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




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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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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.
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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,
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 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 : 2010 | Month : December | Volume : 4 | Issue : 6 | Page : 3439 - 3443

Oxidative Stress And Ascorbic Acid Levels In Cavitary Pulmonary Tuberculosis

RAJINDERJIT SINGH AHI*, ARORA D**, RAKENDRA SINGH***

*Assistant Professor, Department of Biochemisty, Adesh Institute of Medical Sciences and Research, Bathinda; **Associate Professor, Department of Microbiology, Guru Gobind Singh Medical College, Faridkot; ***Assistant Professor, Department of Medicine, Adesh Institute of Medical Sciences and Research, Bathinda

Correspondence Address :
Dr. Rajinderjit Singh Ahi,
Assistant Professor,
Department of Biochemisty,
Adesh Institute of Medical Sciences and Research,
Bathinda.
Mobile: 9914118349
E.mail: rajindersahi@yahoo.co.in

Abstract

Abstract: Oxidative stress is implicated in the pathogenesis of many diseases. It has been evidenced by various studies that free radicals are involved in the progression of pulmonary tuberculosis and also, in the damage caused to the lung tissue.
Aim: The present study was conducted to assess the severity of oxidative stress (MDA) and the levels of antioxidants (vitamin C) in advanced (cavitary) pulmonary tuberculosis by comparing it with the non cavitary cases.
Methodology: 50 cases and 30 controls were included in this study. The cases were further divided into cavitary and non-cavitary on the basis of the chest X-ray reports. The levels of lipid peroxidation (MDA) were estimated by the method of Stocks and Dormandy and those of vitamin C were estimated by the method of Varley. Result: The levels of lipid peroxidation increased significantly in the cavitary cases and also, the levels of the antioxidants (vitamin C) were found to be decreased significantly in the cavitary cases as compared to the non-cavitary cases. Conclusion: Oxidative stress was found to be increased highly significantly in cavitary pulmonary tuberculosis. The levels of the antioxidants (vitamin C) decreased highly significantly with an increase in lipid peroxidation levels.

Introduction
M. tuberculosis is most commonly transmitted from a patient with infectious pulmonary tuberculosis to other persons by droplet nuclei, which are aerosolized by coughing, sneezing or speaking. The disease primarily affects lungs and causes pulmonary tuberculosis and is the most important form of tuberculosis which affects humans (1). Pulmonary tuberculosis is India’s biggest public health problem. Every year, approximately 1.8 million people develop tuberculosis, of which about 0.8 million are new smear positive highly infectious cases. The annual risk of becoming infected with Tuberculosis is 1.5% and once infected, there is a 10% life time risk of developing tubercular disease. Two out of every five Indians are infected with the TB bacillus (2). A free radical can be defined as a chemical species, because it has an unpaired electron. Free radicals are generally produced in the cells by electron transfer reactions. These are extremely reactive species and are thus, short lived. All the major classes of biomolecules may be attacked by free radicals. Lipids, perhaps, are the most susceptible ones (3). Their toxic effects are limited by an antioxidant defence system, which prevents cell damage by these free radicals. Antioxidative defence mechanisms include certain enzymes like superoxide dismutase, catalase and glutathione peroxidase and nonenzymatic biomolecules like ascorbic acid, -tocopherol, -carotene, glutathione, albumin, ceruloplasmin, transferrin, etc (3). Lipid peroxidation is a free radical mediated process. In lipid peroxidation, a primary reactive free radical interacts with polyunsaturated fatty acids to initiate a complex series of reactions that result in a variety of degradation products. The uncontrolled peroxidation of biomembranes can thus lead to profound effects on the membrane structure and function and may be sufficient to cause cell death (4).

Malonyldialdehyde (MDA) is a decomposition product of oxidized polyunsaturated fatty acids. This three- carbon dialdehyde has been proposed to arise from fatty acid hydroperoxides via several mechanisms. The most frequent precursors of MDA are five-membered hydroperoxy epidioxides (endoperoxides) and 1,3-dihydroperoxides (5). Most lipid hydroperoxides are unstable and undergo decomposition to secondary lipid peroxidation products such as MDA (6). Cell injury associated with free radicals occurs either in situations in which the scavenging system for free radicals is overwhelmed by the excessive production of free radicals (“hyperoxidants stress”) or in the diseased state in which this protective antioxidant system is impaired (7). Vitamin C or L-Ascorbic acid is water soluble and is present in its deprotonated state under most physiological conditions. It is considered to be the most important antioxidant in extracellular fluids (8) and has many cellular activities of an antioxidant nature as well (9). Oxidative stress reflects a shift towards the pro-oxidants in the prooxidant-antioxidant balance that characterises the normal aerobic state, thus leading to the production of damaged products (10). Lipid peroxidation products (LPPs) diffuse from the site of inflammation and can be measured in blood (11). The granulomatous destruction of the lung tissue itself may cause the liberation of toxic radicals, or indeed, it may be that the activated macrophages release highly reactive radicals which may then cause the local disruption of the essential structure including membrane lipids, deoxyribonucleic acid and proteins and hence, cause tissue destruction (12). Kwiatkowska et al (13) observed increased levels of lipid peroxidation products (LPP), conjugated dienes and malonyldialdehyde (MDA) in patients with active TB. The highest level of conjugated dienes (CD) and malonyldialdehyde (MDA) were found in patients with advanced TB. Jack et al (14) concludes that increased circulating levels of free radical activity are found in active pulmonary tuberculosis and that they also play a role in resultant fibrosis. It also reinforces the belief that a range of free radical activity (FRA) indicators are produced in any inflammatory process with fibrinogenic potential and that these indicators may measure different stages of the disease process.

