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On Sep 2018




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Prof. Somashekhar Nimbalkar
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Chairman, Research Group, Charutar Arogya Mandal, Karamsad
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On Sep 2018




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"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."



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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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On Aug 2018




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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.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
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.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



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




Dr. Shankar P.R.

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



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

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


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

Important Notice

Original article / research
Year : 2011 | Month : October | Volume : 5 | Issue : 5 | Page : 990 - 993 Full Version

Lipoprotein Profile in Patients with Chronic Obstructive Pulmonary Disease in a Tertiary Care Hospital in South India


Published: October 1, 2011 | DOI: https://doi.org/10.7860/JCDR/2011/.1525
Niranjan M R ,Dadapeer k, Rashmi B K

MD (General Medicine)., DNB., MNAMS Assistant Professor, Department of Medicine, Hassan Institute of Medical Sciences, Hassan 573201, Karnataka, India.

Correspondence Address :
Niranjan M.R.
Assistant Professor, Dept. of General Medicine,
Hassan Institute of Medical Sciences, Hassan 573201,
Karnataka, India.
Phone: 09448672501
E-mail: drniranjanmr@yahoo.co.in

Abstract

Context: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death world over. COPD has been defined as a disease state characterized by airflow limitation. Spirometric tests like Forced Expiratory Volume in first second (FEV1 ) < 80% and FEV1/FVC (ratio of Forced Expiratory Volume in first second to the Fixed Vital Capacity) 0.7 is the diagnostic criteria for COPD. In COPD smoking is the major risk factor and smoking affects the lipid profile of COPD patients.

Aims: To investigate the levels of total cholesterol (TCH), triglycerides (TG), low density lipoproteins (LDL), very low density lipoproteins (VLDL), high density lipoproteins (HDL) and correlating FEV1 and FEV1/FVC ratio with lipid profile.

Settings and Design: A prospective cross-sectional case control study.

Methods and Materials: Fifty cases were selected on the basis of simple random sampling method.

The FEV1, FEV1/FVC ratio and various lipoprotein levels like total cholesterol (TCH), triglycerides (TG), low density lipoproteins (LDL), very low density lipoproteins (VLDL), high density lipoproteins (HDL) were studied and a group of 20 non-smoker healthy subjects were selected as controls. FEV1, FEV1/FVC ratio were correlated with lipid profile.

Statistical Analysis: Comparison of various parameters were performed by “t” test, correlation between two variables were performed by Pearson’s correlation co-efficient “r”

Results: Majority of the patients had moderate (50%) and severe (42%) airflow limitation. Mean LDL concentration among cases was 114.89 ± 19.61(mg/dl) as against control group who had mean LDL concentration of 96.22 ± 19.96(mg/dl), which was statistically significant (p-value < 0.05). However no significant difference in LDL, HDL and in triglycerides levels were observed.

Conclusion: Smoking significantly affects the lipid profile in COPD patients.

Keywords

COPD; Lipoprotein; FEV1, FEV1/FVC ratio; Cholesterol; LDL; HDL; Triglycerides; VLDL

Introduction
Chronic obstructive pulmonary disease (COPD) is a state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases (1). The clinical importance of hyperlipoproteinemia derives chiefly from the role of lipoproteins in atherogenesis.

In COPD, smoking is the major risk factor and smoking affects the lipid profile of COPD patients. The plasma β-lipoprotein, cholesterol and triglycerides concentration are higher and HDL cholesterol is lower in smoker than in non-smokers (2). There are only few data in India where the lipoprotein in COPD were studied. Gupta et al. 2002 carried out a comparison of the lipid profile in bronchial asthma and COPD and concluded that LDL was significantly higher and VLDL was significantly lower in patients of bronchial asthma and COPD as compared to controls (3).

Hence an attempt was made to investigate the levels of total cholesterol (TCH), triglycerides (TG), low density lipoproteins (LDL), very low density lipoproteins (VLDL), high density lipoproteins (HDL) in COPD patients. Moreover, correlation of FEV1 (Forced ExpiratoryVolume in first second) and FEV1/FVC (forced expiratory volume in first second to the fixed vital capacity) ratio with lipid profile was carried out.

Material and Methods

In this study, 50 cases were selected on the basis of simple random sampling method from the Medical Wards, K.R. Hospital, Mysore from June 2005 to March 2006.

As per GOLD (Global Initiative for Chronic Obstructive Lung Disease) guidelines (1) of COPD, any patient who has symptoms of chronic cough, sputum production, or dyspnoea, and / or a history of exposure to risk factors for the disease were considered and included in the study, and was further confirmed by spirometry. The values FEV1 less than 80% of the expected value and ratio of FEV1/ FVC less than 0.7 (70%), after post bronchodilator inhalation, were included in this study. Patients with bronchial asthma, pulmonary tuberculosis, bronchectasis, known congenital or acquired heart diseases, diabetes mellitus and hypertension, were excluded, and 20 non-smoker healthy subjects were selected as a control group.

