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
Case report
Full Version
A Case of Renal Sarcoidosis: A Diagnostic Dilemma
Correspondence Address :
Aravind Bhagavath,
Postgraduate, Department of General Medicine, SSIMS and RC, Bypass Road, NH-4, Davangere-577005, Karnataka, India.
E-mail: aravind.bhagavath@gmail.com
Sarcoidosis is a multi-system disease of unknown aetiology, characterised by non-caseating granulomas. It can involve any organ in the body, but commonly affects the lungs and lymph nodes. The worldwide prevalence of sarcoidosis is 20-60 per/100,000 and people, while in India, it is 61.2 per 100,000. The probable cause is an inflammatory response triggered by various environmental agents in genetically sensitive individuals. Approximately one-third of patients with sarcoidosis remain asymptomatic. Typical symptoms include non-specific pulmonary symptoms such as cough, dyspnoea and chest pain. Cutaneous or ocular manifestations may include malar rash, erythema nodosum, keratoconjunctivitis, anterior uveitis and chorioretinitis. The presence of hilar lymphadenopathy on chest X-ray is highly suggestive of sarcoidosis. In this case, a 68-year-old female patients, presented with complaints of anorexia and fatigue for the past three months. She was found to have anaemia, hypercalcaemia, and abnormal renal function. Abdominal ultrasonography (USG) showed normal findings. The patient was initially evaluated for Tuberculosis (TB) and started on empirical Anti-Tubercular Therapy (ATT). However, as the patient did not show any improvement, further evaluation was conducted, leading to a diagnosis of sarcoidosis. Treatment options for sarcoidosis include systemic steroids, immunosuppresants, and cytotoxic drugs. Biologics such as anti-Tumour Necrosis Factor (TNF) agents (etanercept, golimumab, and infliximab) have also been considered in the treatment. Sarcoidosis can present a diagnostic dilemma as seen in this patient who initially had features resembling disseminated TB. This highlights the importance of strong clinical suspicion by the treating physician and thorough evaluation.
Granuloma, Hypercalcaemia, Ocular manifestations, Pulmonary symptoms
A 68-year-old female patient, presented to the outpatient department with complaints of anorexia and fatigue for the past three months. She reported worsening fatigue and difficulty in performing daily activities. Over the last month, she experienced occasional dizziness and also complained of loss of appetite. There was no history suggestive of weight loss or fever. The patient had a known history of type 2 diabetes mellitus for 30 years and systemic hypertension for 20 years, managed with oral medications. There was no significant family history.
On physical examination, the patient was normothermic, normotensive with regular, normovolemic pulse rate of 80 bpm. She was afebrile. Pale palpebral conjunctiva, bilateral pitting pedal oedema up to the knee, and left inguinal lymphadenopathy were observed. Fundoscopy showed no signs of retinopathy. Examination of the cardiovascular system revealed normal heart sounds without murmurs. Bilateral vesicular breath sounds without added sounds were noted during respiratory system examination. Abdominal examination showed no hepatosplenomegaly or tenderness. A provisional diagnosis of anaemia under evaluation was made, and further investigations were initiated.
Laboratory investigations revealed elevated serum creatinine levels (2.3 mg/dL), hypercalcaemia (13.1 mg/dL), and anaemia (hemoglobin - 9.5 mg/dL). Urine analysis showed 1+ proteinuria on dipstick testing, with no red blood cells (RBCs) or white blood cells (WBCs) observed on microscopy. Due to persistent normocytic normochromic anemia and mildly elevated erythrocyte sedimentation rate (ESR) of 45 mm/hr, serum protein electrophoresis was performed, which indicated an elevation in the alpha 2-beta globulin fraction and hypergammaglobulinemia. Abdominal ultrasound was conducted to rule out kidney disease and showed normal findings. Positron Emission Tomography-Computed Tomography (PET-CT) revealed bilateral axillary, inguinal, retro-peritoneal, and parotid lymphadenopathy (Table/Fig 1). A biopsy of the left inguinal lymph node demonstrated revealed chronic granulomatous lymphadenitis with the presence of Langerhans giant cells (Table/Fig 2). Bone marrow aspiration revealed non-caseating granulomas (Table/Fig 3). Sarcoidosis was suspected as the diagnosis.
The patient was initiated on anti-tubercular therapy (ATT), including Tablet(Tab.) Isoniazid 300 mg/day, Tab Rifampin 600 mg/day, Tab Pyrazinamide 1500 mg on alternate days, and Tab Ethambutol 800 mg on alternate days with renal dose modification. ATT was continued for one month. Other diseases presenting with chronic granulomatous lymphadenitis were also considered. However, hypercalcaemia and renal dysfunction did not improve with empirical ATT. Hypercalcaemia was refractory to therapy, which included hydration and other supportive measures. The Cartridge-Based Nucleic Acid Amplification Test of the sample tested negative for Mycobacterium TB. Histopathologically, the lymph node showed features suggestive of granulomatous lymphadenitis. Sarcoidosis In view of granulomatous lymphadenitis associated with hypercalcemia and renal failure. Sarcoidosis was suspected, serum ACE levels sent and was found to be elevated (159 u/l) (1).
The diagnosis of sarcoidosis was made based on the clinical scenario, supported by of biochemical evidence of elevated serum ACE levels (159 u/l). Oral prednisolone was started at 10 mg (tid) and later tapered over a period of six weeks, resulting in improved laboratory parameters for the patient. (Table/Fig 4) depicts comparative data of investigations before and after starting steroids. The response to steroids can be considered strong evidence of sarcoidosis.
