Safety of high-risk diabetic patients during Ramadan at a tertiary care hospital in Pakistan, practicing updated IDF DAR guidelines.

Objective: To determine trend of following medical advice and safety of high-risk diabetic patients during Ramadan practicing updated IDF DAR guidelines. Methods: The cross-sectional study was conducted at Outpatient Department of Diabetes, Endocrinology and Metabolic Disorders Hayatabad Medical Complex Peshawar, Pakistan from April to June 2022, and comprised of high-risk diabetic patients (>6.0) based on updated IDF-DAR guidelines 2022 intending to fast. A questionnaire was designed to document patient risk factors score, type and duration of diabetes, HbA1c, comorbidities and complications developed during Ramadan. Data was analyzed using SPSS 20. Results: Among all 130 participants, 78(60%) followed medical advice and did not fast and 52(40%) patients fasted against medical advice during month of Ramadan. Out of 130 participants, 89.2% were having type-2 diabetes Mellitus, 55.4% were female and mean age of participants was 52+14.6.40%. In fasting group, 57.7% were in the age range of 16 to 50 years while in non-fasting group 69.2% participants were more than 50 years old (P-value 0.031). There were 80.8% female participants in fasting group versus 38.5% in non-fasting group (P-value 0.001). Hypoglycemia occurred in 58.3% patients in fasting group and 29.3% non-fasting group. (P-value 0.021). On the other hand, 27.8% patients in fasting group and 55.2% of non-fasting group had hyperglycemia (P-value 0.025). Conclusion: Despite advised against fasting in these high-risk patients as per IDF DAR guidelines, almost half of patients fasted considering fasting a religious obligation. Those who fasted had significant hypoglycemia despite adjustment of medications as in guidelines. There is need of more intensive education before fasting, especially in high-risk diabetic patients.

Investigation of Klotho G395A and C1818T Polymorphisms and Their Association with Serum Glucose Level and Risk of Type 2 Diabetes Mellitus.

Objective: The objective was to study the association of Klotho gene G395A and C1818T single nucleotide polymorphisms with glycemia, serum, glycosylated hemoglobin (HbA1c) level and the risk of type 2 diabetes mellitus (T2DM) in the Pashtun population of Pakistan. Methods: In this study, 195 normal individuals and 217 T2DM patients were enrolled. All subjects were divided into three groups, namely overall subjects (control + T2DM patients), control individuals and T2DM patients, and their fasting glucose, HbA1c level, lipid profile and C1818T and G395A polymorphisms were determined. Results: The allele frequencies of G395A in overall subjects were 0.568 for A and 0.432 for G. Similarly, allele frequencies for G395A in overall subjects were 0.597 and 0.403 for C and T alleles, respectively. The AA genotype of G395A was observed to be a risk factor for T2DM. In normal individuals, no significant (p > 0.05) association was observed between klotho C1818T and G395A polymorphisms and hyperglycemia. In overall subjects, the C1818T polymorphism was associated (p < 0.05) with high fasting glucose and HbA1c levels in female subjects only. In T2DM patients, both C1818T and G395A polymorphisms were found to be significantly (p < 0.05) associated with high fasting glucose and HbA1c levels both in males and females. Conclusion: The G395A polymorphism was observed to increase the risk of T2DM. Both C1818T and G395 were associated with high fasting glucose and HbA1c levels in T2DM patients.

Starch composition, antioxidant potential, and glycemic indices of various varieties of Triticum aesitivum L. and Zea mays L. available in Pakistan.

Many varieties of Triticum aesitivum L. (Bread wheat) and Zea maize L. (maize) have been developed in Pakistan, which are randomly consumed by normal individuals and diabetic patients. In this study, 17 wheat and 9 maize varieties were tested for starch composition, glycemic index, radical scavenging activities, and lipid profile. Among various wheat samples, KPK15 was observed to have highest 2,2-diphenyl-1picrylhydrazyl radical scavenging activity, while CZP132011 was highest radical scavenger among various maize samples. Glycemic index of wheat varieties varied between 62.83 ± 2.19 and 70.70 ± 2.82 in Hashim10 and Insaf, respectively, while for maize it ranged between 56.45 ± 1.95 in Sarhad white and 70.76 ± 4.40 in CHT1W. In most of the varieties, a linear correlation was observed between glycemic index and amylose contents. The data show that KPK15 and Saleem 2000 are the best wheat varieties while Sarhad white is the best among maize samples to be consumed by normal individuals and diabetic patients. PRACTICAL APPLICATIONS: Wheat and maize are the most widely used cereal crops being consumed randomly both by normal individuals and diabetic patients. Diabetes is characterized by hyperglycemia, hyperlipidemia, and high oxidative stress. Diet and nutrition play an important role in the development and control of diabetes. In this research, we attempted to find out the best wheat and maize varieties for diabetic patients from locally grown genotypes.

SHORT STATURE: WHA T IS THE CAUSE IN OUR POPULATION.

BACKGROUND: Globally children and adolescents with growth failure are referred to specialized units for evaluation and management. We designed this study to determine the cause of short stature in children and adolescents referred to our endocrine unit for evaluation and further management. METHODS: This descriptive cross sectional study was performed in the Department of Endocrine, Diabetes and Metabolic Diseases, Hayatabad Medical Complex, Peshawar. Children and adolescents between 2-20 years with height below 2 SDS or less then 3rd percentile for their age and gender were included while those with kyphoscoliosis, thalassemia major, diabetes mellitus type-1 were excluded. Detailed history was obtained followed by detailed physical examination and a pre-set penal of investigations. RESULTS: Seventy-three children with mean chronological age of 11.75.3 ± 4.06 years, 56.31% boys and 43.83% girls (p < 0.05) were included. Mean height was 117.28 ± 17.55 cm, -4.23 ± 2.06 SDS below for this population age group. Mean parental height was 156.87 ± 11.82 cm, mean bone age was 8.56 ± 4.03 years while mean bone age delay was 3.23 ± 1.94 years. Common causes found were variants of normal growth present in 38.35%. Constitutional Delay of Growth and Puberty (CDGP) were found in 13.7%, Familial Short Stature (FSS) in 11.0% while overlapping features of both in other 13.7%. Isolated Growth Hormone Deficiency (GHD) was found in 23.3%, primary hypothyroidism in 9.6% and pan- hypopituitarism in 2.7%. Common non endocrine causes found were Turner's syndrome, rickets, chronic anaemia, bronchial asthma and achondroplasia. CONCLUSION: Isolated GHD, CDGP and FSS, primary hypothyroidism and Turner's syndrome are the most common causes of short stature in our set up.