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

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Prof. Somashekhar Nimbalkar

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Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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On Aug 2018

Dr. Arundhathi. S
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On Aug 2018

Dr. Mamta Gupta,
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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
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Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
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.
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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.
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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)
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

Important Notice

Original article / research
Year : 2011 | Month : April | Volume : 5 | Issue : 2 | Page : 249 - 251

The Role Of Oxidative Stress And The Effect Of Radiotherapy On The Plasma Oxidant-Antioxidant Status In Head And Neck Cancer


Dept of Biochemistry, Father Muller Medical College and Hospital, Mangalore-575002; Karnataka, India.

Correspondence Address :
Dr. Malathi M., Professor of Biochemistry, Father Muller Medical
College and Hospital, Mangalore-575002; Karnataka, India.
E-mail :
Phone : 0824 2238255, 9480229866.


Objectives: The present study was aimed to assess the oxidantantioxidant status in head and neck cancer patients before and after radiotherapy.

Methods: The subjects comprised of patients who had visited the Oncology Department and were diagnosed of head and neck cancer. The plasma levels of malondialdehyde (MDA), the marker of lipid peroxidation, and the antioxidants, superoxide dismutase (SOD), vitamin A, vitamin C and ceruloplasmin, were assayed before and after radiotherapy, in comparison to the healthy controls.

Results: The plasma levels of MDA were higher and the levels of SOD, vitamin A, vitamin C and ceruloplasmin were lower inthe head and neck cancer patients as compared to those in the healthy controls. These parameters showed significant changes after radiotherapy, as indicated by a lower level of MDA and higher levels of SOD, vitamin A, vitamin C and ceruloplasmin in the plasma of the cancer patients after radiotherapy, as compared to the plasma levels before radiotherapy. All the results were statistically significant (P < 0.001).

Conclusions: Radiotherapy caused a reduction in the lipid peroxidation and an improvement in the antioxidant status of the head and neck cancer patients.


Antioxidants, Head and Neck Cancer, Lipid Peroxidation, Oxidative Stress

How to cite this article :

MALATHI M, VIJAY M, SHIVASHANKARA A R. THE ROLE OF OXIDATIVE STRESS AND THE EFFECT OF RADIOTHERAPY ON THE PLASMA OXIDANT-ANTIOXIDANT STATUS IN HEAD AND NECK CANCER. Journal of Clinical and Diagnostic Research [serial online] 2011 April [cited: 2019 Aug 21 ]; 5:249-251. Available from

Cancer is the second leading cause of death worldwide. Eleven million new cases of cancer are diagnosed every year (1). It is estimated that there are approximately 2-2.5 million cases of cancer in India at any given point of time, with around 700,000 new cases being detected every year (2). Cancers of the head and neck include cancers of the buccal cavity, the head and neck subset, the larynx, pharynx, thyroid, the salivary glands, and the nose/nasal passages. Head and neck cancers account for approximately 6 percent of all the malignancies in the United States, and over one third of all the cancers in India (3), (4). It is the sixth common cause of death in males and the seventh in females (3). India also has the dubious distinction of having the world’s highest reported incidence of head and neck neoplasia in women. The disproportionately higher prevalence of head and neck cancers with respect to other malignancies in India may be due to the use of tobacco in various forms, the consumption of alcohol and a low socioeconomic condition which is related to poor hygiene, a poor diet or infections of viral origin (4).

