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

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
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."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
Knowledge is treasure of a wise man. The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



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




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"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.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
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 ones 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 journalsNo manuscriptsNo 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 : 1903 - 1910

Serum Lipid Peroxidation And Leptin Levels In Male And Female Type 2 Diabetic Patients In Gorgan (South East Of Caspian Sea), Iran

MARJANI A *, VEGHARI G **, BADELEH MT ***

*,**Department of Biochemistry and Biophysics, Biochemistry and Metabolic Disorder Research Center, Golestan University of Medical Sciences. ***Department of Anesthesia, Golestan University of Medical Sciences.

Correspondence Address :
Abdoljalal Marjani,Gorgan Faculty of Medicine,Department of Biochemistry and Biophysics,Biochemistry and Metabolic Disorder Research Center, Golestan University of Medical Sciences,Gorgan, Golestan province,.Iran.Tel & Fax: +98(171)4421651 & 4440225 E.mail:abdoljalal@yahoo.com

Abstract

Background: The aim of the present study was to determinate the possible relationship between serum leptin and lipid peroxidation in male and female type 2 diabetic patients in Gorgan, Iran.
Methods: The subjects consisted of fifty type 2 diabetic patients and fifty age and sex-matched control subjects. The concentration of leptin, malondialdehyde, lipid parameters and insulin were measured in all subjects. The results were evaluated by using Independent sample ‘t’ test and Spearman’s correlation coefficient test.
Results: Leptin was correlated with BMI (male: r=0.339 and female: r=0.426, p<0.05) and malondialdehyde levels (male: r=0.124 and female: r=0.271, p<0.05) in the type-2 diabetic patients. In the control subjects, only a correlation between leptin and BMI was found (male: r=0.165, female: r= 0.037, p<0.05).
Conclusions: In the correlation analysis using leptin as the dependent variable, BMI was found to be the predictor of leptin in males and females. Increased lipid peroxidation and hyperleptinaemia may play a role in the beginning and development of type 2 diabetes mellitus in this area.

Keywords

Leptin, Lipid peroxidation, Type 2 diabetes mellitus, Gorgan

Introduction
Diabetes is a major public health problem that is approaching epidemic proportions globally. This metabolic disease is one of the most common endocrine disorders affecting almost 6% of the world’s population (1). The prevalence of type 2 Diabetes mellitus (DM) ranges from 1.2% to 14.6% in Asia, 4.6% to 40% in the Middle East and 1.3% to 14.5 % in Iran (2),(3). Diabetes mellitus is considered to be one of a rank of free radical diseases. It causes complications, with increased free radical formation (4). The process of lipid peroxidation is one of the oxidative conversions of polyunsaturated fatty acids to products known as malondialdehyde (MDA). MDA is a highly toxic molecule and its secondary products such as thiobarbutiric acid reactive substance (TBARS), are commonly used to evaluate lipid peroxidation (5). A major development in energy balance regulation came with the discovery in 1994, of leptin, the protein product of the ob gene (6).The functions attributed to leptin are extensive, including the regulation of food intake and energy balance through central hypothalamic pathways, its role as a major signal to the reproductive system in theinhibition of insulin secretion by pancreatic-cells and in the stimulation of glucose transport (7). Previous studies of leptin in type 2 diabetes have shown no difference in basal levels, apart from expected differences due to BMI (8),[9) or a reduced leptin level, which may be explained by differences in fat distribution (10). Importantly however, the relationship between leptin and variables involved in glucose homeostasis and diabetes might show ethnic differences. A recent population study of Peruvian Indians compared with a Caucasian population showed that the Indians had higher insulin and lower leptin levels than the Caucasians (11). Similarly, Chilean Indians also had higher insulin and lower leptin levels than the Caucasians (12). Furthermore, Mexican American subjects showed higher levels of leptin as compared to age and sex-matched non-Hispanic whites (13). These results observed in different ethnic groups reinforce that studies have to be undertaken in different populations. Thus, the aim of the present study was to investigate the possible relationship between serum leptin and the lipid peroxidation of male and female patients diagnosed with type 2 diabetes mellitus in Gorgan,Iran.

