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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Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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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.
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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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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 : 2008 | Month : August | Volume : 2 | Issue : 4 | Page : 1001 - 1008

Biochemical Derangements In Patients With Schizophrenia: A Case-Control Study

UMA DEVI P AND MURUGAN. S

Department of Biotechnology, Karunya University, Coimbatore. 114, Tamil Nadu. India. Tel: +91-0422-26144477 , Mobile:+91 9994583372 Fax: 91 0422 2629369 , e.mail: umadevipongiya@rediffmail.com

Correspondence Address :
Dr. P.Uma Devi
Assistant Professor, Department of Biotechnology,
Karunya University,
Coimbatore. 114, Tamil Nadu. India.
Tel: +91-0422-26144477 , Mobile:+91 9994583372
Fax: 91 0422 2629369 ,
e.mail: umadevipongiya@rediffmail.com

Abstract

Aim:The objective of this study was to evaluate and compare the levels of non dietary antioxidants and the status of complete blood count in schizophrenia patients with positive, negative and cognitive symptoms.
Materials and Methods: This was a prospective observational study involving samples of 60 schizophrenia patients who met the established criteria for schizophrenia, and were admitted to the mental health care center, Coimbatore district. Sixty age and sex matched control subjects were also taken. Planned assessments included the levels of uric acid, albumin, bilirubin. Creatinine and complete blood count were performed using standard biochemical methods by applying the Roche/Hitachi Modular D-P automated chemistry analyzer 112.
Results: It is predicted from the results that there was a significant increase in uric acid levels in all the schizophrenics when compared to normal values (p<0.01), but a statistically more significant increase in the status of uric acid was found for schizophrenics with cognitive symptoms(p<0.001). It was observed that there was a significant decrease in serum bilirubin, albumin and creatinine levels in patients with schizophrenia, when compared to controls (0.01). There was no statistically pronounced difference among the levels of albumin, bilirubin and creatinine in schizophrenia patients with positive, negative and cognitive symptoms.
Conclusion: These data reveal that non dietary antioxidant defence mechanisms might be impaired in schizophrenic patients. Understanding these basic pathological processes may yield novel targets for the development of more effective treatments.

Keywords

Schizophrenia, symptoms, haematological status, non dietary antioxidants.

Schizophrenia is a disabling group of brain disorders characterized by symptoms such as hallucinations, delusions, disorganized communication, poor planning, reduced motivation, and less sociability.While the incidence of the disorder is relatively low (median value 15.2 per 100,000 persons per year) (1), the condition is one of the major contributors to the global burden of disease (2).

The substantial burden of disease is a reflection of two features of schizophrenia: (a) the disorder usually has its onset in early adulthood, and (b) despite optimal treatment, approximately two-thirds of affected individuals have persisting or fluctuating symptoms (3).The symptoms of schizophrenia fall into three broad categories: Positive, negative and cognitive symptoms(4).

Radical-induced damage may be important in schizophrenia as there is increasing evidence that oxidative injury contributes to the pathophysiology of schizophrenia (5). Recently, many reports have shown that schizophrenia is accompanied by an activation of the immune\inflammatory system , including acute phase response as indicated by changes in serum acute phase protein (6),(7),(8),(9) .Some physicians have reported that lower serum albumin (one of the negative acute phase proteins) levels were noted in patients with major depression in Western countries.(10),(11),(12). However, there were no detailed discussions concerning serum albumin levels and schizophrenia patients with different symptoms. Albumin and bilirubin are metal – binding proteins shown to possess free radical scavenging properties , and may thus be selective antioxidants(11).Therefore the roles of serum albumin and bilirubin in patients with schizophrenia are important, and need to be studied .

Uric acid, a by product of purine metabolism, is one of the major radical-trapping antioxidants in plasma. Uric acid can act as an antioxidant, both by binding iron and copper ions in forms that do not accelerate free radical reactions, and by directly scavenging oxidized species such as singlet O2, HOCI and peroxy radicals. Because of its high concentration, urate might be important as a hydroxyl radical scavenger in vivo.
One role of urate is to help suppress lipid peroxidation in erythrocytes. Uric acid has a protective effect against oxo-heme oxidants which cause membrane peroxidation. Haemoglobin and peroxide are both necessary for lipid peroxidation, while urate and ascorbate protect against this peroxidation (13). Urate not only protects erythrocytes, but also the DNA-containing longer lived T and B lymphocytes and macrophages.

