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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
Case report
Full Version
Acute Kidney Injury as an Initial Presentation in Mantle Cell Lymphoma- A Rare Case Report
Correspondence Address :
Dr. Arnav KR Roychoudhury,
Associate Professor, Department of Pathology, Adesh Institute of Medical Sciences and Research, Bathinda-151101, Punjab, India.
E-mail: drarnav2007@gmail.com
Mantle Cell Lymphoma (MCL) is a rare aggressive lymphoid neoplasm accounting for 3-7% of all Non Hodgkin Lymphomas (NHL). Kidney involvement in MCL is rarely reported in biopsies from living patients, being caused by direct lymphoid infiltration. Only 19 cases have been documented of Acute Kidney Injury (AKI) with lymphomatous infiltration. This case report is of a 50-year-old male who presented with AKI and was found to have a MCL infiltrating the kidneys.
Kidney infiltration, Lymphoid neoplasm, Non Hodgkin lymphomas
A 50-year-old male, presented with chief complaints of weight loss and splenomegaly and on clinical examination and investigations, it was diagnosed as chronic lymphocytic leukaemia with rapidly worsening renal function and AKI. There was an increase in creatinine from 1.9 mg/dL to 5.8 mg/dL with proteinuria (0.5 g/L). Urine investigations revealed haematuria with red blood cell count of 40-50/high power field (hpf) and white blood cell count of 0-5/hpf. Blood for t (11;14) by Fluorescence In-situ Hybridisation (FISH) was negative initially but turned out to be positive later in another laboratory and Immunoglobulin Variable Heavy (IgVH) chain gene was found to be hypermutated.
Chest radiograph indicated a widened shadow of the right side of the mediastinum. No previous history of any medical disease or any surgical intervention was recorded. Positron Emission Tomography (PET)/Computed Tomography (CT) showed moderately active B axillary/retroperitoneal/B iliac/mesenteric and inguinal lymph nodes.
The option of aggressive chemoimmunotherapy with Rituximab, Cyclophosphamide, Hydroxidaunorubicin hydrochloride, vincristine (Oncovin) and Prednisolone/Rituximab, Dexamethasone, cytarabine and cisplatin (R-CHOP/R-DHAP) followed by autologous Peripheral Blood Stem Cell Transplantation (PBSCT) and then rituximab maintenance was advised. Rituximab was given in dose of 375 mg/m2 on day prior to initiation of 1st cycle of chemotherapy followed by 500 mg/m2 on day 1 of cycle 2-6 (every 28 days). During treatment, progressive deterioration of renal function was found. At admission, the patient did not report any other ailments. Additional diagnostics revealed signs of progressive multiorgan failure. There was no evidence of Antinuclear Antibody (ANA), Perinuclear Antineutrophil Cytoplasmic Antibodies (p-ANCA) and Cytoplasmic Antineutrophil Cytoplasmic Antibodies (c-ANCA) antibodies. Ultrasound abdomen examination showed enlargement of the kidneys (left kidney length 141 mm, right kidney 134 mm) with signs of parenchymal swelling.
Bone marrow aspiration biopsy was done that revealed hypercellular marrow with suppressed trilineage haematopoesis, lymphocytosis and mild plasmacytosis. Advised to rule out chronic lymphoproliferative disorder. A biopsy of the kidney was done for histopathological evaluation. Renal core biopsies measuring 0.5 cm and 0.3 cm were submitted for Light Microscopic (LM) and Immunoflourescence (IF) studies, respectively. The LM samples were embedded in paraffin, sectioned and stained with Haematoxylin and Eosin (H&E), Periodic Acid-Schiff (PAS), Masson Trichrome (MT) and Periodic Silver Methenamine (PASM) staining. For immunofluorescence, the samples were sectioned at 3 microns using a cryostat and stained with a panel of Fluorescein Isothiocyanate (FITC)-conjugated rabbit antihuman antibodies to Immunoglobulin G (IgG), IgM, IgA, C3C, C1q, Kappa and Lambda light chains. The intensity of immunofluorescence staining was semi-quantitatively scored on a scale of 0 to 4+. Immunophenotyping was performed using immunoperoxidase and avidin-biotin techniques. The follow-up of the patient was done recently with a serum creatinine of 2 mg/dL and normal renal functions.
Microscopic examination: The kidney biopsy showed a core of renal cortical tissue with 11 glomeruli and 2 arteries. The glomeruli were normal in cellularity with no mesangial widening, basement membrane thickening, segmental lesions or crescents. The tubules showed evidence of tubular injury with many being dilated and contained hyaline, granular, red cell and pigment casts. Tubular atrophy was present in 20-25% of the cortical tissue sampled. The interstitium showed moderately dense nodular aggregates of lymphoid cells having a monotonous appearance as shown in (Table/Fig 1),(Table/Fig 2),(Table/Fig 3),(Table/Fig 4). Occasional plasma cells were also present. These features were suspicious of a lymphoma especially in view of the clinical findings.
Immunofluorescence study revealed six glomeruli with minimal, mesangial coarse granular deposits of C1q and C3c along with insignificant deposits of IgG (Table/Fig 5),(Table/Fig 6).
