Efficacy and safety of adjunctive treatment with perampanel in epilepsy patients

INTRODUCTION

Epilepsy is a neurological disease with high global prevalence. Almost one-third of epilepsy patients continue having seizures despite adequate treatment. Perampanel has been widely used in the Western countries as an adjunctive therapy for both generalized and focal seizures. Owing to its high cost, the use of perampanel is limited in our country.

MATERIALS AND METHODS

We conducted a descriptive, retrospective study among epilepsy patients treated with perampanel. We aimed to assess the efficacy and safety of perampanel as an adjunctive in our hospital.

RESULTS AND CONCLUSIONS

From our cohort of 25 patients, most of the patients were either on one or three anti-seizure medications (ASMs) prior to initiation of perampanel. Perampanel was added in 88% of them due to persistent seizures. Twenty-two (88%) patients experienced reduction in seizure frequency. 12% experienced mild side effects, which were leg cramps, hyponatremia and drowsiness. Only 1 patient stopped perampanel due to its side effects.

CONCLUSION

Perampanel is a well-tolerated ASM that should be widely used as an adjunctive. More studies with regards to its efficacy and safety involving more centres are encouraged in Malaysia.

Management of status epilepticus in Malaysia: A national survey of current practice and treatment gap

INTRODUCTION

Early and effective treatment is fundamental in status epilepticus (SE) management. At the initiative of the Epilepsy Council of Malaysia, this study aimed to determine the treatment gap in SE across different healthcare settings in Malaysia.

METHODS

A web-based survey was sent to clinicians involved in the management of SE, across all states and at all levels of healthcare services.

RESULTS

A total of 158 responses were received from 104 health facilities, including 23 tertiary government hospitals (95.8% of all government tertiary hospitals in Malaysia), 4 (80.0%) universities, 14 (6.7%) private, 15 (11.5%) district hospitals and 21 clinics. Intravenous (IV) diazepam was available in 14 (93.3%) district and 33 (80.5%) tertiary hospitals for prehospital management. Non-IV benzodiazepine (rectal diazepam and intramuscular midazolam) was not widely available in prehospital services (75.8% and 51.5%). Intramuscular midazolam was underutilised (60.0% in district and 65.9% in tertiary hospitals). IV sodium valproate and levetiracetam were only available in 66.7% and 53.3% of the district hospitals, respectively. Electroencephalogram (EEG) services were available in only 26.7% of the district hospitals. Non-pharmacological therapies such as ketogenic diet, electroconvulsive therapy, and therapeutic hypothermia were not available in most district and tertiary hospitals for refractory and super-refractory SE.

CONCLUSIONS

We identified several gaps in the current practice of SE management, including limited availability and underutilization of non-IV midazolam in prehospital services, underutilization of non-IV midazolam and other second-line ASMs, and lack of EEG monitoring in district hospitals and limited treatment options for refractory and super-refractory SE in tertiary hospitals.

Characteristics of electroencephalogram changes and correlation with seizures in hospitalised patients

INTRODUCTION

Electroencephalogram (EEG) is an important investigational tool that is widely used in the hospital settings for numerous indications. The aim was to determine factors associated with abnormal EEG and its clinical correlations in hospitalised patients.

MATERIALS AND METHODS

Patients with at least one EEG recording were recruited. The EEG and clinical data were collated.

RESULTS

Two hundred and fifty patients underwent EEG and 154 (61.6%) were found to have abnormal EEG. The abnormal changes consist of theta activity (79,31.6%), delta activity (20, 8%), focal discharges (41,16.4%) and generalised discharges (14, 5.6%). Older patients had 3.481 higher risk for EEG abnormalities, p=0.001. Patients who had focal seizures had 2.240 higher risk of having EEG abnormalities, p<0.001. Low protein level was a risk for EEG abnormalities, p=0.003.

CONCLUSION

This study emphasised that an abnormal EEG remains a useful tool in determining the likelihood for seizures in a hospital setting. The risk factors for EEG abnormality in hospitalised patients were age, focal seizures and low protein level. The EEG may have an important role as part of the workup in hospitalised patients to aid the clinician to tailor their management in a holistic manner.

