Displaying publications 1 - 20 of 242 in total

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  1. van der Aart-van der Beek AB, Koomen JV, Dekkers CCJ, Barbour SJ, Boulton DW, Gansevoort RT, et al.
    Clin Pharmacokinet, 2021 04;60(4):517-525.
    PMID: 33587286 DOI: 10.1007/s40262-020-00956-1
    BACKGROUND AND OBJECTIVE: Dapagliflozin, a sodium-glucose co-transporter inhibitor, was originally developed as an oral glucose-lowering drug for the treatment of type 2 diabetes mellitus. Emerging data suggest that cardiovascular and kidney benefits extend to patients without diabetes. Limited pharmacological data are, however, available in patients without diabetes. We aimed to characterise the pharmacokinetic profile of dapagliflozin in patients with chronic kidney disease without type 2 diabetes.

    METHODS: Plasma samples were collected in a randomised, placebo-controlled, double-blind, cross-over trial (DIAMOND, NCT03190694, n = 53) that assessed the effects of 10 mg of dapagliflozin in patients with a glomerular filtration rate ≥ 25 mL/min/1.73 m2 and proteinuria > 500 mg/day. Mixed-effects models were used to develop a pharmacokinetic model and to evaluate the association between plasma exposure and response.

    RESULTS: Plasma concentrations (n = 430 observations) from 48 patients (mean age 50.8 years, mean glomerular filtration rate 57.9 mL/min/1.73 m2, median proteinuria 1115 mg/24 h) were best described using a two-compartment model with first-order elimination. Apparent clearance and volume of distribution were 11.7 (95% confidence interval 10.7-12.7) L/h and 44.9 (95% confidence interval 39.0-50.9) L, respectively. Median dapagliflozin plasma exposure was 740.9 ng h/mL (2.5th-97.5th percentiles: 434.0-1615.3). Plasma exposure increased with decreasing kidney function. Every 100-ng h/mL increment in dapagliflozin plasma exposure was associated with a decrease in the urinary albumin:creatinine ratio (β = - 2.8%, p = 0.01), glomerular filtration rate (β = - 0.5 mL/min/1.73 m2, p 

  2. Zhang Y, Liu S, De Meyer M, Liao Z, Zhao Y, Virgilio M, et al.
    J Adv Res, 2023 Nov;53:61-74.
    PMID: 36574947 DOI: 10.1016/j.jare.2022.12.012
    INTRODUCTION: The oriental fruit fly Bactrocera dorsalis is one of the most destructive agricultural pests worldwide, with highly debated species delimitation, origin, and global spread routes.

    OBJECTIVES: Our study intended to (i) resolve the taxonomic uncertainties between B. dorsalis and B. carambolae, (ii) reveal the population structure and global invasion routes of B. dorsalis across Asia, Africa, and Oceania, and (iii) identify genomic regions that are responsible for the thermal adaptation of B. dorsalis.

    METHODS: Based on a high-quality chromosome-level reference genome assembly, we explored the population relationship using a genome-scale single nucleotide polymorphism dataset generated from the resequencing data of 487 B. dorsalis genomes and 25 B. carambolae genomes. Genome-wide association studies and silencing using RNA interference were used to identify and verify the candidate genes associated with extreme thermal stress.

    RESULTS: We showed that B. dorsalis originates from the Southern India region with three independent invasion and spread routes worldwide: (i) from Northern India to Northern Southeast Asia, then to Southern Southeast Asia; (ii) from Northern India to Northern Southeast Asian, then to China and Hawaii; and (iii) from Southern India toward the African mainland, then to Madagascar, which is mainly facilitated by human activities including trade and immigration. Twenty-seven genes were identified by a genome-wide association study to be associated with 11 temperature bioclimatic variables. The Cyp6a9 gene may enhance the thermal adaptation of B. dorsalis and thus boost its invasion, which tended to be upregulated at a hardening temperature of 38 °C. Functional verification using RNA interference silencing against Cyp6a9, led to the specific decrease in Cyp6a9 expression, reducing the survival rate of dsRNA-feeding larvae exposed to extreme thermal stress of 45 °C after heat hardening treatments in B. dorsalis.

