in the name of allah, ever beneficent, infinitely...
TRANSCRIPT
In the Name of ALLAH, Ever Beneficent, Infinitely Merciful
Prof. Abdul Basit (F.R.C.P)
Professor of MedicineDirector
Baqai Institute of Diabetology & Endocrinology(BIDE)Karachi, Pakistan
Current Status of Diabetes Care in Pakistan
11th June, 2017
MMDA International Symposium on Diabetes “ 2017 Updates”
Yangon, Myanmar
Prof. Abdul Basit (FRCP)
• Chair- elect IDF MENA Region• Director, Baqai Institute of Diabetology and Endocrinology
(BIDE)• Joint Secretary , Diabetic Association of Pakistan (DAP)• Founder, National Association of Diabetes Educators of
Pakistan (NADEP)• Chairman, Pakistan Working Group on Diabetic Foot
(PWGDF)• Founder member , Diabetes in Asia Study Group (DASG)
Screening and PrevalencePrioritization StrategiesCapacity Building
Future DirectionsManagement updates
Current Status of Diabetes Care in Pakistan
Still the gold standard diagnostic and screening test
in Asians isModified GTT
Screening and Prevalence
Nature Reviews Endocrinology 6, 589-593 (October 2010)
Reference: American Diabetes Association, European Association for the Study of Diabetes, International Federation of Clinical Chemistry and Laboratory Medicine, International Diabetes Federation. Consensus statement on the worldwide standardization of the HbA1c measurement. Diabetologia 2007; 50: 2042-2043
International bodies are now recommending HbA1c as diagnostic criteria but
regional/national studies are required before it can be included in national guidelines
Screening and Prevalence
National Diabetes Survey – Pakistan
2016-17
DROP 2
Parameters being assessed
• Fasting blood glucose• Random post 75 gms.
Glucose load• HbA1c• Fasting lipid profiles• Blood pressure• Obesity measurements
Approved by National Bioethics Committee (NBC) - Pakistan
Collaborators
Sampling progressRequired Done
Punjab 5800 4401 (76%)
Sindh 2630 1730 (66%)
KPK 1695 1513 (89%)
Baluchistan 555 528 (95%)
Islamabad 120 117 (97 %)
Overall 10800 8289 (77%)
DROP 2
Screening and PrevalencePrioritization StrategiesCapacity Building
Future DirectionsManagement updates
Current Status of Diabetes Care in Pakistan
3 top most priority sections
IDF Consultative Sections
Diabetes educationDiabetic footDiabetes and children
Prioritization Strategies
University basedOne year diploma in Diabetes Education
BIDE in Diabetes Education
148 Educators trained
Prioritization Strategies
WDC, Montreal 2009
International recognition
Eight centers designated as IDF Centers of Education
2009-2013
Renewal till 2015 done
WDC, Melbourne in 2013
Prioritization Strategies
Quetta LahoreSehwan Mirpur Khas
Perc
enta
ge o
f Pat
ient
s
Amputation rate
halved0
2
4
6
8
10
12
14
2008 2009 2010
115 diabetic foot clinics
Diabetic foot clinics
A.Basit and A.Nawaz. Preventing diabetes related amputations in a developing country – steps in the right direction. Diabetes Voice 2013;58:36-39
Second Decade of Diabetic Foot Care
International Diabetic Foot GuidelinesNoordwijkerhout, Netherlands 2007 Noordwijkerhout, Netherlands 2011
Advisory Board Member IWGDF
ISDFThe Hague, Netherlands
The Hague,Netherlands2015
Prioritization Strategies
8th International Symposiumon the Diabetic Foot in 2019
May 22-25, 2019World Forum - The Hague - Netherlands
Invited as a member of the International Scientific Advisory Board
Prioritization Strategies
ABCD
Prioritization Strategies
Advisory Board for the Care of Diabetes
Assoc. Prof. Bilal Bin YounusSIDER (Sakeena Institute of Diabetes & Endocrine Research) – Lahore
Prof. Jamal ZafarPakistan Institute of Medical Sciences – Islamabad
