Allergic rhinitis is an inflammatory condition that affects the nasal passages, sinuses, ears, and throat. It occurs when the immune system overreacts to the allergens in the surroundings.
There are two types of allergic rhinitis. Seasonal allergy sufferers develop symptoms during spring, fall, or both seasons when they become exposed to airborne pollen and outdoor mold spores. Perennial allergic rhinitis, which is year-around, is caused by indoor allergens such as house dust, pet dander, dust mites, and indoor molds.

DIFFERENCES OF ALLERGIC RHINITIS, COLD, FLU AND COVID

Allergic Rhinitis is always triggered by breathing in the tiny particles of allergens. The common allergens that causes are pollens, dust, smoke, moulds and flakes of animal skins.

SYMPTOMS OF ALLERGIC RHINITIS

The common symptoms of having Allergic Rhinitis includes sneezing, stuffy or runny nose. Sometimes, the eyes also get red, itchy and watery. Swelling of eyes also happen occasionally.

TREATMENT OF ALLERGIC RHINITIS

You can treat your allergic rhinitis in several ways. These include medications, as well as home remedies and possibly alternative medicines.

MEDICATION

Antihistamine

You can take antihistamines to treat allergies. They work by stopping your body from making histamine.

Examples of antihistamine:
– Chlorpheniramine (Piriton)
– Cetirizine (Zyrtec)
– Loratadine (Clarityne)
– Fexofenadine (Telfast)
– Desloratadine (Aerius)
– Levocetirizine (Xyzal)

Nasal Decongestant Spray (Iliadin, Afrin, Oxy-Nase)

This medication is used for temporary relief of congestion in the nose. It works by narrowing the blood vessels in the nose area, reducing swelling and nose blockage.
Do not use more often, use more sprays, or use longer than directed because doing so may increase the risk of side effects. Also, DO NOT use this medication for more than 10 days. If you use it for longer than the recommended period of time, your congestion/nose blocking may get worsen.

Instructions to use Nasal Spray

ALTERNATIVE AND COMPLEMENTARY MEDICINE

Saline Nasal Irrigation

You can do this by using a solution made with sachets bought from a pharmacy such as Neilmed, EMS, Marimer, Sterimar etc.
Nasal irrigation can be carried out as often as necessary, but a fresh solution should be made each time.

Eucalyptus or Menthol Steam Inhalation

Eucalyptus oil extracted from the leaves of the eucalyptus tree, has anti-inflammatory and antibacterial properties.

Using steam to open the passages in the nose can help to relieve sinus pressure. Steam inhalation is easy to do at home. Boil water, pour it into a large bowl, add in some eucalyptus oil or menthol and lean over, so the face is directly above the water. Cover the head with a towel, and breathe through the nose.

Probiotics & Prebiotics

Probiotics are microorganisms that might offer health benefits by helping the body maintain a healthful balance of gut bacteria.
Probiotics may boost a person’s immune system, which can help the body fight off allergies.
Probiotics also increase good bacteria in your gut, which is thought to help regulate allergy cells throughout the body.
Prebiotics are non-digestible oligosaccharides that encourage the growth of probiotic bacteria.

Vitamin C

Increasing your intake of vitamin C can help alleviate your symptoms because this antioxidant counteracts histamine, the substance that can contribute to inflammation, runny nose, sneezing, and other related symptoms.

Omega-3 fatty acids

Because omega-3 fatty acids are essential fats with anti-inflammatory properties, increasing the consumption of these healthy fats can reduce immune dysfunction and help alleviate allergy-related conditions.

By Ms Lew Hui Li & Ms Chong Hui Ying

Acne or acne vulgaris is a skin condition that occurs when a pore get clogged with dead skin cells, oils and a type of bacteria called Propionibacterium acnes (P. acnes). Acne is triggered by many factors:

• Hormones
• Stress
• Poor hygiene
• Wrong skin care products
• Sun
• Unhealthy diet

Inflammatory Acne Types (More severe)

It is more likely to cause complications such as scarring or pitting.
Examples: Papules; Pustules; Nodules; Cysts

Treatment- Mild Acne

Mild acne can be treated with over-the-counter (OTC) medications, such as gels, soaps, pads, creams, and lotions, that are applied to the skin. OTC acne remedies may contain the following active ingredients:

• Resorcinol: helps break down blackheads and whiteheads
• Benzoyl peroxide: kills bacteria, accelerates the replacement of skin, and slows the production of sebum
• Salicylic acid: assists the breakdown of blackheads and whiteheads and helps reduce inflammation and swelling.
• Retin-A: helps unblock pores through cell turnover
• Azelaic acid: strengthens cells that line the follicles, stops sebum eruptions, and reduce bacteria growth.

