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

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
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Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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Professor & Head,
Department of Dematolgy,
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




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"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

Important Notice

Original article / research
Year : 2007 | Month : April | Volume : 1 | Issue : 2 | Page : 39 - 44

Status of Lipid Peroxidation, Glutathione, Ascorbic Acid, Vitamin E and Antioxidant Enzymes in Schizophrenic Patients

SURAPANENI K M

Department of Biochemistry, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation Chinoutpally, Gannavaram (Mandal)-521286, A.P., India

Correspondence Address :
Corresponding author: Surapaneni K M, Assistant Professor, E-mail: krishnamohan_surapaneni@yahoo.com

Abstract

The exact pro- and antioxidant status in schizophrenic patients is still not clear. To add a new insight to the question, changes in the erythrocyte lipid peroxidation products (MDA), levels of glutathione (GSH), ascorbic acid and plasma vitamin E (non-enzymatic antioxidant parameters) and activities of antioxidant enzymes superoxide dismutase (SOD), glutathione peroxidase (GPX) and catalase in erythrocytes were studied in 48 schizophrenic patients and 48 healthy subjects. It was observed that there was a significant increase in erythrocyte MDA levels and activities of SOD and GPX and a significant decrease in erythrocyte GSH, ascorbic acid, plasma vitamin E levels and catalase activity in patients with schizophrenia, when compared to controls. The results of our study have shown higher oxygen free radical production, evidenced by increased levels of MDA and decreased levels of GSH, ascorbic acid, vitamin E and catalase activity, which supports the oxidative stress in schizophrenic patients. The increased activities of antioxidant enzymes may be a compensatory regulation in response to increased oxidative stress. The decreased concentrations of the glutathione and antioxidant vitamin status support the hypothesis that lipid peroxidation is an important causative factor in the pathogenesis of schizophrenia. These data reveal that antioxidant defence mechanisms might be impaired in schizophrenic patients. These findings also provide a theoretical basis for the development of novel therapeutic strategies, such as antioxidant supplementation. This may suggest the hope for use of antioxidants in clinical trials to prevent and treat schizophrenic patients.

Keywords

Malondialdehyde (MDA), glutathione (GSH), ascorbic acid, vitamin E, superoxide dismutase (SOD), catalase, glutathione peroxidase (GPX), schizophrenia.

If a homeostasis between rate of formation of free radicals and the rate of their neutralisation of free radicals is not maintained, an oxidative damage, known as oxidative stress, occurs (1).
There is abundant evidence that free radicals are involved in membrane pathophysiology in the central nervous system and may play a role in neuropsychiatric disorders including schizophrenia. Schizophrenia is a hereditary, major mental disorder of the brain, resulting from abnormalities that arise early in life and disrupt normal development of the brain. The chemical nature of the schizophrenic brain is still not completely understood. The brain and nervous system are particularly prone to the free radical damage, since the membrane lipids are very rich in polyunsaturated fatty acids and areas of human brain are very rich in iron, which plays an essential role in generating free radicals (2),(3). The radical-induced damage may be important in schizophrenia, as there is increasing evidence that oxidative injury contributes to the pathophysiology of schizophrenia (4). Free radicals, primarily the reactive oxygen species, superoxide and hydroxyl radicals, which are highly reactive, having an unpaired electron in an atomic or molecular orbit, are generated under physiological conditions during aerobic metabolism. As free radicals are potentially toxic, they are usually inactivated or scavenged by antioxidants before they can inflict damage to lipids, proteins or nucleic acids. Alteration in the oxidant–antioxidant profile is known to occur in Schizophrenia (5),(6). Moreover the body’s defence mechanisms would play an important role in the form of antioxidants and try to minimise the damage, adapting itself to the above stressful situation. Antioxidants are compounds that dispose, scavenge and suppress the formation of free radicals, or oppose their actions (1), and two main categories of antioxidants are those whose role is to prevent the generation of free radicals and those that intercept any free radicals that are generated (7). They exist in both the aqueous and the membrane compartment of cells and can be enzymes or non-enzymes. The human body has a complex antioxidant defence system that includes the antioxidant enzymes superoxide dismutase (SOD), glutathione peroxidase (GPX) and catalase. These block the initiation of free-radical chain reactions (4). The non-enzymatic antioxidant components consist of molecules such as glutathione (GSH), vitamin E, ascorbic acid and beta-carotene that react with activated oxygen species and, thereby, prevent the propagation of free-radical chain reactions.

In the present study, the following parameters were assessed in the erythrocytes and plasma to elucidate the oxidant–antioxidant status in schizophrenic patients. Erythrocyte malondialdehyde (MDA) levels were measured as thiobarbituric acid-reacting substances (TBARS), which serve as an index of extent of lipid peroxidation. Erythrocyte GSH, ascorbic acid and plasma vitamin E serve as non-enzymatic antioxidant parameters. The antioxidant enzymes SOD, catalase and GPX in erythrocytes were estimated. The present study is an attempt to examine oxidative stress and the status of the protective antioxidants under condition of stress due to schizophrenia.

