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

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On Sep 2018




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On Aug 2018




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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.
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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.
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Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

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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.
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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

Important Notice

Original article / research
Year : 2011 | Month : November | Volume : 5 | Issue : 6 | Page : 1161 - 1164

Lp (a), Uric Acid, Oxidants and Antioxidant Vitamins in Type 2 Diabetic Patients without Cardiovascular Complications

Suchitra MM , Pallavi M, Shivaprasad P, Sachan, A Madhusudhana Rao A, Aparna R. Bitla, Srinivasa Rao P.V.L.N

Associate Professor, Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati. Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati. Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati. Associate Professor, Department of Endocrinology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati. Research Scholar, Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati. Associate Professor, Department of Biochemistry, Sri VenkateswaraInstitute of Medical Sciences (SVIMS), Tirupati. Professor and HEAD, Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati.

Correspondence Address :
P.V.L.N.Srinivasa Rao
Professor & Head of Department of Biochemistry
Sri Venkaterswara Institute of Medical Sciences (Svims)
Tirupati-517507, Chittor (District)
Andrapradesh, India, Ph: +91 9493547663
E-mail: seenupvln@yahoo.Com

Abstract

Introduction: Type 2 diabetes mellitus patients have increased morbidity and mortality as compared to the general population, particularly with respect to coronary heart disease (CHD), possibly due to increased oxidative stress and dyslipidaemia, and recent data suggest that elevated levels of lipoprotein (Lp) (a) and uric acid (UA).

Methods: The present study included 60 type 2 diabetic patients without any cardiovascular complications and 60 age and sex matched healthy subjects as the controls. The serum levels of lipids, lipoproteins, lipoprotein (a), oxidants and antioxidant vitamins in the type 2 diabetic patients and in the healthy controls were estimated.

Results: The Lp (a), UA, lipid peroxide (LPO), total cholesterol, triglyceride and low-density lipoprotein cholesterol (LDL-C) levels were significantly elevated, while the vitamin C and E levels were significantly lowered in the diabetic patients as compared to those in the controls (p<0.05). In the correlation analysis, lipid peroxide was found to be negatively correlated with vitamin C and E (r = 0.52, p=0.0010, r = -0.49, p=0.0019) and to be positively correlated with uric acid (r = +0.31, p=0.0246) in the diabetic patients. In the ROC curve analysis, significant areas under the curve (AUC) were obtained for lipoprotein (a) (p<0.01), uric acid (p<0.05) and lipid peroxide (p<0.05).

Conclusion: The study showed significantly elevated Lp (a) and uric acid levels in the type 2 diabetic patients without any vascular complications, thus indicating that their measurement, along with the other routine investigations in the type 2 diabetics, may facilitate the early identification and the interventions for patients who were prone to cardiovascular complications.

Keywords

Type 2 diabetes mellitus; Oxidative stress; serum uric acid; Lp (a); antioxidants; CVD risk factors

Introduction
The incidence of diabetes mellitus has been rapidly increasing in most of the industrialized and many developing countries during the last thirty years and the trend is continuing. Currently, India has 40.9 million people with diabetes and the projected estimate for the year 2025 is 69.9 million (1). The morbidity and mortality is higher in patients with type 2 diabetes due to the cardiovascular complications and the risk of atherosclerotic coronary artery disease (CAD) is increased by 2-4 fold in the type 2 diabetics (T2DM) (2).

Oxidative stress, as well as defects in the antioxidant defense systems, have been recognized as the causative factors for the development of the major diabetic complications (3), (4). An enhanced oxidative stress has been observed in the T2DM patients, as has been indicated by the increased lipid peroxidation (5) and the diminished antioxidant status (6). Similarly, diabetes induced disturbances in the lipid profile is responsible for the increased incidence of atherosclerosis; a major complication of diabetes mellitus (5). Though diabetic dyslipidaemia and the oxidant and the antioxidant status in the diabetic patients were characterized extensively; the data on the mean levels of Lp (a) in these patients are quite contradictory (7), (8) and conflicting reports are available regarding the oxidant and antioxidant status in patients of T2DM without any cardiovascular complications.

Similarly, this has been a matter of debate for a few decades, since hyperuricaemia has been presumed to be a consequence of insulin resistance rather than its precursor and has been presumed to be associated with oxidative stress to be related to the development of the complications in diabetes (9). Although, much of the literature addresses the association of hyperuricaemia, hypertension, anddiabetes, the levels of uric acid (UA) in the serum of the T2DM patients still are under scrutiny and their relationship with other cardiovascular risk factors and oxidant/antioxidant indicators remains unclear.

Hence, this study was designed to determine the Lp (a) and the uric acid levels along with the lipid profile and the oxidative and the antioxidant status in diabetes mellitus patients without any vascular complications as compared to the subjects in the normoglycemic group. Further, this study evaluates their association with each other and the diagnostic utility of Lp (a), LPO and uric acid in the T2DM patients.