Treatment- Moderate Acne

A skin specialist, or dermatologist, can treat more severe cases.

• Corticosteroid injection: help prevent scarring, reduce inflammation, and speed up healing.
• Oral antibiotics: combat the growth of bacteria and reduce inflammation, erythromycin and tetracycline are commonly prescribed for acne
• Oral contraceptives: help control acne in women by suppressing the overactive gland.
• Topical antimicrobials:  reduce P. acnes  (example: clindamycin)
• Retinoic acid derivatives: unclog pores and prevent whitehead and blackhead from developing (example: adapalene, tretinoin)

Prevention and Management Tips

Constipation is a very common problem people facing nowadays. Constipation is when you have infrequent or hard to pass bowel movements (meaning they are painful and stools hard to pass) and have a feeling that you have not fully emptied your bowels. Infrequent in this case means less than three times per week. Most of the time, constipation can be treated but if there is ongoing pain with bowel movements or there is blood in stool, seek medical assistance instead.

What causes Constipation?

Common Lifestyle

• Eating foods low in fiber can make the stools become hard and difficult to pass.
• Changes in diet or daily routine especially when travelling along with inactivity
• Dehydration can worsen constipation, making the stool dry or like small lumps.
• Lack of exercise
• Often ignoring the urge to go to toilet due to too busy or doesn’t want to use the public toilet and as the feeling goes off , constipation occur
• Stress as when a person stressed, he/she is more likely to have an unhealthy diet, not getting enough exercise/sleep or forget to stay hydrated.

Medications and Health Condition

• Medicine like pain medications (mainly opioids), high calcium antacid and iron pills can cause constipation.
• Lazy Bowel Syndrome which the colon contracts poorly and restrains stool. ( due to excessive usage of stimulant laxative)
• Pregnancy

Treatment of Constipation

Lifestyle changes to treat constipation

Diet

• Eat a well-balanced diet with whole grains, fresh fruits and veggies. Aim for at least least 3 servings of vegetables and at least 2 servings of fruit per day. A serve is a portion equivalent in size of your own fist.
• Eat fewer high fat foods such as meat, eggs, cheese and processed foods.
• Add fiber supplements to your diet if needed. But remember to drink plenty of water because water help fiber work more efficiently.
• Drink at least 8 glasses of water per day.
• Avoid caffeine-containing drinks and alcohol, which can cause dehydration.

Habit

• Don’t ignore the urge to pass motion. The longer you wait, the harder your stool can become.
• Check how you sit on the toilet. Raising your feet, leaning back or squatting may make having a bowel movement easier.
• Exercise regularly to prevent or treat constipation by lowering the time it takes for food to move through large intestine. Hence less water will be absorbed from the stool into body.
• Do not read, use your phone or other devices while trying to move your bowels.

Health Supplements

Probiotics

Probiotics can play a key role in helping to relieve constipation, but it can be confusing trying to choose the correct and most effective one. Here we aim to help you get the most out of your friendly bacteria.
Bifidobacteria and Lactobacillus species are the majority bacteria found in our large intestine, hence probiotics with specific strains belonging to these species are regarded as the most suitable in helping to relieve constipation.
Megalive Floramax Pro, Megalive Flora 60 Plus, Bio-life A.B Junior Pre & Probiotics, Hexbio etc are probiotics supplements containing those strains which can be found in the market. Generally, probiotic food and supplements are thought to be safe for most people including during pregnancy and breastfeeding. Talk to your doctor or pharmacist, choosing the most suitable probiotics for you and your family, turning unhappy tummies to happy ones.

Over-the-counter

There are a number of options to help treat constipation despite to the lifestyle changes. They can be found over-the-counter without a prescription and come in many forms like pills, powders (to mix with water), enemas or suppositories. Talk with your pharmacist to help you choose wisely.

