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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
Correlation of Liver Attenuation with Visceral Fat Area on Computed Tomography Scan: An Analytical Study
Correspondence Address :
Ankita Pandey,
22-C, Diamond Park, Park Street, Wakad, Pune-411057, Maharashtra, India.
E-mail: ankitapandey2603@gmail.com
Introduction: In the modern world, owing to rapid urbanisation and changes in lifestyles and dietary habits, obesity has emerged as a leading problem. As a result, various morbid conditions have come into the picture which have severe effects on an individual’s life expectancy. Visceral fat plays an important role in causing fatty liver.
Aim: To determine the relationship between visceral fat area and liver fat using Computed Tomography (CT).
Materials and Methods: A retrospective analytical study was conducted at Dr. D. Y. Patil Medical College, Hospital, and Research Centre Pune, Maharashtra, India. The CT scans of 134 patients who underwent CT scans of the abdomen pelvis and CT KUB/CT IVU between January 2022 and June 2022 were assessed by two experienced body imaging medical doctors. Subjects aged between 18 and 75 years were included without any co-morbidities like diabetes or hypertension. Waist circumference, subcutaneous fat area, and visceral fat area were calculated at the umbilical level. The CT attenuation value was measured in the right hepatic lobe, devoid of focal lesions and vessels, using a standard ROI of approximately 200 mm2. Similarly, as an internal control, splenic attenuation was also recorded. Statistical tests were employed to determine the significance of the obtained values, including Spearman’s coefficient and Cohen’s criteria.
Results: The CT attenuation of the liver (fatty liver) showed a moderate correlation with visceral fat (Spearman’s coefficient: 0.329). The association was statistically significant (p-value=0.0001). The CT attenuation of the liver (fatty liver) showed a weak correlation with subcutaneous fat (Spearman’s coefficient: -0.269). The association was statistically significant (p-value=0.0016). The CT attenuation of the liver (fatty liver) demonstrated a weak-moderate correlation with waist circumference (Spearman’s coefficient: -0.305). The association was statistically significant (p-value=0.0003).
Conclusion: Visceral fat area has a stronger correlation with fatty liver than waist circumference and subcutaneous fat. Visceral fat should be considered a risk factor in the development of fatty liver, which may further lead to metabolic syndrome, in order to reduce mortality and morbidity related to it.
Hepatic steatosis, Spearman’s correlation, Visceral fat quantification
Obesity is escalating in developing countries due to urbanisation and sedentary lifestyles, despite lingering undernutrition (1). This shift leads to increased risks of dyslipidemia, type II diabetes, and cardiovascular diseases (1),(2). Visceral fat, exceeding 100 cm, heightens the risk of metabolic syndrome and fatty liver (2),(3),(4). Elevated portal free fatty acids, correlated with visceral fat, exacerbate hepatic gluconeogenesis and insulin levels. Obesity, coupled with these fatty acids, impedes insulin function (5). Visceral fat adipocytes release triglycerides, leptin, and Tumor Necrosis Factor (TNF) α, contributing to metabolic syndrome. Fatty liver, a prevalent liver disease, can precede hepatocellular carcinoma (6). Considering visceral fat in the etiopathogenesis of fatty liver and metabolic syndrome is of utmost importance and in the present scenario with the advent of non-invasive methods like CT, the authors can effectively quantify visceral fat and predict and diagnose the progression and presence of fatty liver, respectively. With this background, the present study was conducted with the aim to determine the relationship between the visceral fat area and liver fat using CT and compare them with subcutaneous fat and waist circumference.
A retrospective analytical study was conducted at Dr. D. Y. Patil Medical College, Hospital, and Research Centre, Pune, Maharashtra, India. CT scans of 134 patients who underwent CT scans of the abdomen pelvis and CT KUB/CT IVU for pathologies not involving the liver between January 2022 and June 2022 were assessed. Liver attenuation and visceral fat on CT scans were assessed by two experienced body imaging medical doctors.
Inclusion criteria: Subjects between the ages of 18 to 75 years without any co-morbidities like diabetes or hypertension were included.
Exclusion criteria: Subjects with liver diseases were excluded from this study.
Waist circumference, subcutaneous fat area, and visceral fat area were calculated at the umbilical level. Total visceral volume is highly correlated to visceral fat calculated at the umbilicus according to several studies (3),(7),(8),(9). Liver attenuation was measured in the right hepatic lobe, devoid of focal lesions and vessels, with a standard ROI of approximately 200 mm2. Similarly, as an internal control, splenic attenuation was also recorded (Table/Fig 1),(Table/Fig 2),(Table/Fig 3),(Table/Fig 4) (10),(11). A CT attenuation value of the liver less than 40 HU and a difference of >5 HU between the attenuation values of the liver and spleen were considered to diagnose fatty liver (12).