Material and Methods

This study was performed in the Biochemistry and Metabolic Disorder Research Center of Gorgan, Iran, in 2008. We had a study group including 50 patients of type-2 diabetes mellitus who referred to the Department of Diabetes Center in 5th Azar Hospital in Golestan University of Medical Sciences and 50 age and sex matched healthy control subjects. At the point of entry into the study, all diabetic patients underwent clinical and biochemical investigations. The data were collected by trained interviewers. The exclusion criterion was the coexistence of any other serious illness. Type-2 diabetes mellitus was defined as nonketosis diabetes by medical history and it is currently treated with oral agents. None of the patients had micro vascular complications (diabetic nephropathy or retinopathy). Administration of insulin for glycaemic control was considered to be an exclusion criterion. In the controls, diabetes was excluded by the fasting blood glucose test. Ten ml of fasting blood was collected from each subject by veinpuncture. The samples were centrifuged for 10 minutes at 3000rpm. The serum was used for the analyses of malondialdehyde (14), fasting blood sugar (15), lipid profile (total cholesterol (16) including the analysis of triglycerides (17), HDL-cholesterol (18) VLDL-cholesterol and LDL cholesterol (19) in those who had type-2 diabetes mellitus and in controls. Lipids levels were measured by biochemical kits and Lipid peroxidation (the level of lipid peroxidation expressed as malondialdehyde [MDA]) was determined using previously described methods and spectrophotometry techniques (Model JENWAY 6105 UV / VIS ) in the Biochemistry and Metabolic Disorder Research Center (Faculty of Medicine). The results were reported as mean± SD. The statistical analysis was done with SPSS version -11.5 software. The results were evaluated by using Independent sample ‘t’ test and Spearman’s correlation coefficient test. P values < 0.05 were considered to be statistically significant.

The Measurement Of Serum Leptin
Serum leptin levels were measured using a human leptin ELISA test kit (Biovendor, Research and Diagnostic Products, Czech).

The Measurement Of Serum Insulin
Serum insulin levels were measured using a human insulin ELISA test kit (DiaPlus, Immunoenzymometric assay, USA).

The Measurement Of Serum Malondialdehyde
2.5 ml of trichloroacetic acid was added to 0.5 ml serum and the tube was left to stand for 10 min at room temperature. After centrifugation at 3500 rev. / min for 10 min, the supernatant was decanted and the precipitate was washed once with sulfuric acid. Then, 2.5 ml of sulfuric acid and 3 ml of thiobarbituric acid (TBA) in sodium sulfate were added to this precipitate and the coupling of lipid peroxide with TBA was carried out by heating this mixture in a boiling water bath for 30 min. After cooling in cold water, the resulting chromogen was extracted with 4 ml of n-butyl alcohol by vigorous shaking. Separation of the organic phase was facilitated by centrifugation at 3000 rev./min for 10 min and its absorbance was determined at awavelength of 530 nm.

