Displaying publications 21 - 40 of 205 in total

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  1. Effect of diacylglycerol interfacial crystallization on the physical stability of water-in-oil emulsions
    Yang J, Qiu C, Li G, Lee WJ, Tan CP, Lai OM, et al.
    Food Chem, 2020 Oct 15;327:127014.
    PMID: 32434126 DOI: 10.1016/j.foodchem.2020.127014
    The influence of diacylglycerol (DAG) combined with polyglycerol polyricinoleate (PGPR) on the stability of water-in-oil (W/O) emulsions containing hydrogenated palm oil (HPO) was studied. Polarized light microscope revealed that DAG promoted HPO to crystallize at the water-oil interface, providing the combination of Pickering and network stabilization effects. It was proposed that the molecular compatibility of fatty acids in DAG with HPO accounted for the promotional effect. The interfacial crystallization of DAG together with the surface activity of PGPR led to the formation of emulsions with uniform small droplets and high freeze-thaw stability. Further exploration of physical properties indicated that the combination of DAG and PGPR dramatically improved the emulsion's viscoelasticity and obtained a larger deformation yield. Water droplets in DAG-based emulsions acted as active fillers to improve the network rigidity. Therefore, DAG is a promising material to be used as emulsifier to enhance the physical stability of W/O emulsions.
  2. Highly Efficient Deacidification of High-Acid Rice Bran Oil Using Methanol as a Novel Acyl Acceptor
    Li D, Faiza M, Ali S, Wang W, Tan CP, Yang B, et al.
    Appl Biochem Biotechnol, 2018 Apr;184(4):1061-1072.
    PMID: 28948493 DOI: 10.1007/s12010-017-2594-1
    A highly efficient process for reducing the fatty acid (FA) content of high-acid rice bran oil (RBO) was developed by immobilized partial glycerides-selective lipase SMG1-F278N-catalyzed esterification/transesterification using methanol as a novel acyl acceptor. Molecular docking simulation indicated that methanol was much closer to the catalytic serine (Ser-171) compared with ethanol and glycerol, which might be one of the reasons for its high efficiency in the deacidification of high-acid RBO. Additionally, the reaction parameters were optimized to minimize the FA content of high-acid RBO. Under the optimal conditions (substrate molar ratio of methanol to FAs of 1.8:1, enzyme loading of 40 U/g, and at 30 °C), FA content decreased from 25.14 to 0.03% after 6 h of reaction. Immobilized SMG1-F278N exhibited excellent methanol tolerance and retained almost 100% of its initial activity after being used for ten batches. After purification by molecular distillation, the final product contained 97.86% triacylglycerol, 2.10% diacylglycerol, and 0.04% FA. The acid value of the final product was 0.09 mg KOH/g, which reached the grade one standard of edible oil. Overall, methanol was a superior acyl acceptor for the deacidification of high-acid RBO and the high reusability of immobilized SMG1-F278N indicates an economically attractive process.
  3. Fulltext The Formation of 3-Monochloropropanediol Esters and Glycidyl Esters during Heat-Induced Processing Using an Olive-Based Edible Oil
    Ji Y, Lan D, Wang W, Goh KM, Tan CP, Wang Y
    Foods, 2022 Dec 16;11(24).
    PMID: 36553815 DOI: 10.3390/foods11244073
    With the prevalence of edible diacylglycerol (DAG) oil, which is beneficial to human, the generation of 3-monochloropropanediol esters (3-MCPDE) and glycidyl esters (GE) as well as the stability of physical properties during heat-induced processing still need to be explored. In this study, the experiment used olive-based edible oil with different contents of DAG (40, 60, and 80%) to make crackers and fry chicken. They were heated at 160 and 180 °C to determine the changes in 3-MCPDE and GE, the crackers’ hardness and gumminess, and the physical properties of the oil. During baking and frying, 3-MCPDE decreased, while the content of GE slightly increased with the prolonged heating duration. Finally, 3-MCPDE and GE were lower than 1.25 mg/kg and 1.00 mg/kg, respectively. The AV increased proportionally as duration increased and POV was below 0.30 g/100 g. In general, the changes in 3-MCPDE and GE were related to the heating temperature and duration, and not significantly (p > 0.05) related to the content of DAG.
