HBA1C

HbA1c. How many of us know exactly what this means?

Now all standard Diabetes centers, Hospitals and Clinicians have started recommending this test for their Diabetic patients. It would be apt to say that HbA1c is considered a gold standard investigation for diagnosis , Treatment and Followup of Diabetic patients. 

So what is HbA1c? 

It is a blood test which will give you an average sugar control for the past three months. It is otherwise called Glycated Hemoglobin or Glycosylated haemoglobin or glyycohemoglobin. This Glycated Hemoglobin comprises of HbA1c, HbA1a, HbA1b, HbS,HbC and HbF. HbA1c is more specific among the other mentioned components.

HbA1c has been used in many international studies for assessment of risk of developing complications of Diabetes. The normal level of HbA1c in a non-diabetic patient should range between 4.0-6.0%. 

American Diabetes Association  recommended the use of HbA1c as a diagnostic marker for diabetes & prediabetes in 2010. People with HbA1c of 6.5% and above are to be diagnosed as diabetes and HbA1c between 5.7-6.4%  are considered to be at risk of diabetes.

The target HbA1c in a Diabetic patient is <7% 

HbA1c is definitely a very good tool in the hands of the clinicians to provide a better control over diabetes. But, we also need to know factors that can affect this blood test. 

What will show faulty higher HbA1c readings?

HbF and HbG

Uraemia

Lead poisoning

Hypertriglyceridaemia

Alcoholism

Opiate addiction

Iron deficiency state

Postsplenectomy

Hyperbilirubinaemia

Chronic aspirin therapy

What will show faulty lower HbA1c readings?

HbS and HbC

Haemolytic anaemia

Pregnancy

Acute or chronic blood loss

Methods used for estimating HbA1c

Ion exchange chromatography

High-performance liquid chromatography

Isoelectric focusing

Agar gel electrophoresis

How frequent do we need to estimate HbA1c?

Usually, it should be done every 3 months and when controlled after every 6 months. In pregnancy

for tight control, monthly determination is necessary. In pregnancy a better marker of sugar(Glycemic) control is estimation of serum fructosamine.

PROSTATITIS

This is a common condition seen in males of all ages.
Prostatitis means infection of the prostrate. But in reality only a very small percentage of cases of prostatitis are due to infection.
Prostatitis can be clinically classified as

• Acute bacterial prostatitis
• Chronic bacterial prostatitis
• Chronic Non bacterial prostatitis / Chronic Pelvic pain Syndrome

Acute cases present like typical urinary tract infection with High grade fever, chills, nausea, vomiting and burning sensation while passing urine. urine culture might reveal the offending organism. But in Chronic Prostatitis the symptoms are very very mild and may persist for years before the patient seeks medical attention.Often urine culture is negative. The most common among the types of prostatitis is Chronic non bacterial prostatitis/ Chronic pelvic pain syndrome.The condition is marked by urinary and genital pain for at least pat three months. Patients have no bacteria in their urine, but may have other signs of inflammation.

Causes of Prostatitis:

1. Instrumentation of the urinary tract.
2. Rectal intercourse
3. Anatomically abnormal urinary tract
4. Recent urinary tract infection
5. Enlarged prostrate
   
6. Autoimmune diseases

Symptoms of prostatitis :

Feel like urinating often
Difficulty while passing urine
Pain while passing urine
Burning sensation while passing urine
Fever with chills
Pain in the external genitilia
Pain near testis
Lower abdominal pain
Reduced stream of urine
Painful ejaculation
Pain during sexual intercourse.

Diagnosis:

Complete clinical examination
Digital rectal examination
Ultrasonography
Urine culture
Culture of prostatic secretions
Urinary flow studies
Blood investigations (PSA -Prostrate Specific Antigen)

Treatment Modalities:

Antibiotics for a prolonged duration
Anti inflammatory drugs
Sitz Bath
Muscle relaxants
In unresponsive cases Surgical removal of prostrate.