ABSTRACT
BACKGROUND: It is well known that anemia and red cell turn over affects the HbA1c value. Iron deficiency anemia increases the HbA1c and haemolytic anemia lowers it. However, the cut-off of haemoglobin (Hb) or red-cell indices when the HbA1c value becomes unreliable is not known. AIM: We sought to find out values of HbA1c and red-cell indices where there is considerable discordance between HbA1c and plasma glucose (PG) values in the diagnosis of diabetes (DM) and pre-diabetes (Pre-DM) making HbA1c values unreliable. METHODS: A cross-sectional study of 237 non-diabetic subjects who attended our out-patient division of preventive health check-up clinics, between November 2016 and December 2017. Data was collected only from relatively healthy subjects who had voluntarily opted for undergoing a preventative health check-up (including a diabetes screening). Patients were classified as concordant (fasting and 2-hr post meal glucose values are in agreement with HbA1c) and discordant (values are not in agreement with HbA1c). RESULTS: A total of 237 patients (73% males) with mean age was 47.2±9.7 years (range 25-75) were included in the study. The HbA1c definition group had more diagnosis of DM (153 vs 96) and but lesser numbers of pre-DM (66 vs 102) compared to the PG group. Out of 237 patients, 133 (56%) showed concordance and 104 (44%) were discordant. The FPG, 2h-PPBG and HbA1c are significantly higher in the concordant group. The Hb value and MCV were significantly higher (p<0.05) in concordant group whereas, RDW and platelets are significantly higher (p<0.05) in discordant group. The highest rate of discordance was noted in the HbA1c strata of 6.5-7% (72%) followed by HbA1c of 5-6.4% (42%) and least in the HbA1c strata >7% (20%). While no single Hb or MCV value could predict discordance, a RDW value >17 was consistently associated with discordance across all the HbA1c strata. CONCLUSION: A HbA1c below 7% is significantly influenced by red-cell turn over indices and clinicians need to perform additional testing using plasma glucose levels to confirm the presence of diabetes or pre-diabetes. In patients whose RDW >17, HbA1c should be replaced by 75gm OGTT as a test of choice for diagnosis of diabetes or pre-diabetes.
ABSTRACT
BACKGROUND: Medical thoracoscopy (rigid and semirigid pleuroscopy) has revolutionized the approach to the diagnosis of pleural disease by offering a very high diagnostic yield. Rigid pleuroscopy offers the advantages of therapeutic intervention and larger biopsy specimens, whereas semirigid pleuroscopy using a standard biopsy forceps yields smaller and more superficial pleural samples. Cryobiopsy through semirigid pleuroscope in anecdotal studies has been used to overcome these disadvantages. We compared the safety and efficacy of cryobiopsy with conventional forceps biopsy in terms of the specimen size and diagnostic yield. METHODS: We analyzed data of 139 (87 cryobiopsies and 52 forceps biopsies) patients with undiagnosed pleural effusion who underwent pleuroscopy using a semirigid pleuroscope. A cryoprobe (ERBE, 2.4 mm) was passed through the working channel of the semirigid pleuroscope, the target area of parietal pleura was frozen for an average freezing time of 8 seconds, then the semirigid pleuroscope along with the probe was forcibly withdrawn en bloc avulsing the frozen parietal pleura. Two to 3 samples were taken from each patient. RESULTS: The diagnostic yield was 99% with cryobiopsy and 96% with forceps biopsy. The average specimen size through cryoprobe (13.2±6.7; range, 7 to 35 mm) was significantly larger than with the conventional forceps (6.8±3.3; range, 2 to 15 mm) (P<0.001), and no major complications were noted. CONCLUSION: Cryobiopsy of the parietal pleura through the semirigid pleuroscope is a safe procedure with a very high diagnostic yield.