  4. Fabrication of oil-in-water emulsions as shelf-stable liquid non-dairy creamers: effects of homogenization pressure, oil type, and emulsifier concentration
    Soo YN, Tan CP, Tan PY, Khalid N, Tan TB
    J Sci Food Agric, 2021 Apr;101(6):2455-2462.
    PMID: 33034060 DOI: 10.1002/jsfa.10871
    BACKGROUND: The popularity of coffee, the second most consumed beverage in the world, contributes to the high demand for liquid non-dairy creamer (LNDC). In this study, palm olein emulsions (as LNDCs) were investigated as alternatives to the more common soybean oil-based LNDCs. LNDCs were prepared via different homogenization pressures (100-300 bar) using different types of oil (palm olein and soybean oil) and concentrations of DATEM emulsifier (5-20 g kg-1 ).

    RESULTS: Increases in homogenization pressure and emulsifier concentration were observed to have significant (P  0.05) differences between the prepared and commercial LNDCs in terms of their color, appearance, and overall acceptability.

    CONCLUSION: Shelf-stable LNDCs with qualities comparable to commercial LNDC were successfully fabricated. Valuable insights into the effects of homogenization pressure, oil type, and emulsifier concentration, as well as functionality and consumer acceptance of the LNDCs when added into black coffee, were obtained. © 2020 Society of Chemical Industry.

  5. Fulltext The In Vitro α-Glucosidase Inhibition Activity of Various Solvent Fractions of Tamarix dioica and 1H-NMR Based Metabolite Identification and Molecular Docking Analysis
    Niaz A, Adnan A, Bashir R, Mumtaz MW, Raza SA, Rashid U, et al.
    Plants (Basel), 2021 Jun 02;10(6).
    PMID: 34199333 DOI: 10.3390/plants10061128
    The Tamarix dioica (T. dioica) is widely used medicinal plant to cure many chronic ailments. T. dioica is being used to manage diabetes mellitus in traditional medicinal system; however, very little scientific evidence is available on this plant in this context. The current study involves the fractionation of crude methanolic extract of T. dioica using n-hexane, ethyl acetate, chloroform, and n-butanol. The screening for antioxidant activity using 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay was carried out. The in vitro antidiabetic potential was assessed by measuring α-glucosidase inhibition. Total phenolic and flavonoid contents were also determined for each fraction. The metabolites were identified using highly sensitive and emerging 1H-NMR technique. The results revealed the ethyl acetate fraction as the most potent with DPPH scavenging activity of 84.44 ± 0.21% and α-glucosidase inhibition with IC50 value of 122.81 ± 2.05 µg/mL. The total phenolic and flavonoid content values of 205.45 ± 1.36 mg gallic acid equivalent per gram dried extract and 156.85 ± 1.33 mg quercetin equivalent per gram dried extract were obtained for ethyl acetate fraction. The bucketing of 1H-NMR spectra identified 22 metabolites including some pharmacologically important like tamarixetin, tamaridone, quercetin, rutin, apigenin, catechin, kaempferol, myricetin and isorhamnetin. Leucine, lysine, glutamic acid, aspartic acid, serine, and tyrosine were the major amino acids identified in ethyl acetate fraction. The molecular docking analysis provided significant information on the binding affinity among secondary metabolites and α-glucosidase. These metabolites were most probably responsible for the antioxidant activity and α-glucosidase inhibitory potential of ethyl acetate fraction. The study ascertained the ethnomedicinal use of T. dioica to manage diabetes mellitus and may be a helpful lead towards naturopathic mode for anti-hyperglycemia.
