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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
CT PNS – Do We Really Require Before FESS?
Correspondence Address :
Dr. Sheetal D, Assistant Professor, Dept of ENT, AJIMS, Kuntikana,
Mangalore, 575004, Karnataka, India
E-mail: drsheetald@rediffmail.com
There exists a controversy for with regards to the advice of CT for the management of sinusitis and hence, this e study was undertaken to correlate between the CT findings and the endoscopic findings in FESS, the anatomical abnormalities and the mucosal changes in patients with chronic rhinosinusitis and the reliability and validity of CT scan in the management of chronic rhinosinusitis.
This was a time bound cross sectional study design. 45 patients with chronic rhinosinusitis underwent pre operative CT PNS , followed by functional endoscopic sinus surgery (FESS). The parameters which were used for the correlation were paradoxical middle turbinate, concha bullosa, bony destruction , ostiomeatal complex disease, polypoidal changes, mucosal thickening and frontoethmoidal disease.
The correlation was calculated by using the formula for Kappa’s agreement. The uncinate process attachment, the agger nasi cells and the, anterior and posterior ethmoid sinuses showed excellent correlation .The maxillary sinus did not show good correlation, but this was acceptable. The middle turbinate anomalies, the hiatus, the infundibulum, the frontal recess and haller’s cells showed poor correlation.
The pre operative CT scan evaluation of the patients who have to undergo ing FESS is essential. Most of the anatomical abnormalities can be studied on by CT scan, but however, endoscopy also gives other valuable information.
CT scan FESS sinusitis correlation
Sinusitis in its simplest form is an inflammation of the mucous membranes of the sinuses. Rarely the disease may involve other parts of the sinus (bone) or the surrounding structures (nose, orbit and, central nervous system) before the patient consults doctors (1). During the past two decades, the concepts of sinusitis and its management have undergone tremeondous changes. The three important factors on to which the pathophysiology of the sinus disease is related are: the patency of the ostia,, the function of the cilia and the quality of the nasal secretions. Alternation in any one of these factors, alone or in combination, can change the physiology and lead to sinusitis. Of the three factors, the patency of the ostia is the most important in the development of chronic rhinosinusitis. The ostiomeatal complex is the key area to for the pathogenesis of chronic rhinosinusitis (2). Based on this concept, functional endoscopic sinus surgery (FESS) aims to eliminate the disease in the from its primary site. i.e. the ostiomeatal complex and allow the resolution of secondary infection in from the larger sinuses(3).
The pre operative diagnosis for these patients is based upon the combination of endoscopy of the lateral nasal wall with CT scan of the paranasal sinuses, but however, the prevalence of the incidental mucosal changes in an asymptomatic population is quite significant. There are various comparative studies of on the imaging modalities , clinical symptomatology, histopathology, culture pattern, anatomical variations and mucosal disease by intranasal endoscopy and there are also imaging studies including CT scan, but a clear correlative study between pre operative CT scan and anatomical defects and mucosal assessment which is found during endoscopic sinus surgery is lacking.
The present study was done to correlate and evaluate between the CT findings and the endoscopic findings in FESS.
The study was conducted in the Department of ENT of the DistrictChigateri General Hospital and Bapuji Hospital which is attached to J.J.M Medical College, Davangere, of in Karnataka State. A total of 45 patients were included in the study and they were all clinically confirmed cases of chronic sinusitis, including recurrent cases, who had undergone pre operative CT and functional endoscopic sinus surgery thereafter. The CT scan findings were discussed with consultant radiologists. Patients with complicated sinusitis, osteomyelitis, aggressive fungal infections and infiltrating tumours were excluded. (Table/Fig 1)
The diagnostic validity was used for the correlation between the CT findings and the endoscopic findings. The Kappa’s measure of agreement was used for agreements . The parameters which were used for the correlation were: paradoxical middle turbinate, concha bullosa, bony destruction, ostiomeatal complex disease, polypoidal changes, mucosal thickening and frontoethmoidal diseasefrontoethmoidal disease.
