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

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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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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




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Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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MD, DM (Clinical Pharmacology)
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Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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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

Experimental Research
Year : 2009 | Month : December | Volume : 3 | Issue : 6 | Page : 1968 - 1971

Visualisation Of Renal Calculi Using C – Arm Fluoroscopy ( in cadavars)

NATEKAR PRASHANT E*

*Professor & Head, Goa Medical College Department of Anatomy, Goa Medical College,Bambolim, Goa,(India)

Correspondence Address :
Dr. Prashant E. Natekar,Professor & Head,Department of Anatomy Goa Medical College City: Bambolim State: Goa Country: India Postal code: 403202Phone: (O) 0832-2495350(R) 0832 2458787 (M) 09326150001E-mail address: drpenatekar@hotmail.com

Abstract

The present study was carried out on cadavers to ascertain the resolving power of C - arm fluoroscopy (mobile) unit. Renal calculi of different sizes were collected from the patients and these calculi were then implanted in the urinary tract of cadavers, at the common sites of impaction. It was seen that calculi as small as 3mm could be identified. However classification of the calculi i.e., prediction of stone composition based on image characteristics was not possible.

Keywords

renal calculi; ureteric calculi, C-arm fluoroscopy; calcium stones; uric acid stones

Introduction
Renal calculus is the commonest condition resolved on X- ray, hence the radiogram forms the most important piece of evidence in the diagnosis of the renal calculi. A calculus is a progressive conglomeration of crystalloid bodies bound together by a cement substance. The former are precipitated out of the urine; the latter, in which they reach saturation by absorption, is provided by the plasma in the form of an irreversible colloid (such as fibrin) (1). It is well known that the problem of renal or ureteric calculi is very large worldwide. Renal colic or ureteric colic patients need quick diagnosis and immediate treatment. It may be a self limiting condition due to spontaneous passage of small calculi of less than 5mm size and complete recovery up to 93% of patients with acute urinary tract calculus obstruction or persisting pain or high grade obstruction may require hospitalization and urological intervention (2),(3).

Plain abdominal x ray for kidney, ureter and urinary bladder (KUB) used alone is of limited diagnostic value with a sensitivity of 53-62% and specificity of 67-69% for detection of ureteral calculi (4). Ultrasound proved to be a non invasive, safe technique, which efficiently detected acute urinary tract obstruction. Ultrasound used alone had some limitations, being an operator dependent technique. Sensitivity of ultrasound increases when used along with X- ray with KUB. Intravenous urography is not likely to be helpful when the results of plain X- ray and ultrasound were negative (5).

It is unusual to have a stone of pure chemical substance. One of the components may predominate but there are always at least traces of others. The radiographic visualization of the calculus depends on its opacity to X -rays. Apart from its size and porosity, it will also depend on its chemical composition and atomic number of elements composing it. A calculus containing calcium, phosphate, magnesium or sodium will cast a shadow in the radiogram. Very rarely, the urinary calculi is composed of a similar salt, however its nucleus consist of ammonia, urates in infants, uric acid in young adults and calcium oxalates in patients above the age of 40. The laminae will be composed of uric acid, ammonia and sodium and magnesium phosphates cysteine and xanthines.

The main aim of this pilot study is to ascertain the resolving power of the C-arm fluoroscopic system with regard to commonly occurring renal stones and also whether the C-arm fluoroscopic system would actually be able to detect or visualize the renal or ureteric calculi based on resolution of size of stone, chemical composition of stone or position of the stone in the urinary tract.

Material and Methods

This study was carried out in the Department of Anatomy at Goa Medical College, Bambolim Goa. Renal stones were collected from patients who were operated in Goa and were classified into various sizes. The cadavers were dissected from the anterior abdominal wall by a midline incision from the xiphisternum to the pubic symphysis. The rectus sheath was incised and the peritoneum was separated. The intestines and other organs were separated and both the kidneys, ureters and urinary bladder were exposed.

