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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
Rare Case of Bladder Endometriosis in a Post-hysterectomy Patient
Correspondence Address :
Rajasi Kane Sengupta,
Ravinagar Square, Amravati Road, Nagpur-440033, Maharashtra, India.
E-mail: rajasisengupta@gmail.com
Bladder endometriosis, a rare but well-known condition with a high risk of morbidity, affects the bladder. A 43-year-old woman presented with a history of recurrent cyclical discomfort during urination. The patient had undergone a non descent vaginal hysterectomy to address the same symptom. Upon examination, a nodule was discovered between the bladder and vaginal vault. The diagnosis of bladder endometriosis was confirmed through cystoscopy and an Magnetic Resonance Imaging (MRI). The nodule was removed via transurethal resection, and histology confirmed it as endometriosis. After 12 months of follow-up, the patient’s postoperative symptoms had completely resolved. Hormonal therapy was initiated, and there were no residual urinary symptoms, chronic pain, or cyclical pain. Women reporting urinary symptoms, particularly those with a history of pelvic surgery, should undergo evaluation for bladder endometriosis. The diagnosis of bladder endometriosis should be considered in women experiencing dysuria and bladder discomfort. A high index of suspicion is required to establish the diagnosis.
Bladder nodule, Cystoscopy, Urinary symptoms
A 43-year-old Para 2 Living 2 (P2L2) presented to the Outpatient Department (OPD) with complaints of recurrent cyclical pain during urination for almost five years. The patient did not have a history of blood in her urine or abdominal pain. Five years ago, patient underwent a non descent vaginal hysterectomy to relieve pelvic pain. However, the pain became cyclical and gradually increased over time. The history and general examination were otherwise unremarkable. On per speculum examination, a cervical stump and a nodule protruding into the vagina, anterior to the stump, measuring 2-3 cm in size, were observed. Per vaginum examination revealed that the nodule had a firm to hard consistency and originated between the bladder and the vaginal vault. It was fixed to the vaginal mucosa and had an irregular outline. The cervical stump felt adherent to the anterior vaginal wall. The urine report indicated the presence of only a few pus cells upon microscopy, and after a culture was performed, E.coli was found. The antibiotic sensitivity report determined the appropriate antibiotics for treatment. Ultrasonography showed a 2-3 cm mass behind the bladder in the region of the vault (Table/Fig 1).
Cystoscopy revealed a 2-3 cm mass in the trigonal area that extended into the bladder. The bladder mucosa above the mass was intact. Pelvic MRI confirmed bladder wall endometriosis and residual cervical stump. Both ovaries appeared unremarkable. With proper informed risk consent, transurethal resection of the mass was performed. Both ureteral openings were identified and found to be normal and patent. The rest of the urinary bladder was unremarkable (Table/Fig 2),(Table/Fig 3),(Table/Fig 4),(Table/Fig 5),(Table/Fig 6).
Histopathology of the shavings revealed bladder endometriosis (Table/Fig 7). The patient had a comfortable postoperative period with mild haematuria for 24 hours, which subsided with intravenous infusion of 1 gm Tranexamic acid. Antibiotics were continued until the third day after the operation, as per the urine culture sensitivity report.
Postoperatively, the patient was started on subcutaneous injections of 3.6 mg Leuprolide acetate every 28 days for three cycles and oral Dienogest 2 mg twice daily for three months. At 3, 6, and 12 months of follow-up, the patient experienced complete remission of symptoms. Follow-up showed no mass and a normal outline of the bladder. The patient had no residual urinary symptoms and no chronic or cyclical pelvic pain.
Endometriosis is known as an enigma. It has been referred to as ‘a riddle wrapped in a mystery inside an enigma’ (1). Endometriosis is a public health disorder that affects nearly 42 million women in India, with a significant socio-economic impact (2). Discussion and disagreement have long surrounded its diagnosis and treatment. Several theories on its possible aetiopathogenesis have been proposed and refuted over time. In fact, despite more than a century of study, the aetiology of endometriosis is still poorly understood. While significant progress has been made, there are still several significant knowledge gaps regarding endometriosis, which have hindered the development of a definitively proven treatment for this disease that profoundly affects the quality of life of countless women worldwide.
The symptomatology of endometriosis tends to be vague, and a high index of suspicion is needed to confirm the diagnosis. The classic triad of endometriosis is dyspareunia, dysmenorrhoea, and infertility. However, this triad often oversimplifies a complex disease that has been causing chronic pain and infertility for centuries (3). Endometriosis is a major cause of nonmenstrual pain and infertility in women, significantly impacting their quality of life (4).
