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Baxter MA, Denholm M, Kingdon SJ, Kathirgamakarthigeyan S, Parikh S, Shakir R, Johnson R, Martin H, Walton M, Yao W, Swan A, Samuelson C, Ren X, Cooper A, Gray HL, Clifton S, Ball J, Gullick G, Anderson M, Dodd L, Hayhurst H, Salama M, Shotton R, Britton F, Christodoulou T, Abdul-Hamid A, Eichholz A, Evans RM, Wallroth P, Gibson F, Poole K, Rowe M, Harris J. CAnceR IN PreGnancy (CARING) - a retrospective study of cancer diagnosed during pregnancy in the United Kingdom. Br J Cancer 2024; 130:1261-1268. [PMID: 38383704 PMCID: PMC11014900 DOI: 10.1038/s41416-024-02605-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND The incidence of cancer diagnosed during pregnancy is increasing. Data relating to investigation and management, as well as maternal and foetal outcomes is lacking in a United Kingdom (UK) population. METHODS In this retrospective study we report data from 119 patients diagnosed with cancer during pregnancy from 14 cancer centres in the UK across a five-year period (2016-2020). RESULTS Median age at diagnosis was 33 years, with breast, skin and haematological the most common primary sites. The majority of cases were new diagnoses (109 patients, 91.6%). Most patients were treated with radical intent (96 patients, 80.7%), however, gastrointestinal cancers were associated with a high rate of palliative intent treatment (63.6%). Intervention was commenced during pregnancy in 68 (57.1%) patients; 44 (37%) had surgery and 31 (26.1%) received chemotherapy. Live births occurred in 98 (81.7%) of the cases, with 54 (55.1%) of these delivered by caesarean section. Maternal mortality during the study period was 20.2%. CONCLUSIONS This is the first pan-tumour report of diagnosis, management and outcomes of cancer diagnosed during pregnancy in the UK. Our findings demonstrate proof of concept that data collection is feasible and highlight the need for further research in this cohort of patients.
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Affiliation(s)
- M A Baxter
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
- Tayside Cancer Centre, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK.
| | - M Denholm
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK
| | - S J Kingdon
- Exeter Oncology Centre, Royal Devon University Hospitals NHS Trust, Exeter, UK
| | | | - S Parikh
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Shakir
- Oncology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R Johnson
- Oncology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - H Martin
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Institute, Cambridge University, Cambridge, UK
| | - M Walton
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - W Yao
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Swan
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - C Samuelson
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - X Ren
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - A Cooper
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - H-L Gray
- Tayside Cancer Centre, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK
| | - S Clifton
- Bristol Haematology and Oncology Centre, Bristol, UK
| | - J Ball
- Bristol Haematology and Oncology Centre, Bristol, UK
| | - G Gullick
- Oncology Department, Royal United Hospitals NHS Foundation Trust, Bath, UK
| | - M Anderson
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, The Newcastle Upon Tyne, UK
| | - L Dodd
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, The Newcastle Upon Tyne, UK
| | - H Hayhurst
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, The Newcastle Upon Tyne, UK
| | - M Salama
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Shotton
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - F Britton
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - T Christodoulou
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - A Abdul-Hamid
- Department of Oncology, Royal Surrey County Hospital NHS Trust, Surrey, UK
| | - A Eichholz
- Department of Oncology, Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK
| | - R M Evans
- South West Wales Cancer Centre, Swansea Bay NHS Trust, Swansea, UK
| | | | - F Gibson
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - K Poole
- The Institute of Cancer Research, Clinical Trials and Statistics Unit, Belmont, Sutton, Surrey, UK
| | - M Rowe
- Sunrise Oncology Centre, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - J Harris
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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Jones DA, Candio P, Shakir R, Ramroth J, Wolstenholme J, Gray AM, Cutter DJ, Ntentas G. Individualised Estimation of Quality-adjusted Survival Benefit and Cost-effectiveness of Proton Beam Therapy in Intermediate-stage Hodgkin Lymphoma. Clin Oncol (R Coll Radiol) 2023; 35:301-310. [PMID: 36732121 DOI: 10.1016/j.clon.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/02/2022] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