The objectives of the present study were to assess the severity of oxidative stress in cavitary tuberculosis and also to assess the level of antioxidants and ascorbic acid and to compare these levels with the levels which were observed in non-cavitary tuberculosis.

Material and Methods

The present study was conducted on fifty patients of pulmonary tuberculosis who attended the Adesh Institute of Medical Sciences and Research, Bathinda. In all cases, a detailed clinical history was taken and their physical examination was recorded on the proforma which was prepared for the present study. Thirty healthy individuals who were symptomless, free from any clinical abnormality and those who were not taking any drug, constituted the control group (Table/Fig 1). The cases and controls were further divided according to age and sex (Table/Fig 2) and (Table/Fig 3).

(Table/Fig 1): Distribution Of Cases

Total number of cases involved in the study were 80 out of which 30 healthy individuals served as control group and 50 diagnosed cases of sputum positive pulmonary tuberculosis served as study group.
(Table/Fig 2): Showing Distribution Of Cases According To Age

[Table-2 shows the distribution of age in study group. The maximum number of patients in study group were in the range of 15-30 years of age while maximum number of patients in control group were in the range of 31-40 years of age with the range of 15-75 years in study group and 18-55 years in control group. The data when compared statistically was non significant (p>0.05).
(Table/Fig 3): Distribution Of Cases According To Sex

(Table/Fig 3) shows that the number of male cases were more than female cases both in study group and control group. In study group 80% were males and 20% were females while in control group 86.67% were males and 13.33% were females. The data when compared statistically, was found to be non significant.

The following investigations were taken into consideration.
1. X-ray chest 2. Sputum examination 3. Estimation of Lipid peroxidation (MDA) levels in red blood cells (15). 4. Estimation of Vitamin C levels in plasma (16).
Collection and Treatment of the Samples: Under aseptic conditions, 5ml of venous blood from human subjects was taken in a vial containing 3.8% sodium citrate.
Washing of Erythrocytes: Citrated blood was centrifuged at 3000rpm for 5 minutes. The buffy coats were separated by aspiration. The packed cell volume (PCV) was washed thrice with phosphate buffer (pH 7.4). The PCV was used for lipid peroxidation (LPO) and haemoglobin estimation.

Estimation of Lipid Peroxidation in Red Blood Cells: Lipid peroxidation in red blood cells was estimated according to the method described by Stocks and Dormandy (15). LPO was estimated in erythrocytes as malonyldialdehyde (MDA) which was formed by the thiobarbituric acid (TBA) reaction.

Haemoglobin Estimation: It was done by the method described by Dacie and Lewis (17).
Ascorbic Acid (Vitamin C): Vitamin C levels in plasma were estimated by a titration method by using the 2-6 dichlorophenolindophenol dye. It was based on the titration of 2-6 dichlorophenolindo- phenol in an acid solution. This blue compound, on titration with a solution of ascorbic acid, was reduced to a colourless leucobase, the vitamin C being oxidised to dehydroascorbic acid (16).

The statistical analysis was carried out by the Students t- test. The data was expressed as mean ± standard deviation with the level of significance set at P<0.01.

Results

(Table/Fig 5) shows the comparison of the parameters between the cavitary and non-cavitary cases.
1.The range of MDA in the cavitary cases was 570-1026 nmol MDA/hr/gm Hb, with a mean  SD of 785.70  132.70 nmol MDA/hr/gm Hb, while in the non cavitary cases, it was 470-988 nmol MDA/hr/gm Hb, with a mean  SD of 638.55  149.05. The data when compared statistically, was found to be HS (P<0.01).
2.The range of vitamin C in the cavitary cases was 0.48-0.90mg% with a meanSD of 0.64  0.10mg% and that in the non cavitary cases was 0.52-1.0mg%, with a mean  SD of 0.72  0.11mg%. The data when compared statistically, was found to be HS (p<0.01).

Discussion

Sputum examination was done for the presence of AFB (Acid Fast Bacilli). On the basis of the chest X-ray findings, the cases in the study group were divided into cavitary and non-cavitary cases (Table/Fig 4). According to this finding, 46% of the cases in study group were found to be cavitary and the rest of the 54% were found to be non-cavitary.

