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

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On Sep 2018

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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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Dr. Arundhathi. S
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Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
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An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
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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.
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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)
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.
On April 2011

Important Notice

Original article / research
Year : 2008 | Month : December | Volume : 2 | Issue : 6 | Page : 1180 - 1185

Erythrocyte Lipid Peroxidation, Glutathione, Ascorbic Acid, Vitamin E, Antioxidant Enzymes And Serum Homocysteine Levels In Patients With Coronary Artery Disease


* Dept. of Biochemistry,Saveetha Dental College & Hospital,** Dept.of Biochemistry,Saveetha Medical College&Hospital,SaveethaUniversity,Chennai–600077,Tamilnadu,(INDIA).

Correspondence Address :
Vishnu Priya V,Asst.Prof.,Dept.of Biochemistry,Saveetha Dental College&Hospital,Saveetha University,162,Poonamallee High Road,Chennai–600077,Tamilnadu,(INDIA).E-mail:


Background: Coronary Artery Disease is the major cause of mortality and morbidity worldwide. It is associated with various risk factors such as age group (41 – 60 years), male gender, smoking habit and hypertension. The exact pro-oxidant and antioxidant status in patients with Coronary Artery Disease is still not clear. To add a new insight to the question, changes in erythrocyte lipid peroxidation products (MDA), glutathione (GSH), ascorbic acid and plasma vitamin E, and activities of antioxidant enzymes like super oxide dismutase (SOD), glutathione peroxidase (GPX), catalase in erythrocytes, plasma glutathione – S – transferase (GST) and serum homocysteine levels were measured in patients with Coronary Artery Disease.
Aim: This work was undertaken to assess oxidative stress and antioxidant status in patients with Coronary Artery Disease and its contribution to the risk of cardiovascular disease.
Settings and Design: The study was conducted in sixty - five patients and the values were compared to control values. Erythrocyte MDA, GSH, ascorbic acid, plasma vitamin E and activities of antioxidant enzymes SOD, GPX, catalase in erythrocytes, plasma GST and serum homocysteine were estimated in Coronary Artery Disease patients. These parameters were measured in sixty - five patients and the values were compared to control values.
Statistical Analysis: Statistical analysis between group 1 (controls) and group 2 (patients) was performed by the Mann Whitney U test. The data was expressed as mean + SD. P < 0.05 was considered to be significant.
Results: It was observed that there was a significant increase in erythrocyte MDA levels, SOD, GPX and plasma GST activities, and a significant decrease in erythrocyte GSH, ascorbic acid, plasma vitamin E levels and catalase activity in patients with Coronary Artery Disease when compared to controls. Serum homocysteine levels were significantly higher in Coronary Artery Disease patients than in the controls.
Conclusions: The results of our study suggest higher oxygen free radical production which is evidenced by increased MDA and decreased GSH, ascorbic acid, vitamin E and Catalase activity and support to the oxidative stress in coronary artery disease. Increased homocysteine levels and decreased antioxidant capacity may contribute to the increased risk of cardiovascular disease in patients with coronary artery disease, in addition to known risk factors such as insulin resistance, hypertension, central obesity, and dyslipidaemia. The increased activities of antioxidant enzymes may be a compensatory regulation in response to increased oxidative stress.


Malondialdehyde,homocysteine, oxidative stress, antioxidants, cardiovascular risk,coronary artery disease

Coronary Artery Disease is the major cause of mortality and morbidity worldwide (1). It is associated with various risk factors such as age group (41 – 60 years), male gender, smoking habit and hypertension. Lipid peroxidation which is mediated by free radicals, is considered to be the major mechanism of cell membrane destruction and cell damage. Free radicals are formed in both physiological and pathological conditions in mammalian tissues (2). The uncontrolled production of free radicals is considered as an important factor in the tissue damage induced by several pathophysiologies (3). The effects of lipid peroxides i.e. endothelial cell damage, uncontrolled lipid uptake, decreased prostaglandin synthesis and associated thrombogenecity, are strongly implicated in the pathogenesis of atherosclerosis. Alteration in the oxidant - antioxidant profile is known to occur in Coronary Artery Disease (4). Oxidative stress due to damage, brought about by free radicals, is also known to influence the response of these patients to therapy. Moreover, the body’s defense mechanisms would play a role in the form of antioxidants and try to minimize the damage, adapting themselves to the above stressful situation. Antioxidants are compounds that dispose, scavenge, and suppress the formation of free radicals or oppose their actions (5), and two main categories of antioxidants are those whose role is to prevent the generation of free radicals and those that intercept any free radicals that are generated (6). They exist in both the aqueous and membrane compartment of cells, and can be enzymes or non-enzymes. The traditional risk factors of coronary artery disease include age, sex, dyslipidaemia, blood pressure and smoking. A continued focus on newer risk factors is warranted, as they may further improve our ability to predict future risk and determine treatment when they are included with classic risk factors (7). The study of these risk factors is important, since the ability to accurately predict the risk of coronary artery disease of a specific individual based on his or her conventional risk factor profile, is limited (8). One of these newer risk factors is homocysteine. Elevated serum homocysteine may be an important cause for atherosclerosis formation (9). So, the present study was undertaken to assess oxidative stress and antioxidant status in patients with Coronary Artery Disease, and their contribution to the risk of cardiovascular disease.