  6. A simple instrument for the assessment of student performance in problem-based learning tutorials
    Sim SM, Azila NM, Lian LH, Tan CP, Tan NH
    Ann Acad Med Singap, 2006 Sep;35(9):634-41.
    PMID: 17051280
    INTRODUCTION: A process-oriented instrument was developed for the summative assessment of student performance during problem-based learning (PBL) tutorials. This study evaluated (1) the acceptability of the instrument by tutors and (2) the consistency of assessment scores by different raters.

    MATERIALS AND METHODS: A survey of the tutors who had used the instrument was conducted to determine whether the assessment instrument or form was user-friendly. The 4 competencies assessed, using a 5-point rating scale, were (1) participation and communication skills, (2) cooperation or team-building skills, (3) comprehension or reasoning skills and (4) knowledge or information-gathering skills. Tutors were given a set of criteria guidelines for scoring the students' performance in these 4 competencies. Tutors were not attached to a particular PBL group, but took turns to facilitate different groups on different case or problem discussions. Assessment scores for one cohort of undergraduate medical students in their respective PBL groups in Year I (2003/2004) and Year II (2004/2005) were analysed. The consistency of scores was analysed using intraclass correlation.

    RESULTS: The majority of the tutors surveyed expressed no difficulty in using the instrument and agreed that it helped them assess the students fairly. Analysis of the scores obtained for the above cohort indicated that the different raters were relatively consistent in their assessment of student performance, despite a small number consistently showing either "strict" or "indiscriminate" rating practice.

    CONCLUSION: The instrument designed for the assessment of student performance in the PBL tutorial classroom setting is user-friendly and is reliable when used judiciously with the criteria guidelines provided.

  7. Medium chain triglyceride and medium-and long chain triglyceride: metabolism, production, health impacts and its applications - a review
    Lee YY, Tang TK, Chan ES, Phuah ET, Lai OM, Tan CP, et al.
    Crit Rev Food Sci Nutr, 2021 Jan 22.
    PMID: 33480262 DOI: 10.1080/10408398.2021.1873729
    Structured lipid is a type of modified form of lipid that is "fabricated" with the purpose to improve the nutritional and functional properties of conventional fats and oils derived from animal and plant sources. Such healthier choice of lipid received escalating attention from the public for its capability to manage the rising prevalence of metabolic syndrome. Of which, medium-chain triacylglycerol (MCT) and medium-and long-chain triacylglycerol (MLCT) are the few examples of the "new generation" custom-made healthful lipids which are mainly composed of medium chain fatty acid (MCFA). MCT is made up exclusively of MCFA whereas MLCT contains a mixture of MCFA and long chain fatty acid (LCFA), respectively. Attributed by the unique metabolism of MCFA which is rapidly metabolized by the body, MCFA and MCT showed to acquire multiple physiological and functional properties in managing and reversing certain health disorders. Several chemically or enzymatically oils and fats modification processes catalyzed by a biological or chemical catalyst such as acidolysis, interesterification and esterification are adopted to synthesis MCT and MLCT. With their purported health benefits, MCT and MLCT are widely being used as nutraceutical in food and pharmaceutical sectors. This article aims to provide a comprehensive review on MCT and MLCT, with an emphasis on the basic understanding of its structures, properties, unique metabolism; the current status of the touted health benefits; latest routes of production; its up-to-date applications in the different food systems; relevant patents filed and its drawbacks.
  8. Fulltext Effects of homogenization process parameters on physicochemical properties of astaxanthin nanodispersions prepared using a solvent-diffusion technique
    Anarjan N, Jafarizadeh-Malmiri H, Nehdi IA, Sbihi HM, Al-Resayes SI, Tan CP
    Int J Nanomedicine, 2015;10:1109-18.
