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.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

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Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
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."



Dr Kalyani R
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.
Knowledge is treasure of a wise man. The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
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It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
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 ones 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 journalsNo manuscriptsNo 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

Important Notice

Original article / research
Year : 2012 | Month : April | Volume : 6 | Issue : 2 | Page : 252 - 256

Serum Adenosine Deaminase Activity and Its Correlation with Glycated Haemoglobin Levels in Patients of Type 2 Diabetes Mellitus

Amandeep Kaur, Sahiba Kukreja, Naresh Malhotra, Neha

1. M.B.B.S., Junior resident 2. M.B.B.S., M.D, Associate Professor 3. M.B.B.S., M.D, Head and Professor 4. M.B.B.S., M.D, Assistant Professor NAME OF DEPART MENT(S)/INSTITUTION(S) TO WHICH THE WORK IS ATTRIBUTED: Deparment of Biochemistry, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India.

Correspondence Address :
Amandeep Kaur
F- 7/65, Kashmir Avenue West, Amritsar, Punjab, India.
Phone: 09915922294
E-mail: amandeep_best@yahoo.com

Abstract

Background: Adenosine deaminase (ADA) is suggested to be an important enzyme for modulating the bioactivity of insulin, but its clinical significance in Type 2 diabetes mellitus (Type 2 DM) is not yet characterized. The present study was undertaken to evaluate serum ADA activity and serum uric acid levels in patients of Type 2 DM.

Material and Method: It is a of case control study. The subjects included in this study were divided into 3 groups. Group A consisted of 60 normal healthy individuals who served as controls with no history of DM. Group B consisted of 60 patients of Type 2 Diabetes Mellitus both males & females in the age group of 40-65 years on oral hypoglycaemic drugs with HbA1c <7%. Group C consisted of 60 patients of Type 2 Diabetes Mellitus both males & females in the age group of 40-65 years on oral hypoglycaemic drugs with HbA1c >7 %. Serum levels of fasting blood sugar, HbA1c, ADA and uric acid were estimated in all the subjects under study.

Results: All the three parameters, FBS, HbA1c and ADA levels were found to be increased in the patients of Type 2 DM as compared to controls. The mean serum uric acid levels showed a bell shaped relation with glycaemic control.

Conclusion: From the present study, it is concluded that there is an increase in serum ADA levels with increase in HbA1c levels. It was found that the serum uric acid levels increased with moderately increasing levels of HbA1c <7% and then decreased with further increasing levels of HbA1c >7% (a bell-shaped relation).

Keywords

Diabetes Mellitus type 2, Adenosine deaminase (ADA), Glycated haemoglobin (HbA1c), Fasting blood Sugar (FBS)

Introduction
Diabetes Mellitus is the most common endocrinological disorder characterized by metabolic abnormalities and long term complications. The incidence and the prevalence of Type 2 DM is globally increasing and becoming a major public health problem for health care providers (1). Diabetes is projected to increase significantly in the coming period and it is estimated that 80 million people in India would be having diabetes by the year 2030 (2). Diabetes is a state characterized by chronic hyperglycaemia resulting from diverse aetiologies, environmental and genetic factors acting together. The long term control of diabetes mellitus is judged by glycosylated haemoglobin which was first isolated by Allen et al (3). It is formed non-enzymatically by a two step reaction. The levels of HbA1c have increased in diabetic patients and reflected their metabolic control over the past 8-10 weeks (4).

Adenosine deaminase, an enzyme, which is present in red cells and the vessel wall catalyses the irreversible hydrolytic deamination of adenosine to inosine and 2’-deoxyadenosine to 2’-deoxyinosine. Inosine and 2’-deoxyinosine are converted to hypoxanthine, xanthine and finally to uric acid (5). ADA is considered as a good marker of cell mediated immunity (6). High lymphocyte ADA activities were found to be elevated in diseases in which there is cell mediated immune response (7). In a study, Hoshino T et al (5) reported elevated ADA activity in the serum of Type 2 DM patients whereas Angielski S et al (8) demonstrated that 5’-nucleotidase and ADA activities were not changed in isolated glomeruli of streptozocin diabetic rats.

A significant co-relation between the ADA levels and uric acid levels in diabetes was analysed by Kurtul N et al. (9). They concluded that high uric acid levels in DM patients were due to the increased ADA activity. Kramer CK et al (10) also reported the association of high uric acid levels with Type 2 DM whereas in a study, Tuomilehto J et al (11) demonstrated low uric acid levels in diabetic patients.