Assoc. Prof. Jehangir KhanAyub Medical College –Abbottabad
Assoc. Prof .Qazi MasroorBahawal Victoria Hospital Quaid-e-Azam Medical College Bahawalpur
Asst. Prof. Sobia SabirLady Reading Hospital –Peshawar
Asst. Prof. Abdul Waheed IqbalTehseel Head Quarter Hospital DadyalBenazeer Bhutto Medical College District – Mirpur Azad Kasmir
Asst. Prof. Salma TanweerNishter Hospital & Medical College – Multan
Assoc. Prof. Irshad KhosoBolan Medical Complex Hospital – Quetta
Prof. Abdul BasitChairman ABCD in PakistanDirector Baqai Institute of Diabetes & EndocrinologyProfessor of Medicine – Karachi
Prof. Zaman ShaikhLiaqat University of Medical and Health Sciences –Hyderabad
AB
CD
Prioritization Strategies
AB
CD
Prioritization Strategies
Islamabad
7 December 2016
Multan7 December 2016
National Diabetic Foot Advisory Board Meeting every Wednesday 9am
IDF, DF MENA Group, 2015
DAP- BIDE- WDF
Centers established
Teachers sensitized
Subjects registered
34Type 1 diabetes
model clinics
Insulin my life
Free insulin vials distributed
Prioritization Strategies
L I F E FOR ACHILD
International recognition
IML Guest Visit
2016 Awareness Walk - IML Patient Participation
Life for a child acceptance
500 children FREE insulin
Genetic studies
HbA1c machines
NICH
Punjab chapter of IML
Pakistan Bangladesh MaliAzerbaijanSudan
ResultingNational impact
DROP
DROP-1
DROP-2
DROP-GDROP-R
DROP-F
Diabetes Registry of Pakistan (DROP)
Prof. Yakoob Ahmedani
Prof. Abdul Basit
Dr. Asher Fawwad
Dr. Zahid Miyan
Dr. Asim bin Zafar
Dr. Farhatullah Khan
Dr. Abdul Rasheed Joyo
Dr. Abdullah Memon
Dr. Aejaz Solangi
Dr. Ahsan Siddiqui
Dr. Ameer Memon
Dr. Asif Brohi
Dr. Fareed Uddin
Dr. Farhan Baloch
Dr. Fateh Dero
Dr. Irshad Ahmed
Dr. Kashif
Dr. Merajuddin Nizami
Dr. Najma Samejo
Dr. Nazeer Khokar
Dr. Nazeer Soomro
Dr. Pawan Kumar
Dr. Riasat
Dr. Riaz Ahmed
Dr. Saif Ul Haque
Dr. Sanober
Dr. Shahid
Dr. Shahjahan Mangi
Dr, Umeet Kumar
Dr. Veru Mal
Dr. Zahoor Shaikh
Dr. Muhammad Irfan
Dr. Jehangir Khan
Dr. Qazi Masroor
Prof. Jamal Zafar
Dr. Bilal Bin Younus
Dr. Abdul Waheed Iqbal
Dr. Salma Tanweer
Dr. Sobia Sabir
Prof. Irshad Khoso
Prof. Abrar Shaikh
Prof. Jamal Raza
Prof. Zaman Shaikh
Dr. Imtiaz Hasan
Dr. Ali Jawa
Dr. Khurshid Khan Dr. Abbas Raza Dr. Osama IshtiaqDr. A.H. Amir
Registry form Website
DROP 1
Online Registry Portal
Screening and PrevalencePrioritization StrategiesCapacity Building
Future DirectionsManagement updates
Current Status of Diabetes Care in Pakistan
Batches completed
Diploma holders 17417
Diploma in Diabetology for Family Physicians
Online
Capacity Building
Diabetes Setup at Hyattabad Med Complex
Diabetes Unit at PIMS
Jinnah-Allama Iqbal Institute Of Diabetes & Endocrinology
Aga Khan University hospital
Baqai Institute of Diabetology & Endocrinology
Jinnah Postgraduate Medical CentreSpecialistsTraining
Capacity Building
People with
Diabetes
Family physicians
Phamacist
Diabetes Educators Dieticians
Foot Care Assistants
PhysioTherapists
ConsulatntDiabetologist
and Endocrinologist
Diabetes care
nurses
Associate Diabetologists
Capacity Building
People with
Diabetes
Family physicians
Phamacist
Diabetes Educators Dieticians
Foot Care Assistants
PhysioTherapists
ConsulatntDiabetologist
and Endocrinologist
Diabetes care
nurses
Associate Diabetologists You name
it and it ought to be
here
Clinical Nutrionist
Pshycologist
Dermatologist
GynaecologistOphthalmologist
Cardiologist
Surgical colleagues
Nephrologist
Capacity Building
Role of multiple
stakeholders
Politicians
DonorsPhilantropy
Physician Associations
Teaching Faculties
Media
Pharmaceutical industry
Public Health Depts
Public forums NADEP etc.