AIMS Radiotherapy for Hodgkin lymphoma leads to the irradiation of organs at risk (OAR), which may confer excess risks of late effects. Comparative dosimetry studies show that proton beam therapy (PBT) may reduce OAR irradiation compared with photon radiotherapy, but PBT is more expensive and treatment capacity is limited. The purpose of this study is to inform the appropriateness of PBT for intermediate-stage Hodgkin lymphoma (ISHL). MATERIALS AND METHODS A microsimulation model simulating the course of ISHL, background mortality and late effects was used to estimate comparative quality-adjusted life years (QALYs) lived and healthcare costs after consolidative pencil beam scanning PBT or volumetric modulated arc therapy (VMAT), both in deep-inspiration breath-hold. Outcomes were compared for 606 illustrative patients covering a spectrum of clinical presentations, varying by two age strata (20 and 40 years), both sexes, three smoking statuses (never, former and current) and 61 pairs of OAR radiation doses from a comparative planning study. Both undiscounted and discounted outcomes at 3.5% yearly discount were estimated. The maximum excess cost of PBT that might be considered cost-effective by the UK's National Institute for Health and Care Excellence was calculated. RESULTS OAR doses, smoking status and discount rate had large impacts on QALYs gained with PBT. Current smokers benefited the most, averaging 0.605 undiscounted QALYs (range -0.341 to 2.171) and 0.146 discounted QALYs (range -0.067 to 0.686), whereas never smokers benefited the least, averaging 0.074 undiscounted QALYs (range -0.196 to 0.491) and 0.017 discounted QALYs (range -0.030 to 0.086). For the gain in discounted QALYs to be considered cost-effective, PBT would have to cost at most £4812 more than VMAT for current smokers and £645 more for never smokers. This is below preliminary National Health Service cost estimates of PBT over photon radiotherapy. CONCLUSION In a UK setting, PBT for ISHL may not be considered cost-effective. However, the degree of unquantifiable uncertainty is substantial.
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Affiliation(s)
- D A Jones
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK.
| | - P Candio
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK; Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Department of Economics and Management, University of Trento, Trento, Italy
| | - R Shakir
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - J Ramroth
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - J Wolstenholme
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - A M Gray
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - D J Cutter
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK; Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - G Ntentas
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK; Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Shakir R, Hanif S, Salawi A, Arshad R, Sarfraz RM, Irfan M, Raza SA, Barkat K, Sabei FY, Almoshari Y, Alshamrani M, Syed MA. Exorbitant Drug Loading of Metformin and Sitagliptin in Mucoadhesive Buccal Tablet: In Vitro and In Vivo Characterization in Healthy Volunteers. Pharmaceuticals (Basel) 2022; 15:ph15060686. [PMID: 35745605 PMCID: PMC9227047 DOI: 10.3390/ph15060686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023] Open
Abstract
The aim of the proposed study is to develop a mucoadhesive buccal delivery system for the sustained delivery of metformin (MET) and sitagliptin (SIT) against diabetes mellitus (DM) with improved bioavailability. Polymeric blend of Carbopol® 940 (CP), agarose (AG) or polyvinylpyrrolidone K30 (PVP) as mucoadhesive agents in formulations (R1–R15) were compressed via the direct compression technique. Tablets were characterized for solid state studies, physicochemical and in vivo mucoadhesion studies in healthy volunteers. Outcomes did not reveal any unusual peak or interaction between the drugs and polymers in the physical mixture through Fourier Transform Infrared Spectroscopy (FTIR) and DSC analysis. The mucoadhesive blend of CP and PVP was superior compared to other blends. The formulation R4 revealed exorbitant loading of drugs with complete drug release for 6 h with ex vivo mucoadhesive strength and time of 26.99 g and 8.1 h, respectively. It was further scrutinized to evaluate it as an optimized formulation where it was found to be stable for up to 6 months. The formulation R4 depicted Korsmeyer–Peppas model and first-order mode of release correspondingly for SIT and MET. Moreover, it showed hemocompatibility, biocompatibility and stability with non-significant changes in the dissolution profile. Overall, the CP blend with PVP was found appropriate to yield the desired release coupled with the optimized mucoadhesive properties of the buccal tablets, ensuring sufficient pharmaceutical stability.