Material and Methods

Subjects: The study was conducted on successive patients after an informed consent was obtained from them and after it was approved by the Institutional Human Ethics Committee. The study group consisted of sixty (60) patients with type 2 diabetes mellitus; who were aged 39-76 years, without any history of angina or myocardial infarction. All had normal electro cardiograms and cardiac stress tests. The diagnosis of NIDDM was based on the criteria of the World Health Organization study group on diabetes i.e., fasting plasma glucose ≥140 mg/dl, 2-h post-glucose load ≥200 mg/dl, or two random plasma glucose values >200 mg/dl. The diabetic patients were normotensive, without a secondary cause of hyperglycaemia and on treatment with only insulin. They did not have any other complications of diabetes. The control group consisted of sixty (60) age and sex matched healthy individuals with normal glucose tolerance tests and the absence of the history of any vascular disease (myocardial infarction, stroke, or intermittent claudication). All the patients and the healthy controls

w(2e)re non-smokers and non-alco(3h)olic. Diabetic patients who received allopurinol, nutritional supplements, oral hypoglycaemic agents or other antioxidant therapy were excluded from the study.

Sample collection Venous blood samples were collected from both the patients and the control subjects in the fasting state (for 12 hours) into three sterile plastic tubes; the first was treated with EDTA, the second with heparin and the third was left to clot, to separate the serum, which was collected by centrifuging the blood at 4000 rpm for 15 minutes at room temperature. Both the plasma and serum was stored at –80°C until the assays were performed.

Laboratory analysis:
Plasma glucose was estimated by the glucose oxidase-peroxidase method by using a kit. Serum total cholesterol, triglycerides (Tgl) and high density lipoprotein cholesterol (HDL-C) were estimated by using commercially available kits and a Beckman Synchron CX9 auto analyzer. The low density lipoprotein cholesterol (LDL-C) and very low density lipoprotein cholesterol (VLDL-C) concentrations were calculated by using Friedewald’s Formula. Vitamin E was measured by the method of Baker et al (1980) (10) and vitamin C was measured by the method of Roe and Kuether (1943) (11). Lipid peroxide was assayed by using thiobarbituricacid acid reactive substances (TBARS) by a spectrophotometric method (12). Lp (a) and uric acid were assayed by using a Beckman Synchron CX9 auto analyzer by using commercially available kits which were based on an immunotrubidimetric method (Daiichi Pure chemicals, Japan) for Lp (a) and uricase and on the peroxidase principle for uric acid.

Statistical Analysis:
All the values which were obtained were expressed as mean and standard deviation (SD). The Mann Whitney U test was applied to compare the difference in the means between the controls and the study group. The correlation between the variables was studied by using Spearman’s rank sum test. The differences were considered as significant if the p value was <0.05. All the analysis was carried out by using the SPSS statistical software package (Version 11.5).

Receiver Operating Characteristics (ROC) Curves: Receiver operating characteristics (ROC) were used to discriminate the positive from the negative results. The area under the curve (AUC) can range from 0.5 to 1 and the diagnostic test that approaches 1 indicates a perfect discriminator.

Results

The clinical characteristics of the study group are shown in [Table/ Fig 1]. The study groups were age and sex matched. Fifty three (53) % of the diabetic patients had a family history of diabetes. In comparison with the control subjects, the diabetic patients had higher BMIs (p<0.05). As expected, the diabetic patients had higher blood glucose and HbA1c values as compared to the controls (p<0.05). The increased HbA1c reflected the poor metabolic control of the patients.

(Table/Fig 2) summarizes the lipid profile of the controls and the type 2 diabetes mellitus patients. The levels of total cholesterol and triglycerides and the LDL-C levels were significantly increased in the diabetic patients than in the controls (p<0.05). On the other hand, the levels of HDL-C were significantly decreased in the diabetic patients as compared to the controls. The Lp (a) levels were significantly higher in the diabetic patients without cardiovascular complications than in the healthy controls (p<0.05).

(Table/Fig 3) illustrates the levels of lipid peroxide and uric acid and the antioxidant status in the controls and in the diabetic subjects. The extent of the lipid peroxidation was significantly increased in the diabetic patients as compared to the healthy controls (p<0.05). The levels of vitamin C and vitamin E were significantly lowered in diabetics as compared to the healthy controls (p<0.001).

(Table/Fig 4) shows the correlation between the variables. In the correlation analysis, a significant positive correlation was found between LPO and uric acid (r= +0.31, p= 0.0246), while a significantnegative correlation was found between LPO and vitamin C and vitamin E (r= –0.52, p=0.0010, r=–0.49, p=0.0019) in the study group. Further, a significant positive correlation was observed between Lp (a) and LPO (r=0.43, p= 0.0026) in the diabetic patients. Similarly, a significant positive correlation was observed between BMI and HbA1c (r= 0.39, p=0.0102, r=0.40, p=0.0038) in the type 2 diabetics. There was no significant correlation of the antioxidants with uric acid and the other parameters in the study.