Even though there are reports available on serum adenosine deaminase levels and serum uric acid levels in patients of Type 2 diabetes mellitus but these are still not very clear and conclusive. Moreover, study showing co-relation of serum ADA activity and serum uric acid levels with the glycaemic control in Type 2 DM patients have not been conducted in this part of the country yet. Hence, in the light of the above mentioned facts, the present study was designed to evaluate the serum ADA activity and serum uric acid levels in patients of Type 2 diabetes mellitus and its comparison with the controls and further to find any correlation of serum ADA activity and serum uric acid levels with the glycaemic control in patients of Type 2 diabetes mellitus.

Material and Methods

The subjects included in the present study were 120 patients of Type 2 diabetes mellitus in age group of 40-65 years of either sex, on oral hypoglycaemic drugs, attending the OPD of Department of Medicine of the institute. A group of 60 normal healthy individuals, age and sex matched from the same population served as controls.

These 180 subjects were divided into 3 groups: • GROUP A comprised of 60 normal healthy individuals both males and females in the age group of 40-65 years from the general population who volunteered for getting included in the present study. • GROUP B comprised of 60 patients of Type 2 Diabetes Mellitus both males & females in the age group of 40-65 years on oral hypoglycaemic drugs with HbA1c<7 %. • GROUP C comprised of 60 patients of Type 2 Diabetes Mellitus age and sex matched on oral hypoglycaemic drugs with HbA1c>7 %.

All the patients and controls were from the same population in the age group of 40–65 years of either sex. Informed consent was taken from all the subjects included in the study. Patients with type 1 diabetes mellitus, acute complications of diabetes mellitus and history of acute infection or other ailments like gross congestive heart failure, tuberculosis, gout, rheumatoid arthritis, skeletal muscle injury and renal failure were not included in this study. It was a case control prospective study. A complete clinical examination of subjects was done. The subjects were screened for serum blood sugar, serum adenosine deaminase, serum uric acid and glycated haemoglobin. Fasting blood sugar estimation by GOD-POD Method (12). Glycosylated hemoglobin (HbA1c) estimation by Nycocard Reader (13). Serum ADA levels estimation by Giusti and Galanti (14). Serum uric acid estimation by Trivedi R.C. et al. (15).

Statistics
Results were analyzed by Oneway ANOVA and Post Hoc Turkey HSD and a probability of less than 5% (p < 0.05) was considered to be statistically significant. The study was approved by the ethical committee of the institute.

Results

The statistical analysis showed sex and number distribution in these three groups was comparable (Table/Fig 1) The mean FBS levels of Group A were 82.00 ± 13.00 mg/dl, Group B were 126.12 ± 22.71 mg/dl and the corresponding values among Group C subjects were 136.97 ± 24.88 mg/dl. In the present study, the mean FBS levels of Group B and Group C were found to be highly significantly higher than Group A (p <0.001). Although the mean FBS levels of Group C were higher than Group B but the difference was statistically not significant (p=0.115). It was further observed that the mean HbA1c levels in Group A were 5.75± 0.46%, in Group B were 6.09± 0.56% and the corresponding values among Group C were 8.72± 1.35%. From this study it was observed that the difference in the levels of HbA1c was found to be insignificant between Group B and Group A (p= 0.300) (Table/Fig 2).

In the present study the mean serum ADA levels in Group A were 17.30± 7.28 U/L, in Group B were 30.04± 10.41 U/L whereas in Group C were 44.23± 16.14 U/L. Statistical analysis showed that the mean serum ADA levels of Group C were significantly higher than Group B (p<0.001) and the levels of ADA were significantly higher in both Group B and Group C as compared to Group A (p<0.001) (Table/Fig 3). The mean serum uric acid levels in Group A were 6.34 ± 1.62 mg/dl, in Group B were 6.90 ± 1.90 mg/dl and in Group C were 5.13 ± 1.32 mg/dl. The mean serum uric acid levels of Group B were significantly higher than Group C (p<0.001) whereas levels of mean serum uric acid in Group C were significantly lower than Group A (p=0.014) but no significant difference was observed between Group A and Group B (p=0.381) (Table/Fig 4).