In the present study, the following parameters were assessed in the erythrocytes and plasma to elucidate the oxidant-antioxidant status in patients with Coronary artery disease. Erythrocyte malondialdehyde (MDA) levels were measured as thiobarbituric acid reacting substances (TBARS), which serve as an index of extent of lipid peroxidation. Erythrocyte glutathione (GSH), ascorbic acid and plasma vitamin E serve as non enzymatic antioxidant parameters. The activities of antioxidant enzymes, superoxide dismutase (SOD), catalase, glutathione peroxidase (GPX) in erythrocytes, glutathione-S -transferase (GST) in plasma and serum homocysteine levels were estimated. GST is an enzyme involved in antioxidant defense, and is also involved in detoxication. The present work is an attempt to determine alteration in oxidant – antioxidant status and its contribution to the risk of cardiovascular disease in Coronary Artery Disease patients.

Material and Methods

Sixty - Five clinically diagnosed patients of acute myocardial infarction, admitted to the Intensive Cardiac Care Unit (ICCU), were chosen for the study. The patients were randomly selected, and had come for cardiac evaluation during September 2006 and December 2007. An equal number of age and sex matched healthy subjects with a similar socio economic status was also investigated. The females of the study group were matched with females of the control group.

Diagnostic Criteria Of Patients
The diagnosis of Acute MI was based on the WHO criteria, which required the presence of at least 2 of the following three elements: i) Ischaemic type of chest pain ii) changes on serial ECG tracings iii) Increase in serum cardiac marker (CKMB) (10).

Exclusion Criteria
The patients with associated renal failure, liver disease, lung disease, pregnancy, thyroid disease, gastro-intestinal disease and those taking methotrexate, carbamazepine or phenytoin, that could alter the required parameters, were excluded from the study. No patient had sustained myocardial infarction within 6 months before taking part in the study. Written consents were also taken from the patients prior to the study, and the objectives of the study were fully explained.
There were two study groups. The controls and patients were divided into two groups.
Group 1: Sixty - Five healthy age and sex matched controls.
Group 2: Sixty - Five patients with clinically diagnosed coronary artery disease.
Blood samples drawn from all the subjects within an hour of admission were processed for the cardiac enzymes (CK, CK-MB, LDH). The heparinised venous blood samples obtained under asceptic conditions from these subjects in the fasting state (after overnight fasting), were used for the analysis of homocysteine. Plasma was separated by centrifugation at 1,000 g for 15 minutes. Separated plasma was used for the estimation of vitamin E, and for the measurement of the activity of GST. All the cases were subjected to routine investigations like haematocrit, urine analysis and blood chemistry (electrolytes, lipids, blood glucose, urea and creatinine). Elevated serum cholesterol and triglycerides along with low HDL levels, is observed in these patients. The buffy coat was removed, and the packed cells were washed three times with physiological saline. The erythrocyte suspension was prepared by the method of Dodge et al. (11), modified by Quist (12). The packed cells were used for the analysis of GSH, ascorbic acid, MDA, SOD, Catalase and GPX. Erythrocyte GSH was estimated by the method of Beutler et al (13), using Di Thio Bis Nitro Benzoic acid (DTNB). Ascorbic acid levels were estimated by the method of Tietz (14). Plasma vitamin E levels were estimated by the method of Baker H et al (15). MDA was determined as the measure of TBARS (16). SOD (EC activity was determined in the haemolysate by the method of Misra and Fridovich, based on the inhibition of auto oxidation of epinephrine to adenochrome at Ph 10.2 (17). Catalase (EC activity was measured by the method of Beers and Sizer (18). The activity of Glutathione Peroxidase (GPX, EC was measured as described by Paglia and Valentine (19) in erythrocytes, and activity of GST (EC was measured by using 1-Chloro-2, 4-Dinitro Benzene (CDNB) (20). Homocysteine was measured using a solid phase immunoassay system, which measures total homocysteine in plasma or serum using a BioRad kit (21).

All reagents used, were of analytical reagent grade. DTNB, CDNB and Thio Barbituric Acid were obtained from Sigma Chemicals, St.Louis; MO.

Statistical Analysis
The statistical analysis between group 1 (controls) and group 2 (patients) was performed by the Mann Whitney U test. The data was expressed as mean + SD. P < 0.05 was considered as significant.


The basic characteristics of the coronary artery disease patients and controls are given in (Table/Fig 1).