    CONCLUSION: This study provides insights into the evolutionary history and genetic basis of temperature adaptation in B. dorsalis.

  3. Zeinali Z, Bulc B, Lal A, van Daalen KR, Campbell-Lendrum D, Ezzine T, et al.
    Lancet Planet Health, 2020 08;4(8):e306-e308.
    PMID: 32800147 DOI: 10.1016/S2542-5196(20)30171-6
  4. Zahoor I, Singh S, Behl T, Sharma N, Naved T, Subramaniyan V, et al.
    Environ Sci Pollut Res Int, 2022 Jan;29(3):3302-3322.
    PMID: 34755300 DOI: 10.1007/s11356-021-17346-0
    Diabetes mellitus is a severe condition in which the pancreas produces inadequate insulin or the insulin generated is ineffective for utilisation by the body; as a result, insulin therapy is required for control blood sugar levels in patients having type 1 diabetes and is widely recommended in advanced type 2 diabetes patients with uncontrolled diabetes despite dual oral therapy, while subcutaneous insulin administration using hypodermic injection or pump-mediated infusion is the traditional route of insulin delivery and causes discomfort, needle phobia, reduced adherence, and risk of infection. Therefore, transdermal insulin delivery has been extensively explored as an appealing alternative to subcutaneous approaches for diabetes management which not only is non-invasive and easy, but also avoids first-pass metabolism and prevents gastrointestinal degradation. Microneedles have been commonly investigated in human subjects for transdermal insulin administration because they are minimally invasive and painless. The different types of microneedles developed for the transdermal delivery of anti-diabetic drugs are discussed in this review, including solid, dissolving, hydrogel, coated, and hollow microneedles. Numerous microneedle products have entered the market in recent years. But, before the microneedles can be effectively launched into the market, a significant amount of investigation is required to address the numerous challenges. In conclusion, the use of microneedles in the transdermal system is an area worth investigating because of its significant benefits over the oral route in the delivery of anti-diabetic medications and biosensing of blood sugar levels to assure improved clinical outcomes in diabetes management.
  5. Yi Wen L, Singh S, Mohamad NFB, Toh YF, Khalil AAK
    Ophthalmic Plast Reconstr Surg, 2020 5 20;37(1):e23-e25.
    PMID: 32427737 DOI: 10.1097/IOP.0000000000001713
    Simple bone cyst is a benign osteolytic lesion, found primarily in the mandible, occasionally in the maxilla, and rarely in the zygoma. A 17-year-old male patient with 6-month history of left facial mass presented with worsening proptosis and displacement of left eyeball associated with reduced OS vision. The lesion was painless to start with, but with time, he reported OS pain. There was no history of any trauma. CT scan and MRI of orbit performed revealed cystic bony lesion involving greater wing of sphenoid. He subsequently had excision of the left facial mass with exenteration of OS due to poor visual prognosis, followed by reconstruction with osteomyocutaneous flap from left scapular region. The histopathologic features were consistent with a diagnosis of simple bone cyst of zygomatic arch.
  6. Yeak J, Zahari M, Singh S, Mohamad NF
    Eur J Ophthalmol, 2019 Jul;29(4):NP1-NP4.
    PMID: 30280587 DOI: 10.1177/1120672118803532
    BACKGROUND: Acute ophthalmoparesis without ataxia was designated as 'atypical Miller Fisher syndrome' as it presents with progressive, relatively symmetrical ophthalmoplegia, but without ataxia nor limb weakness, in the presence of anti-GQ1b antibody. Idiopathic intracranial hypertension is characterized by signs of raised intracranial pressure occurring in the absence of cerebral pathology, with normal composition of cerebrospinal fluid and a raised opening pressure of more than 20 cmH2O during lumbar puncture. We aim to report a rare case of acute ophthalmoplegia with co-occurrence of raised intracranial pressure.

