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

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



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




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



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




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help 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
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : BC28 - BC32 Full Version

Oxidative Stress and Biochemical Parameters among Recovered COVID-19 Patients: A Case-control Study


Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/52579.16534
Djamila Mezouar, Hafida Merzouk, Ilyes Ghailani, Ihab Abdelbasset Benomrane, Ibrahim Bouchoul, Sid Ahmed Merzouk

1. Associate Professor, Department of Natural and Life Sciences, University of Tiaret, Algeria. 2. Professor, Department of Natural and Life Sciences, Laboratory of Physiology, Pathophysiology and Biochemistry of Nutrition, Abou Bekr Belkaid University, Tlemcen, Algeria. 3. Postgraduate Student, Department of Natural and Life Sciences, Laboratory of Physiology, Pathophysiology and Biochemistry of Nutrition, Abou Bekr Belkaid University, Tlemcen, Algeria. 4. Postgraduate Student, Department of Natural and Life Sciences, Laboratory of Physiology, Pathophysiology and Biochemistry of Nutrition, Abou Bekr Belkaid University, Tlemcen, Algeria. 5. Postgraduate Student, Department of Natural and Life Sciences, Laboratory of Physiology, Pathophysiology and Biochemistry of Nutrition, Abou Bekr Belkaid University, Tlemcen, Algeria. 6. Professor, Department of Faculty of Technology Sciences, Laboratory of Physiology, Pathophysiology and Biochemistry of Nutrition, Abu Bekr Belkaid University,

Correspondence Address :
Dr. Djamila Mezouar,
Associate Professor, Department of Natural and Life Sciences, University of Tiaret, Algeria.
E-mail : djamila.mezouar@univtiaret.dz

Abstract

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic has spread rapidly, infecting more than 194 million and killing more than 4 million people worldwide. Algeria has not escaped this scourge; according to World Health Organization (WHO), 162,155 confirmed cases and 4,063 deaths have been recorded from 3rd January 2020 to 26th July 2021. Recent studies have indicated the critical role of an altered immune system, and oxidative stress in the pathological process contributing to several complications during COVID-19 disease.

Aim: To determine blood markers, oxidant/antioxidant status and biochemical parameters in patients highly recovered from COVID-19 and compare with those who have never contracted COVID-19; considered as controls.

Materials and Methods: The present case-control study was conducted in Tiaret, Algeria, between May 2021 and June 2021. Thirty healthy volunteers who had never contracted COVID-19 and 16 volunteers who recovered from COVID-19 in the last six months were included in the study. Blood samples were taken after 8 to 12 hours of fasting, the blood markers and biochemical parameters were evaluated. The participant with chronic diseases (diabetes, hypertension, cardiovascular diseases, kidney disease) was excluded. Student’s t-test was performed for statistical comparison between the two groups. Statistical analysis was performed using Excel Microsoft 2010 software.

Results. The control group consisted of 46.7% male (n=14) and 53.3% females (n=16). While, the case group consisted of 62.5% males (n=10) and 37.5% females (n=6). The plasma levels of Low Density Lipoprotein-Cholesterol (LDL-C), p-value=0.004** and creatinine increased very significantly in the cases compared to the controls. While, total cholesterol, p-value=0.04* and Glutamate Pyruvate Transaminase (GPT), p-value=0.03* increased significantly in the case group on comparision to the control group. On the other hand, erythrocyte Malondialdehyde (MDA) levels, p-value=0.009** increased very significantly in the case group compared to controls. The erythrocyte activity catalase decreased highly significantly in the case group compared to the controls. But erythrocyte Reduced glutathione (GSH) decreased very significantly in group cases compared to controls.

Conclusion: The findings in the present study confirmed the persistence of metabolic alterations and oxidative stress in COVID-19 patients after recovery. Antioxidant supplementation is recommended to improve redox status and reduce oxidative stress after recovery.

