Maternal diet and its association with human milk energy and macronutrient composition among exclusively breastfeeding Malaysian Malay mothers

@# Introduction: This study aimed to determine the relationship of maternal dietary intake with human milk nutritional composition, among Malay mothers during the postpartum period of exclusive breastfeeding. Methods: Human milk samples (20- 30ml) were collected from mothers (n=32) at least once monthly for six months postpartum. Macronutrients and fatty acids contents were determined using proximate analysis and gas chromatography methods, respectively. Maternal dietary intakes were recorded using the multiple-pass diet recall method prior to each milk sampling and were analysed using the Nutritionist ProTM software. Associations between the milk composition and maternal diet were tested using Spearman correlation. Results: The energy content ranged between 49.6-59.2 kcal/100ml, protein 1.3-1.4 g/100ml, carbohydrate 6.5-9.7 g/100ml and total fat 6.5-9.7 g/100ml. The polyunsaturated, monounsaturated, and saturated fatty acids concentrations were 10.5-19.1 %, 40.6-43.5 %, and 38.0-49.7 %, respectively. During confinement (first month postpartum), total energy and total fat content of human milk were the highest whereas total carbohydrate was the lowest, compared to the rest of the exclusive breastfeeding period. In contrast, intakes of total calorie and total fat were the lowest, whereas protein was the highest during this period. However, no associations were detected between human milk nutritional contents and maternal dietary intake. Conclusion: In our study population, the composition of maternal diet and nutritional content of human milk differed between confinement and post-confinement periods. However, the association between maternal diet and human milk composition itself warrants further investigation.

Correlation of severity of ST segment elevation in acute inferior wall myocardial infarction with the proximity of right coronary artery disease

A number of researchers have used different electrocardiographical criteria to predict the culprit vessel in acute inferior wall myocardial infarction [MI] cases. Therefore, the determination of infarct related artery in AMI is extremely important with regard to prediction of potential complications, furthermore, predicting the probable site of occlusion within RCA is worthwhile because proximal occlusions are likely to cause greater myocardial damage and an early invasive strategy may be planned in such cases. Our study aimed at evaluating the ECG criteria to predict the proximity of lesion in the right coronary artery [RCA] in acute inferior wall MI cases. The Objectives were to predict the presence of a proximal lesion in right coronary artery by severity of ST segment elevation in inferior ECG leads. This cross-sectional study carried out at the department of cardiology and cardiac catheterization at Jinnah Hospital, Lahore from April 2008 to September 2008. A total of 60 patients who suffered from inferior wall MI were included in the study who underwent coronary angiography in the first week. The ECGs of these patients were then compared with the angiographic findings to correlate the proximity of culprit lesion in RCA with the degree of ST segment elevation in inferior limb leads. Out of 60 patients, 29 [48.4%] had the culprit lesion in proximal, 23 [38.5%] in mid and 8 [13.4%] in distal RCA. Patients with proximal RCA disease showed a mean ST segment elevation of 12.55 +/- 1.38 mm, with mid RCA disease 8.39 +/- 0.89 mm and with distal RCA disease 6.0 +/- 0.54 mm. This study demonstrated that the severity of ST segment elevation was correlated with proximity of RCA lesion

Metabolic syndrome in patients with ischemic heart disease

To determine the frequency of metabolic syndrome in patients with Ischemic Heart Disease [IHD]. Cross-sectional, descriptive study. Cardiology Department of Punjab Institute of Cardiology, Lahore, from June 2006 to June 2007. A total of 100 subjects with ischemic heart disease, fulfilling the inclusion criteria, were enrolled in the study. Demographic data [age and gender] and the 5 component conditions of the metabolic syndrome were noted. Subjects were physically assessed for the abdominal obesity, based on waist circumference. Fasting blood samples for glucose and lipid profile in first 24 hours after acute coronary insult were drawn and tested in central laboratory. Variables were processed for descriptive statistics. In this study population, 68% were male and 32% were female with mean age of 52 +/- 13.6 years in men and 56 +/- 12.5 years in women. Frequency of metabolic syndrome was 32% in men and 28% in women. It increased with age. The highest rate of metabolic syndrome was in men diagnosed as STEMI [odds ratio: 3.39, 95% Cl=1.36-8.41]. Frequency of metabolic syndrome was high among the patients with IHD. It supports the potential for preventive efforts in persons with high-risk of IHD