All the 50 patients were subjected to a detailed history and thorough clinical examination including anthropometry. Chest X-ray –Postero-Anterior view, spirometry was done on computerized spirometer (kit micro, COSMED, Srl, Rome Italy). Spirometry was performed when the patients were clinically stable with prior proper instructions as per ATS (American Thoracic Society) guidelines (4).

Written consent was taken from both cases and controls, ethical committee clearance were also obtained.

After 12 hour of overnight fast, 5 ml blood samples were drawn in the morning before breakfast from the subjects and controls. Total cholesterol, HDL and triglycerides were directly analysed by using ERBA Mannheim diagnostic equipment (Model-EM 360, V21.0, MADE IN INDIA). LDL cholesterol was calculated by using Friedewalds equation ( LDL cholesterol = (Total cholesterol) – (HDL cholesterol) – (Triglycerides/5) ). VLDL cholesterol was calculated by using the equation, VLDL cholesterol = Triglyceride/5.

Statistical analysis
Comparison of various parameters among male and female subjects with COPD were performed by “t” test, correlation between two variables were performed by Pearson’s correlation co-efficient “r”, analysis was done by using SPSS+ 10.0 computer package for statistics.

Results

Fifty cases of COPD were studied and out of 50 cases studied 44 were males and 6 were females. Mean age of the male patients among cases was 63.32 ± 10.73 years and that of the female in the study was 63 ± 10.18 years.

Majority of the patients in the cases studied were males constituting 88%. The male-female ratio was 7.33:1. Among controls males were 16 and females were 4 in number. The mean age of the males among controls was 57.87 ± 10.20 and that of females was 57.50 ± 8.20

In the present study the duration of illness ranged from 2-20 years with majority belonging to the 6-10 years range.

In our study smoking was the major risk factor. All the 44 male patients were smokers, while history of exposure to smoke of burnt fuels was present in all the female cases (Table/Fig 1).

There was a dose response relationship between the number of pack-years of smoking and decline in lung function. In our study, duration of smoking ranged from 20 pack-years to 60 pack-years (1 pack = 10 cigarettes, calculated by number of packs of cigarette smoked per day multiplied by number of years smoked, which constitutes one pack year). Majority were in 30-50 pack-years of duration of exposure.

Majority of the patients had BMI of < 25.

On viewing chest x-ray, 56% of patients had chronic bronchitis with emphysema. Twenty two percent had chronic bronchitis, 22% had normal chest x-rays. Chest x-rays of all the subjects in the control group were normal.

In spirometry, the expected value is the value given by the computerized spirometer for each patient considering the patient’s age, sex, race, height and weight. The actual value is what the percentage or volume of air the patient breathes out.

The present study (Table/Fig 2) showed the actual mean of FVC as 2.22 ± 0.50 litres, though the expected mean of FVC was 2.92 ± 0.43litres. The actual mean of FEV1 was 1.12 ± 0.34 litres, and the expected mean of FEV1 would be 2.30 ± 0.35 litres. Among the FEV1% and FEV1/FVC ratio the actual mean were 49.76 ± 14.25% and 53.01 ± 14.22% respectively.

All the control group had normal spirometric parameters.

Out of 50 cases studied, 60% of patients were present in FEV1/ FVC ratio of 51-70%, 34% of patients were present in 31-50% group. 6% of patients were present in 21-30% group.

It was observed that mean LDL concentration among cases was 114.89 ± 19.61(mg/dl) as against control group who had mean LDL concentration of 96.22 ± 19.96(mg/dl), which was statistically significant (p-value < 0.05). All other lipid parameters such as Total cholesterol, triglycerides, HDL cholesterol, and VLDL cholesterol were within normal range when compared to controls (Table/Fig 3).

In this study patients with moderate airflow obstruction had mean total cholesterol, HDL, LDL, and triglyceride concentration 180.36 ± 13.80 (mg/dl), 39.88 ± 12.57 (mg/dl), 114.44 ± 20.96 (mg/ dl), 135.60 ± 46.18 (mg/dl) respectively (Table/Fig 4).

The patients with severe airflow obstruction had mean total cholesterol, HDL, LDL, and triglyceride concentration 176.61 ± 17.76 (mg/dl), 41.43 ± 8.23(mg/dl), 114.93 ± 15.90(mg/dl), 137.08 ± 41.15(mg/dl) respectively. As the severity of airflowobstruction increased, no significant difference in lipid profile was observed.

Discussion

Cigarette smoking is clearly the single-most important identifiable etiological factor in COPD (5). About 85% people with COPD develop the disease because of cigarette smoking (6).