Statistical Analysis
The data were entered in Microsoft Excel 2019 and analysed using MedCalc v18.2.1 (MedCalc Statistical Software version 18.2.1, MedCalc Software, Ostend, Belgium; http://www.medcalc.org; 2018). Categorical variables were expressed in terms of frequency and percentages (where applicable), and continuous variables were expressed as mean and Standard Deviation (SD); median, and Interquartile Range (IQR) where applicable. Normal distribution was verified by the Shapiro-Francia test. Spearman’s correlation was performed between liver attenuation and the study parameters.
A p-value <0.05 was considered statistically significant. Cohen’s criteria were used to determine the effect size (strength of the relationship) (13).
A retrospective review of CT scans of 134 patients was done. The mean age of the study participants was 40.38 (15.72) years. The median age and IQR were 36 years and 29-52, respectively. Total Males were 72 (53.73%) and 62 females (46.27%).
There was a statistically significant difference between visceral fat, subcutaneous fat, waist circumference between fatty and non-fatty liver respectively (Table/Fig 5).
The CT attenuation of the liver (fatty liver) showed a moderate correlation with visceral fat (Spearman’s coefficient: 0.329). The CT attenuation of the liver (fatty liver) showed a weak correlation with subcutaneous fat (Spearman’s coefficient: 0.269). The CT attenuation of the liver (fatty liver) demonstrated a weak-moderate correlation with waist circumference (Spearman’s coefficient: 0.305) (Table/Fig 6),(Table/Fig 7),(Table/Fig 8),(Table/Fig 9).
The results of this study demonstrated that CT attenuation of the liver is inversely correlated with the visceral fat area, indicating that visceral fat has a higher likelihood of being associated with fatty liver. Subcutaneous fat and waist circumference also showed some correlation, but they were weaker than visceral fat. In a study by Pickhard PJ et al., involving 474 patients, of which 168 had metabolic syndrome (prevalence of 35.4%) (10), patients with metabolic syndrome had greater visceral fat than those without metabolic syndrome (p-value <0.001). In a study by Eguchi Y et al., which included 129 USG-diagnosed fatty liver patients, the liver spleen ratio and visceral fat area calculated by CT showed a significant negative correlation (r=-0.605, p<0.0001) (2). Previously, it was believed that BMI and visceral fat both played a role in fatty liver. However, BMI alone is insufficient to accurately assess health risks associated with increased adiposity, as it can vary significantly among individuals of the same weight with different levels of visceral fat (14). Research has shown that body fat composition provides a more precise indication of health than BMI or body weight (15).
In the present study, the authors have demonstrated that the visceral fat area has a better correlation with fatty liver than waist circumference and subcutaneous fat. The Insulin Resistance index (HOMA-IR) shows a positive correlation with the severity of fatty liver (2). Metabolic fat is a further indicator of cardiovascular disease. Central obesity is currently measured using waist circumference, but direct visceral fat measurements are more appropriate (1). Fatty liver disease (hepatic steatosis) can be quantified by CT using the CT attenuation value of the liver. CT is a non-invasive method (1). CT quantification of visceral fat is especially important for metabolic syndrome, which is related to both visceral and central obesity. Although simpler, non-specific fat metrics like body weight, belly circumference, and body mass index are more commonly employed, they cannot identify the exact location of fat (13). With the non-invasive measurement of visceral fat and hepatic steatosis, new CT and Magnetic Resonance Imaging (MRI) techniques have the potential to improve the diagnosis of metabolic syndrome with high accuracy. Understandably, calculating visceral fat area, subcutaneous fat area, and waist circumference with CT is not practically possible, hence they are not yet part of the metabolic syndrome definition (14). In conclusion, the result of the present study indicated that the visceral fat area has a strong correlation with fatty liver on CT, which makes it an important factor in the development of metabolic syndrome. Hence, CT evaluation of fatty liver is an indicator of metabolic syndrome.
Limitation(s)
Along with the retrospective nature of the present study, the small sample size was a limitation. To draw broader inferences, patients with known metabolic syndrome and diagnosed cases of fatty liver can be helpful.
Patients with larger waist circumferences, visceral fat areas, and subcutaneous fat are more likely to develop hepatic steatosis. The authors have shown that there is a stronger correlation between fatty liver and visceral fat than there is between waist circumference and subcutaneous fat. In order to lower the mortality and morbidity associated with metabolic syndrome, visceral fat should be regarded as a risk factor for the development of fatty liver, which may then progress to it.
DOI: 10.7860/JCDR/2024/68538.19435
Date of Submission: Nov 30, 2023
Date of Peer Review: Jan 12, 2024
Date of Acceptance: Apr 05, 2024
Date of Publishing: May 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Dec 04, 2023
• Manual Googling: Mar 29, 2024
• iThenticate Software: Apr 01, 2024 (12%)
ETYMOLOGY: Author Origin
EMENDATIONS: 8
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