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
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"

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

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
Knowledge is treasure of a wise man. The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
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,
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 ones 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
(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 journalsNo manuscriptsNo 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)
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 : 2012 | Month : May | Volume : 6 | Issue : 3 | Page : 358 - 360

Anti-oxidant Status in Patients with Chronic Hepatitis C in Rajasthan, India

Santosh K Sharma, Atul K. Sharma, Sadhna Sood

1. Sr. Demonstrator, M.Sc. (Med. Biochemistry) (Biochemistry) GMC Kota. 2. Sr. Resident (General Surgery) GMC Kota. 3. Professor, Deptt. of Biochemistry, SMS Medicsl College Jaipur. Department of Biochemistry and Gastroenterology, SMS Medical College, Jaipur, Rajasthan.

Correspondence Address :
Dr. Atul K. Sharma
Midil School Street, Deeg (Bharatpur) (Raj.) India.
Pin - 321203.
Phone: 9414667375; 9414770227


Hepatitis C is a global disease and being endemic in India, it is one of the most important causes of chronic liver disease and furthermore, it is related to carcinogenesis. The pathogenesis of the Hepatitis C disease includes both direct virus induced liver damage, immunological liver damage and oxidative stress. Vitamin E and A have important roles in the Anti-oxidant defense system and they reduce oxidative stress. Our aims were to estimate the levels of the Anti-oxidants, vitamin A, vitamin E and vitamin C in the serum of Chronic Hepatitis C (CHC) patients and to compare them with the levels in normal healthy controls.
Material and Methods:
A retrospective study was performed at the Department of Gastroenterology and Biochemistry at SMS Medical College, Jaipur, India. In 20 patients of CHC, the serum levels of vitamin A, E and C were estimated by spectrophotometry. Twenty healthy controls were also included in the study and the serum levels of these vitamins were measured in them also.
Statistical analysis:
It was performed by using the StudentÂ’s t-test and the correlation between the variables was studied by using the PearsonÂ’s correlation coefficient test.
The serum vitamin A levels were significantly lower in the patients than in the controls (p<0.001) and the serum vitamin E and vitamin C levels were also significantly decreased (p<0.001).
The increased oxidative stress in the Chronic Hepatitis C patients is evidenced by decreased serum Vitamin A, E and C levels and so, further studies on the liver levels of these Anti-oxidants and the management of the dietary Antioxidants may help in the management of CHC.


Chronic Hepatitis C, Anti-oxidant, Vitamin A, Vitamin E, Vitamin C

The global prevalence of the Hepatitis C virus (HCV) infection is around 2%, with 170 million persons being chronically infected with the virus and 3 to 4 million persons being newly infected each year (1). In India, hepatitis c is an endemic disease leading to acute hepatitis, which may result in chronic liver disease in 50-70% of the cases (2). Hepatitis C is an emerging infection in India and the Hepatitis C virus is an important pathogen which causes liver disease in India. The high risk of chronicity of this blood-borne infection and its association with hepatocellular carcinoma underscores its public health importance (3). Several studies have looked at the prevalence of hepatitis C in chronic liver disease in India. The prevalence of hepatitis C has ranged from 10.8% to as high as 48.5% (4),(5),(6). IndiaÂ’s blood-banking system has serious shortcomings. Professional blood donation continues to flourish despite the presence of a law which condones this. Another malaise in our health system is the reuse of improperly sterilized needles. Both these factors are potential sources for the spread of hepatitis C in India (3). The exact reason behind the liver injury and fibrosis in chronic hepatitis C (CHC) is not fully known, but some studies have suggested that immunological liver damage and oxidative stress may be involved in its pathogenesis (7),(8),(9). If a homeostasis is not maintained between the rate of formation of the free radicals and the rate of their neutralization, oxidative damage accumulates, which is known as oxidative stress (10). Oxidative stress, which is imposed either directly by the virus or by the host-immune response, is a potentially important pathogenic mechanism in the hepatitis C virus disease, as well as in other Original Article Biochemistry Section chronic liver diseases, which can initiate and promote multistage carcinogenesis also (11), (12). Some vitamins play an important role in the anti-oxidant defense system and they reduce oxidative stress (13), (14). To the best of our knowledge, only very few studies have been performed with respect to the estimation of the serum anti-oxidant levels in patients with CHC and their role in the prevention and treatment of chronic hepatitis C. In the light of these explanations, the present study was undertaken to find out the levels of the anti-oxidants, vitamin A, vitamin E and vitamin C in the serum of the CHC patients in Rajasthan (India).