    PMID: 25709435 DOI: 10.2147/IJN.S72835
    Nanodispersion systems allow incorporation of lipophilic bioactives, such as astaxanthin (a fat soluble carotenoid) into aqueous systems, which can improve their solubility, bioavailability, and stability, and widen their uses in water-based pharmaceutical and food products. In this study, response surface methodology was used to investigate the influences of homogenization time (0.5-20 minutes) and speed (1,000-9,000 rpm) in the formation of astaxanthin nanodispersions via the solvent-diffusion process. The product was characterized for particle size and astaxanthin concentration using laser diffraction particle size analysis and high performance liquid chromatography, respectively. Relatively high determination coefficients (ranging from 0.896 to 0.969) were obtained for all suggested polynomial regression models. The overall optimal homogenization conditions were determined by multiple response optimization analysis to be 6,000 rpm for 7 minutes. In vitro cellular uptake of astaxanthin from the suggested individual and multiple optimized astaxanthin nanodispersions was also evaluated. The cellular uptake of astaxanthin was found to be considerably increased (by more than five times) as it became incorporated into optimum nanodispersion systems. The lack of a significant difference between predicted and experimental values confirms the suitability of the regression equations connecting the response variables studied to the independent parameters.
  9. Fulltext A comparative study of the physicochemical properties of a virgin coconut oil emulsion and commercial food supplement emulsions
    Khor YP, Koh SP, Long K, Long S, Ahmad SZ, Tan CP
    Molecules, 2014 Jul 01;19(7):9187-202.
    PMID: 24988188 DOI: 10.3390/molecules19079187
    Food manufacturers are interested in developing emulsion-based products into nutritional foods by using beneficial oils, such as fish oil and virgin coconut oil (VCO). In this study, the physicochemical properties of a VCO oil-in-water emulsion was investigated and compared to other commercial oil-in-water emulsion products (C1, C2, C3, and C4). C3 exhibited the smallest droplet size of 3.25 µm. The pH for the emulsion samples ranged from 2.52 to 4.38 and thus were categorised as acidic. In a texture analysis, C2 was described as the most firm, very adhesive and cohesive, as well as having high compressibility properties. From a rheological viewpoint, all the emulsion samples exhibited non-Newtonian behaviour, which manifested as a shear-thinning property. The G'G'' crossover illustrated by the VCO emulsion in the amplitude sweep graph but not the other commercial samples illustrated that the VCO emulsion had a better mouthfeel. In this context, the VCO emulsion yielded the highest zeta potential (64.86 mV), which was attributed to its strong repulsive forces, leading to a good dispersion system. C2 comprised the highest percentage of fat among all emulsion samples, followed by the VCO emulsion, with 18.44% and 6.59%, respectively.
  10. Fulltext Preparation of astaxanthin nanodispersions using gelatin-based stabilizer systems
    Anarjan N, Nehdi IA, Sbihi HM, Al-Resayes SI, Malmiri HJ, Tan CP
    Molecules, 2014 Sep 10;19(9):14257-65.
    PMID: 25211006 DOI: 10.3390/molecules190914257
    The incorporation of lipophilic nutrients, such as astaxanthin (a fat soluble carotenoid) in nanodispersion systems can either increase the water solubility, stability and bioavailability or widen their applications in aqueous food and pharmaceutical formulations. In this research, gelatin and its combinations with sucrose oleate as a small molecular emulsifier, sodium caseinate (SC) as a protein and gum Arabic as a polysaccharide were used as stabilizer systems in the formation of astaxanthin nanodispersions via an emulsification-evaporation process. The results indicated that the addition of SC to gelatin in the stabilizer system could increase the chemical stability of astaxanthin nanodispersions significantly, while using a mixture of gelatin and sucrose oleate as a stabilizer led to production of nanodispersions with the smallest particle size (121.4±8.6 nm). It was also shown that a combination of gelatin and gum Arabic could produce optimal astaxanthin nanodispersions in terms of physical stability (minimum polydispersity index (PDI) and maximum zeta-potential). This study demonstrated that the mixture of surface active compounds showed higher emulsifying and stabilizing functionality compared to using them individually in the preparation of astaxanthin nanodispersions.
