How Does The Fasting of Ramadan Affect Breast Milk Constituents?

Background: Breast-feeding of infants is associated with their better biological, psychological and intellectual development. However, many factors affect the volume and composition of human milk such as stage of lactation and maternal diet. Many breast-feeding Muslim mothers fast the lunar month of Ramadan. The effects of fasting on milk constituents have not been previously studied in Sudan. Therefore, we aimed to investigate the variations between milk constituents during fasting and non-fasting periods among a group of Sudanese women.Materials and Methods: Twenty four healthy breast-feeding mothers volunteered to participate in this cross-sectional study. Each mother provided 100 ml of breast milk during fasting and again 2 weeks after end of the fasting month of Ramadan. Milk was properly stored and analyzed for the various constituents, using the appropriate laboratory methods. The main constituents analyzed were: ash, protein, lactose, iron and electrolytes.Results: The age range of lactating women was between 18 and 38 years, mean (+SD) 28.8 (± 5.15 years). Most mothers 17 (70.8%) were house-wives. Analysis of breast milk during fasting and non-fasting periods showed that: lactose, protein, sodium, potassium, calcium and phosphate were significantly decreased in the fasting breast milk compared with the non-fasting milk (p=0.01), while total soluble solid, moisture, ash and iron constituents had not significantly changed during fasting.Conclusion: Fasting of Ramdan significantly affects proteins, carbohydrates and electrolytes in breast milk.Keywords: breast-feeding, milk constituents, Ramadan, fasting

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society