Capacity Building
Policy Makers
1st and 2nd March, 2014, Islamabad
Diabetes Leadership Forum
Advocacy Board Meeting
Capacity Building
ObjectiveDevelop professional skills
to analyze the underlying
determinants of NCDs and
to formulate and implement
preventive strategies.
M.Sc NCDsWho Can Apply
MBBS, MD, BDS or equivalent qualification
Master’s degree in Sciences, Social Sciences
Any equivalent degree recognized by PMDC, PNC
or HEC
What needs to be done?
Screening and PrevalencePrioritization StrategiesCapacity Building
Future DirectionsManagement updates
Current Status of Diabetes Care in Pakistan
Low-cost and effective strategies
Basit A, et al,. BRIGHT Guidelines on self monitoring of blood glucose. PJMS 2014; 30:1150-1155
Management updates
Self Monitoring of Blood Glucose (SMBG)
39
Management updates
40
Management updates
Management updates
Prof. Abdul Basit
EDITORS
Prof. A Samad Shera
Dr. Riasat Ali KhanDr. Asima KhanDr. Zahid Miyan Dr. Musarrat
Riaz
PROMPT Core Team
Dr. Asher Fawwad
Dr. A. B. Zafar
Prof. Rubina Hakeem
Co Contributors
Advisory Board for the Care of Diabetes (ABCD)
Prof. ZamanShaikh Karachi
Prof. Bilal Bin YounusLahore
Dr. Sobia SabirPeshawar
Prof. Jamal Zafar
Islamabad
Prof. QaziMasroor
Bahawalpur
Dr. Salam TanveerMultan
Prof. IrshadKhosoQuetta
Dr. JehangirKhan
Abbottabad
Prof. WaheedIqbal
TABLE OF CONTENTS
01 Introduction
0305 Acute emergencies
07MacrovascularComplications
09 Obesity
02Referral Criteria fordifferent levels of care 04 Non Pharmacological
Management
Pharmacological Management 06MicrovascularComplications of diabetes 08Diabetic Foot
43
Factsheet
10PROMPT
MENARegional Council
Meeting20th August, 2016Karachi- Pakistan
Future Plan
MENARegional Council
Meeting20th August, 2016Karachi- Pakistan
Future Plan
The PROMPT document has been approvedby the MENA RC in Khartoum in Dec 2016It will be finalized and submitted in Alexandria in May 2017
The IDF Middle East and North Africa (MENA) Region covers a wide area in North Africa and West-Asia, extending from
Pakistan in the east to Morocco in the west.
Prof. Abdul Basit
Dr. Asher Fawwad
FACILITATOR
COORDINATOR
Committee MembersProf. A. Samad SheraProf. Kamel Salameh
Prof. Hessa Al-KandariProf. Inass Shaltout
Dr. Muhammed HassaneinProf. Mesbah Kamel
MENA Guidelines
Chapter 01 Diabetes in MENA Region
Chapter
Chapter
04
07 Acute Complications of diabetes
Chapter 10 Diabetic Foot
Chapter02Factsheet
05Non Pharmacological Management Pharmacological
Management of Diabetes
Chapter08MicrovascularComplications of diabetes
Chapter11Obesity and Diabetes
Chapter03Chapter06Chapter
Chapter
09
12 Annexure
MacrovascularComplications
Referral Criteria for Different Levels of Care
Diabetes in Elderly
Chapter
MENA Guidelines
Screening and PrevalencePrioritization StrategiesCapacity Building
Future DirectionsManagement updates
Current Status of Diabetes Care in Pakistan
International FacultyIDEC - 2016
Prof. Adel El SayedEgypt
Dr. Maria Al Mahdi Kuwait
Prof. Akhtar HussainNorway
Prof. Morsi ArabEgypt
Dr. Misbah Syed KamelEgypt
Dr. Wasim HanifUnited Kingdom
Prof. Paul ThornalleyUnited Kingdom
Dr. Naila Rabbani United Kingdom
