Showkat Ali Zargar

Sher-i-Kashmir Institute of Medical Sciences, Suryanagar, Kashmir, India

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Publications (111)368.71 Total impact

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    ABSTRACT: Background: Literature regarding safe dose of carvedilol is limited and also safe dose across different child classes of chronic liver disease is not very clear. Aim: We aimed primarily to study, the effect of reasonably safe dose (12.5 mg) of carvedilol in acute reduction of portal pressure and compared it with chronic reduction of portal pressure, after Original Research Article Wani et al.; BJMMR, 7(5): 355-368, 2015; Article no.BJMMR.2015.342 356 proper optimization of dose of carvedilol. Second aim of our study was to define predictors of response for acute and chronic reduction of portal pressure and to assess difference in dose tolerated and response across different child class on chronic basis. Methods: One hundred two consecutive patients of cirrhosis of liver with significant portal hypertension were included and hepatic venous pressure gradient was measured at the base line and after 90 minutes of administration of 12.5 mg carvedilol. After proper dose optimization of carvedilol, hepatic venous pressure gradient was again measured after 3 months to assess the chronic response. Results: The mean age of study population was 58.3±6.6 years. A total of 42.2%, 31.9% and 26.6% patients had child class A, child class B and Child class C cirrhosis, respectively. Mean pre-drug hepatic venous pressure gradient was 16.75±2.12 mmHg which dropped to 13.07±2.32 mmHg after 90 minutes of administration of 12.5 mg of carvedilol. The mean drop of hepatic venous pressure gradient was 4.5±2.2 mmHg and 2.4±1.9 mmHg among responders and non-responders, respectively. Overall, 51% showed acute response while 49% were non-responders. Low cardiac output and high mean arterial pressure were significantly predicting the acute response, while, low baseline cardiac output was found as an independent predictor. After dose optimization, number of responders increased from 52 to 62. Mean dose of carvedilol was higher in non–responders as compared to responders, though statistically insignificant (p>0.05). Mean reduction of hepatic venous pressure gradient from baseline and after 3 months was 5.5±1.7 mmHg and 2.8±1.6 mmHg among responders and non responders on chronic basis, respectively (p<0.001). Absence of any adverse events (OR 11.3, 95% CI; 1.9-67.8), and more than 2.5 mmHg fall in hepatic venous pressure gradient during acute response (OR 8.7, 95% CI; 3.1-25.3) were found as independent predictors of chronic response (p<0.05). Univariate analysis found that no adverse events, no ascites, low baseline cardiac output, more than 2.5 mmHg fall in hepatic venous pressure gradient during acute response, as predictors of chronic response. However, etiology, child class, variceal size (large vs small) and gender were not significantly associated with chronic response Conclusion: At safe dose and with proper optimization of dose, carvedilol may achieve greater response with minimum side effects among different child classes of liver disease.
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    ABSTRACT: Background: Hepatitis B virus (HBV) infection is increased in cancer patients and those receiving chemotherapy are at risk of HBV reactivation with high mortality. Screening for occult and overt HBV infection is not widely practiced in cancer patients. Objectives: To assess the prevalence of occult and overt HBV infection in cancer patients at initial diagnosis prior to receiving chemotherapy(CT). Methods: At initial diagnosis of cancer, patients were examined for any evidence of liver disease followed by screening for serum markers of HBV infection (HBsAg, total anti HB core, anti HBs antibody and HBV DNA). Results: Isolated anti HBsAg positivity and previous resolved HBV infection was seen in 98(14.2%) and 88/690 (12.7%) patients respectively. HBV infection was seen in 68/690(9.8%) patients which included overt and occult HBV infection in 55/690 (8%) and 13/690 (1.9%) respectively. Overt and occult HBV infection in hematological cancers was more as compared to solid cancers [16/140(11.4%) vs 39/550 (7%), p=0.09] and 5/140(3.6) vs 8/550(1.4) p=<0.15] respectively. There was no significant difference in HBsAg positivity based on sex [31/393(7.8%) men vs 24/297(8%) women, p=0.9)], age [7/74(9.4 %) < 20yrs, 39/490 (7.9 %), 21-60 yrs, 9/126 (7.1%) > 60yrs), p=0.84], previous blood transfusions (BT) [13/170 (7.6%) BT vs 42/520 (8.0%), no BT, p=0.9)], history of jaundice [7/88 (8%) vs 35/602 (5.8%, p=0.8)] or ALT values, [42/545(7.7%) vs 13/145(7%), p=0.8)]. Conclusion: HBV infection is increased in cancer patients. Patients should be screened for both occult and overt HBV infection by testing serum HBsAg, HBV DNA and anti HB core antibody.