Hemorrhoids also knows as piles that occur inside and around the anal passage. They are quite common to be happened. Hemorrhoids can either be internal or external. Internal hemorrhoids develop within the anus or rectum. External hemorrhoids develop outside of the anus. External hemorrhoids are the most common and most troublesome. Hemorrhoids cause pain, itching, bleeding and difficulty sitting. Fortunately, they are treatable.

Signs and Symptoms

Signs and symptoms of hemorrhoids usually depend on the types of hemorrhoids.

External hemorrhoids

These are under the skin around your anus. Signs and symptoms are:
– Itching and irritation in your anal region
– Pain or discomfort
– Swelling around your anus
– Bleeding

Internal hemorrhoids

Internal hemorrhoids lie inside the rectum, which usually you can’t see or feel it. But straining or irritation when passing stool can cause:
– Painless bleeding, you might notice small amount of bright red blood on toilet tissue or in the toilet.
– A hemorrhoid to push through the anal opening ( prolapsed or protruding hemorrhoid), resulting in pain or irritation.

Causes

Hemorrhoids are usually caused by constipation. Constipation can make you to strain when you go to toilet so it puts pressure on the blood vessel in the anus which ca make them become swelling.

Other things can increase the risk of getting hemorrhoids are:
– Ageing
– Being obese
– Sitting for long periods of time on the toilet
– Regularly lifting heavy things
– Straining during bowel movement
– Having diarrhea or constipation
– Pregnancy

Complications

Anemia

It is rarely happen, but chronic blood loss from hemorrhoids may cause anemia.

Strangulated Hemorrhoid

If the blood supply to an internal hemorrhoid is cut off, then the hemorrhoid may be “strangulated,” which can cause extreme pain.

Blood Clot

Occasionally, a clot can form in a hemorrhoid which know as thrombosed hemorrhoid. Although it is not dangerous, but it can cause extremely painful.

Preventions

Eat high fiber foods

Eat more fruits, vegetables and whole grains. It can help in soften the stool that will help you avoid the straining which can cause hemorrhoids and pass the stool more easily.

Drink plenty of fluids

Drink six to eight glasses of water which can help you avoid constipation.

Don’t strain

Straining when you are trying to pass a stool creates greater pressure in the veins in the lower rectum which will cause hemorrhoids.

Obesity

Obesity is another factor of hemorrhoids, and you can lose your weight by exercising regularly, consuming low fat diet and reducing consumption alcohol intake.

Good Hygiene

Practice good hygiene by cleaning your anus with warm water during a shower or bath every day and keep your bottom clean and dry. But don’t use soap, as soap can aggravate hemorrhoids. Also avoid using dry or rough toilet paper when you wipe after a bowel movement.

Treatments

Fiber supplements

Most of people don’t get the enough fiber intake daily. And studies shown that over the counter fiber supplements such as psyllium or methylcellulose improved overall symptoms and bleeding from hemorrhoids. 
But when you eat fiber supplement must be make drink enough of water daily. It can cause constipation if it does not.

Sitz bath

A sitz bath is referred to sitting a few inches of warm water 3 times a day for 15 to 20 minutes. A sitz bath may help in decrease the inflammation of hemorrhoids. Drying off the anal area completely after sitz bath which can minimize the moisture that can irritate the skin around your rectal area. 

Medical procedures

If home treatments aren’t helping with your hemorrhoids, your doctor might recommend getting a rubber band ligation. This procedure involves the doctor cutting off circulation to the hemorrhoid by placing a rubber band around it.
This causes loss of circulation to the hemorrhoid, forcing it to shrink. This procedure should only be performed by a medical professional.

Ever wonder how strong the sunlight in Malaysia is?

Putting aside the scorching temperature and blinding brightness, there’s something within Malaysia’s sunlight that is more worrying – Ultraviolet radiation (UV).  According to the Who Health Organisation (WHO) INTERSUN program, the level of UV radiation can be measured using UV Index such as below:

And unsurprisingly, Malaysia in general is usually exposed under UV index 9 to 11+ most of the time all year round.

You may wonder what’s the big deal about UV radiation.

To understand that we’ll need to look into the types of UV radiation that we are commonly exposed to in the atmosphere – UVA and UVB.