Endometriosis is traditionally classified into one of three main forms: ovarian endometriosis, superficial peritoneal endometriosis, and Deep Infiltrating Endometriosis (DIE). Bladder endometriosis is characterised by the abnormal proliferation of endometrial glands and stroma in the detrusor muscle of the bladder (5). This condition can affect various sites within the bladder, most commonly the base and dome, with varying degrees of infiltration. Urinary tract endometriosis is present in approximately 1% of women with endometriosis, but its prevalence increases to 19-53% among patients with Erectile Dysfunction (ED) (6). There are two types of bladder endometriosis: superficial endometriosis, which affects only the bladder surface, and deep endometriosis, which involves the bladder wall or lining. Bladder nodules often co-exist with other deep pelvic endometriosis locations, leading to a range of abdominal and urogenital symptoms that may go unnoticed by medical professionals (5). Despite advancements in our understanding of the genetic and molecular development of endometriosis, the clinical approach to bladder lesions remains challenging and may require the use of various diagnostic tools to establish a comprehensive diagnostic work-up and guide appropriate treatment. The diagnosis is primarily made through cystoscopic exploration and histological analysis of samples obtained via electrofulguration (7). In certain cases, hormone therapy using Danazol or a Gonadotropin hormone-releasing hormone (GnRH) agonist may be beneficial. For optimal results, the lesion should be removed via Transurethral Resection of Bladder Tumour (TURBT) or traditional surgery. Bladder endometriosis is a rare but well-recognised form of endometriosis that can occur in women who have undergone a hysterectomy.
Bladder endometriosis is a rare form of endometriosis that can occur after a hysterectomy. This case presented a diagnostic challenge due to two factors. Firstly, the patient’s cervix had been left behind after a non descent vaginal hysterectomy performed at another hospital. Secondly, she had predominantly urinary symptoms even before her hysterectomy, which persisted and worsened over the past five years. These factors led us to suspect bladder endometriosis. The bladder nodule was likely densely adherent, making it impossible to access the anterior pouch and dissect the uterine vesical fold of the peritoneum to elevate the bladder. Therefore, the surgeon decided to leave behind the cervical stump and proceed with a subtotal hysterectomy. Additionally, both ovaries were preserved, possibly due to the patient’s age being under 40 years at the time of the hysterectomy. The specific symptom of cyclic urinary pain raised a strong suspicion of endometriosis. After conducting thorough research, the diagnosis of bladder endometriosis was confirmed, and the patient received appropriate treatment. The diagnosis of bladder endometriosis is often delayed because the symptoms resemble those of other bladder conditions, such as urinary tract infections and interstitial cystitis (8).
Many times, in the rush of routine office work, one tends to dismiss patient complaints and proceed with predetermined management plan. It is crucial to remember, especially when offering surgical treatment, that listening to the patient’s complaints can help avoid permanent organ loss, incorrect procedures, and potential lawsuits. According to traditional medical school teaching, it is important to elicit the patient’s history in their own words. The specific reason for their visit to the hospital should be carefully noted, and a management plan, including treatment options, should be discussed and documented in our notes.
Bladder endometriosis is primarily a type of DIE. Therefore, proper surgical management involves complete removal of the tissue mass. Care must be taken to avoid damaging the bladder wall, sphincters, and ureteric orifices. The patency of both ureteric orifices should be confirmed at the beginning of the procedure, and preoperative ureteral stenting may be considered in selected cases. Deep infiltrating disease can affect the ureters, leading to blockages (9). The gold standard for diagnosing bladder endometriosis is a histopathological examination of the biopsy specimen. Treatment options for bladder endometriosis include hormonal therapy, such as oral contraceptive pills, progestins, Dienogest (a fourthgeneration synthetic progestin), GnRH agonists (leuprolide acetate, Goserelin), Selective Progesterone Receptor Modulators (SPRMs), and gestrinone. Laparoscopic surgical excision of the endometrial nodules is necessary, and in cases of extensive or recurrent disease, a partial cystectomy may be required. The prognosis for bladder endometriosis is generally good with appropriate treatment.
The purpose of presenting this case is to emphasise that the diagnosis of bladder endometriosis should be considered in women experiencing symptoms of dysuria and bladder discomfort. A high index of suspicion is necessary to reach the diagnosis. Treatment options include hormonal therapy and surgical excision of the endometrial nodules. With appropriate treatment, the prognosis is generally good.
DOI: 10.7860/JCDR/2023/65201.18679
Date of Submission: May 03, 2023
Date of Peer Review: Aug 08, 2023
Date of Acceptance: Sep 02, 2023
Date of Publishing: Nov 01, 2023
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: May 10, 2023
• Manual Googling: Aug 26, 2023
• iThenticate Software: Aug 31, 2023 (10%)
ETYMOLOGY: Author Origin
EMENDATIONS: 5
- 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