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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.
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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

"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.
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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.
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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 : 2022 | Month : December | Volume : 16 | Issue : 12 | Page : WC01 - WC03 Full Version

Association between Serum Sialic Acid Levels and Disease Severity in Psoriasis: A Case-control Study

Published: December 1, 2022 | DOI:
UG Bhavyashree, Laddha Vedant, B Vishal, Malcolm Pinto, Manjunath Shenoy

1. Associate Consultant, Department of Dermatology, Specialist’s Hospital, Kalyaninagar, Bangalore, Karnataka, India. 2. Postgraduate, Department of Dermatology, Yenepoya Medical College, Mangalore, Karnataka, India. 3. Professor, Department of Dermatology, Yenepoya Medical College, Mangalore, Karnataka, India. 4. Associate Professor, Department of Dermatology, Yenepoya Medical College, Mangalore, Karnataka, India. 5. Professor and Head, Department of Dermatology, Yenepoya Medical College, Mangalore, Karnataka, India.

Correspondence Address :
Dr. Malcolm Pinto,
Associate Professor, Department of Dermatology, Yenepoya Medical College and Hospital, Deralakatte, Mangalore-575018, Karnataka, India.


Introduction: Psoriasis is a chronic inflammatory disease distributed worldwide with varying prevalence among different geographical areas and ethnic groups. It has been recently found that oxidative stress is one of the important factors in the pathogenesis of psoriasis. The varied effects of oxidative stress include changes in cellular uptake, altered enzymatic activity of proteins, increased predisposition to aggregation and proteolysis, which subsequently alter their immunogenicity. Sialic Acid (SA) is an acetylated derivative of neuramic acid. It is a marker for acute phase inflammatory response, with increased levels observed in inflammatory diseases.

Aim: To estimate the levels of SA in psoriasis patients and to correlate with the severity of the disease.

Materials and Methods: This case-control study was conducted among 50 patients, diagnosed with psoriasis, and 50 age and sex-matched subjects without psoriasis. General, systemic and dermatological examination was carried out. The severity of psoriasis was assessed according to Psoriasis Area Severity Index (PASI). The serum was treated with ethanol and centrifugation to precipitate proteins. The SA of both the precipitate and supernatant was estimated based on the reaction of SA with the ninhydrin reagent. Calculation of sialic acid was done by the formula: OD of test/OD of standard×concentration of the standard. To establish a correlation student’s t-test was used.

Results: There were 39 males and 11 females in each case and control group. The mean±SD age of cases and controls was 44.04±10.9 years and 44.10±9.996, respectively. The mean PASI value was 23.1666±18.47. Mean SA in cases and controls were 35.792±2.124 and 28.556±3.854 (p-values <0.001). A positive correlation was observed between the free SA and psoriasis severity (p-value <0.001, r=0.460).

Conclusion: Higher levels of free serum SA were significantly associated with more severe forms of psoriasis.


Inflammatory disease, Immunogenicity, Psoriasis area severity index

Psoriasis is a chronic, inflammatory, multisystem disease with varying clinical phenotypes of which chronic plaque psoriasis is most common type. It is influenced by various genetic and environmental factors in combination with skin barrier disruption and immune dysregulation (1),(2). Psoriasis is globally distributed disease with a worldwide prevalence of 2-3%. Its prevalence varies among different geographical locations and ethnic groups (3).

Cells and inflammatory markers involved in the pathogenesis of psoriasis include T-cells, Antigen-Presenting Cells (APC), keratinocytes, Langerhans cells, macrophages, natural killer cells, TH1 cytokines and Vascular Endothelial Growth Factor (VEGF). Oxidative stress is one of the important factors in the pathogenesis of psoriasis (4). It has been suggested that increased production of Reactive Oxygen Species (ROS) may be involved in the pathogenesis of the disease. Higher concentration of ROS leads to the development of oxidative stress which has detrimental effects on various cells and organelles made up of lipids, proteins and nucleic acids by biochemical processes like lipid peroxidation, breakdown of DNA strands, proteolysis etc., (4),(5).

The SA are cytoprotectors found widely distributed in mammalian tissue and bacteria. SA is an acetylated derivative of neuramic acid which occurs as a terminal part of glycoconjugates (glycoproteins, glycolipids) and carbohydrate chains. Free levels of SA form a very small proportion of SA levels. It has been reported as a marker for acute phase response; increased SA concentration has been observed in myocardial infarction, diabetes, tumour’s, psoriasis, and alcoholism. Serum SA levels are found to be elevated during inflammation due to increased levels of richly sialylated acute phase- glycoprotein which serves as a marker of inflammation (5),(6).

