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

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On Sep 2018

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"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."

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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 one’s 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
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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.

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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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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)
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 : OC31 - OC34 Full Version

To Assess Relationship of Lipoprotein (a) with Severity of Coronary Artery Disease in Patients with Acute Myocardial Infarction: A Hospital based Cross-sectional Study

Published: August 1, 2021 | DOI:
Gaurav Bhandari, Girish Rajadhyaksha, Meghav Shah

1. Ex-Senior Resident, Department of Medicine, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India. 2. Professor and Unit Head, Department of Medicine, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India. 3. Assistant Professor, Department of Cardiology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India.

Correspondence Address :
Dr. Meghav Shah,
Assistant Professor, Department of Cardiology, Topiwala National Medical College
and B.Y.L. Nair Charitable Hospital, Mumbai-400008, Maharashtra, India.


Introduction: Elevated plasma concentrations of lipoprotein {Lp(a)} have been consistently shown to be a risk factor for the development of a spectrum of thrombotic and atherosclerotic disorders including Coronary Artery Disease (CAD).

Aim: To assess relationship of Lp(a) with severity of CAD in patients of Acute Myocardial Infarction (AMI).

Materials and Methods: A hospital based, cross-sectional study was conducted at Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India, between November 2016 to April 2018 (18 months). A total of 200 diagnosed cases of AMI who were willing to undergo coronary angiography were enrolled for this study. Prior to coronary angiography, a fasting blood sample was assessed for lipids and Lp(a) levels. The Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) score was calculated according to the coronary angiography results. Patients were divided into two groups based on Lp(a) levels: <25 mg/dL and >25 mg/dL and categorised based on CAD severity and SYNTAX scores as low (<22), intermediate (23-32) and high (>32). Lp(a) levels were categorised as low (<25 mg/dL) and high (>25 mg/dL). A p-value of <0.05 was considered as statistically significant. The statistical evaluation of data was done using the Statistical Package for Social Sciences (SPSS; Chicago, IL, USA) program, version 20.0.

Results: Majority of the patients belonged to the age group 41-60 years. Males comprised 161 (80.5%) patients of the study population. Hypertension was the most prevalent risk factor, observed in 101 (50.5%) patients. Left ventricular ejection fraction <40% was observed in 85 (42.5%) patients. Majority had low SYNTAX score {92 (46%)}. There was a significant difference in patients with Lp(a) <25 mg/dL compared to patients with Lp(a) >25 mg/dL with low (45.7% vs. 54.3%, p-value=0.0001), intermediate (9.9% vs. 90.1%, p-value=0.0001) and high SYNTAX scores (10.8% vs. 89.2%, p-value=0.0001), respectively.

Conclusion: The Lp(a) was significantly associated with severity of CAD and it also displays prognostic significance.


Atherosclerotic plaque, Coronary angiography, Creatine phosphokinase myocardial band, Troponin T

Coronary Artery Disease (CAD) is a significant cause of morbidity and mortality in the developed and developing world. It is rapidly assuming epidemic proportions in developing countries (1). India is one such developing country which is witnessing an epidemiological transition and thus on the threshold of suffering a cardiovascular disease epidemic (2). Cause-specific mortality data highlight cardiovascular disease as a leading contributor of mortality (3). Moreover, demographic data project a major increase in mortality attributable to cardiovascular disease parallel to increase in life expectancy and altering age structure of the growing population. Surveys performed in urban India reveal widespread prevalence of risk factors for CAD highlighting urgent action warranted to curb the spread of this disease as socio-economic development progresses (4),(5),(6).

Pathophysiology of CAD begins with the process of atherosclerosis. Atherosclerotic plaque is characteristic of a core formed of lipid surrounded by smooth muscle cells and foam cells (macrophages with lipids). The atherogenic dyslipidemia profile, especially mild to severe elevation of apo-B containing lipoproteins such as Very Low Density Lipoproteins (VLDL), VLDL remnants, Intermediate-Density Lipoproteins (IDL), Low Density Lipoproteins (LDL), and low levels of High Density Lipoproteins (HDL) appear to induce pronounced cholesterol deposition thus accelerating the progression of atherosclerotic disease within arteries (7).

