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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Serum Magnesium Levels and Lipid Profile in Patients with Epileptic Seizures: A Cross-sectional Study
Correspondence Address :
Dr. Astha Goyal,
Tutor, Department of Biochemistry, Dr. D. Y. Patil Medical College, Pimpri, Pune-411018, Maharashtra, India.
E-mail: asthagoyal2102@gmail.com
Introduction: Recurrent seizures of cerebral origin with episodes of sensory, motor, or autonomic expression, with or without loss of consciousness, are typical symptoms of epilepsy, a chronic neurological condition. As a voltage-dependent calcium channel antagonist, magnesium inhibits calcium ion release, which reduces neuronal excitability in hypomagnesemia. It is well recognised that the most frequently prescribed Anti-epileptic Drugs (AEDs), namely carbamazepine, phenytoin, and phenobarbital, have adverse effects on lipid profiles.
Aim: To compare the levels of serum magnesium and serum lipid profiles in patients with epileptic seizures and healthy controls.
Materials and Methods: The present cross-sectional study included 50 clinically diagnosed patients with epileptic seizures, aged between 18-60 years, and 50 age and sex-matched healthy controls visiting the Department of Neurology, Mahatma Gandhi Medical College (MGMC), Jaipur, Rajasthan, India from October 2019 to March 2020. A 5 mL venous blood sample was collected for biochemical investigations such as serum magnesium, serum Total Cholesterol (TC), serum Triglycerides (TG), serum High Density Lipoprotein cholesterol (HDL-C), serum Low Density Lipoprotein cholesterol (LDL-C), and serum Very Low Density Lipoprotein cholesterol (VLDL-C) and assayed. Student’s t-test was applied, and a p-value of <0.05 was considered statistically significant.
Results: In the present study, epileptic cases (n=50) included 35 male patients and 15 female patients with a mean age of 36.1±15.56 years, and healthy controls (n=50) included 37 male patients and 13 female patients with a mean age of 38.26±8.54 years. When compared to healthy controls, patients with epileptic seizures had lower serum magnesium levels with mean values of 4.18±1.22 and 2.12±1.00, respectively (p-value ≤0.001). Patients with epileptic seizures had higher values of the serum lipid profile, i.e., serum TG, TC, low-density lipoprotein cholesterol, and very low-density lipoprotein cholesterol than healthy controls with a p-value ≤0.001, which is statistically significant. On the contrary, serum HDL-C levels in epileptic patients (43.68±7.37 mg/dL) are lower than healthy controls (49.69±5.73 mg/dL).
Conclusion: Correcting the serum magnesium levels in people with epileptic seizures may help reduce the intensity of the seizures.
Cholesterol, Epilepsy, Excitotoxicity, Glutamate, Hypomagnesemia
A chronic neurological disorder called epilepsy is characterised by recurrent seizures, varying in frequency from once a year to multiple times daily (1). Patients who take AEDs like carbamazepine and phenytoin over an extended period have shown disorders such as Myocardial Infarction (MI), stroke, and atherosclerosis (2). Magnesium, a significant macro-mineral, acts as a co-factor in numerous enzyme activities (3). It is crucial for optimal nerve transmission, neuromuscular coordination, and protection against excitotoxicity (4). As magnesium can act as a chemical gatekeeper, its deficiency increases calcium entry into nerve cells, leading to overstimulation, convulsions, and spasms (5). Long-term antiepileptic therapy is associated with various metabolic abnormalities in tissue and organ systems, including the liver (6). The health of the liver and the activity of the hepatic microsomal enzyme system may be affected by anticonvulsants (6).
Anti-epileptic Drugs (AEDs) induce hyperlipidemia by stimulating the p450 enzyme system in the liver (7). In patients with epilepsy, the risk of cardiovascular death is 1.5-2.5 times higher than in the general population (8). Therefore, evaluating changes in serum lipid levels following antiepileptic drugs may assist in selecting the safest drug and preventing cardiovascular complications later in life. Similar research was conducted by Yuen AW and Sander JW, suggesting that magnesium may play a role in epilepsy, and thus recognising and correlating hypomagnesemia may aid in seizures control and clinical outcomes (9).