    CASE DESCRIPTION: A 28-year-old gentleman with body mass index of 34.3 was referred to us for management of double vision of 2 weeks duration. His symptom started after a brief episode of upper respiratory tract infection. His best corrected visual acuity was 6/6 OU. He had bilateral sixth nerve palsy worse on the left eye and bilateral hypometric saccade. His deep tendon reflexes were found to be hyporeflexic in all four limbs. No sensory or motor power deficit was detected, and his gait was normal. Plantar reflexes were downwards bilaterally and cerebellar examination was normal. Both optic discs developed hyperaemia and swelling. Magnetic resonance imaging of brain was normal and lumbar puncture revealed an opening pressure of 50 cmH2O. Anti-GQ1b IgG and anti-GT1a IgG antibody were tested positive.

    CONCLUSION: Acute ophthalmoparesis without ataxia can present with co-occurrence of raised intracranial pressure. It is important to have a full fundoscopic assessment to look for papilloedema in patients presenting with Miller Fisher syndrome or acute ophthalmoparesis without ataxia.

  7. Yap ML, Chew LJ, Pritpal Singh SS, Sekawi Z, Chee HY, Ong HKO, et al.
    Trop Biomed, 2021 Jun 01;38(2):122-128.
    PMID: 34172700 DOI: 10.47665/tb.38.2.047
    Leptospirosis is an emerging zoonotic disease endemic in tropical regions. Aiming at assessing the potential infection risks via recreational exposure, the molecular prevalence of pathogenic Leptospira in 14 amenity forests in five selected districts of the state of Perak was determined. Water and soil samples along streams and waterfalls were subjected to culture of leptospires and the pathogenic Leptospira spp. was detected by lipL32-based polymerase chain reaction (PCR). Twenty out of 154 samples (13%) that tested positive for leptospires were mostly soils and still water recorded with tolerable temperatures (22.2- 26.5°C) and pHs (5.73-6.70). The localised prevalence was highly varied among eight positive forests (6.7-41.7%), particularly higher in Kampar and Kinta districts which are the more populated urban areas. The importance of public health surveillance should not be underrated given the high prevalence of Leptospira spp. in forests in close proximity to indigenous settlements, even where the places are clean. Overall, this study discovered a wide distribution of pathogenic Leptospira spp. in recreational areas.
  8. Yadav S, Arya DK, Pandey P, Anand S, Gautam AK, Ranjan S, et al.
    Int J Nanomedicine, 2022;17:6843-6859.
    PMID: 36605559 DOI: 10.2147/IJN.S388264
    INTRODUCTION: Foot ulceration is one of the most severe and debilitating complications of diabetes, which leads to the cause of non-traumatic lower-extremity amputation in 15-24% of affected individuals. The healing of diabetic foot (DF) is a significant therapeutic problem due to complications from the multifactorial healing process. Electrospun nanofibrous scaffold loaded with various wound dressing materials has excellent wound healing properties due to its multifunctional action.

    PURPOSE: This work aimed to develop and characterize chitosan (CS)-polyvinyl alcohol (PVA) blended electrospun multifunctional nanofiber loaded with curcumin (CUR) and zinc oxide (ZnO) to accelerate diabetic wound healing in STZ-induced diabetic rats.