Up to 95% of the UV radiation that reaches Earth’s surface is UVA. UVA rays are much more prevalent on Earth and are always present regardless of season or time of day due to its longer wavelength giving it the ability to penetrate through clouds and glass. Although they are less intense than UVB, UVA can penetrate the skin more deeply and cause skin aging and wrinkling. Exposing to UVA also leads to injury in the DNA of the skin. In order to prevent further DNA damage, the skin darkens, causing skin tanning. Even though UVA does not cause significant damage to the epidermis, the outermost layer of skin where most skin cancers occur, they do still bring damage to a deeper layer of the epidermis and thus still contribute to and may initiate skin cancer to develop.

UVB on the other hand is known to be the main reason our skin reddens and gets sunburn when exposed to sunlight for too long. Because of their shorter wavelength, they can only reach and damage the more superficial layer of the epidermis, but they play a big role in the development of skin cancer. UVB intensity varies throughout the day and usually is most intense between 11.00 am to 3.00 pm in Malaysia. UVB does not pass through glass significantly, but it can be reflected and bounce back on a reflective surface, hitting your skin twice.

So to summarise:

So how do we protect ourselves from the harm of UV rays?

One way is to apply sunscreen or sunblock. To evaluate how effective the sunscreen is, you can look at its Sun Protection Factor (SPF). The SPF value of a sunscreen indicates how much longer it will take for your skin to redden and get sunburnt by UVB rays when the sunscreen is applied, compared to when you do not apply any sunscreen. If you usually get sunburnt within 10 minutes under the sun when not applying sunscreen, applying a sunscreen with SP15 will delay the time till sunburnt to 15 times longer. So now your skin takes 150 minutes to get sunburnt.

Some of you may think: What if I want to prevent my skin from darkening because of sunlight exposure?  Then you should be checking out the PA value of the sunscreen. Basically, the more + is added to the back of PA, the better the protection against UVA.

•             PA+ = Some UVA protection.

•             PA++ = Moderate UVA protection.

•             PA+++ = High UVA protection.

•             PA++++ = Extremely High UVA protection.

Since we want to reduce the damage of both UVA and UVB, it is always better to look for broad-spectrum sunscreen and provides protection towards both types of UV rays.

Here we recommend you always use a broad-spectrum sunscreen with at least SPF 15 for daily activity. However, for extended outdoor activities, at least SPF 30 sunscreen should be applied. Keep in mind that sunscreens will start to lose effectiveness over time regardless of its SPF value, so it is important to reapply them every 2 hours. If you are going for a swim or activities that will cause heavy sweating, choose a sunscreen that indicates water-resistant or sweat resistant. Water-resistant sunscreen will remain effective for 40 minutes when swimming while sweat-resistant sunscreen will last 80 minutes when sweating. There is no “waterproof” or “sweatproof” sunscreen so you will still need to reapply the sunscreen frequently.  In order to let sunscreen function properly, always apply it 30 minutes before going out.

Apart from using sunscreen, you can protect yourself from UV rays by wearing clothing with UV cutting properties. Look for clothes with higher UPF (Ultraviolet Protection Factor). The higher the UPF, the less UV can penetrate through the clothing. Clothing with a UPF rating of 30 will allow only 1/30th (about 3 percent) of UV to pass through it and the UPF rating of 50 will only let 2 percent of UV to penetrate.

Even if you are unable to find clothes that claim to have UPF, you can choose to wear more tightly-woven but loose-fitting clothing as they provide more barrier between your skin and the sun. Clothes made from mixture or fully heavyweight natural fabrics like cotton, linen and light synthetic fabrics like polyester, nylon and spandex are some of the good choices. Wearing darker and more vibrant colour clothing will also absorb more UV and prevent them from reflecting other parts of your body when compared to clothing with pale colours. Remember clothes will also start to stretch and lose their colour after being worn and washed for some time, and therefore loses some of its sun-protective effects. So I guess that gives us more reason to buy new clothes once in a while.

Even with the above precautions taken, it is still best to stay in the shade as much as possible when going out. Wearing UV-blocking sunglasses and wide-brimmed hats helps too.

Hopefully, with this, you will be able to protect yourself from the damage of UV better in the future. Stay healthy, stay safe!

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.