Based on the literature review and authors limited knowledge, most studies like those by Aggarwal J et al., and Divya P et al., have focused on young children taking AEDs. The lack of sufficient data from the adult population of epilepsy treated with multiple AEDs for atleast six months prompted us to assess and compare lipid parameter levels, as well as serum magnesium concentrations, among epileptic patients and healthy controls (10),(11).
Therefore, the current study was designed to evaluate the impact of serum magnesium levels and lipid profiles (TG, TC, HDL-C, LDL-C, and VLDL-C) in present epileptic patients and to compare these parameters with those of healthy controls.
The cross-sectional study was conducted in the Department of Biochemistry in association with the Department of Neurology at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India over a six-month period from October 2019 to March 2020. The study was carried out after obtaining approval from the Institutional Ethics Committee (IEC) (vide letter number MGMCH/JPR/06.26/09/2019). Written informed consent was obtained from all participants after explaining the research purpose.
Inclusion criteria: Patients diagnosed with epileptic seizures (as per guidelines by the International League Against Epilepsy (ILAE) (12)) and regularly taking AEDs for the last six months or more within the age group of 18-60 years were included. The control group consisted of 50 age- and sex-matched healthy subjects. An equivalent number of adults who attended the general Outpatient Department of Ophthalmology and were otherwise health were included as controls.
Exclusion criteria: Patients with thyroid dysfunction, cardiovascular disease, chronic liver disease, cancer, pregnant or lactating women, and individuals aged ≤18 years were excluded from the study.
Sample size calculation: The sample size was calculated by Cochran’s formula:
n=z2(pq)/e2
Where, n=sample size
z=confidence level at 95% (1.96)
p=prevalence (1%) (13)
q=(100-p)
e=maximum allowance of error (5%)
So, putting the values into the formula:
n=(1.96) 2 *1*99/(5)2
=3.84*1*99/25
=380.16/25
Therefore, the final calculated sample size in the present study was 15.20.
Study Procedure
Total 5 mL venous blood samples were collected using standard aseptic protocols. The collected samples were analysed on the fully auto-analyser VITROS 5600 and were subjected to investigations for serum magnesium, Total Cholesterol (TC), HDL Cholesterol (HDL-C), LDL Cholesterol (LDL-C), VLDL Cholesterol (VLDL-C), and Triglycerides (TG). Serum magnesium was assessed using the Formazan dye method, TC was assessed using the cholesterol oxidase peroxidase enzyme method, HDL-C was assessed using the direct method, and serum TG was assessed using the glycerol peroxidase method, endpoint as shown in (Table/Fig 1) (14),(15),(16),(17),(18).
Statsitical Analysis
The Statistical Package for the Social Sciences (SPSS) Version 21.0 was used to analyse the data. Means and standard deviations were used to summarise continuous variables. The patients’ outcomes were compared to those of the control group using Student’s Independent t-test. A probability of less than 5% was considered statistically significant for all parameters (p=value ≤0.05).
In the present study, the epileptic cases (n=50) included 35 male patients and 15 female patients with a mean age of 36.1±15.56 years, while the healthy controls (n=50) included 37 male patients and 13 female patients with a mean age of 38.26±8.54 years. Upon applying a Student’s t-test between the two groups, the obtained t-value for age was 0.860, which was found to be statistically non significant with a p-value of 0.391.
Equal distribution in gender was ensured to maintain compatibility between both groups, and its p-value was 0.259, also found to be statistically non significant (Table/Fig 2).
Serum magnesium levels and serum HDL cholesterol levels were significantly lower among the epileptic group compared to healthy controls (p-value ≤0.001) (Table/Fig 2). The mean serum total cholesterol levels and mean serum triglyceride levels of epileptic seizures patients showed a statistically significant increase compared to healthy controls (p-value ≤0.001), while LDL cholesterol and VLDL cholesterol levels were significantly increased in epileptic cases.
It was observed that most adults were using phenytoin monotherapy (19), followed by phenobarbitone (18) and carbamazepine (13). Both male and female distributions in the various groups of AEDs were compared in the study. The duration of epileptic seizures was 24.7±12.5 years in males compared to females with 19.5±14.1 years. The treatment of epilepsy lasted for 16.7±7.42 years in males, while the duration of medication in females lasted for 17.8±8.89 years (Table/Fig 3).