Results

The clinical characteristics of the type-2 diabetic patients and control subjects are described in (Table/Fig 1). The mean duration of diabetes mellitus in type-2 diabetes mellitus patients was 1.5 years (range 1-3 years). The mean age of male and female patients in the type-2 diabetic and control subjects were 50.38±10.78 (18 males) and 50.46±9.53 (32 females), and 48.40± 10.49 years (20 females) and 48.46± 10.65 years (30 females), respectively. A number of obvious differences were found between the two subjects. The female type 2 diabetes mellitus patients had higher levels of fasting blood sugar, total cholesterol, LDL-cholesterol, HDL-cholesterol, VLDL-cholesterol, triglycerides, malondialdehyde, leptin and insulin as compared to the male subjects. Notably, the BMI (32.88±5.82 kg/m²), malondialdehyde (2.57±1.38 nmol/ml) and leptin levels (34.99±10.19 ng/ml) were significantly higher in female type-2 diabetes mellitus patients than in diabetic male subjects (25.05±1.85 kg/m², 2.10±0.67 nmol/ml and 11.04±7.76 ng/ml,) (P< 0.05) (Table/Fig 1). The data shown in Table 1 reveals that the BMI (30.60±5.50 kg/m²) and leptin levels (26.34±12.02 ng/ml) was significantly higher in female control subjects than in male subjects (25.97±4.36 kg/m² and 11.26±5.46 ng/ml,) (P< 0.05). There was no significant difference in other parameters in female type-2 diabetes mellitus patients and male subjects. The data of (Table/Fig 1)shows that the levels of fasting blood sugar, total cholesterol, LDL-cholesterol, VLDL-cholesterol, triglycerides, malondialdehyde and insulin were significantly higher in male and female (leptin was also higher) type-2 diabetes mellitus patients than in male and female controls (P< 0.05). But this is not the same for HDL-cholesterol, age and BMI in female type-2 diabetes mellitus patients(Table/Fig 1). There were no significant differences in age, BMI, HDL-cholesterol and leptin in male type-2 diabetes mellitus patients and in male control subjects. Leptin correlated positively and significantly with the BMI of diabetic and control males (r=0.339and r=0.165, p<0.05) and females (r=0.426 and r=0.037, p<0.05). Leptin also correlated positively and significantly with malondialdehyde (MDA) in the male and female type-2 diabetes mellitus patients (r= 0.124, r= 0.271, p<0.05) (Table/Fig 2).

Discussion

In the present study, we have observed that the levels of malondialdehyde (MDA), a lipid peroxidation product and a marker of oxidative stress, is increased significantly in male as well as in female diabetic patients [Table/Fig 1]. This apparently shows that diabetic patients are exposed to an increased oxidative stress via lipid peroxidation. Some other researchers have also reported elevated lipid peroxidation products in the blood samples of type 2 diabetic patients (20),(21). Several studies have shown that lipid peroxidation is increased in diabetes, particularly in type 2 diabetes mellitus (22),(23),(24). Jain (25) demonstrated that hyperglycaemia stimulates the lipid peroxidation of RBC and Kannan and Jain (26) later showed that it increases oxidative stress in cells in vitro. Contrary to our observations and to that of others, there are several studies which did not find increased oxidative stress in type 2 diabetes mellitus patients (27).
In an animal study, Midaoui and Champlain (28) sufferred the rat from type 2 diabetes mellitus and examined oxidative stress in the model of rat. Notably, they observed that hyperglycaemia alone does not induce oxidative stress unless it was accompanied by insulin resistance; thereby, implying that the involvement of reactive oxygen species is selectively related to insulin resistance (29).

Our results reveal a significant increase in the concentration of MDA in type 2 diabetic patients as compared to the control subjects (Table/Fig 1). This is in agreement with the other published reports (22),(23),(24),(25),(26). Our results show that BMI, MDA and leptin are statistically increased in female diabetic patients as compared to male subjects (Table/Fig 1).