The Pearson’s correlation coefficient for the relationships between serum ADA, Uric acid and HbA1c levels in Group B showed positive correlation between HbA1c and ADA (r=0.002). Similarly when the comparison was made between serum uric acid levels and HbA1c there was positive correlation (r=0.196) but when the comparison was made between serum ADA and uric acid there was no correlation (r=0.000) (Table/Fig 5). The Pearson’s correlation coefficient for the relationships between serum ADA, Uric acid and HbA1c levels in Group C showed positive correlation between HbA1c and ADA (r=0.125). When the comparison was made between serum uric acid levels and HbA1c there was negative correlation (r= -0.015) (Table/Fig 5).

Discussion

Diabetes Mellitus is a cluster of abnormal metabolic paradigm having a common feature of hyperglycaemia (16). Being a chronic metabolic disorder, it has assumed a epidemic proportion and its long term complications could have devastating consequences (17).

Diabetes Mellitus is a cluster of abnormal metabolic paradigm having a common feature of hyperglycaemia (16). Being a chronic metabolic disorder, it has assumed a epidemic proportion and its long term complications could have devastating consequences (17). Group A Group B Group C Number 60 60 60 Male / Female (% age) 53.33/46.66 70/30 43.33/56.66 (Table/Fig 1): Showing sex and number distribution in three group Group N o. FBS H bA1c Mean ± SD Comparison P value Mean ± SD Comparison P value Group A 60 82.00 ± 13.00 Group A vs. B <0.001*** 5.75± 0.46 Group A vs. B 0.300NS Group B 60 126.12± 22.71 Group A vs. C <0.001*** 6.09± 0.56 Group A vs. C <0.001*** Group C 60 136.97± 24.88 Group B vs. C 0.115NS 8.72± 1.35 Group B vs. C <0.001*** (Table/Fig 2): Showing FBS & HbA1c in control and study groups No.: Number of cases; SD: Standard Deviation; p < 0.001; Highly Significant. Group N R ange (U/L) Mean ± SD (U/L) 95% CI Comparison P value Group A 60 2.5-30.0 17.30± 7.28 14.58-20.02 Group A vs. B <0.001*** Group B 60 12.7-55.5 30.04± 10.41 26.16-33.93 Group A vs. C <0.001*** Group C 60 11.6-82.2 44.23± 16.14 38.21-50.26 Group B vs. C <0.001*** (Table/Fig 3): Comparison of Serum Adenosine Deaminase (ADA) levels in three groups N: Number of cases; SD: Standard Deviation; CI: Confidence Interval;***P<0.001; Highly Significant Amandeep Kaur et al., Serum Adenosine Deaminase Activity and Its Correlation www.jcdr.net Journal of Clinical and Diagnostic Research. 2012 April, Vol-6(2): 252-256 254 Group N R ange (mg/dl) Mean ± SD (mg/dl) 95% CI Comparison P value Group A 60 3.8-9.3 6.34 ± 1.62 5.74-6.95 Group A vs. B 0.381NS Group B 60 4.2-12.9 6.90 ± 1.90 6.19-7.61 Group A vs. C 0.014* Group C 60 3.3-7.5 5.13 ± 1.32 4.64-5.63 Group B vs. C <0.001*** (Table/Fig 4): Comparison of Serum Uric acid levels in three groups N: Number of cases; SD: Standard Deviation; CI: Confidence Interval; NS: p > 0.05; Not Significant; *P< 0.05; Significant at 5% significance level; ***P<0.001; Highly Significant. P arameter Group B Group C H bA1c ADA H bA1c ADA ADA r value .002 .125 p value .993 .512 Uric acid r value .196 .000 –0.015 .201 p value .300 .998 .939 .287 (Table/Fig 5): Comparison of Serum ADA, Uric acid and HbA1c in Group B and Group C. r value: Pearson correlation coefficient; *Correlation is significant at the 0.05 level; **Correlation is significant at the 0.01 level. [Table/Fig-6(A &B)]: Yellow boxes indicate generation of free radicals in diabetic patients. Blue box indicate signalling molecules. It is characterized by an absolute or relative deficiency of insulin and insulin resistance.

