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

Users Online : 47280

AbstractCase ReportDiscussionConclusionReferencesDOI and Others
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

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
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."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

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

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
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

Case report
Year : 2023 | Month : March | Volume : 17 | Issue : 3 | Page : OD01 - OD03 Full Version

Autoamputation of Toes in a Renal Transplant Recipient: Warning Sign of an Impending Graft Rejection?

Published: March 1, 2023 | DOI:
V Siva Kesava Reddy, Shubham Nimkar, Mansi Patel, Sourya Acharya

1. Junior Resident, Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India. 2. Junior Resident, Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India. 3. Junior Resident, Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India. 4. Professor, Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India.

Correspondence Address :
Dr. V Siva Kesava Reddy,
Junior Resident III, Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University, Wardha, Maharashtra, India.


The peripheral arterial occlusive disease is responsible for a significant amount of morbidity and mortality in patients of end-stage renal disease. This disease might not be as common as end-stage renal disease in vascular complications arising after renal transplant. The peripheral arterial occlusive disease is responsible for lower limb amputation in chronic kidney disease. It is important to identify the peripheral arterial occlusive disease as it may lead to septicaemia which in turn can result in multiple organ failure and thus can prove to be a potentially fatal complication of renal disease. Here the authors report a case of a 42-year-old female who had undergone a renal transplant four years back. She presented with breathlessness and bilateral pedal oedema along with autoamputation of toes and ultimately had to be taken for haemodialysis. The patient was intrervene for an arteriovenous fistula for haemodialysis in view of graft rejection. Through this brief case report, the authors highlight the importance of a neglected autoamputation which was a missed warning sign of impending renal graft rejection in the present case.


Chronic kidney disease, Haemodialysis, Peripheral vascular disease, Pedal oedema, Septicaemia

Case Report

A 42-year-old female was admitted to the hospital with the complaints of fever which was intermittent and low grade in nature and vomiting since four days. The frequency vomiting was 2-3 episodes per day containing recently ingested food products. She also had a history of decreased urine output for four days and complained of breathlessness on exertion for five days. There was no history of orthopnoea, Haemodialysis nocturnal dyspnoea, cough, cold and fever. No history of chest pain, palpitations. No history of loose stools, pain abdomen, or burning micturition. She also gave a history of non healing lesions on bilateral toes for one year which led to ulceration and gangrene formation. Patient was known hypertensive since seven years on regular antihypertensives and known diabetic on oral hypoglycaemic agents along with injectable insulin regularly. The patient had a past history of pulmonary tuberculosis for which she had taken antitubercular drug therapy for 1.5 years. Patient was a known case of chronic kidney disease on maintenance of haemodialysis for three years. In view of chronic renal failure, the patient underwent left renal transplantation six years back, for which she has been on regular immunosuppressive therapy. She was on cyclosporin 100 mg twice daily, azathioprine 50 mg twice daily and prednisolone 40 mg once a day for last three months. On general examination, patient had a pulse of 68 beats per minute and blood pressure of 160/90 mmHg. She was adequately built with mild puffiness around the eyes. The patient had black crusted lesions on bilateral toes with ulceration of skin and autoamputation of three toes in the right foot and second toe of the left foot and bilateral minimal pedal oedema was also present (Table/Fig 1). Right kidney was measuring about 6.1×2.1 cm with raised echotexture and with loss of corticomedullary differentiation (Table/Fig 2).

An ultrasound abdomen pelvis was done which revealed grade 2 renal parenchymal disease of the transplanted kidney with raised resistive index (Table/Fig 3). The Renal Resistive Index (RRI) of the patient was 0.58. Ankel Brachial Pressure Index (ABPI) was performed and it was noticed that there was no difference in calf blood flow between the ipsilateral (left side) and contralateral leg and patient’s ABPI ankle brachial pressure index was 1.12. On the day of admission, the kidney function tests were deranged which were suggestive of chronic graft rejection (Table/Fig 4).

A permanent tunneled catheter was placed during the course of stay and patient had to be taken up for haemodialysis. Five cycles of haemodialysis were done with multiple blood transfusions in view of low haemoglobin levels. Later a brachiocephalic fistula in the left arm was made in view of further requirement of haemodialysis twice in a week.

