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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.
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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

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

Dr. Shankar P.R.

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

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

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

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : November | Volume : 17 | Issue : 11 | Page : BC10 - BC13 Full Version

Association between Serum Uric Acid Levels and Primary Open-angle Glaucoma: A Cross-sectional Study

Published: November 1, 2023 | DOI:
Vinayak Ganesh Bhat, Rajkumar Patra, CJ Raghuram, Akanksha Giri, N Lakshmana Rao

1. Assistant Professor, Department of Biochemistry, Maharajah’s Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India. 2. Assistant Professor, Department of Ophthalmology, Maharajah’s Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India. 3. Professor, Department of Pathology, Maharajah’s Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India. 4. Postgraduate, Department of Radiodiagnosis, Sri Ramachandra Medical College, Chennai, Tamil Nadu, India. 5. Assistant Professor, Department of Community Medicine, Maharajah’s Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India.

Correspondence Address :
Akanksha Giri,
202, 2nd Floor, Satya Samrudhi Apt, Near Saibaba Shiva Temple, Pradeep Nagar, Vizianagaram, Andhra Pradesh-535004, India.


Introduction: There is an intricate association between serum Uric Acid (UA) levels and Primary Open Angle Glaucoma (POAG). UA levels in the blood are known to be a good indicator of antioxidant function, and a decrease in UA plays a key role in the pathogenesis of POAG. However, the association of serum UA and Uric Acid Creatinine Ratio (UACR) in POAG cases in the Indian population remains unexplored.

Aim: To investigate the association of serum UA levels and serum UACR with POAG.

Materials and Methods: This cross-sectional study was conducted among patients who attended the Outpatient Department (OPD) of Opthalmology at Maharajah’s Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India. The duration of the study was one year and six months, from January 15, 2021 to July 15, 2022. The study included 200 recently diagnosed patients with POAG, who were divided into three groups based on Intraocular Pressure (IOP): Group 1 (mild) with an IOP of 21-30 mmHg, group 2 (moderate) with an IOP of 31-50 mmHg, and group 3 (severe) with an IOP greater than 51 mmHg. Age and gender-matched 199 healthy subjects were included as the control group. Blood samples were collected from the study subjects after obtaining informed consent and were tested for serum UA (using the modified Trinder method) and serum creatinine (using Jaffe’s method) in a semiautomatic analyser (Erba chem 7). The data were analysed using Statistical Package for Social Sciences (SPSS) version 21.0 software and MS Excel 2007.

Results: The mean age of the study participants of all three groups was found to be 51.19±5.06 years with 46.7% male and 53.3% female subjects. The serum UA levels were 5.55±0.74 mg/dL in the mild POAG group, 4.1±0.5 mg/dL in the moderate POAG group, and 2.67±0.6 mg/dL in the severe POAG group (p-value <0.001). The present study also found that among the three study groups of POAG, UA levels were the lowest in the severe POAG group, followed by the moderate POAG group, and then the mild POAG group. This pattern was observed in both the males and females population.

Conclusion: The present study found that serum UA levels were decreased in POAG patients compared to the normal healthy control group. Furthermore, the study revealed a significant negative association between serum UA levels and serum UACR levels with the severity of POAG.


Antioxidant, Intraocular pressure, Irreversible blindness, Oxidative stress

Glaucoma is the third most common cause of irreversible blindness in India (1). According to a study conducted in 2020 (2), 12 million people in India had glaucoma, with 1.5 million patients experiencing blindness. Alarmingly, 75% of cases remain undiagnosed (1),(2), representing the submerged portion of the iceberg. The global burden of glaucoma was estimated to be 3.54% (3), while in India, it was found to be 2.10% in urban populations and 1.45% in rural populations in 2020 (4),(5). Glaucoma manifests as a progressive visual field defect, gradually causing tunnel vision and peripheral vision loss, along with structural damage to the optic disc (6). In India, POAG has a higher prevalence compared to primary angle-closure glaucoma (4). POAG is a multifactorial disease with diverse causative factors (7),(8),(9). Oxidative stress is an important contributor to the pathophysiology of glaucoma (10),(11), leading to physiological and morphological changes in aqueous humour outflow and subsequent damage to retinal ganglion cells (12),(13).

