Salt is composed of Sodium Chloride (NaCl) which in body water becomes essential electrolytes, viz., Sodium (Na⁺) and Chloride (Cl⁻) ions, including in the blood and other extracellular fluids (ECF). Na⁺ ions are necessary cations in muscle contractions and their depletion will effect all the muscles in body including smooth muscle contraction of blood vessels, a fact which is utilized in lowering the blood pressure. Na⁺ ions also hold water with them in the ECF. Na⁺ homeostasis in body is maintained by thirst (water intake), kidneys (urinary excretion) and skin (sweating). In Na⁺ withdrawal, body tries to maintain homeostasis as far as possible. However, in certain conditions (e.g., during exercise, intake of drugs and in disorders causing Syndrome of Inappropriate Anti Diuretic Hormone Secretion (SIADH), diuretics, diarrhea) coupled with moderate or severe dietary salt restriction (anorexia nervosa), hyponatremia can get precipitated. Hyponatremia is one end point in the spectrum of disorders caused by severe Na⁺ depletion whereas in moderate depletion it can cause hypohydration (or less total body water) and lower urinary volume (U v ). Moreover, salt sensitivity varies in various populations leading to different responses in relation to dietary Na⁺ intake. Diabetes and Hypertension often co-exist but Na⁺ withdrawal in salt sensitive subjects worsens diabetes though hypertension gets better and reverse occurs in salt loading. Therefore, Na⁺ or salt restriction may be non-physiological. In hypertensive subjects other alternatives to Na⁺ withdrawal could be Potassium (K⁺) and Calcium (Ca⁺²) supplementation. Further studies are required to monitor safety/side effects of salt restriction.

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It is a universally known fact that maternal well-being is related to neonatal health. This case-control study aims to assess the pattern and strength of association of neonatal morbidity and mortality (in first 7 days of life) in relation to the presence of obstetric & medical risk factors in the mother (indicating maternal ill-health). In 250 cases (at-risk pregnancies), 75 (30%) developed neonatal illnesses while 17 (6.8%) perinatal deaths occurred in first seven days. In the same number of controls (uncomplicated pregnancies) there were only two perinatal deaths and lesser number of newborns (45/250, 16.4%) developed neonatal diseases in the first 7 days. Perinatal deaths, (still births and early neonatal deaths), (OR = 9.05; AR = 88.2%) and neonatal illnesses (OR = 2.2 and AR = 45) were strongly associated with presence of maternal risk factors. This study supports the fact that 'at risk' pregnancies have highly significant chances of developing early (first 7 days) neonatal morbidity (p < 0.001) and mortality (p < 0.001). Still births also occurred significantly more (p < 0.005) in number among 'at risk' (cases) than normal term pregnancies (controls).

ABSTRACT

Background: Gastroesophageal reflux disease (GERD) is the most common among gastric disorders and treated by antacids especially proton pump inhibitors (PPIs). Though symptoms are reported to be controlled by PPIs, however the complications like barrettes esophagus, Cancers at GE junction are not studied and reported extensively. In view of symptomatic relief, the long, non-supervised, over the counter medication use has increased. Safety of such long-term has been attempted with the review of available evidence and presentation of a case. Aim:To update available literature on the long-term use of PPIs and possible mechanisms behind adverse events. Materials and Methods:A case of Barrette's esophagus was presented, with long-term use of PPIs. Detailed history taking of the case was done and another evidence synthesis was done on the effects of the long and short-term use of PPIs. The literature search using Medline, Scopus, Scholar on adverse effects of the use of PPIs was done which were language and date unrestricted.Results: Studies report many adverse effects on short-term (up to 5 years of use, namely: clostridium associated diarrhea, bacterial peritonitis, cholecystitis, pyogenic liver, liver cirrhosis, pneumonia, esophageal inflammations, nocturnal breakthrough acid reflux, interstitial nephritis, drug interaction and nutritional deficiencies mainly of Vitamin B 12 and iron) and long-term use, namely: Concomitant dyspepsia, Barrettes esophagus, osteoporosis, dementia, hypomagnesia, cancers at GE junction. Conclusion:The health care providers and community should be made cautious, larger cohort observational studies are also recommended for more evidence.