Seizure remission rates remain low in a resource-limited country, a multicentre comparison study in Malaysia

Seizure remission rates of 60% with antiseizure medications were reported in developed countries, but might be lower in resource-limited countries. The challenges in epilepsy care in resource-limited regions were highlighted 10 years ago, and still remain an ongoing issue. This study aimed to determine the seizure freedom rates in level-2 epilepsy care centres (centres with general neurologists) compared to level-3/4 centres (centres with epileptologists providing epilepsy surgery evaluation) in Malaysia. This is a retrospective study of 1,347 adult epilepsy patients from two level-2 (n = 290) and two level-3/4 epilepsy care centres (n = 1,057). The seizure remission rates were significantly lower in level-2 centres (42.5%) compared to the level 3/4 centres (61.9%, p < 0.05). Level-2 centres had significantly more patients with undetermined seizure types compared to level-3/4 centres (6.6% vs 3.1%, p < 0.05). Level-3/4 centres had significantly more patients with epilepsy of structural and genetic origins, whereas more patients in level-2 centres had unknown aetiology (46.2% vs. 34.0% in level-3/4, p < 0.05). Level-2 centres had a lower neurologist-to-patient ratio (1:97 vs. 1:50 in level-3/4 centres, p < 0.05). Level-2 centres also had fewer patients, who underwent investigations such as EEG (74.1% vs. 89.6%) and brain MRI (54.1% vs. 72.4%, p < 0.05) in comparison with level-3/4 centres. Our study emphasized the existing challenges in epilepsy care in a resource-limited country to achieve the ideal 60% seizure remission rate.

Prevalence and Factors Influencing Visual Memory Dysfunction among Epilepsy Patients-A Single-Center Study

Background

Epilepsy is associated with cognitive impairment due to the disease itself or side-effects of antiepileptic drugs.

Objective

We aimed to study the prevalence of visual memory dysfunction among epilepsy patients and identify the predictors that could contribute to the impairment.

Materials and Methods

This was a cross-sectional study. We analyzed 250 patients with epilepsy from neurology clinic at our tertiary center. Assessment of visual memory was done using Wechsler Memory Scale-IV (WMS-IV) with scores from subsets of visual reproduction I, II and designs I, II contributing to visual memory index (VMI) score. The correlation between continuous variables was analyzed using Pearson correlation; whereas the VMI scores of different factors were analyzed via a 1-way ANOVA test. The statistical significance was set at P < 0.05.

Results

The prevalence of visual memory dysfunction in our epilepsy population was 37.2%. Analysis of individual predictors showed that older patients, lower educational level, combined generalized and focal types of epilepsy, longer duration of epilepsy, greater number of antiepileptic drugs (AEDs) used, and abnormal neuroimaging contributed to poor visual memory. Multiple logistic regression analysis showed that educational level, types of epilepsy, and the number of AEDs used were significant predictors for visual memory impairment.

Conclusion

Visual memory dysfunction in patients with epilepsy was due to manifold confounding factors. Our findings enabled us to identify patients with visual memory dysfunction and modifiable factors that contribute to it. WMS-IV is a suitable assessment tool to determine visual memory function, which can help clinicians to optimize the patients' treatment.

Lung computed tomography patterns of a cluster of asymptomatic young males with COVID-19 admitted to a teaching hospital in Kuala Lumpur

BACKGROUND AND OBJECTIVE

Coronavirus Disease 2019 (COVID- 19) was first reported in Malaysia in March 2020. We describe here the clinical characteristics and computed tomography (CT) patterns in asymptomatic young patients who had laboratory-confirmed COVID-19.

METHODS

This is a retrospective observational study where 25 male in-patients with laboratory-confirmed COVID-19 in Hospital Canselor Tuanku Muhriz. Demographics, clinical data and CT images of these patients were reviewed by 2 senior radiologists.

RESULTS

In total there were 25 patients (all males; mean age [±SD], 21.64±2.40 years; range, 18-27 years). Patients with abnormal chest CT showed a relatively low normal absolute lymphocytes count (median: 2.2 x 109/L) and absolute monocyte count (median: 0.5 x 109/L). Lactate dehydrogenase was elevated in 5 (20%) of the patients. The procalcitonin level was normal while elevated levels of alanine aminotransferase, total bilirubin, platelet and C-reactive protein were common. Baseline chest CT showed abnormalities in 6 patients. The distribution of the lesions were; upper lobe 3 (12%) lower lobe 3 (12%) with peripheral distribution 4 (16%). Of the 25 patients included, 4 (16%) had ground glass opacification (GGO), 1 (4%) had a small peripheral subpleural nodule, and 1 (4%) had a dense solitary granuloma. Four patients had typical CT features of COVID-19.