A study on serum SA in inactive and primary rheumatoid arthritis hypothesised that primary osteoarthritis may be an inflammatory disease and it was found that their levels were increased in patients with arthritis (6). In serum/plasma, the normal range of Total Sialic Acid (TSA) levels is 1.58-2.22 mmol/L, the free form of SA only amount to 0.5-3 mmol/L, and the Lipid bound Sialic Acid (LSA) forms 10-50 mmol/L (7). A study was done on free serum SA also concluded that it can be a useful marker of inflammation in psoriasis (8). Recent data revealed the role of raised serum levels of free SA in inflammatory diseases like rheumatoid arthritis, psoriasis, systemic lupus erythematosus, and inflammatory bowel disease (9). Psoriasis is a chronic inflammatory disease. Rajappa M et al., reported a significant increase in SA in psoriasis patients and SA levels were positively correlated with disease activity (10). SA is a more stable inflammatory marker with less intraindividual variability providing a more accurate reflection of an individual’s inflammatory status (11).

The present study aimed to evaluate the usefulness of the determination of serum levels of SA assessment of disease activity and severity, and for prediction of the outcome of a therapeutic intervention for psoriasis.

Material and Methods

This case-control study was conducted in the Outpatient Department of Dermatology, Venereology, and Leprosy in the Yenepoya Medical College and Hospital, Mangalore, Karnataka, India from October 2012 to May 2014.The study was conducted after approval from the Institutional Ethical Committee (IEC) dated 9/01/2013, and also after obtaining consent from all the participants.

The study was conducted among all the patients diagnosed to have psoriasis above the age of 18 years who attended OPD during the study period. Age and sex-matched subjects like patient bystanders and people without psoriasis coming for routine health check-up willing to participate in the study were considered as controls and included in the study. The study included 50 cases and 50 age and sex-matched controls.

Inclusion criteria:

• Patients above the age of 18 years attending the OPD of Dermatology with a clinical diagnosis of psoriasis having erythematous scaly plaques, showing positive Auspitz sign (both new and old) were included in the study.
• Age and sex-matched subjects without psoriasis and willing to participate in the study were recruited controls.

Exclusion criteria:

• Patients with acute febrile illness, active systemic diseases, or events such as arthritis, hepatic disease, renal disease, malignancy, and pregnancy.
• Patients on systemic therapy or phototherapy for psoriasis for the past month.
• Participants who refused to participate in the study were excluded.

Clinical Methods

Clinical examination including general, systemic and dermatological examination was carried out. The severity of psoriasis was assessed according to PASI. The PASI is a useful tool for monitoring the response of psoriasis to any therapeutic regimen. A score can vary between 0-72. Body surface area was measured using the ‘rule of 9’ (12).

The study estimated free serum sialic acid among cases and control. To estimate the serum SA, the method proposed by Yao K et al., was used (13). In this method, precipitation of proteins was obtained by treatment of serum with ethanol. The estimation of SA of both the precipitate and supernatant was estimated based on the reaction of SA with ninhydrin reagent. This was compared with N-acetyl neuraminic acid standards ranging from 20-100 mg/mL. SA concentration obtained from the precipitate was protein-bound SA and that obtained from the supernatant was free SA which was read at 470 nm by spectrophotometer.

Reagents used were:

a) 95% ethanol
b) Sialic acid standard (10 mg/100 mL distilled water)
c) Ninhydrin reagent: Mix 6 mL acetic acid, 4 mL of concentrated hydrochloric acid, and 250 mg ninhydrin, vortex for 20-30 minutes
d) Glacial acetic acid
e) 0.1 N sodium hydroxide

Study Procedure

A 100 μL of serum were precipitated using 5 mL ethanol and centrifuged at 5000 rpm for 5 minutes. A precipitate was formed and the precipitate was dissolved in 1 mL of 0.1 N sodium hydroxide. In the standard test tube, 100 L of a SA standard of which 1 mL of glacial acetic acid and 1 mL of ninhydrin reagent was added to all the test tube and kept in a boiling water bath for 10 minutes and cooled under tap water and absorbance was taken at 470 nm in a spectrophotometer against blank set at zero.

Calculation of SA was done by the formula: OD of test/OD of standard×concentration of the standard (14).

Statistical Analysis

Software Statistical Package for the Social Sciences (SPSS) version 17.0 was used to perform statistical analysis. Statistical significance was evaluated between cases and controls using Student’s unpaired t-test and Pearson’s correlation coefficeient. SA levels were correlated with PASI, using Pearson’s correlation coefficient. All values were expressed as Mean±Standard Deviation (SD). The level of significance was set at 5%.


