Chronic kidney disease (CKD) is marked by long term, irreversible loss of function. Since it is irreversible, what we can do is only slow down its progress to end-stage renal disease (ESRD) which requires dialysis. Diabetes and high blood pressure are the most common causes of CKD. For the person having diabetes or high blood pressure, working with doctor to keep blood sugar and blood pressure under control is the best way to prevent kidney disease.

Why is good nutrition important for people with CKD?

Making healthy food choices is important to us all, but it is even more important if you have chronic kidney disease. Good nutrition gives you energy to:
– Do your daily tasks
– Prevent infection
– Build muscle
– Help maintain a healthy weight
– May keep your kidney disease from getting worsen

Will I need to control any other nutrients?

When your kidneys are not working as well as they should, waste and fluid build up in your body. Over time, the waste and extra fluid can cause heart, bone and other health problems.
You may need to balance fluids and other nutrients. There are:
– Sodium
-Phosphorus
-Potassium

SODIUM

Sodium is a mineral found in most foods. It is also found in table salt. Sodium affects blood pressure and water balance in body. If your kidneys do not work well, sodium and fluid build up in your body. This can cause high blood pressure and other problems, like swelling of ankles.

You can limit sodium by avoiding table salt and foods such as:
– Seasonings like soy sauce, sea salt, teriyaki sauce
– Most canned foods and frozen foods
– Processed meats like ham, bacon, hot dog, sausage
– Salted snack foods like chips and crackers

POTASSIUM

Potassium is a mineral found in almost all foods. Your body need some potassium to make your muscles work, but too much potassium can be dangerous. When your kidneys are not working well, your potassium level may be too high or too low.
Having too high or too low of potassium can cause muscle cramps, problems with heart beats and muscles weakness.

Use the list below to get some ideas about how to make healthy choices if you need limit potassium.

PHOSPHORUS

Phosphorus is a mineral found in almost all foods. It works with calcium and vitamin D to keep your bones healthy. Healthy kidneys keep the right amount of phosphorus in your body. When your kidneys are not working well, phosphorus can build up in your blood. Too much phosphorus in your blood can lead to weak bones that break easily.

Use the list below to get some ideas about how to make healthy choices if you need limit potassium.

FLUIDS

You need water to live, but when you have kidney disease, you may not need much water. This is because damaged kidneys do not get rid of extra fluids as well as they should. Too much fluids in your body can be dangerous. It can cause high blood pressure, swelling and heart failure. Extra fluid can also build up around your lungs and make it hard to breathe.

Depending on your stage of kidney disease, your doctor may tell you to limit fluid. To avoid dehydration, let your doctor help plan your fluids intake.

1. DATA & STATISTIC OF BREASTFEEDING

Breastfeeding provides numerous benefits for mothers and their children. However, currently, only 40% of the global average rate of infants below six months of age was exclusively breastfed, with only 23 countries managed to achieve rates of 60% or higher. World Health Organization (WHO) Global Nutrition Targets 2025 has set targets to achieve at least 50% rate of exclusive breastfeeding among members’ countries. The National Plan of Action for Nutrition of Malaysia III (NPANM III), 2016-2025 has set another indicator to achieve at least 70% of infants below 6 months of age to be exclusively breastfed by 2025.

In Malaysia, the prevalence of exclusive breastfeeding was 19.3% in 2006 and has increased to 47.1% in 2016. Even though there was an increment, this was still less than the targeted prevalence set by WHO and NPANM III.

2. BENEFITS OF BREASTFEEDING

Benefits of Breastfeeding 

Children who are breastfed experience improved dental health and neuro developmental outcomes. They have decreased risk of:

• Otitis media
• Diarrhoea
• Respiratory tract infection
• Necrotizing enterocolitis
• SIDS
• Atopic dermatitis
• Asthma
• Celiac Disease
• Crohn’s Disease and ulcerative colitis
• Late-onset sepsis in preterm infants
• Type 1 and type 2 diabetes
• Leukaemia
• Childhood overweight and obesity

Maternal Benefits

There are also maternal health benefits to breastfeeding such as decreased risk of the following:

• Decreased excessive menstrual blood loss
• Breast, ovarian, endometrial and thyroid cancers
• Hypertension
• Type 2 diabetes
• Rheumatoid Arthritis

Breastfeeding is also a great benefit to the environment and society. It was shown that breastfeeding families become sick less often and the parents miss work less. Breast milk will be always available, at the right temperature and ready to be fed,there is no risk of contamination, even in the case of emergency situations, such as natural disasters.

3. HOW MUCH & HOW OFTEN TO BREASTFEED

One of the most common questions new parents have is how often their baby should be fed. The best answer is surprisingly simple: in general, babies should be fed whenever they seem hungry.

Every baby is different. How much and how often your baby feeds will depend on your baby’s needs. Here are a few things to know about how much and how often babies breastfeed during the first days, weeks, and months of life.

First Days

• Your newborn baby’s belly is tiny. He or she does not need a lot of milk with each feeding to be full.
• Your baby may want to eat as often as every 1 to 3 hours. Frequent feeding helps increase your milk supply and gives your baby practice at sucking and swallowing.
• You may be able to hear your baby sucking and swallowing the breast milk.
• Most babies who are getting breast milk should not be fed infant formula in the first few days. If you are concerned about meeting your baby’s needs, talk to a lactation consultant, or your baby’s nurse or doctor, right away to find out how to address any breastfeeding problems and determine the best way to meet your baby’s needs.

First Weeks and Months

• Over the first few weeks and months, the time between feedings will start to get longer— on average about every 2 to 4 hours for most exclusively breastfed babies. Some babies may feed as often as every hour at times, often called cluster feeding, or may have a longer sleep interval of 4 to 5 hours.
• How often your baby feeds might change depending on the time of day. Some feeding sessions may be long, and others short. That is okay. Babies will generally take what they need at each feeding and stop eating when they are full. They should seem content and drowsy after feeding when they have had enough milk.
• Your baby will breastfeed about 8 to 12 times in 24 hours.

6 to 12 Months

• Breastfed babies’ feeding patterns (how often and how long they feed) vary and will likely change as they grow and start eating more solid foods.
• If your baby seems to be less interested in breastfeeding after you introduce solids, try breastfeeding first before you offer solids.
• Your breast milk is the most important source of nutrition, even after you start feeding your baby solids.

12 to 24 Months

• The number of times a day a toddler breastfeeds varies. Some want to breastfeed only before bed or in the morning, while others continue to drink breast milk as a bigger portion of their daily diet. Continue to follow your child’s cues to decide when he or she is hungry and wants to breastfeed.

4. PROPER STORAGE & PREPARATION

• 
• 
  
• Safe Storage of Expressed Breast Milk
• 
  Before expressing or handling breast milk:

• Wash your hands well with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol.
• Mothers can express breast milk by hand or with a manual or electric pump.
• If using a pump, inspect the pump kit and tubing to make sure it is clean. Discard and replace mouldy tubing immediately.
• If using a shared pump, clean pump dials, power switch, and countertop with a disinfectant wipe.

Storing breast milk after expressing:

• Use breast milk storage bags or clean, food-grade containers to store expressed breast milk. Make sure the containers are made of glass or plastic and have tight fitting lids.
  • Avoid bottles with the recycle symbol number 7, which indicates that the container may be made of a BPA-containing plastic.
• Never store breast milk in disposable bottle liners or plastic bags that are not intended for storing breast milk.
• Freshly expressed or pumped milk can be stored:
  • At room temperature (77°F or colder) for up to 4 hours.
  • In the refrigerator for up to 4 days.
  • In the freezer for about 6 months is best; up to 12 months is acceptable. Although freezing keeps food safe almost indefinitely, recommended storage times are important to follow for best quality.

Storage tips:

• Clearly label the breast milk with the date it was expressed.
• Do not store breast milk in the door of the refrigerator or freezer. This will help protect the breast milk from temperature changes from the door opening and closing.
• If you don’t think you will use freshly expressed breast milk within 4 days, freeze it right away. This will help to protect the quality of the breast milk.
• Breast milk can be stored in an insulated cooler with frozen ice packs for up to 24 hours when you are traveling. At your destination, use the milk right away, store it in the refrigerator, or freeze it.

Safe Thawing of Breast Milk

• Always thaw the oldest breast milk first. Remember first in, first out. Over time, the quality of breast milk can decrease.
• There are several ways to thaw your breast milk:
  • In the refrigerator overnight.
  • Set in a container of warm or lukewarm water.
  • Under lukewarm running water.
• Never thaw or heat breast milk in a microwave. Microwaving can destroy nutrients in breast milk and create hot spots, which can burn a baby’s mouth.
• If you thaw breast milk in the refrigerator, use it within 24 hours. Start counting the 24 hours when the breast milk is completely thawed, not from the time when you took it out of the freezer.
• Once breast milk is brought to room temperature or warmed, use it within 2 hours.
• Never refreeze breast milk after it has thawed.

Feeding Expressed Breast Milk

• Breast milk does not need to be warmed. It can be served room temperature or cold.
• If you decide to warm the breast milk, here are some tips:
  • Keep the container sealed.
  • Place the sealed container into a bowl of warm water or hold it under warm, but not hot, running water for a few minutes.
  • Test the milk’s temperature before feeding it to your baby by putting a few drops on your wrist.
  • Do not heat breast milk directly on the stove or in the microwave.
• Swirl the breast milk to mix the fat, which may have separated.
• If your baby did not finish the bottle, use the leftover milk within 2 hours after the baby is finished feeding. After 2 hours, leftover breast milk should be discarded.

5. CONTRAINDICATION

• Mothers should NOT breastfeed or feed expressed breast milk to their infants if

  • Infant is diagnosed with classic galactosemia, a rare genetic metabolic disorder
  • Mother is infected with the human immunodeficiency virus (HIV) (Note: recommendations about breastfeeding and HIV may be different in other countries)
  • Mother is infected with human T-cell lymphotropic virus type I or type II (HTLV – 1/2)
  • Mother is using an illicit street drug, such as PCP (phencyclidine) or cocaine (Exception: Narcotic-dependent mothers who are enrolled in a supervised methadone program and have a negative screening for HIV infection and other illicit drugs can breastfeed)
  • Mother has suspected or confirmed Ebola virus disease

  Mothers should temporarily NOT breastfeed and should NOT feed expressed breast milk to their infants if

  • Mother is infected with untreated brucellosis
  • Mother is taking certain medications
  • The mother is undergoing diagnostic imaging with radiopharmaceuticals
  • Mother has an active herpes simplex virus (HSV) infection with lesions present on the breast  (Note: Mothers can breastfeed directly from the unaffected breast if lesions on the affected breast are covered completely to avoid transmission)

  In conclusion, mothers may resume to breastfeeding after consulting with a physician to determine when their breast milk is safe for their infant.

  Mothers should temporarily NOT breastfeed, but CAN feed expressed breast milk if

  • Mother has untreated, active tuberculosis

  (Note: The mother may resume breastfeeding once she has been treated appropriately for 2 weeks and is documented to be no longer contagious)

  • Mother has active varicella (chicken pox) infection that developed within the 5 days prior to delivery to the 2 days following delivery

  In conclusion, airborne and contact precautions may require temporary separation of the mother and infant, during which time expressed breast milk should be given to the infant by another care provider. Mothers should be able to resume breastfeeding after consulting with a physician to determine when there is no longer a risk of spreading infection.

