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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 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
The Role of Biochemical Markers in the Prediction of Microvascular Complications in Type-2 Diabetes Mellitus
Correspondence Address :
V. Siva Prabodh, Associate Professor
Department of Biochemistry
NRI Medical College
Chinakakani, Mangalagiri
Guntur (Dist) Pin code - 522503
Andhra Pradesh, India.
E-mail: vuddandiprabodh@yahoo.com
The microvasular complications of diabetes encompass longterm complications which affect the small blood vessels. These classically have included retinopathy, neuropathy and nephropathy. The biochemical parameters play a key role in the prediction of microvascular complications in diabetes mellitus. Therefore, the present study was undertaken to investigate the role of biochemical markers in the prediction of microvascular complications in patients with type 2 diabetes mellitus. Fifty type 2 diabetes mellitus patients were studied for their fasting blood sugar, glycosylated haemoglobin, serum creatinine, blood urea nitrogen, lipid profile and microalbuminuria levels and they were also tested for the presence or absence of microvascular complications. The analysis was categorized, based on the presence or absence of the microvascular complications. Thirty non diabetic, healthy subjects were chosen as the control group.
The analysis showed that thirty six subjects had microvascular complications. The incidence and the progression of the microvascular complications increased with hyperglycaemia, a longer duration of diabetes, dyslipidaemia and the presence of microalbuminuria levels in patients with type 2 diabetes mellitus. Therefore, poor glycaemic control, a longer duration of diabetes, dyslipidaemia and the progression of microalbuminuria can predict the microvascular complications in patients with type 2 diabetes mellitus.
Type 2 diabetes, Microvascular complications, Glycosylated haemoglobin, Diabetic retinopathy, Diabetic neuropathy, Diabetic nephropathy
INTRODUCTION
Diabetes is caused worldwide due to contributing factors like increasing urbanization, aging populations, increasing obesity, and falling levels of physical activity. In 2000, the number of people with diabetes worldwide was ~ 171 million, with India, China, and the United States having the highest numbers of people with diabetes. (1). In India, the epidemiological data shows an upward trend in the diabetic population, rising from 33 million in 2000 to 57 million in 2025. (2) Diabetes is a chronic disease which is characterized by hyperglycaemia, with disturbances in carbohydrate, fat, and protein metabolism which results from defects in insulin secretion and/or insulin action. Diabetes can be classified into two major classes : Type 1 diabetes (the classical form of diabetes and these people cannot survive without insulin treatment) and Type 2 diabetes. Like Type 1 diabetes, Type 2 diabetes also involves both genetic susceptibility and environmental factors, although the genetic component may be greater in Type 2 than in Type 1 diabetes. It is caused by a combination of insulin resistance and relative insulin deficiency, with increased hepatic glucose production. It is important to note that some individuals predominantly experience insulin resistance and others experience insulin deficiency. Insulin resistance is generally thought to precede insulin deficiency. (3) Type 2 diabetes is a heterogeneous group of conditions that constitute ~ 90% of the diabetes cases in India. Although Type 2 diabetes is common and tests to screen for and diagnose it are widely available, the disease remains underdiagnosed. (4) Approximately 25% of the people with a new diabetes diagnosis already have microvascular disease, suggesting that they already have had the disease for 4–7 years by the time of the diagnosis.
(5),(6) In these patients, with earlier disease identification and the intensive treatment of hyperglycaemia, the risk for microvascular complications can be reduced.(7),(8),(9) Hence, the present study was undertaken to investigate the role of the biochemical parameters in the prediction of the microvascular complications in Type 2 diabetes patients.
This study was conducted in the Department of Biochemistry, NRI Medical College and General Hospital, Guntur district, Andhra Pradesh. Fifty Type 2 diabetic patients who visited the out-patient and in-patient departments and 30 healthy individuals who came for general checkup which were considered as the controls were included in the study. The fifty Type 2 diabetic patients were divided into 2 groups based on the duration of diabetes mellitus and the presence and absence of the diabetic complications. The groupwise distribution of the subjects was as follows: Group- I: 30 healthy control subjects; Group-II: 36 Type 2 diabetes mellitus patients with microvascular complications (retinopathy, neuropathy, nephropathy); Group-III: 14 Type 2 diabetes mellitus patients without microvascular complications. All the patients, including the controls, were fully informed about the purpose, the procedures and the hazards of the study. After taking voluntary informed consent, all the subjects were screened for the inclusion criteria (male and female Type 2 diabetes mellitus patients with and without complications, who were aged between 35-65 years). Two types of cases were included in the study, based on the duration of the disease. The duration from the first diagnosis before 5 years anda(f2te)r 10 years duration from the firs(t3 d) iagnosis of diabetes mellitus. The control group included non-diabetic healthy volunteers who were consistent with the patients according to the age and the exclusion criteria (Patients with secondary hyperglycaemic states like hypothyroidism, proteinuric conditions like congestive cardiac failure, renal failure and proven renal diseases, eye disorders before the onset of diabetes mellitus and pregnancy were excluded from the study).
Five millitres of fasting venous blood was collected from all the above-mentioned groups. The samples were centrifuged, separated and stored at 4°C until analysis. The blood samples were analyzed for fasting blood sugar, serum creatinine, blood urea nitrogen and lipid profile. For glycosylated haemoglobin estimation, EDTA blood samples were used.