Prof. Graham HitmanUnited Kingdom
Ms. Susan Clever Germany
Dr. Kristien Van Acker Belgium
Dr. Zulfiqar G. AbbasTanzania
Dr. Mohsen NematyIran
Dr. Mahfuzy MohammadMalaysia
Prof. Chandrika N. Wijeyeratne
Srilanka
Prof. MandikaWijeyeratne
Srilanka
Dr. Mohammaed SandidLebanon Dr. Aamir Kamran
IranMs. Barbara Eichorst
United States of AmericaProf. A.K. Azad Khan
BangladeshMr. Lucas Fogarty
USAMr. Piero Galasso
Italy
Future Directions
Dr. George MajajPalestine
Dr. Graham OgleAustralia
Dr. Mohamed EltomSudan
Dr. A. Hakim AzizAfghanistan
Miss. Erin LittleUSA
Dr. Hana AlghanemSyria
Dr. Firdaus JahanOman
Dr. Ibtisam HadeedSaudi Arabia
Prof. Fathy ElsewyEgypt
Dr. Uzma Khan USA
Prof. SulimanAbusrewil libya
Dr. Michele Abi SaadLebanon
Dr. Abdulameer JasimJawad Al-Gbur - Iraq
Mr. BentDenmark
Prof. Liaquat AliBangladesh
Dr. Hamed FarooqiUAE
Prof. Ashma RanaNepal
Dr. Abdullah Al HamaqQatar
Dr. Abdul JabbarUAE
International FacultyIDEC - 2016
Future Directions
Dr. Sobia SabirPeshawar
Prof. ZamanShaikh -Karachi
Prof. Bilal BinYounis - Lahore
Dr. A. H. AamirPeshawar
Dr. Aisha ShaikhKarachi
Dr. Ali JawaKarachi
Dr. Saeed A. Mahar
Dr. Syed AbbasRaza
Prof. TasneemAhsan
Dr. RomainaIqbal
Dr. RobinaSohail
Ms. Saima RasheedKarachi
Prof. ShabeenNaz Masood
Karachi
Dr. ShabanaSaeed
Dr. AyeshaHabib - Karachi
Prof. Jamal ZafarIslamabad
Dr. MusarratRiaz - Karachi
Prof. Qazi Masroor Prof. A. Samad SheraKarachi
Prof. M. YakoobAhmedani - Karachi
National FacultyIDEC - 2016
Dr. Col. Shahid AhmedKarachi
Future Directions
Dr. Qamar MasoodKarachi
Prof. Nazli HossainKarachi
Prof. Nazeer KhanKarachi
Dr. Nilofer FatimiSafdar - Karachi
Dr. Osama IshtiaqIslamabad
Dr. M. Saif Ul HaqKarachi
Dr. Zahid MiyaKarachi
Prof. Jamil AhmedKarachi
Dr. Khadija NuzhatKarachi
Dr. Mahjabeen KhanKarachi
Ms. Fayza KhanKarachi
Prof. Najmul IslamKarachi
Dr. Salam TanveerMultan
Prof. Irshad KhosoQuetta
Prof. Sadaqat JabeenPeshawar
Dr. Rabia SaqibKarachi
Dr. Jehangir Khan
Prof. Rubina HakeemKarachi
National FacultyIDEC - 2016
Dr. Zafar AbbasiKarachi
Dr. Asmat NawazKarachi
Future Directions
Footwear For Every Diabetic (FED) group
• Establishment of 10 risk assessment clinics
• Low cost and durable footwear manufacturing technique
• 10 foot care assistants and 10 cobblers from BIDE to be trained
• 1 foot care assistant and 1 cobbler from each of the 10 project centreswill be trained
2016-2019
A joint Project of WDF – BIDE (BMU), Karachi, Pakistan
Train the Trainer Course :19 – 21st August, 2016
Footwear For Every Diabetic (FED) group - 2016 to 2019A joint Project of WDF – BIDE (BMU), Karachi, Pakistan
Insoles Development
Machines
Footwear For Every Diabetic (FED) group –2016 to 2019
A joint Project of WDF – BIDE (BMU), Karachi, Pakistan
Footwear For Every Diabetic (FED) group - 2016 to 2019A joint Project of WDF – BIDE (BMU), Karachi, Pakistan
Lead : Prof. M. YakoobAhmedani
Deputy : Dr. Farhat Ullah
RAMADAN AND DIABETES
Future Directions
S# Two Years Five Years Ten Years
1To extend the activities of RSG at tertiary care level. To extend the activities of RSG at secondary
care level.To extend the activities of RSG at primary care level.