  Are medications safe to take while breastfeeding?

  Few medications are contraindicated while breastfeeding. Although many medications do pass into breast milk, most have no known adverse effect on milk supply or on infant well-being. So, kindly consult your doctor if you have any doubts.

6. COVID-19 & BREASTFEEDING Q&A

• 1. Can COVID-19 be passed through breastfeeding?

  Ans: Transmission of active COVID-19 (virus that can cause infection) through breast milk and breastfeeding has not been detected to date. There is no reason to avoid or stop breastfeeding.

  2. Should mothers breastfeed in communities where COVID-19 is prevalent?

  Ans: Yes. In all socio-economic settings, breastfeeding improves survival and provides lifelong health and development advantages to newborns and infants. Breastfeeding also improves the health of mothers.

  3. Following delivery, should a baby still be immediately placed skin-to-skin and breastfed if the mother is confirmed or suspected to have COVID-19?

  Ans: Yes. Immediate and continued skin-to-skin care, including kangaroo mother care, improves the temperature control of newborns and is associated with improved survival among newborn babies. Placing the newborn close to the mother also enables early initiation of breastfeeding which also reduces mortality.

  The numerous benefits of skin-to-skin contact and breastfeeding substantially outweigh the potential risks of transmission and illness associated with COVID-19.

  4. Can women with confirmed or suspected COVID-19 breastfed?

  Ans: Yes. Women with confirmed or suspected COVID-19 can breastfeed if they wish to do so. They should:

  • Wash hands frequently with soap and water or use alcohol-based hand rub and especially before touching the baby
  • Wear a medical mask during any contact with the baby, including while feeding
  • Sneeze or cough into a tissue. Then dispose of it immediately and wash hands again
  • Routinely clean and disinfect surfaces that mothers have touched.

  It is important to replace medical masks as soon as they become damp and dispose of them immediately. Masks should not be reused or touched in the front.

  5. If a mother confirmed or suspected to have COVID-19 does not have a medical face mask should she still breastfeed?

  Ans: Yes. Breastfeeding unquestionably reduces mortality in newborns and infants and provides numerous lifelong health and brain development advantages to the child.

  Mothers with symptoms of COVID-19 are advised to wear a medical mask, but even if this is not possible, breastfeeding should be continued. Mothers should follow other infection prevention measures, such as washing hands, cleaning surfaces, sneezing or coughing into a tissue.

  6. If a mother has confirmed or suspected COVID-19 and is too unwell to breastfeed her baby directly. What can she do?

  Ans: If you are too unwell to breastfeed your baby due to COVID-19 or other complications, you should be supported to safely provide your baby with breast milk in a way possible, available, and acceptable to you. This could include:

  • Expressing milk
  • Donor human milk. 

  If expressing breast milk or donor human milk are not feasible then consider wet nursing (another woman breastfeeds the child) or infant formula milk with measures to ensure that it is feasible, correctly prepared, safe and sustainable.

  7. If a mother had confirmed or suspected COVID-19 and was unable to breastfeed, when can she start to breastfeed again?

  Ans: You can start to breastfeed when you feel well enough to do so. There is no fixed time interval to wait after confirmed or suspected COVID-19. There is no evidence that breastfeeding changes the clinical course of COVID-19 in a mother. Health workers or breastfeeding counsellors should support you to relactate.

  8. If a mother has confirmed or suspected COVID-19, is it safer to give her baby infant formula milk?

  Ans: No. There are always risks associated with giving infant formula milk to newborns and infants in all settings. The risks associated with giving infant formula milk are increased whenever home and community conditions are compromised, such as reduced access to health services if a baby becomes unwell, reduced access to clean water and/or access to supplies of infant formula milk are difficult or not guaranteed, affordable and sustainable.

  The numerous benefits of breastfeeding substantially outweigh the potential risks of transmission and illness associated with the COVID-19 virus.

  9. Can a breastfeeding woman get vaccinated against COVID-19?

  Ans: Yes, women who are breastfeeding can take the vaccine when it becomes available to them.   

  None of the currently approved vaccines use the live virus, so there is no risk of passing the virus to the baby through breastmilk.  

  There is also some evidence that, after vaccination, antibodies are found in breastmilk, which may help protect the baby against COVID-19.

7. SUPPLEMENTS FOR BREASTFEEDING MOTHER

• Supplements for breastfeeding mothers:

  1. Omega-3 fatty acids 

  Omega-3 fatty acids are essential to support baby’s brain, eye, immune system and nervous system development. Studies also show that maternal supplementation of omega-3 fatty acids during breastfeeding can reduce food allergies and eczema in baby.

  2. Calcium and vitamin D

  The recommended daily intake of calcium for breastfeeding women is 1200mg/day while an estimated of 600IU (15mcg) of vitamin D is required. Calcium is vital for the bone and teeth formation of baby while vitamin D is needed for calcium absorption.

  3. Iodine

  Babies require iodine for proper growth, development of brain, visual motor skills and hearing. Since breastfed babies depend on breast milk alone as their source of iodine, breastfeeding mothers need to get enough iodine for the baby and themselves. It is recommended that breastfeeding mothers take an iodine supplement of 150mcg per day.

  4. Vitamins B Complex (Vitamin B1, B2, B3, B5, B6, B7, B9, B12)

  Vitamins B group is important for the nervous system development and production of red blood cells. Since they are water-soluble and our bodies do not store them, daily supplementation is needed. These vitamins are mostly obtained from animal food sources and not found in plant-based food. Therefore, it is also crucial for breastfeeding mothers who are vegetarian to take supplements containing vitamin B group.

  5. Fenugreek

  Fenugreek is a herb that is commonly used as a galactagogue to increase breast milk production. Studies indicate that fenugreek may have mild galactagogue effect. Fenugreek can be taken in the form of capsules, powder mixed with drinks or tea, typically in doses of 1-6g daily. It is considered safe in nursing mothers but should be used with caution in people with diabetes as it can lower blood sugar if taken at higher doses.

  Although not considered harmful when used in moderation, fenugreek can cause your breastmilk, sweat, and urine to smell like maple syrup. Your baby’s urine and sweat may start to smell like maple syrup, too. Note that the latter should not be confused with maple syrup urine disease.

  6. Lecithin

  Lecithin is a phospholipid elements. It’s thought to help prevent the breast ducts from getting plugged by increasing the polyunsaturated fatty acids in the milk and decreasing its stickiness. A plugged duct occurs when the milk passageways in the breast become blocked.Reference:

  1. Farahana Mohamad Pilus, Norliza Ahmad, Nor Afiah Mohd Zulkefli. 2019. Predictors of Exclusive Breastfeeding Among Mothers Attending Rural Health Clinics in Hulu Langat District. Malaysian Journal of Medicine and Health Sciences (eISSN 2636-9346). Mal J Med Health Sci 15(SP3): 15-21.American Academy of Pediatrics. 2021. Breastfeeding Overview.
  2. Sanjeev Jain, MD, FAAP. 2020. How Often and How Much Should Your Baby Eat? American Academy of Pediatrics.
  3. Centre of Disease Control and Prevention. 2020. Nutrition: How Much and How Often to Breastfeed.
  4. Centers of Disease Control and Prevention. 2021. Breastfeeding: Proper Storage and Preparation of Breast Milk.
  5. American Academy of Pediatrics. 2021. Breastfeeding Overview.
  6. Centres of Disease Control and Prevention. 2019. Breastfeeding: Contraindication.
  7. World Health Organization. 2020. Coronavirus disease (COVID-19): Breastfeeding Q&A.
  8. 1.Cacho N, Lawrence R. Innate Immunity and Breast Milk. Frontiers in Immunology. 2017;8(584).
  9. 2.World Health Organization. Global Strategy for Infant and Young Child Feeding: The Optimal Duration of Exclusive Breast Feeding. 54th World Health Assembly. Document A54/INF.DOC./4. World Health Organization; Geneva: 2001.
  10. 3.Australian National Health and Medical Research Council (NHMRC). 2013 Australian Dietary Guidelines. National Health and Medical Research Council. Canberra: 2013.
  11. 5.Gunaratne A, Makrides M, Collins C. Maternal prenatal and/or postnatal n-3 long chain polyunsaturated fatty acids (LCPUFA) supplementation for preventing allergies in early childhood. Cochrane Database of Systematic Reviews. 2015;(7).
  12. 6.Kominiarek M, Rajan P. Nutrition Recommendations in Pregnancy and Lactation. Medical Clinics of North America. 2016;100(6):1199-1215.
  13. 7.Leung A, Pearce E, Braverman L, Stagnaro-Green A. AAP Recommendations on Iodine Nutrition During Pregnancy and Lactation. Pediatrics. 2014;134(4):e1282-e1282.
  14. 8.Allen L. B Vitamins in Breast Milk: Relative Importance of Maternal Status and Intake, and Effects on Infant Status and function. Advances in Nutrition. 2012;3(3):362-369.
  15. 9.Fenugreek. Bethesda: U.S. Dept. of Health and Human Services, National Institutes of Health, National Center for Complementary and Alternative Medicine; 2012.
  16. 10.Sim T, Hattingh H, Sherriff J, Tee L. The Use, Perceived Effectiveness and Safety of Herbal Galactagogues During Breastfeeding: A Qualitative Study. International Journal of Environmental Research and Public Health. 2015;12(9):11050-11071.
  17. Donna Murray. 2021. 10 Herbs to Increase Breast Milk Supply.
  18. Jacquelyn Cafasso. 2016. Using Lecithin While Breast-Feeding for Plugged Ducts.

On 31 December 2019, there was an unknown cause that gave rise to pneumonia cases in Wuhan City, China. It was not long until the World Health Organization (WHO) was informed of a new Coronavirus Disease, which is known as COVID-19, until present 2021.

This infectious disease infects human beings, leading to them experiencing mild to moderate respiratory illness and recovering without requiring special treatment. 

However, there are cases where elderly and population with underlying medical conditions such as cardiovascular disease, diabetes mellitus, respiratory disease, and cancer are more prone to develop serious symptoms.

Covid-19 has been existing from 2019 until the present day, there have been plenty of questions and doubts regarding this disease. Here are 8 myths and facts about this highly infectious disease that were found to be closely related to our daily life.

1. Can Covid-19 virus be transmitted through goods, cash and groceries?

• Yes. Covid viruses can stay on the surface for many hours and up to days. Examples such as metal products can have the virus survive up to 9 days, woods up to 4 days, plastic surface up to 3 days and etc.
• Thus, it is better to be safe than sorry. It is strongly suggested to disinfect items’ surfaces and frequently-touched objects using a disinfecting spray or wipe.
• As for groceries such as fruits and vegetables, rinsing them in cold water or cleaning with vegetable brushes are adequate. Using disinfecting spray, wipe or soap can lead to possible food poisoning.

