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

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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.
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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
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Aug 2018

Dr. Rajendra Kumar Ghritlaharey

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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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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)
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.
On April 2011

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
On Jan 2020

Important Notice

Original article / research
Year : 2021 | Month : August | Volume : 15 | Issue : 8 | Page : LC17 - LC20 Full Version

Prevalence of Vitamin D Deficiency and its Associated Risk Factors on Osteoarthritis: A Cross-sectional Survey

Published: August 1, 2021 | DOI:
Ramadevi Kundur, Ramaiah Itumalla, Eitimad Hashim Abdel-Rahman, Malak Saad Althawainy

1. Assistant Professor, Department of Clinical Laboratory Science, College of Applied Medical Sciences, University of Ha’il, Ha’il, Saudi Arabia. 2. Assistant Professor, Department of Health Management, College of Public Health and Health Informatics, University of Ha’il, Ha’il, Saudi Arabia. 3. Assistant Professor, Open Arab University, Sudan Branch Khartoum st. 21 Amarrat Khartoum, Sudan. 4. Student, Department of Clinical Laboratory Science, College of Applied Medical Sciences, University of Ha’il, Ha’il, Saudi Arabia.

Correspondence Address :
Ramaiah Itumalla,
Office No. 50, Department of Health Management, College of Public Health and
Health Informatics, University of Hail, Ha’il, Saudi Arabia.


Introduction: Vitamin D Deficiency (VDD) and several other metabolic factors are known to be involved in the aggravation of Osteoarthritis (OA). A better understanding of the role of these metabolic factors and diseases is required to alleviate the OA progression.

Aim: To analyse the prevalence of VDD in OA patients and its correlation with co-morbidities such as diabetes, hypertension (HT), Cardiovascular Disease (CVD) and acidity and also to assess the effect of Body Mass Index (BMI) and increasing age on the developmental process of OA.

Materials and Methods: A cross-sectional survey was undertaken during September 2018 to March 2019 in King Khaled, King Salman and Hail General Hospitals located in Ha’il province of Kingdom of Saudi Arabia (KSA). The study included 501 participants of OA patients that visited these hospitals. Data pertaining to the variables in this study such as diabetes, HT, cardiovascular problems, vitamin D and calcium deficiency, acidity and anthropometric details was obtained using a structured questionnaire. Data analysis was done using descriptive statistics and Pearson’s correlation with the statistical program SPSS version 21.

Results: VDD, calcium deficiency and acidity were the most prevalent factors observed in the patients. Vitamin D and calcium deficiency was observed to be higher in females than males. VDD significantly correlated to diabetes, HT, acidity and age, both in females and males. Cardiovascular disease and BMI correlated with VDD only in males but not in females. BMI showed positive correlation with HT in males (p<0.01) but not females, and also correlated with age (p<0.01) irrespective of gender.

Conclusion: The study concluded that VDD is more prevalent in females than males in Ha’il region. It is correlated to variables such as diabetes, HT, acidity, BMI and increasing age, which are identified as risk factors contributing to the progression of OA.


Body mass index, Cardiovascular disease, Diabetes, Hypertension

The worldwide prevalence of VDD has become one of the public health concerns in many countries around the globe (1). VDD has been implicated to be the major cause for the development of OA and increased risk of cardiovascular diseases, disorders of glucose metabolism, cancers and neurodegenerative diseases (2). In Saudi Arabia, there is widespread prevalence of VDD in population with different age groups (3). Vitamin D is essential to maintain the bone health and crucial for calcium homeostasis in the human body (4). Vitamin D is implicated in cartilage regeneration in OA, but the specific mechanism isn’t well-defined yet (5). However, the results of various studies have been inconsistent (5),(6). Metabolic Syndrome (MetS) is a complex condition characterised by obesity, HT, hyperglycaemia, hypertriglyceridemia. MetS, OA and VDD are related to each other, sharing obesity as a common risk factor (2),(6). The possible mechanisms are unclear, but positive associations have been observed in some studies (2),(6),(7). Therefore, prospective studies must be focused on protective part of vitamin D in an alleviation of OA.

