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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR


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  Editorial …

29th January 2012, Sunday

All about A1C (Part 1)

  1. A1c is a blood test that provides information about a person’s average levels of blood glucose over the past 3 months. It is also called the hemoglobin A1c, HbA1c or glycohemoglobin test.
  2. The A1c test is based on the attachment of glucose to hemoglobin, the protein in red blood cells (RBCs) that carries oxygen. In the body, RBCs are constantly forming and dying, but typically they live for about 3 months. Thus, the A1c test reflects the average of a person’s blood glucose levels over the past 3 months. The result is reported as a percentage. The higher the percentage, the higher a person’s blood glucose levels have been. A normal A1c level is below 5.7%.
  3. In 2009, an international expert committee recommended the A1c test as one of the tests available to help diagnose type 2 diabetes and pre–diabetes. Previously, only the traditional blood glucose tests were used to diagnose diabetes and pre–diabetes.
  4. Because the A1c test does not require fasting and blood can be drawn for the test at any time of day, experts are hoping its convenience will allow more people to get tested thus, decreasing the number of people with undiagnosed diabetes.
  5. AIc testing is important because early in the disease diabetes has no symptoms. Testing enables health care providers to find and treat diabetes before complications occur and to find and treat pre–diabetes, which can delay or prevent type 2 diabetes from developing.
  6. No test is perfect, the A1c and blood glucose tests are the best tools available to diagnose diabetes, a serious and life–long disease.
  7. A1c laboratory tests are now standardized. Earlier, the A1c test was not recommended for diagnosis of type 2 diabetes and pre-diabetes because the many different types of A1c tests could give varied results. The accuracy has been improved by the National Glycohemoglobin Standardization Program (NGSP), which developed standards for the A1c tests. The NGSP certifies that manufacturers of A1c tests provide tests that are consistent with those used in a major diabetes study. The study established current A1c goals for blood glucose control that can reduce the occurrence of diabetes complications, such as blindness and blood vessel disease. (Nathan DM, Genuth S, Lachin J, et al. The effect of intensive treatment of diabetes on the development and progression of long–term complications in insulin–dependent diabetes mellitus. New England Journal of Medicine 1993:329(14)977–86).
  8. When the A1c test is used for diagnosis, the blood sample must be sent to a laboratory that uses an NGSP–certified method for analysis to ensure the results are standardized. Blood samples analyzed in a health care provider’s office, known as point–of–care (POC) tests, are not standardized for diagnosing diabetes. The following table provides the percentages that indicate diagnoses of normal, diabetes, and pre-diabetes according to A1c levels.

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    Six uses of Tila (Sesame)

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    Any test for diagnosis of diabetes requires confirmation with a second measurement unless there are clear symptoms of diabetes.
  9. Having pre–diabetes is a risk factor for getting type 2 diabetes. People with pre–diabetes may be retested each year. Within the pre–diabetes A1c range of 5.7–6.4%, the higher the A1c, the greater the risk of diabetes. Those with pre–diabetes are likely to develop type 2 diabetes within 10 years, but they can take steps to prevent or delay diabetes.
  10. A1c test may be used at the first visit to the health care provider during pregnancy to see if women with risk factors had undiagnosed diabetes before becoming pregnant. After that, the oral glucose tolerance test (OGTT) is used to test for diabetes that develops during pregnancy—known as gestational diabetes. After delivery, women who had gestational diabetes should be tested for persistent diabetes. Blood glucose tests, rather than the A1c test, should be used for testing within 12 weeks of delivery.
  11. The standard blood glucose tests used for diagnosing type 2 diabetes and pre–diabetes, the fasting plasma glucose (FPG) test and the OGTT, are still recommended. The random plasma glucose test, also called the casual glucose test, may be used for diagnosing diabetes when symptoms of diabetes are present. In some cases, the A1c test is used to help health care providers confirm the results of a blood glucose test.
  12. In some people, a blood glucose test may indicate a diagnosis of diabetes while an A1c test does not. The reverse can also occur i.e. an A1c test may indicate a diagnosis of diabetes even though a blood glucose test does not. Because of these variations in test results, health care providers repeat tests before making a diagnosis. People with differing test results may be in an early stage of the disease, where blood glucose levels have not risen high enough to show on every test. Sometimes, making simple changes in lifestyle—losing a small amount of weight and increasing physical activity—can help people in this early stage reverse diabetes or delay its onset.
  13. All laboratory test results can vary from day to day and from test to test. Results can vary.
    • Within the person being tested: A person’s blood glucose levels normally move up and down depending on meals, exercise, sickness, and stress.
    • Between different tests: Each test measures blood glucose levels in a different way. For example, the FPG test measures glucose that is floating free in the blood after fasting and only shows the blood glucose level at the time of the test. Repeated blood glucose tests, such as self–monitoring several times a day with a home meter, can record the natural variations of blood glucose levels during the day. The A1c test represents the amount of glucose attached to hemoglobin, so it reflects an average of all the blood glucose levels a person may experience over 3 months. The A1c test will not show day–to–day changes.

