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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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.
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

Research Protocol
Year : 2022 | Month : December | Volume : 16 | Issue : 12 | Page : ZK08 - ZK10 Full Version

Comparative Evaluation of Serum Interleukin-6 Expression with Neutrophil-lymphocyte Ratio and Platelet-lymphocyte Ratio in Pre and Post Surgery Oral Squamous Cell Carcinoma Patients: A Research Protocol

Published: December 1, 2022 | DOI:
Pragati A Bhargava, Rahul R Bhowate

1. Postgraduate Student, Department of Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, DMIMSU, Sawangi Meghe Wardha, Maharashtra, India. 2. Professor, Department of Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, DMIMSU, Sawangi Meghe Wardha, Maharashtra, India.

Correspondence Address :
Dr. Pragati A Bhargava,
Postgraduate Student, Department of Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, DMIMSU, Sawangi Meghe, Wardha, Maharashtra, India.


Introduction: Oral Squamous Cell Carcinoma (OSCC) is the 3rd most common malignancy. In Indian scenario, oral submucous fibrosis is the most common condition associated with OSCC. Pre and postsurgical evaluation of serum Interleukin-6 (IL-6), Neutrophil Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) will help in predicting the prognosis, along with planning of postsurgical treatment protocol. The NLR and PLR are easily available and cost-effective biomarkers from peripheral smear.

Need of Study: The IL-6 and NLR are convenient and inexpensive prognostic markers, they could be widely available in routine clinical practice, which might serve as a valuable marker for predicting the prognosis of OSCC and assessing the magnitude of systemic inflammation.

Aim: To compare the serum IL-6 with NLR and PLR in pre and postsurgical OSCC patients.

Materials and Methods: A prospective analytical study, for duration of two years from December 2020 to October 2022 will be conducted at Department of Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Sawangi (Meghe), Wardha, Maharashtra, India, in which total 40 patients from lower and middle socio-economic status and histological confirmed cases of OSCC will be included, after obtaining an informed written consent. A detailed clinical, radiological and histological evaluation of all cases will be recorded in the structured format. Presurgical and postsurgical 5 mL venous blood will be collected for evaluation of IL-6, NLR, Platelet–Lymphocyte ratio. Data analysis will be done using unpaired‘t’ test. For categorical data, Chi-square test will be used to compare the proportions.

Conclusion: The present study results are expected to provide evidence for the role of serum IL-6 alongwith NLR and PLR as adjuvant biomarkers for OSCC.


Malignancy, Peripheral smear, Proinflammatory cytokines

Oral squamous cell carcinoma accounts for 2-3% of all cancers and is the 11th most common cancer worldwide. It remains a major cause of morbidity and mortality in patients with head and neck cancer (1). Recently, several studies have reported that biomarkers involved in inflammation and the immune system are useful for understanding the biological behaviour of OSCC (2),(3).

The IL-6 is a multifunctional cytokine that regulates inflammatory responses (1). It plays an important role in many tumour functions, including development, migration, invasion, growth, proliferation, apoptosis, progression, angiogenesis and differentiation of tumour cells (1). Although neutrophils have anti-tumour effects, increasing NLR is less efficacious but lymphocytes are more responsible for controlling cancer progression (1). Several clinicopathologic factors, such as age, primary tumour size, regional lymph node metastasis and surgical margin involvement have been shown to contribute to the poor prognosis in patients with oral cancer (4). Therefore, it is necessary to search for a potential prognostic indicator that would be available before surgery. Therefore, NLR elevation has been suggested to be associated with poor prognosis (1).

Recent studies have shown an increase of circulating IL-6 after surgery, this relationship was evaluated before and after tumour resection (1),(3). Elevated NLR and PLR have been reported to be associated with a prognosis of survival in various cancers, including oesophageal, nasopharyngeal, gastric, colorectal and endometrial carcinomas (4), but in the previous study only pretreatment evaluation was conducted for IL-6 (3) and NLR, PLR (4),(5). Hence, present study will be undertaken after ethical approval from Institutional Ethics Committee for evaluation of the serum IL-6 with NLR and PLR in pre and postsurgical OSCC patients.

The objective of the study would be estimate and compare pre and postsurgical serum levels of IL-6, PLR and NLR in OSCC patients. The null hypothesis considered for the study was preoperative and postoperative changes in serum levels of NLR, PLR and IL-6 may not be present with cases of OSCC. Though, there is an alternative hypothesis that states that preoperative and postoperative elevated serum levels of NLR, PLR and IL-6 may be present with cases of OSCC. Hence, the present study results would provide a comparative evaluation of these markers in OSCC patients.

Material and Methods

The present prospective analytical study will be conducted in Department of Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Sawangi (Meghe), Wardha, Maharashtra, India, from December 2020 to October 2022. Study will be commenced after the approval of Institutional Ethics Committee [Ref.No.-DMIMS(DU)/IEC/2020-21/9427].

Inclusion criteria: Patients aged between 20-60 years with middle and low socio-economic status, clinical and histopathological confirmed diagnosis will be included in the study.

Exclusion criteria: Patients with history of other body benign/malignant tumour in the past and who underwent preoperative chemotherapy or radiation therapy will be excluded. Patient with diagnosed cases of Cardiovascular System (CVS)/ Respiratory System (RS)/Gastrointestinal Tract (GIT)/endocrinal diseases will also be excluded.