Creatinine (from greek kreas, flesh) metabolism in general, has attracted considerably less attention. In recent years, however, a series of fascinating new discoveries have been made about the role of creatinine. Circumstantial evidence suggests a link between disturbances in Creatinine (Cr) metabolism and muscle diseases as well as neurological disorders, and beneficial effects of oral Cr supplementation in such diseases have in fact been reported. Total Creatinine Kinase (CK) activity and Creatinine content are lower in the brain than in the skeletal muscle or heart. Even though it might be concluded that the CK system plays a less prominent role in brain physiology, there is ample evidence to establish close correlations between Cr metabolism and CK function on one hand, and proper brain function on the other hand (14).

With its hallucinations, delusions, thought disorder, and cognitive deficits, schizophrenia affects the most basic human processes of perception, emotion, and judgment. Evidence increasingly suggests that schizophrenia is a subtle disorder of brain development, plasticity and oxidative injury indicated by altered levels of non dietary antioxidants in schizophrenic patients. Though there is an accumulating evidence of altered antioxidant capacity in schizophrenia, to the best of our knowledge, there are no reports in literature stating the role of uric acid, albumin, bilirubin and creatinine in patients with different schizophrenia symptoms such as positive, negative and cognitive symptoms. Therefore, in this study, the levels of serum uric acid, albumin, bilirubin and creatinine were investigated in schizophrenia patients with positive, negative and cognitive symptoms. In addition, anthropometric and haematological measurements were also made in the selected schizophrenia

Material and Methods

Study Population and Data Collection

Patient Groups
A total of 60 schizophrenic patients of the age group 18-65 years, of both sexes, from good socio-economic backgrounds, were selected from Udhayam Mananala Kaapagam, a mental Health care center, Coimbatore, Tamilnadu, India. The patients were divided into three groups with 20 patients in each groups (1) schizophrenics with positive symptoms, (2) schizophrenics with negative symptoms and (3) schizophrenics with cognitive symptoms. They all met DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-IV) criteria (American Psychiatric Association, 2000)(15) for schizophrenia.

Informed and written consent was obtained from all subjects prior to examination. Patients with a history of drug abuse or dependence, serious medical conditions, and severe head injury or seizure disorders were excluded from the study. With the help of a team of psychologists, the participants were interviewed at the time of collection of biological samples, and information regarding their age, family background, family medical history and economic status were collected. Information regarding chronic illness, smoking, alcohol consumption and drug intake was obtained by questionnaires.

Reference group
Sixty age and sex-matched healthy normal control subjects with no individual and familial history of mental illness or antipsychotic treatment were recruited to participate in this study. They included 30 males and 30 females, their ages ranging from 15 to 65 years. Both patients and controls were recruited during the same period from Coimbatore district. Matching between the patients and controls was done according to sex and age.

Eligibility

Inclusion Criteria
1. Age 18-65 years, Both male or female
2. DSM-IV criteria for schizophrenia,
3. Ability and willingness to sign informed consent for participation in the study
4. Study subjects were currently within normal ranges in their routine blood, urine and feaces tests

Exclusion Criteria
1. Evidence of organic brain damage, mental retardation, alcohol or drug abuse
2. Impairment of renal function
3. Hepatic dysfunction
4. A history of pancreatitis
5. Suicide attempt in past year.
6. Cataracts.
7. Pregnant women or a woman who intends to become pregnant.

The participants were asked to fast overnight before coming for clinical examination, where their weight, height, waist circumference and blood pressure were measured. Body Mass Index (BMI) was calculated and blood samples were taken. Fasting plasma, glucose, cholesterol and triglyceride levels were estimated. BMI was also measured for the selected groups. Waist circumference was measured at the level midway between the lowest rib margin and the iliac crest. In men, a waist circumference of 100 cm and under was defined as normal, of over 100 cm as obese, and in women, 90 cm was defined as the cut-off point.

Clinical charts were prepared for patients and control subjects to know whether they were overweight or obese or not. Thus, it was known from the clinical charts that none of the subjects in the reference group was overweight or obese.

