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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Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
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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 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.
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)
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 : 2010 | Month : October | Volume : 4 | Issue : 5 | Page : 3191 - 3195

Glycosylated Haemoglobin In Non- Diabetic End-Stage Renal Disease Patients Undergoing Haemodialysis


*Assistant Professor, Department of Biochemistry, Teerthanker Mahaveer Medical College and Research Centre Moradabad, ** Professor & Head of Department of Biochemistry, HIMS, Dehradun, ***Associate Professor Department of Nephrology, HIMS Dehradun.

Correspondence Address :
Dr Sangeeta Kapoor (M.D.Biochemistry)
Assistant Professor
Department of Biochemistry
Teerthanker Mahaveer Medical College and Research Centre
Moradabad (U.P.) INDIA
Phone No. 09411874572
E-mail address -


Background: Glycosylated haemoglobin is widely used as a measure for glycaemic control in patients with diabetes mellitus. The significance of the increased levels of glycosylated haemoglobin in non-diabetic patients with end-stage renal disease, receiving maintenance haemodialysis remains unclear at the present time. It is known that the attainment of glycaemic control is important in these patients. Objectives: In this study, an attempt has been made to study glycosylated haemoglobin levels, which may serve as a reliable indicator of integrated glycaemia in these patients. Material and Methods: We enrolled 65 non-diabetic end-stage renal disease patients who received haemodialysis and 30 non-diabetic patients without end-stage renal disease for this study. Glycosylated haemoglobin was analysed by a turbidimetric immunoassay by using a Synchron CX system in order to avoid assay interference from uraemia and anaemia in end-stage renal disease patients. Results: We found that the average glycosylated haemoglobin levels in non-diabetic end - stage renal disease patients on haemodialysis was 5.23% +1.16 and that in the control group was 4.56% + 0.52 (p < 0.001). There was no significant difference in the random blood glucose levels between the two groups. Our data indicated that glycosylated haemoglobin levels are elevated in non - diabetic end-stage renal disease patients undergoing haemodialysis. Conclusions: We conclude that the elevation in glycosylated haemoglobin level cannot be solely explained by glucose reabsorption from the dialysates and that it reflects true glucose intolerance, which is consistent with increased cardiovascular risk in such patients. Moreover, correlations between glycosylated haemoglobin and the duration of dialysis and the lipid profile of the patient were made, thus indicating the cumulative effect of these factors in regulating the glycaemic status of such patients. Cardiac risk ratio (TC / HDLc) and Freidwald’s ratio (LDLc / HDLc ), the indicators of coronary heart disease ( CHD), were also computed . It was found that these ratios varied significantly with the increase in HbA1c levels in ESRD patients.


Glycosylated haemoglobin, haemodialysis, glycaemic control.

The levels of HbA1c (glycosylated haemoglobin) reflect the glycaemic control during the erythrocyte life span (1). We have drawn attention to the elevated levels of HbA1c in non-diabetic patients who were on intermittent haemodialysis and found significantly higher HbA1c levels but no correlation with blood glucose. The knowledge of HbA1c in patients with ESRD (end-stage renal disease) could be important in assessing the overall prognosis in such patients and it also has implications in the assessment of their glycaemic status and in preventing post-dialysis morbidity and mortality (2). A multitude of causes leading to increased HbA1c levels have been thought of by various scientists viz; glucose in the dialysates, insulin resistance, glucose intolerance, etc (3). While the precise mechanisms which cause the elevation of the HbA1c levels remain obscure, this test can be a useful adjunct in the detection of carbohydrate metabolism abnormalities and the consequent cardiovascular risk in these patients (4).

Material and Methods

65 patients from the dialysis unit of HIMS were selected as the test group. All of these had received haemodialysis 3 times a week, for at least 1 year. The study also included 30 normal healthy adults, who served as the controls. The exclusion criteria which were considered were acute cases, diabetes mellitus, pregnancy, active infection, HIV seropositivity and treatment with cholesterol lowering drugs, immunosuppressive agents and corticosteroids .Considering the reliability of the immunoinhibition turbidimetric assay of HbA1c due to non-interference by carbamylated haemoglobin and anaemia, it was used.

