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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
Microalbuminuria in Non-diabetic, Non-hypertensive Myocardial Infarction in South Indian Patients with Relation to Lipid Profile and Cardiac Markers
Correspondence Address :
Dr.B.K.Manjunatha Goud
Asistant Professor of Biochemistry
Ras Al Khaimah Medical and Health Sciences University, Ras Al
Khaimah, U.A.E-11172
Mobile:+971554195204
E-Mail:drmanjunathag@gmail.com
Introduction and Objective: The present study was carried out to compare the levels of urinary microalbumin, the lipid profile, the cardiac enzymes and troponin T in non-diabetic, non-hypertensive myocardial infarction patients and in healthy controls and to know the possible relationship between microalbuminuria and the lipid profile markers and the cardiac enzymes in myocardial infarction in patients from the southern part of India.
Materials and Methods: This study was carried out in 35 nondiabetic, non-hypertensive myocardial infarction patients and in 35 healthy, age matched controls. Urinary albumin, urinary creatinine, creatinine kinase-MB fraction (CK-MB), AST, LDH, troponin I and the lipid profile parameters were estimated by using an automated analyzer. The total cholesterol/HDL cholesterol ratio and the LDL cholesterol/HDL cholesterol ratio were also calculated by using the total cholesterol and the LDL and HDL values.
Results: There was a significant increase in the levels of total cholesterol, LDL cholesterol, total cholesterol/HDL cholesterol ratio, LDL cholesterol/HDL cholesterol ratio, microalbumin, cardiac enzymes and troponin I (p<0.001) in patients with myocardial infarction as compared to those in the healthy controls. On applying Pearson’s correlation, the microalbumin levels were found to correlate positively with the LDL cholesterol levels (p = 0.010, r = 0.952) and Troponin I (p=0.025, r = 0.885) and this was found to be statistically significant.
Conclusion: Microalbuminuria can be used as a predictor for the early detection of cardiovascular and renal changes along with the lipid profile markers in the general population to prevent the mortality and morbidity which are associated with acute myocardial infarction
Microalbuminuria,Myocardial infarction, lipid profile
Introduction
Acute myocardial infarction (AMI) is one of the commonest diseases amongst hospitalized patients in industrialized countries. The mortality rate of AMI is approximately 30% and for every 1 in 25 patients who survive the initial hospitalization, dies in the first year after AMI (1). Indians are four times more prone to AMI as compared to the people of other countries due to a combination of the genetic and lifestyle factors that promote metabolic dysfunction. The risk of cardiovascular disease is predicted by various factors such as age, sex, smoking, hypertension and dyslipidaemia. In most of the cases, the cardiovascular changes are detected only after a person exhibits the classical symptoms and the signs of acute myocardial infarction. This clearly indicates the need for a marker which can detect the risk of cardiovascular changes in the early stages, so that an effective prevention can be made possible.
Microalbuminuria (MA) is defined as the urine albumin to the urine creatinine ratio (UACR) of 30-300 mg/G of creatinine (2). Microalbumiuria is considered to be a predictor of early renal damage in patients with diabetes mellitus. Previous studies have shown that MA is associated independently with cardiovascular morbidity and mortality in diabetic and hypertensive patients (3),(4),(5),(6),(7),(8). Accordingly, the national and international guidelines recommend the screening for MA in patients with diabetes or hypertension (9),(10),(11).
It is less clear, however, whether the screening for MA should be extended to the general population or to individuals who are at alower risk for cardiovascular disease (CVD), such as nondiabetics or non-hypertensives. Investigators have postulated that MA may be a marker of risk, even in apparently healthy people, because it reflects vascular damage in the kidneys and in the systemic endothelial dysfunction (12),(13), (14). As Indians are at a high risk for the development of cardiovascular events, it clearly demands the importance of cost-effective markers for the detection of the early cardiovascular changes.
The present study was undertaken to measure the levels of microalbumin with the cardiac enzymes and the lipid profile parameters in non-diabetic, non-hypertensive acute myocardial infarction patients, to know the relationship between MA and the lipid profile parameters and to compare their levels with those of the healthy controls.
This study was carried out on patients who were admitted to the Cardiology Department, Kasturba Hospital, Manipal. The study group consisted of 35 patients with AMI and an equal number of age and sex matched controls were also included. The mean age of the patients was 59 ± 10 years and that of the controls was 52 ± 10 years. They were diagnosed to have AMI according to the clinical criteria; chest pain which lasted for up to 3 hours, ECG changes (ST elevation of 2mm or more in at least two leads), with elevated cardiac markers. Patients with a history of diabetes,h(y2p)ertension, systemic infection, (u3r)inary tract infection, arthritis, nephropathy (serum creatinine >1.0mg/dl), AMI following surgery and major trauma were excluded from the study.