    International Journal of Advanced Research 12/2014; 3(1):2015. · 1.66 Impact Factor
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    ABSTRACT: Phospholipase C epsilon 1 (PLCE1) plays a crucial role in carcinogenesis and progression of several types of cancers. A single nucleotide polymorphism (SNP, rs2274223) in PLCE1 has been identified as a novel susceptibility locus. The aim of the present study was to investigate the role of three potentially functional SNPs (rs2274223A > G, rs3765524C > T, and rs7922612C > T) of PLCE1 in gastric cancer patients from Kashmir Valley. The study was conducted in 108 GC cases and 195 healthy controls from Kashmir Valley. Genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism method. Data were statistically analyzed using c2 test and logistic regression models. A P value of less than 0.05 was regarded as statistically significant. The frequency of PLCE1 A2274223C3765524T7922612, G2274223C3765524T7922612 , and G2274223T3765524C7922612 haplotypes were higher in patients compared with controls, conferred high risk for GC [odds ratio (OR) =6.29; P = 0.001; Pcorr = 0.003], (OR = 3.23; P = 0.011; Pcorr = 0.033), and (OR = 5.14; P = 0.011; Pcorr = 0.033), respectively. Smoking and salted tea are independent risk factors for GC, but we did not find any significant modulation of cancer risk by PLCE1 variants with smoking or excessive consumption of salted tea. These results suggest that variation in PLCE1 may be associated with GC risk in Kashmir Valley.
    Saudi Journal of Gastroenterology 11/2014; 20(6):371-7. DOI:10.4103/1319-3767.145330 · 1.22 Impact Factor
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    ABSTRACT: Background Age, female sex, and obesity are considered to be risk factors for gallstone disease. The role of type 2 diabetes (T2D) in gallstone formation is still uncertain, and data in Indians is limited. Objectives This is a case-control study to determine the prevalence of gallstones (GS) in patients with T2D, risk factors, and the relative risk compared with subjects without diabetes, selected from the general population. Methods Among 450 cases with T2D of a ≥2-year duration, 377 (88.8 %) participated. Diagnosis of GS was made at ultrasonography and history of cholecystectomy for GS. Controls were selected from the general population and diabetes excluded by oral glucose tolerance test. Cases and controls were matched for age, gender, and body mass index (BMI). Results Gallstones were seen in 67 (17.7 %) cases compared to 40 (5.8 %) in controls (p = 0.001). Prevalence increased with increasing age with peak in the sixth decade (23.4 % in cases and 4.4 % in controls (p = 0.001) and was higher in women (27.9 %) in cases and (7.8 %) in controls, (p = 0.001). In univariate analysis, risk factors for GS included age, female sex, BMI, multiparity, family history of GS, and high triglycerides and cholesterol with low high-density lipoprotein cholesterol. In multivariate analysis, age, (relative risk [RR] 1.54, confidence interval [CI] 1.1-2.1), female sex (RR 1.6, CI 1.0-1.9), and BMI (RR 1.5, CI 1.3-2.5) were the independent risk factors in gallstone formation. Conclusion Patients with T2D had higher probability of having GS compared to the general population. Increasing age, female sex, and higher BMI were independently associated with gallstone disease.
    Indian Journal of Gastroenterology 10/2014; 33(6). DOI:10.1007/s12664-014-0502-y
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    ABSTRACT: Neuroendocrine tumors are derived from primitive stem cells in the gut wall, but also can be seen in other organs. Most Neuroendocrine tumors are slow growing and indolent without symptoms. Nevertheless, aggressive and metastatic disease (e.g., in the brain) does occur. Here we report a case of jejunal neuroendocrine tumor with cystic metastasis in liver presented with progressive right sided abdominal distension.