The Synchron CX system utilizes two unique cartridges, haemoglobin and A1c to determine the HbA1c concentration as a percentage of total haemoglobin. The specific antibodies were combined with HbA1c from the sample to form soluble Ag-Ab complexes. Polyhaptens from the reagent then bound with the excess antibodies and the resulting agglutinated complex was measured turbidimetrically(5).

HbA1c is presented as A1c/Hb ×100. The data are expressed as mean ± S.D. Student’s t-test was employed for statistical analysis and a p value less than 0.05 was considered to be significant and p values less than or equal to 0.001 were considered to be highly significant.

The present study was conducted as per the principles which were laid down by the ethical committee and consent was obtained for performing tests on the patient’s serum samples.


There was no significant difference in the average Random blood glucose (RBG) levels between the ESRD and the control groups (p>0.05). However, in non-diabetic control patients, the HbA1c level was 4.56 %+ 0.52. In ESRD patients, the HbA1c level was 5.23%+1.16 .Thus, there was a significant elevation of HbA1c levels in non-diabetic ESRD patients who received haemodialysis (p<0.001).

(Table/Fig 1): HbA1c levels in ESRD patients and control group.
Also, a significant rise in HbA1c levels was found with the duration of dialysis.

(Table/Fig 2) :HbA1c levels in ESRD patients according to the duration of dialysis.

A significant rise in the levels of HbA1c was also seen with the rise in the levels of serum triglycerides (TG), serum total cholesterol (TC) and serum LDL cholesterol (LDLc).

(Table/Fig 3): Correlation of HbA1c levels with TG levels in ESRD patients.

(Table/Fig 4): Correlation of HbA1c levels with TC levels in ESRD patients.

(Table/Fig 5): Correlation of HbA1c levels with LDLc levels in ESRD patients.

Comparable values of HbA1c were obtained even with decreased values of serum HDLc.

(Table/Fig 6): Correlation of HbA1c levels with HDLc levels in ESRD patients.

Significantly elevated values of Cardiac risk ratio (TC / HDLc ) and Freidwald’s ratio (LDLc /HDLc ) were seen in non-diabetic ESRD patients.

(Table/Fig 7): Cardiac Risk Ratio (TC/HDLc) in ESRD patients and control group.

(Table/Fig 8): Freidwald’s Ratio (LDlc /HDLc) in ESRD patients and control group.

A significant correlation of HbA1c levels was seen with Cardiac risk ratio and Freidwald’s ratio.

(Table/Fig 9): Correlation of HbA1c levels with mean Cardiac risk ratio (TC/ HDLc) in ESRD patients.

(Table/Fig 10): Correlation of HbA1c levels with mean Freidwald’s ratio ( LDLc/HDLc) in ESRD patients.


Carbohydrate intolerance and impaired glycaemic control is common in ESRD and are thought to be predisposing factors in the development of arteriosclerosis. Many studies have demonstrated the elevated HbA1c levels and deranged glycaemic control in ESRD patients who are on haemodialysis. In this study, the HbA1c levels were elevated significantly in ESRD patients with no significant correlation with blood glucose levels, thus indicating true glucose intolerance (6).

The mechanism of the elevated HbA1c levels in ESRD patients who received haemodialysis is not clear at the present time. The possibility is that the patients with ESRD have insulin resistance (7). The elevated HbA1c levels may reflect a true impairment of glycaemic control, as reported in uraemic patients. There is a possibility that ESRD patients have glucose intolerance and have high post-prandial hyperglycaemia, which might have resulted in increased HbA1c levels (8).

Dyslipidaemias are commonly associated with impaired glycaemic control. In this study also, a significant correlation was found between serum HbA1c and TC, TG and LDLc respectively, thus indicating that dyslipidaemia was a concomitant metabolic abnormality with impaired glycaemic control, which was consistent with high cardiovascular risk, leading to premature cardiovascular disease in the ESRD patients(9).
The statistically non-significant correlation of the mean HbA1c levels with HDLc levels is consistent with the observations made by Menon V, Greene T and Pereira AA et al, where the HDLc levels of the patients remained the same, despite the elevation in the HbA1c levels (2).

