Performance of equations for estimation of 24-hour urinary sodium from morning fasting urine samples in a multisite study in India

BACKGROUND Dietary salt intake is an important modifiable risk factor for cardiovascular diseases. Estimation of 24-hour salt intake using morning urine samples needs to be validated in the Indian context. We examined the performance of INTERSALT, Tanaka and Kawasaki equations for the estimation of 24-hour urinary sodium from morning fasting urine (MFU) samples. METHODS We enrolled 486 adults aged 18–69 years from four regions of India with equal rural/urban and sex representation to provide 24-hour urine samples. The next day, a MFU sample was obtained. Based on the volume and sodium content of the 24-hour urine sample, 24-hour sodium excretion (reference method) was calculated. Sodium levels in the MFU samples were measured along with other parameters required, and the above equations were used to estimate 24-hour urinary sodium levels. Intraclass correlation coefficient (ICC) was used to assess the degree of agreement between the estimates from the reference method and the three equations. Bland–Altman (BA) plots were used to identify systematic bias and limits of agreement. A difference of 1 g of salt (0.39 g of sodium) between the mean salt intake by 24-hour urine and as estimated by equations was considered acceptable. RESULTS A total of 346 participants provided both the samples. The mean (SD) daily salt intake estimated by the 24-hour urine sample method was 9.9 (5.8) g. ICC was low for all the three equations: highest for Kawasaki (0.16; 95% CI 0.05–0.26) and least for Tanaka (0.12; 0.02–0.22). Only Tanaka equation provided estimates within 1 g of measured 24-hour salt intake (–0.36 g). BA plots showed that as the mean values increased, all the three equations provided lower estimates of salt intake. CONCLUSION Tanaka equation provided acceptable values of 24-hour salt intake at the population level. However, poor performance of all the equations highlights the need to understand the reasons and develop better methods for the measurement of sodium intake at the population level.

The prevalence pattern of locomotor disability and its impact on mobility, self-care, and interpersonal skills in rural areas of Jodhpur district

Context: Impact of disability is deleterious, affecting an individual's every aspect. Majority of disabled reside in rural areas of developing countries. Moreover, different types of disability add to its wide spectrum. All these make it a major health issue. Aims: The aim of this study was to note the prevalence rate and pattern of locomotor disability in a rural population of Jodhpur District and to observe its impact on mobility, self-care, and interpersonal skills of disabled. Settings: This study was carried out in rural field practice area of the Community and Family Medicine Department of tertiary care setup. Design: This was a cross-sectional study. Materials and Methods: House-to-house survey for a sample size of 1656 was conducted by a team of trained doctors, therapists, and anganwadi workers for identification of locomotor disability applying a pretested survey questionnaire. Statistical Analysis: SPSS version 22 was used for descriptive analysis of variables (frequency distribution), and the Chi-squared test was used for the association of sociodemographic factors with performance qualifier score. Results: The prevalence rate of 2.08% for locomotor disability (male = 57% and female = 43%) was noted, with 31% from 40 to 60 years, 49% were illiterate, and 60% were from lower class. The main etiologies were cerebrovascular accident (25%) and cerebral palsy (23%). About 80% faced some difficulties in mobility domain, 57% in self-care, and 63% in interpersonal skills. Statistically significant association was seen for self-care domain with education level (P = 0.04) and for interpersonal skill domain with age groups and diagnosis (P = 0.022 andP = 0.035, respectively). Conclusion: The overall prevalence of locomotor disability in rural Jodhpur was 2.08%, higher for males and higher from 40 to 60 years. Most disabled were illiterate and were from low socioeconomic status. Self-care, mobility, and interpersonal skills were primarily affected and require proper intervention

Knowledge assessment about risk prevention of rabies amongst doctors in AIIMS, Jodhpur.

Background: Rabies still continues to be a public health problem in India and to protect our citizens from this menace; medical professionals have to be well equipped to tackle it more efficiently. The paper aims to assess the knowledge of residents and faculty in newly established AIIMS regarding risk prevention of rabies. Methods: A cross sectional study using a structured questionnaire on rabies was done at AIIMS Jodhpur amongst the doctors and the data was compiled in Microsoft excel 2010 were further analysed using SPSS version 21. Results: Out of the total sixty respondents, faculty constituted 38.3%, and junior residents and senior residents 28.3% and 33.3% respectively. Nearly 72% responded correctly regarding post exposure prophylaxis (PEP) i.e. 5 dose regimen of intramuscular administration of Anti Rabies Vaccine (ARV) and 56.7% doctors were unaware about the current recommendation of intradermal (ID) route. Rabies immunoglobulin (RIG) or Anti-Rabies Serum (ARS) against Rabies infection used in Class III bites was known to only 45% of the total doctors. Conclusion: The study reveals that there is a scope of improvement in important areas related to the knowledge of doctors in AIIMS regarding animal bites which needs to be upgraded time to time through continuing medical education in order to follow the standard protocol and guidelines at the apex institute.

Comparative Analysis of Electrophysiological Parameters of Median Nerve in Normal and Diabetic Subjects.

Peripheral neuropathy is a common complication in diabetic patients. Nerve conduction study is widely used for the assessment of diabetic polyneuropathy. This study was designed to characterize motor nerve conduction abnormalities in subjects having relatively shorter duration (2.28 ± 1.51 years) of type 2 diabetes mellitus. The median motor nerve conduction study was carried out on 40 male type 2 diabetic patients attending diabetic clinic in the department of medicine and 40 healthy male volunteers who served as control. Motor Distal latency (MDL), Amplitude (Amp) and Conduction Velocity (CV) were measured. On comparing the parameters of median nerves of both the groups, it was found that motor distal latency of (right and left) median nerves was higher in diabetics than in non diabetics with statistically significant difference. Results also showed decreased amplitude and conduction velocities of median nerve of both sides in diabetics (statistically significant). All the parameters were found correlated with blood sugar levels in diabetics.

Profile of School Going Children with Visual Impairment.

Eye is the most vital organ of human body; apart from serving the function of vision, it enables us to do our tasks with coordination. Any abnormality in the eye can impair vision and make the person handicapped for life. WHO estimates that 153 million people worldwide live with visual impairment due to uncorrected refractive errors, 8 million are blind and 12.8 million are in age group of 5-15 years1. In India prevalence of defective vision in age group of 6-15 years is around 13 %2,3. The school children form a special group because they are most vulnerable to the effects of reduced vision and its impact on learning capability and educational potential. In addition, the management of refractive errors is perhaps the simplest and the most effective eye care that can be provided by involving the community4. The school children are more prone to develop decreased visual acuity owing to increased near work due to stressful academic schedule, nutritional deficiencies and excessive viewing of television, playing videogames. Poor vision in childhood affects academic performance in school and has a negative influence on future of child. Considering these issues the present study was carried out to find out the factors affecting vision of school children and to suggest preventive and remedial measures for defective vision.