Dr Ali khan khilji

11/04/2026

Dr Muhammad Ali khan
MBBS, MCPS, FCPS ( DERMATOLOGY )
MRCP (UK), RMP.

WHATSAPP NUMBER : 0330-7776669

Address: Abdul khaliq hospital, Near kabul jaan Resturant,, Airport road Qta.

11/04/2026

24/01/2026

HbA1c Units: Percentage vs mmol/mol — What Should We Follow and Why this topic matters

HbA1c is central to diagnosis, monitoring, and targets in diabetes.Confusion often arises because two different units are used worldwide.

Two Ways of Reporting HbA1c

Percentage (%) – DCCT units
• Older method
• Still used in the USA

• Examples:
• 6.5%
• 7.0%
• 8.0%

Based on the DCCT (Diabetes Control and Complications Trial)

mmol/mol – IFCC units
• Current international standard
• Used in UK, Europe, Australia
• Adopted by NICE, NHS, WHO

• Examples:
• 48 mmol/mol
• 53 mmol/mol
• 64 mmol/mol

Recommended by the International Federation of Clinical Chemistry (IFCC)

What Do We Follow in the UK?

mmol/mol is the standard unit
Percentage is considered older but acceptable as a reference

Best practice

Always write mmol/mol first, with % in brackets

Example:
HbA1c 58 mmol/mol (7.5%)

Diagnostic & Treatment Thresholds (UK Standard)

Clinical Use mmol/mol %
Normal. < 42 < 6.0
Prediabetes 42–47 6.0–6.4
Diabetes (diagnosis) ≥ 48 ≥ 6.5
Common treatment target ≤ 53 ≤ 7.0

Formula for Conversion

mmol/mol → Percentage (%)

HbA1c (%) = (0.0915 × HbA1c [mmol/mol]) + 2.15}

Percentage (%) → mmol/mol
HbA1c (mmol/mol) = (HbA1c [%] − 2.15) ÷ 0.0915}

UK practice = mmol/mol
% is older but still widely understood
Write both units to be safe, clear, and professional

12/01/2026

MRCP Concept for Part 1

Angioedema without urticaria → think C1-INH deficiency

Angioedema with urticaria
Think of Allergic or Histamine mediated angioedema

Most likely causes
Allergic reaction (Type I hypersensitivity)
Drug allergy
Food allergy
Insect sting
Latex allergy

07/01/2026

Mitapivat (Aqvesme)

new oral anemia medicine for thalassemia
• The FDA recently approved mitapivat as an oral drug to treat anemia in adults with thalassemia (both transfusion‑dependent and non‑dependent types).

Indication:
• FDA-approved for adults (≥18 years) with alpha- or beta-thalassemia anemia
• Both transfusion-dependent (TDT) and non-transfusion-dependent (NTDT) patients

Mechanism of Action:
• Oral pyruvate kinase (PK) activator in RBCs
• ↑ ATP production, ↓ 2,3-DPG → stabilizes RBCs, reduces hemolysis
• Results in ↑ hemoglobin and improved anemia

Eligibility / Criteria for Initiation:
• Confirmed alpha- or beta-thalassemia with clinically significant anemia
• Hemoglobin ≤10 g/dL (NTDT)
• Adults ≥18 years
• Adequate liver function (baseline LFTs required)
• Not recommended in severe hepatic impairment or cirrhosis

Dosing:
• 100 mg orally twice daily
• Adjustments based on clinical response and tolerability

Duration / Monitoring:
• Intended for long-term therapy if clinical benefit observed
• Assess hemoglobin response over ~24 weeks initially
• Liver function monitoring:
• Baseline LFTs
• Every 4 weeks for first 24 weeks
• Then as clinically indicated
• Discontinue if no response or significant hepatotoxicity

31/12/2025

Highly Helpful notes for Exams

Iron Deficiency Anemia

Low Hb + Low MCV + High RDW + Low Ferritin = Iron Deficiency
Low Hb + Low MCV + Normal RDW + Normal/High Ferritin = Thalassemia trait (not iron deficiency)

Anemia of Chronic Disease

Low Hb + Low Serum Iron + Low TIBC + Normal/High Ferritin = ACD (iron trapped in storage)
*If CRP/ESR raised → supports inflammatory block of iron

Thalassemia

Low Hb + Very Low MCV + Normal RDW + High RBC count = Thalassemia Trait
If Mentzer Index (MCV/RBC) < 13 → Thalassemia likely
>13 → Iron deficiency

