Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Aug 2018




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Dr. Rajendra Kumar Ghritlaharey

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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

Important Notice

Original article / research
Year : 2007 | Month : October | Volume : 1 | Issue : 5 | Page : 396 - 403

Biochemical Changes in Patients with Asthma

AL OBAIDI A H A*, JAWAD A K Y**, AL SAMARAI A G M*, AL JANABI J M***

*Departments of Biochemistry and Medicine Tikrit University College of Medicine, Tikrit **National Central of Diabetes , ***College of Pharmacy, Tikrit University, IRAQ

Correspondence Address :
Dr Amina Hamed Ahmad Al Obaidi Department of Biochemistry,Medical CollegeTikrit University, Email: aminahamed2006@yahoo.com

Abstract

Background: The changes that occur in diseases in chemical constituents and biochemical mechanisms are of vital importance for homeostasis within the human body.
Aim: The study was performed on asthmatic patients and healthy non asthmatic control subjects to determine the changes in serum levels of some biochemicals in asthma.
Setting and design:A cross – sectional study with matched control.
Methods and materials: A total of 178 sera were used for determination of iron, calcium, very low density lipoprotein (VLDL), lactate dehydrogenase (LDH) and creatine kinase (CK) . The effect of Immunotherapy on serum iron, calcium, VLDL, LDH and CK was evaluated in 169 asthmatic patients after one year of hyposensitization. All the above were determined using a commercial kits and procedures were performed according to manufacturer instructions.
Statistical analysis:Student t test was used to determined the significance of differences.
Results: The iron and calcium serum levels were significantly lower in stable asthmatic group as compared to that in exacerbation asthmatic . Also, serum iron and calcium levels during asthma exacerbation were significantly higher than that in control. Very low density lipoprotein serum level in stable asthmatic patients was significantly higher (P<0.02) than that of asthmatic patients with exacerbation, but it was lower than that in control (P<0.05). Iron, calcium , LDH, and CK serum levels were significantly reduced following vaccination. However, serum VLDL was significantly higher following immunotherapy as compared to that before vaccination.
Conclusions: Serum iron, calcium levels were higher during asthma exacerbation than in stable asthma and control, while VLDL serum level was lower. Immunotherapy for one year reduce serum iron, LDH, CK and calcium levels and increased VLDL serum level.

Keywords

Asthma, VLDL, LDH, Iron, Calcium, CK

Introduction
Homeostasis is the name given to the dynamic processes that enable optimum conditions to be maintained for constituent cells, in spite of continual changes taking place both internally and externally.

Whenever an imbalance occurs, regulatory systems become active to restore the optimum conditions. The changes that occur in diseases in chemical constituents and biochemical mechanisms are of vital importance for homeostasis within the human body. These changes may be either underlying cause of the disease or the outcome sequences. Thus body fluids analysis for determination of the above changes was an important approach that aid clinicians for diagnosis, treatment, monitoring of the disease and elucidation of disease pathogenesis.

Generally, Iron metabolism is of crucial importance in the biology and pathophysiology of the lower respiratory tract. As with many other factors involved in inflammation, it is very important that an appropriate iron balance is maintained. Local deficiency could impair growth and proliferation of cells responsible for the inflammatory response and tissue repair and the synthesis of mediators(1). In contrast, excessive accumulation of iron, especially in free form that is, not bound to one of the specific iron-binding proteins facilitates the generation of potentially toxic hydroxyl radicals (2).

Surfactant synthesis is critically dependent on the availability of fatty acids. One fatty acid source may be circulating triglycerides that are transported in very low density lipoprotein (VLDL), and hydrolyzed to free fatty acids by lipoprotein lipase. Indeed, surfactant phospholipids synthesis is stimulated by VLDL (3).

Interest in the pathogenetic mechanisms of lung injury has focused on the cellular and biochemical mediators considered as potential biological markers of lung injury. Cytoplasmic cellular enzymes, like lactate dehydrogenase (LDH) in the extra cellular space, although of no further metabolic function in this space, are of benefit because they serve as indicators suggestive of disturbances of the cellular integrity induced by pathological conditions. If cell lyses occurs, cytoplasmic enzymes, such as LDH are released into the extra cellular space. Therefore, the extra cellular appearance of LDH is used to detect cell damage or cell death (4).

Since calcium is the major second messenger regulating ASM contraction, investigators (5) hypothesized that abnormalities in calcium homeostasis, manifested by increases in the flux of calcium or alteration in calcium regulatory proteins, may play a critical role in inducing ASM hyper reactivity in asthma. Thus this study was conducted to determine serum levels of different biochemical parameters in asthma and the effect of immunotherapy on their levels.

