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

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Dr Bhanu K Bhakhri

"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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Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
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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."



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




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"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
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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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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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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




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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.
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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 ones 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 journalsNo manuscriptsNo 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

Case report
Year : 2010 | Month : December | Volume : 4 | Issue : 6 | Page : 3573 - 3576

Pure Primary Intraosseous Meningioma: A Case Report And Review Of Literature

SUSHILA JAISWAL ,AWADESH KUMAR JAISWAL*, SANJAY BEHARI *, RAKESH PANDEY

*Department of Pathology and Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, INDIA-226014.

Correspondence Address :
Dr. Sushila Jaiswal, MD,
Assistant Professor, Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences,
Rae Bareli Road, Lucknow 226014 UP, India
FAX: 91-522-2668078,2668017
Telephone: 91-522-2668700 extension 2107, 2741, Mobile: +919450904700
Email: sushilapath@yahoo.com

Abstract

A 60 year old lady presented with progressive increasing swelling over the scalp for 1 year and mild headache for 2 months. Examination revealed a non tender bony hard mass over the left parietal region. CT scan showed localized hyperostosis and thickening of the left parietal bone, with normal underlying brain parenchyma. The mass was surgically excised. Histopathology was suggestive of meningothelial meningioma. The case is discussed in the light of relevant literature.

Keywords

Calvarial, extradural, intraosseous, meningioma

INTRODUCTION
Primary intraosseous meningioma is a term which is used for extradural meningiomas that arises in the bones (1). It accounts for approximately fewer than 2% of meningiomas over all and two thirds of all extradural meningiomas (2). The authors present here, a case of rare primary calvarial meningioma and review of the relevant literature.

Case Report

A 60 year old lady presented to us with the history of progressive increasing swelling over the scalp for 1 year and mild headache for 2 months. There was no history of seizure, severe headache or vomiting. Her neurological examination was unremarkable. Local examination revealed a non tender bony hard mass over the left parietal region. The overlying skin was freely mobile. CT scan showed localized hyperostosis and thickening of the left parietal bone, with normal underlying brain parenchyma ((Table/Fig 1) and (Table/Fig 2)).
The patient was operated and excision of the involved bone was performed. Intra-operatively, the tumour was completely confined in the involved bone and was soft and vascular. It was neither attached with The patient was operated and excision of the involved bone was performed. Intra-operatively, the tumour was completely confined in the involved bone and was soft and vascular. It was neither attached with the underlying dura nor with the overlying scalp tissue. Histopathology showed fibrocollagenous and bony tissue which was infiltrated by a tumour and composed of sheets, nests and whorls of polygonal cells, displaying mildly anisomorphic nuclei with clumped chromatin, conspicuous nucleoli in places and moderate amount of eosinophilic cytoplasm with indistinct cytoplasmic borders. No glial tissue or features of malignancy were noted. These features were suggestive of intraosseous meningothelial meningioma (Table/Fig 3). The patient was discharged on the 7th post operative day and at a follow up after 19 months, she was found to be symptom free and did not have any radiological recurrence (Table/Fig 4). During follow up, she was advised cranioplasty, but she refused any further procedure.

Discussion

Meningiomas are of two types depending on the site of involvement. Primary intradural lesions which are located in the subdural, intracranial or intraspinal space and primary extradural meningiomas which arise in sites other than the subdura e.g. nasal cavity, paranasal sinuses, skin, orbit, calvaria (3),(4), neck (5),(6), parotid gland (7), mediastinum (8), lung (9) and even in the fingers (10). These are also known as ectopic, secondary, extracalvarial (if located outside the calvaria), cutaneous, extracranial, primary extraneuraxial and extradural meningiomas (5),(11),(12). Extradural meningiomas that arise in the skull have been referred to as calvarial, intradiploic and intraosseous (13). Primary extradural meningiomas are different from primary intradural meningiomas in that they may have secondary extracranial extensions and/or they may have metastasized. Yilmaz et al reported a case of frontal primary osteolytic introsseous meningioma in a 41 year old male (14). Sheikhrezaie et al described a case of primary introsseous osteolytic meningioma in the fronto-parietal region in a 62 year old male (15). Pure primary intraosseous localization without underlying dural involvement is very rare (16),(17). Our case is an example of pure primary intraosseous meningioma, which neither had any infiltration or attachment with the underlying dura nor with the scalp tissueA comparison between extradural and intradural meningiomas is summerised in (Table/Fig 5) (5).