Free radicals are implicated in the pathogenesis of a multistage process of carcinogenesis. They are proposed to cause DNA base alterations, strand breaks, damage to the tumour suppressor genes and an enhanced expression of the proto-oncogenes [5 -8]. The burst of the reactive oxygen species (ROS) and the reactive nitrogen species (RNS) has been implicated in the development of cancer. Increased levels of lipid hydroperoxide, MDA and nitric oxide and decreased levels of the antioxidants, catalase, SOD, glutathione peroxidase, vitamin C and vitamin E, in blood and tissues, have been reported in head and neck cancer patients (9)(10)(11)(12)(13)(14)(15)
Radiotherapy is a cornerstone in the treatment of head and neck cancer. Ionic irradiation exposes all cells in the involved field to highlevels of oxidative stress, thus resulting in the formation of ROS, increasing DNA damage and ultimately leading to cell death (16). Another mechanism of the action of radiotherapy is to alter cellular homeostasis, thus modifying the signal transduction pathways and predisposing to apoptosis (16). However, there are conflicting reports on the effect of radiotherapy on oxidative stress. Some studies have reported increased oxidative stress after radiotherapy (17), (18) while others have reported decreased oxidative stress after radiotherapy in cancer patients (18), (19), (20). These studies have shown varied responses of the individual antioxidants to radiotherapy.

The present study was taken up with a view of the paucity of Indian studies on the effects of radiotherapy on the oxidant-antioxidant status in cancer and the existing lacunae in the field of oxidative stress biomarkers of cancer. We assessed MDA, the marker of lipid peroxidation, and the antioxidants, SOD, vitamin A, vitamin C and ceruloplasmin, in the blood of head and neck cancer patients, before and after radiotherapy.

Material and Methods

Source of Data: The study was carried out at the Father Muller Medical College and Hospital, Mangalore. The study protocol was approved by the Institutional Ethics Committee. The subjects comprised of fifty patients who had visited the Oncology Department and were diagnosed of head and neck cancer, based on clinical examination and histopathological studies; they ranged in ages from 30 to 80 years (Group-1A). The same patients were then followed up after they underwent a radiotherapy regimen for six weeks (Group-1B). Fifty, age- and sex-matched, apparently healthy volunteers were included as controls in the study (Group-2). Patients with cancer in regions other than the head and neck, anysystemic diseases and infections, and alcoholics, smokers and tobacco chewers without diagnosed cancer, were excluded from the study. A detailed history of the habits (smoking, alcohol abuse and tobacco chewing), chronic illness and clinical history, was collected from the subjects. Informed consent was obtained from all the participants.

Assays: Six ml. of blood was collected in an EDTA tube by taking aseptic precautions, and this was centrifuged at 3000 rpm to separate the cells and plasma. The plasma was analyzed for the levels of MDA, vitamin A, vitamin C and ceruloplasmin, and the activity of SOD. MDA, the sensitive and convenient marker of lipid peroxidation, was estimated as thiobarbituric acid-reactive substances (21). The plasma levels of vitamin A (retinol) were assayed after extraction into heptane and by then measuring the absorbance at 327 nm (22). The measurement of vitamin C (ascorbic acid) was based on the oxidation of ascorbic acid to dehydroascorbic acid, which on treating with 2,4 dinitrophenyl hydrazine in an acidic medium, formed a red coloured bishydrazone (23). The ceruloplasmin levels were estimated, based on the oxidation of p-phenylene diamine, the colour intensity of which was measured at 530 nm (24). SOD was estimated as super oxide anions are involved in the auto oxidation of pyrogallol at an alkaline pH of 8.5. SOD inhibits the auto oxidation of pyrogallol, which can be determined as an increase in its absorbance at 420nm (25).

Statistical Analysis: The results were evaluated by employing the unpaired “t” test, the paired “t” test and the Chi- square test.


In a total of fifty patients with head and neck cancer, the major anatomical sites of the carcinoma were the tongue (n=13), the oropharynx (n=6) and the hypopharynx (n=4). The remaining sites with a lesser incidence were the buccal mucosa (n=3), the mandible (n=3), the cheek (n=3), the nasopharynx (n=3), the pyriform fossa (n=3), the maxilla (n=3) the vocalcord (n=3), and one each in the floor of the mouth, the supraglotis, the pharynx, the post cricoids, the retromandibular trigone and the right maxillary antrum. The results of the present study are presented in (Table/Fig 1).