In view of autoamputation of three toes in the right foot and second toe in the left foot in both lower limbs, arterial doppler was done and it revealed signs of peripheral artery disease (Table/Fig 5),(Table/Fig 6).

(Table/Fig 5) shows biphasic waveforms, while (Table/Fig 6) shows triphasic waveforms.

There are two distinct waveforms in biphasic waveforms:

1) High resistive with diastolic flow reversal and
2) Low resistive with continuous forward flow during diastole.

There are three distinct waveforms in triphasic waveforms:

1) Systole,
2) Early diastolic flow reversal and
3) A modest forward flow reflecting wave in late diastole.

As the patient was willing only for conservative management, daily betadine dressing was done for both feet. She was hospitalised for 21 days during which, patient was started on immunosuppressive like cyclosporine 100 mg BD, tacrolimus 50 mg BD, prednisolone 40 mg OD orally and tapered gradually. Before discharging her kidney function test was repeated and it was noticed urea and creatinine levels were significantly reduced.

Aggressive diabetic control, low dose steroids, immunosuppressives and other supportive measures with an advise of haemodialysis twice a week and also she was advice to follow-up in General Medicine Outpatient Department (OPD) with fasting blood sugar and post-prandial blood sugar reports after every 3 months and she also advised for betadine dressing after every 15 days so as to prevent the infection of both lower limbs.


Chronic kidney disease is associated with accelerated atherosclerosis and peripheral vascular disease. Renal transplantation is the preferred approach for renal replacement therapy, having been shown to improve quality of life, extend life expectancy and be more cost-effective than continuing dialysis (1),(2). A new endeavour has been made to expand the benefits of transplantation to older patients with additional co-morbidities. Despite a presumed higher risk of complications, current data suggests that results in these patients remain positive (3). However, because there are no commonly accepted rules for selecting transplant candidates, it is uncertain when the dangers outweigh the benefits. When considering an older patient for transplantation, one of the concerns is Peripheral Vascular Disease (PVD), which affects approximately 25% of patients with end-stage renal disease (4).

In addition to a clusterin of common risk factors, patients on dialysis often suffer from hyperphosphataemia and hypercalcaemia, predisposing them to vascular calcification (5). Chang et al., in their study of bypass surgery for limb salvage, remarked that the presence of renal failure implies calcific arteriopathy, decreased resistance to infection, impaired wound healing, host-factor deficiencies, low albumin, uraemia and immunosuppression, each of which adversely influences rehabilitation and survival (6). Major risk factors for this disease in end-stage renal disease are still not understood properly but probably includes uraemia associated risk factors (7). The peripheral arterial disease is common amongst end-stage renal disease patients (8). Even if diabetes mellitus is not taken into account the prevalence of peripheral arterial occlusive disease in end-stage renal disease patients is approximately 10 times that in general population (9). Patients with peripheral artery disease have shown to have higher rate of renal graft rejection postoperatively (10). ABPI is a simple and direct, non invasive and low-cost method of diagnosing lower limb arterial insufficiency (11). Systolic pressure is higher at the ankles in healthy people, with a normal ABPI range of 1.0-1.2 in the supine position (12). This is because the downstream vascular beds differ (13). The ABPI of patients with intermittent claudication ranges between 0.5 and 0.8.

Ankel brachial pressure index indicated that there was no significant difference in calf blood flow between the ipsilateral and contralateral leg to transplantation. The patients ankle brachial pressure index was 0.7. A resting ABPI of 0.9 is considered abnormal by Scottish guidelines (14), and various clinical trials have shown that a cut-off value of 0.9 is highly sensitive and specificity of angiography proven illness (15). RRI is defined as the ratio of the difference between maximum and minimum (end-diastolic) flow velocity to maximum flow velocity computed from doppler measurements of the principal renal and intrarenal (segmental/interlobar) arteries. Normal RRI levels in people range from 0.47-0.70, with a 5-8% difference between two kidneys. Diabetes has an impact on both the micro and macro vasculature, RRI on the other hand, offers predictive information for both micro and macroangiopathy. RRI is thus measured by doppler ultrasonography in diabetic patients (16). Regular and early screening for peripheral vascular disease and diabetes mellitus can detect and prevent renal graft rejection in renal transplant recipients.