2To train around 3,000 doctors through workshops and short courses.
Around 10,000 doctors will be trained through workshops and short courses.
Around 30,000 doctors will be trained.
3
Awareness about safe fasting in people with diabetes will be disseminated through tertiary care centers with the aim that 20 to 30% people with diabetes in the community should be able to observe safe fasting.
Including secondary care centers for dissemination of information with the aim that 50% people with diabetes in the community should be able to observe safe fasting.
The message will be spread through primary care centers with the aim that 90 % people with diabetes in the community should be able to observe safe fasting.
4
Customization of the available IDF and DAR International guidelines for national adaptation and dissemination.
To enhance scientific evidence at the local level through conducting research activities.
To enhance scientific evidence at the International level through conducting multi-national and multi-centered studies.
RAMADAN AND DIABETES Future Directions
Diabetes and Ramadan Conferences
Future Directions
Diabetes and Ramadan Workshops
Awareness Programs Educational material for patients
Ramadan Study Group Website
• Since 2008 Ramadan Study Group has done 12 studies which were published in international and national indexed journals and 2 has been accepted for publication.
Ramadan Study Group Publications
DAR International Alliance 3rd Forum, DUBAI, April 17 2015
The forum was attended by International Faculty including:
• Sir Michael Hirst, IDF President• Dr Shaukat Sadikot, IDF President Elect• Dr Adel El-Sayed, IDF-MENA Region Chair• Dr Evariste Bouenizabila, IDF- Africa Chair• Dr Line Kleinbreil, DESG Chair• Dr Abdelrazzq Al-Madani, President of EDS • And many other experts in the field
Future Directions
Diabetes and Ramadan: Practical guidelines
Mohamed Hassanein et al,Diabetes and Research Clinical Practice 126(2017)303-316
Maternal Child HealthBIDEDAPUIO
Gestational Diabetes Projectwith SOGP (Society of Obstetrics and Gynecologists of Pakistan)
BIDEWDFSOGPFANS
Other community issues addressed
2009
2013
Genomic and lifestyle predictors of foetal outcome relevant to diabetes and obesity and their relevance to prevention strategies in South Asian peoples (GIFTS).
EU
17 centers
2011-2017
Prioritization Strategies
Prof. Zahida Baqai
Prof. Noorjahan Samad
Prof. Abdul Basit
Prof. Shabeen Naz Masood
Dr. Musarrat Riaz
Dr. Asmat Nawaz
Dr. Shehla Naqvi
Mr. Shokat Ali Javed
Prioritization Strategies
S# Two Years Five Years Ten Years
1
To coordinate and liaise with the health care organizations by already constituted GDM Advocacy Board.
To form National Registry regarding GDM in Pakistan and link GDM management with MCH programs.
To include GDM prevention and care in the national health programs.
2
To intensify and expand at national level, the training of health care professionals in prevention, screening, diagnosis and management of GDM.
To develop National GDM guidelines and GDM reference manual for Pakistani population taking into consideration our local socio-cultural parameters.
To develop and promote uniform criteria for diagnosis of GDM, across Pakistan.
3To establish a model network of three GDM centers and thirty GDM clinics, initially in the province of Sindh.
To establish GDM model clinics in all the major cities of Pakistan.
To establish GDM clinics network nationwide.
4
To institutionalize universal screening programs for GDM at least in all teaching hospitals across Pakistan.
To carry out universal screening programs for GDM in all secondary care facilities across Pakistan.
To carry out universal screening programs for GDM in all primary care facilities across Pakistan.
5
To organize across the country, awareness activitiesrelated to diagnosis and management of GDM. Also optimize the use of print and electronic media for dissemination of knowledge regarding GDM.
To incorporate material regarding balanced diet, physical activity and prevention of childhood obesity in the school syllabi for primary prevention.
To include a section on GDM in the syllabi of medical schools in Pakistan.