* One unit of SOD is defined as the amount of enzyme required to cause 50% inhibition of pyrogallol auto-oxidation. ** Significance of difference of the value when compared to controls, P < 0.001 (Highly significant) *** Significance of difference of the value when compared to before radiotherapy, P < 0.001 (Highly significant)The plasma levels of malondialdehyde were higher and the levels of superoxide dismutase, vitamin A, vitamin C and ceruloplasmin were lower in the head and neck cancer patients (Group-1A.), as compared to those in the controls (Group-2). These parameters showed significant changes after radiotherapy, as indicated by lower levels of MDA and higher levels of SOD, vitamin A, vitamin C and ceruloplasmin in the plasma of cancer patients after radiotherapy (Group-1B), as compared to the plasma levels before radiotherapy (Group-1A). All the results were statistically significant (P < 0.001).


The present study revealed increased lipid peroxidation and lowered levels of antioxidants in the head and neck cancer patients. The levels of MDA, the marker of lipid peroxidation, were higher almost by 4-fold in the cancer patients as compared to the controls. The levels of the antioxidants, SOD, vitamin C, vitamin A and ceruloplasmin, were decreased in the head and neck cancer patients. This suggests an increased oxidative stress being involved in the pathogenesis of head and neck cancer.

Previous studies have reported increased blood levels of lipid peroxides and MDA, and decreased blood levels of antioxidants in head and neck cancers [8-15]. Red blood cell membranes are more prone to lipid peroxidation because of their high polyunsaturated fatty acid content and their direct exposure to molecular oxygen and haemoglobin. The compensatory mechanism to counter the ROS results in reduced levels or activities of enzymatic and non-enzymatic antioxidants in blood.

Radiotherapy is the major form of treatment which is available for head and neck cancer. Studies have shown varied findings with respect to the effect of radiotherapy on the oxidant-antioxidant status. Some authors have observed increased oxidative stress after radiotherapy and have suggested that radiation-induced free radicals cause oxidative damage to biomolecules (17), (18), (26). The authors advocating increased oxidative stress in radiotherapy have shown from their studies, that supplementation with antioxidants such as alpha-tocopherol ameliorates the oxidative damage caused by radiotherapy (26). Chitra and Shyamaladevi (26) observed a significant decrease in the malondialdehyde levels and an increase in the activities of antioxidant enzymes in oral cancer patients who were supplemented with alpha-tocopherol during radiotherapy, as compared to radiation-treated oral cancer patients without alpha-tocopherol supplementation.

Studies have shown decreased lipid peroxidation and increased activities of antioxidants after radiotherapy (18), (19), (20). The findings from our study also suggest the amelioration of oxidative stress by radiotherapy, as indicated by decreased MDA levels, and increased levels of SOD, vitamin C, vitamin A and ceruloplasmin in head and neck cancer patients after radiotherapy. Kasapovic et al. (18) proposed that the response to radiotherapy involves the age-related impairment of the antioxidant capacity for the elimination of free radicals, thus causing oxidative damage to the blood cells. They suggested that the cytotoxic effects of radiation on the healthy tissues might be more pronounced during the aging process. In concordance with our study, some researchers have observed increased blood levels of SOD, catalase, glutathione reductase, ceruloplasmin and glutathione in post-radiotherapy cancer patients (18), (19), (20).


The involvement of oxidative stress in head and neck cancer is evident from increased lipid peroxidation and decreased levels of antioxidants in plasma. Radiotherapy caused a reduction in lipid peroxidation and an improvement in the antioxidant status of head and neck cancer patients. Though the levels of antioxidants in plasma did not reach the control values in the post-radiotherapy scenario in cancer patients, the improvement in the antioxidant capacity was of vital importance for survival and for an improved quality of life ofthe radiation-treated patients. Further studies with a larger sample size, different stages of head and neck cancer and assessment of the effect of antioxidant supplementation before and during the radiotherapy regimen, are needed.


The authors are indebted to the Director, the Administrators and the Dean and the Chief of the Medical Services, Father Muller Medical College and Hospital, Mangalore, for their support and encouragement and for providing the required infrastructure


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