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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
Original article / research
Full Version
Outcome of Dismembered Pyeloplasty in Children with Unilateral Pelviureteric Junction Obstruction: A Retrospective Observational Study
Correspondence Address :
Dr. Nibi Hassan,
Assistant Professor, Department of Paediatric Surgery, TD Medical College, Alappuzha-688001, Kerala, India.
E-mail: nibihassan@gmail.com
Introduction: Anderson-Hynes (AH) dismembered pyeloplasty is the standard procedure performed for the management of Pelviureteric Junction Obstruction (PUJO). Ultrasonography (USG) and diuretic renography are of great importance for the diagnosis and follow-up of PUJO.
Aim: To evaluate the morphological and functional outcomes of open dismembered pyeloplasty in children with unilateral PUJO and to find the correlation between functional and morphological outcomes.
Materials and Methods: A retrospective observational study was conducted, assessing the clinical charts of 200 children under 10 years of age with congenital PUJO who underwent open AH dismembered pyeloplasty in the Department of Paediatric Surgery at a teritary teaching Institute, Government medical college, Thiruvananthapuram, Kerala, India from from June 2015 to June 2020. The preoperative radiological assessment included renal USG and diuretic renography for all patients. Morphological and functional surgical outcomes were measured one year after surgery. The morphologic parameters analysed were the Anteroposterior Diameter (APD) of the pelvis and Parenchymal Thickness (PT). The functional outcome was assessed by improvements in Glomerular Filtration Rate (GFR), Split Renal Function (SRF), and drainage curve. Success was defined as improvement in function and morphology in follow-up USG and renogram after one year of surgery. Paired t-test was applied for statistical analysis using Statistical Package for the Social Sciences (SPSS) software version 23.0.
Results: Among the total 200 patients,180 (90%) cases demonstrated improved renal function after pyeloplasty. Among the total 200 cases, males were 120 (60%) and females were 80 (40%). Morphologic outcome improved in 188 out of 200 (94%) cases. The overall outcome was good in 168 out of 200 (84%) patients. The results showed a moderate negative correlation for APD with respect to SRF (r=-0.677, p-value=0.01) and GFR (r=-0.430, p-value=0.01), whereas a moderate positive correlation was observed between SRF and GFR (r=0.423, p-value=0.01).
Conclusion: AH dismembered pyeloplasty is an effective treatment for PUJO in children, not only relieving obstruction but also improving renal function. The present study recommends considering both morphologic and functional parameters to assess the success of the surgery.
Child, Hydronephrosis, Kidney function test, Kidney pelvis, Ureter
Ureteropelvic Junction Obstruction (UPJO) is one of the most common pathological conditions in Paediatric Urology. It is the most common cause of hydronephrosis in children. The frequency of UPJ obstruction has been assessed at 1 in 5,000 live births. However, with the initiation of antenatal ultrasound, the frequency of dilation is reported to be higher (1). Insufficient drainage of urine from the renal pelvis due to UPJO subsequently causes hydrostatic distention of the pelvis and intrarenal calyces. The combination of urine stasis and increased intrapelvic pressure in the collecting ducts causes injury to the kidney (1). In most cases, renal dilation and obstruction are noticed prenatally. Haematuria after slight trauma or dynamic exercise can be a clinical feature, which may be due to the rupture of mucosal vessels in the dilated collecting system (2).
Ultrasonographic and renographic parameters are useful in assessing the severity of UPJO. Usually, a combination of factors such as the Society of Foetal Urology (SFU) grading, APD of the renal pelvis, drainage pattern, Differential Renal Function (DRF), and GFR on diuretic renogram are used to assess the severity of hydronephrosis (1),(2),(3),(4). While APD and DRF have been considered as main predictive factors for surgery in some studies, others have given importance to calyceal dilatation and cortical thinning on ultrasonogram (3),(5),(6).
Anderson-Hynes dismembered pyeloplasty is the standard technique performed for the treatment of UPJO, either via an open, laparoscopic, or robotic approach (7). Diuretic renography, providing information on SRF and renal drainage, is of great importance for the diagnosis and follow-up of UPJO (8).
