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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
Ultrasonographical evaluation of Asymptomatic Gall Bladder Diseases – An epidemiological study in North India
Correspondence Address :
Sanjay Saran Baijal, Professor, Dept of Radiodiagnosis, Sanjay
Gandhi Postgraduate Institute of Medical Sciences, Rae Bareily
Road, Lucknow – 226 014 U.P, India.
E Mail: drsuyash@gmail.com, ssbaijal@sgpgi.ac.in
Phone: +91 522 2668700 Extn: 2574 (O); 2568(R)
Fax No: +91 522 2668717
To detect the prevalence of asymptomatic gall bladder (GB) diseases by using ultrasonography (USG) as the primary screening modality. Ultrasonography is the most appropriate tool which can be used for the diagnosis of gall bladder disease. Despite the availability of sophisticated imaging modalities, especially computerized tomography (CT) and magnetic resonance imaging (MRI), USG still remains the initial and powerful screening modality of choice for evaluating the GB pathology.
Over a period of two and a half years (July 2004 to Jan 2007), 640 subjects (105 healthy volunteers and 535 randomly selected patients with unrelated medical problems) were examined by using real time, grey scale, B mode USG with a 3.5 MHz convex transducer (Sonoline G60S system, Siemens Medical Solutions, WA, USA). To ensure adequate GB distension, the examination was performed after an overnight fast of 8 – 12 hours.
Among the 105 healthy volunteers, the prevalence of the silentGB disease was 15.24%, while among the 535 patients presenting with unrelated symptoms, the prevalence was 10.84 %. However, the overall prevalence was 11.56%. Asymptomatic GB disease is more common in females, in the fourth and fifth decades of life, the mean age being 42.0 ± 12.64%. Cholelithiasis (4.22%), followed by chronic cholecystitis with cholelithiasis (3.12%), were the commonest abnormalities which were detected. The accuracy of USG in delineating asymptomatic GB disease at our center was found to be 94.12%, as revealed by consistent USG and histopathological findings.
Cholecystosonography is a potentially valuable tool which is
used for the diagnosis of GB disease. A strong case is made to
recommend the USG screening of females between the ages of
41 – 50 years who were otherwise normal.
Ultrasonography; asymptomatic gall bladder diseases; cholelithiasis; chronic cholecystitis
The use of ultrasonography (USG) as a diagnostic aid for the visualization of the gall bladder was first suggested by Hubilitz in 1972 (1); since then, it has been used with increased frequency and confidence by radiologists. With the rapid strides in technological advancement, the accuracy and reliability of USG has also increased.
Sonographical patterns for the commonly encountered causes for gall bladder diseases viz. gall stones, carcinoma gall bladder (CAGB), adenomyosis and cholecystitis have been well described in the literature. These conditions may however, not always be symptomatic, especially in the early phases of their natural history. In the United Kingdom, about 8% of the population aged over 40 years have gall stones, which has increased to over 20% in those aged over 60. Fortunately, 90% of these stones remain asymptomattic; however, cholecystectomy remains the most commonly performed abdominal surgical procedure (2).
Reports from western literature present a variable picture for asymptomatic GB diseases (3), (4), Only few studies evaluating this issue in the Indian population, are however present in the literature (5).
Our study was aimed at estimating the prevalence of asymptomatic gall bladder diseases by following standardized diagnostic criteria in healthy volunteers and in patients presenting with symptoms which were unrelated to gall bladder diseases.
USG was carried out in 105 healthy volunteers and 535 patients (males and females) who presented to the medical and surgical gastroenterology units of our institution with signs and symptomswhich were unrelated to the diseases of the billiary system. After an overnight fast, real time, grey scale, B-mode USG examination was done by using a 3.5 MHz convex transducer (Sonoline G60S system, Siemens Medical Solutions, WA, USA).
The patients were initially positioned in the supine position and the right upper abdominal quadrant was examined, starting with the liver, in the routine manner. The gall bladder was examined initially with the patient in the supine position, followed by examination in both the decubitus and the sitting positions. Deep respiratory excursions were advised, with the jagging movement of the gall bladder caused by the transducer, to make the small calculi and those impacted to the wall, more obvious. Sonographical Murphy’s sign was elicited in all the patients, with the transducer placed directly above the gall bladder (6), (7), (8).