Peripheral vascular disease can predict a poor outcome of renal transplant and indicate an impending renal graft rejection which was neglected and not reported by the patient in the present case until late stage, which led to autoamputation of toes in both feet. Regular screening through ankle brachial index is advised for peripheral vascular disease for prompt detection of renal graft rejection. So, regular screening for peripheral vascular disease can detect and prevent renal graft rejection in renal transplant recipients.


Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999; 341(23): 1725-30. [crossref] [PubMed]
de Wit GA, Ramsteijn PG, de Charro FT. Economic evaluation of end stage renal disease treatment. Health Policy 1998; 44(3): 215-32. [crossref] [PubMed]
Eufrásio P, Moreira P, Parada B, Nunes P, Figueiredo A, Alves R .et al. Renal transplantation in recipients over 65 years old. Transplant Proc. 2011; 43(1): 117-19. [crossref] [PubMed]
Rajagopalan S, Dellegrottaglie S, Furniss AL, Gillespie BW, Satayathum S, Lameire N. et al. Peripheral arterial disease in patients with end-stage renal disease: observations from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Circulation 2006; 114(18): 1914-22. [crossref] [PubMed]
Combe C, Albert JM, Bragg-Gresham JL, Andreucci VE, Disney A, Fukuhara S. et al. The burden of amputation among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2009; 54(4): 680-92. [crossref] [PubMed]
Chang BB, Paty PSK, Shah DM, Kaufman JL, Leather RP. Results of the infrainguinal bypass for limb salvage in patients with end-stage renal disease. Surgery. 1990; 108(4): 742-47.
7.Alexander P, Aitken E, Mansouri D, Kingsmore D. The Impact of Renal Transplantation on Lower Limb Perfusion. Int J Transplant Res Med. 2015;1:013. [crossref]
Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY. et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipientsof a first cadaveric transplant. N Engl J Med. 1999;341(23):1725-30. [crossref] [PubMed]
De Wit GA, Ramsteijn PG, de Charro FT Economic evaluation of end stage renal diseasetreatment. Health Policy. 1998;44(3):215-32. [crossref] [PubMed]
Fleming LW, Stewart CP, Henderson IS, Jain AS. Limb amputation on renal replacement therapy. Prosthet Orthot Int. 2000;24(1):7-12. doi: 10.1080/03093640008726516. PMID: 10855433. [crossref] [PubMed]
Nam SC, Han SH, Lim SH, Hong YS, Won JH, Bae JI. et al. Factors affecting the validity of ankle-brachial index in the diagnosis of peripheral arterial obstructive disease. Angiology. 2010; 61(4): 392-96. [crossref] [PubMed]
Caruana MF, Bradbury AW, Adam DJ The validity, reliability, reproducibility and extended utility of ankle to brachial pressure index in current vascular surgical practice. Eur J Vasc Endovasc Surg . 2005; 29(5): 443-51. [crossref] [PubMed]
Al-Qaisi M, Nott DM, King DH, Kaddoura S . Ankle brachial pressure index (ABPI): An update for practitioners. Vasc Health Risk Manag. 2009; 5: 833- 41 [crossref] [PubMed]
Hainsworth T. Guidelines on the management of peripheral arterial disease. Nurs Times . 2006;102: 23-24.
Fowkes FG. The measurement of atherosclerotic peripheral arterial disease in epidemiological surveys. Int J Epidemiol. 1988; 17(2): 248-54 [crossref] [PubMed]
Lubas A, Kade G, Niemczyk S. Renal resistive index as a marker of vascular damage in cardiovascular diseases. Int Urol Nephrol 2014;46(2):395-02. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/60980.17518

Date of Submission: Oct 21, 2022
Date of Peer Review: Nov 18, 2022
Date of Acceptance: Dec 26, 2022
Date of Publishing: Mar 01, 2023

• 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 X-checker: Oct 22, 2022
• Manual Googling: Nov 29, 2022
• iThenticate Software: Dec 22, 2022 (9%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • 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
  • Google
  • Popline (reproductive health literature)