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.

Dietary Intake of Mothers Who Practised Traditional Confinement During Exclusive Breastfeeding Period

@#Introduction: Nutritional requirements increase during lactation. However, maternal dietary intakes of Malaysian mothers are subjected to restrictions commonly included in traditional postpartum practices. This study aimed to assess the maternal dietary intake status during the recommended six month exclusive breastfeeding (part of which included the traditional confinement) period. Methods: Thirty-two Malay mothers aged 18-35 years, who had delivered full-term (at ≥37 weeks) singleton babies and were exclusively breastfeeding, were included in the study. Maternal dietary intake was assessed using multiple-pass diet recall on Days 10, 30, 60, 90, 120, 150, and 180, postpartum. The average total energy and macronutrient intakes were compared against recommended values. Results: The findings of this study demonstrated that maternal intakes of total energy ranged from 1,500-2,000kcal/day, carbohydrate 189-272g/day, protein 58-72g/day, and total fat 32-70g/day. Total calorie intake was the lowest during confinement period (Days 10 and 30) compared to the rest of the exclusive breastfeeding period. This is similar with total fat consumption. On the other hand, protein intake was the highest during confinement period whereas carbohydrate intake was consistent throughout the six-month period. Despite the increased requirements, intakes of total calories, protein, total fat, dietary fibre, and water, did not meet the recommended values throughout the exclusive breastfeeding period. Conclusion: Mothers’ inability to fulfil their nutritional requirements during exclusive breastfeeding period may be associated with traditional postpartum dietary practices. Dietary advice with consideration for cultural food taboos practiced by local mothers during confinement may help to improve maternal nutritional intakes during this crucial time.

Tube thoracostomy in penetrating thoracic injuries

Objective: To determine the frequency of tube thoracostomy in penetrating thoracic injuries at a tertiary care hospital

Study design: Cross sectional study

Place and Duration of study: Department of Surgery Unit III, Civil Hospital / Dow University of Health Sciences Karachi, from March 2012 to March 2014

Methodology: All patients who presented with penetrating chest injuries due to firearm, stabs etc were treated according to ATLS protocol. Tube thoracostomy was performed when indicated. Chest tube was passed under local anesthesia

Results: A total of 100 patients included in this study. There were 92 males and 8 females. Mean age of the patients was 30+7.29 year. Mechanism of injuries included gunshot injury [n=62], stabs [n=24] and shrapnel injury [n=14]. Pneumothorax was diagnosed in 39 patients, haemothorax in 35, sucking wound of the chest in 20 patients and major vascular injury in 4 patients. Associated extra thoracic injuries were present in 26 patients. Tube thoracostomy was performed in 78 patients. Twenty-two patients underwent thoracotomy

Conclusions: Majority of patients with penetrating chest injuries were managed by tube thoracostomy. No mortality occurred in this series

Analysis of 200 cases of tube thoracostomies performed by general surgeons

OBJECTIVE OF STUDY: To observe various indications and complications of tube Thoracostomy

DESIGN: Prospective, descriptive study

PLACE and DURATION OF STUDY: Public and private sector hospitals of Nawabshah and Hyderabad from 1[st] Jan 2005 to Dec 2008

METHODOLOGY: All patients of either sex above the age of 13 years having pathology related to chest cavity and underwent chest intubation were included in the study. Patients below the age of 13 years, having serious co morbid illness like Ischemic heart disease [ASA-3], severe chronic obstructive airway disease requiring ventilator support, and complicated chronic liver disease and patients who lost to follow-up were excluded. Data was collected for age, sex, indications of chest intubations, cause of the disease, procedural and post procedural complications and hospital stay. Descriptive analysis was performed using SPSS version 10 for continuous and frequency variables

RESULTS: Total 200 patients of different pathologies related to chest cavity underwent chest intubations. Mean age was 43.57 years SD+/- 12.68 with 60.5% male and 39.5% female. Indications were: pleural effusion 86[43%] patients, pneumothorax 36[18%] patients, empyema thoracis 33[16.5%] patients, hydropneumothorax 24[12%] patients and haemothorax 18[9%] patients

Etiology for intubations includes 118[59%] patients of complicated pulmonary tuberculosis, 27[13.5%] patients of blunt trauma chest and 21[10.5%] patients of post pneumonic empyema

Procedural complications were found in 24[12%] patients and postoperative complications in 25 [12.5%] patients. Mean hospital stay was 5.5 days

CONCLUSION: We found chest tube insertion as the first line of treatment for variety of life threatening chest diseases. It is safe and effective procedure associated with procedural [12%] and post procedural complications [12.5%] which are comparable to international literature

Gender differences in KAP related to HIV/AIDS among freshmen in Afghan universities.

This cross-sectional study aimed to describe the level of knowledge, perception/ attitude, and practices related to HIV among 1,054 freshmen students in four Afghan universities differences between genders. A probability, two stage sampling method was used. Data were collected by a self administered structured questionnaire. SPSS software was used for data analysis. Descriptive and inferential statistics were performed. Most of respondents were male (72.1%), their average age was 20.1 +/- 2 years, and most were unmarried (93.4%). The majority (90.8%) were aware of HIV but only 28.3% had a good level of knowledge. Around one-third (35.6%) had a positive level of attitude toward HIV. Approximately 30% had at least one risk practice; therefore, they were counted as high-risk behavior group members. Females were statistically more knowledgeable than males, and high-risk behaviors were significantly more prevalent among males; p = 0.01 and p = 0.001, respectively. However, general awareness, and attitude were not statistically different between genders. A considerable proportion of students (14.6%), as compared to peer-countries, were sexually active. A very high level of sharing injecting needles (4.5%) and shaving sets (20.8%) were also reported among informants.