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

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




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Thiruvalla, Kerala
On Sep 2018




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"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




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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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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
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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.
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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.
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 : 2012 | Month : May | Volume : 6 | Issue : 3 | Page : 342 - 345

Pulmonary Function Impairments among Dry Cell Battery Factory Workers

Kaushik Saha, Supriya Sarkar, Ankan Bandyopadhyay, Malay Kr. Maikap, Arpita Banerjee, Debraj Jash , Abhijit Kundu, Arnab Maji

1. MD, RMO cum Clinical Tutor 2. MD, Professor 3. MD, RMO cum Clinical Tutor 4. MD, RMO cum Clinical Tutor 5. MBBS, Post graduate trainee 6. MBBS, Post graduate trainee 7. MBBS, Post graduate trainee 8. MBBS, Post graduate trainee Pulmonary Medicine Department, NRS Medical College, Kolkata, West Bengal, India.

Correspondence Address :
Dr. Kaushik Saha
Rabindra Pally, 1st Lane
Near Nimta High School
Nimta P.O., Kolkata -700049
West Bengal, India.
Mobile: +919433383080
E-mail: doctorkaushiksaha@gmail.com

Abstract

Context:
Inhalation of the ingredients which are found in a dry cell battery factory can affect the pulmonary function of its workers.
Aims:
To evaluate the impact of the dry cell battery exposure on the pulmonary function of exposed workers by using spirometric parameters and its correlation with the duration of the exposure.
Settings and Design:
Cross sectional, randomised study.
Methods and Material:
A standard questionnaire was followed to note the symptoms like cough, breathlessness, morning cough and chest tightness. In the present study, the pulmonary function status assessment was done by a spirometric method by using Spirovit-SP-10 and WrightÂ’s peak flow meter. Out of the total subjects who were studied (n = 119), 60 were control subjects and 59 were workers who were exposed to the ingredients of a dry cell battery.
Statistical Analysis Used:
The unpaired t-test was done to determine the significant difference between the battery workers and the control subjects. We also checked whether there was any correlation between the pulmonary function status and the duration of the exposure at work.
Results:
A few workers reported symptoms of cough, breathlessness, morning cough and chest tightness. The respiratory symptoms were found to be higher in the exposed dry cell battery factory workers (32.75%) as compared to the control subjects (12.65%). A trend of decrement of the lung volumes with an increment in age and the duration of the work exposure was observed. The pulmonary function abnormalities which were found among the male dry cell battery factory workers were of the obstructive (18.5%), restrictive (5.6%) and the mixed (4.5%) types.
Conclusions:
The respiratory impairments among the dry cell battery workers could have been due to their exposure to the work environment. The longer the duration of the exposure, more was the pulmonary function decline.

Keywords

Dry cell battery, Spirometry, FEV1, FEV1/FVC

Introduction
In our day to day life, we use dry cell batteries to run our electronic accessories like cell phones, radios, torches, etc. The ingredients of these dry cell batteries are cadmium as cadmium metal, cadmium oxide and cadmium hydroxide; cobalt as cobalt metal, cobalt oxide and cobalt hydroxide; lithium hydroxide; nickel as nickel metal, nickel oxide and nickel hydroxide; potassium hydroxide and sodium hydroxide, manganese in the form of manganese dioxide and carbon black. The ingestion of the open battery content can cause serious chemical burns of the mouth, oesophagus and the gastrointestinal tract. The contents of an open battery can cause respiratory irritation due to their inhalation. The cadmium oxide fumes can cause metal fume fever. The hypersensitivity to nickel can cause allergic pulmonary asthma (1), (2), (3). For the occupational lung diseases, spirometry is the most widely used instrument to assess the pulmonary function status of a subject and it can measure and judge the restriction or obstruction if any, to the lung function (4). The most important component in the dry cell battery, which is associated with respiratory hazards, is cadmium. Cadmium, a known cause of emphysema in an occupational setting, may be important in the development of tobacco related lung disease (5). This study will help in evaluating the respiratory functional status of the male dry cell battery workers who are exposed to the ingredients of the battery during their work and in making them aware of the Original Article methods which control the health hazards due to the making of a dry cell battery, as well as in implementing preventive measures with regards to the exposure and the consequent occurrence of the respiratory impairments.