Keywords

Catalase activity, Malondialdehyde, Metabolism, Reduced glutathione

The Coronavirus Disease-2019 (COVID-19) pandemic is due to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), which was first discovered in December 2019 in Wuhan, China (1). Until July 2021, COVID-19 has infected more than 194?million and killed more than 4 million people worldwide. In Algeria, according to WHO, there have been 162,155 confirmed cases of COVID-19 with 4,063 deaths from 3rd January 2020 to 26th July 2021 (2). Earlier, WHO has reported that during June 2021, there was a 12% drop in cases worldwide, but an increase of more than 40% in Africa. Also, mortality increased in Africa (more than 20%) and South-east Asia (more than 12%) but decreased in Europe (less than 17%) and North and South America (less than 7%) (3).

With the new variants, especially delta, the situation has become much more alarming in Algeria and all world countries. Coronavirus infection could be symptomatic or asymptomatic. The most common symptoms in those affected are fever, dry cough, and fatigue. While the less common symptoms are body aches, sore throat, diarrhea, conjunctivitis, headache, loss of smell or taste, rash, or discoloration of the fingers or toes. The most severe symptoms are difficulty in breathing or shortness of breath, tightness or pain in the chest and loss of speech or motor skills (4).

The pathogenesis of COVID-19 is still incompletely understood. Nevertheless, recent studies have indicated the key role of altered immune system, oxidative stress and excessive inflammation in the pathological process, which contributes to several complications during COVID-19 (5),(6).

Oxidative stress corresponds to an imbalance between the pro-oxidant and antioxidant systems in favor of the pro-oxidant. According to a previous study, it is involved in the onset of several diseases such as arteriosclerosis, cancer, cardiovascular diseases, inflammatory diseases and the aging process (7). Recent studies show that oxidative stress plays a vital role in the pathogenesis of COVID-19, especially in the respiratory stage, which leads to the death of the infected patient (8),(9). In addition, advanced age, black and South Asian ethnicity, male sex, low socioeconomic status, hyperglycaemia, and obesity represent the main risk factors associated with coronavirus infection (10). These risk factors are associated with a state of significant oxidative stress (11),(12),(13),(14),(15),(16).

The accumulation of free radicals coupled with the weakened antioxidant system leads to oxidative stress, further aggravating respiratory illnesses, COVID-19 included. A strong relationship between coronavirus infection and mitochondrial dysfunction, inducing excessive Reactive Oxygen Species (ROS) release, has been reported (17). In addition, the virus induced modulation of the host cellular antioxidant defense system determines the severity of viral diseases (18).

The persistence of a state of oxidative stress after recovery from COVID-19 is well documented in a very recent study (19). Reducing oxidative stress is a priority in the follow-up of patients recovered from COVID-19. Authors are currently underway on the benefit of intravenous vitamin C supplementation to reduce the state of oxidative stress in these people. Targeting oxidative stress in COVID-19 recovery may provide a promising approach that leads to a successful healing. It is then essential to determine to what extent oxidative stress is present during recovery (19).

There is a paucity of data regarding the state of oxidative stress in COVID-19 patients and those who have recovered within the last six months. Because in the six months after infection, there is always symptoms and complications risk.

The present study aimed to identify blood markers (plasma and erythrocyte) of the oxidant/antioxidant status (Vitamin C, Malondialdehyde (MDA), catalase activity, Reduced glutathione (GSH) and biochemical parameters (total cholesterol, triglycerides, urea, creatinine, uric acid, Glutamic Oxaloacetic Transaminase (GOT), Glutamate Pyruvate Transaminase (GPT), total plasma proteins in people recovered from COVID-19 compared to people who have never contracted COVID-19, considered as controls.

Material and Methods

This case-control study was carried out in Boubeker khaled polyclinic center, Tiaret, Algeria, between May 2021 and June 2021. Investigations of patients, as well as blood sampling conditions, were subjected to a strict code of ethics. The protocol was approved by the Tlemcen Hospital Committee for Research on Human Subjects (D01N01UN1301202019). All participants were informed about the objective of this study and were asked to give their written consent before starting the work.