These stones were placed at the following locations in the urinary tract of the cadaver:
• Lower pole of kidney.
• Pelvi – ureteric junction.
• Level of entry of ureter at the pelvic brim.
• Opening of ureter into urinary bladder.

A mobile C – arm Fluoroscopic system was positioned around the cadaver and the intensity of the X – rays were increased from low to high to resolve the stones. The size and location of the stones were visualized on a monitor and findings were noted. These stones were also analysed biochemically so as to ascertain its chemical composition.

Results

Observations and Results
It was observed that all the stones of 3mm size and above could be resolved under C arm fluoroscopy, however stones of 2mm could not be resolved. It was also observed that 3mm size and above could also be resolved at the four commonest site of stone formation as shown in (Table/Fig 1) when the stones were sent for chemical analysis to detect their chemical composition it was observed that the following substances were present in the stones. They were calcium phosphate, calcium oxalate, calcium carbonate, uric acid stones and creatinine.

Discussion

In our present study, the following were the main types of urinary stones.

Calcium oxalates. calcium phosphate, calcium carbonate, uric acid and creatinine. Calcium stones amounting to almost 95% of renal stones occur due to presence of excessive calcium in the urine, either because of defective kidney function which allows a lot of calcium to pass into the urine or excess calcium which may be absorbed from stomach and intestine. These are usually single, have a mulberry outline and cast a densest shadow of all the calculi due to larger amount of calcium. Oxalates, present in staple diets of certain population easily binds with calcium to form calcium oxalate stones. Phosphates mostly calcium phosphates or commonly triple phosphates of calcium, magnesium and ammonia tend to grow quickly and assume a corralliform shape. Uric acid calculus being rare does not cast shadow if it is pure, however when it is mixed with urates, they show opacity in a radiogram and usually do not attain a large size.

20% of the urethral calculi are found in the lumbar ureter and the calculi are usually larger than 5mm. The remainder 80% are found in pelvic ureter of which 70% are located in the intramural portion of the terminal ureter. Approximately 95% of the urethral calculi are visible on diagnostic plain X ray films covering abdominal pelvis and the remaining 5% are non opaque composed generally of cysteine, xanthine or uric acid (6).

Nearly all lie above a line joining the inferior margin of the bases of the ischial spines (a line corresponding to the lower level of the intramural section of the ureter). Intravenous pyelograms may show normal pelvis and calyces with little or no urethral dilatation on the side of the urethral calculus. When the calculus appears larger than the ureter, it shows dilatation above the level of the stone. Infrequently a non opaque stone is visible as a filling defect in an unobstructed or blocked ureter. An important secondary sign of calculus at the lower end of the ureter is a filling defect in the bladder due to edema around the urethral orifice. Nearly all patients having a urethral calculus complain of pain on the same side which begin in the loin and often radiates down the anterior abdomen into the inguinal or pubic region which is excruciating and spasmodic.

In evaluating patients with acute ureteric calculus disease Intravenous Urography has traditionally being the imaging modality of choice. Unenhanced spiral CT is also accurate in showing calculi of kidney and ureter and signs of acute obstruction like peri-renal stranding and hydronephrosis(7),(8),(9). On comparison of performance of unenhanced Spiral CT to the combination of HASTE (Half-Fourier single shot turbo spin-echo) MR Urography (MRU) and plain abdominal radiography (KUB) in patients suspected of having acute calculus ureteric obstruction, it was observed that based on evaluation of presence of peri renal fluid and presence and level of ureteric obstruction and calculi, 69% patients had acute calculus ureteric obstruction and MRU showed peri- renal fluid in acute ureteric obstruction (77%) with a greater sensitivity than CT showed stranding (45%) while the combination of fluid and ureteric dilatation on MRU had 93% sensitivity (CT 80%), 95% specificity (CT 85%) and 94% accuracy (CT 81%). MRU/KUB showed ureteric calculi in 72% of patients with calculi seen by CT and overall it was observed that MRU/KUB technique having less observer variability (Kappa 0.75), revealed 2.4 abnormalities per acutely obstructed ureter compared with 1.8 abnormalities detected by CT (10).