MATERNAL AND CHILD HEALTH
3 GDM centersand
20 GDM clinics established
Gestational Diabetes Mellitus Prevention and Control Program - Pakistan
Joint project of World Diabetes Foundation & Baqai Institute of Diabetology & Endocrinology
• Number of doctors trained: 568
• Training of Allied HCPs and Nurses 878
Awareness CampsNumber of participants: 5229 women
•
Training of Health care professionals
Number of Women screened for GDM
• No. of women to be screened 25000• No. of women screened 12473
• Frequency of GDM (approx.) 12 %
AgeLess than 40 years 0Between 40 to 50 years 1Greater than 50 years 3
Waist circumference - MalesLess than 90 cm (35.5 inches) 090 cm (35.5 inches) or greater 2
Waist circumference - FemalesLess than 80 cm (31.5 inches) 080 cm (31.5 inches) or greater 2
Family history of diabetesNo family history of diabetes 0Any parent and/or siblings 1
Riaz M, Basit A, et al,. Risk assessment of Pakistani individuals for diabetes (RAPID). Prim Care Diabetes. 2012, 6; 297-302
A score of 4 or more predicts high risk of developing Type 2 diabetes
Risk assessment of Pakistani individuals for diabetes
(RAPID)
Future Directions
Future Directions
• Diabetes Education• Diabetic Foot• Diabetes Registry• Gestational Diabetes• Diabetes Guidelines• Diabetes and Ramadan• Primary Prevention Program
International associations and collaborations
University of Oslo
University of Manchester
Foundation of European nurses for diabetes
University of Birmingham
Diabetes and Ramadan - DAR
IDF Regional CouncilMENA Region
Diabetes in Asia Study Group
DASG
PAD registryXLPAD
M.V Hospital for Diabetes – India
International working group on
Diabetic Foot IWGDF
Qatar Diabetes Association
Life for a Child
Diabetes Specialist Center
India
IDF centres of education
D-Net
GIFTSEU collaboration
Bangladesh University of
Health Sciences
Future Directions
Nationalassociations
and collaborations
Diabetic Association of Pakistan
DAP
Pakistan Society of
Health Systems
Pharmacist PSHSP
Pakistan HypertenLeague
PHL
PakistanEndocrine
SocietyPES
Pakistan Nutrition
and Dietetics SocietyPNDS
Pakistan Nursing Council
PNC
Pakistan Cardiac Society
PCS
PMDCCPSPHEC
Pakistan Working group on
diabetic foot PWGDF
Acknowledgements
Future Directions
Acknowledgement
Consultant Diabetologist
Prof. Yakoob Ahmedani
Dr. Zahid Miyan
Dr. Asim Bin Zafar
ResearchDr. Asher Fawwad
Dr. Faraz Alvi
Ms. Fariha Shaheen
Mr. Bilal Tahir
Mr. Hassan Moin
Diabetic FootDr. Farhat Ullah
Dr. Adil
Mr. Salman
Mr. Sabir hussain
Mr. Kashif Ali
Mr. Arsalan Saeed
Ms. Huma Khan
Mr. Arshad Akhter
Mr. Furqan Uddin
Mr. Rameez
AdministrationMr. Abdul Rehman
Mr. Osama Ul Haq
Junior DoctorsDr. Majid
Dr. Anam Butt
Dr. Lal ChandDr. Zaryab
Mr. Mansoor Siddiqui
Mr. Kamran Adam
Mr. Anwar ul Haq
I.T Department
Mr. Rizwan Alam
Insulin My life
Mr. Iqbal Hussain
Ms. Aneela
Mr. Sufran Ahmed
Dr. Musarrat Riaz
Dr. M. Saif Ul Haque
Ms. Raheela NaseemDietician
Ms. Tahmina Rashid
Ms. Sara Jaffri
Ms. Sanober Aijaz
GDMDr. Asmat Nawaz
Mrs. Saira Shahid
Ms. Hina Naz
Ms. Zainab Akber
Ms. Amna Khatoon
EducationistMrs. Rabia A. Rahman
Ms. Erum Ghafoor
Ms. Sadaf Mateen
Mr. Farrukh Ahmed
Mr. Qutub Uddin
Mr. Naimat Rehman
Institutional Coordinator
Dr. Zafar Iqbal Abbasi
Mr. Faizan Mahmood
Dr. NaveedDr. Shahzaib
Thank You…