The mean +/- SD of erythrocyte GSH, ascorbic acid, MDA, SOD, Catalase, GPx , plasma vitamin E, plasma GST and serum homocysteine in patients with coronary artery disease and controls are indicated in (Table/Fig 2).

There was a statistically significant increase in the erythrocyte MDA and serum homocysteine levels in patients with Coronary Artery Disease, as compared to controls. The activities of erythrocyte antioxidant enzymes, SOD, GPX and plasma GST were significantly increased in group 2 (study subjects) as compared to group1 (controls). The levels of erythrocyte GSH, ascorbic acid, plasma vitamin E and catalase activity were significantly decreased in patients with Coronary Artery Disease as compared to controls.


In the present study, the lipid peroxidation product i.e. MDA levels have been increased significantly in erythrocytes of the patients with Coronary Artery Disease as compared to controls. MDA is a decomposition product of autooxidation of poly unsaturated fatty acids, which is used as an index of oxidative damage (22). The rise in MDA concentration indicates increased membrane lipid peroxidation, characterized by hyperlipidaemia, specifically hypercholesterolaemia, in these patients. Rise in MDA could be due to increased generation of reactive oxygen species (ROS), due to the excessive oxidative damage generated in these patients. These oxygen species in turn, can oxidize many other important biomolecules including membrane lipids. Similar reports of elevated MDA levels have been reported in patients with coronary artery disease (4).

We observed a significant decrease in the levels of erythrocyte glutathione (GSH), ascorbic acid and plasma vitamin E (non enzymatic antioxidant defense system) in patients with coronary artery disease, when compared to controls. The decrease in the levels of these non enzymatic antioxidant parameters may be due to the increased turnover, for preventing oxidative damage in these patients, suggesting an increased defense against oxidant damage in coronary artery disease. Some other groups have also reported decreased GSH, Ascorbic acid and Vitamin E levels in patients with Coronary Artery Disease (23).

In our study, the activities of erythrocyte antioxidant enzymes i.e. SOD and GP, have been increased significantly in patients with coronary artery disease, as compared to controls. SOD is an important antioxidant enzyme having an antitoxic effect against super oxide anion. The overexpression of SOD might be an adaptive response, and it results in increased dismutation of superoxide to hydrogen peroxide. There is an enhanced production of super oxide anions by ischaemic cells. In contrast to our study, decreased concentrations of SOD in the haemolysate of these patients, was reported (4). GPX, an oxidative stress inducible enzyme, plays a significant role in the peroxyl scavenging mechanism, and in maintaining functional integration of the cell membranes. The rise in the activity of GPX could be due to its induction to counter the effect of increased oxidative stress.

The Glutathione – S – Transferase is a group of multifunctional proteins, which plays a central role in detoxification of electrophilic chemicals and the hepatic removal of potentially harmful hydrophobic compounds from blood (24). We have observed a significant increase in the GST activity in patients with Coronary Artery Disease, as compared to controls. The rise in the activity of GST could be due to its induction to counter the effect against increased oxidative stress.

In the present study, we have observed a significant decrease in the activity of catalase in patients with coronary artery disease, as compared to controls. Catalase is the enzyme which protects the cells from the accumulation of hydrogen peroxide by dismutating it to form water and oxygen, or by using it as an oxidant in which it works as a peroxidase.

Homocysteine has been recognized recently as a risk factor for vascular diseases. In our study, Serum Homocysteine levels were significantly increased in patients with CAD, as compared to controls. Increased serum homocysteine levels also lead to the formation of atherosclerotic plaques, which ultimately lead to myocardial infarction. The sulfhydryl groups in homocysteine were oxidized to disulfide, catalyzed by the transition metals by which several reactive oxygen species and hydroperoxides were produced, and initiates lipid peroxidation which is responsible for endothelial injury (25). Similar reports of increased levels of homocysteine in coronary artery disease were reported (26).


In Conclusion, Oxidative stress may be involved in coronary artery disease. The results of our study have shown higher oxygen free radical production and decreased catalase activity, suggesting the incidence of oxidative stress in coronary artery disease. The increased activities of antioxidant enzymes may be a compensatory regulation in response to increased oxidative stress. Increased homocysteine levels and decreased antioxidant capacity may contribute to the increased risk of cardiovascular disease in patients with coronary artery disease, in addition to known risk factors such as age, sex, dyslipidaemia, blood pressure and smoking. So, treatment with antioxidants in the management of the coronary artery disease may be useful as secondary therapy to prevent oxidative damage.


This work was presented as a poster presentation at the 20th International Congress of Clinical Chemistry and Laboratory Medicine, 35th Brazilian Congress of Clinical Analysis and 8th Brazilian Congress of Clinical Cytology (20th International Federation of Clinical Chemistry – World Lab 2008) at Ceara Convention Centre, Fortaleza/CE – Brazil.

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