Inclusion criteria: The 16 volunteers, who recovered from COVID-19 in the last six months and 30 volunteers age, sex matched with healthy volunteers who had never contracted COVID-19 were included.

Exclusion criteria: Patients with chronic diseases (diabetes, hypertension, kidney disease, thyroid disease, cardiovascular diseases) and pregnant female were excluded from this study for both control and case groups.

Sample size: To obtain a power of 80% sample size calculator (Statistical solutions, Sigma) was used.

Study Procedure

The 5 mL of blood was taken in Ethylenediamine Tetraacetic Acid (EDTA) tubes after 8 to 12 hours of fasting and transported in an ice chest to the laboratory. Blood tubes were centrifuged at 3000 rpm for 15 minutes. Plasma was stored at -20°C for biochemical parameters (total cholesterol, triglycerides, urea, serum creatinine, uric acid, Glutamic Oxaloacetic Transaminase (GOT), Glutamate Pyruvate Transaminase (GPT), total plasma proteins) and oxidant/antioxidant status markers determinations (Vitamin C and MDA). The remaining erythrocytes were recovered, washed and haemolysis by adding cold distilled water (1/4) and then incubated for 15 minutes in the refrigerator. Cell debris was removed by centrifugation at 4000 rpm for 15 minutes. Then, the lysate was recovered for erythrocyte oxidant/antioxidant status markers assay (MDA, GSH and catalase activity).

The erythrocyte lysate preparation and vitamin C dosage were carried out on the same day, the sample was taken.

Measurement of biochemical parameters: The determination of biochemical parameters (total cholesterol, triglycerides, LDL-C, HDL-C, urea, creatinine, uric acid, GOT, GPT, total plasma proteins) were carried out by enzymatic spectroscopic methods using Biomaghreb kits (Tunis, Tunisia) (Table/Fig 1).

Measurement of oxidant/antioxidant status markers: Plasma vitamin C was measured according to the method of Jagota SK and Dani HM (20), using the folin’s reagent and a calibration range of ascorbic acid. The absorbance was measured at 769 nm.

Then, plasma and erythrocyte MDA; the most marker used to determine the lipid peroxidation process, was assayed by the method of Draper HH and Hadley M (21). After hot acid treatment, the aldehydes react with Thiobarbituric Acid (TBA) to form a chromogenic condensation product. The absorbance of this chromogen was measured at 532 nm. The MDA concentrations were expressed as micromoles of MDA, using the molar extinction coefficient (1.56×105 M-1cm-1). While, Catalase Activity (CAT, EC 1.11.1.6) was determined by the Claiborne method (22), which is based on the decomposition rate of hydrogen peroxide at 240 nm by the catalase enzyme. Erythrocyte GSH levels were assayed using to the colorimetric method using Ellman's reagent (DTNB). The reaction involves cutting the 5,5-dithiodis-2-nitrobenzoic acid (DTNB) molecule with GSH, which releases Thionitrobenzoic acid (TNB). At pH equal to 8-9, alkaline TNB exhibits an absorbance at 412 nm with an extinction coefficient equal to 13.6 mM-1cm-1 (23).

Statistical Analysis

The results are presented as mean±standard deviations. Statistical analysis was performed using excel Microsoft 2010 software. After variance analysis, the significant differences between the two groups were determined by student’s t-test. Differences were significant for p-value<0.05.

Results

Characteristics of the study population: Analysis of age and Body Mass Index (BMI) (Kg/m2) were not significantly different between the two groups (p-value=0.6 for age and 0.4 for BMI). The control group consisted of 46.7% male (n=14) and 53.3% female (n=16). While, the case group consisted of 62.5% male (n=10) and 37.5% female (n=6) (Table/Fig 2).

The present study showed that 68.75% (n=11) of recovered persons were married, and 93.75% (n=15) were educated. On the other hand, 96.66% (n=29) of the control group were educated (Table/Fig 2). Demographic characteristics such as family members, work environment and type of profession are a primary factors in the possibility of COVID-19 infection.