      The following chart shows how multiple blood glucose measurements over 4 days compare with an A1c measurement.
    Dr K K Aggarwal

    Note: Blood glucose (mg/dL) measurements were taken four times per day (fasting or pre–breakfast, pre–lunch, pre–dinner, and bedtime). The straight black line indicates an A1c measurement of 7.0%. The blue line shows blood glucose test results from self–monitoring four times a day over a 4–day period.
    • Within the same test: Even when the same blood sample is repeatedly measured in the same laboratory, the results may vary due to small changes in temperature, equipment, or sample handling.
  14. The A1c test result can be up to 0.5% higher or lower than the actual percentage. This means an A1c measured as 7.0% could indicate a true A1c anywhere in the range from 6.5–7.5%. The drawing below shows the range of variation that can occur when an A1C is 7.0% on the lab report.

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  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

Dr Ajay Arora on 49th Annual PEDICON

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

3rd eMedinewS Revisiting 2011

Dr Neelam Mohan presenting eMedinewS distinguish lecture on Liver Transplantation in the 3rd eMedinewS RevisitinG Conference held on 22nd January 2012 at Maulana Azad Medical College

Dr K K Aggarwal
    National News

Cut the junk for healthy adult life

Today, kids are blamed for bingeing on fast food that makes them prone to obesity, diabetes and even heart disease in later life. According to a study conducted by the Diabetes Foundation of India, around 25% of schoolchildren in Delhi – the highest in the country – are overweight or obese. And it’s clearly a lifestyle problem because, compared to 34% of private school students, only 12% government school students are overweight. Many experts consider obesity the most serious epidemic among India’s children. Seema Gulati, who headed the study, says body weight is a concern because, as it has no immediate health effect in childhood, people tend to ignore the warning signs. "It’s time we change our mindset. All schools can have special counselling on child health, which includes dietary habits," says Gulati, adding that controlling childhood obesity can cut down half of all non–communicable diseases – diabetes, heart disease, kidney dysfunction and hypertension. (Source: TOI, January 27, 2012)

For comments and archives

Bird flu alert in north AP

The district administrations of Srikakulam, Vizianagaram and Visakhapatnam have issued a bird flu alert in the wake of avian influenza cases in Odisha. The administrations of the three coastal districts have also appealed to the public, particularly poultry farmers and non–vegetarians, to take precaution. A senior Animal Husbandry Department officer said they have started making all possible efforts to stop migration of crows, parrots and cranes, besides poultry chicken, from Odisha. The district administrations have asked the departments concerned, including Animal Husbandry, to report bird deaths. The departments have also been instructed to start culling infected birds, if needed, and bury them in pits with adequate safeguard. (Source: Deccan Chronicle, January 27, 2012)