A recent study in the KSA reveals that VDD is as high as 100% in the Saudi Arabian female population. VDD has become almost like an epidemic in the country and region in general (8). Causative factors for low level of vitamin D are inactivity of the individuals at risk, chronic diseases, diabetes mellitus and obesity (2),(6),(9).

Obesity, BMI and acidity is highly prevalent in Ha’il region of KSA (10),(11), which are also the co-morbidities in OA. It is essential to assess the risk factors that are related with OA, to understand the mechanisms and design strategies for its prevention. Hence, the purpose of the study was to observe the prevalence and effects of VDD in OA patients and its correlation to other co-morbidities such as diabetes, HT, CVD and acidity and also to assess the effect of Body Mass Index (BMI) and increasing age on the developmental process of OA.

Material and Methods

A cross-sectional survey was conducted during the period from September 2018 to March 2019 at King Khaled, King Salman and Ha’il General Hospitals located in Ha’il, Saudi Arabia. Ethical clearance was obtained from the University of Ha’il-RG191240.

Inclusion criteria: The participants who had complaints of bone related problems such as knee pain and other joints pain consistently for more than six months were selected for the study.

Exclusion criteria: Participants with chronic illnesses such as liver diseases or renal impairment and on medications such as steroids which could interfere with vitamin D metabolism. Participants with less than six months of bone related complaints were excluded as they are assumed to have only temporary inflammations in joints and may not be related to OA.

A 20% non response rate was expected. A target of 600 participants was set, and the final sample size came to 501. Data pertaining to the variables in this study such as diabetes, HT, cardiovascular problems, vitamin D and calcium deficiency and anthropometric details was obtained.

A structured questionnaire and sample size was designed according to the World Health Organisation (WHO) STEPS guidelines manual. This manual explains the order of events essential to conduct a STEPS survey (12). The purpose of the study was stated in the questionnaire and the participants consent was taken before the questionnaire was administered.

Statistical Analysis

The responses were tabulated and analysed using Statistical Package for the Social Sciences, SPSS (USA, Version 21.0.). Descriptive statistics are presented as percentage frequency. Pearson’s correlation was used at significance levels of p<0.05 and p<0.01.


The demographic characteristics are presented in (Table/Fig 1). The mean age of the population was 40.44±12.51 and the mean BMI was 28.1±4.23.

Vitamin D Deficiency (VDD), calcium deficiency, diabetes, HT, CVD were higher in females than males, except acidity (Table/Fig 2).

In males (Table/Fig 3), VDD positively correlated with CVD, BMI, age, diabetes, HT, acidity and BMI positively correlated with HT and age (p<0.01).

In females (Table/Fig 4), VDD positively correlated with diabetes, hypertension, age and acidity (p<0.01), and BMI showed correlation only to age (p<0.01).


In this study, females had higher VDD and calcium deficiency than males, both of which are vital for bone strength and functioning and a major contributor of OA. Calcium and Vitamin D are two known essential nutrients for bone health and maintenance. However, 90% of females do not get enough calcium and over 50% of females undergoing bone loss treatment had insufficient vitamin D levels (4). This study confirms that these are the major contributors for progression of OA in females. The study also confirms the overwhelmingly high VDD in KSA reported upto 100% regardless of the medical condition, especially in females (8),(9). In 1980's, a deficiency of 30% was reported in the general population of KSA (13). A systematic review conducted in KSA found that the prevalence of VDD is 81% and almost similar to other gulf countries showing association to bone problems as well as insulin resistance (9). VDD affects bone mineral density and is attributed to calcium homeostasis, poor exposure to sunlight, less dietary vitamin D supplementation, obesity, age and sedentary lifestyle and smoking (3),(4),(13).

A number of studies have been published on VDD in KSA which are presented below (Table/Fig 5) (3),(4),(8),(9),(13),(14).

The VDD is associated with a range of diseases such as diabetes, HT, CVD and cancer (2),(3),(14). This study too had similar observations; VDD positively correlated with diabetes, HT and acidity which were the common co-morbidities observed in both male and female OA patients. However, the correlation was stronger in females as compared to males (Table/Fig 3), (Table/Fig 4).

