Showkat Ali Zargar

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

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Publications (69)172.65 Total impact

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    ABSTRACT: Background Hepatitis B virus (HBV) infection in cancer patients receiving chemotherapy carries high morbidity and mortality. Conventional hepatitis B vaccination with three doses at 0, 1, and 6 months apart is ineffective in prevention of HBV infection. Objectives To compare the efficacy of accelerated, multiple, double-dose HB vaccine with conventional HB vaccine in cancer patients receiving chemotherapy (CT). Methods Patients of cancer who were planned for CT were screened for HBV markers (HBsAg, total anti-HB core, anti-HBs antibody and HBV DNA). Patients with negative HBV serum markers received HB vaccine in two groups. Group A received three double doses (40 μg) of recombinant HB vaccine at 0, 1, and 3 weeks before CT and additional three double doses post CT. Group B received HB vaccine (20 μg) at 0, 1, and 6 months. Efficacy of vaccine in the two groups was compared by anti-HBs titers achieved at 3, 6, and 9 months and by HBsAg positivity following CT at 1 year follow up. Results Protective anti-HBs titers (>10 mIU/mL) at 3, 6, and 9 months in group A and B was 41.1 %, 66.2 %, and 76 % and 26 %, 37.7 %, and 49 % respectively (p = 0.001). Seven of 454 (1.5 %) patients in group A became HBsAg positive after vaccination compared to 19/472 (4.0 %) in group B (p = 0.022). Conclusion Accelerated, multiple, double-dose HB vaccine increases seroprotection and is more effective than conventional HB vaccine in preventing HBV infection. Keywords Accelerated, multiple, double-dose recombinant HB vaccine Cancer patients Chemotherapy HBsAg positivity HBV markers Seroprotection
    Full-text · Article · Nov 2015 · Indian Journal of Gastroenterology
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    ABSTRACT: Background Hepatitis B virus (HBV) infection in cancer patients receiving chemotherapy carries high morbidity and mortality. Conventional hepatitis B vaccination with three doses at 0, 1, and 6 months apart is ineffective in prevention of HBV infection. Objectives To compare the efficacy of accelerated, multiple, double-dose HB vaccine with conventional HB vaccine in cancer patients receiving chemotherapy (CT). Methods Patients of cancer who were planned for CT were screened for HBV markers (HBsAg, total anti-HB core, anti-HBs antibody and HBV DNA). Patients with negative HBV serum markers received HB vaccine in two groups. Group A received three double doses (40 μg) of recombinant HB vaccine at 0, 1, and 3 weeks before CT and additional three double doses post CT. Group B received HB vaccine (20 μg) at 0, 1, and 6 months. Efficacy of vaccine in the two groups was compared by anti-HBs titers achieved at 3, 6, and 9 months and by HBsAg positivity following CT at 1 year follow up. Results Protective anti-HBs titers (>10 mIU/mL) at 3, 6, and 9 months in group A and B was 41.1 %, 66.2 %, and 76 % and 26 %, 37.7 %, and 49 % respectively (p = 0.001). Seven of 454 (1.5 %) patients in group A became HBsAg positive after vaccination compared to 19/472 (4.0 %) in group B (p = 0.022). Conclusion Accelerated, multiple, double-dose HB vaccine increases seroprotection and is more effective than conventional HB vaccine in preventing HBV infection.
    No preview · Article · Jun 2015 · Experimental & Clinical Hepatology
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    ABSTRACT: Prevalence of HBV infection is increased in cancer patients and those receiving chemotherapy are susceptible to HBV reactivation with high morbidity and mortality. Conventional hepatitis B vaccination with three doses at 0, 1 and 6 months apart may be ineffective in prevention of HBV infection in cancer patients.
    No preview · Article · Jun 2015
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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.
    Full-text · Article · Jan 2015
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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.
    Full-text · Article · Jan 2015 · International Journal of Advanced Research
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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.
    Full-text · Article · Dec 2014 · International Journal of Advanced Research
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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.
    Full-text · Article · Oct 2014 · Indian Journal of Gastroenterology
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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.
    Full-text · Article · Oct 2014
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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.
    Full-text · Article · May 2014 · Asian Pacific journal of cancer prevention: APJCP
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    Manzoor Ahmad Malik · Annapurna Gupta · Showkat Ali Zargar · Balraj Mittal
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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.
    Full-text · Article · Jun 2013 · Tumor Biology
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    Manzoor Ahmad Malik · Showkat Ali Zargar · Balraj Mittal

    Full-text · Dataset · Jun 2013
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    Manzoor Ahmad Malik · Showkat Ali Zargar · Balraj Mittal

    Full-text · Dataset · Jun 2013
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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.
    Full-text · Article · May 2013 · Cancer Science
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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
    Full-text · Article · Apr 2013 · British Journal of Cancer
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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.
    Full-text · Article · Mar 2013 · Indian Journal of Gastroenterology

  • No preview · Article · Mar 2013 · Journal of Clinical and Experimental Hepatology

  • No preview · Article · Mar 2013 · Journal of Clinical and Experimental Hepatology

  • No preview · Article · Mar 2013 · Journal of Clinical and Experimental Hepatology

  • No preview · Article · Mar 2013 · Journal of Clinical and Experimental Hepatology

  • No preview · Article · Mar 2013 · Journal of Clinical and Experimental Hepatology