Biochemical parameters in cases and controls: Plasma levels of triglycerides, HDL-C, uric acid, urea, GOT, and total plasma proteins were identical between the two groups. On the other hand, plasma levels, LDL-C and creatinine increased very significantly in the cases compared to the controls (p=0.004** for LDL-C and 0.005** for creatinine). Total cholesterol and GPT risen considerally in the case group compared to the control group (p=0.04* for total cholesterol and 0.03* for GPT) (Table/Fig 3).

Oxidant/antioxidant status markers in cases and controls: erythrocyte MDA levels increased very significantly in the case group compared to controls (p=0.009**) (Table/Fig 4). In addition, erythrocyte catalase activity decreased significantly in the cases compared to the controls (p=0.0002***) (Table/Fig 5). While erythrocyte GSH decreased very significantly in patients compared to controls (p=0.007**) (Table/Fig 5).

Discussion

The findings in the present study showed a significant alteration in the level of biochemical parameters and oxidant/antioxidant markers.

COVID-19 has surprised every one because of its unprecedented high spread around the world. It drew the attention of researchers to seek explanations on the pathophysiology of this infection and the risk factors that can play a role in its evolution and complications. Previous studies described several metabolic alterations in patients during the infection (24). It has been demonstrated that COVID-patients suffer from alterations in kidney function, resulting in elevated proteinuria, haematuria, and even acute kidney injury among severe cases of the infection (25),(26),(27),(28), or slight elevation in creatinine, possibly due to renal tropism of the virus and multiple organ failure (29). These patients presented too altered lipids levels.

It has been found that triglycerides, diglycerides and fatty acids were increased in infected people (30). While LDL-cholesterol, HDL-C and total cholesterol levels decreased significantly in patients compared to controls. Also, it has been reported that reduced serum high density lipoproteins concentration is associated with the severity of COVID-19 (31). On the other hand, it has been shown that reduced LDL-cholesterol levels were associated with a high rate of 30 day mortality among COVID-19 patients (32). Inversely, HDL-C is recognised to play a scavenger for viruses, an immune modulator and a mediator of viral entry (33). Regarding liver function, it has been shown that COVID-19 infection induced liver damage with elevated liver enzymes attributed to the immune mediated damage and direct cytotoxicity (34),(35).

In the present study, the authors found that plasma levels of LDL-C and creatinine increased very significantly in the cases compared to the controls. While total cholesterol and GPT risen considerably in the case group compared to the control group. The elevation of cholesterol could be the result of the liver’s inability to eliminate all the cholesterol, and this has been proven by the increase in the liver enzyme GPT. Authors believed that the increase in creatinine was due to decreased in renal filtration (34).

Besides, it is well known that SARS-CoV-2 induces an increase in ROS formation in response to high levels of infected cells, and acts on antioxidant mechanisms creating an imbalance status between oxidants/antioxidants resulting in cell damage (36). The COVID-19 infection has distinguished itself by a multiorgan system inflammation and oxidative stress. However, the recovery and rehabilitation process in infectious disease survivors are not clearly understood. In addition, pre-existing metabolic abnormalities, such as diabetes, obesity, cardiovascular diseases and hypertension, are important risk factors for severe and critical cases of this infection (37). Diabetes, obesity and hypertension represent the significant comorbidities in people with COVID-19 and are responsible for the progression of COVID-19 disease to very critical stages (38).

Few data have been done on the period after recovery (19). The long term metabolic consequences for survivors of COVID-19 have been observed in patients with these diseases cited above (39). However, no information has been given for patients without metabolic diseases who recovered from COVID-19. Therefore shows the originality of the present study on cured patients compared to controls who have never been infected with the virus.

According to the results from the present study, there was no difference in BMI and age between the two groups. The present study highlighted the persistence of metabolic abnormalities after recovery from COVID-19 infection despite the absence of any metabolic diseases. It is believed that the metabolic disturbances observed in the present study are due to the viral involvement during the infection period.

