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

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Dr. Mamta Gupta,
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Aug 2018

Dr. Rajendra Kumar Ghritlaharey

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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.
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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

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
On Jan 2020

Important Notice

Original article / research
Year : 2008 | Month : August | Volume : 2 | Issue : 4 | Page : 938 - 941 Full Version

Utilization Of Nephrotoxic Drugs In Post-Operative Patients Of Urolithiasis

Published: August 1, 2008 | DOI:

Department of Biochemistry Manipal College of Medical Sciences Deep Heights,Pokhara Nepal.

Correspondence Address :
Dr. Arun Kumar Assistant Professor, Department of Biochemistry Manipal College of Medical Sciences Deep Heights,Pokhara Nepal Email:


Background of Study: Renal (or kidney) stones have been around for centuries. Egyptian mummies have been found to contain stones. Around the 5th century B.C., physicians at a medical school in Asia Minor described renal colic or pain in detail. Much information has been gathered about the condition in recent years, but more is to be learned about the cause and treatment. Urolithiasis is quite common in developing countries, especially in Nepal. This problem is particularly important in the Nepalese context, perhaps because of the climate, terrain, the living condition of the people and economic aspects. A large number of drugs are also responsible for causing urolithiasis or kidney damage.
Aim of Study: To screen the cases of urolithiasis which were operated in the past two years, and to find and establish whether nephrotoxic drugs were used in the treatment.
Materials and Methods: This is a retrospective study of hospital records of over two years, from January 2001- December 2002. 193 cases were operated for urolithiasis, which were the targeted cases of this retrospective study, and a prescription audit was done on the post operative prescriptions and follow up treatment given by surgeons at Nepal Medical College Teaching Hospital (NMCTH), a major teaching hospital of Katmandu valley, with a view to observe whether nephrotoxic drugs were prescribed for urolithiasis, and a suggestion for avoiding their use so that the reoccurrence of disease is prevented.
Results: A majority of subjects (57.51%) had urolithiasis from the productive age group. Four cases of renal damage were observed among the urolithiasis subjects.
31.08% (60 out of 193) of the urolithiasis subjects were prescribed nephrotoxic drugs. Diclofenac sodium was given in 18.13% of the total subjects, including three subjects of renal damage even being given a potent nephrotoxic drug.
Conclusion: Nephrotoxic drugs have to be avoided in pre-operative, post-operative, and follow up prescriptions in urolithiasis patients.


Nepal, Nephrotoxic drugs, renal damage, Urolithiasis

Urolithiasis refers to accretion of hard, solid, non-metallic minerals in the urinary tract. About 1 million people suffer from Urolithiasis each year, and 12% of the people living in the United States will have at least one stone in their lifetime (1). Of those who develop stone, 50% will have a recurrence of forming another stone within the next six years. Urolithiasis is quite common in developing and under developed countries, where the recurrence of endemic bladder stone is quite common due to the dietary proteins being mainly derived from plant sources. The problem of stone is more predominant in the productive age groups, as reported earlier (2). In Nepal, the problem is quite common due to climate, terrain, living conditions of the people, and economic aspects. Endocrinal and metabolic disorders, racial factors, and variation in dietary habits predisposes to urolithiasis. (3)(12).Besides the above factors, drugs are also responsible for urolithiasis, especially struvite stones (13)-(15) and kidney damage (16). The present retrospective study was done on the post operative prescriptions and follow up treatment being given by the surgeons in NMCTH, a major teaching hospital of Kathmandu valley, with a view to observe whether nephrotoxic drugs were prescribed in the post-operative and follow-up period after removal of stone, and a suggestion to avoid their use, as it might further aggravate the problem.

Material and Methods

This is a retrospective study of hospital records of over two years from January 2001 to December 2002 of the cases of urolithiasis that were operated in NMCTH. The total number of subjects who underwent surgical removal of calculi was 193. The criteria of selection of the subjects were based on:

Exclusion Criteria
(a)Prospective cases (b) Cases of other diseases.

Inclusion Criteria
(a) Hospitals records of the last two years (b) Post-operative urolithiasis patients and their follow up treatment.