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Affiliation(s)
- Rouheena Shakir
- Department of Pharmaceutics, Faculty of Pharmacy, The University of Lahore, Lahore 54000, Pakistan; (R.S.); (R.A.); (K.B.)
| | - Sana Hanif
- College of Pharmacy, University of Sargodha, Sargodha 40100, Pakistan;
- Correspondence: (S.H.); (M.I.); (M.A.S.)
| | - Ahmad Salawi
- Department of Pharmaceutics, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia; (A.S.); (F.Y.S.); (Y.A.); (M.A.)
| | - Rabia Arshad
- Department of Pharmaceutics, Faculty of Pharmacy, The University of Lahore, Lahore 54000, Pakistan; (R.S.); (R.A.); (K.B.)
| | | | - Muhammad Irfan
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad 38000, Pakistan
- Correspondence: (S.H.); (M.I.); (M.A.S.)
| | - Syed Atif Raza
- Department of Pharmaceutics, Punjab University College of Pharmacy, University of The Punjab, Lahore 54590, Pakistan;
| | - Kashif Barkat
- Department of Pharmaceutics, Faculty of Pharmacy, The University of Lahore, Lahore 54000, Pakistan; (R.S.); (R.A.); (K.B.)
| | - Fahad Y. Sabei
- Department of Pharmaceutics, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia; (A.S.); (F.Y.S.); (Y.A.); (M.A.)
| | - Yosif Almoshari
- Department of Pharmaceutics, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia; (A.S.); (F.Y.S.); (Y.A.); (M.A.)
| | - Meshal Alshamrani
- Department of Pharmaceutics, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia; (A.S.); (F.Y.S.); (Y.A.); (M.A.)
| | - Muhammad Ali Syed
- Department of Pharmaceutics, Faculty of Pharmacy, The University of Lahore, Lahore 54000, Pakistan; (R.S.); (R.A.); (K.B.)
- Correspondence: (S.H.); (M.I.); (M.A.S.)
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Shakir R, Geurts Y, Ntentas G, Aleman B, Ramroth J, John K, Janus C, Krol A, Roesink J, van den Maazen R, Zijlstra J, van Leeuwen F, Cutter D, Schaapveld M. OC-0295 Colorectal cancer risk following radiotherapy and procarbazine for Hodgkin lymphoma. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02553-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shakir R, Butterworth V, Ramroth J, Cutter D, Ntentas G. OC-0292 Estimating risk of radiation toxicity for lymphoma patients using pre-chemotherapy PET-CT scans. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02550-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Raza A, Murtaza SH, Hanif S, Iqbal J, Ali I, Aftab T, Shakir R, Bedar R, Syed MA. Validation of a rapid and economical RP-HPLC method for simultaneous determination of metformin hydrochloride and sitagliptin phosphate monohydrate: Greenness evaluation using AGREE score. Pak J Pharm Sci 2022; 35:15-21. [PMID: 35221267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Reported high performance liquid chromatographic (HPLC) methods for estimating metformin hydrochloride (MET) and sitagliptin phosphate monohydrate (SIT) are either laborious or contain higher proportions of organic solvents in mobile phase, thus presenting exorbitant procedures. So, a rapid, significantly more economical and eco-friendly HPLC method for synchronized analysis of both drugs was aimed to develop and validate in current study. Analytical evaluation was executed on Shimadzou⌖ C18 column (250mm × 4.6mm, 5μm) using acidified water and methanol 60:40 (v/v) as mobile phase at a flow of 1mL/min; while peaks were detected at 260nm at 25°C. Resultant values of accuracy, precision, linearity, limit of detection (LOD), limit of quantification (LOQ), robustness and specificity depicted that the method was validated in accordance with the ICH Guidelines. The approximate retention time for MET and SIT were 1.96 and 3.70 min, correspondingly. The greenness score of the developed method was evaluated using AGREE software and was found better (0.81) as compared with the methods reported (<0.8). Conclusively, the developed method was time saving, economical, rapid, robust, rugged, precise, accurate and found to be applicable for simultaneous determination of MET and SIT in commercial tablets.