  11. Fulltext Effects of propylene glycol alginate and sucrose esters on the physicochemical properties of modified starch-stabilized beverage emulsions
    Cheong KW, Mirhosseini H, Hamid NS, Osman A, Basri M, Tan CP
    Molecules, 2014 Jun 24;19(6):8691-706.
    PMID: 24962400 DOI: 10.3390/molecules19068691
    This study was conducted to investigate the effect of main emulsion components namely, modified starch, propylene glycol alginate (PGA), sucrose laurate and sucrose stearate on creaming index, cloudiness, average droplet size and conductivity of soursop beverage emulsions. Generally, the use of different emulsifiers or a mixture of emulsifiers has a significant (p < 0.05) effect on the response variables studied. The addition of PGA had a significant (p < 0.05) effect on the creaming index at 55 °C, while PGA-stabilized (PGA1) emulsions showed low creaming stability at both 25 °C and 55 °C. Conversely, the utilization of PGA either as a mixture or sole emulsifier, showed significantly (p < 0.05) higher cloudiness, as larger average droplet size will affect the refractive index of the oil and aqueous phases. Additionally, the cloudiness was directly proportional to the mean droplet size of the dispersed phase. The inclusion of PGA into the formulation could have disrupted the properties of the interfacial film, thus resulting in larger droplet size. While unadsorbed ionized PGA could have contributed to higher conductivity of emulsions prepared at low pH. Generally, emulsions prepared using sucrose monoesters or as a mixture with modified starch emulsions have significantly (p < 0.05) lower creaming index and conductivity values, but higher cloudiness and average droplet size.
  12. Fulltext Influence of astaxanthin, emulsifier and organic phase concentration on physicochemical properties of astaxanthin nanodispersions
    Anarjan N, Nehdi IA, Tan CP
    Chem Cent J, 2013;7(1):127.
    PMID: 23875816 DOI: 10.1186/1752-153X-7-127
    The emulsification-evaporation method was used to prepare astaxanthin nanodispersions using a three-component emulsifier system composed of Tween 20, sodium caseinate and gum Arabic. Using Response-surface methodology (RSM), we studied the main and interaction effects of the major emulsion components, namely, astaxanthin concentration (0.02-0.38 wt %, x1), emulsifier concentration (0.2-3.8 wt %, x2) and organic phase (dichloromethane) concentration (2-38 wt %, x3) on nanodispersion characteristics. The physicochemical properties considered as response variables were: average particle size (Y1), PDI (Y2) and astaxanthin loss (Y3).
  13. Fulltext Cosmos caudatus as a potential source of polyphenolic compounds: optimisation of oven drying conditions and characterisation of its functional properties
    Mediani A, Abas F, Khatib A, Tan CP
    Molecules, 2013 Aug 29;18(9):10452-64.
    PMID: 23994970 DOI: 10.3390/molecules180910452
    The aim of the study was to analyze the influence of oven thermal processing of Cosmos caudatus on the total polyphenolic content (TPC) and antioxidant capacity (DPPH) of two different solvent extracts (80% methanol, and 80% ethanol). Sonication was used to extract bioactive compounds from this herb. The results showed that the optimised conditions for the oven drying method for 80% methanol and 80% ethanol were 44.5 °C for 4 h with an IC₅₀ of 0.045 mg/mL and 43.12 °C for 4.05 h with an IC₅₀ of 0.055 mg/mL, respectively. The predicted values for TPC under the optimised conditions for 80% methanol and 80% ethanol were 16.5 and 15.8 mg GAE/100 g DW, respectively. The results obtained from this study demonstrate that Cosmos caudatus can be used as a potential source of antioxidants for food and medicinal applications.
  14. Fulltext Optimal binary solvent extraction system for phenolic antioxidants from mengkudu (Morinda citrifolia) fruit
    Thoo YY, Ho SK, Abas F, Lai OM, Ho CW, Tan CP
    Molecules, 2013 Jun 14;18(6):7004-22.
