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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 …

30th January 2012, Monday

All about A1c (Part 2)

  1. A1c can give false results in some people. It can be unreliable for diagnosing or monitoring diabetes in people with certain conditions that are known to interfere with the results. Interference should be suspected when A1c results seem very different from the results of a blood glucose test. People of African, Mediterranean, or Southeast Asian descent, or people with family members with sickle cell anemia or a thalassemia are particularly at risk of interference. People in these groups may have a less common type of hemoglobin, known as a hemoglobin variant that can interfere with some A1c tests. Most people with a hemoglobin variant have no symptoms and may not know that they carry this type of hemoglobin.
  2. Not all of the A1c tests are unreliable for people with a hemoglobin variant. People with false results from one type of A1c test may need a different type of A1c test for measuring their average blood glucose level.
  3. False A1c results may also occur in people with other problems that affect their blood or hemoglobin. For example, a falsely low A1c result can occur in people with anemia, heavy bleeding.
  4. A falsely elevated A1c result can occur in people who are very low in iron, for example, those with iron deficiency anemia.
  5. Other causes of abnormal A1c results include kidney failure and liver disease
  6. Health care providers can use the A1c test to monitor blood glucose levels in people with type 1 or type 2 diabetes. The A1c test is not used to monitor gestational diabetes.
  7. The American Diabetes Association (ADA) recommends that people with diabetes who are meeting treatment goals and have stable blood glucose levels should have the A1c test twice a year. Health care providers may repeat the A1c test as often as four times a year until blood glucose levels reach recommended levels.
  8. The A1c test helps health care providers adjust medication to reduce the risk of long–term diabetes complications. Studies have demonstrated substantial reductions in long–term complications with the lowering of A1c levels.
  9. When the A1c test is used for monitoring blood glucose levels in a person with diabetes, the blood sample can be analyzed in a health care provider’s office using a POC test to give immediate results. However, POC tests are less reliable and not as accurate as most laboratory tests.
  10. Estimated average glucose (eAG) is calculated from the A1c. It helps people with diabetes relate their A1c to daily glucose monitoring levels. The eAG calculation converts the A1c percentage to the same units used by home glucose meters i.e. milligrams per deciliter (mg/dL). The eAG number will not match daily glucose readings because it is a long-term average rather than the blood glucose level at a single time, as measured with the home glucose meter. (Diabetes Care 2011;34(Supp 1):S11–S61, Table 9)

    A1c (%)

    eAG (mg/dL)















  11. People will have different A1c targets depending on their diabetes history and their general health.
  12. Studies have shown that people with diabetes can reduce the risk of diabetes complications by keeping A1c levels below 7%.
  13. An A1c level that is safe for one person may not be safe for another. For example, keeping an A1c level below 7% may not be safe if it leads to problems with hypoglycemia.
  14. Less strict blood glucose control, or an A1c between 7–8% or even higher in some circumstances, may be appropriate in people who have limited life–expectancy; long–standing diabetes and difficulty attaining a lower goal; severe hypoglycemia and advanced diabetes complications such as chronic kidney disease, nerve problems, or cardiovascular disease
  15. Large changes in a person’s blood glucose levels over the past month will show up in their A1c test result, but the A1c does not show sudden, temporary increases or decreases in blood glucose levels. Even though the A1c represents a long–term average, blood glucose levels within the past 30 days have a greater effect on the A1c reading than those in previous months.

The corrected point 8 of All about A1c level (part 1) editorial:
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.


A1C Level


below 5.7 percent


6.5 percent or above


5.7 to 6.4 percent

*Any test for diagnosis of diabetes requires confirmation with a second measurement unless there are clear symptoms of diabetes.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

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

Avoid smoking in winter

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

3rd eMedinewS Revisiting 2011

Dr U Kaul was awarded with AJCC Oration 2012 in the 3rd eMedinewS RevisitinG Conference held on 22nd January 2012 at Maulana Azad Medical College

Dr K K Aggarwal
    National News

Man with deadly TB strain is HIV+

MUMBAI: A patient with extra–extremely drug–resistant tuberculosis (XXDR TB) has tested positive for HIV. Public health experts say the coming together of the two dreaded infections is worrying. Fourteen XXDR TB cases have been detected in the state so far. State government officials and the Mumbai District AIDS Control Society (MDACS) are tight–lipped about the co-infection case. A source said: "The patient is yet to be started on antiretroviral therapy (ART) for HIV infection. Such patients are usually treated for TB at the beginning. Once they stabilize, ART is started." TB is the commonest HIV–related opportunistic infection. An expert summed up the deadly nature of the combined infection saying that when HIV brings down immunity, TB catches up. "The two need to be dealt with in a synchronized manner. Efforts and the machinery to integrate the Revised National Tuberculosis Control Programme (RNTCP) with the HIV programme need to be strengthened." (Source: TOI, Jan 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