A total of 45 patients were included in the study. The A majority of the patients were males (62%), than as compared to the females (38%)(Table/Fig 1). The most common age group of the patients was between 20-40 years and the average duration of the disease was 1 -5 years. The common symptom of presentation was headache (90%), followed by nasal discharge (80%). Concurrent nasal allergy was seen in 9% of the patients. (Table/Fig 2)
The CT evaluation of these patients was done by consultant radiologists. Concha bullosa was seen in 35% and 42% of the patients on the right and left sides respectively. Paradoxical middle turbinate was seen in 17% and 8% of the patients on the right and left sides respectively. The uncinate process was commonly attached to the lamina (70% on the right, and 66% on the left side), followed by the middle turbinate (24% on the right, 31% on the left side). The hiatus was obstructed in 57% of the patients on the right side and in 59% of the patients on the left side. The infundibulum was found to be obstructed in 57% of the patients on the right side and in 64% of the patients on the left side. In the assessment of mucosal disease, the maxillary sinus was found to be the commonest to get affected (57% on the right and, 46% on the left side), followed by the anterior ethmoid cells (40% on the right and, 37% on the left side), the posterior ethmoid cells (33% on the right and, 28% on the left side), the frontal sinus (28% on the right and, 26% on the left side) and, the sphenoid (20% on the right and, 13% on the left side) respectively. The maxillary sinus was hypoplastic in 13% of the patients on the right and in 15% of the patients on the left side respectively. The frontal sinuses were normal in 88% of the patients, but however, the frontal recess was obstructed in 35% and narrowed in 15% of the patients. The agger nasi cells were present in 37% and 33% of the patients on the right and left sides respectively. Haller’s cells were present in 6% and 8% of the patients on the right and left sides respectively. (Table/Fig 3)
Some of the parameters were studied only on by CT scan and were not explored during FESS. The ethmoidal fovea was symmetrical in 84% and asymmetrical in 15% of the patients. Kero’s type II was the commonest type (77%) of olfactory fossa, followed by type I (20%). The internal carotid artery bulge was dehiscent in 2% andthe optic nerve canal was dehiscent in 2% of the cases. The sphenoid sinus was asymmetrical in 84% of the cases. The vomer was pneumatised in 13% of the cases. In abnormal sphenoid pneumatization, the anterior clinoid was commonly pneumatised in 14%, followed by the posterior clinoid in 2% of the cases.
After the functional endoscopic sinus surgery, the findings were noted. The concha bullosa was seen in 33% and 40% of the patients on the right and left sides respectively. The uncinate process was commonly attached to the lamina papyracea (71% on the right and, 69% on the left), followed by the middle turbinate (26% on the right and 31% on the left). The hiatus was obstructed in 53% patients on the right and in 61% patients on the left side. The infundibulum was found to be obstructed in 59% patients on the right and in 66% patients on the left side. In the assessment of mucosal disease, the maxillary sinus was found to be the commonest to get affected (46% on the right and, 40% on the left), followed by the anterior ethmoidal cells (33% on the right and, 42% on the left side) and, the posterior ethmoidal cells (33% on the right and, 28% on the left side)., The frontal sinus was ere not seen in all the patients, but however, the frontal recess was obstructed in 37% and narrowed in 15% of the patients. The maxillary sinus was hypoplastic in 33% patients on the right side and in 15% patients on the left side. The agger nasi cells were present in 33% and 28% patients on the right and left sides respectively. Haller’s cells were present in 2% and 4% of the patients on the right and left sides respectively. (Table/Fig 4)
Some of the parameters were seen only in by endoscopy. In the assessment of the spheno-ethmoidal recess, purulent discharge was present in 20% and 24% patients on the right and left sides, followed by mucoid discharge in 13% and 17% patients on the right and left sides respectively. The sphenoid sinus ostium was not seen in most of the cases. But among those which were seen, the oval shape was common (46%), followed by the slit shape (3%). The lateral sinus was present in only one case. The accessory maxillary ostium was present in 13% and 11% patients on the right and left sides respectively.
