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

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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 Academy of Higher Education and Research , Kolar, Karnataka
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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,
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On Aug 2018




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"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.
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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)
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

Important Notice

Images in Medicine
Year : 2022 | Month : January | Volume : 16 | Issue : 1 | Page : TJ01 - TJ03 Full Version

Pictorial Essay of Named CT Signs in COVID-19 Pneumonia on High Resolution Computed Tomography


Published: January 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/52201.15897
Chandrashekar Patil, Raja Kollu, KS Prashanth Kumar, Smitha Yesumalini Ravula

1. Consultant Radiologist, Department of Radiology, Malla Reddy Medical College for Women, Hyderabad, Telangana, India. 2. Consultant Radiologist, Department of Radiology, Malla Reddy Medical College for Women, Hyderabad, Telangana, India. 3. Consultant Radiologist, Department of Radiology, Malla Reddy Medical College for Women, Hyderabad, Telangana, India. 4. Resident, Department of Radiology, Malla Reddy Medical College for Women, Hyderabad, Telangana, India.

Correspondence Address :
Smitha Yesumalini Ravula,
4-1-11/A/2, Sri Sai Gurudatta Apartments, Flat No. 203, Tilak Road, Boggulkunta, Hyderabad, Telangana, India.
E-mail: ravulasmitha22@gmail.com

Keywords

Computed tomography halo sign, Coronavirus disease-2019, Melting sugar sign, Target sign, Vascular tree-in bud

In December 2019, there was an outbreak of Severe Acute Respiratory Syndrome (SARS) cases in Wuhan, Hubei Province, China which was caused by a novel Coronavirus (nCoV). Due to its high homology (~80%) to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the novel coronavirus has been referred initially as 2019-nCoV and later as SARS-CoV-2. The disease where upon spread worldwide rapidly and on 11th March 2020 it was declared a pandemic by the World Health Organisation (WHO) (1).

The gold standard test to diagnose COVID-19 is real-time Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR). Although imaging is not considered as a primary tool to diagnose COVID-19, but it’s been routinely used to screen patients to assess the extent of lung parenchyma involved and to know the progression of disease (2). On High Resolution Computed Tomography (HRCT) COVID-19 pneumonia imaging features can be classified as classical and atypical. Classical features include peripheral ground glass opacities, with or without consolidation, crazy paving pattern, reverse halo sign and the atypical features not commonly but sometimes seen are less specific and include central distribution of ground glass opacities, nodules, tree in bud appearance, cavities (3).

When searching the internet for studies of CT imaging signs in COVID-19 published in English using PubMed and Google scholar computerised databases, we discovered the following signs in separate journal articles and were unable to find all of the signs collectively in one article. However, we found one article that mentioned a few of the named signs but did not include the “target sign, vascular tree-in bud sign and the melting sugar sign.”

During the second wave of COVID-19 pneumonia, authors have noticed few frequently seen yet non specific signs, which are described below.

1. Crazy Paving Pattern

Ground-glass opacity with a superimposed reticular pattern, giving the appearance of interlobular septal thickening which has the appearance of irregularly arranged pavement tiles (Table/Fig 1). This pattern was first noticed in patients with Pulmonary Alveolar Proteinosis (PAP) and is very characteristic of PAP, but it can also be seen in patients with acute lung diseases such as pneumocystis or viral pneumonia, acute eosinophilic pneumonia, Organising Pneumonia (OP), nocardia infection, oedema, haemorrhage, diffuse infiltrative lung disease and acute lung injury (4).

2. Reverse Halo Sign

Reverse halo sign, also known as the Atoll sign, because of its resemblance to a coral reef. On CT, the reverse halo sign can be seen as a central area of ground glass opacity with a surrounding complete or crescentic ring of consolidation (Table/Fig 2) (5).