Immunohistochemistry revealed strong cytoplasmic membrane positivity with Cluster of Differentiation 20 (CD20), CD5 and nuclear positivity for cyclin D1 in the infiltrating lymphoid cells. MIB-1 index averaged 30%. Few of the small reactive lymphocytes showed positivity for CD3. CD23 was negative. The morphology and immunoprofile was that of a MCL invading renal parenchyma associated with significant acute tubular injury.
Immediately afterwards chemotherapy was started with R-CHOP regimen. Rituximab infusion was started in the 1st cycle which caused infusion reaction but was well-tolerated in the rest of the cycles. The patient was followed for every 28 days for next cycles.
The Acute Kidney Injury (AKI) is one of the complications of malignancies with very few published cases in literature and is limited to single case reports [1,2]. Various studies have shown a wide range in the incidence of AKI in various cancers ranging from 12-49% (3). AKI with lymphomatous infiltration is extremely rare with only 19 cases being documented in world literature (4). Cancer patients can be immunocompromised due to a plethora of underlying factors, commonest being chemo-radiotherapy leading to impairment of normal leucocyte function. MCL is a rare aggressive lymphoid neoplasm accounting for 3-7% of all NHL (5). Lymphomatous infiltration of the kidney can also cause AKI and a renal biopsy is often adequate for making a diagnosis with the use of appropriate immunohistochemical stains. This immunologic dysregulation leads to sepsis which causes unregulated production of proinflammatory cytokines ultimately causing dysfunctional renal perfusion and irreversibly causing AKI (4),(6).
Da’as N et al., studied in detail the renal involvement and renal manifestations in NHL and chronic lymphocytic leukaemia in 700 patients and showed that only upto 10% of patients with NHL and lymphocytic leukaemia have kidney injury. Since the patterns of glomerular injury are so diverse and heterogenous in patients with lymphomas, it poses a diagnostic challenge to the clinicians. Chronic Lymphocytic Leukaemia (CLL) infiltrates the kidney interstitium in approximately 90% of patients seen at autopsy but clinical kidney disease is very uncommon (7).
MCL is a rare aggressive lymphoid neoplasm occurring in about 3-7% of NHL in United States and Europe and affects males more than females (5),(8). They have a characteristic morphology and distinctive cytogenetic abnormality, t(11;14)(q13;q32) (9),(10). Cell cycle regulator protein cyclin D1 has been found to be overexpressed in around 70% of cases which ultimately leads to dysregulation of the G1-S phase of the normal cell cycle (10),(11). Most commonly diagnosed in their late 60s, the most common sites of extranodal manifestations of MCL are gastrointestinal tract followed by bone marrow, liver, spleen and Waldeyers ring. Most frequent NHL infiltrating kidneys are extranodal marginal zone lymphoma that is MALToma (Mucosa Associated Lymphoid Tissue lymphoma), Diffuse Large B-Cell Lymphoma (DLBCL) and Burkitt’s lymphomas (12). Involvement of the genitourinary tract by lymphoma occurs rarely, its incidence being estimated to be about 5% with renal involvement being most common and occuring in approximately 37% of cases.
MCL typically expresses B-cell antigens such as CD19, CD20, Paired Box Protein 5 (PAX5), CD5, Cyclin D1 B-cell Lymphoma 1 (BCL1), BCL2, CD43 and is negative for CD10 and CD23. Ki-67 is one of the important prognostic indicators and increases in aggressive variants of MCL. Most cases of MCL are moderately to strongly positive for cyclin D1 with rare cases of cyclin D1 negativity. In these cases, SOX11 could be used and is highly specific for MCL (13).
WHO classification has divided MCL into two aggressive variants (12),(14),(15).
a. Blastoid variant which is primarily composed of cells closely resembling lymphocytes with dispersed chromatin and high mitotic rate.
b. Pleomorphic variant which is composed of pleomorphic cells with oval to irregular nuclei with prominent nucleoli and pale cytoplasm.
Da’as N et al., in his pioneering work found that NHL is a rare cause of acute renal failure (9.5%) (7). Also, infiltration of renal parenchyma by lymphoma cells is very rare and is observed in only about 1% of cases. Most often, renal lymphoid infiltration is asymptomatic, but sometimes it may also cause acute tubulointerstitial nephritis. So far, eight cases of kidney impairment due to MCL have been described; four of them presenting with proliferative Glomerulonephritis (GN), one Focal Segmental Glomerulosclerosis (FSGS), two renal MCL infiltration with AKI, and the last, AKI due to acute tubulointerstitial nephritis (7),(16),(17),(18),(19). Also, it has been found that untreated renal infiltration with MCL may be the reason for tubulointerstitial inflammation and AKI (18).
Sepsis has been associated with the development of AKI in malignancies. Lymphomatous infiltration of the kidney can also cause AKI and this case report shows the importance of the renal biopsy as a useful diagnostic tool in case of kidney impairment in such patients. It is felt that identification of these multifactorial predictors and early intervention can help prevent and reduce the severity of AKI. This case is being reported for its rarity and to emphasise the importance of the renal biopsy as an extremely useful diagnostic tool in case of kidney impairment due to a lymphomatous infiltrate.
DOI: 10.7860/JCDR/2022/52693.16374
Date of Submission: Oct 02, 2021
Date of Peer Review: Nov 23, 2021
Date of Acceptance: Mar 19, 2022
Date of Publishing: May 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: Oct 04, 2021
• Manual Googling: Feb 22, 2022
• iThenticate Software: Apr 02, 2022 (18%)
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