Article in PDF
How to Cite
Citation Manager
Readers' Comments (0)
Audio Visual Article Statistics
Link
to PUBMED
Print this Article
Send to a Friend
Advertisers
Access Statistics Resources
Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Evaluation of Urinary Calcium, Creatinine and their Ratio in Preeclampsia: A Case-control Study
Correspondence Address :
Monika Rathee,
World Medical College, Jhajjar, Haryana, India.
E-mail: monikarathee786@gmail.com
Introduction: Preeclampsia is a hypertensive disorder characterised by high blood pressure during pregnancy. It is the major cause of maternal and perinatal morbidity and mortality in females. Prediction of Pregnancy Induced Hypertension (PIH) can be done by using a valuable marker i.e. Urinary Calcium-Creatinine ratio (UCa/Cr).
Aim: To evaluate the urinary calcium, creatinine and UCa/Cr ratio in patients with preeclampsia and also to check the association of UCa/Cr ratio with the severity of the disease.
Materials and Methods: The present case-control study was conducted in the Department of Biochemistry in collaboration with department of Obsteritics and Gynecology, Maharishi Markandeshwar University, Ambala, Haryana from January 2018 to January 2021. Total of 120 pregnant women with gestational age ≥20 weeks (60 normal and 60 preeclampsia) were evaluated for urinary calcium, urinary creatinine and UCa/Cr ratio. For statistical analysis, Unpaired t-test and Chi-square test and was applied.
Results: The mean age of control group was 27.51±5.05 years and for case group was 29.8±5.49 years. The level of urinary calcium and urinary creatinine was found to be significantly (p-value<0.001) lower in case group (3.54 mg/dL and 42.90 mg/dL respectively) as compared to control group (8.22 mg/dL and 80.40 mg/dL respectively). The level of UCa/Cr ratio was also significantly (p-value <0.001) lower in case group (0.08±0.04) than control group (0.11±0.04) (p<0.001).
Conclusion: UCa/Cr ratio was significantly decreased in preeclampsia compared to normal pregnancy. UCa/Cr ratio in spot urine can be useful in identifying pregnant women at risk for preeclampsia.
Gestation, High blood pressure, Hypertension, Maternal morbidity, Pregnancy
Preeclampsia is most common hypertensive disorder accounting for approximately 2-10% of the total gestations (1),(2). PIH is a major cause of maternal and perinatal morbidity and mortality in females (3). About 5-7 % of the pregnancies are affected by preeclampsia and hypertensive disorders (4). Prediction of preeclampsia in patients extremely essential to save mother and foetal life so that early detection and timely intervention and treatment will prevent the occurrence of complications of PIH (5),(6). The pathophysiology behind pre-eclampsia is decreased perfusion of organs due to vasospasm. It is usually associated with oedema or proteinuria or both. The mechanism is unknown till now that how pregnancy initiates or aggravates hypertension. It is one of the most significant unsolved problems in Obstetrics. This is the disorder of widespread vascular endothelial malfunction and vasospasm which occurs after 20 weeks of gestation and presents till 4-6 weeks postpartum (7).
Prediction of PIH can be done by using UCa/Cr (8). In normal pregnancy, there is increase in glomerular filtration rate which results in increasing of creatinine clearance and calcium excretion in urine. But in women developing Pulmonary Embolisms (PE) because of vasospasm and decrease of renal flow, creatinine clearance decreases, followed by increase in serum creatinine level (9).
The conditions like eclampsia, preeclampsia and gestational hypertension are mostly preventable (10). This has led to the screening of the deliberate examination of substantial segments of the population in search for the disease at its earlier stages, is a logical extension of the role of preventive medicine (11). The pregnant women who are at risk for preeclampsia can be identified by proposing various methods. Renal function changes in preeclampsia indicate that some of the changes are present before the clinical diagnosis of preeclampsia. The association of microalbuminuria and hypocalciuria with preeclampsia as early as 24 weeks is one of the changes (12).
Various predictors like roll-over test, second trimester mean arterial pressure test, serum uric acid test, angiotensinogen sensitivity test, isometric test have been used for prediction of gestational hypertension. But because of their complexity in result interpretation or high incidence of false positivity these are not proved ideal (7). It has been found that decreased urinary excretion of calcium and creatinine may be considered as a useful tool for the early diagnosis of pre-eclampsia (7). When used as a single test, the UCa/Cr ratio is a better predictor of preeclampsia than the urinary microalbuminuria concentration (13). In spite of great advances in Obstetrics, this disorder is very much common in India.