Sample size calculation: Using single proportion formula, for the sample size n:


And Zα/2-is the critical value of the normal distribution at α/2.
(e. g. for confidence level of 95%, α is 0.05 and the critical value is 1.96)
MOE-is the Margin Of Error
P=2.65 which is the sample proportion based on the number of patients reporting at Sharad Pawar Dental College and Hospital (SPDC) having OSCC.
N=population size.

The total sample size was calculated to be 40.

Study Procedure

Patients visiting Department of Oral Medicine and Radiology with clinical and histopathological confirmed diagnosis of OSCC will be included in the study. Clinical Tumour Node and Metastasis (TNM) classification and histopathological grading will be followed to categorise the OSCC cases (6). Imaging evaluation for lymph node status will also be done.

Parameters assessed: Patients peripheral smear will be used to evaluate NLR and PLR. Preoperative samples will be collected after biopsy confirmation and postoperative samples will be collected on 7th day. The NLR, PLR and IL-6 will be assessed and compared pre and postoperatively. The correlation between NLR, PLR, IL-6 with clinical size of the tumour, lymph node status will also be assessed.

Preoperative NLR and PLR with IL-6 will be correlated with the prognosis as it is found that a high overall tumour stage and lymph node involvement are linked to poor prognosis (3),(4). Increased levels of both preoperative and postoperative NLR, PLR (cutoff value of 2.7 and 135, respectively) and IL-6 (cutoff value serum values ≥5 pg/mL) (4) may indicate grave outcome of the disease.

Estimation of serum IL-6: In the present study human IL-6 Enzyme Linked Immunosorbent Assay (ELISA) kit (Diaclone, France), batch: 1006-120, Cat.No: 950.030.096 will be used according to company’s guidelines for estimation of IL-6.

Statistical Analysis

Data will be entered into Microsoft excel worksheet (Microsoft, USA). Data analysis will be done using IBM Statistical Package for Social Sciences (Statistics for Windows, version 21.0. Armonk, NY: IBM Corp). Categorical data will be described in terms of frequencies and percentages. Continuous data will be presented by mean and Standard Deviation (SD). Comparison of means will be done using unpaired ‘t’ test. For categorical data, Chi-square test will be used to compare the proportions. Spearman correlation coefficient will be used to analyse the correlation between NLR, PLR and IL-6 with clnical size of the tumour, lymph node status. For analysis, p-value less than 0.05 will be considered statistically significant.


Interleukin-6 is a multifunctional cytokine that regulates immune responses (1). IL-6 activates the Janus Kinases (JAK)/Signal Transducer and Activator of Transcription (STAT), Phosphoinositide 3-kinase (PI3K), and the Mitogen Activated Protein Kinase (MAPK) pathways (1),(5). This signalling influences cell migration, malignant tumour growth and invasion, anti-apoptotic signalling, angiogenesis, and bone remodelling. In this study, we will examine the association between IL-6 expression and clinicopathological factors in patients with OSCC (1),(6). The IL-6 expression is associated with Primary Ovarian Insufficiency (POI), vascular invasion, and pathological nodal status in OSCC. In particular, vascular invasion strongly correlated with IL-6 expression, suggesting that IL-6 is involved in lymphangiogenesis in OSCC (7),(8). Additionally, some studies have reported that IL-6 over expression plays transcriptional and regulatory roles in invasion and metastasis, leading to poor prognoses for patients with head and neck cancers (7),(9),(10). The IL-6 production is increased in response to various stimuli, such as infection and inflammation (1),(11).

Leukocyte count is usually increased in response to infection, inflammation, allergic reaction, and malignancy (12). The NLR elevation has been suggested to be associated with poor prognosis (4),(13),(14). Platelets can promote tumour growth by increasing angiogenesis, increasing microvessel permeability and extravasation of cancer cells (15),(16). Platelets could interact with tumour cells through receptors or ligands and increase tumour cell growth or invasion platelets have a negative effect in host immune attack against tumours (4),(6). Researchers observed that the numbers of neutrophils and lymphocytes were inversely correlated and that NLR was an indicator of poor prognosis (4),(17). Based on these findings it is conceivable that the white blood cell differential in Head and Neck Squamous Cell Carcinoma (HNSCC) is preferentially skewed towards either a myeloid or a lymphoid lineage, with the lymphoid preponderance being associated with better disease outcome (12). It is important to point that the roles of different cellular, subsets in dictating cancer behaviour (14),(16),(18).


The main limitation of this study includes areca nut, tobacco and alcohol habit which are responsible for metabolic syndrome, coronary artery disease, chronic obstructic pulmonary disease and hepatic disease which can change the NLR, PLR and IL-6 values, and in turn influcences the final outcome of the results in the present study.


The NLR and PLR can be an adjuvant biomarker for the OSCC in predicting prognosis and are easily available investigation from the peripheral smear of the patient but IL-6 is a proinflammatory biomarker even if it is not easily available in routine practice, it helps in binding the correlation with NLR and PLR.


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DOI and Others

DOI: 10.7860/JCDR/2022/58470.17343

Date of Submission: Jun 15, 2022
Date of Peer Review: Aug 06, 2022
Date of Acceptance: Oct 18, 2022
Date of Publishing: Dec 01, 2022

Author declaration:
• 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: Jun 29, 2022
• Manual Googling: Sep 07, 2022
• iThenticate Software: Oct 17, 2022 (17%)

ETYMOLOGY: Author Origin

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