For comments and archives

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology: Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    International News

Early elective deliveries fall at surveyed hospitals

The rate of early elective newborn deliveries — those before 39 completed weeks that are not medically indicated — declined on average from 17% in 2010 to 14% in 2011 among hospitals surveyed by the Leapfrog Group, a quality–improvement organization. (Source: Medscape Medical News)

For comments and archives

Reflux drugs no help for children with asthma

Proton pump inhibitor (PPI) treatment doesn’t ease asthma for children who don’t have gastroesophageal reflux symptoms, even for those with a positive pH test, a randomized trial determined. (Source: Medpage Today)

For comments and archives

Common chemicals tied to lower vaccine response

Exposure to perfluorinated compounds (PFCs) –– chemicals used in many consumer products –– appears to be associated with reduced immune responses to routine childhood vaccines, researchers found. (Source: Medpage Today)

For comments and archives

    Twitter of the Day

@DrKKAggarwal: #AJOR –Stage plan for managing gout may keep joints clean Maintaining serum urate levels at less than 6 mg/dL is… fb.me/Uo20Yj2D

@DeepakChopra: Our life is a timeline of choices. When you expand your awareness, seemingly random events will be seen to fit into a larger purpose.

    Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Why do we close our eyes during pooja?

Whenever we pray, think of God, undertake an internal healing procedure, make love, kiss someone, or meditate, we automatically close our eyes. It is a common Vedic saying that the soul resides in the heart and all the feelings are felt at the level of heart.

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    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

How is fertility in men and women preserved before cancer treatment?

In men: Semen samples may be frozen at a sperm bank or fertility center before starting chemotherapy or radiation therapy. Sperm counts may be low or absent as a result of the underlying cancer. If sperm counts are low and/or the supply is limited from the frozen sample, the sperm can be used for in vitro fertilization (IVF) and intra cytoplasmic sperm injection (ICSI).

In women: If time and circumstances allow, women may be treated with IVF. Embryos created by IVF are then frozen and may be stored for years. If radiation will be administered to the pelvis, the ovaries may be repositioned surgically out of the radiation ?eld. This will reduce the risk that radiation will damage the eggs.

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

A small candle and the man

I’m really interested in story about a small candle carried by a man who was climbing the stairs of a lighthouse.

In their way up to the top, the candle asked the man, "Where are we going?" "We’re going to the top of this lighthouse and give signals to the big ships on the ocean," the man answered.

"What? How could it be possible for me with my small light to give signals to those big ships?" "They will never be able to see my light", replied the candle weakly. "That’s your part. If your light is small, let it be. All you have to do is keep burning and leave the rest to me", said the man.

A little later, they arrived at the top of the lighthouse where there was a big lamp with a loop behind it. Then the man lit the lamp with the light of the candle and instantly, the place shone so brightly that the ships on the ocean could see its light.

With our being and our limitations, we’re hardly able to do any meaningful things. Yet, one thing you should bear in mind is that your life is like a small candle in God’s powerful hand. All your abilities and expertise will remain as a small light if you don’t put your life in God’s hand. On the contrary, even if your light is so small or dim, if you entrust all your life to God, he is able to make your small light into a big one that brings blessings to many people.

Even it wasn’t impossible for Joshua, who was Moses’ servant, to feel slightly fear when God ordered him to lead the Israelis invading the Canaan. God comforted and strengthened Joshua that He would never leave him. God even promised him victory over victory. All God asked from him was, "Be strong and very courageous. Be careful to obey all the law my servant Moses gave you; do not turn from it to the right or to the left, that you may be successful wherever you go." (Joshua 1:7)

Do not look at your inability, limitations, and weaknesses. God entrust you with something, whether it is a work or a ministry. Have faith that you are in His mighty hand that He will use you according to His will. When we put all our trust in Him, we will see how He uses our lives, including our limitations, to be blessings to others.