3. Is the virus able to stick to our clothes and shoes?

• There’s not much research about how long the virus lives on fabric.
• The possibility of COVID-19 being spread on shoes and infecting individuals is very low as well. As a safeguard, especially when there are infants and small children crawling or playing on floors, do remove the shoes before entering home.
• It is also recommended that proper hygiene needs to be practised, besides from showering every day, clothes should be washed with detergent or soap in 60-90 ⁰C water, drying clothes under a hot sun or in a high temperature dryer can help to kill the virus as well.

4. Can Covid-19 be prevented by rinsing the nasal cavity with saline solution? Besides, is gargling with mouthwash, warm water with salt or vinegar solution proven to prevent viruses and other things to travel into the throat and lung?

• Evidence has shown that rinsing the nose with saline solution can help the patient to recover faster from the common cold symptoms, but unable to prevent Covid-19 and other infectious respiratory diseases such as pneumonia.
• Moreover, the Centers for Disease Control and Prevention (CDC) suggested that gargling with warm salty water can help with soothing a sore throat, but not effective in stopping infection with Covid-19.

5. Are there any medications that can prevent and cure Covid-19? 

• There has been news where medications such as oral steroids, hydroxychloroquine, azithromycin and Ivermectin are claimed to be able to treat or prevent Covid-19.
• Oral steroids such as Dexamethasone have anti-inflammatory and immunosuppressive effects, which only should be used for Covid-19 patients with severe and critically ill conditions. For some Covid-19 patients on ventilators, a daily 6 mg dose of dexamethasone for 10 days may improve their health.
• Dexamethasone provides no improvement for patients with mild symptoms.
• As for hydroxychloroquine and azithromycin, randomized clinical trials and studies have been conducted to evaluate the safety and efficacy of these medications.
• In conclusion, The COVID-19 Treatment Guidelines Panel does not recommend the use of azithromycin, chloroquine, or hydroxychloroquine for the treatment of COVID-19 in both hospitalised and non-hospitalised patients.
• On the other hand, while initial research is still ongoing, FDA has neither approved nor supported the use of ivermectin to treat or to prevent COVID-19.
• All in all, currently there is no drug approved that is able to prevent and treat Covid-19 disease and taking a drug for an unapproved use can be very dangerous. Misinformation and misuse of medications can lead to overdose, side effects and contraindications that can be fatal. Patients with covid symptoms should receive proper and supportive care to alleviate the symptoms.

6. Can drinking alcohol or eating garlic help to prevent Covid-19?

• Drinking alcoholic beverages, such as wine, beer or liquor doesn’t help to prevent Covid-19. Besides, alcohol is known to harm human health and is associated with a range of diseases. Alcohol can also compromise one’s immune system; increase the risk of adverse health outcomes, leading to the person more vulnerable to Covid virus. 
• Garlic, though is known to have antimicrobial properties and used in public to prevent disease such as cold, there has been no evidence that it can help to prevent or cure Covid-19.

7. Do UV bulbs, disinfectants such as bleach or chlorine help to kill Covid-19 viruses on our body?

• First of all, it does not help with killing the virus inside the body. Besides, do not use UV bulbs, high concentration alcohol or chlorine on your hands or any part of the body because it can irritate your skin, damage body tissues such as eyes and lips.
• As advised by the Centers for Disease Control and Prevention (CDC), the best way to prevent the spread of coronavirus and reduce the likelihood of getting infected is by washing our hands with soap and water for at least 20 seconds, especially after going to the bathroom; before and after meals; and after coughing, sneezing, or blowing one’s nose.
• If soap and water are not available, alcohol-based hand sanitizer that contains at least 60% alcohol should be used.

8. Do vitamin and mineral supplements contribute to preventing and healing patients from Covid-19?

• Micronutrients, such as vitamin B, C, D, E, zinc and magnesium, are important to maintain a well-functioning immune system and play a vital role in promoting health and nutritional well-being. 
• However, there is currently no guidance on the use of micronutrient supplements as a treatment of COVID-19.

In summary, prevention is better than cure. Always protect yourself by following the standard operation procedure (SOP) such as wear mask properly, stay at least 1m from others, get vaccinated, avoid crowds and unventilated area, practice washing and sanitizing hands often, cover coughs and sneezes with hands, clean and disinfect frequently touched area, monitor your health daily and seek for health professionals if required.

Indigestion is a condition which can be pain or discomfort in your upper abdomen (Dyspepsia) or burning pain behind the breastbone (Heartburn).

Dyspepsia and heartburn may occur together or on their own.

Symptoms

– Feeling sick
– Feeling uncomfortably full or heavy
– Feeling full or bloated
– Belching or farting
– Bringing up food or bitter-tasting fluids or food into your mouth
– Heartburn, a painful burning feeling in the chest, often after eating

Causes

1) Medications
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen are one class of medications that can affect your digestive tract and cause indigestion.

2) Obesity
If you are very overweight, you are more likely to experience indigestion because of increased pressure inside your stomach. The increased pressure, particularly after a heavy meal, may lead to acid reflux into the oesophagus.

3) Overeating or eating too fast

4) Fatty, spicy and acidic foods

5) Smoking & drinking too much alcohol

6) Stress and anxiety

TREATMENTS

Medications

A) Antacids (Maalox plus)
Antacids are a type of medicine that can provide immediate relief for mild to moderate symptoms of indigestion. They work by neutralising the acid in your stomach (making it less acidic), so that it no longer irritates the lining of your digestive system.

B) Proton pump inhibitor (Controloc, Vencid), which can reduce stomach acid. PPIs may be recommended if you experience heartburn along with indigestion.

C) Histamine-2 Blockers (Famotidine), which can also reduce stomach acid.

D) Prokinetics (Motilium), which may be helpful if your stomach empties slowly.

E) Alginates (Gaviscon).
Some antacids contain a medicine called as alginate. This helps relieve indigestion caused by acid reflux. Alginates form a foam barrier that floats on the surface of your stomach contents, keeping stomach acid in your stomach and away from your oesophagus.

Alternative Treatments

A) Probiotics (Megalive FloraMax Plus, Megalive Flora 60 Plus, Hexbio, Bioflor), good bacteria exist in gut can limit the growth of bad bacteria and improve gut function.

B) Digestive Enzymes (Blackmores Digestive)

C) Aloe Vera Juice (Lifestream Aloe Vera Juice), reduce reflux symptoms by reducing acid production, boosting digestion and having anti-inflammatory properties.
D) Ginger helps to speed up emptying of stomach, thus helps in relieving indigestion and heartburn.

Diet

Lifestyle Remedies

– Eating smaller and more frequent meals. Chew your food slowly and completely.

– Do not chew with your mouth open, talk while chewing or eat quickly. This causes you to swallow air and can aggravate indigestion.

– Maintaining a healthy weight. Excess weight put pressure on your stomach, making it easier for stomach acid to be pushed back up into your oesophagus. This is known as acid reflux, and is one of the most common causes of indigestion.

– Avoid late night eating for three to four hours before you go to bed. Going to bed with a full stomach means there is an increased risk that acid in your stomach will be forced up into your oesophagus while you are lying down.

– Quit smoking. If you smoke, the chemicals you inhale in cigarette smoke may contribute to your indigestion.

– Drink fluids after meals, rather than during meals.

– Avoid alcoholic beverages

– Avoid drinks that contain caffeine – such as tea, coffee and cola.

– Avoid spicy and greasy foods.

– Managing stress. Practice relaxation techniques such as deep breathing, meditation or yoga.

What is breast cancer
Breast cancer is the most common type of cancer affecting women in Malaysia. Among 19 women in Malaysia, there is 1 woman are at risk, compared to one in eight in Europe and the United States.

What are the symptoms of breast cancer?

• A lump that is painless and hard in the breast
• A lump at the underarm area
• Swelling and redness of breast
• Nipple pain, tenderness or discharge, including bleeding
• Itchiness, soreness or rashes on nipple

How to lower the chances of breast cancer?

• Limit the consumption of alcohol to one per day for women, two for men.
• Do not smoke.
• Be physically active and exercise 1.5 to 2.5 hours weekly.
• Breastfeed your baby.
• Maintain normal body weight and reduce high-fat diet.
• Avoid staying up late frequently.
• Having clinical breast exam (CBE) starting from 20s.
• Having annual screening mammograms starting from 40 years old.
• Talk with your healthcare providers if you are on hormone replacement therapy.
• Self-examination

What is the diagnosis for breast cancer?

1. Mamogram

A mammogram is an X-ray for breast. It is the best way to find out breast cancer at early stage.

• Clinical Breast Exam (CBE)

This is an examination done by a doctor or nurse, who uses his or her hands to feel for lumps or other changes.

• Ultrasound

Ultrasound is done when a suspicious lumps are detected on your breast through breast self examination or mammogram.

• MRI

MRI can help the healthcare providers to differentiate between normal and diseased tissue.

• Biopsy

Biopsy diagnostic procedure that can be determine if the suspicious area is cancerous.

Any treatment can be done for breast cancer?

1. Surgery    

There are 2 types of surgery: breast-conserving surgery and mastectomy.

Both types of surgery are often followed by radiation therapy or other treatments such as chemotherapyor hormone therapy.

2. Radiotherapy  

Radiation therapy uses high-energy rays to kill cancer cells. 

           Common side effects of radiation therapy are:

• Swelling and heaviness in the breast
• Sunburn sensation at treated area
• Fatigue

3. Hormone therapy  

      Hormone therapy uses drugs that may either block the hormones (estrogen and progesterone) from reaching the cancer or lower the level of hormones in the body.

      Tamoxifen is an example of a hormone therapy.

     Common side effects of hormone therapy are:

• Fatigue
• Hot flashes
• Vaginal discharge or irritation
• Nausea and diarrhea
• Weight gain
• Changes in menstruation
• Bone and joint pain

4. Chemotherapy

Chemotherapy uses drugs to target cancer cells. The drugs will be injected

into the bloodstream through an intravenous (IV) needle that is inserted into a vein or through oral consumption.

Common side effects of chemotherapy are:

• Fatigue
• Loss of appetite
• Nausea and/or vomiting
• Diarrhea or constipation
• Weight change
• Mouth sores
• Short-term hair loss
• Increase the risk of infections or bleeding

Myths of breast cancer:

1. You have breast cancer if you found out there is a lump in your breast.

Actually, only small percentage of lumps will turn out to be cancer cells. However, you can seek for medical advice from doctor if you found any persistent lump in your breast.

• You are most likely to have breast cancer if you have a family history of breast cancer.

The truth is women who have a family history of breast cancer are in a higher risk group, but most women who have breast cancer have no family history. Statistic shows that only about 10% of individuals diagnosed with breast cancer have a family history of this disease.  

• Mammogram can cause the spreading of breast cancer.

The harmfulness of radiation from mammogram is extremely low, it won’t cause any spreading of cancer cells.

Reference:

1. https://www.health.ny.gov/diseases/cancer/breast/freq_asked_quest_breast_cancer.htm
2. https://www.nationalbreastcancer.org/breast-cancer-myths/a-mammogram-can-cause-breast-cancer-to-spread/
3. https://www.breastcancerfoundation.org.my/about-breast-cancer#how-breast-cancer-spreads
4. https://www.cdc.gov/cancer/breast/basic_info/screening.htm

Apa itu autisme? Autisme adalah masalah perkembangan kompleks. Ia berlaku kepada kanak-kanak di antara 1 dalam 68 orang. Kanak-kanak lelaki mempunyai kemungkinan mendapat autism 4 kali lebih berbanding kanak-kanak perempuan.