Many investigators have demonstrated that leptin has a major relationship with BMI (30),(31),(32),(33),(34),(35). In our study, also, leptin showed a correlation with BMI, both inmales and females with diabetes and in control subjects. Leptin showed a correlation with MDA in both males and females with diabetes. A clear tendency towards being obese and overweight was apparent in female and male diabetic patients (BMI, 30.07±6.08 and 25.05±1.85 kg/m2) and in control subjects (BMI, 30.60±5.50 and 25.97±4.36 kg/m2). Some of the type 2 diabetes mellitus patients suffered from Hyperlipidaemia. Therefore, our results apparently showed that being obese and overweight gave rise to increased oxidative stress in type 2 diabetes mellitus patients. Being obesity and overweight did not change the oxidative stress in the control subjects. Our study focussed on the association between serum leptin concentration and lipid peroxidation in type 2 diabetics. Recent studies have showed that leptin significantly increases intracellular reactive oxygen species in microvascular endothelial cells, particularly in diabetics (36). According to our study,increased leptin levels observed in male and female diabetics may be related to increased lipid peroxidation (Table/Fig 2).Literature findings on the role of leptin in diabetes is conflicting. Investigators have reported either increased (37), decreased (38),(37),(38),(39) or unchanged (40),(41) leptin levels in diabetics. As Wauters et al. (42) have pointed out, adiposity and gender are the main determinants of leptin levels in normal controls and diabetic patients. Therefore, part of the controversy among previous reports could be related to the difference in the adiposity or the gender of the patients. Many investigators have described leptin alterations only in obese or overweight patients (38), (37),[40). Few workers have studied only men (37) or women (39). The mechanism by which leptin stimulates oxidative stress conditions is unclear, but it may be related to the fact that leptin stimulates mitochondrial fatty acid oxidation and the increased generation of reactive radicals (43). Sebnem et al. (44) have observed a significant decrease in the leptin levels in the plasma of streptozotocin- induced diabetic rats. Streptozotocin-induced hypoleptinaemia may be related to a reduced adipose tissue mass and to the reduced assimilation and storage of energy substrates in the fat tissue in insulin deficiency and/or to the direct toxic effect of streptozotocin on the adipose tissue (45). Panarotto et al. (46) has described lower leptin concentrations in females with diabetes as compared to those in the control subjects. Our data only appear to be in contrast with this finding; our patients actually had higher leptin levels and higher fasting serum glucose concentrations than those studied by Panarotto's group. Moreover, in correlation analysis, BMI is considered to be a significant predictor of hyperleptinaemia (Table/Fig 2). In the correlation analysis using leptin as the dependent variable, BMI and MDA were found to be significant predictors of leptin. In the present study, it was found that there was a correlation between serum leptin and BMI in males and females in normal and diabetic subjects. Gender specific correlation showed an association between leptin and MDA in diabetic patients. Serum leptin showed a significant relationship to MDA in male and female diabetic patients (r = 0.124 and r= 0.271, p < 0.05). This trend reflects the increased MDA in males and females. Therefore, serum MDA levels are confounded by leptin or vice versa, such that in diabetes. Nakanishi et al. (47) have investigated the association between leptin and oxidative stress and have explained this association exclusively through obesity. Many investigators demonstrated that leptin had a major correlation with BMI [48,(49),(50),(51),(52). There is still a controversy that leptin concentrations are affected by type 2 diabetes. Surveys of Mexican-American (53) and German (54) subjects showed that leptin did not differ between normal subjects and subjects with type 2 diabetes, with matched BMI in males and females. In another report, it was found that baseline plasma leptin levels in subjects with newly diagnosed or long-standing type 2 diabetes were not significantly different from nondiabetic controls matched for BMI (54). Other reports comparing plasma leptin levels between controls and weight-matched subjects with type 2 diabetes have led to discrepant conclusions, showing no effect (55),(56) or a decrease in leptin (57),(58). Our present study shows a similar relationship between leptin and oxidative stress in obese and overweight type 2 diabetes mellitus hyperleptinaemic patients. Finally, our study on individuals who were referred to the Department of Diabetes Center in 5th Azar Hospital in the Golestan University of Medical Sciences on the South East of the Caspian Sea indicated that Type 2 diabetes was associated with higher leptin and MDA levels and BMI. In the correlation analysis, we found a significant relation between leptin levels and BMI in males and females. Increased lipid peroxidation and hyperleptinaemia may play a role in the beginning and in the development of type 2 diabetes mellitus.

References

1.
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