CONCLUSION

We found that the CT imaging showed peripheral GGO in our patients. They remained clinically stable with no deterioration of their respiratory symptoms suggesting stability in lung involvement. We postulate that rapid changes in CT imaging may not be present in young, asymptomatic, non-smoking COVID-19 patients. Thus the use of CT thoraxfor early diagnosis may be reserved for patients in the older agegroups, and not in younger patients.

Modified French Osteotomy for Humeroradial Synostosis in a Child with Multiple Synostoses Syndrome: A Case Report

Congenital humeroradial synostosis can occur as an isolated clinical entity or as part of a syndrome. Bilateral elbow fixed flexion deformity is very incapacitating and challenging to treat. Here we present the case of a boy with fixed flexion deformity of both elbows due bilateral humeroradial synostosis. Other characteristic features of multiple synostoses syndrome were also present in this child, his elder brother and mother. We elected to improve the position of the right elbow by adapting the modified French osteotomy described by Bellemore et al.

The predictive and diagnostic accuracy of vascular endothelial growth factor and pentraxin-3 in severe dengue

This study aimed to evaluate vascular endothelial growth factor (VEGF) and pentraxin 3 (PTX-3) as predictive and diagnostic markers in differentiating severe dengue from non-severe dengue. The study was conducted in Ampang Health Clinic, Ampang Hospital and Serdang Hospital. The plasma levels of VEGF and PTX-3 were compared between severe dengue and non-severe dengue by ELISA from the day of presentation until discharged. Multiple logistic regression was used to develop predictive and diagnostic models by incorporating other clinical parameters. The receiver operating characteristics (ROC) analysis was used to assess the accuracy of the biomarkers and the developed models. Eighty-two patients were recruited, 29 with severe dengue and four died. The Area Under the Curve (AUC) was statistically significant in VEGF as diagnostic marker at Day 2 and 3 of illness with sensitivity of 80.00%-100.00% and specificity of 76.47%-80.00%. The predictive model with AUC of 0.84 (p < 0.01) has a sensitivity of 100.00% and specificity of 79.25% for predicting severe dengue. The diagnostic model with AUC of 0.71 (p < 0.01) has a sensitivity of 76.19% and specificity of 73.58% for diagnosing severe dengue. The AUC for PTX-3 was not statistically significant. VEGF may be used in combination with other clinical parameters to predict the severity of the disease. As a single biomarker, it may be used as an adjunct investigation to support the diagnosis of severe dengue. PTX-3 was not able to differentiate severe dengue from non-severe dengue.

Successful intravenous thrombolysis of a wake-up stroke with underlying valvular atrial fibrillation

A 42-year-old female admitted with new-onset atrial fibrillation had a wake-up stroke on the high-dependency unit and the time last seen well (TLSW) was 6.5 h. She suffered left-sided body weakness and her National Institutes of Health Stroke Scale (NIHSS) score was 17. An emergency CT perfusion showed right M1 segment occlusion with more than 50% penumbra. She was given recombinant tissue plasminogen activator (r-tPA) at 9 h from TLSW. An immediate diagnostic angiogram with intention to treat, owing to the presence of large vessel occlusion, showed complete reperfusion after intravenous r-tPA. She was discharged with NIHSS of 2, and at 3-month follow up her Modified Rankin Scale was 0. We demonstrated a successful reperfusion and excellent clinical recovery with intravenous thrombolysis in a patient who presented with a wake-up stroke with underlying valvular atrial fibrillation despite evidence of large vessel occlusion.

Choosing chemical markers for quality assurance of complex herbal medicines: Development and application of the herb MaRS criteria

With increasing use of herbal medicines for chronic or serious illness, relevant quality assurance methods are essential for making claims of therapeutic benefit. Adequate demonstration of safety and efficacy based on chemical composition and ensuring consistency between manufactured batches is critical. To date, there has been no uniform standard approach or detailed framework provided to industry for selecting relevant chemical markers used to standardize herbal products. We developed the Herbal Marker Ranking System (Herb MaRS) providing guidance on prioritizing the selection of chemical markers for quality control of complex multi-herb mixtures, while also taking into account the bioactivity in relation to the symptoms of the disease and its concentration in the formula. We apply the Herb MaRS evaluation criteria to a seven-herb formulation for the treatment of irritable bowel syndrome with constipation. Our ranking scale accommodates the clinical and pharmacological use of the formulation and its claimed indications.

