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

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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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Sanjay Gandhi institute of trauma and orthopedics,
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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.
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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.
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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

Case report
Year : 2012 | Month : April | Volume : 6 | Issue : 2 | Page : 303 - 305

Bilateral Papillo-oedema in a Paediatric Patient with a Cerebro-Renal Disorder

Deepa Muzumdar, Neelam Puthran, Varsha Kulkarni

1. MS, Ophthalmology, Asscociate Professor 2. MS, Ophthalmology, Professor & Head 3. MS, Ophthalmology, Professor Department of Ophthalmology Bharati Vidyapeeth Deemed University Medical College Pune, Maharashtra, India.

Correspondence Address :
Dr. Deepa Muzumdar
F-5 Sankul, Erandawane, Pune - 411004
Phone: 9890294951


A 7-year-old boy, a known case of Polycystic Kidney Disease since birth, presented with an acute onset of headache and blurring of vision, and was discovered to have systemic hypertension of 140/110 mm Hg. Further examination revealed the presence of grade IV hypertensive retinopathy in both the eyes. MRI of the brain revealed diffuse cerebellar and cortical atrophy with a prominent ventricular system, which was indicative of a variant of the Dandy Walker Syndrome. Although there was initial improvement in the vision following the control of the blood pressure, the patient developed bilateral optic atrophy shortly thereafter. This case report highlights the occurrence of papillo-oedema with visual impairment in a cerebro renal disoder and also the importance of ophthalmic screening in paediatric patients.


Polycystic Kidney, Dandy-Walker Variant, Papillo-oedema, Visual impairment

Hypertensive retinopathy is rarely seen in pre-pubertal children who suffer from systemic hypertension. However, in the event of malignant hypertension, children can develop vision threatening ocular complications. This is a case report of visual loss which occurred in a child with the rare combination of Polcystic Kidney Disease, a Dandy – Walker variant and severe systemic hypertension.

Case Report

A 7-year-old boy with Polycystic Kidney Disease (PKD) which was diagnosed in utero, developed a sudden blurring of vision and mild headache. He was found to have severe systemic hypertension and was referred to our institution for the same. The patient was asymptomatic since birth and had normal developmental milestones with a normal IQ. His clinical examination revealed a macrocephaly of 56 cms and a blood pressure of 140/110 mm Hg. His systemic examination showed no other significant findings. His ocular examination revealed a normal head posture, with orthophoria. His ocular movements were normal in all the directions of gaze. His visual acuity was counting fingers at a distance of three metres in each eye, and his colour vision was normal. His pupillary reactions to direct and consensual light were brisk and equal. His anterior segment examination did not reveal any other abnormality. The posterior segment examination of both the eyes revealed Grade 3 papillo-oedema, and an altered A:V ratio with numerous superficial haemorrhages at the posterior pole. Few hard exudates and an early fan formation were noted in the left macular region. Cotton wool spots were conspicuous by their absence (Table/Fig 1) & (Table/Fig 2). A diagnosis of Grade IV hypertensive retinopathy was made. His visual evoked potentials (VEP) showed a delayed latency in P100. Automated perimetry was not done as the child was unable to cooperate. Case Report Opthalmology Section MRI of the brain showed diffuse cortical and cerebellar atrophy, with a prominent Sylvian fissure and enlargement of the ventricular system. There were prominent cystic spaces in the posterior fossa, with hypoplasia of the cerebellar vermis. There were no signs of cerebral oedema in the MRI (Table/Fig 3),(Table/Fig 4) & (Table/Fig 5). The electroencephalogram findings were indicative of a generalized cerebral disorder. The patient’s mother was also discovered to have polycystic kidneys. She was asymptomatic, with a normal blood pressure. The patient was managed with titrated doses of intravenous sodium nitroprusside and oral amlodepin 5mg twice daily. There was a marked improvement in the vision to 6/18 in both eyes by the fourth day after the control of the blood pressure, although the fundus findings remained unchanged. The patient did not report for follow up until three months later. His systemic hypertension remained under control. However, his vision was found to have deteriorated to 6/60 in the right eye and to counting fingers at 3 metres in the left eye. His colour vision for red was also found to be impaired. Fundoscopy revelaed that all the haemorrhages and exudates had cleared, but both the optic discs showed partial optic atrophy changes (Table/Fig 6)&(Table/Fig 7).


