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

Users Online : 49550

AbstractCase ReportDiscussionConclusionAcknowledgementReferences
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
Lucknow
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,
Muzaffarnagar.
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,
Bengaluru.
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
Consultant
(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)
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

Important Notice

Case report
Year : 2007 | Month : December | Volume : 1 | Issue : 6 | Page : 521 - 524 Full Version

Bilateral Disc Edema in Familial Mediterranean Fever


Published: December 1, 2007 | DOI: https://doi.org/10.7860/JCDR/2007/.152
KUMAR S
Correspondence Address :
Dr. Sunil Kumar, FRCS, MS, Mohammad Dossary Hospital, PO Box 335, Al Khobar 31952, Saudi Arabia. Email: sunkaru79@hotmail.com

Abstract

I report a case suffering from Familial Mediterranean fever (FMF) who presented with complaints of blurred vision. This report illustrate that possible diagnosis of pseudotumor cerebri should be considered as a cause of poor vision in FMF.

Introduction
Familial Mediterranean fever (FMF, MIM 249100) or Recurrent polyserositis (1),(2) is an autosomal recessive multi-system disease, with incomplete penetration (3), manifested by self limited episodes of fever accompanied by painful attacks affecting the abdomen, chest or joints, and sometimes a skin rash (4). It is most prevalent in people of Armenian, Sephardic Jewish, Levantine Arabic and Turkish ancestry. It was first recognized as a distinct nosological entity only in 1947 (5). It is caused by mutations in gene MEFV, on the short arm of chromosome 16. Ocular involvement is rare in FMF. Episcleritis (6), optic neuritis, retinal colloid bodies (7), ophthalmoparesis and prolonged latencies of the visually evoked potentials (8) have been reported in FMF.

Case Report

A 23-year-old, single, Arab female, of Palestinian ancestry presented in the eye department of Mohammad Dossary hospital with the complaints of not seeing well with her current glasses for last few weeks. Her best corrected visual acuity was 6/9 and 6/12 in right and left eye respectively.

She read all the Ishihara plates with each eye. Slit lamp examination of both anterior segment was unremarkable. Both pupils were reacting to light without any afferent pupillary defect. Fundus examination after dilatation of pupil revealed bilateral overt disc edema. (Table/Fig 1) and (Table/Fig 2)

Her BMI was 27.5 kg/M2. There was no past history of diabetes mellitus or hypertension. She denied any past or present history of headache. She reported recurrent episodes of pain in abdomen & extremities along with fever since childhood. These episodes used to last for two to three days. During an episode, the pain in extremities hampered her day to day activities. She was diagnosed to have familial Mediterranean fever (FMF); however she was not taking any regular medication. Further interviewing her revealed that episodes of similar nature occurred in other family members in last three generations (Table/Fig 3). Interestingly, her grandmother was erroneously operated for appendicitis during an episode of FMF.

Her Complete blood counts, Erythrocyte sedimentation rate, urine analysis, fasting blood sugar, serum electrolytes, serum calcium, blood urea, serum creatinine, liver function test, TSH, T3 and T4 were within normal limit. Anti-nuclear antibodies were not detectable.

Detailed neurological examination of this patient to elucidate her bilateral disc edema was not rewarding. Contrast enhanced computerized tomogram (CT) scan of brain was performed to exclude a mass lesion or sinus thrombosis causing the bilateral disc edema. The only abnormal finding noted was the enlargement of optic nerve sheaths bilaterally (Table/Fig 4). CT scan of optic nerve excluded the possibility of buried optic nerve drusen mimicking papilloedema.

Despite thorough, repeated history and detailed systemic/ neurological examination I was unable to pinpoint any etiological factor that may cause or need further investigation to rule out as a cause, for bilateral disc edema present in my case.

Bilateral disc edema in the clinical settings of normal ocular, neurological and systemic examination along with normal neuro-imaging was thought of probably due to pseudotumor cerebri. Lumbar puncture to document the opening pressure of cerebrospinal fluid was refused by the patient. Treatment was commenced with tablet acetazolamide 250 mg four times a day. Three weeks later, while on tablet acetazolamide, her disc edema was regressing but visual acuity remain same.

Discussion

This patient, suffering from FMF, presented with complaints of blurred vision and bilateral disc edema with no detectable cerebral mass lesion. She did not suffer from headache which is in contrast to the majority (94-99%) of patients suffering from pseudotumor cerebri. Most of the patients suffering with pseudotumor cerebri are young female, either overweight or have a history of recent weight gain. None of these features were documented in my patient and additionally, she denied taking any medication that could have been responsible for her visual findings. This disease was noted in her previous three generations and, interestingly, all affected members were females.

Pseudotumor cerebri in a patient suffering from FMF was reported by Gokalp et al however their patient presented with headache (9). Their patient was normal weight female and all her relevant laboratory and radiological parameter were normal. They did not comment about the similar disease in other family members.