This pattern has been identified in a multitude of COVID-19 cases. It’s attributed to the advancement of the disease. The reverse halo sign was considered to be distinct to OP, but it can be seen in a variety of pathologies like polymyositis dermatomyositis, chronic eosinophilic pneumonia, drug induced reactions due to usage of amiodarone, bleomycin, buslphan, gold, interferon and methotretxate. Pulmonary infarction being the most important differential diagnosis among non infectious processes (6),(7).

3. CT Halo Sign

A halo of ground-glass opacity surrounding a nodule or mass (Table/Fig 3). It is a non specific sign seen in conditions like invasive aspergillosis (representing haemorrhage), mucormycosis, candida, pseudomonas, herpes simplex virus, and cytomegalovirus infections, other causes, such as Wegener granulomatosis, haemorrhagic metastasis, kaposi sarcoma and neoplasms (adenocarcinoma, bronchioalveolar carcinoma) (8).

4. Target Sign

Target sign is described as a central nodular opacity with surrounding ring-like opacity. Central nodular opacity depicts perivascular inflammation or focal enlargement of the pulmonary artery (Table/Fig 4) (9).

The pathogenesis of this sign is believed due to the distinctive vascular features of COVID-19, characterised by endothelial injury leading to disruption of cell membranes, widespread thrombosis with microangiopathy, and angiocentric inflammation (10).

5. Vascular Tree-in Bud Sign

Is a pulmonary vascular abnormality causing pulmonary thrombosis due to hypercoaguability and lack of fibrinolysis that enhances the peripheral pulmonary vessels on CT imaging and can be detected by the presence of peripheral tortuous and dilated vessels with irregular branching pattern (Table/Fig 5) and acts as a marker of thrombotic vasculopathy with angiogenesis and microthrombosis. In a study done by Patel BV et al., the presence of this sign in in-patients reported poor prognosis (11).

6. Melting Sugar Sign

On serial imaging in COVID-19 patients the consolidation area of the lung begins to absorb, reducing its density and gradually becoming a ground glass opacity, like “melted sugar or tinted sign” marked decrease in the attenuation of GGO, with a slightly increased extension of the GGO which suggest alveolar expansion (Table/Fig 6)a,b (12).

7. Dandelion Sign

It is characterised by the presence of patchy round ground glass opacity with prominent pulmonary vasculature (Table/Fig 7) and interlobular septal thickening due to increased vascular permeability caused the action of inflammatory mediators (13).

8. Feather Sign

It is identified by the presence of irregular stripe of ground glassing with pulmonary vascular thickening (Table/Fig 8) owing to increased vascular permeability leading to dilatation of pulmonary capillaries and thereby causing pulmonary vascular thickening. In a study by Jin J et al., reported feather sign and dandelion sign to be typical imaging features of vasculopathy seen in COVID-19 pneumonia (14).

Few of the other named CT signs in literature include pomegranate sign and rime sign although these signs were not identified in our institute but the imaging features have been described below.

1. Pomegranate sign: It is characterised by increased range of GGO and the significant thickening of the interlobular septum, complicated with a small amount of punctate alveolar haemorrhage. It is an exudative lesion accompanied by tiny amount of bleeding, showing round and imbricates arrangement similar to a pomegranate.

2. Rime sign: Defined as multiple exudative and punctate haemorrhages in the lesion accompanied with extensive interstitial fibrosis forming large white lung, similar to white rime attached to the branches. On CT imaging diffuse GGO, vascular thickening, interlobular septal thickening, showing “rime sign” is seen in lungs (15).

These are some of the most commonly observed CT imaging findings in COVID-19 pneumonia cases at our institute. We wanted to illustrate and interpret some of the named signs to familiarise the named signs and their differential diagnosis. Though imaging findings in COVID-19 pneumonia revealed a wide spectrum, indicating a significant overlap with various infectious and non infectious aetiologies, with an exception of the feather sign, vascular tree in bud and dandelion sign which are typical imaging findings in COVID-19. However, the other signs are not pathognomonic to COVID-19, they are still commonly seen.