Lang et al classifed extradural meningiomas, based on their position with respect to the cranium. Type I tumours included lesions that were purely extracalvarial, with no attachment to the bone. Type II tumours were purely calvarial, being located entirely within the bone of the skull. Type III tumours corresponded to the calvarial tumours with extracalvarial extension; in other words, a tumour that is located within the skull but also having a soft-tissue component that is extended extracranially. Type II and type III tumours were subdivided into the skull base (B) or convexity (C) tumours (5). Our case was an example of type II tumour.calvarial, being located entirely within the bone of the skull. the nasal cavity or the sinuses Type III tumours corresponded to the calvarial tumours with extracalvarial extension; in other words, a tumour that is located within the skull but also having a soft-tissue component that is extended extracranially. Type II and type III tumours were subdivided into the skull base (B) or convexity (C) tumours (5). Our case was an example of type II tumour.

The convexity and the skull base are the two primary locations for intraosseous meningiomas. Like many intracranial lesions, the clinical presentation and differential diagnosis depend largely on the size and location of the lesion. Convexity intraosseous meningiomas most commonly present as slowly growing scalp masses, with a possible relationship to a cranial suture (19). The common locations include the periorbital region and the frontoparietal region (20). These are typically firm and painless, with normal overlying skin and may bedetected incidentally (12). The neurological signs and symptoms are usually absent in the patients; however, the presenting symptoms such as neurological deficit, seizures, vomiting, dizziness, hearing loss, tinnitus, headache and vague sensations in the head have also been reported (22),(23),(24). These symptoms may be present for months or years prior to the diagnosis. Like their convexity counterparts, skull base intraosseous meningiomas are usually slow- growing and painless. Their location, however, may cause different symptoms than the convexity lesions for months to years prior to the diagnosis (25). These symptoms may include cranial nerve deficits such as ophthalmoplegia or visual field problems, or the signs and symptoms which are related to mass effects such as proptosis or deformity (25). The associated findings on ophthalmological examination may include conjunctival oedema and optic atrophy. The lesions involving may present with nasal obstruction or epistaxis (5). Azar-Kia, et al. postulated that calvarial meningiomas arise from meningocytes that are trapped in the cranial sutures during head molding at birth (18).

The microscopic features of intraosseous meningiomas are similar to that of convential meningiomas i.e arranged in sheets and forming whorls and psammoma bodies. The cells are polygonal with central nuclei, often containing empty looking vacuoles and homogenous cytoplasm (17). The bone appears normal, with replacement of the marrow by fat, fibrosis and tumour cells. Few case reports on intraosseous meningiomas revealed meningotheliomatous meningiomas (22),(24),(26),(27) and also the microcystic (27), psammomatous (28), transitional (25), chordoid, atypical, malignant and the fibroblastic types (29). The authors of one report reviewed 48 cases in the literature and found that the majority (30 cases, 62.5%) were of the meningothelial type; transitional (12 cases, 25%) was the next most common, followed by fibroblastic (4 cases, 8.3%), psammomatous (1 case, 2.1%) and malignant (1 case, 2.1%) (24). Like intradural meningiomas, the tumour cells of intraosseous meningiomas are usually positive for vimentin and epithelial membrane antigen, but are negative for desmin, cytokeratin, and glial fibrillary acidic protein (24),(30). The tumour cells may show positive staining for the S100 protein (30). In another report, the (MIB-1) staining index was found to be 2.4%, suggesting a low proliferative potential (24).

Recent studies indicate that intraosseous meningiomas have a higher incidence of malignant features than the intradural meningiomas (24),(30). These malignant features may be indicated by microscopic tumour invasion of the underlying dura or the overlying soft tissue structures (26). Other features which are possibly consistent with a more malignant subtype include increased mitotic activity, increased cellularity, atypia, papillary features, giant cells and focal areas of necrosis. Metastasis, although rare, also indicates a more malignant subtype. One report reviewed 65 published cases of intraosseous meningiomas which were assessed during the CT era and found that 17 (26%) had atypical or malignant histological features (5). Osteolytic lesions, although they are a more rare form of intraosseous meningiomas, have a higher likelihood of atypical or malignant features as compared to the osteoblastic tumours. In our case, there was no evidence of malignancy and also, the patient was disease free after 19 months of treatment.

The treatment for intraosseous meningiomas is the total excision of the involved bones. Cranioplasty may be performed simultaneously or at a later date. Our patient underwent complete surgical excision of the tumour. Cranioplasty was advised during follow up, which she refused.


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