Ethical considerations
The design and the layout of this project was carried out with the approval of the Chairman, Kovai Medical Center and Hospitals, and due permission was obtained from the board of institutional review Committee of the Kongu mananala Arakkattalai, before the start of the work. Informed and written consent was obtained from all subjects prior to examination.


Blood Sampling and Determination of plasma constituents
Assessments for the present analyses included fasting blood samples for glucose, cholesterol and triglycerides. The metabolic fasting sample was drawn between 8 and 10 a.m., after at least 8 hour’s fasting, before medication administration.
Haemoglobin concentration was determined using cyanmeth reagent, and other haematological parameters were measured. Uric acid was estimated as described by Kageyama et al.,(16). Bilirubin levels of serum were measured by the method of Ehrlich (1883)(17). Serum albumin protein levels were measured by using bromocresol green, as described by Doumas et al (18) respectively. Creatinine levels were estimated by the rate of change in absorbance using alkaline picrate, as described by Bowers, 1980 (19).

All the operations were in accordance with the guidelines of the apparatus; and samples were done in triplets. Statistical analysis between control and patient groups were performed by Student’s‘t’ test. The results were expressed as a difference between the two values. All the values were presented as a mean value ± SD

Results

a (statistical significance compared to control group)
b (statistical difference between positive and negative group)
c (statistical difference between positive and cognitive group)
d (statistical difference between negative and cognitive group)

Demographic and clinical characteristics of selected schizophrenia patients and control subjects are presented in (Table/Fig 1).There were no significant effects of gender or age at onset of schizophrenia, duration of illness, and height on the schizophrenia patients with different symptoms. Women and men did not differ with respect to duration of illness. The groups did not differ in the proportions of medication intake, or in terms of physical co morbidity, including diabetes mellitus (data not shown). There was a significant main effect on weight between control and patient groups. Genetic predisposition was more in schizophrenia patients with positive symptoms as compared to patients with other symptoms. Almost all the patients had sleep disturbances.
The mean levels of haematological parameters in schizophrenia patients and their controls are presented in (Table/Fig 2). Results showed that there was no significant change in the levels of Hb and total RBC count among controls and schizophrenics. There was a significant decrease in MCT value in all types of schizophrenia patient groups as compared to the control group. WBC and platelet counts were found to be significantly elevated in schizophrenia patients with positive, negative and cognitive symptoms when compared to the control group (p 0.01, p 0.01, and p 0.001 respectively).
(Table/Fig 3)summarizes all analyzed biochemical parameters. Among them, the average levels of uric acid were significantly high in all schizophrenia patients as compared to healthy control subjects. Elevation of uric acid was statistically more significant in patients with cognitive symptoms when compared with schizophrenia patients with positive and negative symptoms. In contrast, the mean levels of albumin and bilirubin were lower significantly in schizophrenics when compared with control subjects. When intra group comparison was made, no statistically noticeable difference was found among schizophrenia patients with different symptoms. There was also no significant change in the level of creatinine in controls as well as patients with different symptoms.

Discussion

Albumin and bilirubin are metal-binding proteins shown to possess free radical scavenging properties, and may thus be selective antioxidants (20). In the present study, we evaluated the levels of albumin and bilirubin, which significantly contributes to total antioxidant status (TAS). Results showed that the levels of these antioxidants are reduced significantly in schizophrenia patients as compared to control groups.The antioxidant property of bilirubin, the end product of heme catabolism in mammals, was first demonstrated by Stocker et al (21). In vitro studies have demonstrated that bilirubin exerts an antioxidant effect (22) in either free or albumin-bound form (23).

Several authors have suggested that psychological stress induces the production of reactive oxygen species (ROS). Several studies have supported the idea that bilirubin exerts antioxidative effects in vivo, and it was reported that psychological stress provokes bilirubin oxidation in vivo (24).We investigated whether the concentration of bilirubin is changed in serum from schizophrenia patients with different symptoms. The concentration of bilirubin in schizophrenia patients with different symptoms was significantly lower than that of healthy volunteers. These finding supports the findings of Tsuyoshi et al (25), and suggest that schizophrenia patients are associated with a decrease in the levels of bilirubin in human serum.

Albumin, the most abundant plasma protein, is an important extracellular antioxidant regulating glutathione levels in lung epithelial cells (26),(27). Bilirubin protects albumin from oxidative damage and acts in concert with vitamin E to inhibit the oxidation of low density lipoproteins (28). The potential importance of these nondietary antioxidants is emphasised by the current observations that plasma albumin correlated positively with dopamine function.

