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AbstractThe present study aimed to explore fluctuations in fatty acids and phenolic profiles of olive oil extracted from fruits of Olea ferruginea Royle harvested at green raw and purple ripe stages from the district Zhob, Balochistan, Pakistan. First, fruit sampling was conducted on 26th June when green olives appeared on trees; second, purple ripe olives were picked on 26th August. Due to very small size and large pit size, oil is extracted without de-pitting the fruit. High-performance liquid chromatography–mass spectrometry (HPLC-MS) system was used for fatty acid and phenolic profiling of both oil samples. Results showed that fatty acid composition of oil extracted from raw green and ripe purple olives falls in the normal range set for purity criteria for olive oils and olive pomace oils by International Olive Council 2019 except for behenic, caprylic, capric and lauric in both oils and oleic acid and linoleic acid of oil extracted from raw green olives which do fall in standard ranges. Fatty acid composition of the olive oil showed that the oil is rich in monounsaturated fatty acids (range 50.71% in oil of green olives and 58.77% in oil of ripe purple olives), polyunsaturated fatty acids (range 30.45% in oil of raw green olives and 19.32% in oil of ripe purple olives) and saturated fatty acids (range 15.27–18.58% in olive oil obtained from raw green and ripe purple olives). SFAs showed least variation with ripening stages. There was high concentration of total phenolics in oil obtained from green raw olives (33.41 mg kg−1) as compared to oil of ripe purple olives (18.49 mg kg−1). The present study revealed that alpha, beta, gamma and delta tocopherols showed a uniform trend along with ripening of olive fruit, i.e. there is a clear decline in total tocopherol content of olive oil obtained from ripe purple olives. Green raw olives showed high values of α-tocopherol (192.47 mg kg−1), β + γ-tocopherols (233.65 mg kg−1) and δ-tocopherol (1087.48 mg kg−1). The present work concludes that ripening of olive fruit affects chemical composition of olive oil.

Objective: To determine the frequency of Cardiometabolic Risk Factors (CMRF) among young people with T2DM presenting at the Tertiary Care Unit in Karachi, Pakistan. Study Design: Retrospective longitudinal study. Place and Duration of Study: Baqai Institute of Diabetology and Endocrinology (BIDE), a Tertiary Care Unit, Karachi Pakistan, from Jan 2000 to Dec 2019. Methodology: The data of participants with diabetes (PWD) aged 18-45 years on the first visit was extracted from the computerized Health Management System (HMS). The demographics, anthropometric, biochemical, and medical information on obesity, smoking, hypertension, dyslipidemia, HbA1c, and family history of diabetes were gathered. Results: The study comprised 5336 participants with diabetes with a mean age of 31.94±5.52 years. High frequency of obesity, hypertension, dyslipidemia, cigarette smoking, poor glycemic control, and a positive family history of diabetes were observed, and their associations were statistically significant. Out of these, 4114(77.1%) were obese, 1663(31.4%) were hypertensive, 585(11%) were smokers, 4162(78%) had a positive family history of diabetes, 2519(47.2%) had HbA1c >10%, 2113(39.6%) had HbA1c between 7-10%. For dyslipidemia, 3383(63.4%) had high triglycerides, 3202(60%) had high LDL-C, 4578(85.8%) had low HDL-C, and 1729(32.4%) had high total cholesterol. Conclusion: The results validate the importance of early screening for CMRF in young diabetics for management and complications prevention in the early stages of the disease and advocate screening for CMRF in health care policy.

Objective: To determine the outcome of heel ulcers in people with diabetes. Materials and Methods: This retrospective cohort study was conducted at the Diabetic Foot Department of Baqai Institute of Diabetology and Endocrinology (BIDE), Karachi. Ethical approval was obtained from the Institutional Review Board of BIDE. Relevant records of all patients of both genders with diabetes aged 18–80 years and ulcer over the heel visiting the Diabetic Foot Clinic from January 2016 to December 2020 were retrieved from the hospital management system of BIDE for evaluation. Pre-designed proformas were filled and Statistical Package for Social Science version 20 was used to analyze data. Results: Overall data of 1073 diabetic people with heel ulcers was retrieved, among them the mean age was 57.95 ± 11.96 years, and 715(66.6%) participants were male. Type 2 diabetes was found in 821 (97.9%) participants and 548 (65.6%) had >10 years duration of diabetes. In regard to type of ulcer, 876 (81.6%) were neuropathic ulcers, 91 (8.5%) were ischemic, and 89 (8.3%) were neuroischemic ulcers. According to university of Texas classification wound classification, 725 (67.6%) fell in stage B followed by 238 (22.2%) in stage A. Regarding heel ulcer outcome, a majority of 459 (95.8%) healed without amputation and only 15 (3.1%) healed with major amputation. Conclusion: We found that the majority of the people with heel ulcers had a favorable outcome and healed without an lower extremity amputation.

