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

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Dr Bhanu K Bhakhri

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Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"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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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
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Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




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"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
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
Consultant
(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.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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

Important Notice

Original article / research
Year : 2009 | Month : December | Volume : 3 | Issue : 6 | Page : 1841 - 1846

Cerebrospinal Fluid And Serum Zinc, Copper, Magnesium And Calcium Levels In Children With Idiopathic Seizure

PRASAD R *, SINGH A *, DAS B K *, UPADHYAY R S **,SINGH T B ***, MISHRA O P *

*Dept. of Pediatrics, Institute of Medical Sciences, **Dept. of Botany, ***Dept. of Biostatistics, Banaras Hindu University, Varanasi. India.

Correspondence Address :
Dr. Rajniti Prasad,Sr Lecturer,Department of Pediatrics,Institute of Medical Sciences,Banaras Hindu University,
Varanasi – 221005. (India).e
mail:rajnitip@yahoo.co.in

Abstract

Objectives: The present study was conducted to observe the alteration and their relations in cerebrospinal fluid (CSF) and serum Zinc (Zn), Copper (Cu), Magnesium (Mg) and calcium (Ca) levels in patients with different type of idiopathic seizure and to determine the ratios of serum and CSF Ca/Mg and Cu/Zn.
Methods: The children of aged 1 to 14 years, having two or more unprovoked seizures with normal MRI scan and abnormal EEG were included in study group. Control group consisted of 40 healthy children without seizure. Zn, Mg and Cu levels in CSF and serum were analyzed by atomic absorption spectrophotometer.
Results: The study subjects included 34 generalized seizures (GS), 5 cases of simple partial seizure (SPS) and 5 Complex partial seizures (CPS). Serum copper (Cu) was significantly elevated (P-0.01) in children with seizure. Within seizure group, serum Mg was significantly increased in GS and serum copper (Cu) levels were significantly increased in CPS and GS as compared to control (p-0.001). However, calcium and zinc did not show any significant change in all groups. CSF Calcium was significantly increased in CPS patients. The ratio obtained for the levels of these parameters revealed a significant increase in serum Cu/Zn ratio (P-0.002) and CSF Ca/Mg (P-0.04) in patients with idiopathic seizure as compared to control. This ratio was also significant between SPS versus CPS and CPS versus GS.
Conclusion: The findings of present study suggest that high serum Cu and increased ratio of serum Cu/Zn and CSF Ca/ Mg may be responsible for enhanced neuronal excitability in children with idiopathic seizures.

Keywords

Idiopathic seizure, zinc, copper, magnesium , calcium

Introduction
The exact pathogenesis of seizure is not fully understood but involves several factors like genetic predisposition, changes in the levels of neurotransmitters and some trace elements. Several reports suggested that the level of some trace elements play a vital role in causation of seizure (1), (2). Among trace elements, Zinc (Zn) acts as a co-factor of glutamic acid decarboxylase, an enzyme which maintains the production of GABA in central nervous system and decreased level of Zn in CSF has also been observed in Febrile seizure (2), (3). Magnesium (Mg) is also involved in neuronal function and inhibits the facilitatory effects of calcium on synaptic transmission and exerts a voltage dependent blockage of N-methyl-D-aspartate (NMDA) receptor channel. Copper (Cu) inhibits Mg++-adenosine triphosphatase(ATPase) and Na+-K+-ATPase enzymes and disturbs the sodium and potassium homeostasis, which results in genesis of epileptiform discharges (4). In some cases the altered levels of trace elements in epileptic patients were attributed to anti-convulsant drugs therapy or due to other unknown reasons.

A careful literature review reveals that a comprehensive record of zinc, copper, magnesium and calcium in serum and CSF and their ratios in children with idiopathic seizures is missing. Hence to observe their significance in children, the current study was conducted to estimate their levels in children suffering from idiopathic seizures. Furthermore, an attempt has been made to find out ratios of them such as Ca/Mg, Cu/Zn and to correlate with types of seizure.

Material and Methods

The present study was carried out in Department of Pediatrics, a tertiary care hospital, India from June 2006 to July 2008. A total of 44 children suffering from seizure aged, 1 year to 14 years were enrolled for the study.

Inclusion Criteria
Cases: Children of age group 1 year to 14 years, having two or more unprovoked seizures (first presentations in hospitals) with normal CT / MRI Scan and abnormal encephalogram(EEG) were included in study group. Children with GS were treated with sodium and valproic acid, whereas cases with SPS and CPS received carbamazepine and valproic acid respectively.

Control
40 healthy children (22 male and 18 female) without seizures.

Exclusion criteria
Children with malnutrition, acute bacterial meningitis and those taking Cu, Zn, Mg and Ca containing preparations were excluded from the study.

The protocol of study was approved by Institute Postgraduate Medical Board. Parents of each patient were explained about the illness of their child and informed consent was taken from the parent or legal guardian after explaining the procedure, which is an integral part of study.

Collection And Storage Of Samples
Blood samples were collected through vein puncture using aseptic precautions. The serum was separated and transferred into plastic tubes. The patients underwent lumbar puncture and the CSF was collected in acid washed plastic tubes. One millimeter of CSF was used for trace elements estimation. Both CSF and serum samples were stored at -20C until analysis. The glass and polypropylene equipments used for trace elements analysis were soaked in 10% (v/v) nitric acid for 12 hours and then rinsed with double distilled deionized water.

Estimation of Cu, Zn, Ca and Mg
The Cu, Zn, Ca and Mg levels in CSF and serum were assayed by atomic absorption spectrophotometer in the Department of Botany, Faculty of Science, Banaras Hindu University, Varanasi. Both CSF and serum samples were diluted with double deionized distilled water and dilution factor was 1:3 and 1:6 for zinc and copper respectively and 1:10 for Ca, Mg estimation. The standard solution contained 100 g/ml of each element and used for calculation in analysis of Cu, Zn, Ca and Mg levels in CSF and serum. Sample reading was taken thrice and arithmetic mean was calculated.