Significance of perfusion defects on dipyridamole thallium cardiac SPECT in patients with left bundle branch block

Left Bundle Branch Block [LBBB] is a known cause of false positive results in myocardial perfusion studies. We aimed at investigation of correlation between degree of severity of perfusion defect on cardiac Single Photon Emission Computed Tomography [SPECT] and presence of coronary artery disease on angiography in patients with LBBB. This was an analytical study and was carried out at Department of Nuclear Cardiology and Department of Cardiac Catheterisation of Punjab Institute of Cardiology, Lahore from January 2007 to April 2007. In this study patients having LBBB without known coronary artery disease [CAD] referred for myocardial perfusion studies to the Nuclear Cardiology Department from outpatient, indoor and emergency departments were included. Thallium201 stress/rest Single-Photon Emission Tomography [SPECT] acquisition scanning was performed. The myocardial perfusion pattern was classified as normal, fixed defect and reversible defect. Coronary angiography was used to confirm CAD only in patients with abnormal scan. Thirty consecutive patients having LBBB were studied. All patients underwent myocardial perfusion imaging using dipyridamole pharmacologic stress. Fourteen patients [47%] revealed normal Thallium201 uptake and distribution at the septum. Reversible defects were noted in 13 [43%] patients. Fixed defects were noted in 3 [10%] patients. Among four patients with mild perfusion defects only 1 [25%] had significant coronary artery disease. In patients with moderate perfusion defects, coronary angiogram was positive for significant coronary artery disease in 1 [33%] patient. In six patients having severe perfusion defects significant coronary artery disease was noted in 5 [83%] patients. All patients with fixed defects had significant coronary artery disease. False positive studies were found to be significantly greater in patients with reversible defects particularly with mild to moderate defects. Conclusions: Patients with left bundle branch block showing moderate to severe reversible perfusion defects on dipyridamole thallium cardiac SPECT have high likelihood of coronary artery disease

Injection Sclerotherapy versus Electrocoagulation in the management outcome of early haemorrhoids

To study the symptomatology of early hemorrhoids and to compare injection Sclerotherapy [IS] with electrocoagulation [EC] in the management outcome of early haemorrhoids with respect to pain during the procedure, reduction in bleeding per rectum, and overall patient satisfaction score. A total of 102 patients were included in this experimental study at the POP Hospital, Wah Cantt from October 2004 to June 2005. A detailed history was taken and proctoscopic examination was performed. Patients were then randomly divided into two groups [Lottery method]. One group was subjected to EC and the other to IS. In the EC, using the EC machine [Wieda, China], direct current of 10-20 mA was applied in the submucosal plane of each pile core for 5-7 minutes. In the IS 1-2 ml of 5% phenol in almond oil was injected in the same plane in each pile core. Pain during the procedure, reduction in bleeding per rectum and overall patient satisfaction, were studied as outcome measures. The mean age of the patients was 44 years, 86 were males and 16 were females. Two thirds of the patients were having symptoms for more than 6 months. A third of patients had associated local pain while another third had associated mucous discharge. Chronic constipation was present in 81% patients. Only 24.5% of the patients had a positive family history of haemorrhoids. Patients in the electrocoagulation [EC] group experienced more pain during the procedure than the injection Sclerotherapy [IS] group [P<0.000], but EC was significantly more effective than IS in terms of reducing the bleeding per rectum [P= 0.039], and also significantly higher number of patients were fully satisfied with EC than with IS [P<0.04]. EC, although more painful, is a safe, more effective and a highly satisfying procedure for treating early hemorrhoids

In hospital outcome of acute inferior wall Myocardial Infarction with or without right ventricular infarction

Patients of acute inferior wall MI with concomitant right ventricular infarction is considered as high risk patients because of associated high morbidity and mortality. Total of 50 patients were enrolled for seven days of hospital stay. They were divided into two groups; one with only acute inferior wall MI and the other with acute inferior wall MI associated right ventricular involvemen. The fatality rate was 33.3% with right ventricle involvement compared with 2.6% without right ventricle involvement. [p=0.003].The major cause of death was cardiogenic shock. Complications were as follow; cardiogenic shock [p=0.012], Tricuspid regurgitation [p=0.04], AV Block [p=0.04], tachyarrhythmia [p=0.077] and VSD in both groups. The conclusion was that right ventricle involvement was an independent predictor of prognosis in patients with acute inferior wall myocardial infarction