The lockdown resulting from COVID-19 outbreak affected individuals and nations equally. It not only harmed the economy but also led to the total shut down of all educational activities resulting in a significant gap in learning and understanding among students worldwide. Institutions, teachers, educators and students all had to quickly respond to an unexpected and ‘forced’ transition from face-to-face to remote teaching. The educational institutions also had to create learning environments for students and teachers in the light of the conditions in which both universities and schools had to operate. Although it leads to a number of challenges, but also provided opportunities that can best be described as blessing in disguise.

Background: Diabetic foot ulcer is a major cause of morbidity, mortality, hospitalisation, poor quality of life and socio-economic burden in diabetic patients. Educating patients about foot care and improving foot care practices can help in the prevention of foot ulcer and thus reduce the rate of lower extremity amputations. Objective: The aim of this study is to evaluate the knowledge and practices regarding foot care in diabetic patients presenting with foot ulcers in a tertiary care hospital of Karachi, Pakistan. Methodology: This cross-sectional study was conducted at a specialised foot clinic of Baqai Institute of Diabetology and Endocrinology, a tertiary care hospital of Karachi, Pakistan. All patients with type 2 diabetes presenting with a history of foot ulcers were included in the study after taking informed consent. Only those patients with either already diagnosed diabetes mellitus or diagnosed in the clinic according to the American Diabetes Association diagnostic criteria were included in the study. Information regarding history, physical examination, Hba1c levels were collected in all patients through hospital HMS software. Ankle-brachial index and vibration perception threshold were done as part of foot examination in every patient. X-ray and tissue culture/sensitivity were done where indicated. The Nottingham assessment of functional foot care revised 2015 questionnaire was used to evaluate patients’ foot care knowledge and practices before presenting to our institute. The interview was conducted by a trained healthcare professional on one-to-one basis. Patients who scored >70% had good knowledge and practices of foot care, those between 50% and 70% had average and those who scored

Background COVID-19 has posed unique challenges for adolescents in different dimensions of their life including education, home and social life, mental and physical health. Whether the impact is positive or negative, its significance on the overall shaping of adolescents’ lives cannot be overlooked. The aim of the present study was to explore impacts of the pandemic on the adolescents’ everyday lives in Pakistan. Methods Following ethical approval, this cross-sectional study was conducted through September to December, 2020 via an online survey on 842 adolescents with the mean age of 17.14 ± SD 1.48. Socio-demographic data and Epidemic Pandemic Impact Inventory-Adolescent Adaptation (EPII-A) was used to assess the multi-dimensional effects of the pandemic. Results Among the 842 participants, 84% were girls. Education emerged as the most negatively affected Pandemic domain (41.6–64.3%). Most of the adolescents (62.0–65.8%) had reported changes in responsibilities at home including increased time spent in helping family members. Besides, increase in workload of participants and their parents was prominent (41.8% & 47.6%). Social activities were mostly halted for approximately half (41–51%) of the participants. Increased screen time, decreased physical activity and sedentary lifestyle were reported by 52.7%, 46.3% and 40.7% respectively. 22.2–62.4% of the adolescents had a direct experience with quarantine, while 15.7% experienced death of a close friend or relative. Positive changes in their lives were endorsed by 30.5–62.4% respondents. Being male and older adolescents had significant association with negative impact across most domains (pConclusions Results have shown that COVID-19 exert significant multidimensional impacts on the physical, psycho-social, and home related domains of adolescents that are certainly more than what the previous researches has suggested.