The current study included 50 cases and control with a mean±SD age of cases and controls was 44.04±10.9 years and 44.10±9.996, respectively. Demographic characteristics are shown in (Table/Fig 1).

The mean PASI was 23.16. There was a positive correlation between serum sialic acid values in cases with the PASI score. The p-value was <0.001 and the coefficient of correlation was 0.460 (Table/Fig 2),(Table/Fig 3).


Psoriasis is a chronic inflammatory disease characterised clinically by erythematous scaly plaques with induration predominantly involving the scalp, extensors of the upper limbs, lower limbs, and lumbosacral region. In addition to keratinocytes, dendritic cells, and T-cells which are the three main cells involved in the pathogenesis of psoriasis, other cells such as Natural killer (NK) cells, NK-T cells, and neutrophils also play a role. Psoriasis lesions contain increased numbers of T cells of different subsets cells that produce Interleukins (IL)IL-17 and IL-23 indicating a Th 17 response. Th1 cell polarisation is also seen with a production of Interferon-γ and Tumour necrosing factor -α was recently described to play an important role in maintaining chronic inflammation (15),(16). Psoriasis patients have increased levels of inflammatory markers, ROS, a compromised function of the antioxidant system, and lipid peroxidation. This suggests a link between psoriasis, inflammation, and oxidative damage (17). In the present study, levels of free SA were found to be elevated, which may be a result of inflammation.

The present study observed a significant increase in the free SA levels in patients with psoriasis compared to controls. Significant increase in free serum SA levels parallels oxidative stress in psoriasis patients. These findings were consistent with an Indian study by Rajappa M et al., which found TSA levels (181.44±67.60 vs 33.09±7.72, p-value <0.0001) and protein-bound sialic acid (PBSA) (56.06±17.96 vs 13.10±2.77 p-value <0.0001) higher in psoriasis patients. In their study, patients with arthritis were included and Serum TSA and PBSA levels were also assayed by modified Aminoff’s method. while in the present study, patients with arthritis were excluded and free serum SA measured by a method proposed by Yao K et al., They demonstrated that there was a significant association of oxidative stress and inflammation with psoriasis and therapy with Methotrexate significantly reduces inflammatory and oxidative stress parameters (10),(13).

The findings of the present study are also consistent with a study by Shenoy C et al., in which Lipid-Bound Sialic Acid (LBSA) levels were measured. This is a more accurate measure since only small amount of SA is found free in the blood and it is usually bound to glycoproteins, glycolipids, oligosaccharides, and polysaccharides (18).

There was a significant correlation between the free serum SA levels with the PASI scoring found in this study with the p-value of 0.001 and the coefficient of correlation was 0.460. Shenoy C et al., reported a non significant negative correlation between LBSA levels and PASI (r=-0.1533, p-value=0.464). This was probably because they studied LBSA, which acts not only as marker of inflammation but also as free radical scavenger (18). The present study suggests the potential utility of serum free SA as a biomarker of multiple parameters like hyperproliferation, inflammation, and oxidative stress in psoriasis. Oxidative stress can be used as a biomarker for the assessment of the severity and therapeutic response in psoriasis. One of the pivotal factors in cardiovascular morbidity is oxidative stress. It is hypothesised that oxidative stress and systemic inflammation occurring in psoriasis could serve as a missing link in the causal relationship between psoriasis and co-morbidities, thus warranting early intervention measures.


The LBSA value was not measured which is more accurate.


The role of oxidative stress and its implication as a biomarker for assessing disease severity and treatment response in psoriasis has been previously studied. This present study is, nevertheless, an important addition to support the role of free serum SA as a marker of inflammation in psoriasis. The severity of psoriasis as estimated by PASI scoring was associated with higher levels of free serum SA. There is a scope for future research in this field with a larger sample size to develop concrete evidence regarding the role of SA. This may translate into a potential target for pharmacotherapeutics in this ever-evolving field of psoriasis.


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DOI and Others

DOI: 10.7860/JCDR/2022/60052.17186

Date of Submission: Sep 04, 2022
Date of Peer Review: Sep 30, 2022
Date of Acceptance: Nov 08, 2022
Date of Publishing: Dec 01, 2022

• 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: Sep 17, 2022
• Manual Googling: Nov 04, 2022
• iThenticate Software: Nov 07, 2022 (9%)

Etymology: Author Origin

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