The success rate of pyeloplasty is nearly 98% after open AH pyeloplasty (9). Though the failure rate is less, the criteria used to analyse the postoperative results vary from one study to another. According to one school of thought, if the pelvicalyceal dilatation decreases, it is considered a good result. For others, the result is considered good only if there is improvement in SRF (5),(6),(7),(8). Another group states that regardless of morphological changes, the drainage pattern is important, and there should be unobstructed drainage in the postoperative diuretic renogram (4). In the present study, the authors retrospectively evaluated the morphological and functional outcomes of dismembered pyeloplasty for the management of unilateral UPJO in children one year after surgery.
The null hypothesis stated that there is no significant difference in morphological and functional outcomes one year after pyeloplasty.
A retrospective observational study was conducted in the Department of Paediatric Surgery Government medical college, Thiruvananthapuram, Kerala, India from June 2015 to June 2020. The study was conducted after obtaining mandatory Institutional Ethical Committee and research body clearance - (HEC no: 10/102018/MCT).
Inclusion and Exclusion criteria: Children under 10 years of age with Congenital Unilateral PUJO who underwent AH dismembered pyeloplasty were included in the study. Children with PUJO in a solitary kidney, cases with bilateral PUJO, recurrent PUJO, and patients with secondary PUJO were excluded from the study.
Study Procedure
The patients were classified into three age groups- less than one year 52/200 (26%), 1-5 years 124/200 (62%), and 5-10 years 24/200 (12%) of age. The morphologic parameters analysed were the APD of the pelvis and PT. APD is defined as the Anteroposterior Diameter in the cross-sectional view of the kidney measured from its middle, from one side of the parenchyma to the other at the hilar level. Improvement in APD was defined as a decrease in pelvic APD compared to the preoperative value by 20%. Improvement in PT was defined as an increase in the maximum measurable PT by 3 mm (5). The functional outcome was assessed by improvements in GFR, SRF, and drainage curve. Kidney function was classified as good when SRF is ≥40% and poor when <10% [6,7]. A reduction of SRF by more than 10% of the previous value was considered as deterioration, an increase of more than 10% was defined as improvement, and changes within 5% were considered as preservation (6). Improvement in the drainage curve means a change in the pattern of the curve from upgoing to downsloping after surgery. The improvement in GFR on the postoperative renogram was defined as an increase in the value by a minimum of 5 mL/minute (3),(5),(6).
Statistical Analysis
Statistical analysis was performed using SPSS software version 23.0. In present study, the paired t-test was used to compare the study variables APD, PT, SRF, and GFR before and after surgery. The Pearson’s correlation test was used to determine the correlation between functional and morphological outcomes (SRF and APD).
Among the total 200 cases, males were 120 (60%) and females were 80 (40%). A total 124 (62%) were between 1to 5 years, 52 (26%) were <1 year, and 24 (12%) were > 5 years (Table/Fig 1). In the age group of 1-5 years, 112 out of 124 (90%) patients had a good outcome. In the more than five-year group, 16 out of 24 (66%) patients had a good outcome. In the less than one year group, 40 out of 52 (76%) patients had a good outcome. The left side was involved in 136 out of 200 (68%) cases, while the right side was involved in 64 out of 200 (32%) cases. A total of 176 out of 200 (88%) cases were antenatally diagnosed. It was observed that 16 out of 200 (8%) presented with a preoperative mass, and four out of 200 (2%) cases had a persisting mass postoperatively. The mean preoperative SRF was 40.54, and the mean postoperative SRF was 45.77. The mean preoperative GFR was 37.40 mL/min, and the mean postoperative GFR was 41.30 mL/min. There was a statistically significant increase in postoperative SRF and GFR (Table/Fig 2),(Table/Fig 3). GFR improved in 184 out of 200 (92%) cases, and SRF improved in 180 out of 200 (90%) cases.
Out of the 200 patients with an upgoing drainage curve preoperatively, 180 showed a downgoing curve postoperatively, indicating unobstructed drainage. The overall functional outcome was good in 90% of cases (Table/Fig 2),(Table/Fig 3). In 188 out of 200 (94%) cases, APD decreased postoperatively. The mean preoperative APD was 28.78, and the mean postoperative APD was 17.1. There was a statistically significant decrease in postoperative APD (p=0.01) (Table/Fig 3),(Table/Fig 4).