The diagnosis of inflammatory sinus disease can often be difficult to be made, ke as the nasal symptoms are neither sensitive nor specific in predicting the underlying pathology. Pfleiderer et al (1986) demonstrated only a 44% correlation between the plain maxillary sinus X-rays and the sinuscopic findings. Mass et al (1989) demonstrated a 90% correlation between the endoscopic and the CT findings. Indeed, endoscopy sometimes provides information that CT would cannot demonstrate (4). Lloyd reported an incidental sinus abnormalities in 39% of the asymptomatic sinus group (5). Cooke and Hadley showed 37.5% of their cases and Havas et al reported the abnormal appearence of the paranasal sinus on CT scan in their series, in 42.5% of the asymptomatic adults (6). Till date, only one study has shown a correlation between endoscopy and CT scan in the diagnosis of surgical sinusitis on in 50 patients, but a detailed correlation of between the pre er operative endoscopic findings and CT scan is has not been reported (7).
In our study preoperative, the CT findings were correlated with the operative endoscopic findings in a total of 45 patients who underwent functional endoscopic sinus surgery.
The middle turbinate abnormalities (concha bullosa, paradoxical middle turbinate, medial displacement, etc) showed a poor correlation (K=13.3%). In our study, the concha bullosa didn’t show good correlation (K=59.7%). In various studies, the incidence of the concha bullosa was reported to be between 9-20% (8).
The endoscopic evaluation of the uncinate process variations in various studies ranged s from 0.4-15% (8). In our study, the uncinate process attachment showed excellent correlation (K=84.97). The assessment of the hiatus semilunaris and the infundibulum showed poor correlation (K=0 & 24 respectively). But during FESS, a good correlation was seen between the disease at the hiatus semilunaris, the infundibulum and the mucosal disease in the maxillary sinus. In our study, the frontal recess showed poor correlation (K=10%) and the agger nasi cells showed excellent correlation (K=79.95%). These associations are not reported till o date. All the cases of maxillary sinus hypoplasia were confirmed during the FESS.
Some parameters were studied only on by CT scan. Kero’s classification figures the incidence of the olfactory fossa as type I-11.59%, of 450 skulls, type II-70.16% and type III-18.25% of 450 skulls (9). Our study showed type I-20%, type II-77% and type III-2%. Both studies showed type II as the commonest type of the olfactory fossa. The sphenoid sinus was found to be symmetrical in 15% and asymmetrical in 84% of the cases on CT scan. Bolger et al showed anterior clinoid pneumatization in 13.3% of the patients and, pterygoid pneumatization in 43.6% of the cases (8). Our study showed anterior clinoid pneumatization in 3% patients unilaterally and in 8% patients bilaterally , posterior clinoid pneumatization in 2% patients unilaterally and in none bilaterally, and pterygoid process pneumatization in 3% patients unilaterally and in 6% patients bilaterally. The optic canal indenting on the lateral wall of the sphenoid varied from in 7-88% of of the cases (10). Our study showed optic canal dehiscence in 6% of the cases. The bulging of the internal carotid artery, consequent to extreme pneumatization of the sphenoid sinus, varied from in 4-7% of the cases (11).
Our study showed internal carotid artery bulging in 2% of the cases. Some parameters were seen only during FESS. The lateral sinus was seen in 1 case on the right side. The accessory maxillary ostium was present in 13% patients on the right and in 11% patients on the left side. The sphenoid sinus ostium was not seen in most of the cases. Among the infundibular disease and the intrasinus mucosal diseases, the maxillary sinus did not show a good correlation, but this was acceptable (K=47.63%), where as the anterior and the posterior ethmoid sinuses showed excellent cor-relation (K=83% and 100%). There were few limitations in our study, like there was no control group for correlating the anatomical variations with normal individuals, all the landmarks shown on CT were not revealed during FESS unless they were diseased or pathological and also, , the CT scan was not interpreted by a single radiologist.
CT scan is mandatory as a pre operative work up in patients who have to undergo ing FESS; as it provides a map on by the help of which to the operation can be done. e. However, endoscopy and CT scan are complimentary in the assessment of various anatomical variations in the ostiomeatal complex and in intrasinus mucosal disease.
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