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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 prevalence of the elevation serumalanine aminotransaminase at Gorgan in northern Iran
Correspondence Address :
Dr. Azad Reza Mansourian, Biochemistry and metabolic Disorder
research, Golestan university of medical sciences, Gorgan-IRAN.
E-Mail: azad_r_mansourian@yahoo.com
The elevation of serum alanine aminotranferase levels is associated most commonly with some forms of liver diseases. The aim of this study was to determine the prevalence of elevated serum alanine aminotransferase levels and the possible liver damages in this region.
This was a clinical laboratory based study. The data was obtained from the Danesh Medical Diagnostic Laboratory at Gorgan in northern Iran. The aminotransferase activity was measured by the pyridoxal -5-phsphate reaction. Values over 31 and 41 U/L were considered as indicative of elevated enzyme activity in females and males respectively.
The findings of this study indicated that 16% of our populationin general and of those who were aged 18-40 years in particular, had a form of liver disorder due to elevated enzyme, with a higher incidence among the female subjects, which seemed to be slightly higher than that reported by other studies earlier. The incidence was slightly higher among females.
It seemed that high proportions of people (16%) in this region had an elevated serum enzyme activity of alanine aminotranferase and according to well-documented reports, it might probably be associated with non-alcoholic fatty liver disease. A comprehensive study is recommended to elaborate carefully the state of liver diseases in this region of Iran.
alanine aminotranferase, liver disease, Iran
Alanine transaminase(ALT) is an enzyme which is present mainly in the liver and the status of this enzyme predicts the liver function. ALT is one- of the best markers whose levels can be evaluated to assess the liver damage, and the serum elevation of ALT is mostly clinically significant for the diagnosis of liver lesions such as hepatitis bile duct disorder. This enzyme is predominantly found in the liver and also the kidney, heart and pancreas contain smaller amounts of this enzyme, which is accompanied by ALT elevation within the blood. Any damage to the liver is accompanied by ALT elevation within the blood. Another enzyme, aspartate aminotransferase is usually simultaneously assessed, although the proper biochemical tests for the detection of liver damage include the evaluation of alkaline phosphatase lactate dehydrogenase (LDH) and bilirubin. Due to the high specificity of ALT, its serum activity is usually assessed for the diagnosis of a wide variety of liver lesions, particularly cirrhosis and hepatitis.
In case of the serum elevation of bilirubin, the measurement of the ALT activity can help to diagnose whether the bilirubin elevation is due to blood or liver diseases. The determination of the ALT activity can also be used to follow up any liver damage which can occur due to some medication which was prescribed by clinicians in order to prevent the artherosclerosis which is caused by elevated cholesterol levels within the blood circulation.
Although ALT is a liver specific enzyme and is well recommended, alkaline phosphatase and creatine kinase have to be measured to distinguish liver cell damage versus biliary duct or myopathy lesions. Liver damage and particularly, chronic liver damages such as fatty liver of non-alcoholic origin and viral hepatitis, occur in people all over the word (1).
The activity of serum ALT is mostly measured to evaluate the liver damage (2), (3), although liver biopsy is an excellent method to diagnose the liver damage confidently. But, due to the invasivenature of this method, it cannot be used for a population based study and therefore, the serum ALT measurement can be a useful method to evaluate the liver damage (4). On the basis of the above facts, the present study was carried out at Gorgan in northern Iran to find out the prevalence of ALT elevation with the subsequent estimation of liver diseases in this region of Iran.
The ALT data of the sample population for this present study were collected from patients who were referred to the Danesh Medical Diagnostic Laboratory at Gorgan which is located in northern Iran. In this study, the data of 573 subjects, who were referred to the above laboratory during one year (2009-10), was obtained. On collecting the data on the serum ALT activity, each patient’s name was replaced with a code name to maintain the anonymity of the patients.
ALT is a liver enzyme which is elevated during the occurrence of liver lesions and is released into the blood circulation. Its activity can subsequently be determined by laboratory methods. The determination the ALT activity in this study was based on IFCC without the addition of pyridoxal-5-phosphate. ALT catalyzes the following reaction: L-Alanine+ 2-Oxyglutarate ---------- → L-Glutamate+Pyruvate which is a reversible reaction.
Pyruvate+ NADH+ H ------- → L-Lactate + NAD The reference ranges of ALT in this method were < 31U/L and<41 U/L for females and males respectively and the ALT values above these figures were considered as elevated ALT activity (5).
In this study, 93 persons (52 females and 41 males) out of 573 subjects who were referred to the Danesh Medical Diagnostic Labora-tory showed elevated ALT levels, which may have been associated with some sort of liver damage (4), although there were contradictory reports in this area of research. The ALT elevation cannot be accepted universally as a marker for assessing liver damage. In this study, the patients were divided into 4 major groups. Out of 93 patients (5),subjects in the age groups of <18, 18-40, 40-65, >65 years had elevated ALT levels. The gender prevalence among the various age groups were as follows (3,2), (29,41), (7,6) and(2,3) males and females respectively. The lowest incidence of the ALT elevation was observed among the <18 and >65 year age groups (5%). The 18-40 years age group showed the highest prevalence (75%), which was slightly higher among females than among the males (78% verses 70%). The age group of 40-65 years showed an elevated (14%) ALT prevalence. On the whole, a total of 93 out of 573 patients showed an elevated ALT prevalence (16%), which was slightly higher than that which was seen in some other studies (4).