The PT improved in 72 patients, was maintained in 116 patients, and deteriorated in 12 patients. Forty-eight out of 64 patients with PT less than <3 mm had a good outcome, 60 out of 64 patients with PT 3-5 mm had a good outcome, and 60 out of 72 patients with PT >5 mm had a good outcome. The mean preoperative PT was 3.95±1.213 mm, and the mean postoperative PT was 7.14±1.889 mm (p-value <0.001) (Table/Fig 5).
The morphological outcome was good in 94% of cases. The overall outcome (both functional and morphological) was good in 168 out of 200 (84%) cases (Table/Fig 3). Intraoperatively, 165 out of 200 patients (82.5%) were found to have intrinsic PUJO. Twenty-five patients out of 200 (12.5%) had lower polar crossing vessels, six patients had long-segment PUJO, and four others had nondependent PUJO. Redo pyeloplasty was required for two out of 200 patients. Both of them were in the age group less than one year, with SFU grade four hydronephrosis and initial SRF <20%. Both of them had good morphological and functional outcomes in follow-up.
A moderate negative correlation was observed for APD with respect to SRF (r=-0.677, p<0.05) and GFR (r=-0.430, p<0.05), whereas a moderate positive correlation was observed between SRF and GFR (r=0.423, p<0.05) (Table/Fig 6). The null hypothesis was rejected, and the alternative hypothesis was accepted.
The ideal outcome of AH pyeloplasty in classical PUJO is assessed by improvement in morphology, function, and clinical symptoms. The male to female ratio was 3:2, indicating that PUJ obstruction is more common in boys. This is similar to the prevalence observed in the literature, which reports a prevalence of 1 in 1000-1500 (3),(9),(10),(11). The patient’s age at the time of repair is still controversial. Reduction in the grade of hydronephrosis may be better in a younger cohort. Early surgery is indicated by the development of any sign of deterioration. It is suggested that early surgery can prevent irreversible renal damage and improve renal function (12),(13),(14),(15),(16). Similar to present study, other studies also do not demonstrate that the infant kidney is more likely to have resolution of pyelocaliectasis postoperatively [2,5]. The comparatively increased incidence of an unfavourable outcome in the age group >5 years compared to the others is likely a reflection of long-standing PUJO and its consequences compared to the other two groups. In 68% of cases, the side of involvement was left. This is comparable to the literature, which reports that two-thirds occur on the left side (7).
Children with clinically palpable masses were associated with an unfavourable outcome, as two of these cases required redo pyeloplasty. Risk factors associated with redo pyeloplasty are age less than one year, higher-grade hydronephrosis, and poor initial SRF (9). Improvement in renal pelvic APD and renal PT after pyeloplasty are predictors of good outcomes, as evidenced in several previous studies (12),(17),(18). Improvement in functional parameters like GFR, SRF, and drainage pattern on the postoperative renogram has been extensively used as indicators of good results after pyeloplasty in several studies (8),(12),(17),(18). In present study, there was found to be an excellent correlation between the improvement in morphological outcome and functional outcome after pyeloplasty. The cardinal observations of present study were correlated with similar studies in the current literature and tabulated (Table/Fig 7) (8),(12),(17),(18).
The clinical implication of the observations of this study suggests that the assessment of postoperative results, follow-up, and prognostication after pyeloplasty should be based on the consideration and correlation of both morphological and functional parameters.
Limitation(s)
A limitation of present study was that other important morphological parameters, such as Corticomedullary Differentiation (CMD), SFU grade, and calyceal dilatation, could not be included for analysis because these data were not uniformly available in all records.
The AH dismembered pyeloplasty is an effective treatment for PUJO in children, relieving obstruction and improving renal function. The present study emphasises the need to assess both morphological and functional parameters and correlate them to determine the outcome after pyeloplasty in children. Instead of using these parameters as independent predictors of outcome, they should be used collectively for postoperative follow-up and prognostication.
DOI: 10.7860/JCDR/2023/62423.18420
Date of Submission: Jan 17, 2023
Date of Peer Review: Mar 04, 2023
Date of Acceptance: Jul 17, 2023
Date of Publishing: Sep 01, 2023
AuthorAUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• 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
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