Oesophageal intubation and ventilation as initial airway support of newborn infant with tracheal agenesis

Tracheal agenesis is a rare congenital airway anomaly which presents as an airway emergency at birth. We report a case of late premature Chinese infant with tracheal agenesis type II (by Floyd's classification) who presented with severe respiratory distress at birth. He had multiple failed attempts at intubations with accidental oesophageal intubation and ventilation. Tracheal agenesis with tracheo-oesophageal fistula was suspected from an emergency optical laryngoesophagoscopy done. The infant was subsequently stabilized on oesophageal ventilation. The diagnosis was confirmed on CT scan and parents were counseled regarding the poor outcome and decided for withdrawal at day 7 of life.

Validation of a method for the simultaneous determination of four schisandra lignans in the raw herb and commercial dried aqueous extracts of Schisandra chinensis (Wu Wei Zi) by RP-LC with DAD

A rapid and specific reversed-phase high performance liquid chromatography (RP-LC) method with photodiode array detection (DAD) was developed and validated for the determination of four common schisandra lignans, schisandrin (1), schisandrol B (2), deoxyshisandrin (3) and gamma-schisandrin (4), in raw herb materials and commercial dried aqueous extracts of Schisandra chinensis (Wu Wei Zi). The extraction solvent and extraction method were optimised where it was found that a 4 h Soxhlet extraction using methanol was successful at extracting >99.5% of each of the schisandra lignans analysed from the raw herb material. The sample preparation process for the dried aqueous extract samples involved sonication using methanol for 2 x 30 min. The herb and extract solutions were separated on a Varian Microsorb-MV 100-5 C18 column using a gradient mixture of 0.1% aqueous phosphoric acid and acetonitrile. Subsequent detection and quantitation of the schisandra lignans was performed at 210 nm. The correlation coefficients of the linear regression analysis performed on these calibration curves were >0.9996 for all four schisandra lignans assayed. The detection limits and quantification limits ranged from 0.12 to 0.57 and 0.41 to 1.89 mg g(-1), respectively. The mean recoveries of the various analytes ranged from 92.20 to 107.01%. The method was used to investigate the levels of the four mentioned components in herb samples and dried aqueous extracts. The identities of the chromatographic peaks were confirmed by (+) electrospray ionisation LC-MS/MS.

Role of plants, mycorrhizae and phytochelators in heavy metal contaminated land remediation

Phytoremediation is a site remediation strategy, which employs plants to remove non-volatile and immisible soil contents. This sustainable and inexpensive process is emerging as a viable alternative to traditional contaminated land remediation methods. To enhance phytoremediation as a viable strategy, fast growing plants with high metal uptake ability and rapid biomass gain are needed. This paper provides a brief review of studies in the area of phytoaccumulation, most of which have been carried out in Europe and the USA. Particular attention is given to the role of phytochelators in making the heavy metals bio-available to the plant and their symbionts in enhancing the uptake of bio-available heavy metals.

Body image and dieting behaviors among elite figure skaters

OBJECTIVE

This study explored links among body image, dieting behavior, and nutritional status among 40 nationally ranked junior figure skaters.

METHOD

Questionnaires were provided to 40 junior skaters (range 12.9-22.9 years) during a skaters' camp. Food intakes were recorded over 4 consecutive days and blood samples were drawn. Nutritional status was assessed using food intake records and selected biomarker data.

RESULTS

Data suggested that these athletes dieted despite relative satisfaction with body image. Although biochemical measures of nutritional status were all within normal range, inadequate energy intakes and delayed menarche (in women) were widespread in this athlete sample.

DISCUSSION

Data dispute common theories of dieting being linked to dissatisfaction with body image. The article also cautions against overreliance on biochemical assessment as a marker of nutritional inadequacy.