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    ABSTRACT: Background: Phospholipase C epsilon 1 (PLCE1) encodes a member of the phospholipase family of proteins that play crucial roles in carcinogenesis and progression of several cancers including esophageal cancer (EC). In two large scale genome-wide association studies (GWAS) single nucleotide polymorphisms (SNP, rs2274223A>G, rs3765524C>T) in PLCE1 were identified as novel susceptibility loci of esophageal cancer (EC) in China. The aim of the present study was to investigate this finding in Kashmir Valley, a high risk area. Materials and Methods: We determined genotypes of three potentially functional SNPs (rs2274223A>G, rs3765524C>T and rs7922612C>T) of PLCE1 in 135 EC patients, and 195 age and gender matched controls in Kashmiri valley by PCR RFLP method. Risk for developing EC was estimated by binary logistic regression using SPSS. Results: The selected PLCE1 polymorphisms did not show independent association with EC. However, the G2274223T3765524T7922612 haplotype was significantly associated with increased risk of EC (OR=2.92; 95% CI=1.30-6.54; p=0.009). Smoking and salted tea proved to be independent risk factors for EC. Conclusions: Genetic variations in PLCE1 modulate risk of EC in the high risk Kashmiri population.
    Asian Pacific journal of cancer prevention: APJCP 05/2014; 15(10):4319-23. DOI:10.7314/APJCP.2014.15.10.4319 · 1.50 Impact Factor
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    ABSTRACT: Background and study aims Endoscopic sphincterotomy (ES) is one of the most important advances in the treatment of common bile duct (CBD) stones. However, the use of ES to remove CBD stones in high-risk patients without cholecystectomy is still debatable. The aim of this study was to compare the efficacy of a wait-and-see policy versus cholecystectomy after ES for CBD stones in high-risk patients with co-existing cholelithiasis. Patients and methods A total of 162 patients after undergoing ES with the clearance of CBD stones were randomised after informed consent to cholecystectomy or conservative management of their gallbladder stones. Results The results indicated that cholecystectomy after ES for CBD stones significantly reduced the biliary complications in high-risk patients. Conclusion Every patient who has both CBD stones and gallstones with significant co-morbid illnesses, after clearance of CBD stones by ES, should undergo early cholecystectomy.
    Arab Journal of Gastroenterology 03/2014; DOI:10.1016/j.ajg.2014.01.005
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    ABSTRACT: Portal cavernoma cholangiopathy (PCC) is defined as abnormalities in the extrahepatic biliary system including the cystic duct and gallbladder with or without abnormalities in the 1st and 2nd generation biliary ducts in a patient with portal cavernoma. Presence of a portal cavernoma, typical cholangiographic changes on endoscopic or magnetic resonance cholangiography and the absence of other causes of these biliary changes like bile duct injury, primary sclerosing cholangitis, cholangiocarcinoma etc are mandatory to arrive a diagnosis. Compression by porto-portal collateral veins involving the paracholedochal and epicholedochal venous plexuses and cholecystic veins and ischemic insult due to deficient portal blood supply or prolonged compression by collaterals bring about biliary changes. While the former are reversible after porto-systemic shunt surgery, the latter are not. Majority of the patients with PCC are asymptomatic and approximately 21% are symptomatic. Symptoms in PCC could be in the form of long standing jaundice due to chronic cholestasis, or biliary pain with or without cholangitis due to biliary stones. Endoscopic retrograde cholangiography has no diagnostic role because it is invasive and is associated with risk of complications, hence it is reserved for therapeutic procedures. Magnetic resonance cholangiography and portovenography is a noninvasive and comprehensive imaging technique, and is the modality of choice for mapping of the biliary and vascular abnormalities in these patients. PCC is a progressive condition and symptoms develop late in the course of portal hypertension only in patients with severe or advanced changes of cholangiopathy. Asymptomatic patients with PCC do not require any treatment. Treatment of symptomatic PCC can be approached in a phased manner, coping first with biliary clearance by nasobiliary or biliary stent placement for acute cholangitis and endoscopic biliary sphincterotomy for biliary stone removal; second, with portal decompression by creating portosystemic shunt; and third, with persistent biliary obstruction by performing second-stage biliary drainage surgery such as hepaticojejunostomy or choledochoduodenostomy. Patients with symptomatic PCC have good prognosis after successful endoscopic biliary drainage and after successful shunt surgery.