For comments and archives

    Cardiology eMedinewS

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

2nd National Heart Valve summit

Mechanical valves need lifelong anti coagulation: Dr D K Satsangi

Read More

What’s wrong with TAVI? Dr Z Turi

Read More

AVR Mortality: Elderly 7–9 % mortality in 80+: Dr OP Yadava

Read More

Bad Teeth Are Related To Bad Heart Arteries

Read More

    Pediatric eMedinewS

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Anaphylaxis after Pediatric Immunization Rare

Read More

Paracetamol the Most Common Prescribed Drug In Pediatrics

Read More

Children With Pulmonary Hypertension Behave Differently Than Adults.

Read More

Breastfeeding May Reduce Mother’s Risk Of Hypertension.

Read More

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    Healthy Driving

(Conceptualized by Heart Care Foundation of India and Supported by Transport Department; Govt. of NCT of Delhi)

How does vision affect drowning?

Depth perception: Passing other vehicles and changing lanes requires good judgment of distance, especially in busy traffic. A person with good eyesight has the most reliable depth perception. Drivers who have recently lost the use of one eye need to take extra care. They may need to stop driving for a period of time until their vision has adjusted.

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A female diabetic patient with BP of 135/85 mmHg came for evaluation.
Dr Bad: Continue only the antidiabetic treatment; your BP is perfect.
Dr Good: You also need to control your BP. It is towards higher side.
Lesson: The threshold for initiating antihypertensive therapy is lower (BP of at least 130/80 mnmHg) in women with NIDDM than it is in non diabetic patients.

For comments and archives

Make Sure

Situation: A 20–year–old college student complained of dysuria, frequency and pyuria.
Reaction: Oh my God! Why did you not advise macrolide?
Lesson: Make sure to remember that macrolide are very effective against E. coli, S. saprophyticus and C. trachomatis infection.

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    Quote of the Day

(Dr GM Singh)

The intuitive mind is a sacred gift and the rational mind is a faithful servant. We have created a society that honors the servant and has forgotten the gift. Albert Einstein

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Liver function tests (LFTs)

  • To screen for, detect, evaluate and monitor for liver inflammation and damage.
  • Periodically to evaluate liver function; whenever you are at risk for liver injury; when you have a liver disease; when you have symptoms such as jaundice.
    Mind Teaser

Read this…………………

As per the pediatric AIDS clinical trials group (PACTG), protocol 076 AZT should be started in pregnant women from:

a. 20 weeks of gestation
b. 12 weeks of gestation
c. 14 weeks of gestation
d. 10 weeks of gestation

Yesterday’s Mind Teaser: Tinnitus can be an associated symptom in which of these causes of vertigo?

a. Acute labyrinthitis
b. Acoustic neuroma
c. Meniere’s disease
d. All of the above

Answer for Yesterday’s Mind Teaser: a. Acute labyrinthitis

Correct answers received from: Yogindra Vasavada, Dr Avtar Krishan, Anil Bairaria, Muthumperumal Thirumalpillai.

Answer for 27th January Mind Teaser: d. All of the above
Correct answers received from: Dr KV Sarma, Dr Rajshree Aggarwal, Dr Shashi Saini, Raju Kuppusamy, Dr Neelam Nath, Dr Chandresh Jardosh.

Send your answer to ijcp12@gmail.com

   Laugh a While

(Dr GM Singh)

All the desirable things in life are either illegal, expensive or fattening or married to someone else.