Authors have proposed the association between oxidative stress and the pathogenesis of COVID-19. The COVID-19 patients exhibited a high serum level of oxidative stress and inflammatory markers and a low serum level of antioxidants, compared to the healthy control group, especially in patients admitted to intensive care (6). In vitro and in vivo study has shown that certain viruses can modify the redox balance of the cell (40). The onset of oxidative stress by viral infection is necessary for the activation of innate immunity through the production of cytokines (41). In addition, the oxidative stress induced by several viruses involved in the facilitation of viral replication inside the cell (40).

The MDA is an important indicator of lipid peroxidation, especially for its stability as a final product of this chain process. Mehri F et al., 2021 (39) found serum MDA levels nearly three times higher in the group of COVID-19 patients compared to controls. In the present study, the authors found that erythrocyte MDA levels increased significantly in the case group compared to controls.

Currently, the management of COVID-19 mainly involves nutritional support, including taking micronutrients, mainly Zinc and vitamin C. The vitamin C is known for its antiviral effect against several respiratory viruses and other viruses. This effect is likely the result of an enhanced immunological response against viral infections rather than a direct effect against viral replication. More, vitamin C has potent antioxidant and anti-inflammatory effects, which reduce the risk of tissue damage from oxidative stress and suppress the excessive inflammatory response mediated by cytokines. Vitamin C also increases interferon production and stimulates lymphocyte proliferation, enhancing the host's antiviral immune response (42). Low levels of vitamin C was found in patients with respiratory distress syndrome; this could be due to increased metabolic consumption following an increased inflammatory response, glomerular hyperfiltration, dialysis, decreased blood pressure and gastrointestinal absorption or decreased recycling of dehydroascorbate to ascorbic acid (43). The results from the present study indicated that plasma vitamin C levels were similar between the two groups

According to research, the deficiency of antioxidant enzymes and the synergy between the SARS-CoV-2 virus and a bacterial pathogen, Streptococcus pneumonia is the most likely cause of death associated with COVID-19. A decrease in catalase activity induces H2O2 accumulation in the body. On the other hand, the additional production of H2O2 by the virus increases the concentration of H2O2 to a critical level in the respiratory tract. The high level of H2O2 is responsible for lung damage (44). The authors of the present study indicated that erythrocyte catalase activity decreased significantly in the cases compared to the controls.

THe GSH represents the most important endogenous antioxidant non enzymatic of the whole organism. The GSH depletion is associated with COVID-19 mortality. At the same time, the high levels of GSH are associated with a decrease in the severity and mortality rate due to the infection (45). In addition, it has been demonstrated that thiol can block the angiotensin converting enzyme 2, so preventing the penetration of SARS-CoV-2 into cells (46). In the present study, erythrocyte GSH levels decreased significantly in the cases compared to the controls.

The results of the present study showed that redox status was still altered in COVID-19 patients after recovery. In these patients, erythrocyte MDA levels were high, while catalase activity and GSH levels were low compared to controls. These findings pointed out the persistent oxidative stress after recovery. This oxidant/antioxidant imbalance could be due to dysfunctional endothelial cells and inflammation state observed during COVID-19 which persisted after recovery. Authors also supposed that increased circulated lipid levels noted in the present study such as LDL-C and total cholesterol and decreased HDL-C concentration could be responsible for this oxidative stress state.

Limitation(s)

The principal limitation of the present study was the small sample size. Second, the study was carried out during confinement representing an obstacle. In addition, other oxidative stress markers and lifestyle parameters are necessary to understand the period after recovery. Thus, further studies with a huge sample size are essential, considering other potential parameters like lifestyle factors, type of treatment during the infection and the duration of the disease.

Conclusion

In conclusion, the present study results confirmed metabolic alterations and oxidative stress persistence in COVID-19 patients after recovery. These alterations should not be neglected and should be supported by adequate treatment. Antioxidant supplementation is also recommended to improve redox status and reduce oxidative stress after recovery.

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DOI and Others

DOI: 10.7860/JCDR/2022/52579.16534

Date of Submission: Sep 28, 2021
Date of Peer Review: Oct 26, 2021
Date of Acceptance: Feb 20, 2021
Date of Publishing: Jun 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

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