Enlarged optic nerve sheath have been reported in various studies in patients with pseudotumor cerebri (10),(11) and it seems to represent a direct consequence of long term increased pressure in CSF spaces (12). One study correlated the cerebrospinal fluid opening pressure with the diameter of optic nerve (13). I presume that the enlarged optic nerve sheath in my case represent the radiological evidence of high cerebrospinal fluid pressure.

This case has one limitation. The cerebrospinal fluid pressure, one of the Dandy criteria (14), was not documented in this patient, as she refused for lumbar puncture. It is not possible to say categorically that pseudotumor cerebri was due to FMF. The co-existence of two may be purely coincidental however I believe that bilateral disc edema in this patient was due to FMF and wanted to report this observation with a view to promote awareness and hopefully to stimulate further research to elaborate the relation between pseudotumor cerebri and FMF.

Conclusion

This report highlights that provisional diagnosis of pseudotumor cerebri should be considered for deteriorating vision of recent onset in a patient suffering from familial Mediterranean fever.

Acknowledgement

I wish to acknowledge the valuable suggestion and comments of Dr. Vijay Sharma, MRCP, consultant neurologist, National University Hospital, Singapore, in the preparation of this manuscript.


EDITORIAL COMMENT
Familial Mediterranean Fever (FMF) is a disease of many faces. Almost all the organs are somehow affected. Visual and central nervous system involvement however is not common. In the present case, fundoscopic findings show bilateral papilloedema, and the physical findings propound a possible high intracranial pressure (ICP) which may be diagnosed as Pseudotumor Cerebri (PC) despite lack of a lumbar puncture. The enlargement of optic nerves on CT scan in this case is interesting and can explain the papilloedema following an increased ICP. The enlarged retrobulbar optic nerve most probably exerts anteroposterior compression on the globe evidenced by the posterior scleral flattening associated with idiopathic intracranial hypertension (15). Madill and Connor’s neuroimaging study shows significantly shorter axial length of the eye globes in patients with idiopathic intracranial hypertension compared with control subjects (16). ICP has been shown to be correlated with intraocular pressure (IOP) (17). A measurement of the IOP could also be helpful as an easy and non-invasive test in evaluation of this patient. Although, the presumptive diagnosis of PC questions the validity of this paper to some extent, a possible correlation or even coincidence of FMF, visual problems and increased ICP is very interesting, and deserves attention.

Mohammad Reza Mohebbi, MD
Department of Neurology,
University of Texas Medical School at Houston,
Houston, Texas 77030
USA




References

1.
Eisenberg S, Aksentijevich I, Deng Z, et al. Diagnosis of familial Mediterranean fever by a molecular genetics method. Ann Intern Med. 1998;129:539-542.
2.
Ben-Chetrit E, Levy M. Familial Mediterranean fever. Lancet. 1998; 28:659-664.
3.
Vinceneux P, Pouchot J. Familial Mediterranean fever, clinical and laboratory findings. Presse Med. 2005;34:938-946.
4.
Haghighat M, Derakhshan A, Karamifar H. familial Mediterranean fever. Shiraz E-medical Journal 2006;2
5.
Ben Chetrit E, Levy M. Enigmas in familial Mediterranean fever (FMF). Clinical and experimental rheumatology 2001;19:S1-S5.
6.
Scharf J, Meyer E, Zonis S. Episcleritis associated with familial Mediterranean fever. Am J Ophthalmol. 1985;100:337-339.
7.
Michaelson I, Eliakim M, Ehrenfeld EN. Et al. Fundal changes resembling colloid bodies in recurrent polyserositis (periodic disease). AMA Arch Ophthalmol. 1959;62:1-4.
8.
Finsterer J, Stollberger C, Shinar Y. Cranial nerve lesions and abnormal visually evoked potentials associated with the M694V mutation in familial Mediterranean fever. Clin Rheumatol. 2002;21:317-321.
9.
Gokalp HZ, Baskaya MK, Aydin V. Pseudotumor cerebri with familial Mediterranean fever. Clin Neurol Neurosurg. 1992;94:261-263.
10.
Weisberg LA. computed tomography in benign intracranial hypertension. Neurology 1985;35:1075-1078.
11.
Gibby WA, Cohen MS, Goldberg HI. et al. Pseudotumor cerebri: CT findings and correlation with vision loss. Am J Roentgenol. 1993;160:143-146
12.
Wessel K, Thron A, Linden D. et al. Pseudotumor cerebri: clinical and neuroradiological findings. Eur Arch Psychiatry Neurol sci. 1987;237:54-60
13.
Kesler A, Yaffe D, Shapira M. et al Optic nerve sheath enlargement and reversal of optic nerve head in pseudotumor cerebri. Harefuah. 1996 130:457-459.
14.
Tables and Figures
[Table / Fig - 1] [Table / Fig - 2] [Table / Fig - 3] [Table / Fig - 4]

JCDR is now Monthly and more widely Indexed .