Autoimmune Hemolytic Anemia (AIHA)

High LDH + High Bilirubin + High Retics + Positive Direct Coombs = AIHA
Warm AIHA → IgG | Cold AIHA → IgM (C3 positive)

G6PD Deficiency

Acute hemolysis after drugs/infection/fava beans + High Retics + Heinz bodies = G6PD
Test G6PD after crisis resolves (false normal during acute attack)

Aplastic Anemia

Pancytopenia + Low Retics + Normal MCV → Think Aplastic
Bone marrow biopsy → Hypocellular, fatty replacement

Cold Agglutinin Disease

Hemolysis + MCV artificially high + RBC clumping on smear + Positive Coombs (C3) = CAD
Symptoms worse in cold exposure

31/12/2025

Myerson’s sign (glabellar tap sign)

• It is a clinical finding where repetitive tapping on the glabella causes the patient to continue blinking (unable to habituate/suppress the reflex).
• In healthy individuals, blinking stops after a few taps (habituation).

• In Parkinson’s disease, patients continue to blink, so the sign is considered characteristic but NOT specific for Parkinson’s.
• It can also be present in:
• Other extrapyramidal disorders
• Dementia, especially frontal lobe involvement
• Other neurodegenerative illnesses
• Normal elderly patients (occasionally)

31/12/2025

High LDH + high bilirubin + low reticulocyte count = think B12 deficiency, not hemolysis

High LDH + high bilirubin + HIGH reticulocyte count = think TRUE HEMOLYTIC ANEMIA

29/12/2025

Dementia:

We should suspect dementia when a patient has:

A. Progressive cognitive decline
This means the brain functions are slowly getting worse over time (months to years).Decline must be seen in at least one cognitive domain:

Memory : ability to recall recent or past events, names, appointments.

Executive Function Planning, organizing, problem-solving, multitasking, judgment.

Language Speech, naming objects, understanding words, word-finding difficulty.

Visuospatial Skills Understanding space, depth, navigation, getting lost in familiar places.

Attention Ability to concentrate, focus on tasks, follow conversations.

Social Cognition Understanding social rules, behavior changes, loss of empathy or manners.

B. Functional impairment
The decline affects daily living activities, known as ADLs (Activities of Daily Living).

ADLs Basic tasks needed for independent living.
Instrumental ADLs Managing money, paying bills, taking medications correctly, shopping, using the phone.

Basic ADLs Eating, dressing, bathing, toileting, hygiene, moving around.

If a patient now struggles with things they could previously do — like finances, medication administration, driving, or personal hygiene — it supports the suspicion of dementia.

C. Duration longer than 6 months
Symptoms should be chronic (long-term).
If problems have lasted only a few days or weeks, consider other causes first.

28/12/2025

Anemia Management in Chronic Kidney Disease (CKD)

Pathophysiology & Screening

Anemia in CKD results from reduced erythropoietin, iron deficiency, inflammation, and shortened RBC lifespan. Screen for anemia with CBC and iron studies when eGFR 1 g/dL in 2 weeks

Iron Therapy

Correct Iron Deficiency First

Indications:
• TSAT

28/12/2025

🧠 “Weekend Migraine” / Let-Down Migraine

Migraine attacks on weekends are very common and are classically called:

Main mechanism :- Migraine is triggered by a sudden drop in stress-related neurotransmitters, not stress itself.

Why migraines happen on weekends

Stress let-down phenomenon (most important)

• During the workweek, stress levels are high, leading to increased cortisol and adrenaline
• On the weekend, stress levels suddenly decrease •This abrupt neurochemical withdrawal can trigger a migraine attack

Sleep pattern changes
• Sleeping longer than usual
• Late nights / circadian rhythm disruption
• Migraine brains are very sensitive to sleep changes

Caffeine withdrawal
• Less coffee or tea than weekdays
• Caffeine withdrawal headache → migraine trigger

Missed or delayed meals
• Skipping breakfast
• Late brunch
• Hypoglycemia triggers migraine

Dehydration
• Less routine water intake
• Alcohol consumption

Hormonal influences (especially women)
• Estrogen fluctuation may coincide with weekends
• Additive trigger, not primary cause

Reduced routine / structure
• Migraine brains prefer regularity
• Sudden lifestyle change → attack

Weekend migraines occur due to stress let-down, sleep changes, caffeine withdrawal, and disruption of routine.