BackgroundCOVID-19 has posed unique challenges for adolescents in different dimensions of their life including education, home and social life, mental and physical health. Whether the impact is positive or negative, its significance on the overall shaping of adolescents' lives cannot be overlooked. The aim of the present study was to explore impacts of the pandemic on the adolescents' everyday lives in Pakistan.MethodsFollowing ethical approval, this cross-sectional study was conducted through September to December, 2020 via an online survey on 842 adolescents with the mean age of 17.14 ± SD 1.48. Socio-demographic data and Epidemic Pandemic Impact Inventory-Adolescent Adaptation (EPII-A) was used to assess the multi-dimensional effects of the pandemic.ResultsAmong the 842 participants, 84% were girls. Education emerged as the most negatively affected Pandemic domain (41.6-64.3%). Most of the adolescents (62.0-65.8%) had reported changes in responsibilities at home including increased time spent in helping family members. Besides, increase in workload of participants and their parents was prominent (41.8% & 47.6%). Social activities were mostly halted for approximately half (41-51%) of the participants. Increased screen time, decreased physical activity and sedentary lifestyle were reported by 52.7%, 46.3% and 40.7% respectively. 22.2-62.4% of the adolescents had a direct experience with quarantine, while 15.7% experienced death of a close friend or relative. Positive changes in their lives were endorsed by 30.5-62.4% respondents. Being male and older adolescents had significant association with negative impact across most domains (pConclusionsResults have shown that COVID-19 exert significant multidimensional impacts on the physical, psycho-social, and home related domains of adolescents that are certainly more than what the previous researches has suggested.

OBJECTIVE: To determine the linear growth in children/adolescents with type 1 diabetes mellitus (T1DM) at a tertiary care hospital. METHODS: This observational study was conducted in Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan from January-2001 to July-2021. All children/adolescents diagnosed with T1DM of either gender, between 8-18 years age visiting the outpatient department were included after informed consent. Predesigned questionnaire was developed for data records. Height of study participants and parents was checked in centimeters (cm) by stadiometer and mid-parental height was calculated. Weight was checked in kilograms (kg) on calibrated digital weight machine. Centers for Disease Control and Prevention growth chart was plotted and growth velocity was checked every six months to check linear growth. Final height was compared with targeted height of respective participants. RESULTS: Total of 66 people participated (24 male, 42 female), with mean age at diagnosis was 11.17±4.77 years and duration of diabetes at first visit was 1.97±3.3 years. Mean age at menarche was noted 13.56±1.41 years. The overall height standard deviation score (SDS) at first visit was -0.62±2.58 and at last visit was -1.34±0.94, whereas the overall weight SDS at first visit and at last visit was -0.62±2.58 and 1.34±0.94 respectively. Furthermore, overall mid-parental height was 160.95±10.28 cm and 50% males and 85.7% females achieved genetic target height (p-value=0.002). CONCLUSION: Majority of males did not achieve genetic target height, however females achieved genetic target height along with late age of menarche as compared to general population.

OBJECTIVE: To evaluate the outcomes of pregnancy in women with type 1 diabetes mellitus (T1DM). METHODS: This prospective cohort study was conducted at Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University, Karachi-Pakistan from January 2007 to December 2020. All women diagnosed with T1DM and pregnancy, visiting the outpatient department of BIDE were included after written informed consent. Predesigned questionnaire was developed for data records. It includes demographic details, diabetes mellitus & obstetric history, clinical examination, treatment details, maternal, perinatal and neonatal outcomes. RESULTS: There were 31 pregnancies in which mean age of women was 35.03±9.70 years, duration of diabtes before pregnancy was 128.46±75.50 months and median gestational age at delivery was 34.30±3.9 weeks. Only 5 (16.1%) pregnancies were planned and 7 (22.6%) women have HbA1c

OBJECTIVE: To observe frequency of cardiometabolic risk factors (CMRF) among young people with type 2 diabetes mellitus (T2DM). METHODS: This retrospective study was conducted at Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi-Pakistan. Data of all patients of T2DM aged 18-45 years, from 1st January-2000 to 31st December-2019 of first patient visit was retrieved and analyzed from computerized hospital management system record. Age, gender, duration of diabetes, smoking habit, family history of diabetes, glycemic status, fasting lipid profile, blood pressure and body-mass-index was noted to assess CMRF in T2DM. RESULTS: Out of 5336, 54.5% (2907) were male and 1643 (30.8%) people were newly diagnosed. Mean age of patients at diagnosis of diabetes was 31.94±5.52 years, mean age at first out-patient department (OPD) visit was 35.52±4.58 years and mean diabetes duration was 3.52±3.58 years. At time of first OPD visit 3878 (77.1%) were obese, 585 (11%) were smokers and 1663 (31.4%) were hypertensive. Furthermore, 4161 (78%) had positive family history for diabetes, 1274 (47.2%) had HbA1c >10%, 1069 (39.6%) had 7-10% and 357 (13.2 %) had

