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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
Original article / research
Full Version
Sonographic Evaluation of the Renal Volume in Normal Pregnancy at the University of Port Harcourt Teaching Hospital: A Pilot Study
Correspondence Address :
Dr. Enighe W. Ugboma
P O Box 3055, Port Harcourt, Rivers state, Nigeria
Phone: 2348133041140
E-mail: haugboma@yahoo.co.uk
Introduction:
The renal system is affected by the changes that occur in pregnancy, with the renal volume being one of the most important changes that occur. The data on the renal volume changes in pregnancy in the west African sub region, including Nigeria, is apparently sparse.
Objective:
The purpose of this study was to sonographically establish the range of the renal volume in normal pregnant women in the University of Port Harcourt Teaching Hospital, Nigeria.
Subjects and Methods:
A prospective, descriptive, cross sectional study on the sonographic measurements of the renal volume was performed on 150 healthy, normal, pregnant women. The renal volume was calculated by using the ellipsoid method. The body mass index, gestational age and parity were obtained. The correlations between the variables were calculated.
Results:
The age distribution of the women ranged from 20-41, with a mean of 29.7 years and the parity ranged from 0-6. The gestational age ranged from 9-40 weeks, while the body mass index ranged from 19.5 to 54. A mean renal volume of 163.44cm3 +(SD) 51.3 and 141.85cm3 + 41.07 for the left and right kidneys respectively, was obtained, with a range of 100cm3-214cm3 for both the kidneys. The mean renal volume was seen to increase with an increase in the gestational age and the body mass index. It was not so with the parity. The mean renal volume significantly correlated positively with the gestational age (r=0.29 and 0.11 (p<0.001) for the left and right kidneys respectively) and the body mass index (r=0.25 and r=0.24, (p<0.001) for the right and left kidneys respectively), but not with the parity (r=0.04 and 0.07, (p< 0.17) for the left and right kidneys respectively). The left mean renal volume was found to be significantly larger in the left kidney than in the right one.
Conclusion:
This study was able to establish a range of sonographic measurement of the renal volume in normal pregnancy for the locality.
Renal volume, normal pregnancy, Ultrasound scan
INTRODUCTION
The changes in the renal system are important for the favourable outcome of an index pregnancy (1). These changes in the renal system are anatomical and physiological / functional, which affect the renal blood flow, the kidneys, calyces, ureter, bladder and the urethra. Some of the physiological changes which are seen, are increase in the renal plasma flow and the glomerular filtration rate with corresponding anatomical changes which are seen as changes in the renal volume (2). These changes occurs in early pregnancy, peaking at various stages of the pregnancy and returning to normal at various times during the pueperium (2),(3),(4). Various mechanisms have been described to explain the actual effect of the pregnancy on the kidneys, but these mechanisms remain unclear (5). These mechanisms are thought to include an increase in the renal volume, changes in the sodium and electrolyte regulation and the hormonal effects of relaxin which is produced in the kidneys during pregnancy. The renal volume is one of the parameters which is affected by pregnancy and it is an important parameter which assesses the health of the kidneys (5), as it is believed to be an exact measurement of the renal size (6) and a pointer to the functional Original Article Radiology Section capacity of the kidney (7), as this relates to the number of nephrons (7). In pregnancy, sonographic measurements of the renal volume and length are important for the evaluation and follow up of patients with renal pathologies (8),(9),(10). There is however, a paucity of published information on the sonographic assessment of the renal volume in pregnancy, in spite of studies which have been done in other groups such as in chronic renal failure, diabetes and in the non pregnant population (11),(12),(14), (15),(16),(17),(18). The ultrasound estimation of the renal volume by using the ellipsoidal method (11) is simple, reliable, non-invasive and reproducible (12). It has advantages over other radiological imaging modalities such as conventional radiography and computed axial tomography, in that ionizing rays which are harmful to the developing foetus are not used. In ultrasound, sound energy is used and it has been found to have no adverse effect on the developing foetus. Thus, it is safe. It can also be used at any stage of the pregnancy (13),(14),(15). There is a paucity of published information on the normative values for the renal volume in normal pregnancy in our environment, in Nigeria and in the west African sub-region. The above reason has necessitated this study.