Elevated plasma concentrations of lipoprotein (a)-Lp(a) is a risk factor that plays a role in the development of a spectrum of thrombotic and atherosclerotic disorders including CAD. However, mechanisms of Lp(a) that mediate the underlying pathophysiological effects are yet to be delineated. Atherosclerosis and thrombosis remain functionally bound due to the thrombotic events that ensue most often from rupture of an unstable atherosclerotic plaque, a common and significant manifestation of atherosclerotic disease. Lp(a) is capable of directly mediating functional linkage owing to its pro-atherogenic and prothrombotic effects. It displays a profound effect on endothelial function, perturbation of which has important ramifications for both atherogenesis and thrombosis. Hence, its capability to imbalance the pro and anticoagulant, pro and anti inflammatory, and vasorelaxation and vasoconstriction properties of the endothelium. Furthermore, it also plays a role in barrier function of the endothelium. Thus, Lp(a) constitutes a functional link not only between atherosclerosis and thrombosis, but also between endothelial dysfunction and both of these diseases (8). These properties of Lp(a) warrant further studies of Lp(a) as a novel risk factor in patients with CAD. Against this background, this study aimed to evaluate Lp(a) as an independent risk factor for CAD in patients with AMI.

Material and Methods

This hospital based, cross-sectional study was performed at Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India. A total of 200 patients planned to undergo coronary angiography during the 18-month study duration from November 2016 to April 2018 were enrolled in this study. Study approval was obtained from the Institutional Ethics Committee (ECARP/2017/57). All patients provided written informed consent prior to study enrolment.

Inclusion and Exclusion criteria: Patients above the age of 18 years diagnosed with AMI based on electrocardiography and elevated cardiac markers such as troponin T and Creatine Phosphokinase Myocardial Band (CPK MB) were included in the study. Patients with thyroid disorders, renal failure (serum creatinine >1.5 mg/dL), nephrotic syndrome, sepsis, undergoing pregnancy, and terminally ill patients were excluded from the study.

Data Collection

Data for demographic details such as age, gender, cardiovascular risk factors, SYNTAX score, and lipid profile were collected. The study population was divided into two groups based on Lp(a) levels: <25 mg/dL and >25 mg/dL. This cut-off was determined based on another study revealing atherosclerotic cardiovascular disease onset at Lp(a) levels 20-30 mg/dL (9).

Angiographic Evaluation

Coronary angiography was performed using the Judkins technique. Severity of CAD was evaluated using the SYNTAX score (10) and was as categorised low (<22), intermediate (23-32) or high score (>32) on coronary angiography. The SYNTAX score was compared with Lp(a) levels to determine an association of Lp(a) with severity of CAD.

Laboratory Investigations

Fasting venous blood samples were obtained for all patients. These samples were evaluated for troponin T/I or Creatine Phosphokinase-Myocardial Band (CPKMB) levels, complete lipid profile (cholesterol, triglycerides, HDL, LDL, VLDL), Lp(a), random blood sugar, thyroid profile tests if clinically suggestive of thyroid disorder, haemoglobin, white blood cell count, platelets, total bilirubin, serum glutamic oxaloacetic transaminase/serum glutamic pyruvic transaminase, and serum creatinine.

Statistical Analysis

Continuous variables are expressed as mean±standard deviation and categorical variables as expressed as percentages. Categorical variables were compared using either Chi-square test. A p-value of <0.05 was considered as statistically significant. The statistical evaluation of data was done using the SPSS; Chicago, IL, USA program, version 20.0.


Demographics of study population: The study recruited 200 patients. Majority of the patients belonged to the age group 41-60 years. Males comprised 161 (80.5%) patients of the study population. Hypertension was the most prevalent risk factor, observed in 101 (50.5%) patients. Left ventricular ejection fraction <40% was observed in 85 (42.5%) patients. Majority had low SYNTAX score {92 (46%)}. Almost three-quarter patients i.e., 147 (73.5%) had high Lp(a) levels. Lipid profile of the study comprised of cholesterol >200 mg/dL reported in 25 (12.5%) patients, triglycerides >150 mg/dL in 48 (24%) patients, HDL >40 mg/dL in 110 (55%) patients, and LDL >200 mg/dL in 73 (36.5%) patients (Table/Fig 1).

Association between Lp(a) with severity of CAD: There was a significant difference in patients with Lp(a) <25 mg/dL compared to patients with Lp(a) >25 mg/dL with low (45.7% vs. 54.3%, p-value=0.0001), intermediate (9.9% vs. 90.1%, p-value=0.0001) and high SYNTAX scores (10.8% vs. 89.2%, p=0.0001), respectively (Table/Fig 2).


The present study was conducted to evaluate Lp(a) as independent risk factor for CAD. The study revealed a correlation between Lp(a) and severity of CAD as assessed by the SYNTAX score. Patients with Lp(a) >25 mg/dL displayed greater severity of CAD as compared to patients with Lp(a) <25 mg/dL.