Punthumapol C and Kittichotpanich B in their study found increased serum uric acid levels which were independently and significantly associated with severity of preeclampsia (14). Hawkins TLA et al., studied that the influence of the uric acid levels has major adverse effects on maternal and particularly in foetal. They depicted that, hyperuricaemia remains important finding as it identifies women at increased risk of adverse outcomes and even in women with gestational hypertension without any other feature of preeclampsia (15).
Therefore, the study aimed to determine the relationship between hypocalciuria, preeclampsia, and calcium to creatinine ratio for early detection of preeclampsia in a random urine sample which may be an effective tool and it may identify population of greatest risk to be included in primary prevention programmes.
The present case-control study was conducted in the Department of Biochemistry in collaboration with Department of Obstetrics and Gynaecology, Maharishi Markandeshwar University, Ambala, Haryana, India, from January 2018 to January 2021. Ethical clearance was taken from Institutional Ethics Committee (No. 1619). Consent forms were obtained from every participant after explaining the study purpose.
Inclusion and exclusion criteria were selected according to the previous study done by Vasava S et al., (16).
Inclusion criteria: Pregnant women at 20 or more weeks of gestation with Systolic Blood Pressure (SBP) ≥140 mmHg or Diastolic Blood Pressure (DBP) ≥90 mmHg (16) along with proteinuria- (>5g/24 hour), impaired liver function, singleton primigravida, thrombocytopenia, pulmonary oedema, oliguria- <500 mL/24 hour was included as cases (17). Normotensive pregnant women with gestational age ≥20 weeks and without proteinuria, oliguria was included.
Exclusion criteria: The subjects with history of rheumatoid arthritis, renal disorder, cardiovascular disease / gestational diabetes mellitus, smoking, multiple pregnancy, stroke, any vaginal bleeding, anaemia, chronic hypertension or with any recent or present fever or infectious disease and who are not willing to participate are excluded from the study.
Sample size calculation: The sample size of 120 was calculated at power of 80% at 95% of confidence.
Total 120 subjects were divided into 2 groups:
Group 1 (case group): 60 pregnant women with preeclampsia were included in group 1, which was further divided according to the severity of preeclampsia into-
• Group 1.1 (Mild preeclampsia) having SBP 140-149 and DBP 90-99 mmHg,
• Group 1.2 (Moderate preeclampsia): SBP 150-159 and DBP 100-109 mmHg and
• Group 1.3 (Severe preeclampsia): SBP ≥160 and DBP ≥110 mmHg (16). Each divided group includes 20 pregnant women.
Group 2 (control group): 60 normal pregnant women with normal blood pressure were considered as controls.
Procedure
Urine sample (5 mL) was collected in sterile urine container. All the samples were analysed on fully auto analyzer (Mindray). Urinary calcium was evaluated by Modified Arsenaso method and urinary creatinine by Modified Jaffe’s Kinetic method.
Biological reference interval: A normal biological reference value for urinary calcium is 0.8-30 mg/dL, for urinary creatinine is 28-259 mg/dL and for urinary calcium creatinine ratio is less than 0.14 mg/dL. If value of UCa/Cr ratio is more than 0.20, it is the indication of hypercalciuria (18).
Statistical Analysis
The Statistical Package for Social Sciences software (SPSS) version 27.0 is used for statistical analysis. Unpaired t-test and Chi-square test was applied to statistically analyse the data. A p-value<0.05 was considered to be significant.
In the present study the mean age of control group is 27.51± 5.05 and for case group is 29.8± 5.49. The mean systolic blood pressure for control group and case group was 127.33±12.74 and 155.16±13.81 respectively while diastolic blood pressure was 80.33±6.88 for control group and 104.33±13.45 for case group (Table/Fig 1).
Case group had significantly lower (3.54±1.97) urinary calcium level than control group (8.22±2.43) (p-value <0.0001). While, urinary creatinine level was significantly lower in cases (80.40±19.32) as compared to controls (42.90±14.94) (p-value <0.0001). Case group had significantly lower U Ca/Cr ratio (0.08±0.04) than control group (0.11±0.04)(p<0.0001) (Table/Fig 2).
In mild group, 2 (10%) females were with urinary creatinine less than equal to 28 mg/dL, 18 (90%) females were in the range 28 to 259 mg/dL. In moderate group, 3 (15%) females were with urinary creatinine less than 28 mg/dL, 17 (85%) females were in the range 28 to 259 mg/dL. In severe group, 2 (10%) females were with urinary creatinine less than 28 mg/dL, 18 (90%) females were in the range 28 to 259 mg/dL. But this difference was statistically non significant (p-value=0.851) in preeclampsia cases (Table/Fig 3).