Subjects and methods This was a prospective, descriptive, cross sectional study in which the sonographic evaluation of the renal volume in randomly selected normal pregnant women was done in the Radiology Department of the University of Port Harcourt Teaching Hospital Port Harcourt (UPTH), Rivers state, Nigeria, over a six month period (September 2009-March 2010). UPTH is a 500 bed tertiary hospital which serves as a catchment area for Port Harcourt and the surrounding towns and villages in southern Nigeria. Normal pregnant women with no known renal or cardiovascular diseases, who attended the antenatal clinic of the hospital, who was referred to the Radiology Department for a routine obstetric scan during the period, were recruited for the study after their informed consent was obtained. The age, parity and blood pressure were obtained. Urinalysis was done by the researchers, by using a dipstick, prior to the ultrasound examination of the women, to exclude proteinuria and glycosuria. The height (in metres) and weight (in kilograms) were obtained. The body mass index (BMI) was calculated by using the formula, weight/(height) (2). A real time, grey scale, ultrasound examination was done by using an Aloka 3500 machine which was fitted with a 3.5-5MHz curvilinear transducer. The right kidney was scanned through the left posterior oblique or the left lateral decubitus position by scanning through the anterior axillary line intercostally or subcostally, while the left kidney was scanned through the right posterior oblique or the right lateral decubitus position by scanning through the anterior axillary line intercostally or subcostally (16). The liver was used as an acoustic window on the right, while the spleen was used on the left for a detailed renal scan. The kidneys were clearly identified, as were outlined by the brightly echogenic renal capsule with a central (sinus) echogenicity. A longitudinal scan of each kidney was done. The superior and inferior poles were clearly identified and marked. The renal length (L) (in cm) was taken as the longest distance between the poles (A-B) (bipolar length) (Table/Fig 1). The antero-posterior diameter (AP) (thickness) (in cm) was also measured on the longitudinal scan, (C-D) (Table/Fig 1) with the maximum distance between the anterior and the posterior walls of the kidney at the middle.The renal width (W) (in cm) was measured on the transverse scan (Table/Fig 2). The hilum was identified and the transverse diameter was measured at this point (E-F).
A total of one hundred and fifty women took part in the study, with their ages ranging from 20-41 years, with a mean age of 29 years. The age group of 25-29 years had sixty eight women, which was the highest number of the subjects, while the 40-44 years age group had only three women, which was the lowest incidence. The parity ranged from 0 to 6, with the women of parity 0 having the highest incidence [53, (35.3%)] and those of parity 6 having the lowest incidence (2). The body mass index (BMI) ranged from 19.5-54, with a mean of 29.45. The obese group had the highest incidence of sixty one (41%), while the underweight had the lowest incidence of eight (5%). The gestational age ranged from 9-40 weeks, with an average of 28 weeks. Most of the women 93 (61%) were seen in the third trimester, while only 9(6%) were seen in the first trimester.The mean renal volume throughout the pregnancy was found to be 163.44cm3 + 51.3 for the left kidney and 141.85cm3 + 41.07 for the right kidney, with a range of 100cm3-214cm3 for both the kidneys. There was a poor correlation between the left and right mean renal volumes, with the left mean renal volume being significantly greater than the right mean renal volume (p<0001) (Table/Fig 3).The lowest mean renal volume of both the kidneys was seen in the under weight group (BMI<20). The highest values of the renal volumes were seen in the obese group in both the kidneys. On an average, there was a significant steady increase in the mean renal volume with an increase in the BMI in both the kidneys (p<0.01) (Table/Fig 4). In addition, a significant positive linear correlation was seen between BMI and the renal volume, r=0.25 and r=0.24, (p<0.001) for the right and left kidneys respectively. There was a significant steady increase in the mean renal volume with an increase in the gestational age, with the highest value in the first trimester (p<0.01) (Table/Fig 5). There was also a significant linear positive correlation between the gestational age and the renal volume r=0.29 and 0.11 ;( p<0.001) for the left and right kidneys respectively. Women of parity 2-3 had the highest values of the mean renal volume. On an average, there was no significant increase in the renal volume with an increase in the parity in both the kidneys (p <0.01). (Table/Fig 6). There was no significant correlation between the parity and renal volume, r=0.04 and 0.07, (p< 0.17) for the left and right kidneys respectively. The relationship between RRV and LRV shows large variations between their values making them poorly correlated.