Sarcoidosis is a multisystem inflammatory disorder of unknown aetiology that affects multiple organs. The clinical, radiological, and histopathological similarities between sarcoidosis and tuberculosis pose a challenge for physicians in differentiating the diseases. Kidney involvement occurs in less than 5% of cases (2). The worldwide 8prevalence of sarcoidosis is 20-60/100,000, while in India, it is 61.2/100,000 (3). Approximately one-third of patients remain asymptomatic. Common pulmonary symptoms include cough, dyspnoea, and chest pain. Cutaneous or ocular manifestations may include malar rash, erythema nodosum, keratoconjunctivitis, anterior uveitis, and chorioretinitis. The presence of hilar lymphadenopathy on chest X-ray raises suspicion of sarcoidosis. The exact cause of sarcoidosis is unknown. Advanced imaging modalities such as PET scan using 18FDG or 18FMT (fluoromethyl-tyrosine) can be useful, with 18FMT being highly specific for aiding diagnosis of sarcoidosis (4). Most patients experience remission and do not require aggressive therapy.
Histopathologically, sarcoidosis and tuberculosis are characterised by granulomatous inflammation. The primary causes of granulomatous inflammation in sarcoidosis are believed to be a chronic, poorly degradable unknown antigen and a prolonged host response. In countries with a high burden of tuberculosis like India, the uncommon manifestations of tuberculosis may be more common in sarcoidosis. Recent studies suggest that mycobacterial antigens may be the triggering agents in some sarcoidosis patients, with stronger evidence from countries with a high burden of tuberculosis. Tuberculosis can also occur as a complication of treatment in sarcoidosis treatment, and the two conditions can rarely coexist (5).
In 1939, Harrell GT and Fisher S first described hypercalcaemia in sarcoidosis (6). Hypercalcaemia occurs due to increased activity of activated macrophages within the granulomas. These macrophages express 1-alpha hydroxylase activity, leading to the conversion of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol. Other mechanisms for hypercalcaemia in sarcoidosis include the expression of Parathyroid Hormone-related Protein (PTH-rP) in sarcoid macrophages, which may exert an autocrine action of 1α-hydroxylase activity, and increased levels of serum Interferon (IFN)-γ (7). Hypercalcaemia can be present in 10-17% of sarcoidosis patients (8). Renal failure secondary to hypercalcaemia is seen in 1-2% of sarcoidosis cases and is likely the cause of sarcoidosis associated renal dysfunction. Hypercalcaemia can lead to nephrolithiasis or nephrocalcinosis, with nephrolithiasis occurring in less than 10% of cases and nephrocalcinosis in less than 5% of cases (9). Sarcoidosis can also cause granulomatous interstitial nephritis, which is a rare finding on renal biopsy. It is observed in up to 0.9% of native kidney biopsies and approximately 6% of biopsies with interstitial nephritis (9).
Genitourinary involvement is seen in 20-40% of extrapulmonary tuberculosis (TB) cases (10). Renal involvement is present in 74% of cases with haematogenous spread. The spectrum of renal TB presentation includes hypercalcaemia, nephrolithiasis, nephrocalcinosis, and acute tubulointerstitial nephritis with or without granulomas (11). Hypercalcaemia is reported in about 2-10% of patients with sarcoidosis, while hypercalciuria is even more frequent. This is rare in TB but has been infrequently reported in miliary TB (12). In a TB-endemic country like India, distinguishing between TB and sarcoidosis is important, especially due to the different treatment regimens for these two diseases.
The treatment for sarcoidosis depends on the severity of the disease. Mild cases may not require treatment, while more severe cases may require medication to reduce inflammation and suppress the immune system. Corticosteroids are the first-line treatment for organ-threatening sarcoidosis (7). Other treatment options include immunosuppressants, cytotoxics, and biologics such as anti-TNF agents (etanercept, golimumab and infliximab). There is currently no guideline for treatment. Based on a literature, review hypercalcaemia and hypercalciuria can be treated with corticosteroids (13). Glucocorticoids help resolve interstitial nephritis and manage hypercalcaemia. If glucocorticoids fail, ketoconazole or hydroxychloroquine can be used. Additional immunosuppressive agents like azathioprine or mycophenolate mofetil can also be used in sarcoidosis treatment (14). Understanding the uncommon presentations of sarcoidosis will aid in diagnosis and appropriate management of the disease. Physicians need to be aware of these presentations to facilitate better understanding and treatment of sarcoidosis patients.
The patient presented with features suggestive of disseminated tuberculosis (TB) but was ultimately diagnosed with sarcoidosis. Sarcoidosis can often pose a diagnostic challenge, as seen in this patient who had symptoms resembling disseminated TB. To avoid exacerbating any potential underlying TB infection with steroid therapy for sarcoidosis, empirical anti-TB treatment (ATT) was initiated. Corticosteroids continue to be the preferred treatment for sarcoidosis.
DOI: 10.7860/JCDR/2023/61636.18169
Date of Submission: Nov 19, 2022
Date of Peer Review: Feb 02, 2023
Date of Acceptance: Apr 17, 2023
Date of Publishing: Jul 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. No
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Nov 23, 2022
• Manual Googling: Mar 08, 2023
• iThenticate Software: Apr 12, 2023 (15%)
ETYMOLOGY: Author Origin
EMENDATIONS: 8
- 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