    RESULTS: In-vitro characterization results revealed that nanofiber was fabricated successfully using the electrospinning technique. SEM results confirmed the smooth surface with web-like fiber nanostructure diameter ranging from 200 - 250 nm. An in-vitro release study confirmed the sustained release of CUR and ZnO for a prolonged time. In-vitro cell-line studies demonstrated significantly low cytotoxicity of nanofiber in HaCaT cells. Anti-bacterial studies demonstrated good anti-bacterial and anti-biofilm activities of nanofiber. In-vivo animal studies demonstrated an excellent wound-healing efficiency of the nanofibers in STZ-induced diabetic rats. Furthermore, the ELISA assay revealed that the optimized nanofiber membrane terminated the inflammatory phases successfully by downregulating the pro-inflammatory cytokines (TNF-α, MMP-2, and MMP-9) in wound healing. In-vitro and in-vivo studies conclude that the developed nanofiber loaded with bioactive material can promote diabetic wound healing efficiently via multifunction action such as the sustained release of bioactive molecules for a prolonged time of duration, proving anti-bacterial/anti-biofilm properties and acceleration of cell migration and proliferation process during the wound healing.

    DISCUSSION: CUR-ZnO electrospun nanofibers could be a promising drug delivery platform with the potential to be scaled up to treat diabetic foot ulcers effectively.

  9. Xavier RG, Roslani AC, Draman Yusof MR, Ng DS, Govindaraju R, Singh S, et al.
    Asian J Surg, 2021 03;44(3):560-561.
    PMID: 33627224 DOI: 10.1016/j.asjsur.2020.11.028
  10. Wen LY, Wah LP, Mohamad NF, Singh S, Toong LY
    J Fam Pract, 2023 Mar;72(2):E1-E7.
    PMID: 36947782 DOI: 10.12788/jfp.0563
    A patient's age, clinical presentation, medical history, and circumstances at time of palsy onset suggest likely underlying causes and help prioritize choice of imaging.
  11. Walewski J, Hellmann A, Siritanaratkul N, Ozsan GH, Ozcan M, Chuncharunee S, et al.
    Br J Haematol, 2018 11;183(3):400-410.
    PMID: 30168134 DOI: 10.1111/bjh.15539
    Some patients with relapsed/refractory Hodgkin lymphoma (HL) are not considered suitable for stem cell transplant (SCT) and have a poor prognosis. This phase IV study (NCT01990534) evaluated brentuximab vedotin (1·8 mg/kg intravenously once every 3 weeks) in 60 patients (aged ≥18 years) with CD30-positive relapsed/refractory HL, a history of ≥1 prior systemic chemotherapy regimen, who were considered unsuitable for SCT/multi-agent chemotherapy. Primary endpoint was overall response rate (ORR) per independent review facility (IRF). Secondary endpoints included duration of response (DOR), progression-free survival (PFS) per IRF, overall survival (OS), proportion proceeding to SCT and safety. The ORR was 50%, with 12% CR; 47% proceeded to SCT. Median DOR was 4·6 months and median duration of CR was 6·1 months. After a median follow-up of 6·9 and 16·6 months, median PFS and OS were 4·8 months (95% confidence interval, 3·0-5·3) and not reached, respectively; estimated OS rate was 86% at 12 months. Most common adverse events (≥10%) were peripheral neuropathy (35%), pyrexia (18%), diarrhoea and neutropenia (each 10%). Brentuximab vedotin showed notable activity with a safety profile consistent with known toxicities, and may act as a bridge to SCT, enabling high-risk patients who achieve suboptimal response to frontline/salvage chemotherapy/radiotherapy to receive potentially curative SCT.
  12. Wai BH, Singh S, Varma SL
    Addiction, 1996 Mar;91(3):435-8.
    PMID: 8867206
    One hundred and seventy-one drug-dependent females in a drug rehabilitation centre were studied to estimate the prevalence of HIV infection among them. Twenty-four (14%) were positive on the Western Blot test. The presence of HIV infection was significantly correlated with syphilis (p < 0.03) and age (p < 0.001); 83% of those who were HIV positive were intravenous drug users. The need for harm reduction programmes to prevent spread of HIV infection among injecting drug users is stressed.
  13. Vihal S, Pundir S, Rathore C, Ranjan Lal U, Gupta G, Kumar Singh S, et al.
    Curr Drug Deliv, 2025;22(1):80-91.
    PMID: 38956909 DOI: 10.2174/0115672018246645231019131748
    BACKGROUND: The therapeutic effect of NS oil in mild to moderate psoriasis is limited owing to low play load of thymoquinone (<15 %w/w), irritation, dripping, low viscosity and thus, less contact time on the lesions.