The UA is naturally present in human blood as a byproduct of purine catabolism and acts as a major water-soluble antioxidant molecule. It scavenges strong oxidant superoxide and nitrogen radicals (14). A study by Benoist d’Azy C et al., found that levels of oxidative stress biomarkers were increased, while antioxidative stress markers were decreased in subjects with POAG (10). This suggests that UA levels in the blood can serve as an indicator of antioxidant function in POAG. Serum UA levels can vary among individuals based on their kidney function and purine catabolism. Serum Urine Albumin-to-Creatinine Ratio (UACR) provides an accurate measure of UA levels in the serum (15), reflecting the actual antioxidant activity in the human body. A literature search revealed no previous studies on the association between serum UA levels and POAG in the Indian population. Therefore, the present study was conducted to investigate the association between serum UA and POAG.

Material and Methods

A cross-sectional study was conducted in the OPD of Opthalmology at Maharajah’s Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India. The duration of the study was one year and six months, from January 2021, to July 2022. The study protocol received approval from the Institution’s Ethics Committee (IEC number IEC/108/21). Written informed consent was obtained from all study participants for the use of their clinical data in research.

Inclusion criteria: Recently diagnosed cases of open-angle glaucoma without any prior treatment, aged 18 years or older. The diagnosis of POAG was based on the presence of an open anterior chamber angle and glaucomatous damage in visual fields of one or both eyes, or IOP higher than 21 mmHg without any visual field defect (16). If both eyes of a patient were affected by POAG, the eye with the highest IOP was selected for the study. Age and gender-matched individuals without glaucoma, who visited the institution for general ophthalmic complaints such as spectacle correction or dry eye, were included as controls in the study.

Exclusion criteria: Both cases and controls with conditions that can affect visual field tests other than glaucoma, such as diabetic retinopathy, hypertensive retinopathy, age-related macular degeneration, and stroke, were excluded from the study. Additionally, patients with glaucoma under treatment, normotensive glaucoma, pseudoexfoliative syndrome, secondary glaucoma, those who underwent cataract or refractive surgery, had retinitis pigmentosa, or had acute systemic illness. Patients taking medication that could alter serum UA levels were also excluded from the study.

Sample size calculation: The study enrolled 200 recently diagnosed cases with POAG and 191 healthy controls who visited the Institution during the study period, using convenience sampling.

Study Procedure

The study participants were divided into three groups based on IOP: group 1 (mild) with IOP of 21-30 mmHg, group 2 (moderate) with IOP of 31-50 mmHg, and group 3 (severe) with IOP >51 mmHg [17,18]. Detailed clinical history was obtained from all study participants, including demographic details such as age and sex. A comprehensive ocular examination was performed in the ophthalmology department, including assessments of best-corrected visual acuity, IOP, anterior segment examination using a slit lamp biomicroscope with a 90D lens, detailed fundus examination, and visual field examination to confirm the diagnosis.

After obtaining informed consent, a 5 mL blood sample was collected from all subjects under aseptic conditions. The blood samples were analysed for serum UA (using the Modified Trinder method) and serum creatinine (using Jaffe’s method) using a semi-automated chemistry analyser (Erba chem 7). The cut-off biological reference values were taken according to the kit manufacturer’s instructions: For males, serum UA levels were considered to be 4.4-7.6 mg/dL, while for females, the range was 2.3-6.6 mg/dL. Serum creatinine levels for males were considered to be 0.7-1.4 mg/dL, and for females, the range was 0.6-1.1 mg/dL. The serum UA to UACR for both males and females was considered to be 3.5-6.

Statistical Analysis

The data were analysed using International Business Machines (IBM) SPSS Statistics version 21.0 software and MS Excel 2007. Qualitative variables were expressed as frequencies (n) and percentages (%), while quantitative variables were expressed as means and Standard Deviation (SD). The Student’s unpaired t-test was used for mean comparisons between two groups. A p-value <0.05 was considered statistically significant.


In the present study, age and gender were not found to be statistically significant factors among the three groups. The mean serum UA and UACR levels were significantly higher in the mild POAG group compared to the moderate POAG group and the severe POAG group. The gender-based analysis of serum UA showed a strong association, with significantly higher levels among males. This association was also found in the gender-wise analysis of the parameter, with a p-value <0.001 for both male and female subjects (Table/Fig 1).