Material and Methods

Patients:
The study was performed on asthmatic patients and healthy non asthmatic control subjects. A total of 178 sera were used for determination of iron, calcium, VLDL, LDH and CK. The effect of Immunotherapy on serum iron, calcium, VLDL, LDH and CK was evaluated in 169 asthmatic patients after one year of hyposensitization. Their age range was from 17 to 52 years. The subjects included in the study were outpatients from the Asthma and Allergy Centre or Samara General Hospital outpatients Clinic. The diagnosis and classification of asthma was performed by specialist physician and was established according to the National Heart Blood and Lung Institute / World Health Organization (NHLBI/WHO) workshop on the Global Strategy for Asthma (6). Subjects were considered atopic by positive skin tests to at least one common aeroallergen. Patients were excluded if they were smokers, if they had respiratory infection within the month preceding the study, a rheumatological illness, malignancy, diabetic, heart failure, history of venous embolisms, coronary heart disease and liver or kidney diseases.

At enrolment, they all underwent full clinical examination, pulmonary function test, and blood sampling. Sputum samples were collected from patients when indicated. Normal volunteers were also enrolled in the study as a healthy control. None of them had any previous history of lung or allergic disease and were not using any medication. They had a normal lung function test (FEV1 > 80%) and negative skin allergy test. General stool examination was performed for all patients and control to exclude parasitic infections. Acute asthma exacerbation was defined as dyspnea and wheezing with or without increased coughing (6). The sampling performed during the period from May 2004 to December 2005. All samples collected at morning following overnight fasting. The study was approved by the college ethics committee and a written informed consent was taken from subjects.

Determination of Biochemical Parameters:
Serum levels of Determination of iron, calcium, Triglycerides, LDH, and CK were determined using commercial kits, and the procedures performed according manufacturer instructions.

Statistical Analysis:
The values are reported as mean ± SD and 95% confidence interval. For statistical analysis between groups paired t test was used. The levels of each marker were compared between the study groups and control group, using SPSS computer package. P values of < 0.05 were considered significant.

Results

Biochemical Changes in Asthma:
The iron serum level was significantly lower (P<0.0001) in stable asthmatic group (78.21 ± 26.24 µg/dl) as compared to that in exacerbation asthmatic (113.23 ± 45.47 µg/dl). However, no significant difference from that for control group (83.25 ± 29.43 µg/dl) was achieved. Also, serum iron level during asthma exacerbation (113.23 ± 45.47 µg/dl) was significantly higher (P<0.0001) than that in control (Table/Fig 1).
Calcium serum concentration in stable asthmatic patients was significantly lower (8.21 ± 2.28 mg/dl, P<0.0001) than that of asthmatic with exacerbation (10.98 ± 2.53 mg/dl). In addition, serum calcium concentration was significantly higher (P<0.001) in asthmatic during exacerbation (10.98 mg/dl) than that of control (8.23 ± 3.46 mg/dl). However, calcium serum concentration in stable asthmatic was similar to that of control.

Very low density lipoprotein serum level in stable asthmatic (31.89 ± 17.02 mg/dl) not significantly different (P>0.05) from that of control (31 ± 13.9 mg/dl). However, VLDL serum of stable asthmatic patients was significantly higher (P<0.02) than that of asthmatic patients with exacerbation (25.19 ± 12.69 mg/dl). Furthermore, VLDL serum level in asthmatic with exacerbation was significantly lower (P<0.05) than that of control subjects.
Effect of Immunotherapy on Iron, Calcium, VLDL, LDH, and CK Serum Levels in Asthmatic Patients:
Iron serum level was significantly reduced (P<0.001) from 88.44 µg/dl (± 38.56) before vaccination to 66.19 µg/dl (± 3.75) after vaccination. Calcium serum level was significantly reduced (P<0.001) from 9.02 mg/dl (± 2.74) before vaccination to 8.15 mg/dl (± 3.49) after vaccination. However, serum VLDL was significantly higher (P<0.02) following immunotherapy (33.97 ± 19.61 mg/dl) as compared to that before vaccination (29.28 ± 14.49 mg/dl) (Table/Fig 2).

Serum LDH was reduced significantly(P<0.001)from 334.6 IU/l (±120.9) before vaccination to 197.53 IU/l (± 67.82) after immunotherapy. Also creatine kinase reduced significantly (P<0.001) following immunotherapy, so it was reduced from 239.7 IU/l (± 135.8) to 106.3 IU/l (± 96.4) following immunotherapy(Table/Fig 2).

Discussion

Asthma is a chronic inflammatory disease of the airways and ROS/RNS are suggested to contribute to its pathology. Data on several ROS/ NOS profile as well as the presence of iron and iron binding proteins in different lung compartments, also the amount of iron and its distribution in different pulmonary diseases have already been reported (1),(7),(8). However, more studies on the matter are needed in view of the increasing incidence of asthma and because many questions about iron metabolism and its relation with the metabolisms of other related parameters in the lung remained unanswered (9). For example, the relationship between nitric oxide and iron as well as the participation of myeloperoxidase (MPO) in to this association and role of iron in the defense against infectious agents in the lung is not fully understood (9).