After obtaining an ethical clearance from the institutional ethical committee, informed consent was obtained from all the subjects who were involved in the study. 5ml of blood samples were drawn into plain vacutainers from the antecubital vein of all the patients. Similarly, samples were also obtained from age and sex matched healthy controls. Early morning mid stream urine samples were collected under strict aseptic precautions. Fasting lipid profile, creatinine kinase MB isoform, aspartate transaminase, lactate dehydrogenase, troponin I and microalbumin levels were determined by using an automated analyzer, Hitachi 912, after proper processing and in accordance with the manufacturer’s instructions. The total cholesterol: HDL cholesterol ratio was calculated by dividing the HDL cholesterol values from the total cholesterol values. The LDL: HDL ratio was calculated by dividing the HDL values from the LDL values.
Statistical analysis
The results were expressed as mean ± standard error of the mean (SEM). p values which were <0.05 was considered to be statistically significant. Statistical analysis was performed by using the Statistical Package for Social Sciences (SPSS-16, Chicago, USA). The ‘independent sample t test’ was used to compare the mean values. Pearson correlation was applied to correlate between the parameters.
As depicted in (Table/Fig 1), there was a significant increase in the levels of total cholesterol, LDL cholesterol, total cholesterol/ HDL cholesterol ratio, LDL cholesterol/HDL cholesterol ratio, microalbumin, cardiac enzymes and troponin I (p<0.001) in patients with myocardial infarction as compared to those in the healthy controls. On applying Pearson’s correlation, the microalbumin levels were found to correlate positively with the LDL cholesterol levels (p = 0.010, r = 0.952) and Troponin I (p=0.025, r = 0.885) and this was found to be statistically significant.
In line with previous studies, we found a significant rise in the cardiac enzymes CK-MB, AST, LDH and troponin I in AMI patients. After infarction, the enzymes leak from the cytosol due to myocardial tissue injury. We found a significant increase in the total cholesterol, LDL cholesterol, the TC/HC ratio and the LDL/HDL ratio. LDL has an important role in the transport of cholesterol from the liver to the peripheral tissues. Previous studies have shown that elevated LDL levels increased the risk for the development of atherosclerosis. LDL cholesterol undergoes oxidation due to various factors and oxidized LDL plays a key role in the initiation and development of atherosclerotic plaque in the coronary arteries (15). An original paper described that the increase in the LDL/HDL ratio was a better indicator of the atherogenic tendency (16) and this was in agreement with our study, which also found an increase in the LDL/ HDL ratio. The total cholesterol/HDL cholesterol ratio can further confirm the atherogenic risk, which was evident in our study group in comparison with the healthy controls.
Previous studies have shown the increase in the microabumin levels in diabetic and/or hypertensive patients and also in non diabetic and non hypertensive patients. Several studies have shown that microalbuminuria is a good predictor of early renal damage and this helps to initiate preventive measures for renal damage (17). In agreement with previous studies, we found a significant increase in the microalbumin levels in patients with AMI as compared to those in healthy controls. This may be due to dyslipidaemia induced renal glomerular damage or in some cases, due to ischaemia and reperfusion.
In comparison to earlier studies, we found a positive correlation between microalbuminuria and cardiac troponin I, which was statistically significant. A positive correlation may indicate that the extent of microalbumiuria is proportional to the size of the infarct and the severity of the coronary artery damage. Similarly, we found a positive correlation between microalbuminuria and LDL cholesterol and total cholesterol, which was statistically significant. A positive correlation between the atherogenic lipid profile parameters and microalbuminuria clearly indicated the role of the latter in the development of atherosclerosis. However, the exact mechanism of the accelerated atherosclerosis in microlabuminuria is not clear. Abnormal vasodilatation, endothelial dysfunction, inflammation andabnormal coagulation may be involved in this process.
In conclusion, microalbuminuria can be used as a predictor for the early detection of cardiovascular renal changes along with the lipid profile markers in the general population, to prevent the mortality and morbidity which are associated with acute myocardial infarction. However, due to its non- specific nature, there should be proper selection criteria, so that it can be used as an effective screening tool in the general population.
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