Material and Methods

This study was conducted in the Department of Biochemistry and Gastroenterology, SMS Medical College, Jaipur, Rajasthan. Twenty patients who were seropositive for hepatitis C were included in the study. A detailed history was obtained from all the patients regarding the demographics, the history of drug abuse, previous blood transfusion, haemodialysis and alcohol or tobacco abuse. A thorough physical examination was carried out on all the patients. Routine haematological and radiological investigations were also done. Twenty age and sex matched controls were selected from the general population of Jaipur, who were non-smokers, nonalcoholics, free from any abnormality on routine clinical examination, without any Anti-oxidant supplementation prior to the study and who had no history of taking drugs that could affect the Antioxidant status. An informed written consent was taken from both the patients and the controls. This study was also approved by the Institutional Ethical Committee, SMS Medical College, Jaipur.5 ml of fasting (in the morning) venous blood samples were collected for the study, in plain vials (without anti-coagulant). The serum was seperated by centrifuging the blood at 3000 rpm for 10 min. It was stored at -20ºC to estimate the levels of vitamin A, vitamin E and vitamin C. Serum vitamin A was estimated by using Trifluoroacetic acid (15). Serum Vitamin E was estimated by using bathophenonthroline (16). Serum vitamin C was estimated by using 2, 4 – dinitrophenylhydrazine and a spectrophotometer (17). The results were presented as mean±S.D. Statistical analysis was performed by using the Student’s t-test and the correlation between the variables was studied by using the Pearson’s correlation coefficient test.


The data of the patient’s demographics and laboratory investigations are presented in (Table/Fig 1). The serum vitamin A level in the CHC patients was 34.7 ± 7.5 μg/dl, which was significantly lower than that of the controls (54.6 ± 10.5 μg/dl, p<0.001). The serum vitamin E (α-tocopherol) levels were also significantly decreased in the CHC patients as compared to the controls (0.66 ± 0.14 v/s 1.04 ± 0.17 mg/dl, p<0.001). The serum vitamin C levels were also significantly decreased in the CHC patients as compared to the controls (0.74 ± 0.19 v/s 1.36 ± 0.32 mg/dl, p<.001) (Table/Fig 2).