Autisme mempengaruhi perkembangan otak dan memberi kesan kepada keupayaan individu untuk berkomunikasi, berinteraksi secara sosial dan belajar seperti kanak-kanak normal yang lain.

Simptom Autisme

Kesusahan untuk berinteraksi dan berkomunikasi secara sosial.

1. Kesukaran dalam emosi-sosial secara dua hala: Anak tersebut mungkin tidak dapat mempunyai perbualan secara dua hala, tidak menunjukkan minat kepada orang lain, ataupun tidak memulakan atau memberi respon kepada interaksi sosial seperti bercakap “hai” atau mengajak kawan lain untuk bermain.

2. Kesukaran dalam komunikasi tidak verbal: Anak ini mungkin menunjukkan gejala hubungan mata yang sangat rendah dengan orang lain, mungkin menghadapi kesukaran dalam menunjukkan gerak geri atau tidak dapat mengikut gerak geri orang dewasa seperti orang dewasa menunjuk kearah sesuatu.

3. Tidak memberi respons apabila nama dipanggil. Kerana mereka tidak memberikan tumpuan semasa dipanggil atau tiada konteks mata dan keinginan untuk berkomunikasi kerana lebih memilih untuk bermain sendirian sahaja.

Tingkah Laku Yang Terhad Atau Berulang

1. Pergerakan, penggunaan objek atau percakapan yang berulang. Anak ini mungkin mengulangi pergerakan motor dan aksi berulang kali, seperti mengepakkan tangan, berpusing atau melompat, mengulangi perkataan atau ayat yang sama, atau mungkin berinteraksi dengan permainan berulang seperti menyusun mainan atau memusingkan objek secara berterusan.

2. Minat yang sama dan terhad kepada sesuatu perkara sahaja. Anak ini mungkin menunjukkan ikatan yang kuat kepada minat tertentu seperti karakter kartun, permainan dan topik yang tertentu.

3. Hiper- atau hipo-reaktiviti terhadap penerimaan sensori. Anak ini mungkin tidak mengendahkan sensitiviti terhadap cahaya, bunyi, kesakitan, suhu, tekstur dan pergerakan dalam persekitaran mereka. Misalnya, mereka sangat seronok untuk melompat dan merempuh barang, mencari atau mengelak cahaya terang dan bunyi yang kuat, sama seperti kemahuan untuk menyentuh, menghidu atau menjilat sesuatu objek.

Komplikasi

Seseorang yang menghidap autisme akan mendapat gejala yang berlainan mengikut umur masing-masing.

• Peringkat awal kanak-kanak – Hiperaktif, panas baran
• Peringkat akhir kanak-kanak – suka menyerang, mencederakan diri sendiri
• Peringkat remaja dan dewasa – kemurungan dan epilepsi

Rawatan

Standard emas untuk rawatan autisme adalah Rawatan Tingkah Laku Intensif menggunakan pendekatan Analisis Tingkah Laku Gunaan ( Applied Behavioral Analysis ABA)

Tiada ubat yang dapat menyembuhkan autisme tetapi ada beberapa jenis ubat yang dapat mengawal gejala-gejala yang timbul disebabkan autisme seperti:

• Berkelakuan ganas
• Hiperaktif
• Masalah tidak mampu fokus
• Kebimbangan yang mungkin timbul

Pemantauan Perkembangan Awal Kanak-Kanak

Sila dapatkan nasihat dari pihak profesional jika anak anda terlepas salah satu perkembangan di bawah:

4 Bulan

Memberi pandangan tepat
Mula membuat bunyi
Tersenyum apabila melihat orang lain

6 Bulan

Memberi respons apabila nama dipanggil
Mula membuat bunyi ”ah”, ”eh”, ”oh”
Boleh berguling dari posisi baring ke meniarap

9 Bulan

Memahami perkataan ”tidak”
Duduk tanpa sokongan
Boleh menggunakan jari untuk tunjuk kemahuan

12 Bulan

Berjalan dengan sokongan
Mempunyai 1 hingga 3 perkataan
Boleh menggelengkan kepala untuk nyatakan ”tidak” dan melambaikan ”bye”.

A report done by the World Health Organization (WHO) examined more than 55,000 confirmed cases of COVID-19 and found out that headache occurred in 13.6% of the COVID-19 cases. However, the actual occurrence of headache in COVID-19 may be higher in some populations.[1] Besides that, a recent online survey explored the real-world impact of COVID-19 on patients with migraine and showed that about 60% of respondents had an increased episodes of migraine frequency, 16% reported a decrease in migraine frequency, and a little over 10% reported converting from episodic migraine to chronic migraine. [2]

Headache is one of potential symptoms of COVID -19 and it is a common condition that causes pain and discomfort in the head, neck or scalp.[1] However, migraine is often described as recurrent throbbing or pulsating, moderate or severe headache felt on either right or left side of the head.[3]

Headaches are classified into primary and secondary headaches. Primary headaches are the results of underlying process of brain whereas secondary headaches are usually due to underlying medical condition. Examples of primary headaches include tension headache, cluster headache, migraine etc.[1] There are 3 types of migraines such as migraine with aura, migraine without aura and silent migraine. Migraine without aura is the most common type, where the migraine happens without any specific warning signs.[3]

Image 1 : Tension headache, cluster headache and migraine[7]

The exact cause of migraine is unknown but the attacks from migraine are believed as the result of abnormal brain activity temporarily affecting nerve chemicals, blood vessels and signals in the brain. Migraine is initiated by specific triggers like emotional trigger, physical trigger, environmental trigger and dietary trigger as shown in the table 1 below.[3]

Table 1 : List of examples of specific triggers that initiate migraine[3]

There are a few treatments to reduce symptoms of migraine but there is no cure for migraine. The most common classes of drugs prescribed by healthcare professionals to treat headaches include painkillers, analgesics and anti-emetics.[4]

Prevention is better than cure. One of the best ways to prevent headaches or migraines is by avoiding the specific triggers that could possibly trigger an attack. Avoid excess caffeine intake by limiting caffeine to 2 to 3cups, or none of coffee daily can actually help in reducing migraines.[5] Staying in a quiet, dark room may help to ease migraines too. Furthermore, practising a healthy lifestyle such as sufficient sleep, lower stress, stay hydrated and exercise regularly is important to prevent migraines.

Taking supplements and herbs are also highlighted in reducing headaches and migraines. 

According to studies by University of Minnesota, taking 200mg of vitamins B12 twice daily and taking 200mg of Magnesium twice daily may help in migraine. In addition, frequency of headache may be reduced by taking150mg of coenzyme Q10 once daily.[5] Taking 60mg-100mg of Ginkgo biloba once daily also aids in reducing headaches and migraines.[6]

Conclusion

Most headaches aren’t symptoms of life-threatening medical conditions. However, please consult the doctor if you have headache for quite some time or headache that happens after any head trauma incidents.

References :

1. https://www.healthline.com/health/headache/coronavirus-migraines (medically reviewed by Deena Kuruvilla, MD, written by Jill Seladi-Schulman, Ph.D. on 27Aug2020)
2. https://www.medscape.com/viewarticle/950452 (by Deena Kuruvilla, MD on 12 May 2021)
3. https://www.nhs.uk/conditions/migraine/
4. https://www.who.int/news-room/fact-sheets/detail/headache-disorders (WHO website 8 Apr 2016)
5. https://www.healthline.com/health/headache (medically reviewed by Saurabh Sethi, M.D., written by Rachel Nall, MSN, CRNA and Matthew Solan and Verneda Lights on 2 Aug 2018)
6. https://pubmed.ncbi.nlm.nih.gov/19415441/ (by Giovanni D’Andrea et al. Neuro Sci. 2009 May)
7. Image :  https://www.wisemedical.com.au/headache-or-migraine/ (website)

Puasa Ramadan ertinya menahan diri daripada makan dan minum serta segala perbuatan yang boleh membatalkan puasa, mulai dari terbit fajar sehinggalah terbenam matahari pada bulan Ramadan.

Pada bulan Ramadan, umat Islam akan menahan lapar dan dahaga lebih daripada 12 jam sehari. Oleh itu, mereka yang berpuasa perlu menggunakan dua waktu makan yang dibenarkan sehari iaitu sahur dan iftar dengan sebaik mungkin.

Penghidratan adalah salah satu risiko yang dihadapi semasa berpuasa kerana cuaca yang panas dan lembap. Ramai yang mengalami sakit kepala dan masalah untuk menumpukan perhatian semasa berpuasa. Tabiat pemakanan yang berbeza dalam 30 hari berpuasa boleh mengakibatkan pelbagai masalah penghadaman, sakti gastrik dan sembelit. Ketidakhadaman juga boleh berlaku akibat makan terlalu banyak daripada biasa semasa berbuka.

Namun begitu, daripada menambahkan jumlah makanan semasa berbuka atau sahur, lebih baik bagi anda memilih jenis dan kualiti makanan yang sesuai dimakan supaya kesan-kesan negatif berpuasa di bulan Ramadan boleh dielakkan.
Mari lihat jenis makanan yang sesuai dimakan sewaktu sahur dan berbuka untuk meningkatkan tenaga anda.

1) Kekalkan Hidrasi dengan Makanan yang Mempunyai Kandungan Air yang Tinggi

Selain daripada minum air kosong, anda boleh mengambil makanan yang tinggi dengan kandungan air seperti tembikai merah, timun, tomato dan strawberi.
Elakkan minuman yang mengandungi kafein seperti kopi dan teh kerana kafein boleh menambah pembuangan air kencing dan menyebabkan air dalam badan kita kurang.

2) Makanan Tinggi Protein

Makanan tinggi protein boleh membantu anda kurang penat sepanjang hari. Protein mengambil masa lebih lama untuk hadam dan anda akan merasa kenyang untuk tempoh masa yang panjang. Telur, keju, ayam dan daging adalah pilihan yang baik.
Susu tepung seperti MK Nutrasure dan Ensure Gold Liquid sesuai untuk diambil semasa bulan puasa kerana kandungan protein yang lebih tinggi berbanding susu tepung yang lain.

3) Makanan yang Tinggi Kandungan Kanji dan Serat

Makanan berserat tinggi boleh membantu mengawal ketidakhadaman dan pedih ulu hati. Anda boleh cuba oat, bijirin tinggi serat dan roti gandum penuh kerana ia boleh membantu anda merasa kenyang untuk tempoh masa yang lebih panjang.
Karbohidrat kompleks dalam makanan berkanji seperti nasi perang, dan kentang adalah pilihan yang bagus untuk tenaga dan mampu meningkatkan tumpuan. 

4) Penghadaman yang Lancar dengan Buah-buahan dan Sayur-sayuran

Untuk mengatasi masalah sembelit, kurangkan pengambilan makanan yang berlemak, bergoreng dan pedas sewaktu sahur. Anda boleh meningkatkan pengambilan buah-buahan dan sayur-sayuran kerana ia kaya dengan serat dan boleh mengelakkan sembelit. Amalkan brokoli, sayur bayam, keledek, lentil dalam pemakanan.

