With the divine blessings of Bhagawan Sri Sathya Sai Baba, two state-of-the-art Gastroenterology Endoscopy Systems were commissioned at SSSIHMS - Prasanthigram. 

Valued at ₹Rs. 2.45 crores, the advanced systems were inaugurated by the Managing Trustee of the Sri Sathya Sai Central Trust, Mr RJ Rathnakar, in the presence of the Director of SSSIHMS, Prasanthigram, Dr. Gurumurthy, Joint Director of SSSIHMS, Prasanthigram, Dr Anil Kumar Mulpur and Gastroenterologists Dr Geeta Kamath, Dr Jay Kamath, Dr Veda Vishwanathan, and senir staff of the hospital. 

Endoscopy in gastroenterology is a minimally invasive diagnostic and therapeutic procedure that uses a flexible, camera-equipped tube (endoscope) to visually examine the digestive tract. It enables physicians to detect and treat conditions of the oesophagus, stomach, and intestines—including inflammation, ulcers, and polyps—and also facilitates biopsies and polyp removal when necessary.

The newly commissioned Olympus systems bring a significant technological leap to patient care. Equipped with powerful processors, high-resolution endoscopes, and unmatched visualisation capabilities, the systems deliver exceptional clarity and diagnostic precision. The latest Narrow Band Imaging (NBI) technology enhances accuracy through superior contrast and illumination, enabling gastroenterologists to make more informed clinical decisions.

The endoscopes incorporate Responsive Insertion Technologies (RIT), greatly improving manoeuvrability and ease of insertion. Additionally, the systems include paediatric upper-GI probes, ensuring enhanced diagnostic outcomes for children and for adults with medically narrowed oesophagi.

Speaking on the occasion, Sri Rathnakar noted that these two endoscopy machines mark a major upgrade to the existing systems. “In recent years, we have commissioned numerous state-of-the-art medical equipment to elevate the standards of patient care. These new endoscopy systems stand as yet another testament to that commitment. Bhagawan Baba’s healthcare mission continues to progress from strength to strength,” he said.

In view of the latest updates by the American Diabetes Association (ADA), there is a need to re-examine the concept of the HBA1C values and what they entail. 

Before 1968, diagnosis and monitoring of Diabetes Mellitus (DM)  were always glucose-centric, based on blood glucose values.  In 2009 ADA recommended that HbA1c can be adopted as one of the diagnostic criteria for diabetes.

What is HbA1C , How is it formed and how does it help in the DM management

HbA1c, also termed as Glycated hemoglobin/Glycohemoglobin, is formed under physiological conditions by the Nonenzymatic glycation of specific sites of Hemoglobin.

Blood contains millions of Red Blood cells (RBC). A single RBC contains approximately 270 million molecules of the hemoglobin protein. When the RBCs in the blood are continuously exposed to glucose in the blood, glucose molecules are attached to hemoglobin molecules (Glycation) at a specific site, leading to the formation of Glycated Hemoglobin. 

As the formation of HbA1c is concentration dependent,  higher blood Glucose levels lead to raised HbA1c formation. This is the reason why HbA1c is treated as a marker of Glycemic (blood glucose) status of an individual over a period of the last 90-120 days, which is the average life span of RBC.   

Over a period of decades, incessant efforts of international committees led to the standardization of HbA1c methods and the establishment of reference values. 

What is the reference Range?

 The reference range for HbA1c is 4 - 6.5 %. A value>6.5% is the criterion for the diagnosis of diabetes. ADA suggested that people with HbA1c values between 5.7-6.4% be categorized as a high-risk group for diabetes and called it the "Prediabetes" stage.

New Guidelines for HBA1C by ADA ( Table 1.1)

  Advantages of the HbA1c Test over Blood Glucose Test

§   It is a better index of overall glycemic exposure for over 90-120 days and risk for long-term complications. 

§   Biologic variabilities like age and gender have less impact on the result. 

§   The patient need not fast before the test. It is relatively unaffected by acute (in conditions like stress or illness-related) perturbations in glucose levels.

However, the HbA1c test has its own limitations. Besides being expensive, it cannot be an emergency room test to titrate insulin or OHA dosage. It cannot register hypoglycemia as it expresses the "average" Glucose.

Mean Plasma Glucose can be calculated from HbA1c % as follows 

Mean Plasma Glucose  = (33.3 x  HbA1C%) - 86

ADA  Recommendations

Perform the A1C test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control) and quarterly in patients whose therapy has changed or who are not meeting glycemic goals.

Along with medication, diet, exercise, and a healthy lifestyle play a crucial role in the management of Diabetes. 

Shilpa (name changed) fell on her chin while climbing down a flight of stairs in her home when she was 9-years-old. She had some pain on the right side of her jaw. The parents took her to a local doctor, who gave her some painkillers. The pain subsided in a few days, but nobody suspected that it would cause any problem later in her life. 

As she grew older, Shilpa's parents started noticing a bent in her jaw, and as she reached the age of 15, her mouth gradually closed shut permanently. She could no longer speak and could only have soft food with great difficulty. Her parents did not know what to do. It was then that their neighbour suggested that they should visit the Sri Sathya Sai Institute of Higher Medical Sciences(SSSIHMS), Prasanrthigram, for treatment. In the Plastic Surgery department of the SSSIHMS, Prasanthigram, after undergoing various tests, it was understood that Shilpa suffered from an ailment called the TM joint Ankylosis of the right jaw. In simple terms, the right joint of side of Shilpa's lower jaw had got injured and had fused abnormally, while the left side of her jaw kept growing normally. Due to this, she was unable to open her mouth. 

According to Dr. D.V Raghava Reddy, the Head of Department of Plastic Surgery, at the SSSIHMS, a surgery was performed in which a portion of the bone was drilled from the right joint of the jaw and the right side of the lower jaw was disconnected from the base of the skull. An acrylic ball was then placed in the spherical cavity to bring back mobility to the jaw. After the surgery, Shilpa was taught the protocol for recovery, which she followed diligently. Now Shilpa can open her mouth, speak, and eat the way other children of her age can. 

RARE PHOTOGRAPH OF BHAGAWAN BABA during the inauguration of the HOSPITAL