The HCV infection is characterized by increased markers of oxidative stress (18). The lipid peroxidation products are found to be increased in the serum, peripheral blood mononuclear cells, and the liver specimens of the hepatitis C patients. 4-Hydroxynonenal and 8-hydroxyguanosine, markers of oxidative DNA damage, are elevated in the HCV infection. Oxygen derived free radicals play a role in liver injury because of hepatitis C and other liver disorders. The increase in free radical formation is manifested by the increased hepatic and serum levels of the lipid peroxidation products (8), (19); these have also been reported in subjects with the HCV infection.The increased oxidative stress in hepatitis C may be explained on the basis of chronic inflammation, and the continued generation of reactive oxygen species. The reactive nitrogen species may be explained by NAD(P)H oxidase (Nox 2 protein) of the Kupffer cells and the polymorphonuclear cells in the liver (20). In previous studies which were conducted on CHC patients, the oxidative status of the subjects was determined by using the measurements of Malondialdehyde (MDA) (9) and the 8-isoprostane levels (21). The reduced levels of the lipid soluble vitamins in plasma and the liver tissue of cirrhotic patients, mainly alcohol related, have been reported previously (22), (23). Only few studies have looked at the levels of Anti-oxidants in the serum of patients with chronic hepatitis (8), (23). The present study showed significant reduction in the serum vitamin A levels in the CHC patients as compared to the controls, which was similar to the reports of previous studies (9). The reported normal range of vitamin A is 40-80 μg/dl (15). The observed values for this vitamin for the control group were within this range. Having been identified in 1913, vitamin A was the first fat-soluble vitamin which has been discovered. Being also known as retinol, vitamin A has been called the “anti-infective” vitamin due to its role in supporting the immune system, but it rarely receives much attention. The amount of circulating retinol depends on the specific hepatocyte function, such as the de-esterification of stored retinol and the retinol binding protein synthesis, which are possibly affected in chronic hepatitis. That is why with preserved or increased liver levels, the serum retinol level is decreased (24). Vitamin E (alpha Tocopherol) is a lipid soluble vitamin and it helps in cellular growth and in the maintenance of membrane permeability. It is an efficient Anti-oxidant and a modulator of the immune system (14). The finding of decreased serum levels of vitamin E in the CHC patients in the present study, was also supported by the findings of previous studies (9), (21). The reported normal range of Vitamin E is 0.8-1.2 mg/dl (17). The observed values for vitamin E for the control group were within this range. Vitamin E supplementation may increase the Anti-oxidant protective effect against both plasma lipid peroxidation and DNA damage (14). In the study by Jain et al (2002) (21), vitamin C (ascorbic acid) which is the most effective water soluble vitamin, was also found to decrease significantly (P<0.001) in the CHC patients as compared to the controls. Ascorbic acid exists in blood in the oxidized (DHAA) and reduced forms (RAA) and its transportation across the cell membranes is in the form of DHAA, which is less ionized at physiological pH and it has more membrane permeability (25). Ascorbate is an excellent reducing agent (Terminal Small-Molecule Anti-oxidant). It readily undergoes two consecutive, yet reversible, one-electron oxidation processes to form the ascorbate radical (Asc•–) as an intermediate. Because Asc•– has its unpaired electron in a highly delocalized π-system, it is a relatively unreactive free radical. These properties make ascorbate a superior biological, donor Anti-oxidant (26), (27). The increased inflammation of neutrophils by the formation of lipid peroxides leads to oxygen mediated injury in the liver (28). Damaged hepatocytes, inflammatory cells and cytokines, by generating superoxide radicals, peroxy radicals and singlet oxygen, contribute to oxidative stress (29),(30),(31). Vitamins E and C, with other Anti-oxidants, is believed to act against superoxide radicals, peroxy radicals and singlet oxygen (16). So, their decreased levels may indicate their use in fighting again oxidative stress.Whereas the antioxidants/reductants might be useful at improving HCV-associated diseases, whether these compounds suppress, enhance, or have no effect on HCV remains to be studied further. With regards to the Anti-oxidant therapy, it should also be noted that ascorbic acid (vitamin C) can in fact promote hydroxyl radical production in the presence of free irons (32). Thus, some Antioxidants can act as pro oxidants rather than Anti-oxidants in the hepatitis C patients with excess iron deposition in the liver. In conclusion, increased oxidative stress in Chronic Hepatitis C is evidenced by decreased serum vitamin A, E and C levels. A dietary supplement of Anti-oxidants may help in the management of CHC.