In this study, about 290 (58%) had acidity irrespective of gender, which is similar to a previous study in Ha’il (11), and correlated with high levels of VDD especially in females. Vitamin D is implicated to have a gastro-protective function and acid reflux prevention (15). It regulates gastrin secretion, smooth muscles in pyloric region, reduces free radicals and oxidative stress (16). There are several reports, which show that VDD contributes to the onset of diabetes. Vitamin D has been identified as a modulator of inflammation and beta cells survival and with increase in age, if vitamin D is sufficient, it can provide protection against diabetes (2),(17),(18). However, few studies also report that there is no evidence of association between VDD and the onset of diabetes, impairment of glucose metabolism is not a risk factor to develop OA, neither did supplementation of Vitamin D improve insulin secretion (19),(20). Another study reported that diabetes is predictive of severe OA progression independent of BMI or age (21). OA and diabetes have common risk factors such as obesity and increasing age, which explains as to why there is a higher prevalence of OA in the diabetic population (22).

In this study, VDD showed positive correlation to HT (more strongly in females than males) whereas BMI strongly correlated to HT in males but not in females. There are several studies reporting a positive association and possible role of vitamin D in controlling HT (23),(24),(25), whereas others reported that supplementing high doses of vitamin D did not reduce HT (26),(27). HT was observed to be higher in males although females were more obese and BMI increase affects males more than females (28). VDD was found to be associated with BMI and CVD in males but not females, in this study. This is similar to a previous study in KSA; VDD was high among Arab adolescent boys and mostly associated with cardio metabolic risk factors, indicating a disadvantage for males (2),(14). Vitamin D supplementation for six months improved myocardial efficiency in elderly subjects with heart failure history (29). On the contrary, in another study, vitamin D supplementation in hypertensive patients with low Vitamin D had no significant effect on blood pressure and cardiovascular risk factors (30).

In KSA, reports show that VDD is largely attributed to obesity and age (2),(9),(31). Although age has its effect on both genders, the effects of obesity seem to be riskier in males than in females. Vitamin D is inversely associated with BMI and thereby to obesity irrespective of gender (32). Supplementation of vitamin D leading to a reduction in BMI has been observed (33). BMI was the only factor observed to be linked to the progression of OA after adjusting for weight, as other metabolic components showed no significance (34). Therefore, increase in BMI could aggravate OA irrespective of other factors.

The effect of VDD in OA is ambiguous. There are several reports showing that VDD is observed in OA patients (3),(4),(35). Uncertainity of VDD role in OA was observed in a study where supplementation of vitamin D for two years didn’t reduce knee pain in OA patients (36). In another study, a small but statistically significant benefit was seen in OA patients with knee pain when oral vitamin D was given (37). Due to this ambiguity about vitamin D supplementation for treatment and prevention of OA, further studies are recommended. The health authorities and policy makers can consider vitamin D screening in the region in order to tackle the issue.


As the data collection was only based on questionnaire, the usual anomalies such as outliers and participant’s reluctance and negligence in accuracy are possibilities despite all the precautionary measures. The results of the study may not be generalised to the whole country.


In present study, vitamin D and calcium deficiency have been the most prevalent factors observed in OA patients and correlated significantly to age, diabetes, HT and acidity in both males and females. Acidity is high in Ha'il region irrespective of gender and could be a contributing factor in aggravation of OA. BMI increase is age related and correlated to HT in males but not in females. This study recommends that vitamin D and calcium supplementation along with a decrease in BMI could help to reduce the burden of OA progression. Further research is required to elucidate the intricate metabolic mechanisms of metabolism to alleviate OA progression.


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DOI and Others


Date of Submission: Jan 02, 2021
Date of Peer Review: Feb 15, 2021
Date of Acceptance: Apr 06 , 2021
Date of Publishing: Aug 01, 2021

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Jan 04, 2021
• Manual Googling: Apr 01, 2021
• iThenticate Software: May 10, 2021 (23%)

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