Mean serum magnesium levels in male and female epileptic patients taking AEDs has been depicted in (Table/Fig 4). In males, serum magnesium levels were elevated in carbamazepine (mean 2.13±0.08 mg/dL), followed by those on phenobarbitone and phenytoin. In female epileptic patients, serum magnesium levels were elevated in phenobarbitone (mean 3.05±1.88 mg/dL), followed by phenytoin, with the least levels found in those on carbamazepine (1.97±0.69 mg/dL).
Patients with epilepsy have to undergo chronic treatment with AEDs. It is important not only that their seizures be under control, but also that adverse effects due to long-term AED use should be minimal. According to the current study, the epileptic cases (n=50) included 35 male patients and 15 female patients with a mean age of 36.1±15.56 years, while the healthy controls (n=50) included 37 male patients and 13 female patients with a mean age of 38.26±8.54 years were enrolled.
The present study shows low serum magnesium levels in epileptic patients compared to healthy subjects. This observation was similar to the study conducted by Osborn KE et al., who reported that serum magnesium levels are lower in epileptic seizures patients compared to healthy controls (19). A similar study conducted by Krishna CR et al., included 50 cases, and 40 (80%) showed significantly lower magnesium levels, i.e., 0.964±0.58 mg/dL (20). Theoretically, low magnesium levels could enhance glutamatergic neurotransmission, encourage excitotoxicity, and eventually cause oxidative stress (21). Since, excessive glutamatergic neurotransmission has been firmly linked to seizures activity, magnesium could potentially reduce the excitotoxicity associated with epilepsy (22).
The serum lipid profile was also evaluated and compared. In contrast to normal controls, epileptic patients receiving AEDs showed elevated levels of blood Triglycerides (TG), Total Cholesterol (TC), LDL cholesterol, and VLDL cholesterol. A similar finding by Steinberg D showed that the increase in the level of lipid profile was significantly higher in epileptic patients (23). He explained that excess levels of serum lipids begin to seep into the inner wall of the artery. This triggers an inflammatory response, which speeds up the accumulation of cholesterol in the artery wall. This, in turn, produces more inflammation. Eventually, the deposited cholesterol hardens into a plaque that can rupture and lead to the blood clots that cause heart attacks and strokes.
Elevated levels of lipid profile concentration, except HDL, during treatment might be associated with an increased risk of vascular disease in patients with epilepsy. A study by Nikolaos T et al., shows similar results, suggesting that long-term use of AEDs raises cholesterol levels (24). This observation was similar to the study conducted by Manimekalai K et al., who observed statistically significant high mean TC, HDL-C, LDL-C, and TG levels in young adults receiving AEDs compared with the control group (25).
The total duration of epileptic seizures in patients is quite long, while the patients seeking medication started a little later in their life, or there was a delay in treatment. The decision to start AED therapy should be based on an informed analysis of the likelihood of seizures recurrence, the consequences of continuing seizures for patients, and the beneficial and adverse effects of the pharmacological agent chosen (26). The patients’ and family’s views should also be considered when AED treatment is begun (27).
Limitation(s)
The parameters could not be studied before the initiation of the AEDs, and therefore, any confounding factors over time could not be eliminated. Secondly, a brief time period was taken for the study.
The study showed that, in comparison to healthy patients, epileptic seizures patients had low levels of magnesium and high levels of lipid profile. Due to the long-term administration of AEDs, patients’ lipid profiles may become deranged. Therefore, in patients receiving such therapy, physicians should continue to monitor the patient’s serum lipid profile. Regular monitoring of these biomarkers can be helpful in selecting an appropriate treatment protocol and overall controlling the mortality and morbidity rate. Screening for neurobehavioral co-morbidities should be an integral part of management with “active” epilepsy.
Author’s contribution: MA: Conception and design, acquisition of data; SS: Analysis and interpretation of data; AG: Drafting the article or revising it critically for important intellectual content; SAS: The final approval of the version to be published has been given by the author.
DOI: 10.7860/JCDR/2024/69769.19601
Date of Submission: Jan 25, 2024
Date of Peer Review: Mar 01, 2024
Date of Acceptance: May 10, 2024
Date of Publishing: Jul 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
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ETYMOLOGY: Author Origin
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