Nem Oct 09

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Presentation at CME program organized by Bangladesh Academy of Family Physicians (BAFP) in October 2009

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Nem Oct 09

  1. 1. DR. G. C. DHAR <ul><li>WHAT IS NEW IN MEDICINE TODAY? </li></ul>
  2. 3. HOW TO Dx DIABETES?
  3. 4. Equal or more than 6.5% HbA1C Only
  4. 5. Pre-diabetes HbA1C: Equal or more than 6% but <6.5%.
  5. 6. FDA-approved A1CNow SELFCHECK <ul><li>Bayer’s Diabetes Care </li></ul>
  6. 7. Advantages <ul><li>Can be done any time of the day, in any physical and mental situation. </li></ul><ul><li>No need for fasting or timed samples. </li></ul><ul><li>Better index of overall glycemic exposure and risk for long-term complications </li></ul>
  7. 8. HbA1C Gold Standard for Measuring Glucose Control
  8. 9. EXCEPTIONS <ul><li>Gestational diabetes </li></ul><ul><li>Haemoglobin disorders </li></ul><ul><li>Haemolytic anaemias </li></ul><ul><li>Certain rare cases of type 1 diabetes. </li></ul>
  9. 10. Reference <ul><li>Joint opinion from international expert committee: </li></ul><ul><li>- American Diabetes association (ADA). </li></ul><ul><li>- European Association for the Study of Diabetes (EASD). </li></ul><ul><li>- International Diabetes Federation (IDF). </li></ul><ul><li>Published in: </li></ul><ul><li>Diabetes Care: July 2009 edition </li></ul><ul><li>Clinical Diabetes: September 2009. </li></ul>
  10. 11. HbA1C Unit is changing from percentage to mmol/mol
  11. 12. From 01 st . June 2011 <ul><li>The American Diabetes Association (ADA) </li></ul><ul><li>European Association for the Study of Diabetes (EASD) </li></ul><ul><li>International Diabetes Federation (IDF) </li></ul><ul><li>HbA1C unit should be expressed in : </li></ul><ul><li>International Federation of Clinical Chemistry (IFCC) units </li></ul><ul><li>mmol/mol </li></ul>
  12. 14. His BP is 155/97mmHg Irregular intake of anti-hypertensive drugs.
  13. 15. Recent study states <ul><li>Adults (aged 45 years or over) who has herpes zoster are 31% more likely to suffer a stroke within one year than people who have no shingles. </li></ul><ul><li>Risk is about about 4-fold, if the attack involves the eye (herpes zoster ophthalmicus). </li></ul>
  14. 17. What happens with Varicella zoster virus? <ul><li>1. Primary varicella zoster virus (VZV) infection usually affects children and causes varicella or chicken pox. </li></ul><ul><li>2. After an attack of chicken pox VZV becomes inactive, sequestered in the sensory and autonomic ganglia. </li></ul><ul><li>3. Reactivation of VZV cause migration of viruses to skin forming skin lesion called shingles. </li></ul>
  15. 18. What happens with Varicella zoster virus? <ul><li>4. Retrograde spread of VZV to cerebral arteries occur frequently. </li></ul><ul><li>5. VZV is the only human virus proven to replicate in cerebral arteries causing inflammatory and thrombotic processes called VZV vasculopathy. </li></ul><ul><li>6. This vasculopathy results in occlusion or rupture of involved vessels, manifested as ischemic or hemorrhagic stroke. </li></ul><ul><li>7. Pre-existing atherosclerosis is more dangerous. </li></ul>
  16. 19. What happens with Varicella zoster virus? <ul><li>Clinicians must be aware that VZV not only causes occlusive large and small arterial disease, but also can lead to ectasia of cerebral arteries, aneurysm, dissection and subarachnoid haemorrhage. </li></ul>
  17. 20. STROKE PREVENTION IS VITAL
  18. 21. What to do? <ul><li>1. Physicians should be aware of the potential elevated risk of stroke when they care for patients with acute herpes zoster attack. </li></ul><ul><li>2. Careful monitoring and management of the preexisting risk factors for stroke such as hypertension, hyperlipidemia, and diabetic mellitus could be helpful to reduce the risk for stroke. </li></ul>
  19. 22. What to do? <ul><li>1. Check BP and manage it. </li></ul><ul><li>2. Go for blood test to detect or manage hyperglycemia. </li></ul><ul><li>3. Perform blood work for lipid profile and treat accordingly. </li></ul><ul><li>Ref: “Stroke” online 08 th . October 2009. </li></ul><ul><li>Will be published in November print issue. </li></ul>
  20. 23. T H A N K S !

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