Statistical Analysis
The data was analyzed using SPSS software version 10. Student‘t’ test and Man Whitney U-test was used to compare the significant difference of means between control and patients. Data, which did not follow normal Gaussian distribution ,were compared by Wilcoxan Rank sum or Kruskal- Wallis test. Post-hock test has been used to find out pair wise significant difference, if one way ANOVA is significant. The ratio and correlation coefficients were also calculated. Categorical data were compared by calculating the chi-square value or by Fischer exact test.

Discussion

Serum copper levels in children with seizure and their subgroups were significantly increased as observed by other workers (5), (6), (7), (8), (9) but Smith et al.(10) and Kurekci et al.(11) have reported no significant change. The increased copper levels in serum may be due to effect of anti-epileptic drugs, increased hepatic synthesis or decreased breakdown or both of copper binding protein, altered intestinal absorption and altered excretion patterns, changes in the distribution among body tissues or some combination of above factors (8), (9). CSF Cu were found comparable in both cases and control as observed by Goody et al.(12) This variation in serum and CSF value might be due to some unknown factors which need to be further evaluated.

Zinc is essential for normal development of the brain. Although serum and CSF Zn level in patients with seizure was found to be decreased but statistically insignificant as observed by other workers (9), (10), (12). Low Zn concentrations have been reported in serum and CSF of patients with epilepsy (13). The mechanism by which depletion of zinc facilitates seizure activity is hypothesized as its inhibitory effect on GABA, an inhibitory neuro-transmitter. Zinc also plays an important role in both the synthesis and function of GABA (14). Goody et al;(12) and Kapaki et al;(15) had reported increased CSF concentration in patients with neurological disorders.

The present study demonstrated low serum and CSF Mg levels in cases but insignificant. Our results are simillar with study of other workers (16), (17), (18), (19). However Alwarez-Dominiguez et al. (20) showed higher serum magnesium level in epilepsy. Rude (21) hypothesized that magnesium deficiency is responsible for hyper- excitability of neuron. It is apparent from the study that in normal subjects the serum magnesium levels is lower than levels in CSF, suggesting that some mechanism other than mere diffusion is responsible for maintaining this relatively higher concentration in CSF.

It is well documented that low levels of calcium are responsible for initiation of seizures. However, in present study serum calcium in seizure remained comparable to the control as reported by Rutter et al (22) but other workers (18), (19) showed higher levels of calcium in epileptic children. Calcium facilitates the release of acetylcholine by nerve impulses, which may be responsible for neuromuscular irritability. Hypomagnesemia and hypercalcemia combine to produce a membrane state, which becomes responsive to an otherwise sub-threshold stimulus.

Generalized seizure group had significantly higher levels of serum Mg as compared to partial seizure group in present study. Shah et al (16) had found nearly comparable levels unlike our result. The present study also showed significant decrease in CSF Ca in children with SPS and CPS. We can hypothesize that type of seizure had influence on concentration of Mg and Cu in serum.

It was observed that serum Cu/Zn and CSF Ca/Mg ratios were significantly elevated in study group. The elevated Cu/Zn ratio may be closely associated with initiation and continuance of seizures. Leaver et al.(23) also observed decline both in calcium and magnesium concentrations and high serum Ca/Mg ratio as with our result. Our observation on the possible use of Cu/Zn ratio is a new concept and may help to judge enhancement of neuronal excitability.
The strongest correlations observed in our study were between CSF Ca and CSF Mg (r=0.39) as observed by Woodbury et al.(24) and Bogden JD et al. (25) The correlation between plasma and CSF Mg (r=0.35) although significant, is not strong enough to allow a useful estimate of Mg concentration in CSF from its concentration in plasma.
The estimation of serum and CSF levels of Ca, Mg, Cu and Zn and their ratios are essential for the rational understanding of pathogenesis and management of childhood idiopathic seizure and their sub-groups. The changes in trace metals might be associated to type of seizure rather than anti-convulsant therapy. However, it is suggested to conduct a study with greater sample size to evaluate the role of trace elements and their ratios in childhood seizures.

References

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Meret S, Henkin RI. Simultaneous direct estimation by Atomic Absorption Spectrophotometry of copper and zinc in serum, urine and cerebrospinal fluid. Clin Chem 1971;17: 369-73.
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Govil MK, Mangal BD, Alam SM, Mahendru RK, Srivastava DK, Mudgal JC. Serum and cerebrospinal fluid calcium and magnesium levels in cases of idiopathic grand mal epilepsy and induced convulsions. J Assoc Phys India 1981; 29: 695-99.
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Sood AK, Handa R, Malhotra RC, Gupta BS. Serum, CSF, RBC, Urinary Levels of Magnesium and Calcium in Idiopathic generalized tonic clonic Seizures. Indian J Med Res 1993; 98:152-59.
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Alvarez Dominquez L, Prats-Quinzannos J, Calvetmieas E, Alsina- Kirtchner MJ , Ramon Bariza F. Study of calcium and magnesium in cerebrospinal fluid and its relation to different neurological diseases. Ann Esp Pediatr1978; 11: 753-62.
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Rude RK. Magnesium Metabolism and Deficiency. Endocrinol Metabl Clin North America1993; 22: 377-95.
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Rutter N, Smales OR. Calcium, Magnesium and Glucose levels in Blood and CSF of children with Febrile Convulsions. Arch Dis Child 1976;5: 141-3.
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