In our present study we have observed that all stones of 3mm and more could be easily visualized under C arm fluoroscopy irrespective of their location. It was also observed that chemical composition had no additional advantage in locating and detecting the stone as all stones could be visualized irrespective of their chemical composition. An additional advantage of C arm fluoroscopy is that very often 3mm stone goes undetected as an artifact or technical error which can be easily diagnosed under C arm fluoroscopy. This study is useful so as to avoid cystoscopic procedures and also because of the mobile unit the same can be utilized in operation theatres for diagnosing the renal calculi. Identification of a stone in a bifid or double ureter, where the diagnosis depends on the skill of the urologist in finding and catheterizing both ureteral orifices. This study also helps in avoiding the differential diagnosis of renal and ureteric calculus. Although digital radiography, intravenous pylography, ultrasonography and CT scan detects the calculi of 3mm size, C arm fluoroscopy also can detect the same especially in operation theatres.

Besides this our study provides findings which are important to surgeons before and during surgical interventions and will also provide immense contribution in treatment of renal and ureteric calculi so as to rationalize the early line of management and treatment both clinically and surgically.

Acknowledgement

I am thankful to Mr. Usgaonkar from Siemens for providing the C arm fluoroscopy unit. I am also thankful to Dr. Sanjay Sardessai, Associate Professor Department of Radiology for guidance in Radiology.

References

1.
S. Cochrane Shanks, Peter Kerley A. Atextbook of X-ray diagnosis. H.K.Lewins & Co. Ltd.London. 1964; 828-829.
2.
Mutgi A, Williams J W, Nettleman M. Renal colic utility of the plain abdominal roentgenogram. Arch Intern Med 1991;151:1589-92
3.
Haddad MC, Shariff HS, Shahad MS, Mutaiery MA, Samihan AM, Sammak BM, Southcombe LA and Crawford AD. Renal colic diagnosis and outcome. Radiology. 1992;184:83-88.
4.
Roth CS, Bowyer BA, Berquist TH. Utility of the plain abdominal radiograph for diagnosing ureteral calculi. Annals of Emergency Medicine. 1985; 14: 311-15.
5.
Pervez A & Ammar A. Role of Ultrasound in evaluation of renal colic and assessment of risk factor for renal calculi. Gomal Journal of Medical Sciences. 2007; 5: 22-26.
6.
Alfred de Lorimer, Henry G Mochring, John R Hannan. Clinical Roentgenology: The digestive tract, the gall bladder, Liver and pancreas, the excretory tract & special studies emphasizing differential consideration. Charles Thomas publisher.Springfield, Illinois USA. 1956;Vol IV 478-479.
7.
Smith RC, Rosenfield AT, Kyuran AC, Kirk RE, Verga M, Glickman MG, et al. Acute flank pain: comparison of non-contrast-enhanced CT and intravenous urography. Radiology 1995; 194: 789–94.
8.
Smith RC, Verga M, Dalrymple N, McCarthy S, Rosenfield AT. Acute ureteral obstruction: value of secondary signs on helical unenhanced CT. AJR Am J Roentgenol 1996;167:1109–13.
9.
Heneghan JP, Dalrymple NC, Verga M, Rosenfield AT, Smith RC. Soft tissue "rim" sign in the diagnosis of ureteral calculi with use of unenhanced helical CT. Radiology 1997; 202: 709–11.
10.
Regan F, Kuszyk B, Bohlman M E, & Jackman S. Acute ureteric calculus obstruction; Unenhanced spiral CT versus HASTE MR Urography and abdominal radiograph. British Journal of radiology 2005; 78: 506-11.

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[Table / Fig - 1]
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