5) Pilih Lemak dan Minyak yang Sesuai

Lemak yang baik memainkan peranan yang penting dalam diet seimbang. Makanan yang kaya dengan lemak sihat seperti salmon, zaitun dan kacang-kacang boleh dirangkumi dalam pemakanan anda. Selain itu, minyak yang digunakan untuk memasak juga sangat penting. Anda boleh menggunakan minyak kepala dara, minyak dedak beras dan lain-lain.

6) Berbuka Puasa dengan Kurma

Kurma secara tradisinya dimakan pada permulaan iftar kerana ia mengandungi gula semula jadi, serat dan mineral. Selain itu, kurma mudah dicerna, menjadikannya sumber tenaga dan nutrien yang cepat bagi individu yang berpuasa.

7) Supplemen

Selain pemakanan yang sihat, supplemen dan minuman sihat adalah sumber vitamin dan mineral yang bagus.
Individu yang mempunyai masalah gastrik atau ketidakhadaman boleh mengambil probiotik untuk mengurangkan senak dan kembung yang disebabkan oleh perubahan tabiat makan secara tiba-tiba. Probiotik boleh membantu menyeimbangkan semula mikroflora normal dalam sistem pencernaan dan megurangkan risiko gastrik.

Susu tepung seperti MK Glucerwin, MK Colostrum, Ensure Gold Liquid, Glucerna membekalkan nutrisi yang lengkap dan membekalkan makro- dan micro-nutrien yang diperlukan oleh badan kita. Susu tepung adalah pilihan alternatif yang sesuai untuk Muslim yang berpuasa sebagai makanan penggantian pada waktu sahur atau iftar.

Bagi individu yang tidak gemar susu tepung atau minuman sihat, multivitamin adalah pilihan terbaik semasa bulan puasa. Multivitamin bukan hanya membekalkan vitamin dan mineral yang lengkap, ia juga membantu membekalkan tenaga untuk badan kita sepanjang tempoh
berpuasa. Oleh itu, multivitamin adalah penting pada bulan puasa untuk menambahkan balik vitamin dan mineral yang diperlukan untuk seharian.

Perlu diingatkan bahawa kesederhanaan adalah kunci untuk pemakanan sihat. Selain itu, kita juga harus mengamalkan pergerakan fizikal yang aktif, contohnya, dengan berjalan-jalan atau berjoging setiap hari. Pemakanan yang sihat adalah penting dan harus diamalkan selalu bukan sahaja pada bulan puasa! Dengan ini, kami mengucapkan selamat berpuasa kepada semua orang!

Human heart disease and chest pain from clogged arteries and artery damaged with cholesterol resulting in a cardiac arrest with 3D illustration elements.

Apakah itu asma?

Asma merupakan penyakit paru-paru kronik yang membengkak dan menyempitkan saluran pernafasan. Semasa serangan asma, simptom-simptom yang mungkin akan pesakit mengalami adalah seperti ‘wheezing’ (bunyi bersiul apabila sedang bernafas), kesesakan dada, sesak nafas dan batuk.

Serangan yang ringan hanya akan berlangsung selama beberapa minit dan dapat diselesaikan sama ada secara spontan ataupun dengan ubat sedutan pelega. Serangan yang teruk akan berterusan walaupun dengan penggunaan ubat sedutan, dan akan memerlukan pemeriksaan segera oleh doctor.

Apakah Penyebab Asma?

Faktor-faktor ini berbeza untuk setiap individu:

1. Jangkitan sistem pernafasan seperti selesema, sinusitis dan bronkitis
2. Pencemaran udara ataupun pendedahan kepada asap rokok
3. Bahan penyebab alahan seperti debu, bulu haiwan, makanan, dan lipas
4. Pendedahan kepada cuaca sejuk dan kering atau perubahan suhu secara tiba-tiba
5. Perubahan emosi atau tekanan
6. Senaman fizikal
7. Ubat-ubatan (aspirin, asid mefenamic, ibuprofen)

Apakah Gejala Asma?

Serangan asma mungkin berlaku secara tiba-tiba atau secara progresif selama beberapa hari atau jam. Simptom yang menandakan serangan asma adalah seperti berikut:

1. Bunyi berdeham atau “wheezing” semasa bernafas
2. Sesak nafas
3. Ketat dada
4. Batuk
5. Kesukaran bercakap
6. Keletihan
7. Jantung berdebar-debar
8. Penggunaan otot aksesori untuk bernafas
9. Kadar pernafasan berkurang

Apakah Rawatan Asma?

Ubat-Ubatan

1. Ubat Penyelamat (reliever)

Ubat penyelamat diambil apabila tanda-tanda serangan asma bermula. Contoh: Salbutamol.

2. Ubat Pengawal (controller)

Ubat pengawal diambil setiap hari untuk kawalan asma yang berterusan. Ia membantu mengurangkan keradangan ketika serangan asma.
Contoh: Budesonide, Fluticasone.

Supplemen

1. Vitamin D

Vitamin D dianggap memberi kesan kepada tahap sel imun tertentu dan mengurangkan tindak balas keradangan yang disebabkan oleh jangkitan pernafasan virus. Banyak kajian telah menunjukkan hubungan antara vitamin D dan asma. Tahap vitamin D yang tinggi telah dijumpai untuk melindungi daripada perkembangan asma dan wheeze yang berulang pada zaman kanak-kanak. 

2. Vitamin C

Vitamin C mempunyai ciri-ciri anti-radang dan antioksidan yang menjadikan ia potensi minat dalam asma.

Antioksidan biasanya menghalang kesan merosakkan tekanan oksidatif dan spesies oksigen reaktif yang dihasilkan oleh sel-sel radang di dalam paru-paru. Idea ini ialah pengambilan antioksida yang rendah seperti vitamin C menyebabkan ketidakseimbangan yang menyokong keradangan kronik dan kerosakan pada paru-paru.

3. Cendawan susu harimau (Tigermilk Mushroom)

Cendawan susu harimau merupakan salah satu alternative yang boleh menguatkan system pernafasan. Cendawan susu harimau boleh melegakan simptom pernafasan contohnya batuk kronik dan berulang, asma dan resdung dengan berkesan sebab ia merupakan agen anti radang yang semula jadi.

4. Cordyceps Sinesis

Cordyceps mengandungi nutrient seperti adenosine, cordycepin, asid cordycepic, polisakarida, asid amino dan vitamin. Menurut klinikal studi, Cordyceps dapat meredakan masalah pernafasan seperti asma atau batuk dan menguatkan fungsi paru-paru.

5. Bawang Putih

Bawang putih mengandungi bahan pencegah radang (anti-inflammatory) dan juga allicin iaitu sejenis agen antioksida yang dapat mengurangkan serangan asma.

Langkah-langkah untuk mencegah serangan asma

1. Hindari daripada allergen
Allergen seperti bulu binatang, debu, serbuk dari bunga harus dielakkan.

2. Hindari daripada asap rokok
Asap rokok dapat mengiritasi saluran penafasan dan seterusnya mengalami serangan asma. Oleh itu pesakit asma digalakkan berhenti rokok suaya melindungi paru-paru sendiri.

3. Rajin olahraga
Berolahraga dapat membantu melatih stamina otot pernafasan dan memperkuat daya tahan tubuh penderita asma. Berenang agak digalakkan oleh doctor untuk penderita asma. Elakkan berolahraga ketika cuaca dingin ataupun cuaca jerebu.

4. Laraskan diet
Gastritis atau GERD merupakan salah satu factor risiko asma. Oleh itu, laraskan diet agar acid perut tidak naik dan mencetuskan asma. Elakkan kopi, the, makanan pedas dan masam.

5. Vaksinasi Flu
Influenza akan menyebabkan masalah paru-paru yang sedia ada menjadi lebih teruk. Pesakit asma digalakkan mengambil vaksin supaya mendapat perlindungan yang lebih baik terhadap pesakit asma.

Cara penggunaan inhaler (MDI) yang betul

1. Duduk atau berdiri tegak
2. Keluarkan penutup dari corong
3. Letakkan alat sedut dengan jari telunjuk di bahagian atas tabung dan ibu jari di bahagian bawah
4. Goncang alat sedut
5. Tarik nafas sepenuhnya melalui mulut dan hembus nafas perlahan-lahan
6. Letakkan pelekap mulut alat sedut di dalam mulut. Tutup bibir di sekitar corong dengan rapat. Dongakkan kepala sedikit ke belakang
7. Mula untuk menarik nafas perlahan-lahan dan mendalam melalui corong dan pada masa yang sama tekan ke bawah pada tabung alat sedut dengan jari telunjuk
8. Terus tarik nafas dalam dan dengan perlahan-lahan tahan nafas selama 5 hingga 10 saat (mengikut kemampuan)
9. Keluarkan alat sedut dari mulut dan hembus nafas perlahan-lahan melalui hidung tanpa membuka mulut
10. Tunggu 1 minit sebelum mengulangi dos kedua
11. Gantikan penutup selepas digunakan
12. Bilas mulut selepas menggunakan steroid yang telah disedut

Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) is a condition in men where the prostate gland is enlarged but non-cancerous. As the prostate enlarges, the gland presses and pinches against the urethra. The bladder wall becomes thicker (Figure 1). Eventually, the bladder may become weaken and lose the ability to empty completely, leaving some urine in the bladder.

Figure 1: Normal prostate vs enlarged prostate

BPH affects about 50 percent of men between the ages of 51 and 60 and up to 90 percent of men older than 80, evidence clearly shows that the morbidity of BPH increase with age. In addition, BPH can be induced by a range of risk factors, including obesity, hyperlipidemia, type 2 diabetes, genetic factor and certain hormonal disorders.

The common symptoms of BPH includes:

•  Difficulty starting to urinate despite pushing and straining
• A weak stream of urine; several interruptions in the stream
• Dribbling at the end of urination
• A sudden strong desire to urinate
• Frequent urination
• The sensation that the bladder is not empty after urination is completed
• Frequent awakening at night to urinate (nocturia)
• Pain while urinating

How is benign prostatic hyperplasia (BPH) treated?

At present, the primary goals of BPH treatment are to improve quality of life, inhibit disease progression, and reduce complications. BPH is usually treated with alpha-adrenergic blockers and 5-alpha reductase inhibitors. Alpha blocker helps to relax the smooth muscles of the prostate and bladder neck to improve urine flow and reduce bladder blockage. It has faster onset of action so it is recommended as first line treatment for men with mild to moderate symptoms. Examples of alpha blockers are terazosin (Hytrin), doxazosin (Cardura) (Kamiren XL), tamsulosin (Harnal OCAS) and alfuzosin (Xatral). 5-alpha-reductase inhibitors are medicines that can stop the prostate from growing further or even cause it to shrink by decreasing the production of hormone, dihydrotestosterone (DHT) which affects the growth of prostate gland. Finasteride (Proscar) and dutasteride (Avodart) are example of alpha-reductase inhibitors.

Apart from medications, behavioural modifications and therapies may be helpful, particularly as an adjunct to medications. Lifestyle changes include nightly fluid restriction, timed bladder voiding, double-voiding techniques, regular physical activity, pelvic floor muscle training and avoiding caffeine, alcohol, and highly seasoned food.