Material and Methods


The study was conducted in Department of Biochemistry, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation, Chinoutpally, Gannavaram (Mandal), A.P., INDIA. The study included 48 patients, without any organic illness, of either sex (30 males and 18 non-pregnant, non-lactating females) in the age group ranging from 22 to 65 years, newly diagnosed for schizophrenia, at OPD of Psychiatry, Dr PSIMS & RF General Hospital, Chinoutpally. The results were compared with those of 48 age- and sex-matched normal subjects who comprised the control group. Diagnosis of schizophrenia was made by Diagnostic and Statistical Manual of Mental Disorders (DSM – IV) classification. Subjects who had no other psychiatric disorder and subjects with normal nutritional habits without supplementing any vitamins during the previous 6 months were included. The complete clinical and personal history of the subjects was recorded. Subjects with history of electro-convulsive therapy (ECT) in last 1 year, substance dependence for last 1 month and history or present symptoms of any other stress-induced disorder were excluded. Informed consent was taken form patients before drawing blood. All the blood samples were collected before starting the treatment for schizophrenia. Due permission was obtained from the ethical committee of the Dr. PSIMS & RF General Hospital, Chinoutpally, before the start of the work.

The controls and patients were divided into two groups:
• Group 1: Forty-eight healthy age- and sex-matched subjects as controls.
• Group 2: Forty-eight schizophrenic patients.

The heparinised venous blood samples obtained from these subjects were used for the analysis. Plasma was separated by centrifugation at 1000 g for 15 minutes. Separated plasma was used for the estimation of vitamin E. The buffy coat was removed, and the packed cells were washed three times with physiological saline. The erythrocyte suspension was prepared by the method of Dodge et al (8), modified by Quist (9). The packed cells were used for the analysis of GSH, ascorbic acid, MDA, SOD, catalyse and GPX. Erythrocyte GSH was estimated by the method of Beutler et al (10), using dithio-bis-nitrobenzoic acid (DTNB). Ascorbic acid levels were estimated in plasma by the method of Tietz (11). Plasma vitamin E levels were estimated by the method of Baker et al (12). Erythrocyte MDA was determined as the measure of TBARS (13). SOD (EC 1.15.1.1) activity was determined in the hemolysate, according to the method described by Marklund and Marklund (14), with some modifications as described by 1 and Chatterjea (15). Catalase (EC 1.11.1.6) activity was measured in the hemolysate by the method of Sinha (16), and the activity of GPX (EC 1.11.1.9) was measured as described by Paglia and Valentine (17), in erythrocytes. All reagents used were of analytical reagent grade. DTNB and thiobarbituric acid were obtained from Sigma Chemicals, St. Louis, MO, U.S.A. Statistical analysis between group 1 (controls) and group 2 (patients) was performed by the student t-test using the stat-view package. The data were expressed as mean  SD; P < 0.05 was considered as significant.

Results

The mean  SD of erythrocyte GSH, ascorbic acid, MDA, SOD, catalase, GPX and plasma vitamin E was indicated in (Table/Fig 1). There was a statistically significant increase in the erythrocyte MDA levels in schizophrenic patients, compared to the controls. The activities of erythrocyte antioxidant enzymes SOD and GPX were significantly increased in group 2, compared to group1. The levels of erythrocyte GSH, ascorbic acid, plasma vitamin E and catalase activity were significantly decreased in patients with schizophrenia, compared to controls.

Discussion

The results indicate that there is increase in free-radical generation and antioxidant defence is impaired in schizophrenic patients. Impaired antioxidant defence and increased lipid peroxidation have been reported in chronic schizophrenic patients (18). The free radicals play an important role in the genesis of structural and functional changes of neuronal membrane that could be responsible for the beginning or aggravation of the basic disease (19). The brain and nervous system possess high potentials for the initiation of free-radical reactions, which, relative to the other tissues, can cause more damage in the brain and nervous system, due to insufficient antioxidant protection and existing intensive aerobic metabolism, accompanied with oxygen free-radical production (20). Of the different brain regions, the basal ganglia may be particularly at risk of radical-induced damage, because they contain large amounts of iron (which can be associated with increased free-radical production through the Fenton reaction). There are several ways by which excess free radicals may be generated in the brain. The metabolism of catecholamines, such as norepinephrine and dopamine, is probably associated with free-radical formation, and conditions associated with increased catecholamine metabolism may increase the free-radical production. Antipsychotic drugs can also cause an increase in metabolic turnover of catecholamines (21).