Gestational age and infant size at birth are associated with dietary sugar intake among pregnant adolescents

The objective of this study was explore the relationship between pregnancy outcomes and dietary sugar intake by pregnant adolescents. From two urban, prenatal clinics in the City of Camden, NJ, a cohort of 594 nondiabetic, pregnant adolescents, aged 13-19 y, who delivered live, singleton newborns between 1985 and 1990, was recruited and followed through pregnancy. Registered dietitians collected up to three 24-h recalls during pregnancy. The adolescents were categorized according to total sugar in their diets, with those in the top 10th percentile defined as high sugar consumers (> or = 206 g, n = 60) and the remainder as reference consumers (< 206 g). Primary outcome measures were birth of small-for-gestational-age infants and gestational age. The cohort was 61% black, 30% Hispanic (Puerto Rican) and 9% white. The adjusted odds ratio was 2.01 (95% confidence interval 1.05-7.53) for the delivery of a small-for-gestational-age infant for adolescents consuming high sugar diets, regardless of their ethnicity. In addition, gestational age at delivery was -1.69 +/- 0.62 wk (beta +/- SE) shorter among Puerto Rican adolescents consuming high sugar diets (P = 0.007) compared with all reference sugar consumers and white adolescents consuming high sugar diets. Black adolescents consuming high sugar diets did not exhibit a shortening of gestation. Thus, adolescents consuming high sugar diets are at increased risk for delivering small-for-gestational-age infants, and for delivering infants earlier if they are of Puerto Rican ethnicity.

Dietary and serum folate: their influence on the outcome of pregnancy

We examined the influence of folate intake from diet and supplements b y 28 wk of gestation and third trimester circulating concentrations of serum folate on the outcome of pregnancy in women from Camden, NJ. Mean daily folate intake by week 28 included both dietary and supplemental folate obtained prospectively in 832 women. Circulating concentrations of serum folate as well as serum vitamin B-12 were assayed at 28 wk of gestation (+/- 2 wk) by radioimmunoassay. The outcomes of interest included preterm delivery (<37 wk) and infants with low birth weight (<2500 g). Mean folate intake was significantly correlated with circulating concentrations of serum folate (r=0.17, P<0.001). Women with a low mean daily folate intake (</-240 microgram/d) had an approximately twofold greater risk of preterm delivery and infant low birth weight after maternal characteristics, energy intake, and other correlated nutrients were controlled for. Lower concentrations of serum folate at week 28 were also associated with a greater risk of preterm delivery and low birth weight.

Effect of high-sugar intake by low-income pregnant adolescents on infant birth weight

PURPOSE

The objective of this study was to determine the effect of total sugar intake by pregnant adolescents from low-income families on infant birth weight and small-for-gestational-age (SGA) infants.

METHODS

The study sample consisted of 337 adolescents, enrolled in a county-wide demonstration project in Camden, New Jersey, who delivered live, singleton newborns. The adolescents were divided into two groups at the 90th percentile for the study sample total sugar intake (206 g): high-sugar intake (> or = 206 g, n = 34) and low-sugar intake group (< 206 g, n = 303).

RESULTS

The sample was 46% black, 30% white, and 24% Hispanic. The sample gestational age and birth weight (mean +/- SD) were 39 +/- 3 weeks and 3189 +/- 666 g, respectively. After adjusting for energy intake, the high- compared with the low-sugar intake group was more likely to consume higher total sugar and carbohydrate but lower protein and fat. Likewise, the high-compared to the low-sugar intake group consumed significantly more calcium and magnesium. After adjusting for possible confounding variables such as maternal age, ethnicity, marital status, parity, smoking, net weight gain, body mass index, energy intake, and gestational age at birth, adolescents on high- compared to low-sugar diets gave birth to infants weighing 215 +/- 104 g less (p = 0.04). The adjusted odds ratios were 3.41 (95% confidence interval, 1.14 to 10.23) for delivering a SGA infant among adolescents with high- compared with low-sugar intakes.

CONCLUSIONS

Low-income adolescents consuming high-sugar diets are at increased risk for delivering lower birth weight and SGA infants.

Maternal growth during pregnancy and the competition for nutrients

The influence of maternal growth in knee height during pregnancy on birth weight, gestation, and maternal body composition was examined in 318 teenagers (144 growing, 174 nongrowing) and 276 mature women from the Camden Study. Body-composition differences associated with maternal growth did not arise until after 28 wk gestation, when growing gravidas continued to accrue fat, had larger gestational gains, and retained more of their gestational weight gain postpartum. Nevertheless, still-growing young mothers had infants with lower birth weight, particularly when the mother continued to accrue higher amounts of fat on the arm or back (subscapular site) late in gestation. Thus, despite an apparently sufficient weight gain and the accumulation of abundant stores during pregnancy, young still-growing women appeared not to mobilize fat reserves late in pregnancy to enhance fetal growth, apparently reserving them instead for their own continued development.