In groups mild, moderate and severe mean value of urinary calcium was 3.88±2.156 mg/dL, 3.35±1.984mg/dL and 3.39±1.80mg/dL (p-value=0.647) respectively and mean value of urinary creatinine was 44.17±15.391mg/dL, 42.99±15.919mg/dL and 41.54±14.10mg/dL (p-value=0.86) respectively (Table/Fig 4).
Preeclampsia is a condition, which cannot be ascribed by any single cause. Insufficient invasion by trophoblast cells in uterine wall can lead to development of a disease in early pregnancy. To explain the pathophysiology of disease there is no scientific evidence (19). Various studies concluded that calcium homoeostasis is an important part of foetal and maternal physiology during gestation (20),(21),(22). For the production of endothelial derived releasing factor, a certain calcium level is required which maintains vasodilatation in normal pregnancy. Modification of calcium metabolism has been indicated in pathogenesis of hypertension during pregnancy.
In present study, case group had significantly lower urinary calcium and urinary creatinine level than control group (p-value <0.001). The mean and SD of UCa/Cr was 0.08±0.04 in case group and 0.11±0.04 in control group. Patients in case group had statistically significantly lower UCa/Cr ratio than control group (p-value <0.001). In mild, moderate and severe mean value of urinary calcium was 3.88±2.165mg/dL, 3.35±1.984mg/dL and 3.39±1.80 mg/dL (p-value >0.05 mg/dL) respectively. In mild, moderate and severe mean value of urinary creatinine was 44.17±15.391 mg/dL, 42.99±15.919 mg/dL and 41.54±14.10 mg/dL (p-value >0.05 mg/dL) respectively.
Results of the present study corresponds with the result of studies done by Gaurang K et al., (24), Taufield PA et al., (mean urinary calcium concentration was 313±140 mg/24 hour in normal pregnant women and 42±29 mg/24 hour in preeclamptic women) (25), Segovia BL et al., (26), Ingec M et al., (29), Kazemi AFN et al., (9), Sirohiwal D et al., (30), Donovan A et al., (31), Dasgupta M et al., (32), Sheela CN et al., (33). Comparison of urinary calcium in preeclamptic patients with the normal pregnant women with previous studies is presented in (Table/Fig 5).
In the results of present study, there is decrease of urinary creatinine in case group but the studies done by Mittal S et al., (23), Kazemi AFN et al., (9) and Moni SY et al., (34) showed increase in urinary creatinine in preeclamptic patients (Table/Fig 6).
Kazemi AFN et al., (9) found significantly lower UCa/Cr ratio i.e. for normal pregnant women 0.155±0.084 mg/dL and for preeclamptic is 0.106±0.077 mg/dL (p-value <0.007). Izumi A et al., found a limited value of calcium creatinine ratio in prediction of preeclampsia (35) (Table/Fig 7).
The present study calculated the predictive value of calcium creatinine ratio. Preeclampsia and gestational hypertension is the significant causes of both foetal and maternal morbidity and mortality.
Limitation(s)
The present study was conducted on a small sample size so, to validate these findings further studies should be done on large sample sizes.
Present study, concluded that UCa/Cr ratio,urinary calcium and urinary creatinine excretion was significantly decreased in preeclamptic than normotensive pregnant women. For the early diagnosis of preeclampsia, UCa/Cr ratio in spot urine and a single random UCa/Cr may be an effective tool and it may identify population of greatest risk. Therefore, to significantly reduce the mortality and morbidity in patients of preeclampsia, early therapeutic use of calcium may be advised. For future recommendations, UCa/Cr can be studied among high risk factors (diabetes, renal disease, autoimmune disorder etc.) to measure the chances of developing preeclampsia.
I would like to acknowledge and give special thanks to my guide (Dr. Sunita Manhas) who made this work possible. I would also want to thanks to Dr. Monika for helping me in technical work and every stage of work.
DOI: 10.7860/JCDR/2022/57665.16858
Date of Submission: May 11, 2022
Date of Peer Review: Jun 08, 2022
Date of Acceptance: Aug 04, 2022
Date of Publishing: Sep 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: No
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 27, 2022
• Manual Googling: Aug 05, 2022
• iThenticate Software: Aug 15, 2022 (19%)
ETYMOLOGY: Author Origin
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com