Objective: To study health care professionals’ perspective working at tertiary care settings regarding gestational diabetes mellitus (GDM) and to recognize differences in the practice and approach amongst them. Study type, settings and duration: A cross-sectional survey was carried out at several tertiary care hospitals of all four provinces (Punjab, Sindh, Baluchistan and Khyber Pakhtunkhwa) from January 2017 to December 2018. Methodology: A Nationwide cross-sectional survey on the practice patterns with respect to screening, diagnosis, management and follow-up of Gestational Diabetes Mellitus was carried out at several tertiary care hospitals of Pakistan covering physicians/ diabetologists/ endocrinologists and Obstetrician/ gynecologists. Health care professionals from public and private sectors were invited to participate. Total 300 health care professionals (HCPs) participated in this survey Results: Among the survey participants 49.8% were general physicians, 37.8% were gynecologist/obstetrician while 12.4% were diabetologist/ endocrinologist. Regarding screening methods used by HCPs, 75gm oral glucose tolerance test (OGTT) was used by 20.4%, 50-gram glucose challenge test (GCT) by 18%, and 100- gram OGTT by 1% . A large proportion of study participants (40.4%) were using fasting blood glucose/random blood glucose for the diagnosis of GDM while 75gm OGTT for the diagnosis of GDM were practiced by only 25.1%, followed by 50gm GCT by 20%, urine glucose by 8%, HbA1c by 5.2% and 100 gm OGTT by 1.3%. While 97% advised self-monitoring of blood glucose level. Out of them 55.8% advised self-monitoring of blood glucose daily, 24.6% weekly while 19.6% monthly. Most common regimen prescribed by HCPs for management of GDM included life style modification (LSM) plus metformin plus insulin in 38.8% study participants. Postpartum screening for persistence of diabetes was advised by 80.4% HCPs. Investigations done for follow up of GDM through FBS/RBS by 50%, HbA1c by 25.3%, OGTT by 19.5% and multiple tests used by 5.2%. Conclusion: The present study reveals that there are major differences amongst health care professionals regarding various aspects of GDM management.

Objective: To study health care professionals’ perspective working at tertiary care settings regarding gestational diabetes mellitus (GDM) and to recognize differences in the practice and approach amongst them. Study type, settings and duration: A cross-sectional survey was carried out at several tertiary care hospitals of all four provinces (Punjab, Sindh, Baluchistan and Khyber Pakhtunkhwa) from January 2017 to December 2018. Methodology: A Nationwide cross-sectional survey on the practice patterns with respect to screening, diagnosis, management and follow-up of Gestational Diabetes Mellitus was carried out at several tertiary care hospitals of Pakistan covering physicians/ diabetologists/ endocrinologists and Obstetrician/ gynecologists. Health care professionals from public and private sectors were invited to participate. Total 300 health care professionals (HCPs) participated in this survey Results: Among the survey participants 49.8% were general physicians, 37.8% were gynecologist/obstetrician while 12.4% were diabetologist/ endocrinologist. Regarding screening methods used by HCPs, 75gm oral glucose tolerance test (OGTT) was used by 20.4%, 50-gram glucose challenge test (GCT) by 18%, and 100- gram OGTT by 1% . A large proportion of study participants (40.4%) were using fasting blood glucose/random blood glucose for the diagnosis of GDM while 75gm OGTT for the diagnosis of GDM were practiced by only 25.1%, followed by 50gm GCT by 20%, urine glucose by 8%, HbA1c by 5.2% and 100 gm OGTT by 1.3%. While 97% advised self-monitoring of blood glucose level. Out of them 55.8% advised self-monitoring of blood glucose daily, 24.6% weekly while 19.6% monthly. Most common regimen prescribed by HCPs for management of GDM included life style modification (LSM) plus metformin plus insulin in 38.8% study participants. Postpartum screening for persistence of diabetes was advised by 80.4% HCPs. Investigations done for follow up of GDM through FBS/RBS by 50%, HbA1c by 25.3%, OGTT by 19.5% and multiple tests used by 5.2%. Conclusion: The present study reveals that there are major differences amongst health care professionals regarding various aspects of GDM management.