Low zinc intake during pregnancy: its association with preterm and very preterm delivery

Zinc affects growth, development, and reproduction. However, the effect of poor maternal zinc nutriture, usually measured as plasma zinc, on poor pregnancy outcome has not been consistent. The influence of dietary zinc on pregnancy outcome was examined in a cohort of 818 pregnant girls and women from a poor urban community in Camden, New Jersey (1985-1990). Zinc intake in this sample was 11.1 mg/day, a level ascertained from averaged 24-hour dietary recalls during pregnancy. Gravidas with low zinc intake (< or = 6 mg/day, amounting to 40% of the recommended dietary allowance for pregnancy) had lower caloric intake and multivitamin usage as well as a higher incidence of inadequate weight gain during pregnancy and iron deficiency anemia at entry to prenatal care compared with those with higher intakes. A low zinc intake was associated with approximately a twofold increase in the risk of low birth weight (< 2,500 g) after controlling for calories and other confounding variables. The risk of preterm delivery (< 37 completed weeks) was also increased, particularly when rupture of the membranes preceded the onset of labor (adjusted odds ratio = 3.46, 95% confidence interval 1.04-11.47). A low intake of dietary zinc earlier in pregnancy was associated with a greater than threefold increase in the risk of very preterm delivery (< 33 completed weeks). In conjunction with iron deficiency anemia at entry to prenatal care, the adjusted odds ratio for very preterm delivery with low zinc intake was 5.44 (95% confidence interval 1.58-18.79). Among the urban poor, a marginal zinc intake during pregnancy may play an important role in the duration of gestation and is associated with increased risk of preterm and very preterm delivery.

Maternal weight gain, diet and infant birth weight: correlations during adolescent pregnancy

Inadequate weight gain during pregnancy is an important risk factor for low birth weight (LBW), but the contribution of diet to weight gain is uncertain. Pregnancy weight gains were examined at 4-week intervals from 12 to 36 weeks' gestation, as well as total gain for gestation, in a cohort of over 2000 young pregnant women, aged less than or equal to 18 at entry to prenatal care. The effect of diet was studied in a 15% random sample of the cohort, using a 24-hour dietary recall obtained at entry to prenatal care (averaging 17 weeks' gestation). As early as 16 weeks' gestation, gains below the lower limit of a clinical standard were associated with a decrement in birth weight at delivery of more than -85 g (p less than 0.01), and after 24 weeks of approximately -180 g (p less than 0.001). After adjusting for potential confounding variables, teenagers who went on to develop inadequate total weight gain for gestation had consumed 1878 kcal vs 2232 for teenagers with adequate total gain (p less than 0.05). There were significant deficits in protein (p less than 0.05) and carbohydrate intake (p less than 0.05) associated with inadequate gain. However, there was no direct effect of nutrient intake on birth weight, LBW, or preterm delivery. This suggests that the relationship between nutrient intake during pregnancy and birth weight may be indirect and moderated by weight gain during pregnancy.

Demographic, dietary, life style, and anthropometric correlates of blood pressure

The relationships between systolic and diastolic blood pressure, and select demographic, dietary, life-style, and anthropometric variables were examined for a specialized sample of 10,419 adults, 18 years and over, from the National Health and Nutrition Examination Survey (NHANES) I conducted in 1971-1974. The bivariate relationships of blood pressure to each of the measurements above were examined using zero-order correlation coefficients, and Step-wise linear regression. Age and body mass index (BMI) played a major role in accounting for most of the variance in blood pressure. These two indices alone accounted for 94.5% and 89.0% of the variance in systolic and diastolic blood pressure. In contrast, only 5.5% and 11.0% of the changes in systolic and diastolic blood pressure were explained by all other variables combined. Diet explained less than 1% of the total variance observed for blood pressure for whites, and less than 5% for nonwhites. Select dietary variables such as sodium/potassium ratio, calories from fat, and % saturated fat were not significantly (p less than 0.001) correlated to blood pressure. On the other hand, food calcium, sodium/calcium ratio, food vitamin C, and calcium/phosphorus ratio were significantly correlated to both systolic and diastolic blood pressure.