Shepard CW, Finelli L, Alter MJ. Global epidemiology of the Hepatitis C virus infection. Lancet Infect Dis 2005; 5: 558-67.
Devi KS, Singh NB, Mara J. Seroprevalance of the hepatitis B virus and the hepatits C virus among hepatic disorders and injecting drug users in Manipur-A preliminary report. Indian J Med Microbiol 2004; 22: 136-37.
Mukhopadhya A. Hepatitis C in India; J. Biosci. 2008; 33: 465–73.
Sarin SKGR, Banerjee K, Khandekar P. Low prevalence of the hepatitis C viral infection in patients with non-alcoholic chronic liver disease in India. J Assoc Physicians India 1996; 44: 243-45.
Sood ASS, Midha V, Jyoti D. High seroprevalance of the hepatitis C virus and dual infection (hepatitis B and C virus) in non-alcoholic chronic liver disease in north India. J Assoc Physicians India 1999; 47: 205-08.
Ray GGU, Banerjee PK, Pal BB, Dhar K, Pal AK, Biswas PK. The aetiological spectrum of chronic liver disease in eastern India. Trop Gastroenterol 2002; 21: 60–62.
Koziel MJ. Immunology of viral hepatitis. Am J Med 1996; 100: 98-109.
De Maria N, Colantoni A, Fagiuoli S, Liu GJ, Rogers BK, Farinati F, et al. Association between reactive oxygen species and the disease activity in chronic hepatitis C. Free Radic Biol Med 1996; 21: 291-95.
Yadav D, Hertan HI, Schweitzer P, Norkus EP, Pitchumoni CS. Serum and liver micro-nutrient Anti-oxidants and serum oxidative stress in patients with chronic hepatitis C. The Am. J Gastroenterol 2002; 97(10): 2634-39.
Sies H. Oxidative stress: from basic research to clinical applications. Am. J. Med. 1991;91: 31S-38S. Review.
Factor VM, Laskowska D, Jensen MR, Woitach JT, Popescu NC, Thorgeirsson SS. Vitamin E reduces chromosomal damage and it inhibits hepatic tumor formation in a transgenic mouse model. Proc Natl Acad Sci 2000; 97: 2196-201.
Lieber CS. Role of oxidative stress and Anti-oxidant therapy in alcoholic and nonalcoholic liver diseases. Adv Pharmacol 1997; 38: 601-628.
Penny M, Alice H, Barbara V, Steinbergm D, Joseph L. Anti-oxidant vitamin supplements and cardiovascular disease. Circulation 2004; 110: 637-41.
Lee CYJ, Wan JMF. Vitamin E supplementation improves cell mediated immunity and oxidative stress in Asian men and women. J Nutr 2000; 130: 2932-37.
Neeld JB, Pearson WN. Macro and micro methods for the determination of serum vitamin A by using trifluroacetic acid. J Nutr 1963; 79: 454.
Fabianek J, De Filippi, Rickards T, Herp A. A micro-method for tocopherol determination in blood serum. Clin Chem 1968; 14: 456-46
Natelson, S. Determination of ascorbic acid by 2,4- dinitrophenyl hydrazine. In: Techniques of Clinical Chemistry, 3rd Edition, Charles C Thoma Springfield, USA, 1971; 165-66.
Choi J, Lee KJ, Zheng Y, Yamaga AK, Lai MMC, Ou JH. Reactive oxygen species suppress the hepatitis C virus RNA replication in human hepatoma cells. Hepatology 2004;39: 81–89.
Farinati F, Cardin R, De Maria N, Della Libera G, Marafin C, Lecis E, Burra P, Floreani A, Cecchetto A, Naccarato R. Iron storage, lipid peroxidation and glutathione turnover in chronic anti-HCV positive hepatitis. J Hepatol 1995; 22:449-56.
Choi J, James J-H Ou, Mechanisms of Liver Injury. III. Oxidative stress in the pathogenesis of the hepatitis C virus: Am J Physiol Gastrointest Liver Physiol 2006;290: G847–G51,
Jain SK, Pemberton, Philip W, Smith A, McMahon, Raymond FT, et al. Oxidative stress in chronic hepatitis C: Not just a feature of the last stage of the disease. J Hepatol 2002:36(6):805-11.
Rocchi E, Borghi A, Paolillo F, Pradelli M, Casalgrandi G. Caritonoids and liposoluble vitamins in liver cirrhosis. J lab. Clin. Med 1991; 118:176-85.
Von Herbay A, Degroo H, Hegi U. Low vitamin E content in the plasma of patients with alcoholic liver disease, hemochromatosis and WilsonÂ’s disease. J Hepatol 1994;20:41-46.
Blomhoff R, Green MH, Green JB, Berg T, Norum KR. Vitamin A metabolism: A new perspective on the absorption, transport and storage of vitamin A. Physiology Rev 1991; 71:951-90.
Mann GV, Newton P. The membrane transport of ascorbic acid. Ann. N. Y. Acad. Sci 1975; 258:243-52.
Buettner GR. The pecking order of free radicals and Anti-oxidants: Lipid peroxidation, α-tocopherol, and ascorbate. Arch. Biochem. Biophys. 1993;300: 535-43.
Niki E.. Vitamin C as an Anti-oxidant. World Rev. Nutr. Diet 1991; 64:1-30.
Rosser BG, Gores GJ. Liver cell necrosis: Cellular mechanism and clinical implications. Gastroenterology 1995;108:252-275.
Babior BM. The respiratory burst of phagocytes. J Clin Invest 1984;73:599-601.
Houglum K, Venkatramani A, Lyche K, Chojkier M. A pilot study on the effect of d-α-tocopherol on hepatic stellate cell activation in chronic hepatitis C. Gastroenterology 1997;113:1069-73.
Larrea E, Garcia N, Qian C. Tumour necrosis alpha gene expression and its response to interferon in chronic hepatitis C. Hepatology 1996;23:210-17.
Buettner GR, Jurkiewicz BA. Catalytic metals, ascorbate and free radicals: combinations to be avoided. Radiat Res 1996;145:532-41

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DOI: JCDR/3810:1927


Date of Submission: Sep 18, 2011
Date of peer review: Dec 08, 2011
Date of acceptance: Dec 22, 2011
Date of Publishing: May 01, 2012

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