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

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On Sep 2018

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"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."

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On Sep 2018

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"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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Dr. Saumya Navit

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

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Dr. Arunava Biswas
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Assistant Professor
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Calcutta National Medical College & Hospital , Kolkata

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Best regards,
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Muzaffarnagar Medical College,
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,
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.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
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
(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)
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.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2011 | Month : August | Volume : 5 | Issue : 4 | Page : 798 - 800

The Effect of Chemotherapy on the Pulmonary Function Tests in Cancer Patients with Healthy Lungs

avjot k. miglani, rajiv arora

Department of Physiology, Punjab institute of medical sciences, Jalandhar, Punjab, India.

Correspondence Address :
Dr. Avjot K. Miglani
(Associate professor, (M.B.B.S, M.D) Physiology,
Punjab institute of medical sciences (PIMS), Jalandhar,
Punjab, India.
E-mail:; Mob.: 07837744009


Aim: The present study was aimed at determining the effect of chemotherapy on lung function tests.

Material and Methods: This study was conducted on 35 cancer patients with healthy lungs, who undertook cancer chemotherapy. The pulmonary function test parameters, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1)and the FEV1/FVC ratio was recorded by using a computerized spirometer, Medspiror (Med Systems (P) Ltd.Chandigarh).

Results: All parameters showed a significant decline in the patients after the 1st and 2nd cycles of chemotherapy, as compared to those prior to the chemotherapy.

Conclusion: The present study confirms the fact that chemotherapeutic drugs have a toxic effect on lungs.


Chemotherapy pulmonary function tests

The incidence of respiratory illnesses has increased in the last 2-3 decades, thus leading to derangements of the lung functions, partly due to the increase in smoking, pollution, the life span and partly due to the use of various neoplastic drugs. At present, about 50% of the patients with cancer can be cured with chemotherapy, thus contributing to a cure in about 17% of the patients (1).

The ideal anticancer drugs can eradicate the cancer cells without harming the normal tissues, but unfortunately, no currently available agents meet this criterion and the pulmonary toxicity which is caused by the administration of chemotherapy is usually irreversible and progressive. So, the present study was undertaken to estimate the extent of damage which is done by anticancer drugs on the lungs.

Material and Methods

The present study included 35 patients of either sex, who were diagnosed to have malignancy, but had healthy lungs. This study was conducted in the Department of Radiotherapy/Oncology, Shri Guru Teg Bahadur (S.G.T.B) Hospital, which is attached to the Government Medical College, Amritsar.

Patients with pulmonary metastasis and lung disease or those who had been previously exposed to radiotherapy during the treatment were excluded from the study.

All the subjects were explained about the procedures which were to be undertaken and written informed consent was taken from them as per the Helsinki declaration. This study was approved by the institutional ethics committee.

The patients were randomized into the following three groups : • Group I (1st visit) : before the start of chemotherapy. • Group II (2nd visit) : 3-4 weeks after the 1st visit(1st dose). • Group III (3rd visit) : 3-4 weeks after the 2nd visit(2nd dose).

Pulmonary function tests (PFT) were performed on the patients in the three groups at the baseline (before chemotherapy), 3-4 weeks after the start of chemotherapy and again, after the next3-4 weeks. The tests were done on a computerized spirometer, Medspiror (Med Systems (P) Ltd.Chandigarh), with the patients in a standing posture.

Recording of the PFTs
The relaxed subject in a standing position, were prepared to grip the sterile mouthpiece, as was demonstrated to him/her prior to the recording. When the subject was confident and familiar with the procedure, he/she was asked to perform a maximum inspiration after a deep expiration. The subject was then instructed to expire with maximum effort (maximum expiration).The mouthpiece was then removed and the following spirometric parameters were recorded for analysis.

1. Forced vital capacity (FVC): The maximum volume of air which expired after a maximum inspiration. 2. Forced expiratory volume in first second (FEV1): The fraction of vital capacity which expired during the 1st second of a forced expiration. 3. The FEV1/FVC ratio.

The data was collected, tabulated and analyzed by using the paired t-test for the comparison of the means and by the Chi-square test for the two-by-two tables. A ‘p’ value of 0.05 was takenas the cut off for the measure of significance.

The patients on whom the study was undertaken were on various chemotherapy regimens.


The mean age of the subjects in all the groups was 51.71+9.97 years (range 30 to 70 years).The number of male subjects was 13 and that of the female subjects were 22.

Forced Vital Capacity(FVC)Litres
The value of the FVC was higher in the group I cancer patients (before chemotherapy) in comparison to group II and group III cancer patients (after chemotherapy). The t-value which was calculated by comparing between group I and group II, was found to be 3.99 i.e highly significant. The FVC declined further in group III as compared to group I. The t-value was found to be 6.26, which showed that it was statistically highly significant (p <0.001).

Forced expiratory volume in the first second (FEV1)Litres
The difference in the value of the FEV1 in the group I cancer patients and group II patients was statistically highly significant, while the difference of its value between the group I and group III cancer patients was also statistically highly significant.

The FEV1/FVC ratio
The mean value of FEV1 as a percentage of FVC was found to be almost similar in all the three groups. The mean and standard deviation of FEV1/FVC in group I, group II and group III was 84.32+3.64, 85.67 + 4.48 and 85.11 + 5.15 respectively. The difference whatsoever was statistically at the cut off level of significance (p<0.05).The ratio of FEV1/FVC was more in favour of the restrictive pattern of lung disease.