Background: Dietary habits and sedentary lifestyle are major risk factors for rapidly rising incidence of type 2 diabetes. Aim: This study aims to study the association of dietary patterns with glycated haemoglobin (HbA1c) among type 2 diabetics in Karachi. Setting: Individuals attending outpatient department of Baqai Institute of Diabetology and Endocrinology (BIDE), Karachi, Pakistan. Design: Retrospective observational study. Methodology: A total of 3193 subject's data were available. Demographic, clinical parameters, food and nutrient intake were explored; patients were categorised into groups according to the adequacy of food intake. The nutrition care process at BIDE consists of getting details of 24-h diet recall. Academy of nutrition and dietetic food exchange system was used to estimate the food requirement, energy and macronutrient intakes. Statistical Analysis: Linear regression analysis was performed for establishing relationship of HbA1c. P < 0.05 was statistically significant. SPSS version 17.0 was used for the analysis. Results: Majority of the patients (89.5%) were above the age of 35 years, using oral hypoglycaemic agents (OHA) or insulin and being overweight or obese (88%). Mean HbA1c was significantly higher (P = 0.006) in cluster 1 (high cereal, vegetable and meat) as compared to cluster 2 (moderate cereal, high vegetable and moderate meat) and cluster 3 (low cereal, moderate vegetable and moderate meat). High percentage of dietary energy was found to be significant predictors of higher levels of HbA1c (P < 0.01). Females with type 2 diabetes using OHA or using OHA with Insulin following the prescribed diet pattern were associated with better glycaemic control. Conclusion: Significant association between dietary patterns and level of HbA1c was seen among type 2 diabetics. Dietary energy was found to be significant predictors of higher levels of HbA1c. Females with type 2 diabetes using OHA or using OHA with insulin following the prescribed diet pattern were associated with better glycaemic control.

Objective. To explore the impact of maternal body weight on maternal nutrition and micronutrient status in early pregnancy and potential impact on metabolic status in newborns. Methodology. The EU FP7 project GIFTS was conducted from Jan 2012 to May 2014. Demographic details and anthropometric measurements of women in the first trimester of pregnancy were obtained. Blood samples were collected for OGTT, insulin, lipid profile, serum folate, ferritin, vitamin D, vitamin B12, and red cell folate. Newborn anthropometric characteristics were observed. Cord blood samples were collected after delivery for glucose, insulin, and lipid profile of newborns. Results. A total of 301 pregnant mothers, 108 overweight, 63 underweight, and 130 normal weight were included. Prevalence of vitamin D deficiency (

Few studies have assessed the dietary Practices of people with diabetes during Ramadan (1). A sub study of Ramadan prospective diabetes study (2) which was conducted at the outpatient department of Baqai Institute of Diabetology and endocrinology, Karachi Pakistan in 2009 analyzed the food choices of patients with diabetes during Ramadan. Several irregularities regarding dietary intake and food choices were noted among the study participants. Although, the patients were counseled regarding diet before Ramadan, many did not follow the dietary advice. All patients had taken food at Iftar but majority of them preferred fried items like samosas, pakoras (fried snack), chicken rolls etc. these deeply fried items can lead to post Iftar hyperglycemia. Patients were also opted for fruit chat, dahibara and chanachaat at Iftar, higher load of these items can also worsen glycemic control. The striking finding was almost absence of meat (protein) intake at Iftar but study from India showed increment of all three macronutrients during Ramadan (3). This may result in higher intake of items from carbohydrate and fat groups resulting in hyperglycemia after iftar. Intake of vegetables at Iftar was also negligible and hence the diet was not well balanced. The food choices at sahoor included roti, paratha (fried bread), slices, khajla, pheni, meat, egg and milk. Though it is advisable to take complex carbohydrates, protein and fat at sahoor as these are slowly digestible and can prevent hypoglycemia during fasting but khajla pheni are extremely rich in fat and carbohydrate content and should be avoided (4). However, paratha in 2 teaspoon of oil can be taken at sahoor.Patients with diabetes who fast during the month of Ramadan should have pre Ramadan dietary guidance and counseling session in order to modify their food preferences and choices during the holy month of Ramadan (4).