Fasting blood sugar was investigated by the glucose oxidase method, serum creatinine by Jaffe’s method, cholesterol by the oxidase/peroxidase (CHOD–POD) method, triglycerides by the enzymatic GPO–POD method, high density lipoprotein by phosphotungstate precipitation and CHOD–POD, glycosylated haemoglobin (HbA1c) by the cation exchange resin method and microalbumin levels in the urine sample by using the turbilatex method. Retinopathy was tested by using the Direct Fundoscopic Method. Peripheral neuropathy was tested by using the Joint and Position Sense Method.
Statistical analysis was carried out by the Student’s ‘t’ test by using microtab-2 software and the p values which were < 0.05 were considered as significant.
Diabetes is the leading cause of renal failure and adult blindness in developing countries, which affects the small vessels such as those supplying the retina, nerves and the kidneys. With this background, a case-control study with a total of fifty proven cases of Type 2 diabetes and thirty controls (healthy subjects) were considered to assess the role of biochemical markers in the prediction of the microvascular complications and to describe the correlation between glycosylated haemoglobin and the progression of the complications in Type 2 diabetic patients, with an assessment of the micro-albumin levels in urine. The following findings were observed in this study.
(Table/Fig 1) shows the comparison of the biochemical parameters between the controls (n=30, group I) and the cases with diabetes (n=50, group II and III). There was a significant increase in fasting blood sugar (at the p<0.001 level), glycosylated haemoglobin (at the p<0.001 level), blood urea nitrogen (at the p<0.05 level), microalbumin (at the p<0.001 level), total cholesterol (at the p<0.01 level) and decreased high density lipoprotein (at the p<0.05 level) values in cases with diabetes (group II and III) as compared to those of the controls (group I).
Blood urea nitrogen, serum creatinine and the microalbumin levels were significantly increased in group II as compared to group III (Table/Fig 2). But there was no significant elevation of the lipid profile levels. (Table/Fig 3) shows the significant difference (at the p<0.05 level) between blood urea nitrogen, serum creatinine, total cholesterol and the triglyceride levels in cases with retinopathy as compared to the cases without retinopathy.
Out of the 50 cases (Group II and III) which were studied, 36 cases showed microvascular complications such as retinopathy, neuropathy, and nephropathy. The occurrence of microvascularcomplications i.e. progression of microalbuminuria, increased in the patients with poor glycaemic control. The glycosylated haemoglobin (HbA1c) levels significantly (p<0.01) increased in the microalbuminuric cases as compared to the normoalbuminuric cases (Table/Fig 4).
The incidence and the progression of the microvascular complications increased with a longer duration of diabetes. Twenty five patients with the duration of Type 2 diabetes mellitus from the firstdiagnosis before 5 years and twenty five patients after 10 years of duration from the first diagnosis of diabetes mellitus were studied. Of these, 13 cases had microvascular complications with less than 5 years of diabetes duration, and 23 cases had microvascular complications with more than 10 years of diabetes duration.
Diabetes mellitus is a global problem, with approximately 150 million diabetic patients. This chronic condition poses a five times greater risk of developing micro vascular complications, mainly nephropathy and it has become the leading cause of end stage renal disease. NIDDM (Non insulin dependent diabetes mellitus) is a chronic degenerative disease and poses major challenges to the public health (10).
In this study, the role of biochemical markers (such as glycosylated haemoglobin, microalbuminuria, blood urea nitrogen, fasting blood sugar, total cholesterol,triglycerides and high density lipoprotein) were found to be significant in the prediction of the micro vascular complications in diabetic patients. The severity of retinopathy and neuropathy was related to the longer duration of diabetes and the high levels of glycosylated haemoglobin. The incidence of retinopathy was significantly increased with the duration of the diabetes mellitus and it was associated with a poor glycaemic control. Similar results were reported by Gaede et al (1999) (11) and Klein et al (1996) (12).
In the present study, the progression of microalbuminuria was associated with the duration of diabetes and a poor glycaemic control (p<0.01). Similar results were observed by Mogensen and Christensen (1984) (13). In a study by Viberti et al (1982) (14), an increased rate of albumin excretion predicted the impairment of renal function in patients with diabetes. Similar findings were observed by Varghese et al (2001) (15), who reported that the duration of diabetes and retinopathy were the major risk factors for microalbuminuria and that HbA1c was also associated with microalbuminuria, which was consistent with the findings of the present study.
It was observed that the longer duration of diabetes was one of the predictors of the diabetic microvascular complications in the present study. Przegl Lek et al (2002) (16), observed that the most important predictor for all forms of neuropathy was the duration of diabetes. In a study which was carried out by Porta et al (2001) (17) of the EURODLAB Prospective Study Group, the metabolic control and the duration of diabetes were found to be strong indicators ofthe progression to proliferative retinopathy.
In the present study, elevated levels of total cholesterol and triglycerides and decreased HDL levels were observed in the cases with complications. This was also observed in the studies which were carried out by Tuttle et al (1999) (18) and Ravid et al (1998) (19).
Thus, this study concluded that poor glycaemic control, a longer duration of diabetes, dyslipidaemia and the progression of microalbuminuria can predict the microvascular complications in patients with Type 2 diabetes mellitus.
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