    AIMS: This study aimed at developing and characterizing the ethanolic vesicular hydrogel system of Nigella sativa (NS) oil (NS EV hydrogel) for the enhancement of anti-psoriatic activity.

    OBJECTIVE: The objective of this study was to develop NS EV hydrogel and evaluate its anti-psoriatic activity.

    METHODS: The identification and quantification of TQ content in different NS seed extracts and marketed oil were measured by an HPTLC method using n-hexane and ethyl acetate as solvent systems. Preparation of ethanolic vesicles (EVs) was performed by solvent injection method, while its antipsoriatic activity was evaluated employing an Imiquad (IMQ)-induced plaque psoriasis animal model.

    RESULTS: A compact HPTLC band was obtained for TQ at an Rf value of 0.651. The calibration plot was linear in the range of 1-10 μg/spot, and the correlation coefficient of 0.990 was indicative of good linear dependence of peak area on concentration. From the different NS sources, the high TQ content was obtained in the marketed cold press oil, i.e., 1.45±0.08 mg/ml. Out of various NS oilloaded EVs, the F6 formulation revealed the smallest particle size (278.1 nm), with log-normal size distribution (0.459) and adequate entrapment efficiency. A non-uniform shape was observed in the transmission electron microscopy. The viscosity of F6 formulation hydrogel was 32.34 (Pa·s), which exhibited plastic behavior. In vivo, efficacy studies demonstrated decreased inflammation of the epidermis and dermis and a marked decrease in the levels of IL-17 by NS EV hydrogel compared to plain NS oil and standard drugs (Betamethasone and Dr. JRK Psorolin Oil).

    CONCLUSION: It may be concluded from the findings that NS-loaded EV gel was as good as betamethasone cream but more efficacious than the other treatments.