The case sheets of the subjects were retrieved from the Department of Medical Records, and the post-operative prescriptions and follow up treatment given by the surgeons were audited. An informed consent was taken from the subjects who participated in the study, and was pre-approved by the institutional ethical committee board of Kathmandu University, Nepal.
The absolute data was collected and entered in Microsoft Excel for Windows 98.


The total subjects were 116 males and 77 females. The age varied from 3 years to a maximum of 74 years, with a mean ± SD of 40.17 ± 18.69 years. Of the total study group subjects a majority of subjects ie.57.51% (111 out of 193) who had urolithiasis were from the productive age group from 21-40 years (Table/Fig 1). There were 60 patients in whom nephrotoxic drugs were used, comprising of 46 males and 14 females, as shown in (Table/Fig 1).

The distribution of types of stones is shown in (Table/Fig 2).

There were four cases of renal damage as indicated by the serum urea and creatinine concentration of the subjects shown in [Table/Fig 3 ].

The pattern of nephrotoxic drugs beings used in urolithiasis patients is shown in Table 4. Diclofenac sodium, though it is a potent nephrotoxic drug, was used in 58.33% (35 out of 60) cases of renal stone compared to other nephrotoxic drugs which were used, as shown in (Table/Fig 4).

There were five patients in whom two nephrotoxic drugs, namely Megapan and Diclofenac sodium were prescribed while the remaining cases with a single nephrotoxic drug (Table/Fig 5).

The postoperative medications used in urolithiasis patients are shown in (Table/Fig 6).


A majority of the urolithiasis subjects were from the productive age group, and the findings of the present study correlate with those previously reported by Ansari et al (2003) (2). It revealed that incidence of stone disease is predominant in the productive age group. In the current study, it was observed that most of the cases of urolithiasis were confined to damage of the right kidney. The findings were similar to the cross-sectional study conducted in Tabriz, Iran, where Ahmadi et al (2007) (17) reported the prevalence of right sided renal stone in the patients. In the present study, only four of our patients had urea and creatinine levels above the normal reference range. An earlier study conducted in the United States reported serum creatinine to be higher in blacks than in white individuals and people of other races or ethnicities. The differences have been assumed to be largely related to race-related differences in body composition, especially muscle mass. Black patients were roughly four-fold more likely to have a serum creatinine concentration >10 mg/dl, and were six-fold more likely to have a serum creatinine concentration >15 mg/dl. Higher serum creatinine concentrations were associated with a lower relative risk for death (0.93; 95% confidence interval 0.88 to 0.98 per mg/dl); the association was slightly more pronounced among non black patients. In the present study, there were four cases of renal damage, as they were due to long standing calculi that might have caused altered renal functions, and in these cases in particular, nephrotoxic drugs had to be avoided. A study conducted by Hemal et al (1989) (18) cautions the use of diclofenac sodium in Urolithiasis, but the present study revealed that 18.13% of the subjects with urolithiasis were prescribed diclofenac sodium. Another study conducted by Mohkam et al (2008) (19) in the paediatric age group, also reported the toxicity associated with the use of ceftriaxone in paediatric age groups. A recent study conducted by Pannu et al (2008) (20) reported the damage of kidney in up to 25 % of all cases of severe acute renal failure in critically ill patients, due to the nephrotoxic drug used for treatment. Another study by Guo et al (2002) (21) highlighted the toxicity caused by nephrotoxic drugs, and suggested on, the prevention of such toxicity by recognizing and treating the cases of nephrotoxicity due to drugs. From the present study, it is recommended that nephrotoxic drugs should be avoided in cases of urolithiasis, either preoperatively or post-operatively, or in follow up prescriptions. The third generation Cephalosporins (cefotaxime, ceftizoxime,ceftriaxone,ceftazidime,cefoperazone), Quinolones and Fluoroquinolones (norfloxacin, ciprofloxacin, ofloxacin, pefloxacin, lomefloxacin, sparfloxacin) are relatively safe drugs that can be used in urolithiasis due to their specific susceptibility to gram negative bacteria and resistant strains of pseudomonas and hospital borne resistant strains, to which these subjects may have been exposed to, and therefore these antibiotics should be prescribed. As far as antipyretic drugs are concerned, aspirin may be the safest and efficacious drug that could be used.


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