Moderate compression was applied and the patient was observed for facial wincing. A focused question regarding pain on pressure was also asked if no wincing was noted; in case of a positive response, control examinations with probe pressure over the left lumbar region and the hypogastrium was also done. The patient was then turned to the left decubitus position and compression was given over the gall bladder to confirm the Sonographical Murphy’s sign in all the above situations (7), (8).
The incidence of GB disease in the study groups was 11.6%. Cholelithiasis was present in 66 cases (10.3%); acalculous cholecystitis was present in 3 (0.47%); and gall bladder polyps in 3 (0.47%).
Among the 640 subjects who were screened, the ages ranged from 3 – 78 years and the male-female ratio was 1:1.5 (Table/Fig 1).The male-female ratio in asymptomatic patients with GB disease (n=74) was 1:1.8, with a peak incidence in the fifth decade. [Table/ Fig 1]
It was observed that among the 105 healthy volunteers, the prevalence of the silent GB disease was 15.2%. Subjects with diseases other than that of the hepatobiliary system showed a lower incidence of 10.84 %. Thick wall GB, echo and acoustic shadowing were the commonest USG morphologies which were observed in 85.1%, 70.3%, and 73% of the patients (Table/Fig 2).
USG abnormalities were detected in 20.27% of the pregnant women, in 15.24% of the healthy volunteers, in 8.11% of the cases with Koch’s abdomen and in 8.75% of the cases with benign prostatic hyperplasia, among others.
USG has established itself as a first line of investigation in GB diseases. The reported accuracy of USG in various series is 90 – 98% (9). USG diagnoses gall stones and gall bladder malignancies (CAGB) with high accuracy (7), (8) (9).
Pant and Gupta (10) examined 2500 patients with USG and found calculi in 62 (2.48%), while Brinholz (11) studied an asymptomatic population of 581 subjects and found silent gall stones in 64 subjects at an incidence of 11%. In the present study, 74 (11.6%) patients had asymptomatic gall stones. This variation of the incidence in various series may be due to the diverse dietary habits.
GB polyps have been found in 1% patients undergoing cholecystectomy (1). The evidence for the adenoma – carcinoma sequence is abundant (12).The risk of developing carcinoma in a polyp is reported to be about 0.0020 – 0.0160% per year. This risk increases with the size of the polyp or with GB wall thickening. Of the patients who were screened in this study, 0.47% were found to have GB polyps, an incidence which was similar to that from earlier reports. CAGB is associated with stones in 40 – 100% of the patients.
The importance of the development of carcinoma in patients with asymptomatic gall stones has been well emphasized. In the present study, carcinoma was present in 2 (0.37%) patients and in both, it was associated with gall stones. One patient underwent surgery and the diagnosis was confirmed on histopathological examination. The survival of the patients with CAGB varies with the stage of the disease at the time of presentation. Patients with stage 1 disease have 90 – 95 % survival rates, while the rates are 65 – 90 % for stage 2 disease and 8 – 20 % for stage 3 disease. Most of the patients with stage 4 disease die within 6 months (13), (14), (15). These findings suggest that USG examination should not be localized to the disease in question and that a complete abdominal examination should be performed in order to pick up silent diseases which may subsequently become symptomatic. USG may also be used as a screening modality for the early detection of CAGB.
The peak incidence of asymptomatic GB diseases in the present study occurred in women in the fourth decade; this is also the peak age for carcinoma in this region (16), (17).
We suggest that every woman over the age of 40 years, living in an endemic zone, should be screened sonographically at least annually. The false negativity of ultrasonography for such screening is acceptably low, and was found to be 2.3 % in a series of 133 patients (18) (19).
We further suggest that every female who is referred to a radiologist for USG should be screened for the GB disease as well; thus, we might be able to pick up the cases of carcinoma earlier and this might make a worthwhile cure possible.
Though we have not compared ultrasonography with any other modality which is capable of diagnosing gall bladder diseases, a review of relevant literature emphasizes ultrasound as the modality with maximum specificity and sensitivity for diagnosing symptomatic as well as asymptomatic gall bladder diseases. CT scan however, has been mentioned as the first line in the diagnostic work up if a patient presents with acute abdomen, which may further turn out to be due to a symptomatic gall bladder disease (18).
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