*Double voiding – it involves passing urine twice each time you go to toilet. Firstly, urinate as usual then wait for 20-30 seconds, urinate again. This technique is effective for those who feel like their bladder is not empty or who return quickly to the bathroom after voiding.

Natural remedies for enlarged prostate (BPH)

• Saw palmetto

Remedy that comes from fruit of palm tree. It is an inhibitor of 5 alpha reductase. It has anti-inflammatory and hormone-blocking properties. Saw palmetto is used to relieve urinary symptoms caused by benign prostatic hyperplasia (BPH).

• Pygeum bark

It contains a wide range of fatty acids, alcohols and sterols such as beta-sitosterol. It has an antioxidant and anti-inflammatory effect on urogenital system. Able to improve symptoms of benign prostatic hyperplasia.

• Tomato

It consists of lycopene, a powerful antioxidant that protect cells from damage and improve prostate health.

• Pumpkin seed

It consists of zinc which is able to decrease the production of dihydrotestosterone (DHT) and inhibit this androgen from binding to receptors, potentially reducing BPH symptoms.

• Cranberry

It contains phytonutrients with anti-inflammatory properties. It is used to prevent bladder and urinary tract infection by preventing bacteria from sticking to the wall of the bladder. Shown improvement in urinary flow.

References:

1. Information H, Diseases U, Problems P, Hyperplasia) P, Hyperplasia) P, Health N. Prostate Enlargement (Benign Prostatic Hyperplasia) | NIDDK [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases. 2021 [cited 18 October 2021]. Available from: https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia
2. Egan K. The Epidemiology of Benign Prostatic Hyperplasia Associated with Lower Urinary Tract Symptoms. Urologic Clinics of North America. 2016;43(3):289-297.
3. Calogero A, Burgio G, Condorelli R, Cannarella R, La Vignera S. Epidemiology and risk factors of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction. The Aging Male. 2018;22(1):12-19.
4. Yoo S, Oh S, Park J, Cho S, Cho M, Jeong H et al. The impacts of metabolic syndrome and lifestyle on the prevalence of benign prostatic hyperplasia requiring treatment: historical cohort study of 130 454 men. BJU International. 2018;123(1):140-148.
5. Yu Z, Yan H, Xu F, Chao H, Deng L, Xu X et al. Efficacy and Side Effects of Drugs Commonly Used for the Treatment of Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia. Frontiers in Pharmacology. 2020;11.
6. Fonseca J, Martins da silva C. The diagnosis and treatment of lower urinary tract symptoms due to benign prostatic hyperplasia with α-blockers: focus on silodosin. Clin Drug Investig. 2015;35(suppl 1):7-18.
7. 10 natural remedies for enlarged prostate and lifestyle tips [Internet]. Medicalnewstoday.com. 2021 [cited 4 November 2021]. Available from: https://www.medicalnewstoday.com/articles/321231#lifestyle-tips

Hypertension is defined as persistent elevation of systolic blood pressure (BP) of 140 mmHg or greater and/or diastolic BP of 90 mmHg or greater, taken at least twice on two separate occasions.

What are the symptoms of Hypertension

Hypertension is generally a silent condition as it has no particular symptoms. However, there are some symptoms which occur simultaneously can be associated with high blood pressure. These symptoms include:

• Headaches
• Shortness of breath
• Nose bleed
• Facial redness and fatigue
• Dizziness
• Chest pain
• Visual changes
• Blood in the urine
• Throwing up
• Asphyxiated
• Agitated

What are the causes of Hypertension

The exact causes of primary hypertension remains unclear, but several risk factors are strongly and independently associated with its development, which include:

1) Age
Advancing age is associated with increased blood pressure, particularly systolic blood pressure and an increased incidence of hypertension.

2) Obesity
Obesity and weight gain are major risk factors for hypertension and are also determinants of the rise in blood pressure that is commonly observed with aging.

3) Family history
Hypertension is approximately twice as common in subjects who have one or two hypertensive parents and multiple epidemiologic studies suggest that genetic factors account for approximately 30 percent of the variation in blood pressure in various populations.

4) High-sodium diet
Excess sodium intake (eg: >3 g/day [sodium chloride]) increases the risk for hypertension and sodium restriction lowers blood pressure in those with a high sodium intake.

5) Excessive alcohol consumption
Excess alcohol intake is associated with the development of hypertension and alcohol restriction lowers blood pressure in those with increased intake.

6) Physical inactivity
Physical inactivity increases the risk for hypertension and exercise is an effective means of lowering blood pressure.

What are the effects of Hypertension on the body?

The blood vessels and body organs can be damaged by the excessive pressure on the artery walls caused by hypertension. The higher the blood pressure and the longer it goes uncontrolled, the greater the damage.
Uncontrolled high blood pressure can lead to complications including:

1) Damaged arteries

Healthy arteries are flexible and strong. Blood flows freely and unobstructed through healthy arteries and vessels.
Hypertension makes arteries tougher, tighter, and less elastic. This damage makes it easier for dietary fats to deposit in your arteries and restrict blood flow. This damage can lead to increased blood pressure, blockages, and, eventually, heart attack and stroke.

2) Damaged heart

To pump blood against the higher pressure in the vessels, the heart has to work harder. This causes the walls of the heart’s pumping chamber to thicken (left ventricular hypertrophy). Eventually, the thickened muscle may have a hard time pumping enough blood to meet the body’s needs, which can lead to heart failure.

3) Damaged other organs

Weakened and narrowed blood vessels in kidneys which can prevent these organs from functioning normally.
Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.

4) Damaged brain

Your brain relies on a healthy supply of oxygen-rich blood to work properly. High blood pressure can reduce your brain’s supply of blood.
Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain type of dementia (vascular dementia). A stroke that interrupts blood flow to the brain also can cause vascular dementia.

What are the treatments of Hypertension?

MEDICATIONS

1) ACE Inhibitors
Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure by relaxing your blood vessels.
Example: Perindopril, Enalapril, Ramipril

2) Angiotensin II Antagonists
Angiotensin II antagonist work in a similar way to ACE inhibitors. They’re often recommended if ACE inhibitors cause troublesome side effects.
Example: Ibesartan, Losartan, Valsartan

3) Beta-Blockers
Beta blockers can reduce blood pressure by making your heart beat more slowly and with less force.
Example: Atenolol, Bisoprolol.

4) Calcium Channel Blockers
Calcium channel blockers reduce blood pressure by widening your blood vessels.
Example: Amlodipine, Nifedipine, Felodipine

5) Diuretics
Diuretics work by flushing excess water and salt from the body through your urine.
They’re often used if calcium channel blockers cause troublesome side effects.
Example: Furosemide, Amiloride, Spironolactone

SUPPLEMENT

1) Fish Oil
Fish oil may improve heart health by reducing blood lipid levels, inflammation, and high blood pressure. Studies show that those with high blood pressure may benefit from high-dose fish oil supplements (0.18-15g per day with 450-600mg content of EPA and DHA per g of fish oil).

2) Garlic
Garlic is found benefit in reducing both blood pressure and heart disease risk. Adding a garlic supplement may help lower blood pressure naturally. In fact, garlic supplements reduced systolic and diastolic blood pressure by an average of 8.3 mmHg and 5.5 mmHg respectively. It is estimated that this reduction may help decrease the risk of stroke, heart attack, and coronary artery disease by up to 40%.

3) CoQ10
CoQ10 is suggested to improve heart-related conditions like hypertension through neutralizing free radicals, increasing the production of energy in cells, and preventing the formation of blood clots. There is study suggest that this supplement can help in reducing both systolic and diastolic blood pressure (dose vary from 75–360 mg/day).

4) Magnesium
Magnesium is a mineral that’s critical for many bodily functions, including blood pressure regulation. Magnesium supplements may help reduce blood pressure by increasing the production of nitric oxide, a signaling molecule that helps relax blood vessels.
Every 100-mg daily increase in dietary magnesium was linked to a 5% reduction in high blood pressure risk.

Glaucoma is a disease involving the optic nerves of the eyes- usually affecting both of the eyes. It usually occurs when there is an escalation of pressure in the eyes. Our eyes usually produce a protective fluid (that surrounds the tissues of the eyes) also known as aqueous humour. An optimum eye pressure is achieved when the amount of fluid produced is equivalent to the amount of fluid being drained out of the eyes. If there is any slight blockage in the outflow channel, the pressure in the eyes rises due to the accumulation of the fluid surrounding the eyes.

            There are several distinguished types of glaucoma; one being acute or close-angle glaucoma that is rare and occurs due to a sudden, high increment in the eye pressure which causes pain. Another type being chronic or open-angle glaucoma which occurs gradually and is often left undetected due to the absence of any signs or symptoms. Next, secondary glaucoma is caused by an inflammation of the middle layer of the eyes. Another type of glaucoma would be childhood or congenital glaucoma which is extremely rare and only occurs in very young children due to abnormalities in the eyes.

            A few risk factors increase the chances of developing glaucoma. One of them is family history which means if your parents or siblings have glaucoma, you have a significant risk of developing it as well. Another risk factor would be age– the older you are, the higher the risk of developing glaucoma. Ethnic groups also play a role in increasing the chance of developing glaucoma, in which people who are of Afro-Caribbean and African descent will have a higher risk of developing glaucoma. Other than that, short sightedness can also make you more prone to develop glaucoma. Diabetes also appears to be another risk factor of developing glaucoma.

            Oftentimes, glaucoma goes undetected due to absence of signs and symptoms in the early stages. Given the situation that you have acute or open-angle glaucoma, it will take a long time before your eyesight deteriorates. When a person experiences blurred vision, dull pain around the head, nausea or vomiting or seeing a glare or shadow around the light of a lamp, he or she is usually at a severe level and require guidance from an ophthalmologist with urgency. Therefore for those that have a higher risk for developing glaucoma, it would be advisable to undergo an eye examination yearly. After all, prevention is better than cure.

            Thus, eye tests that are simple and painless should be performed regularly for early detection. Firstly, an eye pressure test in which a local anesthetic eye drop will be placed in both of the eyes before a small instrument is gently placed against your eye to measure the intraocular pressure of the eyes.

                                                                         Eye pressure test  

                            Next, optic nerve examination can be conducted to examine the condition of your optic nerves.

Once damage is done to the vision by glaucoma, it is hardly reversible. However, there are treatments that can prevent the eye-sight from going worse. The go-to treatment for acute or open-angle glaucoma is eye drops that patients need to use for lifelong. In the early stages of glaucoma, these eye drops can help control the eye pressure and therefore prevent further damage to the eyes. The effectiveness of the eye drop will be determined by the ophthalmologist upon regular glaucoma checks. If the use of eye drops is unable to control glaucoma, laser procedures can help to drain the fluid out of the eye effectively or surgery on the draining channel can be performed as well. 

            Certain lifestyle habits can be easily adapted to reduce the severity of glaucoma. Firstly, limit caffeine intake as caffeine can increase the pressure of the eyes. Next, limit alcohol intake as excessive drinking of alcohol can damage optic nerves. Fish oil supplements can help to improve eye health as well. Exercising cautiously can help to improve glaucoma and general health. Other than that, sleeping with your head on a pillow can help to reduce eye pressure as well.