Polycystic kidney disease (PKD) is a relatively common hereditary disorder[1, 2]. Although genetic testing could not be done in our case, the presence of PKD in the mother favoured an inherited genetic aetiology. Hypertension is commonly seen in Polycystic Kidney Disease [1, 3], Hypertension does not produce significant fundus changes in paediatric patients (4), but malignant hypertension may show hypertensive retinopathy and/or an ischaemic optic neuropathy [2, 3] Although the occurrence of malignant hypertension with fundus changes may be seen in some cases of pheochromocytoma, paraglioma and other nephropathies [5,6,7], the same has not been reported in polycystic renal disease. Children with malignant hypertension may present with symptoms such as headache, double vision, and blurred vision. Our patient had developed systemic hypertension by the young age of seven years and he presented with headache and blurred vision. He was detected to have grade IV hypertensive retinopathy with grade 3 papillooedema in both the eyes. Papillo-oedema may also occur in patients with the Syndrome Dandy Walker (SDW), which is a rare genetic disorder with a sporadic inheritance (8). The characteristic radiological picture shows hypoplasia of the cerebellar vermis, cystic dilatation of the ventriclular spaces and a posterior fossa cyst (9). The MRI of our patient confirmed the presence of an SDW variant. The clinical features of the syndrome include a moderate delay in the psychomotor development, macrocephaly, hypotonia and ataxia (10). While our patient did have mild macrocephaly, his developmental milestones, intelligence and central nervous system were normal. The predominant symptoms and signs in SDW are generally due to the hydrocephalus and they include seizures, vomiting, abducens nerve palsy and papillo-oedema (10). Other ocular abnormalities are rarely seen and we found only a single report in the literature on multiple ocular malformations in a case of Dandy Walker malformation (8). Other than hypertensive retinopathy, papillo-oedema and vision loss, there were no other ocular findings in our case. Vision impairment is generally not a feature of papillo-oedema, except when it is chronic and after early optic atrophy has set in. This patient did not show any signs of chronic papillo-oedema. Macular oedema could have accounted for the accompanying vision loss, but it was present only in one eye. The presence of bilateral optic nerve ischaemia, as indicated by the studies on the visual evoked potentials (VEP), was likely to have been the result of the combination of both the hypertension induced ischaemic optic neuropathy as well as the Dandy Walker syndrome induced internal hydrocephalus. This could account for the bilateral visual loss. Control of the systemic hypertension has been reported to result in visual improvement; while recurrences of visual loss tend to occur with poor control (11). Repeated attacks are liable to lead to serious blinding complications in children [11,12]. It has recently been suggested that the retinal examination need not be used as a screening tool for the evidence of the target organ damage in children with hypertension (4). However, our case indicated that retinal examination must be included in the screening protocol to save the children from permanent visual loss. In some cases of the Dandy Walker Syndrome, visual improvement had resulted, following the placement of a peritoneal shunt for the hydrocephalus (9). Our patient showed a good initial response to the anti hypertension treatment alone. However, three months later, although there was regression of the retinopathy, the optic nerve was found to have progressed to optic atrophy.


We, therefore, surmise that the combination of the hydrocephalus from the Dandy Walker Syndrome and the grade IV hypertensive retinopathy due to malignant hypertension, which was secondary to the polycystic kidney disorder, together resulted in the bilateral papillo-oedema, while the visual loss was secondary to an ischaemic optic neuropathy. Obvious hypertension and signs of ischaemic damage to the optic nerve should prompt the urgent management of hypertension to prevent permanent visual damage.


Patricia A, Gabow N. Autosomal dominant polycystic kidney disease. Engl J Med 1993; 329:332-42.
Kliegman R, Behhrman R, Jenson HB. Polycystic Kidney Disease. In; Nelson’s Textbook of Peadiatrics (vol 2) 18th edition, New Delhi, Saunder’s Elseiver; 2008;2185-86.
Chapman AB, Stepniakowski K, Rahbari-Oskoui F. Hypertension in autosomal dominant polycystic kidney disease. Adv Chronic Kidney Dis March 2010;17(2):153-63.
Foster BJ, Ali H, Mamber S, Polomeno RC, Mackie AS. The prevalence and severity of hypertensive retinopathy in children. Clin Pediatr (Phila) Nov 2009;48(9):926-30.
Venkatesh P, Garg S.P., Verma L, Tewari. A decreased vision-presenting feature in paraganglioma. Indian Pediatrics 2002; 39:681-84.
Chen TY, Liang CD, Shieh CS, Ko SF, Kao ML. Reversible hypertensive retinopathy in a child with bilateral pheochromocytoma after tumor resection. J Formos Med Assoc 2000; 99: 945-47.
Guyomard JL, Jacob H, Roche O, Pierre-Kahn V, Charlin JF. An atypical case of malignant hypertensive retinopathy in a young child. J Fr Ophtalmol Jan 2004;27(1):57-62.
Ewald O, Scremin F, Busch F, Von Hertwig R. Ocular alterations in a pediatric patient with Dandy-Walker malformations: case report. Arq. Bras. Oftalmol Jan/Feb. 2006;.69 (1): 97-99.
Gluson, Dohnys, Plavner, Ashwal. Dandy Walker Syndrome. In; Paediatric Neurology-Principles and Practice, 4th edition, Philadelphia, Mosby Elseiver;1984;391.
Fenichel GM, ed. Dandy Walker Syndrome. In; Clinical Paediatric Neurology-Signs and Symptoms Approach, 4nd edition, Philadelphia, WB Saunders; 1993; 366.
Logan P, Eustace P, Robinson R. Hypertensive retinopathy: a cause of the decreased visual acuity in children. J Paediatr Ophthalmol Strabismus. Sep–Oct 1992; 29(5):287-89.
Taylor D, Ramsay J, Day S, Dillon M. Infarction of the optic nerve head in children with accelerated hypertension. British Journal of Ophthalmology 1981; 65: 153-60.

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DOI: JCDR/2012/3542:1945


Date of Submission: Aug 22, 2011
Date of peer review: Oct 17, 2011
Date of acceptance: Dec 22, 2011
Date of Publishing: Apr 15, 2012

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