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

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
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Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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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."



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




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




Dr. C.S. Ramesh Babu
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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.
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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

Important Notice

Case report
Year : 2008 | Month : December | Volume : 2 | Issue : 6 | Page : 1203 - 1206

Umbilical Endometriosis

RAI R *,SATHYAMOORTHY A** ,D’SOUZA C***

*,**,***Dept.of General Surgery,Fr Mullers Medical College,Mangalore,Karnataka,(India)

Correspondence Address :
Dr. Rakesh Rai,Dept.of General Surgery,Fr Mullers Medical College,Mangalore,Karnataka,Ph:9886494433,E-Mail:dr.rakeshrai@gmail.com

Abstract

Endometriosis is a disorder in which abnormal growth of tissues, histologically resembling that of the endometrium, are present in locations other than the uterus. The lesions are usually found in the peritoneal surface of reproductive organs, but also can be found anywhere in the body. Primary cutaneous endometriosis is uncommon. The frequency which arises in the skin of all endometriosis is 1.1%, and those which arise in the umbilical region are about 30%. Umbilical endometriosis is a very rare surgical condition, but should be considered in the differential diagnosis of any umbilical nodule. We report a case of a 28yr old lady who presented with a bluish nodule at the umbilicus for 3 months, with no associated discharge. It was histopathologically confirmed as umbilical endometriosis.

Keywords

Endometriosis, Umbilicus, Cutaneous endometriosis

In the late nineteenth century, the term endometriosis was coined by Sampson to characterize ectopic tissue possessing the histological structure and function of the uterine mucosa. It also includes those abnormal conditions which may result not only from the invasion of organs and other structures by this tissue, but also from its reaction to menstruation. Endometriosis is a well recognized gynaecological condition that presents infrequently to general surgeons. Cutaneous endometriosis presenting to general surgeons is often mistaken for a suture granuloma, abscess, cyst, lipoma or incisional hernia(1).Umbilical endometriosis is rare, with an estimated incidence of 0.5 to 1.0 percent of all patients with endometrial ectopia(2), Subcutaneous endometriosis should be suspected in any female presenting with cyclic pain emanating from a mass in the vicinity of an abdominal surgical scar or the umbilicus(3). We report our case to highlight the challenges involved in its diagnosis.

Case Report

A 28 year-old-woman presented to the surgical outpatient clinic with the history of a painful umbilical nodule, of three months duration. She had regular menstrual cycles without dysmenorrhoea. The patient had not conceived, following four years of married life. There was no past history of any surgeries. General physical examination was normal. Local examination revealed a 3 X 2 cm, non tender, not reducible, firm, lobulated umbilical nodule, without a cough impulse. There was no discharge or ulceration on the surface. Other systemic examination were unremarkable (Table/Fig 1).

Her routine haematological investigations were normal. Ultrasonography gave the diagnosis as umbilical adenoma. Hence, no FNAC was done. The patient was subjected for excision biopsy, with a differential diagnosis of umbilical adenoma and umbilical endometriosis. The swelling was found to have no communication with the peritoneal cavity. The excised specimen was sent for histopathological examination, which revealed glandular structures lined by endometrial epithelial cells and,surrounded by a cellular stroma. These features were suggestive of endometriosis (Table/Fig 2),(Table/Fig 3).

The patient was further evaluated to look for any other foci of endometriosis. The final diagnosis of isolated umbilical endometriosis was confirmed. The patient was discharged on the 3rd post operative day. Sutures were removed on the 7th post operative day. On 3 months follow up, the patient was asymptomatic.

Discussion

The prevalence of pelvic-endometriosis has been reported to be as high as 44% in asymptomatic women undergoing laparoscopy for non gynaecological symptoms, while the incidence of umbilical endometriosis is estimated to be only 0.5% to 1% of all women with an extragonadal endometriosis. The presentation of endometriosis to general surgeons is rare and atypical, and presents diagnostic difficulties(1).

Umbilical endometriosis occurs in women between 30 to 40 years of age. It is usually a solitary, firm, brownish or bluish nodule ranging from 0.5 to 3 cm in size .Umbilical endometriosis is rare, with an estimated incidence of 0.5 to 1.0 percent of all patients with endometrial ectopia(3). The mechanism of formation of umbilical endometriosis appears to be unknown, although there are two major theories: metastases and metaplasia. The metastasis theory suggests that the implantation is either by lymphatic or haematogenous spread(1),(2).