References

1. Ow Yong, S.E. (2021). [Comparison of normal eye with glaucoma eye]. Vista Eye Specialist. https://www.vista.com.my/pages/2021/02/17/glaucoma/
2. Salmon, J. (2015) Glaucoma information for patients. Available at: https://www.ouh.nhs.uk/patient-guide/leaflets/files/11826Pglaucoma.pdf
3. NHS. (2021). Glaucoma. Available at: https://www.nhs.uk/conditions/glaucoma/
4. Glaucoma UK. (2021). Living with Glaucoma. Available at: https://glaucoma.uk/care-support/living-with-glaucoma/
5. Othman, S. (2019). Glaukoma. Available at: http://www.myhealth.gov.my/dewasa-glaukoma/

Gout is a crystal-induced arthritis. A condition that resulted from deposition of monosodium urate (MSU) crystals in various tissues (eg joints, connective tissue, kidney) due to elevated serum urate level. 

Gout is always associated with the symptoms of sudden, severe attacks of pain, swelling, redness and tenderness in one or more joints. In patients with acute gout attack, joints of the lower limbs are more affected than upper limbs. It will usually last for few days to 3 weeks with a gradual complete resolution of the inflammation.
The normal uric acid level for adult male is 2.5-7.0 mg/dL. whereas for adult female is 1.5-6.0 mg/dL.

RISK FACTOR

1) Diet

Diet with purine-rich food will cause body to produce too much uric acids which form MSU crystal and gout.
Example of purine rich food: red meat, shellfish, drinking beverages sweetened with fruit sugar (fructose), alcohol consumption, especially of beer.

2) Weight

It is likely that higher BMI increases the risk of gout by increasing the serum uric acid level. Hyperuricemia has been associated with obesity via both increased production and decreased renal excretion of urate.

3) Medical Conditions

Some underlying medical conditions can increase the risk of developing gout, including:
– High blood pressure
– Diabetes
– Kidney disease
– High levels of cholesterol in blood

4) Certain Medications

Certain medications can increase your uric acid levels and your risk of developing gout. These include:
– Diuretics: used to treat high blood pressure or an abnormal build-up of fluid in your body
– Certain medicines used to treat high blood pressure: Beta-blockers and ACE inhibitors
– Low-dose aspirin: used to reduce the risk of blood clots

5) Family History

Gout is caused by a combination of genetic and environmental factors. Patients with family history of gout will have an increase risk of developing gout too.

SIGN AND SYMPTOMS

Gout is always associated with the symptoms of sudden, severe attacks of pain, swelling, redness and tenderness in one or more joints. In patients with acute gout attack, joints of the lower limbs are more affected than upper limbs. It will usually last for few days to 3 weeks with a gradual complete resolution of the inflammation. For acute gout attack, it is usually monoarticular. However, gout will progress into chronic gout when the patients does not have a good control on their diet or uric acid level. For chronic gout, it is usually polyarticular arthritis and the formation of tophi.

STAGES OF GOUT

1) Acute Gout

Acute gout commonly present as an acute, self-limiting, mono-articular inflammatory arthritis. Joint at the lower limbs are more affected than the upper limbs. The affected joints will have erythema (redness of the skin), warmth and swelling over the joint. Fever may be present.
Attack of acute gout last for a few days to 2-3 weeks, with a gradual complete resolution of all inflammatory sign

2) Chronic Gout

Chronic gout present with polyarticular arthritis and the formation of tophi. Tophi are chalky deposits of MSU crystal. They are subcutaneous and painless. They will appear as a firm, nodular or fusiform swellings. Tophaceous disease more likely occur in patients where serum urate level more than 9mg/dl.
Sites of tophi includes digit of the hands and feet (most common), pinna of the ear, bursa around elbows and knees, achilles tendon (tendon that connect calf muscle to heel).

DIAGNOSIS OF GOUT

Clinical diagnosis of gout is based on whether the patients experience two or more of the following criteria:

1. Presence of clear history of at least two attacks of painful joint swelling with complete resolution within 2 weeks.
2. A clear history or observation of podagral
3. Presence of tophus
4. Rapid response to colchicine within 48 hours of starting treatment. 

TREATMENT

A) Medications

– NSAIDs
Non-steroidal anti-inflammatory drugs (NSAIDs) are usually recommended as the first treatment for gout. They work by reducing pain and inflammation during an attack.
Example: Indomethacin, Naproxen, Diclofenac, Celecoxib

– Colchicine
If NSAIDs are ineffective, a medicine called colchicine can be used instead.
Colchicine reduces some of the swelling and pain associated with a gout attack. When taken in high doses, side effects of colchicine include feeling sick, abdominal pain and diarrhea.

– Corticosteroids
Corticosteroids are sometimes used to treat severe cases of gout if other treatments don’t work or unable to take an NSAIDs or colchicine.
A short course of steroid tablets often provides relief, but they can’t be used long-term in high doses as they cause side effects, including weight gain, osteoporosis, muscle weakness.

– Allopurinol
Allopurinol helps reduce the production of uric acid. It can help prevent gout attacks, although it won’t help relieve symptoms during an attack.

B) Alternative treatment

– Urinary Alkalinizer
Sodium citrate is metabolized to bicarbonates which increases urinary pH by increasing the excretion of free bicarbonate ions without producing systemic alkalosis when administered in recommended doses. (Ural: 1-2 sachet dissolved in water for four times a day)
 A rise in urinary pH increases the solubility of cystine in the urine and the ionization of uric acid to more soluble urate ion. By maintaining an alkaline urine, the actual dissolution of uric acid stones may be accomplished.

– Cherry Juice
According to studies, tart cherry reduce uric acid because of the ingredients anthocyanins. Anthocyanin have its anti-inflammatory effect which makes cherry juice a natural anti-inflammatory. Hence, this will help to resolve gout swelling in patient.

– Celery Extract
Studied shown that celery extract have significantly reduced the serum uric acid, lipid peroxidation, and increase activity of antioxidant enzyme levels in gouty rats. This may be due to the inhibition of xanthine oxidase activity.

– Juniper Berry
Juniper is traditionally known as a diuretic, it was valued as a urinary and kidney remedy in Europe and the Mediterranean. The American ethnic physicians used Juniper berry to treat arthritic gout because of the inhibition of xanthine oxidase. Juniper berry is noted to exert powerful antioxidant activity. It also has anti-inflammatory, analgesic, and hepatoprotective effects.

LIFESTYLE ADVICES

Certain lifestyle changes can also help reduce your risk of experiencing further attacks of gout, including:

– Avoiding foods containing high levels of purine such as red meat, offal, oily fish, seafood and foods containing yeast extract.

– Avoid alcohol intake.
Alcohol disrupts the removal of uric acid from the body. Normally, purines would break down into uric acid and get flushed out of the body through urine. However, this process is interrupted when uric acid levels get too high. Crystals form around the joints, and gout develops.
To prevent gout attack, avoid alcohol during attack and avoid beer.

– Avoid sugary drinks and snacks – these are associated with an increased risk of gout.

– Maintain a healthy weight – follow a balanced diet with high-protein, low-carbohydrate diets.

– Drink plenty of water – keep yourself well-hydrated will reduce the risk of crystals forming in your joints.

– Take regular exercise – try activities that do not put too much strain on your joints, such as swimming.

What is Menopause?

Menopause is the end of a woman’s menstrual cycles, occurs when the ovaries stop producing  hormones that drive menstrual cycle. It is a natural process of aging and it is not a disease or disorder.  Menopause is diagnosed when you have not had a period for 12 consecutive months. This usually happens between the ages of 45 and 55. But some women can go through menopause early. It can be the result of surgery, for example if their ovaries are removed in a hysterectomy or if there have been damage to their ovaries, such as from chemotherapy. If it happens before age 40, for any reason, it’s called premature menopause.

Signs and Symptoms

Every woman experiences menopause differently. Some women barely have any complaints, while some woman may have very severe menopausal symptoms that could impact their life, including relationships, social life, family life and work. In the months or years leading up to menopause (peri-menopause), you might experience these signs and symptoms:

• Hot Flushes – A sudden feeling of heat in the upper part or all of your body, often with blushing and heavy sweating. Hot flashes can be very mild or strong enough to wake you up (called night sweats).
• Irregular Periods – They may be shorter or last longer. You might bleed more or less than usual. 
• Emotional symptoms – Such as mood swings, anxiety, depression, low self-esteem and problems with memory or concentration.
• Sleep disturbances – Often due to hot flushes, insomnia, stress or depression and make you feel tired and irritable during the day
• Vaginal dryness – The walls of the vagina lose volume and moisture and become thin, dry, and easily irritated due to lack of oestrogen. This can lead to painful sex, an increase in vaginal infections, and chronic vaginal discomfort.
• Palpitations
• Reduced sex drive
• Dry and itchy skin
• Thinning of hair
• Muscle ache and joint pain

Complications

Once you have gone through menopause, the risk of the development of a number of medical conditions increases. Some examples of possible complications include:

• Heart and blood vessel (cardiovascular) disease. When your estrogen levels decline, your risk of heart disease increases. So it’s important to get regular exercise, eat a healthy diet and maintain a normal weight.
• Osteoporosis. This condition causes bones to become brittle and weak, leading to an increased risk of fractures. Postmenopausal women with osteoporosis are especially susceptible to fractures of their spine, hips and wrists.
• Urinary incontinence. As the tissues of your vagina and urethra lose elasticity, you may experience frequent, sudden, strong urges to urinate, followed by an involuntary loss of urine, or the loss of urine with coughing, laughing or lifting. You may have urinary tract infections more often.
• Weight gain. Many women gain weight during the menopausal transition and after menopause because metabolism slows down. You may need to eat less and exercise more, just to maintain your current weight.

Treatment

There is no specific medical treatment for menopause. The treatments instead focus on the relief of symptoms and preventing or managing chronic conditions that may occur with aging. Common treatments include:

• Hormone replacement therapy (HRT). You take medications to replace the hormones that your body isn’t producing anymore. HRT comes in several different forms including tablet, implants, and skin patches. They can help with hot flashes and vaginal symptoms, as well as making your bones stronger.

• Topical hormone therapy. This is an estrogen cream that can be applied into vagina to help with dryness, discomfort with intercourse and some urinary symptoms.
• Non-hormone medications. Certain anti-depression drug related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs) may decrease menopausal hot flashes. Gabapentin, which is used to treat seizures and the blood pressure drug clonidine has also been shown to help reduce hot flushes.
• Medications to prevent or treat osteoporosis. Depending on individual needs, doctors may recommend medication to prevent or treat osteoporosis. Several medications are available that help reduce bone loss and risk of fractures. Vitamin D supplements can also be used to help strengthen bones.

Lifestyle and home remedies

Lifestyle changes help many women deal with menopause symptoms. These steps may help relieving symptoms and improving quality of life during this transition.