References

1.
Ksiazek TG, Erdman D, Goldsmith CS, Zaki SR, Peret T, Emery S, et al. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med. 2003;20:1953-66. [crossref] [PubMed]
2.
Zhao W, Zhong Z, Xie X, Yu Q, Liu J. Relation between chest CT findings and clinical conditions of coronavirus disease (COVID-19) pneumonia: A multicenter study. American Journal of Roentgenology. 2020;5:1072-77. [crossref] [PubMed]
3.
Simpson S, Kay FU, Abbara S, Bhalla S, Chung JH, Chung M, et al. Radiological society of north America expert consensus document on reporting chest CT findings related to COVID-19: Endorsed by the society of thoracic Radiology, the American college of Radiology, and RSNA. Radiology: Cardiothoracic Imaging. 2020;2(2):e200152. [crossref] [PubMed]
4.
Webb WR, Higgins CB. Thoracic imaging: Pulmonary and cardiovascular radiology, 3rd edition Lippincott Williams & Wilkins; 2016:1142, 1722-31.
5.
Elicker BM, Webb WR. Fundamentals of high-resolution lung CT: Common findings, common patterns, common diseases and differential diagnosis. Lippincott Williams & Wilkins; 2013:66-67. [crossref]
6.
ZareMehrjardi M, Kahkouee S, Pourabdollah M. Radio-pathological correlation of organizing pneumonia (OP): A pictorial review. Br J Radiol. 2017;90(1071):20160723. [crossref] [PubMed]
7.
Marchiori E, Zanetti G, Meirelles GS, Escuissato DL, Souza Jr AS, Hochhegger B. The reversed halo sign on high-resolution CT in infectious and noninfectious pulmonary diseases. American Journal of Roentgenology. 2011;1:69-75. [crossref] [PubMed]
8.
Webb WR, Higgins CB. Thoracic imaging: Pulmonary and Cardiovascular radiology, 3rd edition Lippincott Williams & Wilkins; 2016:965-67.
9.
Müller C, Müller NL. Sinal do alvona TC de tóraxem um casal com pneumonia por COVID-19. Radiologia Brasileira. 2020;4:252-54. [crossref] [PubMed]
10.
Ackermann M, Verleden SE, Kuehnel M, Haverich A, Welte T, Laenger F, et al. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in COVID-19. N Engl J Med. 2020;2:120-28. [crossref] [PubMed]
11.
Patel BV, Arachchillage DJ, Ridge CA, Bianchi P, Doyle JF, Garfield B, et al. Pulmonary angiopathy in severe COVID-19: Physiologic, imaging, and hematologic observations. Am J Respir Crit Care Med. 2020;5:690-99. [crossref] [PubMed]
12.
Han X, Fan Y, Alwalid O, Li N, Jia X, Yuan M, et al. Six-month follow-up chest CT findings after severe COVID-19 pneumonia. Radiology. 2021;1:E177-86. [crossref] [PubMed]
13.
Fu X, Li J, Huang Z, Xu Z, Yao W, Cui Y, Ouyang K, Liu H. Dandelion clock-like sign on CT for diagnose of COVID-19. Nan fang yi ke da xue xue bao. 2020;2:159-63.
14.
Jin J, Gao DH, Mo X, Tan SP, Kou ZX, Chen YB, et al. Analysis of 4 imaging features in patients with COVID-19. BMC Medical Imaging. 2020;1:01-07. [crossref] [PubMed]
15.
Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J. Fleischner society: Glossary of terms for thoracic imaging. Radiology. 2008;3:697-722. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/52201.15897

Date of Submission: Sep 04, 2021
Date of Peer Review: Nov 10, 2021
Date of Acceptance: Dec 02, 2021
Date of Publishing: Jan 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Sep 06, 2021
• Manual Googling: Sep 06, 2021
• iThenticate Software: Dec 01, 2021 (20%)

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