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

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"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
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Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
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Thiruvalla, Kerala
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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."



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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."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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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.
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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."



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Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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




Dr. C.S. Ramesh Babu
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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

Important Notice

Experimental Research
Year : 2010 | Month : February | Volume : 4 | Issue : 1 | Page : 2129 - 2133

The Anomalous Origin Of Multiple Coronary Ostia And Their Clinical Significance

GAJBE U L*, GOSAVI S**, MESHRAM S***, GAJBHIYE V M****

*M.B.B.S, M.S,ASSOCIATE PROFESSOR, Dept.of Anatomy,J. N.M.C Sawangi (M), Wardha. (M.S.) **M.B.B.S, M.S,ASSOCIATE PROFESSOR, Dept.of Anatomy,F.I.M.S Kadapa, A.P ***M.B.B.S, M.D,ASSISTANT PROFESSOR, Dept.of Anatomy ,F.I.M.S Kadapa, A.P ****M.B.B.S, M.S,ASSOCIATE PROFESSOR, Dept.of Anatomy,KAMINENI INSTITUTE OF MEDICAL SCIENCES ,Narketpally, A.P

Correspondence Address :
Dr. Surekha W. Meshram,Dept. of Anatomy, F.I.M.S, Kadapa, (A.P), India Mobile no. 9225845392 Email:surekhameshram@gmail.com surekha_1261975@rediffmail.com,drsurekhameshram@yahoo.com

Abstract

The anomalous origin of multiple coronary ostia from a single coronary sinus is a very rare finding. In this study of 30 hearts, we found out the origin of multiple ostia of coronary arteries from a single coronary sinus. The courses of arteries arising from these anomalous ostia were also studied in detail and the findings were correlated with clinical findings and pathophysiological conditions. Very few data exist on the clinical relevance of anomalies in different coronary arteries, which necessitate a proper management and follow up protocol. This study helps the cardiologist during routine diagnostic work up for cardiac diseases and in the management of these Diseases.

Keywords

Coronary arteries, Ostia, Anomalous.

Introduction
The word ‘coronary’ is derived from a Latin word. It refers to a crown like arrangement of all coronary arteries as they encircle the heart in the atrioventricular sulcus. Anomalous coronary ostia are very rare anomalies detected in a small population.

According to the World Health Organization (WHO), coronary heart diseases constitute the main cause of death in the industrial world. The main risk factors are lipid disorders, hypertension, diabetes, obesity, lack of physical activities and other disorders which cause functional impairment and damage to vascular cells. But, the risk factors don’t explain the local distribution of atherosclerotic lesions. The pattern of this distribution corresponds to zones of disturbed flow with vortex formations and low velocity flow in coronary arteries. The anatomical details and pathophysiological patterns of most coronary artery anomalies are presently well known. On the contrary, few data exist on the clinical relevance of the variation of different coronary arteries, which necessitate a proper management and follow up protocol.

Certain authors proposed that coronary arterial patterns are not fully established at the time of birth. The fact that human adult heart has a higher incidence of existence of multiple ortifices than human foetal heart, suggested that these ostia may have developed after birth.

Considering the significance of the knowledge of the coronary arterial pattern in cardiac surgeries and keeping in mind the ever evolving and yet unexplored facets of this subject, the present study was undertaken to shed more light on this topic.

Normally, the anterior aortic sinus shows the presence of one ostium of origin of the right coronary artery and the left posterior aortic sinus shows the presence of one ostium of the left coronary artery.

The present study reports the anomalous origin of multiple coronary arteries from anomalous coronary ostia and shows light on their clinical significance.

Material and Methods

The study was carried out in the Department of Anatomy, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha. A total of thirty hearts were obtained from the cadavers of adult individuals of both sexes, aged between 17-60 years. First the hearts were fixed in 10% formalin.