    PMID: 23771061 DOI: 10.3390/molecules18067004
    Antioxidants have been widely used in the food industry to enhance product quality by preventing oxidation of susceptible substances. This work was carried out to maximise the recovery of total phenolic content (TPC), total flavonoid content (TFC), 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) (ABTS) radical-scavenging capacity and 2,2'-diphenyl-1-picrylhydrazyl (DPPH) radical-scavenging capacity from Morinda citrifolia fruit via modification of the ethanol concentration, extraction time and extraction temperature at minimal processing cost. The optimised conditions yielded values of 881.57 ± 17.74 mg GAE/100 g DW for TPC, 552.53 ± 34.16 mg CE/100 g DW for TFC, 799.20 ± 2.97 µmol TEAC/100 g DW for ABTS and 2,317.01 ± 18.13 µmol TEAC/100 g DW for DPPH were 75% ethanol, 40 min of time and 57 °C. The four responses did not differ significantly (p > 0.05) from predicted values, indicating that models obtained are suitable to the optimisation of extraction conditions for phenolics from M. citrifolia. The relative amounts of flavonoids were 0.784 ± 0.01 mg quercetin/g of extract and 1.021 ± 0.04 mg rutin/g of extract. On the basis of the results obtained, M. citrifolia extract can be used as a valuable bioactive source of natural antioxidants.
  15. The effects of physical refining on the formation of 3-monochloropropane-1,2-diol esters in relation to palm oil minor components
    Zulkurnain M, Lai OM, Latip RA, Nehdi IA, Ling TC, Tan CP
    Food Chem, 2012 Nov 15;135(2):799-805.
    PMID: 22868161 DOI: 10.1016/j.foodchem.2012.04.144
    The formation of 3-monochloropropane-1,2-diol (3-MCPD) esters in refined palm oil during deodorisation is attributed to the intrinsic composition of crude palm oil. Utilising D-optimal design, the effects of the degumming and bleaching processes on the reduction in 3-MCPD ester formation in refined palm oil from poor-quality crude palm oil were studied relative to the palm oil minor components that are likely to be their precursors. Water degumming remarkably reduced 3-MCPD ester formation by up to 84%, from 9.79 mg/kg to 1.55 mg/kg. Bleaching with synthetic magnesium silicate caused a further 10% reduction, to 0.487 mg/kg. The reduction in 3-MCPD ester formation could be due to the removal of related precursors prior to the deodorisation step. The phosphorus content of bleached palm oil showed a significant correlation with 3-MCPD ester formation.
  16. Discrimination of orange beverage emulsions with different formulations using multivariate analysis
    Mirhosseini H, Tan CP
    J Sci Food Agric, 2010 Jun;90(8):1308-16.
    PMID: 20474048 DOI: 10.1002/jsfa.3928
    The constituents in a food emulsion interact with each other, either physically or chemically, determining the overall physico-chemical and organoleptic properties of the final product. Thus, the main objective of present study was to investigate the effect of emulsion components on beverage emulsion properties.
  17. Effect of polyoxyethylene sorbitan esters and sodium caseinate on physicochemical properties of palm-based functional lipid nanodispersions
    Cheong JN, Mirhosseini H, Tan CP
    Int J Food Sci Nutr, 2010 Jun;61(4):417-24.
    PMID: 20151850 DOI: 10.3109/09637481003591574
    The main objective of the present study was to investigate the effect of polyoxyethylene sorbitan esters and sodium caseinate on physicochemical properties of palm-based functional lipid nanodispersions prepared by the emulsification-evaporation technique. The results indicated that the average droplet size increased significantly (P < 0.05) by increasing the chain length of fatty acids and also by increasing the hydrophile-lipophile balance value. Among the prepared nanodispersions, the nanoemulsion containing Polysorbate 20 showed the smallest average droplet size (202 nm) and narrowest size distribution for tocopherol-tocotrienol nanodispersions, while sodium caseinate-stabilized nanodispersions containing carotenoids had the largest average droplet size (386 nm), thus indicating a greater emulsifying role for Polysorbate 20 compared with sodium caseinate.
