds). A modest correlation between HRPT and WM was observed for sphincter length (R = 0.4) and likewise agreement between dyssynergic subtypes (κ = 0.4). During bearing down, 2 or more anal pressure-segments (distal and proximal) could be appreciated and their expansion measured with HRPT but not WM. In constipated vs healthy participants, the proximal segment was more expanded (2.0 cm vs 1.0 cm, P = 0.003) and of greater pressure (94.8 mmHg vs 54.0 mmHg, P = 0.010) during bearing down on-commode but not on-bed.

    Conclusions: Because of its better resolution, HRPT may identify more structural and functional abnormalities including puborectal dysfunction (proximal expansion) than WM. Bearing down on-commode with an inflated rectal balloon may provide additional dimension in characterizing DD.

  15. Siah KTH, Rahman MM, Ong AML, Soh AYS, Lee YY, Xiao Y, et al.
    J Neurogastroenterol Motil, 2020 07 30;26(3):299-310.
    PMID: 32606253 DOI: 10.5056/jnm20107
    During the Coronavirus Disease 2019 (COVID-19) pandemic, practices of gastrointestinal procedures within the digestive tract require special precautions due to the risk of contraction of severe acute respiratoy syndrome coronavirus-2 (SARS-CoV-2) infection. Many procedures in the gastrointestinal motility laboratory may be considered moderate to high-risk for viral transmission. Healthcare staff working in gastrointestinal motility laboratories are frequently exposed to splashes, air droplets, mucus, or saliva during the procedures. Moreover, some are aerosol-generating and thus have a high risk of viral transmission. There are multiple guidelines on the practices of gastrointestinal endoscopy during this pandemic. However, such guidelines are still lacking and urgently needed for the practice of gastrointestinal motility laboratories. Hence, the Asian Neurogastroenterology and Motility Association had organized a group of gastrointestinal motility experts and infectious disease specialists to produce a position statement paper based-on current available evidence and consensus opinion with aims to provide a clear guidance on the practices of gastrointestinal motility laboratories during the COVID-19 pandemic. This guideline covers a wide range of topics on gastrointestinal motility activities from scheduling a motility test, the precautions at different steps of the procedure to disinfection for the safety and well-being of the patients and the healthcare workers. These practices may vary in different countries depending on the stages of the pandemic, local or institutional policy, and the availability of healthcare resources. This guideline is useful when the transmission rate of SARS-CoV-2 is high. It may change rapidly depending on the situation of the epidemic and when new evidence becomes available.
  16. Lee YY, Chua AS
    J Neurogastroenterol Motil, 2013 Jul;19(3):295-300.
    PMID: 23875095 DOI: 10.5056/jnm.2013.19.3.295
    Despite being a large ethnic group within the South-East Asia, there is a paucity of reported literatures on dyspepsia in the Malay population. Recent population-based studies indicate that uninvestigated dyspepsia, based on the Rome II criteria, is reported in 12.8% and 11.6% of Malays in the urban and rural communities respectively. Organic causes of dyspepsia including upper gastrointestinal tract cancers, its precancerous lesions, and erosive diseases are uncommon which is largely due to an exceptionally low prevalence of Helicobacter pylori infection in this population. On the other hand, functional dyspepsia and irritable bowel syndrome are relatively common in the Malays than expected. Within a primary care setting, functional dyspepsia, based on the Rome III criteria, is reported in 11.9% of Malays, of which epigastric pain syndrome is found to be more common. Married Malay females are more likely to have functional dyspepsia and psychosocial alarm symptoms. Also based on the Rome III criteria, irritable bowel syndrome, commonly overlapped with functional dyspepsia, is reported in 10.9% of Malays within a community-based setting. Rather than psychosocial symptoms, red flags are most likely to be reported among the Malays with irritable bowel syndrome despite having a low yield for organic diseases. Based upon the above observations, "proton pump inhibitor test" is probably preferable than the "test and treat H. pylori" strategy in the initial management of dyspepsia among the Malays.
  17. Lee YY, Chua AS
    J Neurogastroenterol Motil, 2012 Jul;18(3):239-45.
    PMID: 22837871 DOI: 10.5056/jnm.2012.18.3.239
    The diagnosis of functional dyspepsia (FD) is challenging since it depends largely on symptoms which are often heterogeneous and overlapping. This is particularly so in Asia with many different cultures and languages. Symptom-based diagnosis of FD based on Rome III criteria has not been fully validated and it may not be suitable in some Asian populations. Clinicians often assume that investigations in FD are not rewarding and physiological tests are often not available unless in the research setting. Investigation of alarm features and role of Helicobacter pylori in FD remain controversial but experts agreed that both should be tested. Physiological tests including gastric accommodation and chemical hypersensitivity tests are underutilized in Asia and available studies were few. While experts do not recommend routine clinical use of gastric accommodation tests but they agree that these tests can be advocated if clinically indicated. Empiric therapeutic trial is not currently a diagnostic option. The pathogenesis of FD is still poorly understood and there is a substantial placebo response. As a conclusion, a diagnosis of FD is challenging especially so in the context of Asia and despite the limitations of available physiological tests experts agreed that these tests can be advocated if and when clinically indicated.
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