Dissections conducted on the heart included the removal of the epicardium and subepicardial adipose tissue and the tracing of each artery. The dissections of the ascending aorta were done and the origin of the coronary arteries was observed minutely. The ascending aorta was transversally sectioned approximately 1 cm above the commissures of the aortic leaflets. After that, the aorta was longitudinally opened at the level of the posterior aortic sinus (non coronary sinus) to enable the visualization and analysis of the right and left aortic leaflets and their respective coronary ostia. Then, the courses of coronary arteries arising from the anomalous ostia were traced minutely with the help of fine forceps. The most representative preparations were photographed.

Aims And Objective
The present study was aimed:
1. To study the number of coronary ostia.
2. To study the courses of the coronary arteries arising from the anomalous ostia.
3. To study the clinical significance of the anomalous coronary ostia.

Observation And Results
In the present study of 30 hearts, the following observations were recorded and presented under the following headings:
1. The site of ostia
2. The number of ostia
3., Arteries arising from the anaomalous ostia

1. Site of ostia
Normally the right coronary artery arises from the right aortic sinus and the left coronary artery from the left posterior aortic sinus.
In the present study, ostia for the left coronary artery in all 30 hearts were observed to be situated in the left posterior aortic sinus region.
In right coronary artery, ostia was seen originating in relation to the anterior aortic sinus or the sinuaortic junction in all the cases.

2. No of ostia
Out of 30 hearts, 5 hearts showed more than one ostium in the anterior aortic sinus region.

(a)Two ostia : Two specimens showed two ostia in the anterior aortic sinus, one for the right coronary artery and one for the right conus artery, respectively (Table/Fig 1).The right conus artery, arising separately from the anterior aortic sinus, is also called as the third coronary artery. (b)Three ostia: Three specimens had 3 separate ostia in the anterior aortic sinus. They were for the right contrary artery, the right conus artery and a vasa vasorum to the pulmonary trunk, respectively (Table/Fig 2).

Discussion

arteries and the presence of multiple anomalous ostia are rare and could cause certain clinical consequences. When multiple ostia are observed in the anterior aortic sinus, the most common variation observed is an accessory orifice for the right conus artery. The 3rd coronary artery usually forms an anastomosis with the likewise branch of the left coronary artery. This anastomosis lies on the distal part of the pulmonary trunk and is known as the “vieussens arterial ring”. The functional significance of this anastomosis is still under question. However, several authors have proposed that it functions as an important collateral path between the right and left coronary arteries (Table/Fig 3).

The following (Table/Fig 4) reports the incidence of the 3rd coronary artery, as reported by various authors and compared it with the present study.

Several authors have reported multiple supernumerary ostia in the anterior aortic sinus.

The following (Table/Fig 5) shows the anomalous origins of different arteries from the aortic and pulmonary sinuses as reported by different authors and compared them with the present study.


The Importance Of The Anomalous Origin Of Arteries
1. During open heart surgeries, it is very difficult to cannaulate these vessels which arise from the anomalous ostia.
2. While performing coronary arteriography and angiography, a preliminary aortic root injection of the dye must be given to locate the exact no. of orifices and coronary arteries so that fatal outcomes can be prevented.
3. The multiple coronary ostia may be associated with cardiac abnormalities like hypertrophic cardiomyopathy and are rarely associated with congenital coronary anomalies.
4. The knowledge of the existence of such multiple ostia is important to correctly interprete the angiographic findings.
]
The presence of multiple ostia has not been associated with clinical symptoms as reported in literature.

To confirm the clinical association between anomalous ostia and pathophysiological conditions, this correlation needs to be studied in live subjects who are investigated for multiple ostia by non invasive techniques like computed tomography. Individuals who are detected to be having multiple ostia should be followed up regularly to watch out for any related symptoms of angina, myocardial infarction, left ventricular dysfunction, etc. Although this process would be very expensive, impracticable and time consuming, it will eliminate any selection bias associated with cardiac patients and help to confirm any association between the presence of multiple ostia and clinical symptoms.

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