  18. Optimization of processing parameters for the preparation of phytosterol microemulsions by the solvent displacement method
    Leong WF, Che Man YB, Lai OM, Long K, Misran M, Tan CP
    J Agric Food Chem, 2009 Sep 23;57(18):8426-33.
    PMID: 19694442 DOI: 10.1021/jf901853y
    The purpose of this study was to optimize the parameters involved in the production of water-soluble phytosterol microemulsions for use in the food industry. In this study, response surface methodology (RSM) was employed to model and optimize four of the processing parameters, namely, the number of cycles of high-pressure homogenization (1-9 cycles), the pressure used for high-pressure homogenization (100-500 bar), the evaporation temperature (30-70 degrees C), and the concentration ratio of microemulsions (1-5). All responses-particle size (PS), polydispersity index (PDI), and percent ethanol residual (%ER)-were well fit by a reduced cubic model obtained by multiple regression after manual elimination. The coefficient of determination (R(2)) and absolute average deviation (AAD) value for PS, PDI, and %ER were 0.9628 and 0.5398%, 0.9953 and 0.7077%, and 0.9989 and 1.0457%, respectively. The optimized processing parameters were 4.88 (approximately 5) homogenization cycles, homogenization pressure of 400 bar, evaporation temperature of 44.5 degrees C, and concentration ratio of microemulsions of 2.34 cycles (approximately 2 cycles) of high-pressure homogenization. The corresponding responses for the optimized preparation condition were a minimal particle size of 328 nm, minimal polydispersity index of 0.159, and <0.1% of ethanol residual. The chi-square test verified the model, whereby the experimental values of PS, PDI, and %ER agreed with the predicted values at a 0.05 level of significance.
  19. Clinicians' diagnostic practice of dengue infections
    Ng CF, Lum LC, Ismail NA, Tan LH, Tan CP
    J Clin Virol, 2007 Nov;40(3):202-6.
    PMID: 17928264 DOI: 10.1016/j.jcv.2007.08.017
    BACKGROUND: Difficulties in the classification of dengue infection have been documented. Such difficulties could be due to the low awareness of the World Health Organization diagnostic guidelines among clinicians.
    OBJECTIVE: To study the diagnostic practices of clinicians in classifying patients as dengue fever (DF) or dengue haemorrhagic fever (DHF)/dengue shock syndrome (DSS) at the time of discharge during an outbreak.
    METHODS: A prospective descriptive study of clinical features and disease classification in adult and pediatric dengue patients in the University of Malaya Medical Centre.
    RESULTS: Five hundred and twenty adult and 191 pediatric patients were enrolled. Thrombocytopenia and evidence of plasma leakage were present in 8% of adult and 19% of pediatric patients. Of these, 93% and 49%, respectively, were given the discharge diagnoses of DF instead of DHF/DSS. Hemoconcentration, serous effusion and thrombocytopenia were not recognized in clinicians' discharge diagnosis of DHF/DSS for adult patients. The receiver operating characteristic (ROC) curve suggested a lack of consistency in the use of WHO guidelines in establishing DHF/DSS in adult patients, while implying otherwise for pediatric patients.
    CONCLUSION: DHF/DSS is an under-recognized condition by clinicians managing these patients. This can affect the case fatality rate of DHF/DSS and the economic burden of the disease. The lack of awareness in disease manifestations especially plasma leakage, can lead to delayed recognition of DHF/DSS.
    Study site: Outpatient department and inpatients, adult medical and pediatric wards, University Malaya Medical Center (UMMC), Kuala Lumpur, Malaysia
  20. Inducing curricular change: Initial evaluation of outcomes
    Azila NM, Tan NH, Tan CP
    Med Educ, 2006 Nov;40(11):1125.
    PMID: 17054624
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