This study showed that the mean renal volume in pregnancy was found to be 163.44cm3 + 51.33 for the left kidney and 141.85cm3 + 41.08 for the right kidney, with a range of 100- 214cm3 for both the kidneys. The renal volume was seen to increase significantly throughout the pregnancy, with the mean renal volume being the largest in the third trimester (p<0.01). This was in agreement with Reynard et al (17), findings, who postulated that the renal volume increased during pregnancy, with the renal plasma flow rate increasing by 75% in the third trimester. This could be explained by the fact that in late pregnancy, there was the highest increase in the renal plasma flow, the glomerular filtration rate and hyperfiltration, leading to this increase in the renal volume. Weight gain is normal in pregnancy and with this, there is an increase in the body mass index. In the absence of weight gain, a poor pregnancy outcome is seen (18). This weight gain is due to the weight of the foetus, placenta, membranes and the liquor amni. Cohen et al, (19) and other researchers (14), (15), showed that the total renal volume correlated positively with the body mass index in the non-pregnant state. This has now also been proved to occur in the pregnant state, as the present study showed a significant positive linear correlation between the renal volume and the body mass index. In pregnancy, the additional factors which are responsible for this, could be explained by the fact that the increase in the renal volume may be linked to other factors which are connected with the physiological state of the pregnancy, such as an increase in the renal plasma flow with hyperfiltration and increased accumulation of the intrarenal fluid, leading to an increase in the renal volume. There was no real significant difference in the renal volumes across the various parities. Also, there was no significant correlation of the renal volume with an increase or decrease in the parity. (r=.04,p<0.01) This was found to agree with the findings of the study which was done by Obembe et al (20), where the parity was found to have little or no effect on the renal function. This could be explained by the fact that after pregnancy, the renal volume returns to its pre-pregnancy state and thus in subsequent pregnancies, there is no added additional enlargement. However, more long term studies are needed to be done where the prepregnancy and post partum renal sizes are assessed in women of various parities, to see if there are any significant changes and these women should be followed up through their subsequent pregnancies. This study also revealed that the renal volume on the left was consistently larger than that on the right, as was seen in some studies which were done on women who were in the non pregnant state. Emamian et al (6), in Denmark, evaluated the kidney dimensions sonographically in 665 adult volunteers and showed that the renal volume of the left kidney was larger than that of the right kidney. This was contradictory to the findings of Okoye et al’s (21) study in Enugu, Nigeria, who by using the mean renal length and mean renal volume as a determinant parameter of the renal size, demonstrated no significant difference between the sizes of the left and right kidneys. This was however contradicted in the study which was done by Ibe-Lambert (22), in Lagos, among normal Nigerian adults, where the left kidney was found to be longer than the right kidney. The reason for the larger left kidney could be that the spleen which has a superior correlation of the kidney, is smaller than the liver, thus giving the left kidney more room to grow. Also, because the left renal artery is shorter and straighter than the right one, the increased blood supply to the left kidney via the left renal artery may result in the relatively increased volume (22) of that kidney
This study established a value for the renal volume in pregnancy in this environment, which can be used as a reference value for pregnant women.The study also showed that the body mass index and gestational age had a significant positive linear correlation with the renal volume, but not with the parity. The limitations of this study were the small population size and the inability to compare the pre and post pregnancy renal volumes, as well as the pre and post BMI to the various factors. Further investigations are needed to compare these factors, as well as a larger study population is required,which may improve the precision of the values which are obtained.
DOI: JCDR/3657:1910
Financial OR OTHER COMPETING INTERESTS:
None.
Date Of Submission: Nov 23, 2011
Date Of Peer Review: Dec 08, 2011
Date Of Acceptance: Jan 23, 2012
Date Of Publishing: Apr 15, 2012
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