Framingham’s study had suggested that as the TC/HDLc (Cardiac risk ratio) increases, so does the risk of coronary heart disease (CHD). In populations with low CHD incidences, the average values of the Cardiac risk ratio are below 3.99. LDLc /HDLc (Freidwald’s ratio) (0 -3.55) is considered to be an even more accurate measurement of recent cardiovascular disease. In this study, it has been found that both these ratios were significantly (p< 0.05) elevated in non-diabetic ESRD patients, as compared to the control subjects. Both the parameters may thus be used for analyzing the probable risk of atherosclerosis in non-diabetic ESRD patients (10).

Furthermore, a positive correlation between HbA1c levels and Cardiac risk ratio and Freidwald’s ratio has suggested that there is a trend towards a significance between HbA1c levels and the risk of atherosclerosis, thus indicating the probability of CHD (11).

Our results therefore suggest that HbA1c may be an important target for intracellular glycoxidation and peroxidation reactions that result in the formation of advanced glycation end products (AGEs) which are further implicated in the causation and the progression of atherosclerosis. Also, chronically deranged glycaemic control in these patients has been associated with increased circulating levels of oxidised LDLc, a highly atherogenic form of LDLc (2).


HbA1c levels measured by the turbidimetric immunoassay method can provide quick and reliable information for evaluating glycaemic control in non-diabetic ESRD patients who received haemodialysis. A new set of recommendations must be considered, regarding the normal range of the HbA1c levels while assessing the glycaemic control in diabetic ESRD patients.

In summary, in non-diabetic patients with ESRD, HbA1c as a marker of impaired glucose metabolism, is a significant predictor of CVD mortality (12).
The results for this study may have important implications:
(a) The current definitions for normal glycaemic status may not be appropriate for this population.
(b) The high prevalence of dysglycaemia along with high HbA1c levels in non- diabetic ESRD patients on haemodialysis may explain the high risk for cardiovascular disease (CVD).
(c) HbA1c may have a role in risk stratification and in the early identification of patients who have non-diabetic ESRD and are at a high risk for CVD (13).

1. A follow up study could not be formulated to study the synergistic contribution of elevated HbA1c levels and dyslipidaemia in CVD mortality in ESRD patients.
2. The precise mechanisms behind the HbA1c level elevation in ESRD patients remain obscure.
3. Direct evidence for the usefulness of this test in the evaluation of hyperlipidaemia could not be provided.
4. The correlation of HbA1c levels with blood glucose measurements at specified time points i.e . fasting and post-prandial blood glucose levels needs to be further contemplated.


The authors wish to thank the ethical committee from where this study was approved and the thesis committee of HIMS, Dehradun, from where this study was funded. We also wish to thank the staff and nurses of the dialysis unit and the technical staff of the Clinical Biochemistry Laboratory for their help in measuring the HbA1c levels.


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Menon V, Greene T, Pereira AA, Wang X, Beck GJ, Kusek JW et al. Glycosylated hemoglobin and mortality in patients with non-diabetic chronic kidney disease. J Am Soc Nephrol 2005; 16:3411-17.
Kobayashi S, Maejima S, Ikeda T, Nagase M. Impact of dialysis therapy on insulin resistance in end-stage renal disease : comparison of haemodialysis and continuous ambulatory peritoneal dialysis. Nephrol Dial Trans 2000; 15(issue 1) :65–70.
Hirszel P, Galen MA, Happe T, Lasrich M. Glycosylated hemoglobin in patients treated by chronic dialysis. Int Urol Nephrol 1981; 13 (pt 2):185–191.
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Wang X, Peesapati SK, Renedo MF, Moktan S. Haemoglobin A1c levels in non-diabetic patients with end-stage renal disease (ESRD) receiving hemodialysis. J Endocrinol Invest 2004; 27(pt 8): 733–5.
Argani H, Noorazarian A, Rahbaninobar M, Noori M, Khosroshahi HT. Comparison of glucose tolerance in renal transplant recipients and hemodialysis patients. BMC Nephrology 2004; 5:11.
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Khaw KT, Wareham N , Bingham S , Luben R ,WelchA, Day N . Association of hemoglobin A1c with cardiovascular disease and mortality in adults. The European Prospective Investigation into cancer in Norfolk. Ann Intern Med 2004 ; 141 : 413-20.
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Levey AS. National Kidney foundation/ DOQ I clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis 2002; 39 (issue2): 1–266.

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