(Table/Fig 4): Distribution Of Cases According To The Presence/Absence Of Cavity In Chest X-Ray


The cases and controls were also divided on the basis of demographic data like age and sex, but however, on statistical analysis, these data when compared, were found to be non-significant (Table/Fig 2) and (Table/Fig 4). By statistical analysis, oxidative stress (MDA) was found to be highly significant in the cavitary cases as compared to that in the non-cavitary cases (Table/Fig 5).
(Table/Fig 5): Showing Comparison Of Different Parameters Between The Cavitary And Non Cavitary Cases

The levels of vitamin C were reduced highly significantly in the cavitary cases as compared to those in the non-cavitary cases. It was evident from the present study, that LPO in the cavitary tuberculosis of lung was increased as compared to that in the non-cavitary cases. Our work confirms the presence of increased oxidative stress in patients with cavitary pulmonary tuberculosis. It was measured as increased MDA levels. In pulmonary tuberculosis, the imbalance between the production of oxygen free radicals and antioxidant defences was found to be more in the cavitary cases as compared to the non-cavitary cases. This reflects increased oxidative challenge to the patients with cavitary pulmonary tuberculosis. Our findings correlated well with the data which was published in the past. Increase in MDA levels is an indicator of increased LPO, thus reflecting that the imbalance between oxidative stress and the antioxidants is in favour of the former. The cavitary cases in the study group exhibited higher levels of oxidative stress and lower antioxidant (Vitamin C) levels as compared to those in the non-cavitary cases. In a study conducted in Ethiopian subjects, the concentrations of anti-oxidants like vitamin C, vitamin E and vitamin A were found to be significantly lower in tuberculosis patients and high malondialdehyde concentrations were associated with clinical severity (18). High MDA concentrations and low levels of non-enzymatic antioxidants like vitamins C and E may indicate the depletion of antioxidants due to excessive lipid peroxidation by ROS in PTB patients. Ascorbate is the first antioxidant to be depleted upon exposure to both environmental and inflammatory oxidants, thus suggesting that it is the ultimate antioxidant either by directly scavenging these oxidants or trapping their intermediates (19). Reduced levels of serum vitamin C have been reported in patients with pulmonary tuberculosis (20). Ascorbic acid plays a major role in pulmonary antioxidant defense. Sufficient amounts of ascorbic acid are necessary to maintain normal metabolic processes in the lung (21).

(Table/Fig 5): Pie Chart showing distribution of cases according to presence/absence of cavity in chest x-ray
According to the presence/absence of cavity in chest X-ray, the cases in study group were divided into cavitary and non cavitary group. The number of cases were 23 and 27 respectively.


The administration of nutrients such as ascorbic acid and alpha tocopherol have been shown to accelerate tuberculosis healing, based on decay cavity closure and negative sputum (22). Furthermore, a clinical trial cohort study of 26,975 Finnish men during a median follow-up of 6-7 years found a high inverse association between calculated vitamin C intake and the incidence of tuberculosis. Subjects with an intake of >90mg of vitamin C and with an increased consumption of fruits, vegetables and berries were found to have a significantly lower risk of tuberculosis (23). It was evident from the above studies, that the supplementation of antioxidant vitamins had a positive bearing on the overall health and recovery of the patient. The control and case groups varied in size i.e the number of cases and controls were not same in this study. This can be one of the limitations of this study. Also, as the present study involved a small sample size, it is warranted to conduct studies with a larger sample size to find similar encouraging results and to include vitamin supplementation in the regimen of ATT. However, larger cross sectional and longitudinal studies are warranted to confirm our observations.

References

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Fauci SA, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL and Longo DL. Tuberculosis. In : Harrison’s Principles of Internal Medicine, 14th ed. McGraw -Hill Inc, New York ; 1998 : 1004-1014.
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Park K. Tuberculosis. In: Textbook of Preventive and Social Medicine, 20th ed. Bhanot Publishers, Jabalpur, India 2009; 160.
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Cheesman KH and Slater TF. An introduction to free radical biochemistry. Br Med Bulletin 1993; 49(3) : 481-93.
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Slater F. Lipid peroxidation. Biochem Soc Trans 1983; 10: 70-71.
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Frankel EN and Neff W. Formation of malondialdehyde from lipid oxidation products. Biochem Biophys Acta 1983; 754: 264.
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Chiu D, Lubin B and Shinet SB. Peroxidation reactions in red cell biology. Free radicals in Biology, San Diego Academic, 1982; 5: 115.
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Krazanowski JJ. Oxidants, antioxidants and cardiovascular disease. Journal of the Florida Medical Association 1 991; 78; 435.
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Stoker R and Frei B. Endogenous antioxidant defence in human blood plasma. In: Seis H, ed.: oxidative stress: oxidant and antioxidants. London: Academic Press, 1991; 213-43.
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