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Affiliation(s)
- Aqeela Raza
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, The University of Lahore, Pakistan
| | - Syed Hassan Murtaza
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, The University of Lahore, Pakistan
| | - Sana Hanif
- Department of Pharmaceutics, Faculty of Pharmacy, The University of Lahore, Pakistan
| | - Javed Iqbal
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, The University of Lahore, Pakistan
| | - Ijaz Ali
- Department of Pharmaceutics, Faculty of Pharmacy, The University of Lahore, Pakistan
| | - Tayyaba Aftab
- Department of Pharmaceutics, Faculty of Pharmacy, The University of Lahore, Pakistan
| | - Rouheena Shakir
- Department of Pharmaceutics, Faculty of Pharmacy, The University of Lahore, Pakistan
| | - Rushda Bedar
- Department of Pharmaceutics, Faculty of Pharmacy, The University of Lahore, Pakistan
| | - Muhammad Ali Syed
- Department of Pharmaceutics, Faculty of Pharmacy, The University of Lahore, Pakistan
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Razzaq S, Syed MA, Irfan M, Khan I, Sarfraz RM, Shakir R, Ali S, Iqbal Z, Niaz Y, Mujtaba SH, Raza SA, Raza S, Hanif S. Optimization of metronidazole SR buccal tablet for gingivitis using genetic algorithm. Pak J Pharm Sci 2021; 34:2149-2158. [PMID: 35034875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Gingivitis is a condition that needs sustained concentration of antibiotic locally over extended period of time. The current study aimed to formulate and evaluate the sustained and localized release of metronidazole (MTZ) as mucoadhesive buccal tablet containing hydroxypropylmethyl cellulose (HPMC), Carbopol 940® (CP), carboxymethylcellulose (CMC) and ethyl cellulose (EC) as mucoadhesive polymers. Tablets were directly compressed with proportions of polymeric blends (F1-F16). The results indicated that weight variation (249±2.10mg) and friability (0.21%) were within USP compendial limits. Maximum mucoadhesive strength and time were depicted by F1 and F14 which were 28.47g and 12hr respectively. Formulations, except F4, were within physiological pH limit. Maximum swellability index (261.9%) was exhibited by F16, at 8 hr, containing highest concentration of CP, HPMC and additional CMC. For in vitro release, the pre-set 8 hr complete release were shown by formulations, F15 and F16 which were 100% and 97%, respectively. Genetic algorithm was applied on the attributes to optimize polymeric response in accordance with desirability. The software predicted composition (F17) was tested which revealed that physical characteristics were in accordance with the compendial standards. The release kinetics, evaluated through DDsolver⌖, suggested that release of MTZ followed non-Fickian diffusion type in Korsmeyer-Peppas model. Therefore, MTZ, if delivered as mucoadhesive buccal formulation (F17) containing amounts (mg) of CP (16.4), HPMC (78.7), CMC (8.3) and EC (10.5) will simulate satisfactory release i.e. 96% at 8 hr in simulated buccal fluid.
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Affiliation(s)
- Sobia Razzaq
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | | | - Muhammad Irfan
- Department of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Ikramullah Khan
- Department of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | | | - Rouheena Shakir
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | | | - Zafar Iqbal
- Universitätskilinikum Eppendorf Hamburg, University of Hamburg, Hamburg, Germany
| | - Yasir Niaz
- Liberty Lab for Robotics, FAST, Pakistan
| | | | - Syed Atif Raza
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Sheheryar Raza
- Department of Electrical and Computer Engineering, Isfahan University of Technology, Isfahan, Iran
| | - Sana Hanif
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
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Dodwell D, Shakir R. Assessing New Drugs in Advanced Cancer: Beyond Randomised Evidence. Clin Oncol (R Coll Radiol) 2021; 33:e201-e202. [PMID: 33223383 DOI: 10.1016/j.clon.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/09/2020] [Accepted: 11/06/2020] [Indexed: 11/19/2022]
Affiliation(s)
- D Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - R Shakir
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Shakir R, Adams R, Cooper R, Downing A, Geh I, Gilbert D, Jacobs C, Jones C, Lorimer C, Namelo W, Sebag-Montefiore D, Shaw P, Muirhead R. Patterns and predictors of relapse following radical chemoradiotherapy delivered using intensity-modulated radiotherapy with a simultaneous integrated boost in anal squamous cell carcinoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Casswell G, Shakir R, Macnair A, O'Leary B, Smith F, Rulach R, Bowden C. UK Training in Clinical Oncology: The Trainees' Viewpoint. Clin Oncol (R Coll Radiol) 2018; 30:602-604. [DOI: 10.1016/j.clon.2018.06.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/16/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