  14. Varma SL, Chary TV, Singh S, Azhar MZ, Dharap AS
    Acta Psychiatr Scand, 1995 Mar;91(3):213-5.
    PMID: 7625199
    Schizophrenics (n = 250) and normal controls (n = 90) were studied to investigate and compare their dermatoglyphic patterns. Their fingerprint patterns were studied. The frequency of arches in the patient and control groups was similar. The frequency of loops in the control group was higher than in the patient group, and the trend was consistent in all the digits. The whorls in the patient group showed an increase over the control group in all the digits, although this finding was not statistically significant.
  15. Varma SL, Zain AM, Singh S
    Am. J. Med. Genet., 1997 Feb 21;74(1):7-11.
    PMID: 9033998
    There is increasing evidence that genetic factors play a role in the etiology of schizophrenic disorders. One thousand eighty-nine first-degree relatives of schizophrenics and 1,137 controls were studied to discover their psychiatric morbidity. Psychiatric morbidity was found in 16.34% of the first-degree relatives (FDR) of schizophrenics (parents, 5.69%; siblings, 7.71%; offspring, 2.94%) as compared to 6.9% in the controls (P < 0.001). Schizophrenia was found in 8.3% of the patient group, which was significantly higher (0.2%) as compared to the controls. Schizoid-schizotypal personality disorder was found in 3.03% of FDRs of the schizophrenic group. Depressive disorder was found in 4.4% and 2.1% in the control and patient group, respectively, which was statistically significant. Morbidity risk of schizophrenia was found in 16.97%, 6.22% and 5.79% of schizophrenia, schizoid-schizotypal personality disorder and depressive disorder, respectively, in the FDR of schizophrenic group.
  16. Varma S, Wai B, Singh S, Subramaniam M
    Eur. Psychiatry, 1998 Dec;13(8):431-3.
    PMID: 19698662 DOI: 10.1016/S0924-9338(99)80693-2
    Female drug dependants (n = 171) and controls (n = 1137) were studied to search for psychiatric morbidity in them. The psychiatric morbidity was found to be 36.3% and 6.9%, respectively. The most common psychiatric disorder found was dysthymic disorder followed by adjustment disorder, anxiety disorder and borderline personality disorder. The diagnosis was significantly dependent on the type of drug used (P < 0.001) and HIV seropositivtty status of the patients (P = 0.04). The findings highlight the relationship of the psychiatric morbidity to the HIV status and female drug users.
  17. Utama GL, Dio C, Sulistiyo J, Yee Chye F, Lembong E, Cahyana Y, et al.
    Saudi J Biol Sci, 2021 Dec;28(12):6765-6773.
    PMID: 34866975 DOI: 10.1016/j.sjbs.2021.07.051
    β-glucan is a natural polysaccharide derivative composed of a group of glucose monomers with β-glycoside bonds that can be synthesized intra- or extra-cellular by various microorganisms such as yeasts, bacteria, and moulds. The study aimed to discover the potential of various microorganisms such as Saccharomyces cerevisiae, Aspergillus oryzae, Xanthomonas campestris, and Bacillus natto in producing β-glucan. The experimental method used and the data were analyzed descriptively. The four microorganisms above were cultured under a submerged state in Yeast glucose (YG) broth for 120 h at 30 °C with 200 rpm agitation. During the growth, several parameters were examined including total population by optical density, the pH, and glucose contents of growth media. β-glucan was extracted using acid-alkaline methods from the growth media then the weight was measured. The results showed that S. cerevisiae, A. oryzae X. campestris, and B. natto were prospective for β-glucans production in submerged fermentation up to 120 h. The highest β-glucans yield was shown by B. natto (20.38%) with the β-glucans mass of 1.345 ± 0.08 mg and globular diameter of 600 μm. The highest β-glucan mass was achieved by A. oryzae of 82.5 ± 0.03 mg with the total population in optical density of 0.1246, a final glucose level of 769 ppm, the pH of 6.67, and yield of 13.97% with a globular diameter of 1400 μm.
  18. Tzeng CR, Huang Z, Asada Y, Zhang C, Ho MT, Li RHW, et al.
    Hum Reprod, 2023 Jul 05;38(7):1368-1378.
    PMID: 37105234 DOI: 10.1093/humrep/dead081
    STUDY QUESTION: How do age, ethnicity, and other characteristics affect serum anti-mullerian hormone (AMH) levels in Asian women undergoing fertility treatment?

    SUMMARY ANSWER: Age, ethnicity, obesity (BMI ≥ 30 kg/m2), and polycystic ovarian syndrome (PCOS) significantly impacted serum AMH levels, with the rate of decrease accelerating as age increased; a concentration of 4.0 ng/ml was the optimal cut-off for diagnosis of PCOS.

    WHAT IS KNOWN ALREADY: There are significant differences in ovarian reserve among women from different races and ethnicities, and Asian women often have poorer reproductive outcomes during assisted reproductive treatment cycles.

    STUDY DESIGN, SIZE, DURATION: A population-based multi-nation, multi-centre, multi-ethnicity prospective cohort study of 4613 women was conducted from January 2020 to May 2021. Infertile women of 20-43 years of age were enrolled. The exclusion criteria included: age <20 or >43, non-Asian ethnicity, and missing critical data.

    PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants were Asian women of Chinese, Japanese, Korean, Thai, Vietnamese, Malay, Indian, and Indonesian ethnicities from 12 IVF centres across Asia. These women were all naïve to ovarian stimulation cycles and attended IVF centres for fertility assessment. The AMH measurement was performed using an AMH automated assay on a clinically validated platform.