    02/2014; 4(Suppl 1):S2–S14. DOI:10.1016/j.jceh.2014.02.003
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    ABSTRACT: AbstrAct Aims: Idiopathic pancreatitis may be diagnosed once all causes of pancreatitis are excluded by thorough history, metabolic profile and conventional imaging modality, i.e., abdominal ultrasonography. In this study, we have attempted to evaluate the cause of idiopathic pancreatitis with the help of magnetic resonance cholangiopancreatography (MrcP). Methods: Fifty patients presenting with idiopathic pancreatitis were assessed prospectively using MrcP with strength 1.5 tesla for potential cause of the attack of pancreatitis. results: Magnetic resonance cholangiopancreatography was able to establish the cause of pancreatitis in eleven (22%) patients, as follows. common bile duct stone in one (2%), pancreatic divisum in one (2%), gallbladder stone in one (2%), pancreatic duct stone in one (2%), chronic pancreatitis in two (4%), gallbladder sludge in two (4%) and anomalous pancreaticobiliary union in three (6%) patients. conclusion: Magnetic resonance cholangiopancreatography, a non-invasive and complication free imaging modality is able to establish the cause of acute pancreatitis in patients in whom the diagnosis of idiopathic pancreatitis has been made following standard investigations. Idiopathic pancreatitis should not be diagnosed unless MrcP has been performed.. The efficacy of magnetic resonance cholangiopancreatography in assessing the etiology of acute idiopathic pancreatitis. Int J Hepatobiliary Pancreat Dis 2014;4:32–39.
    01/2014; 44:32-39. DOI:10.5348/ijhpd-2014-18-OA-6
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    ABSTRACT: Genetic alterations in the deleted in colorectal carcinoma (DCC) gene have been a priori reported to associate with metastasis in variety of human cancers. We investigated the association between potentially functional SNPs in DCC and susceptibility to esophageal (EC) and gastric (GC) cancers in Kashmir Valley. We genotyped two SNPs DCC rs714 (A>G) and DCC rs2229080 (C>G) of DCC in 135 EC patients, 108 GC patients, and 195 controls matched by age and sex in Kashmir Valley by polymerase chain reaction-RFLP method. Risk for developing EC and GC was estimated by binary logistic regression by using SPSS. We also performed a meta-analysis on DCC rs714 (A>G) and evaluated the association between the DCC rs714 (A>G) polymorphisms and cancer risk. A significant difference in DCC rs714 (A>G) genotype distribution between EC and GC cases and corresponding control groups was observed (odds ratio (OR) = 1.92; P = 0.03; P-trend = 0.04; false discovery rate (FDR) Pcorr = 0.03: OR = 2.15; P = 0.02; P-trend = 0.01; FDR Pcorr = 0.03). But no such association was observed in DCC rs2229080 (C>G). Further, DCC rs714 (A>G) AA genotype showed significantly increased risk for both gastric squamous cell carcinoma (OR = 5.63; P = 0.02; FDR Pcorr = 0.01) and gastric adenocarcinoma (OR = 2.15; P = 0.02; FDR Pcorr = 0.01). Smoking and salted tea are independently associated with both EC and GC, but gene-environment interaction did not further modulate the risk. Meta-analysis also suggested both independent and overall association of DCC rs714 (A>G) polymorphism with cancer (P = 0.000). In conclusion, genetic variations in DCC rs714 (A>G) modulate risk of EC and GC in high-risk Kashmir population.
    Tumor Biology 06/2013; DOI:10.1007/s13277-013-0870-4 · 2.84 Impact Factor
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    Manzoor Ahmad Malik, Showkat Ali Zargar, Balraj Mittal
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    Manzoor Ahmad Malik, Showkat Ali Zargar, Balraj Mittal
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    ABSTRACT: Studies have persistently associated esophageal squamous cell carcinoma (ESCC) risk with low socioeconomic status (SES), but this association is unexplored in Kashmir, an area with a high incidence of ESCC in the northernmost part of India. We conducted a case-control study to assess the association of multiple indicators of SES and ESCC risk in Kashmir valley. A total number of 703 histologically confirmed ESCC cases and 1664 controls matched to the cases for age, sex, and district of residence were recruited from October, 2008 to January, 2012. Conditional logistic regression models were used to calculate unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs). Composite wealth scores were constructed based on the ownership of several appliances using multiple correspondence analysis. Higher education, living in the kiln brick or concrete house, use of liquefied petroleum gas and electricity for cooking, and higher wealth scores all showed an inverse association with ESCC risk. Compared to farmers, the individuals who had government jobs and worked in the business sector were at lower risk of ESCC, but this association disappeared in fully adjusted models. Occupational strenuous physical activity was strongly associated with ESCC risk. In summary, we found a strong relationship of low SES and ESCC in Kashmir. The findings need to be studied further to understand the mechanisms through which such SES parameters increase ESCC risk. This article is protected by copyright. All rights reserved.