Material and Methods

This study was carried out in the suburbs of Kolkata, West Bengal, India. Of the total subjects who were studied (n = 119), 60 were control subjects and 59 were workers who were exposed to the dry cell battery factory ingredients. The control subjects were selected from those in the population who were not directly engaged in dry cell battery making, but were associated with other jobs in the same area of the study. All the subjects who were included in this study were nonsmokers and non-alcoholics. Subjects who were already diagnosed with respiratory diseases like tuberculosis, asthma, chronic obstructive pulmonary disease, etc. in the past or present or those who had any major medical or surgical illnesses were excluded from the study. A screening chest X-ray (CXR) was done for all the subjects and the subjects with an abnormal chest X-ray were excluded from this study. A written informed consent was taken from all subjects before the start of the study.
Pulmonary function tests
The forced vital capacity (FVC) was recorded by using Spirovit- SP10 (Schillar Health Care Pvt. Ltd., Switzerland) and the peak expiratory flow rate (PEFR) was recorded by using WrightÂ’s peak flow meter (Clement and Clark, UK). The forced expiratory volume in one second (FEV1), the FEV1/FVC ratio and the forced expiratory flow rate at 25-75% (FEF25-75%) were calculated from the same tracing. Before the recordings were taken, all the subjects were well motivated to ensure that the recordings were done at optimum levels (6). The spirometric measurements were made with the subjects in a comfortable sitting position. The body height and body weight were measured by using a standard scale without wearing footwear. All the measured lung volumes which were obtained were expressed in terms of body temperature pressure which was saturated with water vapour (7). The body surface area was calculated by using the Du-Bois and Du-Bois formula (8). The pulmonary function test values were predicted from the standard prediction equation of the normal subjects in Kolkata (9). The criteria which was followed for the categorization of the lung function impairment (obstructive or restriction) was based upon the value of FEV1/FVC and the categorization of the severity which was based upon the FEV1 % which was predicted (10).
Statistical analysis
For the data analysis and the statistical calculations, S.P.S.S, version 12 was used. The Students unpaired ‘t’-test was performed to determine whether there was any significant difference between the exposed and the control workers.

Results

All the subjects (males, n = 119) were divided into two categories: the control subjects (60) and the exposed battery workers (59). The physical parameters of the control and the exposed male battery workers are presented in (Table/Fig 1). The age, height, weight and the body surface area of the control and the exposed groups were comparable; no significant differences were noticed. The lung volumes (FVC, FEV1, and FEV1/FVC) and the flow rates (FEF 25-75%, PEFR) of the control and the exposed male battery workers are presented in (Table/Fig 1). It was found that the mean values of the lung volumes and flow rates of the control subjects were higher than those of the exposed workers, but there was no statistically significant difference between them. The duration of the exposure was categorically divided into three groups: up to 10 years (n = 18), 11-20 years (n = 15) and above 20 years (n = 28). The different lung volumes and the flow rates of both the control and the exposed male battery workers according to the duration of the exposure are presented in (Table/Fig 3). A trend of gradual decrement of the lung function parameters was found in the exposed subjects as the duration of the exposure increased. There was a statistically significant (p value < 0.05) difference between the above 20 years exposure group and the other two exposure groups in all the pulmonary function parameters, but there was no difference between the 11-20 years exposure group and the up to 10 years exposure group. The respiratory symptoms as reported by the control and the exposed subjects are presented in (Table/Fig 4). Respiratory symptoms like cough with breathlessness, morning cough, cough throughout the day, andchest tightness were reported. The percentage figures of these symptoms were significantly higher in the exposed subjects (32.75%) as compared to the control subjects (12.65%). Cough with breathlessness was found to be higher among all the symptoms in the exposed as well as the control subjects. The spirometric assessment of the respiratory function impairments among the exposed workers and control subjects are presented in (Table/Fig 5). The respiratory impairments of the restrictive, obstructive and the mixed types among the exposed workers as a whole, were much higher (28.60%) as compared to those in the controls (6.40%). According to the category, in exposed workers, the restrictive type of impairment was 5.60%, the obstructive type was 18.50% and the combined type was 4.50%; the corresponding figures in the control subjects were 3.50% restrictive and 2.90% obstructive. No combined type of impairments were found in the control subjects.