Steroids may soothe joints for RA patients

It’s possible to control local inflammation in rheumatoid arthritis by interfering with protein changes in the joints, an international team of researchers found. (Source: Medpage Today)

For comments and archives

Oral HPV–cancer link clarified

Oral infection with human papillomavirus (HPV) occurred three times as often in men as in women, a potential explanation for men’s higher rate of HPV–related head and neck cancers, investigators reported here. And the cancer–related HPV type 16 (HPV–16) accounted for fewer than 15% of all oral HPV infections but was five times more prevalent in men. (Source: Medpage Today)

For Comments and archives

Risk of cardiac death pretty much set by 55

Even a couple of traditional cardiovascular risk factors in middle age spell high lifetime risk for the heart, researchers affirmed. Two or more major risk factors at age 55 predicted a 29.6% chance of death from cardiovascular disease by age 80 for men and 20.5% for women, Donald M. Lloyd–Jones, MD, of Northwestern University in Chicago, and colleagues found. (Source: Medpage Today)

For comments and archives

  Twitter of the Day

@DrKKAggarwal: #IJCP High–fiber diet no help for diverticulosis A high–fiber diet afforded no protection against asymptomatic… fb.me/1rSZ0kKDZ

@DrKKAggarwal: When consciousness expands random events are seen to fit a pattern which is part of a larger purpose.

    Spiritual Update

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

What is the significance of Swastika (Sathiyo)?

During a marriage ceremony, swastika is painted on the wall or entrance of the house to wish for the well–being and happiness of the newly weds.

For comments and archives

    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

How to preserve male and female fertility before cancer treatment?

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).

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)

Another way to win

Kay Poe and Esther Kim have been best friends since they were seven years old. Among other things they have in common, the two young ladies from Houston both compete at the highest levels in taekwondo. How good are they? Esther and Kay advanced to the finals in the Women’s Olympic Flyweight division at the 2000 U.S. Olympic Team Trials on May 20 in Colorado Springs.

"I don’t think of her as just a friend. I think of her more as a sister," Kay says. "We’ve grown up together, and we always push each other and help each other out the best we can training wise." What a story was unfolding! Reporters and photographers were poised to record the outcome of so intense a competition between two girls who have been close for so long. But a sports story would soon be overshadowed by a far more important friendship story.

Kay had dislocated her left kneecap in her semi-final match of the round robin tournament. Though ranked number one in the world at her sport, it was questionable that she could compete against her best friend. She could barely stand, so it was a foregone conclusion that Esther would win, travel to the 2000 Olympic Games in Sydney, and represent the United States in the international competition these two had trained and worked toward for so long.

On the day of the match, Esther Kim shocked the crowd by forfeiting rather than defeat her friend in an unfair competition. In allowing the better taekwondo fighter to represent the United States in Sydney, she won a personal battle over ego and selfishness. Amidst frequent stories of cheating and taking unfair advantage in order to win at any price, Esther showed how to win by losing.

"Even though I didn’t have the gold medal around me," said Esther, "for the first time in my life, I felt like a real champion." Her generosity of spirit was honored with the Citizenship through Sports Award and with an all–expenses–paid trip to the 2000 Olympic Games from the International Olympic Committee.

In the Bible, Paul wrote about giving up certain "rights" for the sake of people he loved (see 1 Corinthians 9:1–15). Parents do it all the time for their children. And occasionally friends make magnanimous gestures like Esther’s.

The next time you are inclined to bemoan the selfishness of the masses, recall this story of a 20–year–old athlete’s largesse. The next time you have the chance to show magnanimity, let it inspire you to rise to the level of her example.

For comments and archives

  Cardiology eMedinewS

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

2nd National Heart Valve summit

What’s wrong with TAVI? Dr Z Turi

Read More

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

Read More

Cohort A and B results PARTNER trial: TAVI Dr Larry S Dean

Read More

India need to approve TAVI: Dr Ashok Seth

Read More

  Pediatric eMedinewS

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

Prolonged Use of a Bottle May Contribute To Obesity As Well As Dental Caries

Read More

Frenotomy for Ankyloglossia (tongue–tie)

Read More

Infant Brain Yields Autism Clues

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?

Accommodation (near vision focusing): A driver needs to look from the road to the dashboard and back again quite frequently. This ability to change focus from far to near is called accommodation. Most people over the age of 45 have gradually increasing difficulty with near vision, and may require glasses to see dashboard instruments clearly.

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    IJCP Special

Dr Good Dr Bad

Situation: A patient was found to have BP >170/110 mm Hg.
Dr Bad: Start with one drug.
Dr Good: Start with two drugs.
Lesson: For every 20/10 mm Hg reduction in BP, one drug needs to be added.

For comments and archives

Make Sure

Situation: A patient with diabetes shows deteriorating kidney function.
Reaction: Oh my God! His HbA1c is very high!
Lesson: Make sure that strict glycemic control is maintained in patients with type 2 diabetes in order to delay vascular complications.