    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Immunization death and legal autopsy

  • It is recommended that an autopsy in a death suspected to be due to an adverse event following immunization (AEFI) be performed as soon as possible (within 72 hours) to avoid tissue damage, development of post mortem artifacts and autolysis of the adrenal glands, which can alter diagnosis.
  • The detailed patient’s history is included in the autopsy form that it is submitted to the team (autopsy surgeon/pathologist/forensic specialist) conducting autopsy. The additional specific information to the autopsy team will help them look for any underlying disease/pathologies in the deceased, which may be cause of death or contributed in the cause of death.
  • Samples for both histopathological and toxicological examination should be sent to approved and accredited government reference labs through investigating police agencies. The samples should be collected and transported to forensic labs as early as possible to avoid loss of biological samples due to decomposition.
  • All samples should be labeled with the name, number and autopsy report/form number along with the necessary documents requesting the examination and investigation, and the conclusions from the autopsy, which should list the cause of death, utilizing International Classification of Disease (ICD 10) and, if possible, the causative agents/drugs.
  • Samples for histopathology to be sent to a pathologist to detect underlying disease/pathologies in the deceased that may have caused or contributed to death. The samples should be representative of the suspicious area of disease/pathology; however, in general liver (80–100gm), brain (100 gm) with meninges, fragments from both adrenal glands, half of transverse section of kidneys, half of spleen and whole heart should be sent.
  • All the visceral specimens should be collected in separate containers or a wide–mouthed bottle as prescribed; 10% formalin should be added as preservatives. The quantity of the formalin should be sufficient to cover all the pieces of specimen viscera in bottle.
  • The specimens should be sealed, signed, labeled by the doctor/autopsy surgeon and should be handed over to police/investigating officer for further pathological examination.

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    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

Check your BMI to know chances of future heart attack

If you are less than 40 years of age, male, with a strong family history of diabetes, blood pressure or heart disease, have a normal weight as judged by body mass index (BMI) but have a pot belly, or have gained more than 10 kg since the age 18, do not ignore and go to your cardiologist to reduce your chances of a future heart attack, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

A BMI of 20 to 23 kg/m2 is associated with little or no increased risk unless visceral fat is high, or the subject has gained more than 10 kg since age 18.

  • Subjects with a BMI of 23 to 30 kg/m2 may be described as having low risk, while those with a BMI of 30 to 35 kg/m2 are at moderate risk.
  • Subjects with a BMI of 35 to 40 kg/m2 are at high risk, and those with a BMI above 40 kg/m2 are at very high risk from their obesity.
  • At any given level of BMI, the risk to health is increased by more abdominal fat (increased weight to hip ratio, WHR), hyperlipidemia, hypertension, age less than 40 years, male sex, and a strong family history of diabetes, hypertension, or heart disease.

The body mass index (BMI) is the most practical way to evaluate the degree of obesity. It is calculated from the height and weight as follows:

BMI = body weight (in kg) ÷ square of stature (height in meters)

Overweight is defined as a BMI between 23 and 30 kg/m2 and obesity as a BMI greater than 30 kg/m2.

    Readers Responses
  1. Dear Dr Aggarwal, Indeed a heroic effort by the team of Dr K K Aggrawal especially in inclement weather on 22 Jan 2012 to organize the annual feat of e–medinews at MAMC auditorium. Topics, presentation and organization moved smoothly. Long live spirit of medical fraternity as carried by Dr K K Aggrawal. Dr (Major) B K Singh MD, DNB.
    Forthcoming Events

Ajmer Health Fair: Ajmer’s Largest Ever Super Specialty Health Camp

Date: February 11 and 12, 2012
Venue: Patel Stadium, Ajmer
Organizer: Heart Care Foundation of India


The Annual conference of Indian Menopause Society is to be held from 17 to 19th Feb 2012 in Hotel The Claridges, Surajkund Faridabad. It is multidisciplinary approach to the problems of midlife onwards in women. This conference has participation of British Menopause Society and South Asian Federation Of Menopause Societies and opportunity to hear from international faculties.

For information Contact Dr. Maninder Ahuja (Organizing Chairperson) 9810881048 down load forms from web sit http://indianwoman35plus.com/ or Indianmenopausesociety.org or http://fogsi.org/

Contact at ahuja.maninder@gmail.com
Call for free papers and posters on theme topics of conference.

    eMedinewS Special

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    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta