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

Users Online :

AbstractMaterial and MethodsResultsDiscussionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

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
Lucknow
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,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



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




Dr. Shankar P.R.

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



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
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 : 2012 | Month : June | Volume : 6 | Issue : 5 | Page : 777 - 779 Full Version

QTc Changes in Non-pregnant Females with Severe iron Deficiency


Published: June 1, 2012 | DOI: https://doi.org/10.7860/JCDR/2012/.2216
Vitthal H. Khode, K.F. Kammar

1. Assistant Professor in Physiology, SDM College of medical sciences and hospital, Sattur, Dharwad-580009, Karnataka, India. 2. Professor and Head, Physiology, Karnataka Institute of Medical sciences (KIMS), Vidya Nagar, Hubli-580022, Karnataka, India.

Correspondence Address :
Dr Vitthal H. Khode, Assistant Professor, Physiology,
SDM College of medical sciences and hospital,
Sattur, Dharwad-580009, Karnataka, India.
Phone: 9916821453
E-mail: drkhoday@yahoo.co.in

Abstract

Background:
A prolonged QT interval is a biomarker for ventricular tachyarrhythmias and a risk factor for sudden death. It is associated with a faulty storage of excess iron in the myocardium, which is described in several hereditary and acquired conditions. However, we do not have enough evidence on the fact that iron deficiency can affect the QT interval. We hypothesized that iron plays an important role in the generation and the propagation of electrical impulses at the level of the myocardial membrane and that it alters the QT interval; so we recorded the QT interval in severely anaemic, non-pregnant females and compared it with that in age and sex matched controls.
Methods:
30 non-pregnant females with severe iron deficiency anaemia, Haemoglobin- <6gm% and low serum ferritin levels were subjected to the ECG test. The QTc of each subject was calculated by using Bazzet’s formula and this was compared with that of an equal number of sex and age matched controls.
Results:
A significantly shortened QTc was observed in severe iron deficiency anaemia (SIDA) (390±23ms) as compared to that in the controls (419±19ms) (P>0.001). There was a significant positive correlation between the serum ferritin levels and the QTc interval.
Conclusion:
A shortened QTc was observed in the SIDA group because of the sympathetic over activity which was secondary to the hyper dynamic circulation.

Keywords

QTc interval, Severe iron deficiency anaemia, Non-pregnant females

Introduction
The QT interval represents the electrical depolarization and repolarization of the left and right ventricles. A prolonged QT interval is a biomarker for ventricular tachyarrhythmias like torsades de pointes and a risk factor for sudden death. The modern computer based ECG machines can easily calculate the corrected QT, but this correction may not aid in the detection of patients who are at an increased risk of arrhythmia. The standard clinical correction can be done by using Bazzet’s formula. An abnormal prolonged QT interval could be due to the Long QT syndrome, adverse drug reactions, hypothyroidism and myocardial injury and it is also associated with a faulty storage of excess iron as has been described in several hereditary and acquired conditions (1),(2),(3),(4). In the heart, iron is deposited predominantly in the myocardial cells, rather than in the interstitium (5),(6). This leads to an impaired generation and propagation of electrical impulses at the level of the myocardial membrane (6),(7),(9). It has been suggested that excessive intra-cellular iron interferes with the electric function of the heart, either by generating large amounts of free radicals or by causing selective dysfunction of the Na+ channels (6),(8),(10). The aberrant function of the Na+ and the K+ channels contributes to the aetiology of the prolonged QT syndrome, ventricular tachyarrythmias and atrial fibrillation (7),(11),(12),(13),(14). Iron also has a role in the production of the rectifying currents. However, we do not have enough evidence on the fact that iron deficiency can cause impairment of the generation and the propagation of the electrical impulses and that it can affect the QT Interval. Some studies have shown an increased QTc in anaemic patients. We hypothesized that iron plays an important role in the generation and the propagation of electrical impulses at the level of the myocardial membrane and that it alters the QT interval; so we recorded the QT interval in severely anaemic, non-pregnant females and compared it with that in age and sex matched controls.

Material and Methods

This cross sectional case control study was conducted in the Department of Physiology and Medicine in our medical institution. After taking the approval of the ethical committee, 60 individuals were selected for the study and they were categorized into two groups. Group 1 included 30 non-pregnant females with severe iron deficiency anaemia (SIDA) (Hb<6gm%). Group 2 included 30 age and sex matched controls. The sample size was calculated on the basis of the prevalence of the admitted patients in our hospital. After taking the informed consent of the patients, their histories were noted. Their physical examinations were done. Their vitals were recorded. During the general physical examination, the following signs were looked for: pale tongue, pale conjunctiva, koilonychia, pedal oedema and ascites. This was followed by a cardiovascular examination in which the heart sounds, cardiac murmurs, raised JVP, hepatosplenomegaly, basal crepitation and any other cardiac abnormalities were looked for. This was followed by routine respiratory, central nervous and abdominal system examinations. Except for pale tongue, pale conjunctiva and koilonychia, no other of the above said abnormalities were found. Particular care was taken to exclude the intrinsic cardio vascular diseases. A complete haemogram was done by using an autoanalyzer and by doing peripheral smears. The serum ferritin levels were estimated. About 3 ml of the patients blood samples were collected by a clean venipuncture. The blood was allowed to clot. The serum was separated and it was stored at –200C. The ferritin levels were estimated by ELISA in batches of ten each, along with normal and abnormal controls. The ECG was recorded after giving 5 minutes of rest to the patients to allay their anxieties. The ECG was recorded by using a CARDIART 108T, J8A 14901 machine, all the 12 leads. The QT interval was corrected for the heart rate by using Bazzet’s formula. The standard clinical correction is done by using Bazett’s formula, which is named after the physiologist Henry Cuthbert Bazett for calculating the heart rate-corrected QT interval QTc. Bazett’s formula is as follows: QTcB=QT⁄√RR where QTc is the QT interval which is corrected for the heart rate, and RR is the interval from the onset of one QRS complex to the onset of the next QRS complex, which is measured in seconds, which is often derived from the heart rate (HR) as 60/HR (here QT is measured in milliseconds). However, this nonlinear formula over-corrects at high heart rates and under-corrects at low heart rates.

Statistical Analysis
All the data were entered and analyzed by using Statistical Package for Social Sciences (SPSS), version 16. The data were presented as mean ±SD. The independent t-test was used to analyze the difference between the variables in the control group and in the patients with severe iron deficiency anaemia. The difference between the groups was considered as statistically significant at a probability value of <0.05. The correlation between serum ferritin and QTc was analyzed by using Pearson’s formula.

Results

The demographic data on the severe iron deficiency anaemia cases and the healthy controls has been summarized in [Table/Fig-1]. The mean age of the SIDA group was 28.10±5.10 years (range 20-40), while the mean range of the control group was 28.17±5.02 years, which was statistically not significant. The serum ferritin level was significantly lower in the SIDA group (p>0.0001). There was a significant difference in the QTI in the two groups. The QTI in the SIDA group was 310±37 ms against 350±27ms in the control group (p<0.0001). The QTc was also shortened in the SIDA group as compared to that in the control group (390±23ms 419±19ms respectively with statistical significance (p<0.001).

Discussion

In the present study, we observed a shortened QT interval and a shortened QTc in the SIDA patients as compared to those in the age and sex matched controls. There was a positive correlation between serum ferritin and QTc.

Our study had several limitations. The sample size was small. Relatively low number of the included subjects was due to the study design, which was set up to limit the influence of several co variables and the less number of the admitted SIDA patients in our hospital. Measuring the serum iron and the total iron binding globulin (TIBG) was necessary, which we did not do, as serum iron is an indicator of the extra-cellular iron and as TIBG is another indicator of the total iron stores. We did not perform echocardiography to assess the ventricular function of the heart, which could have been a confounding factor in assessing the QT interval. We measured the QT interval manually by using a magnifying lens, which cannot be as accurate as that which is measured by computerized measurements. We did not measure the serum electrolytes like Na+, K+ and Ca+ which could affect the QT interval. An additional limitation was that not all the medications which could affect the QTc were included in our methodology.

In the initial description of the formula for the QT interval which was corrected for the heart rate, Bazzet noted that women had a longer corrected QT interval than men (15). Although these observations have been reproduced several times, the mechanism of this gender difference in the QT interval is unclear (16),(17),(18),(19),(20). The gender differences appear at puberty and decrease but do not disappear later in life (4). Because of the gender differences in the QT interval, men were excluded from this study. In vitro studies have reached discrepant conclusions, but the weight of evidence does not support an acute physiologic effect of oestrogens or androgens on the action potential duration (21),(22). Some studies have reported a prolonged QT interval in pregnant females. That was the reason why pregnant females were excluded from this study. In our study, we observed a significant reduction in the QT interval and in QTc as compared to those in healthy individuals. There was a significant correlation between Haemoglobin and Ferritin and QTc. Many investigators have found a significant correlation between serum ferritin and QTc. Wu et al., independently showed that the serum iron levels affected the dispersion of QT in patients who were treated with peritoneal dialysis (23). However, the studies on the dialyzed subjects are frequently hampered by abrupt changes in the electrolyte levels and varying degrees of cardiomyopathy (24). These co-morbidities influence the action potentials through the heart, possibly obscuring the effect of the iron metabolism abnormalities (7),(25). We tried to limit the effect of several co- variables by eliminating the subjects with pre-existing arrhythmias and those who were taking medications which were known to affect the depolarization of the heart. One report suggested that by lowering the ferritin levels, some cardic arrhythmias could be reversed (26). To substantiate this finding, we did not observe any ectopics in patients with low ferritin levels. The experimental data suggested that the propagation of the action potential through the membrane of the myocardial muscle was primarily affected by elevated serum iron and ferritin levels by the reduction of the currents which passed through the Na+ channels as a whole (8),(9). These channels are critical for depolarization, whereas the prolongation of QT is predominantly dependent on the K+ rectifier current (11),(12),(13),(14),(25). Excessive iron deposition in the heart resulted in the alteration of the outward K+ current, but the inward rectifier current was unchanged (6). This data suggested that the observed prolongation of QT (which correlated with increased serum ferritin levels) was an intracellular phenomenon. Recently, new data have emerged which have suggested that in the epithelial cells, there is a concurrent uptake of Na+ and iron, the latter being sequestrated as ferritin (27). This process affects the inward K+ current as well. It is possible that this ferritin dependent K+ current is involved in the pathology. It is possible that very low levels of ferritin might affect the ferritin dependent K+ current, both the outward and the inward rectifier current and that it may affect the QT interval. But we observed a rather shortened QTc in the SIDA subjects. Possibly the ferritin levels were not low enough to cause dysfunction of the ferritin dependent K+ current. A shortened QTc is caused by increased sympathetic activity which is secondary to the hyperdynamic circulation. The sympathetic activity shortens the QTc by shortening the phase of repolarization.

The focus of our study was to check whether SIDA prolonged the QTc in females, which made them more prone to develop cardiac arrhythmias. Studies have shown that it is not because of changes in the oestrogen or progesterone levels (21),(22). We observed that even SIDA could not prolong the QTc; in fact, it shortened it. So, this study excluded the possibility of SIDA being one of the cause for a prolonged QT interval. It also forms a platform for further studies to elucidate other mechanisms by which the QTc can be prolonged.

References

1.
Fletcher LM, Bridle KR, Crawford DH. Effect of alcohol on iron storage diseases of the liver. Best Pract Res Clin Gastroenterol 2003;17:663-77.
2.
Beutler E. Hemochromatosis: Genetics and pathophysiology. Ann Rev Med 2006;57:331-47.
3.
Alla V, Bonkovsky HL. Iron in non-hemochromatotic liver disorders. Semin Liver Dis 2005;25:461-72.
4.
Hearnshaw S, Thompson NP, McGill A. The epidemiology of hyperferritinaemia. World J Gastroenterol 2006;12:5866-9.
5.
Fitchett DH, Coltart DJ, Littler WA, et al. Cardiac involvement in secondary haemochromatosis: A catheter biopsy study and analysis of the myocardium. Cardiovasc Res 1980;14:719-24.
6.
Kuryshev YA, Brittenham GM, Fujioka H. Decreased sodium and increased transient outward potassium currents in iron-loaded cardiac myocytes. Implications for the arrhythmogenesis of human siderotic heart disease. Circulation 1999;100:675-83.
7.
Campbell RM. The treatment of the cardiac causes of sudden death, syncope, and seizure. Semin Paediatr Neurol 2005;12:59-66.
8.
Obejero-Paz CA, Yang T, Dong WQ, et al. Deferoxamine promotes survival and it prevents electrocardiographic abnormalities in the gerbil model of iron-overload cardiomyopathy. J Lab Clin Med 2003;141:121-30.
9.
Schwartz KA, Li Z, Schwartz DE, Cooper TG, Braselton WE. The earliest cardiac toxicity which is induced by an iron overload selectively inhibits the electrical conduction. J Appl Physiol 2002;93:746-51.
10.
Rosenqvist M, Hultcrantz R. The prevalence of haemochromatosis among men with clinically significant bradyarrhythmias. Eur Heart J 1989;10:473-8.
11.
Sudden Arrhythmia Death Syndromes Foundation. (Version current at August 20, 2009).
12.
Aerssens J, Paulussen AD. Pharmacogenomics and the acquired long QT syndrome. Pharmacogenomics 2005;6:259-70.
13.
Brugada R, Hong K, Cordeiro JM, Dumaine R. Short QT syndrome. CMAJ 2005;173:1349-54.
14.
Vorchheimer DA. What is QT interval prolongation? J Fam Pract 2005;Suppl:S4-7.
15.
Bazzet H. An analysis of the time relations of electrocardiograms. Heart 1920;353-70.
16.
Goldberg RJ, Bengston J, Chen ZY, et al. Duration of the QT interval and cardiovascular mortality in healthy persons. Am J Cardiol 1991; 67:55-58.
17.
Rautaharju PM, Zhou SH, Wongs S. Sex differences in the evolution of the electrocardiographic QT interval with age. Can J Cardiol 1992; 8:690-95.
18.
Makkar RR, Trom BS, Steinman RT, et al. The female gender as a risk factor for torsades de pointes which is associated with cardiovascular drugs. JAMA 1993; 270:2590-97.
19.
Larsen JA, Tung RH, Sadananda R, et al. The effects of hormone replacement therapy on the QT interval. Am J Cardiol 1998; 82:993-95.
20.
Kadish AH, Larsen JA. The effect of gender on the cardiac arrhythmias. J Cardiovasc Electrophysiol 1998; 9:655-64.
21.
Prinzmetal M, Nakashima M, Oishi H, et al. Estrogen and the heart. Am J Obstet Gyencol 1967; 1967:575-76.
22.
Giemeno A, Webb J. The action of sex steroids on the electrical and mechanical properties of the rat atrium. Am J Physiol 1963; 1963: 198-200.
23.
Wu VC, Huang JW, Wu MS, et al. The effect of iron stores on the corrected QT dispersion in patients who underwent peritoneal dialysis. Am J Kidney Dis 2004;44:720-28.
24.
Selby NM, McIntyre CW. The acute cardiac effects of dialysis. Sem Dial 2007;20:220-28.
25.
Dubin DB. Rhythm, Part II: Blocks. In: Dubin DB, ed. Rapid Interpretation of EKG’s, 6th edn. Tampa: Cover Publishing, 2000;173-86.
26.
Miskin H, Yaniv I, Berant M, Hershko C, Tamary H. Reversal of the cardiac complications in thalassemia major by long-term, intermittent, daily intensive iron chelation. Eur J Haematol 2003;70:398-403.
27.
Turi JL, Piantodosi CA, Stonehuerner JD, Ghio AJ. Iron accumulation in the bronchial cells is dependent on the concurrent sodium transport. Biometals 2008;21:571-80.

DOI and Others

Financial OR OTHER COMPETING INTERESTS:
None.
Date of Submission: Nov 14, 2011
Date of Peer Review: Apr 01, 2012
Date of Acceptance: Apr 26, 2012
Date of Publishing: Jun 22, 2012

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com