For comments and archives

  Quote of the Day

(Dr GM Singh)

"In this world people will always throw stones in the path of your Success, it depends on you? What you make from them – a wall or a bridge."

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

AFB Culture

Positive AFB cultures identify the particular mycobacterium causing symptoms, and susceptibility testing on the identified organism gives the doctor information about how resistant it may be to treatment.

  • Positive AFB smear or culture several weeks after drug treatment has started may mean that the treatment regimen is not effective and needs to be changed. It also means that the person is still likely to be infectious and can pass the mycobacteria to others through coughing or sneezing.
  • Negative AFB culture means that someone does not have an AFB infection or that mycobacteria were not present in that particular specimen (which is why multiple samples are often collected). Cultures are held for six to eight weeks before being reported as negative. If someone has TB, the infection may be in another part of the body and a different type of sample may need to be collected. A negative culture several weeks after treatment indicates that the TB infection is responding to drug treatment and that the person is no longer infectious.
    Mind Teaser

Read this…………………

Which of the following have been consistently true in the vaccine?

a. Circumcision is protective against HPV infection.
b. Condoms protect against HPV infection.
c. HPV vaccination enhances clearance of previous infections.
d. Vaccination confers protection against vaccine type related cervical neoplasia.

Yesterday’s Mind Teaser:  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

Answer for Yesterday’s  Mind Teaser: c. 14 weeks of gestation

Correct answers received from: Dr K.Raju, Dr.Chandresh Jardosh, Dr.NeelamNath, Dr Jainendra Upadhyay Muthumperumal Thirumalpillai, Anil Bairaria, Dr Arvind Khanijo

Answer for 28th January Mind Teaser: a. Acute labyrinthitis
Correct answers received from: Dr.Chandresh Jardosh, Dr.NeelamNath, Dr Jainendra Upadhyay Muthumperumal Thirumalpillai, Anil Bairaria

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr G Singh)

"My father refused to spend money on me as a kid. One time I broke my arm playing football and my father tried to get a free X–ray by taking me down to the airport and making me lie down with the luggage."

    Medicolegal Update

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

Can a doctor disclose the medical condition of the patient?

  • The conclusive summary of the Principle of "duty of care", as applicable to persons in medical profession, includes the duty to maintain confidentiality.
  • From ancient age in India the medical ethics has viewed the duty of confidentiality as a relatively non–negotiable tenet of medical practice.
  • The Hippocratic Oath express about patient confidentiality as Whatever, in connection with my professional service, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.
  • Patient Confidentiality is mandated in America by laws known as Health Insurance Portability and Accountability Act (HIPAA) of 1996, specifically the Privacy Rule, and various state laws, some more rigorous than HIPAA. However, numerous exceptions to the rules have been carved out over the years in view of medico–legal cases.
  • Many American states require physicians to report gunshot wounds to the police and impaired drivers to the Department of Motor Vehicles.
  • Confidentiality is also challenged in cases involving the diagnosis of a sexually transmitted disease in a patient who refuses to reveal the diagnosis to a spouse, and in the termination of a pregnancy in an underage patient, without the knowledge of the patient’s parents.
  • In India a law like HIPAA is required or should be incorporated in code of medical ethics by MCI

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

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

Chronic kidney disease (CKD) is heart disease (coronary heart disease) risk equivalent

The two main causes of chronic kidney disease are diabetes and high blood pressure, which are responsible for up to two–thirds of the cases. This was stated by Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

The time is to reduce the need of the kidney transplants in the country. Over 40% of the patients needing transplant have either diabetes or high blood pressure. If the community’s BP and sugar are kept under control over 50% of the kidney transplants can be avoided at any given time. Mild to moderate CKD is associated with an adverse cardiovascular prognosis Renal dysfunction is defined by a serum creatinine concentration that exceeds 1.5 mg/dL(133 μmol/L) or an estimated glomerular filtration rate that is less than 60 mL/min per 1.73 m2.

Also, chronic kidney disease can cause high blood pressure. The Facts about Chronic Kidney Disease (CKD)

  • Early detection can help prevent the progression of kidney disease to kidney failure.
  • Heart disease is the major cause of death for all people with CKD.
  • Glomerular filtration rate is the best estimate of kidney function.
  • Hypertension causes CKD and CKD causes hypertension.
  • Persistent proteinuria (proteins in the urine) means CKD.
  • High risk groups include those with diabetes, hypertension and family history of kidney disease.
  • Three simple tests can detect CKD: blood pressure, urine albumin and serum creatinine (blood test).
    Readers Response
  1. Dear Dr KK Aggarwal, Sir I came late but it was very impressive I really enjoy and learn. Thank you for such wonderful arrangements. Sanjeev Choubey.
    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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3. eMedinewS audio lectures (This may take a few minutes to open)

4. eMedinewS ebooks (This may take a few minutes to open)

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  Personal Cleanliness

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  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein

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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