The demographical characteristics of this part of Iran are as follows: This area consists of a cosmopolitan society of different races and ethnic groups. The diet mostly consists of fatty foods which are mainly fried in cooking oils of an unsaturated nature and are baked in general, although in recent years, the unsaturated start to have a good place but those of about 40 years of age already had enough fat. This is mainly an agricultural region and generally the level of education is good as a whole, but some people with higher education also reside in this region. The men and women participate in sports, but it seems, most men they do the practice. This region is also located at the south east of the Caspian sea, and consists of forests and agricultural lands and so, herbicides are used there occasionally. (Table/Fig 1)
In our study, we also found that the ALT elevation correlated with age, but not with the increasing chronological age among the middle age group of 18-40 years. We found that the prevalence of the ALT elevation was slightly higher among the female patients. In our study, we found that except for the <18 years age group, the prevalence of ALT was inversely correlated with the chronological age as follows: 12%, 2.2% and 0.9% for the 18-40, 40-65, and >65 years age groups respectively
We argue that it is advisable that the ALT measurement among the 18-40 years age group should be followed by further careful paramedical examinations to confirm the high prevalence of the ALT activity and its association with liver diseases.
ALT has been considered as a specific enzyme which is related to liver disease. The simultaneous determination of ALT and asparate aminotransferase (AST) can be useful in the differential diagnosis of heart and muscle versus liver damages. Although ALT is a liver specific enzyme, it has been well recommended that alkaline phosphatase and creatine kinase should also be measured to distinguish liver cell damage versus biliary duct or myopathys lesions. Liver damage and particularly chronic liver damages such as fatty liver of non-alcoholic origin and viral hepatitis are involved in people all over the word (1). Our findings from this study indicated that the ALT activity was most prominently elevated among the 18-40 years age group. We also may simultaneously argue that perhaps this latter age group was most frequently visited by the clinicians.
and as this study was not a population –based study and as the elderly and children did not consist of a large sample size, we cannot argue for sure that the liver disorder was predominantly seen among the middle age group of upto 40 years of age. This can be considered as a limitation of our study.
Considering the cost- effectiveness of any laboratory test, ALT has been accepted as the best single enzyme test for the prediction of liver damage and as the first step of any multiple enzyme measurement or other para- clinical tests (5). It should be also mentioned that the ALT/AST ratio is a valuable index in the differential diagnosis of minor or sever chronic liver damage if the latter ratio is less than one or more than one respectively. There are many reports on the role of ALT in assessing liver function and hence, the measurement of ALT has been widely applied in the determination of fatty liver damages which are accompanied by other disorders (6). Although ALT measurement is commonly considered to be a result of fatty liver damage, other organ abnormalities such as type-2 diabetes may also exist (7).
In the real sense, it seems that the ALT/AST ratio which is widely used to evaluate the severity and prognosis of the damage which is done to the liver and the clinical utility of the ratio has extensively been studied (8), (9). ALT elevation can most probably be associated with liver malfunction. It seems that there is some intervention by some other factors such as insulin resistance and its related factors such as obesity and elevated triglycerides which can manipulate the usefulness of ALT elevation, in the clear cut diagnosis of liver damages. The non-alcoholic fatty liver seems to be at the top of the ALT elevation and it might be correlated with the latter disorder. The fatty liver itself can be caused by some metabolic disorders which have been mentioned earlier. Hepatitis is the other main cause of ALT elevation which has been reported in some studies (1) and it seems that as it is an age related syndrome, its prevalence has increased with the chronological age (1), (10).
Due to some controversial reports about the role played by the serum ALT activity alone, there are studies suggesting that the confirmation of the ALT factor should be accompanied by molecular biological methods such as the PCR technique, particularly for hepatitis. There are also many reports indicating that serum ALT cannot be used in the diagnosis of hepatitis, but it seems that it is an applicable method in studying fatty liver lesions (11), (12), (13), although there are some studies which even suggest that the ALT elevation does not correlate with fatty liver disease as well (14).
The main concept behind this present study was to assess the prevalence of elevated ALT levels in this region, regardless of the type of liver disease. A comprehensive literature review about the role of ALT was present with controversial findings and at some point there are reports that are in agreement and those that are overlapping with the conclusions of one another.
From all these contradictory results and from our present study we can conclude that in northern Iran, the prevalence of serum ALT levels is about 16%, regardless of the origin of the disorder, which caused this elevation. On the basis of the acceptable facts in the literature, it can be suggested that the serum ALT levels are usually elevated due to any liver damage, particularly non-alcoholic fatty liver damage (NAFLD). Therefore, ALT determination is a single non-invasive laboratory test which gives its very first clue to the medical team to further examine the patients for other more specific medical and para-medical investigations for any liver damage and particularly, NAFLD assessment.
In conclusion, according to our findings that about 16% of our population might have a type of liver damage and considering the extensive report in this area of research, particularly NAFLD should carefully be investigated
The authors wish to thank the Danesh Medical Diagnostic Laboratory for its sincere cooperation in this research project
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