• If you’re having hot flashes, drink cold water, dress lightly, take a cool shower and fan yourself; Avoid hot drinks, spicy food and caffeine.
• Use an over-the-counter vaginal moisturizer or lubricant for dryness.
• Exercise regularly to sleep better and prevent conditions like heart disease, diabetes, and osteoporosis.
• Strengthen your pelvic floor muscles with Kegel exercises to prevent bladder leaks.
• Stay socially and mentally active to prevent memory problems.
• Don’t smoke. Tobacco might cause early menopause and increase hot flushes.
• Limit intake of alcohol, to lower your chance of getting breast cancer and help you sleep better.
• Maintain a healthy weight and eat low-salt, low-fat, low-sugar, high-fiber diet that’s rich in a variety of fruits and vegetables.
• Practice things like yoga, deep breathing, or massage to help you relax.

Herbs and Supplements for Menopause

A number of supplements and multivitamins are available that may help ease these symptoms. Examples are:

• Evening Primrose Oil
• Calcium Supplements
• Dong Quai
• Ginseng
• Black Cohosh
• Red Clover
• Flaxseed
• Soy
• Valerian root
• St. John’s Wort

References

1. Menopause. NHS.[Internet].NHS.UK.2022[Cited 15 July 2022]. Available from: https://www.nhs.uk/conditions/menopause/#:~:text=Menopause%20is%20when%20your%20periods,chemotherapy%2C%20or%20a%20genetic%20reason.

• Menopause. Symptoms and Causes[Internet].Mayo Clinic.[Cited15 July 2022]. Available from: https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397

• Clinical Practice Guidelines on Hormone Therapy during Menopause in Malaysian Women. MOH/P/PAK/207.10(GU) [Accessed on 15 July 2022]

• Gabriela Pichardo, M. June 2022. Menopause. [Internet]. Available from: https://www.webmd.com/menopause/guide/menopause-basics

• Menopause: Understanding the menopausal transition. [Internet]National Institutes of Health (NIH). [Cited 15 July 2022] Available from: https://www.nia.nih.gov/health/what-menopause

• Jade Poole. How is menopause diagnosed and treated. [Internet]. MyMed. [Cited 15 July 2022] Available from: https://www.mymed.com/diseases-conditions/menopause/how-is-menopause-diagnosed-and-treated

• 10 Herbs and Supplements for Menopause. [Internet] Healthline. [Cited 15 July 2022]. Available from: https://www.healthline.com/nutrition/menopause-herbs

• 11 Supplements for Menopause. [Internet]. WebMD [Cited 15 July 2022]. Available from: https://www.webmd.com/menopause/ss/slideshow-menopause

Body weight is one of many determinants of health. Maintaining a healthy body weight can lower your risks towards many weight-related diseases and health issues. However, each person’s healthy weight range will vary and depend on factors such as age, gender, genetics, body frame, existing medical history and lifestyle habits. So, weight management is a process of adopting long-term lifestyle modification to maintain a healthy body weight on the basis of these factors.

You may assess your body weight status via two simple physical examination methods:

Body mass index (BMI)

BMI is a person’s weight in kilograms divided by the square of height in meters. A high BMI can indicate high body fatness, and a low BMI can indicate too low body fatness.

• If your BMI is less than 18.5, it falls within the underweight range.
• If your BMI is 18.5 to 24.9, it falls within the normal or healthy weight range.
• If your BMI is 25.0 to 29.9, it falls within the overweight range.
• If your BMI is 30.0 or higher, it falls within the obese range.

Waist Circumference

Another way to estimate your potential disease risk is to measure your waist circumference. It is also a good estimate of visceral fat, the dangerous internal fat that coats the organ. Waist circumference measurement correlates well with abdominal fat content irrespective of the BMI. It is most useful in individuals who are in the normal and overweight categories of BMI. Your waistline may be telling you that you have a higher risk of developing obesity-related conditions if you are:

• A man whose waist circumference is more than 40 inches
• A non-pregnant woman whose waist circumference is more than 35 inches

Being too thin (underweight) or obese (overweight), both may impact your health condition. Maintaining a healthy weight is not only important for improving your physical appearance but is also beneficial for your overall well-being. Prioritizing weight management not only lowers the health risks but can also lead to an improved quality of life.

Underweight is a condition when energy intake is less than energy expenditure, it may lead to health risks such as malnutrition, decreased immune function, osteoporosis, infertility, developmental delays, and increased risk of surgical complications 2. A person may be underweight due to genetics, improper metabolism, lack of appetite, over-exercising, certain medicines, and underlying medical problems such as overactive thyroid, anorexia, etc 3.

Overweight and obesity are consequence of an energy imbalance where energy intake has exceeded energy expenditure over a considerable period of time, lead to abnormal or excessive fat accumulation that presents a risk to health. Obesity is one side of the double burden of malnutrition, and today more people are obese than underweight in every region. It once considered a problem only in high-income countries, overweight and obesity are now dramatically on the rise in low- and middle-income countries, particularly in urban settings. The World Health Organization (WHO) reported one in five Malaysian adults will be obese by 2025 4. Obese and overweight people are more prone to illnesses and conditions such as diabetes, hypertension, heart diseases, gall bladder diseases and osteoarthritis. Obesity may influence the risk of cancers of the colon, rectum, prostate, gall bladder, cervix, endometrium and ovary. Obesity also affects mobility, physical endurance and other functional measures. Obese people may also have low self-esteem 5.

Factors Weight Gain

Poor diet and overeating

Poor eating habits are probably the leading cause of obesity among all others. More often than not, people are likely to gain weight when they consume more calories than they burn through physical activity. Examples of unhealthy eating choices that directly lead to weight gain include:

• Eating more portions than your body needs
• Eating excessive amounts of processed or fast food
• Consuming beverages with too much sugar content
• Drinking too much alcohol 6

Physical inactivity

Another important factor is the lack of physical exercise. Nowadays, most people’s work desk jobs that consist of sitting and staring at a computer for long hours every day. When it comes to leisure activities, many of us prefer to lounge around and binge-watch or scroll endlessly on our phones instead of heading out to exercise. If you fail to incorporate exercise into your daily lives, the energy provided by the food you eat will only be stored by the body to become fat, which can lead to excessive weight gain 6.

Stress, emotional factors, and poor sleep

Some people eat more than usual when they are bored, angry, upset, or stressed. This “stress eating” are due to secretion of stress hormone called cortisol in our body. It increases appetite and may ramp up desire to eat fatty, salty or sugary “comfort foods” 7.  Studies also have found that the less people sleep, the more likely they are to have overweight or obesity. This is partly because hormones that are released during sleep help control appetite and the body’s use of energy 8.

Health Conditions

On fairly rare occasions, obesity could be caused by certain health conditions. Examples of medical conditions that commonly contribute to weight gain include hormonal imbalance, hypothyroidism and Cushing’s syndrome. Other medical problems such as arthritis can hinder one from engaging in physical activity, which can ultimately result in weight gain as well. Certain medicines also may cause weight gain, including some corticosteroids, antidepressants, and seizure medicines 8.

Ways to Achieve Healthy Weight

Healthy eating

Healthy eating features a variety of healthy foods. Fad diets may promise fast results, but such diets limit your nutritional intake, can be unhealthy, and tend to fail in the long run. A healthy eating plan shall:

• Emphasize fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products
• Include a variety of protein foods such as seafood, lean meats and poultry, eggs, legumes (beans and peas), soy products, nuts, and seeds.
• Is low in added sugars, sodium, saturated fats, trans fats, and cholesterol.
• Stay within your daily calorie needs 9.

Exercise regularly and stay physically active

Engaging in physical activity is one of the simplest ways to get rid of excess weight on your body. The more you exercise, the more calories your body burns off. On top of burning fat, exercising also increases your metabolism significantly 6. The World Health Organization (WHO) recommended regular exercise 60 minutes per day for children and 150 minutes per week for adults, to lower the risk or overweight and obesity 4.

Set smart weight goals

Losing or gaining weight does not happen overnight. A good and healthy weight loss or weight gain should adopt the concept of energy balance as its guiding principle. Setting a SMART goal should be specific, measurable, achievable, relevant and timely. For example, if your BMI is 23 kg/m2 and above, losing 10% to 15% of your current body weight over 6 months at a rate of 0.5 kg to 1 kg a week is a healthy target 10.

Last but not least, a heathy and successful weight management include regular monitoring of your progress and maintenance of healthy weight in the long term. Making lifestyle modifications goes beyond the physical aspects, this requires you to tap into your mental stamina as well. Believe it or not, your outlook or mindset can play an essential role in your weight management journey.

Reference:

1. Assessing Your Weight. (2022, June 3). Centers for Disease Control and Prevention. Retrieved September 10, 2022, from https://www.cdc.gov/healthyweight/assessing/index.html
2. Marcin, A. (2017, May 15). 6 Health Risks of Being Underweight. Healthline. Retrieved September 10, 2022, from https://www.healthline.com/health/underweight-health-risks
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Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic disorder caused due to a defect in an enzyme called glucose-6-phosphate dehydrogenase that causes red blood cells to break down prematurely.

G6PD is an enzyme that protects the red blood cells from damage and destruction by harmful and toxic compounds that form in the body under certain conditions like stress, fever, or following the ingestion of certain foods or drugs. The enzyme generates compounds that can neutralize the toxic compounds formed in the body.

Causes of G6PD

It is an X-linked disorder that may be inherited from mother (usually a healthy carrier) or affected father to son or daughter. G6PD cannot be spread from one person to another. [1]

Sign and Symptoms of G6PD

People with G6PD deficiency do not display any signs of the disease until they are exposed to certain chemicals in food or drugs whereby their RBC being broken down in excess.

Other symptoms:

• Sudden rise of body temperature
• Dark yellow-orange urine
• Weak and rapid pulse rate.

It is common for babies to have jaundice (yellowing of the skin and eyes) in the first week of life, but some babies with G6PD deficiency have jaundice for longer than usual.

Diagnosis of G6PD

• Blood tests

Blood tests may reveal low red blood cell count, increased bilirubin levels, and increased plasma hemoglobin levels. Other blood tests may confirm presence of intravascular hemolysis. However, the blood tests may be normal between the attacks.

• Blood film examination

Examination of a stained blood film under the microscope may show abnormal broken red cells (hemolytic RBCs). Special stains show denatured hemoglobin within red cells (Heinz bodies) and increased immature red cells (reticulocytes) due to formation of new red cells (erythropoiesis) by the bone marrow as compensatory response. If the abnormal cells have the appearance of a bitten piece they are termed bite cells.

• Urine tests

The urine specimen during the attack is dark colored and positive for hemoglobin and hemosiderin

• Screening tests to detect low G6PD levels

Several screening tests are available that demonstrate the decreased capacity of G6PD deficient cells to reduce dyes. The enzyme can also be directly assayed.

Drugs to Avoid

Foods and Chemical to Avoid

• Fava Beans (broad beans)
• Red wine
• Henna dyes used for tattoo & Hair
• Blueberries [also yogurts containing these]
• Soya products
• Tonic water
• Naphthalene (moth balls)

References:

1. The Royal Children’s Hospital Melbourne. (n.d.). Retrieved from https://www.rch.org.au/kidsinfo/fact_sheets/g6pd_deficiency/
2. Schick P. (Dec 2018) Glucose-6-Phosphate Dehydrogenase Deficiency. Medscape. Available from http://emedicine.medscape.com/article/200390- overview.
3. MIMS 158th Edition Sep 2019 Malaysia. Drugs and Other Substances to Avoid in G6PD Deficiency. Pg 174-177