Indeed, Catalase which is an antioxidant enzyme contains iron and therefore iron is a critical element in much oxidative reaction (2). Free irons as a transition metal that participate in the generation of free radicals catalyze the transformation of H2O2 to the highly reactive hydroxyl radical via the Fenton and Haber- Weiss reactions (1). Thus high body iron stores increase free radical production and may elevate asthma risk (10).

Our findings, indicated that serum iron in stable asthmatic patients not differ significantly from that of control. However, in patients with exacerbation, the serum level of iron was significantly higher than that in patients with stable asthma and control. This results is in agreement with that found by others (9),(10). Whereas, Vural et al (11) reported that serum iron level in asthmatic not significantly different from control group.

In fact, mediators, including NO released during chronic inflammation were shown to increase heme oxygenase expression in asthmatic patients (9). Heme oxygenase reaction, with its products bilirubin, carbon monoxide and free iron, is interpreted as an antioxidant defense mechanism due to release of bilirubin (10). However, free iron, a catalyst during ROS production, is another product of this reaction and therefore may possess some inflammatory effects (9). The usual source of iron in the lung is serum iron, which is derived from catabolized erythrocytes and absorbed iron (1). Metabolism of Iron is of a crucial importance in the biology and pathophysiology of the lower respiratory tract . As with many other factors involved in inflammation, it is very important that an appropriate iron balance is maintained. Excessive accumulation of iron exerts toxic effects through its ability to catalyze formation of highly reactive hydroxyl radicals (1).

Studies have reported that nitric oxide synthase can bind transition metals, however, only iron increased the rate of the reaction, whereas others, e.g. nickel and cobalt inhibited the reaction or without effect like manganese. On the other hand, NO was reported to cause iron release from erythrocytes (1). Serum iron levels were reported to have only limited importance for diagnosis and prognosis of bronchial asthma and the estimation of this parameter were recommended in special cases only (12).

Reports on serum iron levels in bronchial asthma are scare [9-12]. In one report, no change was detected in serum iron levels in patients with asthma as compared to controls (11). However, significantly increased serum iron levels in asthmatic patients were found in this study, and our finding was consi

Conclusion

In Conclusions, serum iron, calcium levels were higher during asthma exacerbation than in stable asthma and control, while VLDL serum level was lower. Immunotherapy for one year reduced serum iron, LDH, CK and calcium levels and increased the VLDL serum level.

References

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Mateos F, Brock JH, Arellano JL. Iron metabolism in the lower respiratory tract. Thorax 1998;53:594-600.
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Olakanmi O, McGowan SE, Hayek MB, et al. Iron sequestration by macrophages decreases the potential for extracellular hydroxyl radical formation. J Clin Invest 1993;91:889-899.
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Mallampalli RK, Salome RG, Bowen SL, Champell DA. Very low density lipoproteins stimulate surfactant lipid synthesis in vitro. J Clin Invest 1997;99:2020-2029.
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Cobben N. Relationship between enzymatic markers of pulmonary cell damage and cellular profile : A study in bronchoalveolar lavage fluid. Exp Lung Res 1999; 25:99-111.
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Amrani Y, Panettieri Jr RA. Modulation of calcium homeostasis as a mechanism for altering smooth muscle responsiveness in asthma. Curr Opin Allergy Clin Immunol 2002;2:39-45.
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Global Initiative for Asthma. Global strategy for asthma management and prevention. NHLBI/WHO Workshop Report. NIH Publication 02-3659. Bethesda, MD: NHLBI, 2002.
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Wood LG, Gibson PG, Garg ML. Biomarkers of lipid peroxidation, airway inflammation and asthma. Eur Respir J 2003;21:177-186.
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Barnes PJ, Chung KF, Page CP. Inflammatory mediators in asthma: an update. Pharmacol Rev 1998;50:515-96.
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Ekmekci OB, Donma O, Sardogan E, et al. Iron, nitric oxide and myeloperoxidase in asthmatic patients. Biochemistry 2004;69:462-467.
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Kocyigit A, Armutcu F, Gurel A, Ermis B. Alterations in plasma essential trace elements selenium, manganese, zinc, copper and iron concentrations and the possible role of these elements on oxidative status in patients with childhood asthma. Biological Trace Element Research 2003; 96:1-11.
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Vural H, Uzun K, Uz E, Kocyigit A, Cigli A, Akyol O. Concentrations of copper, zinc and various elements in serum of patients with bronchial asthma. J Trace Elements Med Biol 2000;14:88–91.
12.
Wiersbitzky S, Ballke E, Burgardt R, et al. Long term study of various immunologic functions in children with chronic non specific lung diseases. J Biol Chem 1985;164:241-253.
Tables and Figures
[Table / Fig - 1] [Table / Fig - 2]

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