    MAIN RESULTS AND THE ROLE OF CHANCE: A total of 4556 infertile Asian women were included in the final analyses. The mean ± SD for serum AMH concentrations (ng/ml) across specific age groups were: overall, 3.44 ± 2.93; age <30, 4.58 ± 3.16; 30-31, 4.23 ± 3.23; 32-33, 3.90 ± 3.06; 34-35, 3.21 ± 2.65; 36-37, 2.74 ± 2.44; 38-39, 2.30 ± 1.91; 40 and above, 1.67 ± 2.00. The rate of AMH decrease was ∼0.13 ng/ml/year in patients aged 25-33 and 0.31 ng/ml/year in women aged 33-43. The highest rates of PCOS were found in Indians (18.6%), Malays (18.9%), and Vietnamese (17.7%). Age (P S): This study was technically supported by Ferring Pharmaceuticals and received no specific grant from any funding agency. All authors have no competing interests to disclose.

    TRIAL REGISTRATION NUMBER: NCT04203355.

  19. Tran NT, Hyder AA, Kulanthayan S, Singh S, Umar RS
    Health Policy, 2009 Apr;90(1):58-65.
    PMID: 18937995 DOI: 10.1016/j.healthpol.2008.08.009
    Road traffic injuries (RTIs) are a growing public health problem that must be addressed through evidence-based interventions including policy-level changes such as the enactment of legislation to mandate specific behaviors and practices. Policy makers need to be engaged in road safety research to ensure that road safety policies are grounded in scientific evidence. This paper examines the strategies used to engage policy makers and other stakeholder groups and discusses the challenges that result from a multi-disciplinary, inter-sectoral collaboration. A framework for engaging policy makers in research was developed and applied to describe an example of collective road safety research in Malaysia. Key components of this framework include readiness, assessment, planning, implementation/evaluation, and policy development/sustainability. The case study of a collaborative intervention trial for the prevention of motorcycle crashes and deaths in Malaysia serves as a model for policy engagement by road safety and injury researchers. The analytic description of this research process in Malaysia demonstrates that the framework, through its five stages, can be used as a tool to guide the integration of needed research evidence into policy for road safety and injury prevention.
  20. Thota RS, Ramkiran S, Singh S, Damani A, Wajekar AS, Koyyalagunta L
    Indian J Anaesth, 2023 Dec;67(12):1051-1060.
    PMID: 38343679 DOI: 10.4103/ija.ija_325_23
    BACKGROUND AND AIMS: Cancer pain guidelines remain confined due to implementation barriers, preventing them from attaining a global perspective. The guidelines must be robust in development and inculcate high-quality content to achieve practical utility. Quality indicators related to safe opioid practice empower effective guideline implementation.

    METHODS: The protocol was registered prospectively in PROSPERO (CRD42021244823). Guidelines published over the last decade providing insights into cancer pain management and incorporating safe opioid practice were evaluated. The review's primary outcome was to evaluate the quality of cancer pain guidelines. Appraisal of guidelines for research and evaluation II (AGREE II) instrument was used to assess a guideline's quality. The ADAPTE collaboration-guideline adaptation resource tool kit (ADAPTE) provided insights into its adaptation based on specific questions within the guideline.

    RESULTS: Fourteen cancer pain guidelines met the eligibility criteria and were included for quality evaluation. Eight guidelines were evaluated with combined AGREE II and ADAPTE process, attaining >66.7% in the rigour of development domain score, summated scaled domain score, and specific ADAPTE tools to evaluate the quality of each guideline. The intra-class correlation coefficient was utilised for resolving inter-rater agreement. 'Safe opioid practice' within a guideline was assessed for quality content implementation.

    CONCLUSION: Combined AGREE II and ADAPTE identified four cancer pain guidelines, namely Ministry of Health Malaysia, National Comprehensive Cancer Network, NCEC-National Clinical Guideline, and World Health Organization, which were of the highest quality and incorporated safe opioid practice effectively.

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