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Charlton P, Sabbagh A, Shakir R, Owens R, O'Brien G, de Pennington N, Eichholz A. Implementation of the Oxford Acute Referral System (OARS) an Electronic System to Document and Manage the Acute Referral of Patients with Metastatic Spinal Cord Compression (MSCC). Clin Oncol (R Coll Radiol) 2018. [DOI: 10.1016/j.clon.2018.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Shakir R. Global neurology challenges and way forward. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Shakir R. Neurology resources around the world. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Shakir R, Buffa F, Higgins G, Horne A, Stuart R, Vallis K, Panakis N. 144 Audit of palliative whole brain radiotherapy (WBRT) in patients with non-small cell lung cancer (NSCLC) treated at the Oxford Cancer Centre over 2½ years. Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30161-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shakir R. Latin American contributions to the WFN. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.09.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Shweta B, Nupur G, Archana A, Inderjeet G, Suman G, Manisha B, Thakur D, Shakir R, Shashi K. The serological profile of herpes virus amongst patients with bad obstetric history. Apollo Medicine 2015. [DOI: 10.1016/j.apme.2015.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Shakir R, Ngo N, Naresh KN. Correlation of cyclin D1 transcript levels, transcript type and protein expression with proliferation and histology among mantle cell lymphoma. J Clin Pathol 2008; 61:920-7. [PMID: 18552173 DOI: 10.1136/jcp.2008.057455] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Cyclin D1 expression is central to mantle cell lymphoma (MCL) biology. The cyclin D1 gene produces two forms of mRNA: long (D1L) and short (D1S) versions. AIMS To study the relationship between histology, cyclin D1 mRNA (transcript) levels, cyclin D1 transcript type, cyclin D1 protein expression by immunohistochemistry (IHC), and proliferation (Ki-67%). METHODS 17 MCLs were initially studied for: levels of expression of cyclin D1 transcripts and for cyclin D1 transcript type by reverse-transcriptase PCR; intensity and percentage cyclin D1 protein expression by IHC; and Ki-67% by IHC. The relationship between cyclin D1 protein expression and proliferation was further validated on an independent set of 23 MCLs. RESULTS MCLs expressed variable levels of cyclin D1 at both transcript and protein levels. Furthermore, D1L and D1S were the predominant transcripts in 69% and 31% of cases, respectively. While only 9% of cases with dominance of D1L had blastoid histology, 60% of the cases with dominance of the D1S had blastoid features. Furthermore, the levels of D1L showed direct correlation with cyclin D1 protein expression and Ki-67%. Among these cases, and in the independent set of MCLs (n = 40), the level of cyclin D1 protein expression directly correlated with Ki-67%. CONCLUSIONS MCLs express variable levels of cyclin D1 transcripts and protein, and have variable proliferation (Ki-67%). Cases with dominance of D1S transcripts are more likely to be of blastoid morphology. There is correlation between D1L transcripts levels, cyclin D1 protein expression and Ki-67%.
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Affiliation(s)
- R Shakir
- Department of Histopathology, Hammersmith Hospital & Imperial College, London, UK
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Cetinkaya B, Gumrukcu I, Lappert MF, Atwood JL, Shakir R. Lithium and sodium 2,6-di-tert-butylphenoxides and the crystal and molecular structure of [Li(OC6H2Me-4-But2-2,6)(OEt2)]2. J Am Chem Soc 2002. [DOI: 10.1021/ja00526a053] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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de Bittencourt PR, Adamolekum B, Bharucha N, Carpio A, Cossío OH, Danesi MA, Dumas M, Meinardi H, Ordinario A, Senanayake N, Shakir R, Sotelo J. Epilepsy in the tropics: I. Epidemiology, socioeconomic risk factors, and etiology. Epilepsia 1996; 37:1121-7. [PMID: 8917065 DOI: 10.1111/j.1528-1157.1996.tb01035.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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22
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de Bittencourt PR, Adamolekum B, Bharucha N, Carpio A, Cossío OH, Danesi MA, Dumas M, Fernandes JG, Genton P, Manreza ML, Meinardi H, Ordinario A, Senanayake N, Shakir R, Singhal BS, Sotelo J. Epilepsy in the tropics: II. Clinical presentations, pathophysiology, immunologic diagnosis, economics, and therapy. Epilepsia 1996; 37:1128-37. [PMID: 8917066 DOI: 10.1111/j.1528-1157.1996.tb01036.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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23
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Taylor RW, Birch-Machin MA, Schaefer J, Taylor L, Shakir R, Ackrell BA, Cochran B, Bindoff LA, Jackson MJ, Griffiths P, Turnbull DM. Deficiency of complex II of the mitochondrial respiratory chain in late-onset optic atrophy and ataxia. Ann Neurol 1996; 39:224-32. [PMID: 8967754 DOI: 10.1002/ana.410390212] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Defects of the mitochondrial respiratory chain are increasingly being recognized as an important cause of neurological disease in humans. In many of these patients, the biochemical defect results from an abnormality of the mitochondrial genome. Respiratory chain defects involving complex II, which is entirely encoded by the nuclear genome, are comparatively rare. We report the clinical and biochemical findings in 2 elderly sisters who presented with late-onset neurodegenerative disease. In both patients, a partial deficiency of complex II (approximately 50% of control values) was shown to be present in mitochondria from muscle and platelets. The enzyme defect was not expressed in cultured skin fibroblasts or immortalized lymphocytes. There was an overexpression of the 70-kd flavoprotein subunit in muscle mitochondria from both patients, although we showed that this subunit is present in normal amounts in mitochondrial membranes. Our studies highlight the diversity of the clinical presentation of respiratory chain disease and that complex II deficiency should enter the differential diagnosis of certain patients with late-onset neurodegenerative disease.