In the present study, we also observed that serum uric acid levels were elevated than that of the control groups (p<0.01). Further, it is evident from our results that the levels of uric acid increased more significantly in patients with cognitive symptoms. There was no detectable change in the levels of uric acid between positive and negative symptomatic people, even though they differed significantly in their uric acid values when compared with control groups. Previous reports indicated that levels of plasma proteins including albumin, uric acid and bilirubin in blood, are reported to be lower in haloperidol-managed (29) and first episode schizophrenic patients (30).

Serum uric acid (UA) like other antioxidants such as albumin, bilirubin, or vitamins A, C and E, is a powerful free-radical scavenger and increases in response to oxidative stress (31) (32). Uric acid formation may even provide a significant antioxidant defense mechanism against nitration by peroxynitrite in rat heart during hypoxia [33)]. It is therefore postulated that serum uric acid level is an important marker in oxidative stress.

High levels of serum uric acid (UA) in the elderly may cause cerebral strokes that lead to cognitive dysfunction. This finding suggests that reducing serum UA might decrease the occurrence of cognitive dysfunction.
"Even minimal elevations in serum UA are associated with structural and functional brain changes, specifically involving the development of ischaemic injury," noted lead author Tracy D. Vannorsdall, PhD, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.

In this cross-sectional, observational study, 180 adults were enrolled from the Johns Hopkins Aging, Brain Imaging, and Cognition Study. Participant ages ranged from 20 to 96. All completed neuropsychological testing to assess cognitive abilities and clinical tests including non-fasting blood samples for serumUA.

In normal, healthy adults, cerebral ischaemia is often indicated by hyper intensities in the cerebral white matter, which is detected by magnetic resonance imaging (MRI). These white matter hyper intensities (WMH) are increasingly common in "advancing age, cerebral atrophy, cerebrovascular risk factors such as hypertension and stroke, dementia, schizophrenia and cognitive dysfunction in the non-demented," the authors noted. In this study, images from brain MRI were used to calculate the "WMH burden" -- the ratio between the WMH volume and total brain volume.

Data analysis established that higher serum UA levels were associated with greater WMH burden (r =.232; P =.002); they were also associated with lower scores in 4 of the 8 areas of cognitive functioning. Greater WMH burden was associated with lower performance in 7 of the 8 areas of cognitive functioning (P values <.05). These results indicate an association between higher serum UA levels and lower cognitive performance.

The researchers add, however, that "once a term for WMH volume was added to the regression models, the UA-cognition associations were attenuated." In this latter analysis, the levels of UA were no longer predictive of cognitive dysfunction. Further analysis also determined that the previously detected association between verbal learning/memory and WMH burden no longer existed, once serum UA levels were included in the model.

The inhibitory interaction of UA with nitric oxide (which mediates vascular tone) and the decreased capacity for vasodilatation in the cortex of patients with WMH, both support impaired vascular tone as a possible mechanism for UA influence on cortical function. Both increased production and decreased excretion of UA may result in elevated serum levels. Future clinical trials could determine whether medications that reduce production of serum UA, even within normal levels, would also decrease the occurrence of cerebral ischaemia and related cognitive dysfunction(34).

Conclusion

As per the previous results, the levels of the blood antioxidants albumin, uric acid and bilirubin were reduced (35),[ 36], and total antioxidant capacity was low (37). In this study, we analyzed the various disturbances of the non-dietary antioxidant systems in schizophrenics with various symptoms. . These results demonstrate altered membrane dynamics and non-dietary antioxidants in schizophrenia.. These results may suggest that the cause of these disturbances are basic biochemical anomalies of the central nervous system, observed in schizophrenia, and evoke the potential role of antioxidants in the therapeutic strategy and their implication in preventive and early intervention approaches in populations at risk for schizophrenia.

Acknowledgement

The corresponding author is grateful to The Chanceller (Dr. Paul Dhinakaran), the Vice-Chanceller (Dr.Paul P. Appasamy and the Registrar (Dr. Anne Mary Fernandez) of Karunya University, Coimbatore, India, for providing encouragement and financial support to carryout this research publication

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