The diagnostic accuracy of the individual risk factors were assessed by the receiver operating characteristic (ROC) curve analysis which revealed the significant area under the curve (AUC) for Lp(a), Uric acid and LPO, as depicted in (Table/Fig 5), with Lp(a) having a more significant AUC (0.867, p<0.01), followed by uric acid (0.775, p<0.05) and LPO (0.739, p<0.05).

Discussion

Diabetes mellitus has been known to be a state of excess generation of free radicals which are contributed by several mechanisms, including hyperglycaemia and a defective antioxidant status, which causes oxidative stress. The data of the present study revealed a depleted level of the extracellular antioxidant status in the type 2 diabetics, regardless of any complications, in favour of an oxidative stress in such patients. These results were in agreement with those of previous studies (4), (13), which demonstrated a strong association between poor glycaemic control and the depletion of the protective antioxidant defence mechanisms in diabetes mellitus. In the present study, all the diabetic patients were poorly controlled, as was indicated by their high glucose and HbA1C levels. In addition to this, dyslipidaemia, which we observed in the present study, was in agreement with the findings of other studies (5), (14). These findings are not surprising, because long-term hyperglycaemia causes generalized vascular endothelial damage, which reduces functional lipoprotein lipase, leading to an increase in Tgl and a decrease in HDL-C (14).

The studies on Lp (a) are quite significant and show a higher incidence of coronary artery disease (CAD), with elevated Lp (a) levels in T2DM. Solfrizzi et al (2002) (15) suggested that the elevated Lp (a) levels did not appear to be an independent predictor of CAD, but that they were a risk factor only in the subjects with type 2 diabetes. In the present study, the Lp (a) levels were found to be significantly higher in the study group than in the controls. However, the mean plasma Lp (a) levels were still in the normal range in the study group. This observation was in agreement with the findings of Singla et al (2009) ((16) who reported that there was a strong association between the Lp (a) levels and T2DM. Heller et al (1993) (17) suggested that hyperinsulinaemia could be a causal factor for the increase in the Lp (a) levels in T2DM. Similarly, Wolffenbuttel et al (1993) (18) also reported that the Lp (a) levels were elevated in diabetics as compared to the non-diabetic subjects of similar age. They also reported that the changes in insulin had no correlation with the degrees of metabolic control and the changes in the Lp (a) levels. However, it was not possible to draw a definite conclusion on this finding with our results, as we had not measured the effect of glycaemic control on Lp (a). However, higher Lp (a) levels were found to be associated with the diabetic complications, which could further enhance the cardiovascular complications (19) and hence, lower the Lp (a) levels should be considered in type 2 diabetic patients without cardiovascular complications.

So far, the studies on uric acid suggest that uric acid is a plasma antioxidant, followed by vitamin C which stabilizes it in plasma and protects it from oxidation (20). However, the antioxidant property of uric acid has been questioned by recent studies in the exacerbated oxidative state of diabetes and they have demonstrated that uric acid could be related to the development of diabetes. In the present study, we found significantly elevated levels of serum uric acid in the T2DM patients without cardiovascular compilations. Nieto et al (2000) (21) reported that an increase in the serum uric acid in the T2DM patients might therefore reflect a compensatory mechanism to counter the oxidative stress that occurs in these conditions. However, a high level of uric acid does not confer protection and patients with elevated uric acid levels have a greater risk of developing cardiovascular events (22). Similarly, Corry et al (2008) (23) also suggested that uric acid, although it is one of the major antioxidants in the circulation, can induce oxidative stress in a variety of cells, including the vascular smooth muscle cells and thus, mediate the progression of cardiovascular disease (24). A positive association with lipid peroxide which was observed in the present study, may imply that though uric acid was a major plasma antioxidant in the circulation, followed by vitamin C, it could become a strong pro-oxidant in the diabetic state and could be associated with increased free radical formation and lipid peroxidation (20).

It is important to recognize the associations between these risk factors as these do not function in isolation. The association between the parameters which were assessed in this study showed a significant negative correlation of LPO with vitamins C and E, which indicated the depleted antioxidant status with an increased state of oxidative stress (13). Correspondingly, a significant positive correlation of uric acid with LPO and its negative correlation with the antioxidant vitamins may predict a pro-oxidant activity of uric acid apart from its antioxidant property (20) and its association with oxidative stress (9).

From the present study, it may be concluded that type 2 diabetes mellitus without any cardiovascular complications shows significantly elevated Lp (a) and uric acid levels. Further, this study also revealedthe importance of assessing Lp (a) and uric acid in these patients, in addition to the markers of oxidative stress, the antioxidant status and the lipid profiles to enable the formulation of specific therapies for an early intervention and a better management of the disease. However, a major limitation of the present study was the small study population, which warrants further cross-sectional studies by using a larger sample size.

References

1.
International Diabetes Federation (IDF). Diabetes Atlas, 3rd ed., 2007.
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