COPD is a disease of late adulthood. As the age advances the lung function (FEV1) declines and other risk factors add to the disease process (7). In the present study the mean age was 63.16 ± 10.45. COPD is a male dominant disease, the prevalence in males due to higher prevalence of smoking in this sex, and also males are more susceptible to smoking than females (7). In our study males accounted for 88%, with a male-female ratio of 7.33:1. In the present study all males were smokers, while all 6 female patients were non-smokers but all of them were exposed to smoke of burnt fuels which is very common in rural population. In this part of the country, cooking is predominantly carried out by using wood and cow dung. In a study by Behera and Jindal (1996) respiratory symptoms in India were reported in 13 percent of 3608 non-smoking women involved in domestic cooking (8). In the study by Mishra et al (1990), it was observed that the female population had exposure to kitchen smoke due to cooking with wood, cow dung and coal (9). In a New Guinea household pollution, due to heating and cooking within a small space was responsible for COPD commonly in women than men (10). A study from Jindal et al (2006) showed that the exposure to solid fuel combustion is also shown to be an additive risk factor along with environmental tobacco smoke exposure in causing COPD (11). Hence domestic environmental factors may be of great importance in the aetiology of COPD.

Smoking is a very important risk factor for COPD, seen in 85% of patients who develop COPD. In the present study all males were smokers, when compared with the Thiruvengadam et al (1977) study group, who also had smoking history in all males (12).

Present study consisted of mean value of FEV1/FVC% ratio 53.01 ± 14.22. According to GOLD criteria majority of the patients in the present study belonged to moderate to severe airflow obstruction, which was comparable with that of Tandon (1973) (13) and Singh and Jain (1989) (14) which consisted of FEV1/FVC ratio 56.70% and 48.45% respectively.

Smoking affects the lipid profile in the following ways. The plasma β-lipoprotein, cholesterol and triglycerides concentration are higher and HDL cholesterol is lower in smoker than in non-smokers. Free fatty acid concentration tends to be variable, but inhalation during smoking produces an immediate increase of free fatty acids of about 30% through stimulation of the adrenal medulla, by nicotine which increases the concentration of epinephrine in the plasma and the urinary excretion of catecholamine and their metabolites (15).

In addition, the plasma cortisol concentration may increase by as much as 40% within 5 minutes of the start of smoking, although the normal diurnal rhythmicity of cortisol is unaffected. Smokers excrete more 5-hydroxy indole acetic acid than do non-smokers (15).

The study by Gupta et al (2002) showed a significantly higher LDL and significantly lower VLDL levels when compared to controls (3). The present study also showed significantly elevated LDL levels when compared with controls but VLDL was normal. This may be due to the fact that the present study group had 88% of smokers, which increases VLDL levels also.

The study by Don and Paul (2003) showed no significant differences in the LDL or HDL concentrations and even with severe airflow obstruction, had slightly lower serum concentrations of triglycerides (16). Present study showed no significant difference in LDL, HDL and also in triglycerides levels. This may be due to the study population studied which was much larger (N = 6629) in the former study as compared to the present (N = 50) study. Moreover, the former study had 73.7% of severe form of COPD patients but present study had only 50%.

In an analysis of the 1988-1994 National Health and Nutritional Examination Survey of 18,162 randomly selected adults in the US, Cassano and co-authors explored that higher HDL was associated with better lung function, total cholesterol had little or no association with lung function and lower LDL was associated with better function (6).

Fekete and Mosler (1987) studied plasma lipoprotein fractions in 29 patients with chronic obstructive pulmonary disease (COPD) and compared with non-COPD subjects and found triglycerides were significantly lower in COPD females only, the other parameters being almost identical (17). Marquis et al. (2005) studied 16 men and 18 women with COPD to evaluate the metabolic syndrome in COPD patients who participated in a pulmonary rehabilitation program and concluded that metabolic syndrome was frequent in patients with COPD and waist circumference, fasting lipid profile, blood pressure and fasting glucose should be obtained in all COPD patients, beginning pulmonary rehabilitation program and this would allow a better cardiovascular risk assessment (18).

Bahar et al. (2003) studied lipid profile in 20 patients with COPD and 20 healthy controls and concluded that COPD patients did not show an atherogenic lipid pattern and that the increased HDL levels might be related to the drugs used by these patients (19).

In conclusion smoking significantly affects the lipoprotein profile in COPD patients in the form of increases in LDL levels. Hence all COPD patients who are smokers needs to check their lipoprotein levels. However there was no correlation with severity of airflow obstruction and dyslipidemia, and there is a need for more detailed studies to understand these relationships.

Key Message

Smoking increases LDL levels, hence all COPD patients who are smokers needs to check their lipoprotein levels.

References

1.
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management and prevention of COPD. NHLBI/WHO Workshop Report, Executive Summary; 2004; 1-21.
2.
Burtis A Carl, Ashwood R Edward. Lipids, lipoproteins and apolipoproteins. In: Burtis A Carl, Ashwood R Edward editors, Tietz Textbook of Clinical Chemistry,3rd edition. Philadelphia: WB Saunders Company 1993; 61-62.
3.
Gupta R, Bhadoria DP, Mittal A, Bhandoria P, Gupta S. Lipid profile in obstructive airway disorders. J Assoc Physicians India 2002; 50:186-87.
4.
American Thoracic Society. Lung function testing: Selection of reference values and interpretative strategies. Am Rev Respir Dis 1991; 144:1202-17
5.
Doll R, Peto R. Mortality in relation to smoking: 10 years observation on British doctors. Br Med J 1976; 2:1525.
6.
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