Kamariya CP et al., conducted a case-control study to assess the correlation between Lp(a) and young Myocardial Infarction (MI) patients (11). Their results indicated significantly increased levels of Lp(a) in young MI patients. In contrast, the current study reports elevated Lp(a) levels (>25 mg/dL) in 60.9% patients <40 years compared to 75.1% in patients >40 years, although not statistically significant. The findings may be justified by increased levels of Lp(a) in majority of MI cases irrespective of age. Furthermore, Pare G et al., revealed high Lp(a) levels were associated with an increased risk of MI independent of established MI risk factors, including diabetes mellitus, smoking, high blood pressure, and apolipoprotein B and A ratio (12).

Literature has consistently evidenced elevated plasma concentrations of Lp(a) as a risk factor influencing the development of a variety of thrombotic and atherosclerotic disorders. Senthilkumari S and Ramadevi M, aimed to observe whether Lp(a) is significantly elevated in patients with acute coronary syndrome in comparison to healthy controls or not (13). The study found mean plasma Lp(a) levels and lipid parameters were significantly higher in the study group (23.87±7.56 mg/dL) as compared to control group (10.4±3.11 mg/dL) (p=0.0001). In the present study, Lp(a) levels were increased in majority of CAD patients, 73.5% of the patients (147/200 cases) had high Lp(a) (>25 mg/dL) levels and only 26.5% (53/200 cases) had low levels of Lp(a) (<25 mg/dL).

Majority of the patients in the present study were males. Males contributed 80.5% of the study population whilst females contributed only 19.5%. This finding is in agreement with the study performed by Mosca L et al., which revealed higher prevalence of CAD in men (14). Furthermore, in the present study, 70.8% of males had high Lp(a) while remaining 29.2% had low Lp(a). Amongst females, 84.6% had high Lp(a) and 15.4% had low Lp(a). However, no significant association was found between Lp(a) and gender (p-value=0.08) which is in line with study findings by Senthilkumari S et al., where there was no significant difference observed in Lp(a) level between males (24.52±7.33 mg/dL) and females (22.89±7.99 mg/dL) (13).

The SYNTAX score is an angiographic grading tool to determine complexity of CAD. Higher values are indicative of more complex disease with potentially worse prognosis (15), (16). Habib SS et al., conclude higher Lp(a) levels are associated with more severe and diffuse blockage of the coronary vessels (17). Lp(a) levels correlated significantly with coronary vessel score (p-value=0.033). Additionally, Gupta R et al., indicated that measurement of Lp(a) provides a better marker for predicting the presence of angiographically defined CAD as compared to traditional measures (18). Similarly, Dahlen GH et al., found that Lp(a) levels were independently and significantly associated with presence of CAD (p-value <0.021) and tended to correlate with lesion scores (19). Hikita H et al., reported total number of plaques, number of non calcified plaques and low attenuation plaques were significantly higher in the group Lp(a) level of ≥25 mg/dL as compared to the group with Lp(a) level of <25 mg/dL (20). In the present study, greater percentage of patients with intermediate (90.1%) and high SYNTAX (89.2%) scores had high Lp(a) levels as compared with patients with low SYNTAX score. Lp(a) was significantly associated with SYNTAX score. Thus, Lp(a) is significantly associated with severity of CAD.

The CAD has multiple risk factors such as diabetes, hypertension, dyslipidemia, smoking and many more. Studies regarding association of the mean Lp(a) levels with diabetes are contradictory. Singla S et al., found a higher mean concentration of Lp(a) in a diabetic subjects (21). Holanda M et al., found no difference in the mean Lp(a) concentration between diabetic and non diabetic subjects (22). In the present study, high values of Lp(a) were found in diabetic patients (72.6%) while non diabetic patients (27.4%) had low Lp(a). However, no significant association was found between Lp(a) and diabetes mellitus in this study. Correlation between Lp(a) and hypertension was also studied in this study, 74.3% of hypertensive patients had high Lp(a) while 25.7% had low Lp(a). This finding is in concordance with a similar study conducted by Ghorbani A et al., where, no significant association was found between Lp(a) and stages of hypertension (23).


The enrolled subjects might not have been representative of the entire population with CAD, as they were referred for coronary angiography in tertiary care hospitals. Also, moribund patients, patients who cannot tolerate coronary angiography or patients not willing to consent for coronary angiography were not included in the study.


High lipoprotein values were associated with high SYNTAX score and thus have poor prognosis. However, future studies are warranted to investigate potential genetic influence of Lp(a) levels and the role of screening Lp(a) levels as a method of primary prevention of CAD.


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DOI and Others


Date of Submission: Jan 20, 2021
Date of Peer Review: Mar 31, 2021
Date of Acceptance: May 20, 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 21, 2021
• Manual Googling: May 04, 2021
• iThenticate Software: Jun 14, 2021 (23%)

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