    Cancer Science 05/2013; 104(9). DOI:10.1111/cas.12210 · 3.53 Impact Factor
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    ABSTRACT: BACKGROUND: Although cigarette smoking is an established risk factor for oesophageal squamous cell carcinoma (ESCC), there is little information about the association between other smoking and smokeless tobacco products, including hookah and nass, and ESCC risk. We conducted a case–control study in Kashmir Valley, India, where hookah smoking, nass chewing, and ESCC are common, to investigate the association of hookah smoking, nass use, and several other habits with ESCC. METHODS: We recruited 702 histologically confirmed ESCC cases and 1663 hospital-based controls, individually matched to the cases for age, sex, and district of residence from September 2008 to January 2012. Conditional logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS: Ever-hookah smoking (OR¼1.85; 95% CI, 1.41–2.44) and nass chewing (OR¼2.88; 95% CI, 2.06–4.04) were associated with ESCC risk. These associations were consistent across different measures of use, including intensity, duration, and cumulative amount of use, and after excluding ever users of the other product and cigarette smokers. Our results also suggest an increased risk of ESCC associated with ever-gutka chewing and -bidi smoking. However, the latter associations were based on small number of participants. CONCLUSION: This study shows that hookah and nass use are associated with ESCC risk. As prevalence of hookah use seems to be increasing among young people worldwide, these results may have relevance not only for the regions in which hookah use has been a traditional habit, but also for other regions, including western countries. British Journal of Cancer (2012) 0, 000–000. doi:10.1038/bjc.2012.449 www.bjcancer.com & 2012 Cancer Research UK Keywords: oesophageal cancer; hookah; nass; smoking; tobacco
    British Journal of Cancer 04/2013; 108(7):1552. DOI:10.1038/bjc.2013.111 · 4.82 Impact Factor
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    ABSTRACT: BACKGROUND: Increasing resistance against Helicobacter pylori has resulted in reduced eradication rates. OBJECTIVE: This study aims to determine whether eradication rates for H. pylori infection with sequential therapy is better than standard triple therapy. PATIENTS: Patients with endoscopy documented peptic ulcer and H. pylori infection confirmed by histology and rapid urease test. INTERVENTION: Patients were randomized into two groups; 134 received standard triple therapy (pantoprazole 40 mg, clarithromycin 500 mg and amoxicillin 1 g each administered twice daily) for 10 days and 138 received sequential regimen (pantoprazole 40 mg plus amoxicillin 1 g twice daily for 5 days followed by 40 mg pantoprazole, 500 mg clarithromycin, and 500 mg tinidazole each administered twice daily for 5 days). Eradication was confirmed by histology and rapid urease test. Compliance and adverse effects were determined by the recovery of empty medicine strips and questioning. RESULTS: The eradication rates with sequential therapy were significantly greater than with standard therapy on both intention-to-treat analysis (76.0 % vs. 61.9 %, p = 0.005; difference, 14.1 % [95 % CI, 6.5-19 %] and per protocol analysis (84.6 % vs. 67.4 %, p = 0.002; difference, 17.2 % [95 % CI, 8.5-23.5 %]). The incidence of side effects did not differ between the two therapy groups. One patient in standard therapy discontinued treatment due to side effects. LIMITATION: Cultures were not performed. Loss to follow up was 5.2 % in standard therapy and 6.5 % in sequential therapy. CONCLUSION: Sequential therapy was significantly more effective than standard therapy for eradicating H. pylori infection in peptic ulcer disease in Asian patients. Side effects were similar.
    Indian Journal of Gastroenterology 03/2013; 32(3). DOI:10.1007/s12664-013-0304-7
  • 03/2013; 3(1):S33–S34. DOI:10.1016/j.jceh.2013.03.078
  • 03/2013; 3(1):S15. DOI:10.1016/j.jceh.2013.03.033
  • 03/2013; 3(1):S108-S109. DOI:10.1016/j.jceh.2013.03.185
  • 03/2013; 3(1):S97. DOI:10.1016/j.jceh.2013.02.242
  • 03/2013; 3(1):S108. DOI:10.1016/j.jceh.2013.03.184

Publication Stats

2k Citations
368.71 Total Impact Points

Institutions

  • 1988–2015
    • Sher-i-Kashmir Institute of Medical Sciences
      • Department of Gastroenterology
      Suryanagar, Kashmir, India
  • 2010–2011
    • Sanjay Gandhi Post Graduate Institute of Medical Sciences
      Lakhnau, Uttar Pradesh, India