More commonly, cutaneous endometriosis occurs in a surgical scar from abdominal or pelvic procedures, which include hysterectomy, caesarean sections, episiotomy and laparoscopy. Endometriosis is usually present in the pelvic organs and is rarely described in the umbilicus, vagina, vulva and appendix(4). Cutaneous endometriosis is a rare condition, especially in patients without a history of abdominal or pelvic surgery or known preexisting endometriosis(5)

The lesion is often slightly tender and painful. At the time of menstruation, the pain becomes more pronounced and may be associated with swelling and slight bleeding of the lesion. Rare cases have undergone malignant transformation, and give rise to endometrial carcinoma. The possibility of coexisting genital-pelvic endometriosis should be investigated. Hormonal therapy may be a consideration when there is coexistent pelvic endometriosis.

The histopathologic features of endometriosis can be reminiscent of the main phases of the menstrual cycle. The proliferative phase has a uniform stromal cell population and pronounced epithelial mitotic activity; the secretory phase has decapitation secretion within the glandular cells and 2 stromal cell types: a large cell and a small clear cell that are morphologically similar to the uterine "predecidual cell" and the "endometrial granulocyte" respectively. Disintegration of the epithelium and dissociation from the stroma resemble menstruation(3).

The differential diagnosis of umbilical nodules includes: embryological rests, irreducible umbilical hernia, pyogenic granuloma, primary malignancy such as malignant endometriosis in the umbilicus, umbilical polyp, melanocytic nevus, seborrheic keratosis, epithelial inclusion cyst, desmoid tumour, haemangioma, granular cell tumour, keloid, and foreign body granuloma or secondary metastatic tumour from an intra-abdominal malignancy. Surgical excision of the umbilical endometrioma with sparing of the umbilicus when possible is necessary for proper histopathological diagnosis that will dictate the treatment plan(1),(3). Local recurrence after adequate surgical excision is uncommon(2).

The possibility of coexisting genital-pelvic endometriosis should be explored. The fact that up to 50% of these affected women may have concomitant pelvic endometriosis makes further pre-operative diagnostic investigations advisable in a non-emergent setting . Gyaecological referral should be made early for better preoperative planning. This is important as concurrent pelvic endometriosis needs to be treated to prevent reseeding of endometrial tissue from the pelvis. In suspicious cases where emergency surgical exploration is not warranted MRI is the most recommended investigation. This modality of imaging has been shown to be useful for delineating the size and location of extra-pelvic endometriosis and in excluding intra-abdominal extension of the disease(3),(7). Hormonal therapy may be a consideration when there is coexistent pelvic endometriosis.

Conclusion

Endometriosis at this site is not only rare it can also present diagnostic pitfalls to the general surgeon, as this case illustrates. Thus, it should be considered in the differential diagnosis of all pre-menopausal women presenting with umbilical swellings. For some patients, there may be no relationship between the swelling and menstruation, as alluded to above in our case. The diagnosis is often made incidentally by histologic examination after surgical exploration and excision of the lesion.

References

1.
. Seleem M I. Umbilical endometriosis: A diagnostic dilemma. Kuwait medical journal.2002; 34(4):303-05.
2.
. Tabbakh R, Halliday M. Endometriosis in general surgical practice .The internet journal of surgery TM ISSN: 1528-8242.
3.
. Munoz, Heidi, Waxtein, Leon, Vega, Elisa, Cortes, Roberto , Hojyo, Teresa M , Dominguez S, Luciano . An Ulcerated Umbilical Nodule. Archives of dermatology. 1999; 135(9): 1113-18
4.
. Mirei K, Shinichiro T, Hideki K, Taiichi Y, Hideya Y, Seiji K . Umbilical endometriosis. Rinsho derma. 2002; 44(7):824-25.
5.
. Elm MK, Twede JV, Turiansky GW. Primary cutaneous endometriosis of the umbilicus: a case report. Cutis. 2008; 81(2):124-6.
6.
. Schachter, Lee, Tash, Jennifer, Olgac, Semra, Bochner, Bernard H. Umbilical Endometriosis.The journal of Urology.2003; 170(6):2388-238.
7.
. Yuen J S P, Chow P K H, Koong H N, Ho j m s, Girija R. Unusual sites (thorax and umbilical hernia sac) of endometriosis. J. R. Coll. Surg. Edinb. 2001(46):313-15.

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