Discussion

The workers of the battery factory were exposed to different chemical dusts, mainly cadmium. With modernization (proper designing and effective ventilation of the working place), a decline of the cadmium dust by 100 to 500 times in the work-room was observed in western countries (2). In our country, the scenario may not be the same. The most important route of the dust exposure was inhalation. It was found that the contamination by cigarettes or pipe tobacco in the workers could cause an additional inhalation exposure. Cigarettes or pipe tobacco could get contaminated from the workersÂ’ hands depending upon their habits, their sweating and their maintenance of personal hygiene. With the release of contaminated cadmium during the burning of tobacco, there could be an increased amount of cadmium in the inhaled tobacco smoke. The smokers generally had higher faecal amounts of cadmium than the non-smokers (11). In a study which was done with 16024 workers, it was found that the current smokers had higher mean urinary cadmium/ creatinine levels than the former smokers or non-smokers. The higher levels of urinary cadmium were associated with a significant lower FEV1 in the current (-2.06%, 95% confidence interval(CI) -2.86 to -1.26 per 1 log increase in urinary cadmium) and formal smokers (-1.95%, 95% CL -2.87 to 1.03), but not in the never smokers (-0.18%, CI -0.60 to 0.24). Similar results were obtained for FVC and FEV1/FVC (3). In our study, we excluded smokers, to avoid the direct or indirect smoking related spirometric changes. Among the non-smokers, there was a significant correlation between the air levels of cadmium and the faecal content of cadmium, indicating that in the work places, the cadmium concentrations in the air may also have reflected the general dust contamination of the working areas. There was always an invisible thin layer of dust on all the surfaces (wall, furniture, etc.) in the factory. The workers may have contaminated their clothes, hands and other body surfaces, depending on their personal habits, sweating, etc. Then, cadmium might have entered the body of the workers by inhalation or ingestion through contaminated food. Cadmium oxide dust which is inhaled from air will be deposited in the respiratory tract and a part of the deposited cadmium will be absorbed from the alveoli (12). In a study on battery workers who were exposed to Manganese (Mn), it was found that the concentrations of Manganese in blood (MnB) and urine (MnU) were significantly higher in the exposed group (MnB 0.81 Vs 0.68 micro grams/ 100ml; MnU 0.84 Vs 0.09 micro gram/ gram creatinine). The prevalence of the respiratory symptoms and the lung function parameters did not differ in the control and the exposed groups (13). In a study population of 3086 employees in carbon black production plants, it was found that the coughed sputum and the symptoms of chronic bronchitis were associated with the degree of exposure to carbon. The lung function tests also showed a small decrease with respect to an increase in the dust exposure in both smokers and non smokers. Nearly 25% of the CXR showed small opacities of category 0/1 or greater (14). In the present study, the age, height, weight, body surface area and the body mass index were comparable among the battery workers and the control subjects. In the present study, a reduction in the mean values of lung function parameters, i.e., FVC, FEV1 and FEV1/FVC, FEF25-75%, PEFR was noted in the exposed workers as compared to the control subjects, but it was not statistically significant. Contrary to the findings of Mannino DM, et al. in our study, we found a decline in the spirometric parameters in the dry cell battery workers and this decline showed a definite correlation with the duration of exposure (12). In smokers, this decline could be even higher. We detected obstructive airway disease (FEV1/FVC ratio < 70%) in 18.50% workers, though they were asymptomatic, and significantly all had a long history of battery factory exposure (> 20 years). However, our study population was small (n = 59), and we excluded smokers, those who had a present or past respiratory disease and those with an abnormal X-ray of the chest. So, the actual prevalence of the decrease in the spirometry parameters may have been higher. Further studies are required to evaluate the effect of the dry battery ingredients on the lung functions among factory workers, and to identify the causative factors and the necessary steps to prevent the decline of lung function in the dry cell battery factory workers.

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Du Bois D, Du Bois EF. A formula to estimate the approximate surface area if height and weight be known 1916. Nutrition 1989;5:303-11.
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Chatterjee S, Saha D, Chattopadhayay BP. Pulmonary function studies in healthy non-smoking men of Calcutta. Ann Hum Biol 1988;15:365-74.
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Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests.Eur Respir J 2005 26:948-68.
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Piscator M, Kjellstrom T. Lind B. Contamination of cigarettes and pipe tobacco by cadmium oxide dust. Lancet II 1976:587.
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DOI and Others

DOI: JCDR/2012/3975:1899

Financial OR OTHER COMPETING INTERESTS:
None.


Date of Submission: Oct 21, 2011
Date of peer review: Jan 01, 2012
Date of acceptance: Jan 17, 2012
Date of Publishing: May 01, 2012

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