In the present study, the lipid peroxidation product, i.e. MDA, levels have been increased significantly in erythrocytes of the schizophrenic patients than that in control group. This may show the presence of increased oxidative stress. Rise in MDA could be due to increased generation of reactive oxygen species (ROS), due to the excessive oxidative damage generated in these patients. These oxygen species, in turn, can oxidise many other important biomolecules, including membrane lipids. The lipid peroxides and free radicals may be important in pathogenesis of schizophrenia (22). The raised MDA level reflects the oxidative injury due to schizophrenia, which is attributed to free-radical formation that abstracts hydrogen atoms from lipoproteins, causing lipid peroxidation, of which MDA is the main product (23). The membrane phospholipids, specifically polyunsaturated fatty acids, are converted to MDA by peroxidation, which can be analysed by reactivity to thiobarbituric acid. Increased levels of thiobarbituric acid reaction products have been found in the cerebrospinal fluid of neuroleptic-treated patients (24) and also in plasma of schizophrenic patients, with or without tardive dyskinesia (25).

We observed a significant decrease in the levels of erythrocyte-reduced GSH, ascorbic acid and plasma vitamin E (non-enzymatic antioxidant defence system) in schizophrenic patients, when compared to controls. GSH, vitamin E and ascorbic acid are important chain-breaking antioxidants, responsible for scavenging the free radicals and suppression of peroxidation in aqueous and lipid region of the cell (26). The decrease in the levels of these non-enzymatic antioxidant parameters may be due to the increased turnover, for preventing oxidative damage in these patients, suggesting an increased defence against oxidant damage in schizophrenic patients. Similar reports of decreased GSH, ascorbic acid and vitamin E levels in schizophrenic patients were reported by various studies (27).

In our study, the erythrocyte antioxidant enzyme, i.e. SOD and GPx, activities have been increased significantly in patients with schizophrenia, compared to controls. The increased activity of SOD may be indicative of increased superoxide generation by whichever mechanism,

Conclusion

In conclusion, oxidative stress may be involved in schizophrenic patients. The results of our study have shown higher oxygen free-radical production, and decreased catalase activity supports the higher oxidative stress hypothesis in schizophrenic patients. The increased activities of antioxidant enzymes may be a compensatory regulation in response to increased oxidative stress. Lipid peroxides could be a part of the cytotoxic mechanisms leading to the neural injury. The decreased concentrations of the glutathione and antioxidant vitamin status support the hypothesis that lipid peroxidation is an important causative factor in the pathogenesis of schizophrenia. It is evident from the study that increased oxidative stress in schizophrenics leads to decrease in the levels of antioxidants like GSH, vitamin E and ascorbic acid and disturb their metabolism, which weaken their ability to fight the growing stress. Intense oxidative stress and decreased antioxidants may contribute to neural death and alter the information processing in schizophrenia. So, the treatment with antioxidants in the initial stages of the disease may be useful as secondary therapy to prevent the oxidative damage and deterioration of the neural tissues in schizophrenic patients. Further studies are needed to use antioxidants such as vitamin E, ascorbic acid and beta-carotene as secondary therapy, in addition to current drug therapy in schizophrenia.

References

1.
Sies H. Oxidative stress: from basic research to clinical application. Am J Med 1991;91:31S–8S.
2.
Reddy RD, Yao JK. Free radical pathology in schizophrenia. Prostaglandins Leukot Essent Fatty Acids 1996;55(1–2):33–43.
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Cadet JL, Kahler LA. Free radical mechanisms in schizophrenia and tardive dyskynesia. Neuro Sci Biobehav Res 1994;18(4):457–67.
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Mahadik SP, Soheffer, RE. Oxidative injury and potential use of antioxidants in schizophrenia. Prostaglandins Leukot Essent Fatty Acids 1996;55:45–54 [Review].
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Haliwell B. Reactive oxygen species and the central nervous system. J Neurochem 1992;59:1609–23.
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Lohar JB. Oxygen radicals and neuropsychiatric illness. Arch Gen Psychiatry 1991;48:1097–106.
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Cotgreave I, Moldeus P, Orrenius S. Host biochemical defense mechanisms against prooxidants. Annu Rev Pharmacol Toxicol 1988;28:189–212.
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Dodge JF, Mitchell G, Hanahan DJ. The preparation and chemical characterization of hemoglobin free ghosts of human red blood cells. Arch Biochem Biophys 1968;110:119–130.
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Quist EH. Regulation of erythrocyte membrane shape by calcium ion. Biochem Biophys Res Commun 1980;92:631–637.
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Beutler E, Duron O, Kelly BM. Improved method for the determination of blood glutathione. J Lab Clin Med 1963;61:882–888.
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Tietz NW, editor. Text book of clinical chemistry. Philadelphia, London, Toronto: W B Saunders company; 1986. p. 960–2.
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Baker H, Frank D, Winley NC. Clin Vitaminol 1968;772.
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Jain SK, Mcvie R, Duett J, Herbst JJ. Erythrocyte membrane lipid peroxidation and glycosylated hemoglobin in diabetes. Diabetes 1989;38:1539–42.
14.
Marklund S, Marklund G. Involvement of superoxide anion radical in the autooxidation of pyrogallol and a convenient assay of superoxide

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