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Affiliation(s)
- R W Taylor
- Departments of Neurology and Ophthalmology, University of Newcastle upon Tyne, U.K
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al-Din AS, Khogali M, Poser CM, al-Nassar KE, Shakir R, Hussain J, Behbahani K, Chadha G. Epidemiology of multiple sclerosis in Arabs in Kuwait: a comparative study between Kuwaitis and Palestinians. J Neurol Sci 1990; 100:137-41. [PMID: 2089130 DOI: 10.1016/0022-510x(90)90024-h] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
On December 31, 1988 there were 201 registered multiple sclerosis patients in Kuwait, an overall prevalence rate (PR) of 10.2 per 100,000; among them were 186 Arabs, of whom 72 were Palestinians and 51 Kuwaitis. Comparison of these two subgroups, who had a similar age distribution revealed that the disease was 2 1/2 times more frequent among Palestinians (PR 23.8/100,000) than among Kuwaitis (PR 9.5/100,000). Palestinians also showed significant differences from Kuwaitis in eye color, blood group distribution and HLA-DR and HLA-DQW epitopes frequency. This suggests that genetic rather than environmental factors might be the underlying cause for the high susceptibility to develop MS among Arabs originating from the Eastern Mediterranean basin.
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Affiliation(s)
- A S al-Din
- Department of Medicine, Faculty of Medicine, University of Kuwait, Safat
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Abstract
We treated 15 children with Sydenham's chorea with sodium valproate at a dose of 15 to 20 mg/kg/d. In 13 of them the chorieform movements disappeared within 1 week of therapy. The remaining 2 had incomplete response. Two patients relapsed; 1 of them responded to the reintroduction of valproate. The mean duration of treatment was 6.7 weeks. We observed no major side effects. This study strongly suggests that valproate is an effective drug in the treatment of Sydenham's chorea.
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Affiliation(s)
- A S Daoud
- Department of Paediatrics, Farwania Hospital, Kuwait
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Al-Din ASN, Jamil AS, Shakir R. Coma and brain stem areflexia in brain stem encephalitis. West J Med 1985. [DOI: 10.1136/bmj.291.6506.1422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lewis B, Mitchell WD, Marenah CB, Cortese C, Reynolds EH, Shakir R. Cerebrotendinous xanthomatosis: biochemical response to inhibition of cholesterol synthesis. BMJ 1983; 287:21-2. [PMID: 6407679 PMCID: PMC1548166 DOI: 10.1136/bmj.287.6384.21-a] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Zaworotko MJ, Shakir R, Atwood JL, Sriyunyongwat V, Reynolds SD, Albright TA. Synthesis and structure of dicarbonyl(η5-methylcyclopentadienyl)triphenylphosphinemanganese(I). ACTA ACUST UNITED AC 1982. [DOI: 10.1107/s0567740882006426] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Lipson A, Nickoloff EL, Hsu TH, Kasecamp WR, Drew HM, Shakir R, Wagner HN. A study of age-dependent changes in thyroid function tests in adults. J Nucl Med 1979; 20:1124-30. [PMID: 536771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Total serum thyroxine (T4), triiodothyronine (T3), T3 resin uptake (T3U), thyrotrophin (TSH), and reverse T3 (rT3) were measured in 209 healthy adults 20--89 yr old. Mean T4 values for men were stable throughout life, but in females under age 60, T4 values were significantly higher than in older women. Values for T3U in males were significantly higher than in females throughout all decades, although females had a significant increase in T3U after age 60. TSH values increased significantly in females over age 60. Throughout all decades, males had stable TSH levels that were slightly higher than the female results before age 60 and lower thereafter. Mean serum T3 declined similarly for both sexes with increasing age, although not to the extent previously reported. Men had significantly higher mean rT3 values over all decades than females, although female rT3 levels decreased after age 50 whereas males maintained stable values. The physiologic reasons for these findings may be due to sex-related changes in binding proteins and alterations in metabolic clearance rates, production, and degradation of these hormones with increasing age.
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