In the present study, it was seen that the value of the FVC was high in the group I cancer patients (before chemotherapy) in comparison to the group II and group III patients (after chemotherapy). The FVC is a measure of the stroke volume if the lungs and thorax are regarded as a simple air pump. Any reduction in it will affect the ventilatory capacity. The causes of stroke volume reduction include pathologies such as fibrosis in the lung itself, which reduces its distensibility. The usual pulmonary injury with cytotoxic therapy is probably due to progressive pulmonary fibrosis, with relatively little of an inflammatory component and with a tendency to cause irreversible lung damage. Bleomycin and Mitomycin are cytotoxic antibiotics which cause pulmonary fibrosis in up to 5-10% of the patients (2), while the pulmonary toxicity from the combination of Gemcitabine and Paclitaxel is reported to be approximately 5% (3),(4). Several cytotoxic drugs that act by the alkylation of DNA have also been shown to cause alveolitis and pulmonaryfibrosis e.g. Busulphan, Chlorambucil, Cyclophosphamide (5) and Melphalan. These effects have also been seen with Methotrexate and Carmustine.

Similarly, the value of FEV1 was seen to decline significantly in the group II and group III patients, as compared to that in the group I patients. This decline is due to the toxic effects of chemotherapeutic drugs on lung functions. Many studies have shown similar results as those of this study.

The ratio of FEV1/FVC was more in favour of the restrictive pattern of the lung disorders.

We found a similarity in our findings with those of Jensen et al (6) (1990), who suggested that mantle-field irradiation was associated with a primary obstructive and minor restrictive lung function impairment, whereas chemotherapy and combined modality therapy was associated with a restrictive lung function impairment. Also, Nysom et al (7) (1998) who studied acute lymphoblastic leukemia patients, observed slight restrictive pulmonary disease which developed after the intake of chemotherapy.

Pulmonary toxicity is usually irreversible and progressive as a result of the administration of chemotherapy. The initial site of damage seems to be the endothelial cells with an inflammatory type reaction resulting in drug induced pneumonitis (2), (3). Another type of damage occurs as a result of an immunological mechanism, resulting in an allergic type reaction. Either the lung or the drug may act as an antigen in an allergic type reaction. Chronic exposure to chemotherapy causes extensive alteration of the pulmonary parenchyma, with changes in the connective tissue, obliteration of the alveoli and dilatation of the air spaces, which is known as honeycombing. Continuous lung injury and repair result in restrictive lung disease, the increased work of breathing and a functionally reduced lung volume, thus leading to an impaired gas exchange. The chest X-ray may be within normal limits, but it can show a pattern of diffuse interstitial markings. The pulmonary function tests can show a restrictive pattern when pulmonary fibrosis has occurred before the clinical symptoms have appeared.

But few studies have been carried out, which do not show similar results. Ooi et al (8)(2001) found lung function indices including FVC,FEV1,TLC and DLCO, in patients who received chemotherapy, but did not have significant declined lung function indices. According to Dimopoulou et al (9) (2002), after chemotherapy, there were no significant changes in the forced vital capacity (FVC), FEV1,TLC or the alveolar volume.


The present study highlights the observation that most of the spirometric parameters in cancer patients after chemotherapy showed a significant decline. Some drugs may cause direct damage to the lung parenchyma, like Bleomycin, Cyclophosphamide and Nitrofurantoin which can cause the generation of toxic oxygen free radicals. Others may act on the system, whereby the lung matrix repairs itself, interfering with or increasing collagen formation. In some cases, this restrictive type of abnormality is associated with an obstructive pattern as well. In case of intrinsic drug induced lung diseases, the physiological effects of the diffuse parenchymal disorder reduce all the lung volumes, probably by the excessive elastic recoil of the lungs in comparison to the outward recoil of the chestwall. The expiratory airflow is reduced in proportion to the lung volumes. This decline after chemotherapy is probably due to the toxicity of the various chemotherapeutic drugs.


Katzung B. Basic & clinical pharmacology, 7th edition, Appleton & Lange;1998;656.
Marruchella A, Franco C, Garavaldi G, Uccelli M, Bottrighi P. Studied Bleomycin induced upper lobe fibrosis:a case report. Tumori 2002;88:414-6.
Rivera MP, Detterbeck FC, Socinski MA et al. Impact of preoperative chemotherapy on pulmonary function tests in resectable early-stage non-small cell lung cancer. Chest 2009;135:1588-95.
Friedberg JW, Neuberg D, Kim H, Miyata S, McCauley M. Gemcitabine added to doxorubicin, bleomycin and vinblastine for the treatment of de novo Hodgkin disease: unacceptable acute pulmonary toxicity. Cancer 2003;98:978-82.
Segura A, Yuste A, Cercos A, Herranz C. Pulmonary fibrosis induced by cyclophoshamide. Ann Pharmacother 2001;35:894-7.
Jensen BV, Carlsen NL, Groth S, Nissen NI. Late effects on pulmonary function of mantle-field radiation,chemotherapy or combined modality therapy for Hodgkins disease. Eur J Haematol 1990;44:165-71.
Nysom K, Holm K, Hertz H, Hesse B. Risk factors for reduced pulmonary function after malignant lymphoma in childhood. Med Pediatr Oncol 1998;30:240-8.
Ooi GC, Kwong DL and Tsang KW. Pulmonary sequelae of treatment for breast cancer:a prospective study. International Journal of Radiation Oncology, Biology, Physics 2001;50:411-419.
Dimopoulou I, Galani H, Dafni U, Samakovii A, Roussos C, Dimopoulous MA. A prospective study of pulmonary function in patients treated with paclitaxel and carboplatin. Cancer 2002;94:452-8.

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