There was no statistical difference in age and gender between the cases and controls. Serum UA and serum UACR showed a significant association between the cases and controls, with a p-value <0.001. Both male and female subjects showed a significant association with serum UA and UACR levels (p-value <0.001) (Table/Fig 1). The present study demonstrated that serum UA levels and UACR significantly decreased (p-value less than 0.001) with an increase in intraocular pressure in untreated POAG study groups. This effect was particularly evident in the severe POAG group compared to the control group (Table/Fig 2),(Table/Fig 3).


The present study investigated the association between serum UA and serum UACR in Indian subjects with mild, moderate, and severe POAG. The use of UACR was aimed at reducing potential interference arising from differences in renal function. Age and gender-matched subjects were selected as controls from the same rural areas of the district. UA is naturally produced in the human body during purine catabolism and excreted through the kidneys. A study by Waring WS reported that UA contributed up to two-thirds of the antioxidant activity in human blood (19). Another study by De Lau LM et al., found a decreased risk of Parkinson’s disease in subjects with higher UA levels in a large population-based cohort study (20). It has been observed that oxidative stress alters aqueous humour outflow and increases intraocular pressure, leading to damage to retinal ganglion cells (12).

Previous studies have demonstrated that POAG patients have lower antioxidant activity in serum and aqueous humour (21),(22),(23). Many studies have also shown increased oxidant activity in the serum and aqueous humour (22),(24),(25). Tanito M et al., showed that serum antioxidant capacity reflects the local redox status of the eye (26). It is also understandable that UA gets consumed by excess oxidising agents produced in POAG in both the serum and aqueous humour.

The present study investigated serum UA levels according to the severity in participants with POAG and found that among these groups, those with the most severe POAG had the lowest levels of UA. This pattern was observed in both the male and female population. All the associations were statistically highly significant (p-value <0.001). In a previous study by Li S et al., it was found that baseline serum UA levels were significantly higher in subjects with non progressing Primary Angle Closure Glaucoma (PACG) compared to progressing PACG. In contrast, patients with lower baseline serum UA levels had a higher probability of developing glaucoma progression during the follow-up period (27). These results suggest that decreased serum UA levels may be associated with an increased risk of developing POAG. The decreased levels of UA can be an indicator and a risk factor for developing POAG.

The study by Kim SW and Kang GW (2016) found that the male population had a higher risk of developing POAG than females (8). This gender difference could be explained by higher oestrogen levels in females than in males. Oestrogen hormone has a great anti-inflammatory property regulated by pro-inflammatory genes at the molecular level (28). The present study showed higher UA values in male subjects than in female subjects, which could be due to the smaller study population.

The present study demonstrated that serum UA levels in POAG subjects were significantly lower than those in the control subjects (p-value <0.001). Additionally, current study showed that serum UACR levels in POAG subjects were significantly lower than in the control subjects (p-value <0.001). On the other hand, a study by Yuki K et al., showed statistically significant higher UA levels in normotensive glaucoma subjects (29). Another study by Mohammadi M et al., concluded that there was a higher UA level in glaucoma patients compared to controls, but this finding was not statistically significant (30). In conclusion, based on the findings of the current study, it is hypothesised that there is a strong association between mean serum UA levels and serum UACR levels with POAG severity in untreated POAG subjects.


This research was conducted at a hospital facility in northern Andhra Pradesh. To achieve a more comprehensive perspective, it is essential to conduct the study at the community level, including sampling from each village. Additionally, conducting nationwide research can provide precise insights into the overall situation.


The present study found that serum UA levels decreased in POAG patients compared to the healthy controls. It was also found that UA levels had a significant association with the severity of POAG. Therefore, serum UA and UACR can be used as potential biomarkers in patients with POAG to assess the severity of the disease. A more detailed study is required with a larger study population selected at the community level, including urban and rural populations from various parts of India.


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DOI and Others

DOI: 10.7860/JCDR/2023/63326.18670

Date of Submission: Feb 07, 2023
Date of Peer Review: Apr 22, 2023
Date of Acceptance: Oct 15, 2023
Date of Publishing: Nov 01, 2023

• 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: Feb 21, 2023
• Manual Googling: Jun 15, 2023
• iThenticate Software: Oct 12, 2023 (9%)

ETYMOLOGY: Author Origin


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