In the present study, we observed that the mean serum ADA levels of Group C were significantly higher than Group B (p< 0.001). Also the levels of ADA were significantly higher in both Group B and Group C than Group A (p < 0.001). Similar results were reported by Hoshino T et al (5) and Kurtal N et al. (9). Type-2 diabetes mellitus has been shown to be a state of increased free radical activity (18). Chronic hyperglycaemic status favours auto-oxidation and the formation of advanced glycation end products (19). The generation of free radicals in the diabetic patients can be due to the following mechanisms:

Hyperglycaemia leads to activation of NADPH oxidase, which is a multi-subunit enzyme, that catalyses O2–. formation by one electron reduction of O2 using NADPH or NADH as electron donor (20) (Table/Fig 6). 2O2 + NADPH (or NADH)  2O2– + NADP (or NAD) + H+Another source of superoxide anion formation could be auto-oxidation of glucose which is subjected to enediol rearrangements that result in the formation of an enediol radical ion. This species is capable of reducing molecular oxygen to form superoxide anion(19) (Table/Fig 6).

Hyperglycaemia causes formation of Advanced glycation End Products (AGEs) as result of non-enzymatic reactions between intra-cellular glucose-derived dicarbonyl precursors with the amino group of both intracellular and extracellular proteins (21). The AGEs stimulate receptors for advanced glycation end products (RAGE). Their interaction is believed to initiate and aggravate the diabetic complications. In addition they increase the generation of reactive oxygen species in macrophages thereby causing heightened oxidative stress (22). (Table/Fig 6) AGEs bind to AGE receptors on several cell types (endothelial cells, mesangial cells and macrophages) lead to release of cytokines; TNF-α, IL-1, IL-6 and growth factor from macrophages and mesangial cells (23) resulting in activation of T lymphocytes (24) (Table/Fig 7).

Furthermore, in the presence of superoxide dismutase, superoxide anion leads to formation of H2O2 which is responsible for activating the signalling molecules leading to inflammation, cell growth, apoptosis and fibrosis (20) (Table/Fig 6). Activated lymphocytes and macrophages influence each other and also release inflammatory mediators that affect other cells (23). A close correlation has been found between the severity of inflammation and a local increase in both expression and activity of ADA (25). ADA plays a crucial role in lymphocyte proliferation anddifferentiation (26) and shows its highest activity in T- lymphocytes (6). The high plasma ADA activity might be due to abnormal T- lymphocyte responses or proliferation (26).

The Pearson’s correlation coefficient for the relationships between serum ADA, Uric acid and HbA1c levels in Group B showed positive correlation between HbA1c and ADA (r=0.002) but the difference was not statistically significant (p=0.993) which means that with the increase in HbA1c, levels of serum ADA were also increased. This finding was in accordance with the study of Kurtul N et al. (9). Similarly when the comparison was made between serum uric acid levels and HbA1c there was positive correlation (r=0.196) which was statistically not significant (p=0.300). The reason for increased uric acid levels in this group could be due to increased activity of ADA, an enzyme responsible for converting adenosine to uric acid. Another reason behind the increase in serum uric acid levels could be due to increased flux of glucose-6-phosphate through the hexose monophosphate shunt due to impairment of the glycolytic pathway. This finding was in accordance with study by Dehghan A et al (27) and Modan M et al. (28).

The Pearson’s correlation coefficient for the relationships between serum ADA, Uric acid and HbA1c levels in Group C showed positive correlation between HbA1c and ADA (r=0.125). Although statistically not significant (p=0.512). Similarly when the comparison was made between serum ADA and uric acid there was positive correlation (r=0.201) but statistically not significant (p=0.287). When the comparison was made between serum uric acid levels and HbA1c there was negative correlation (r=-0.015) which was statistically not significant (p=0.939) meaning thereby that when the levels of HbA1c increased more than 7% there is decrease in uric acid levels. The reason for this finding is thought to be due to the uricosuric effect of glycosuria. This finding was in accordance with Choi H.K. et al (29) and Tuomilehto J et al study (11).

In conclusion our study suggests that there is an increase in serum ADA levels with increase in HbA1c levels. Furthermore, it was found that the serum uric acid levels increased with moderately increasing levels of HbA1c (<7%) and then decreased with further increasing levels of HbA1c >7% (a bell-shaped relation). Serum ADA and serum uric acid levels reflect closely related components of the same disease i.e. Type 2 Diabetes Mellitus.

Acknowledgement

The authors are thankful to the management of the institute for the financial support.

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DOI and Others

DOI: JCDR/2012/3926:2030

Financial OR OTHER COMPETING INTERESTS:
None.


Date of Submission: Jan 06, 2012
Date of peer review: Feb 09, 2012
Date of acceptance: Feb 21, 2012
Date of Publishing: Apr 15, 2012

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