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

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Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




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Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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On Sep 2018




Prof. Somashekhar Nimbalkar

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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

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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

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Professor and Head
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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




Dr. C.S. Ramesh Babu
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Best regards,
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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

Original article / research
Year : 2011 | Month : June | Volume : 5 | Issue : 3 | Page : 559 - 560

Myeloma in the Young

GARIMA GOEL, SHARADA RAI, ASTHA GUPTA, RAMDAS NAIK,POORNIMA BALIGA

Department of Pathology, Kasturba Medical College Mangalore, Karnataka, India

Correspondence Address :
Dr Garima Goel, MBBS, MD
Assistant Professor, Department of Pathology
Kasturba Medical College, Light house Hill Road, Mangalore
Karnataka 575001, India
Email: drgarima_80@yahoo.co.in; Phone: +919650333630

Abstract

Introduction: Multiple myeloma (MM) is a neoplastic plasma cell proliferation involving the bone marrow and extraosseous tissues which usually occurs in the elderly, (aged, 60 to 70 years), while patients younger than 30 or 40 years account for only 0.3 and 2.2 %,of all myelomas, respectively.

Materials and Methods: The present study analyzed 7 patients younger than 40 years among 87 patients of MM who presentedto our hospital from 2005 to 2008. Complete diagnostic workup was carried out for all the patients.

Results: The youngest of the 7 patients included in the study was a 30 year old female. All the patients had marrow involvement by neoplastic plasma cells.

Conclusion: The survival of patients younger than 40years with MM is longer than observed in other series of patients of all ages with MM.

Keywords

Multiple myeloma, Young adults, Survival

How to cite this article :

GARIMA GOEL, SHARADA RAI, ASTHA GUPTA, RAMDAS NAIK,POORNIMA BALIGA. MYELOMA IN THE YOUNG. Journal of Clinical and Diagnostic Research [serial online] 2011 June [cited: 2019 Aug 22 ]; 5:559-560. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=June&volume=5&issue=3&page=559-560&id=1395

Multiple myeloma (MM) is a malignant disorder of the plasma cells that accounts for about 1% of all the malignant disorders (1). MM is a disease of the elderly, with a peak age incidence between 60-70 years. The occurrence of MM in patients who are younger than 40 years is rare, the frequency being only 2.2% (1), (2). Adolescents and very young adults may have a atypical clinical presentation and an indolent course with prolonged survival (3). In this study, we have analyzed the characteristics of 7 patients who were younger than 40 years, with MM, from a single institution. The purpose of this study was to describe the presenting clinical and laboratory features and to analyze the response to therapy and survival in patients with MM, who were younger than 40 years.

Material and Methods

We analyzed 7 patients of MM who were younger than 40 years among 87 patients of multiple myeloma, who presented to our hospital from 2005 to 2008. A complete diagnostic workup was carried out for all the patients. The diagnosis of MM was based on the Salmon and Durie criteria (4).

Results

Seven patients who were younger than 40 years were reviewed from 87 cases of multiple myeloma, who were diagnosed at ourhospital from 2005 to 2008. The youngest of these was a 30 year old female. The clinical and laboratory data of our 7 patients is given in (Table/Fig 1) and (Table/Fig 2). All the patients had marrow involvement by neoplastic plasma cells. The major criteria (>30%) was fulfilled in 5 patients and the minor criteria (10-30%) in 2 patients. All the patients showed the ‘M’ band in the serum electrophoresis, except for case 2. However, none of the patients showed Bence Jones proteins in the urine. Five of the 7 patients presented with a history of backache, one patient with generalized weakness and one with bony tenderness over the anterior chest wall. Two of the 7 patients had impaired renal function (creatinine ≥ 2 mg/dl) and 5 had a haemoglobin level which was less than 11gm% at diagnosis. All patients had radiological involvement in the form of lytic lesions in the bone, except for case 4, which showed only osteoporotic changes, whereas case 5 showed the presence of pathological fractures along with the lytic lesions. Five patients had stage II (A, 4 patients: B, one patient) and the remainder had stage III (both A) disease. Three out of 7 patients developed extramedullary plasmacytoma during the course of the disease.

All, but 2 of the 7 patients were treated with a combination chemotherapy regimen of VAD (Vincristine, Adriamycin and High dose Dexamethasone). Two patients were lost to follow up before the initiation of therapy. At the time of the analysis, two of the sevenpatients (Cases 1 and 2) had died, 3 were alive with a median survival of 38 months and the remaining 2 patients were lost to follow up.

Discussion

MM is a malignant disorder which is characterized by the proliferation of monoclonal plasma cells.(1),(3) The peak incidence of MM is in the seventh decade, whereas, it is a rare entity in young patients, with less than 2% cases occurring in patients under the age of 40 years and it is still rarer in patients who are younger than 30 years (1), (5). A study of 3815 cases of MM by the National Cancer Institute showed that the frequency of such an occurrence was 7/3815 ie; 0.18%.6 Whereas, Hewell et al in their study, have reported the frequency to be 1%.7 In our study, the frequency of MM in patients who were younger than 40 years was found to be 8%. The increased frequency might be due to a smaller sample size as compared to that of other studies.

In various studies which were done in the past, the presenting clinical and laboratory features such as bone pain, weakness and fatigue and infection were similar to those which were observed in older patients (6). Renal function impairment is a well known complication of MM. A Mayo clinic analysis revealed renal function impairment and hypercalcaemia in 30% and 20% of the patients, respectively (3). In our subjects however, there was no evidence of hypercalcaemia, but 2 out of 7 patients (14%) showed renal impairment.

Various studies which were done in the past, suggested the association of the extramedullary component in most of these patients. Blade et al and Geetha et al in their respective studies, described the increased association of extramedullary plasmacytoma with bone marrow plasmacytosis in patients of MM who were younger than 40 years (2),(6). In our study, 3 out of 7 cases developed extramedullary plasmacytomas during the course of the disease.

The treatment for young patients with multiple myeloma was similar to that which was used for the elderly patients. The literature shows that both radiotherapy and chemotherapy have been used for the management of such patients (1).

The median duration of survival of the patients with MM in all the age groups usually ranges between 2-3 years.3 Blade et al, in their study on 72 patients, found that the median survival was 54 months in younger patients with MM, which was clearly longer than that which was usually seen in patients with MM (6)(7)(8). In our study, out of the 4 patients for whom the follow up was available, 2 were found to be alive and responding well to combination chemotherapy at the time of analysis. The median survival was found to be 38 months in the present study. Thus, the occurrence of myeloma in younger individuals does not appear to impart a worse prognosis or survival.

Conclusion

The presenting clinical and laboratory features and the response to therapy by patients who were younger than 40 years with MM, are similar to those which are observed in other myeloma series. However, the survival of such patients is longer than that which is observed in other series of patients of all ages with MM. Therefore, we can presume that age does have some beneficial effect on the natural history and the course of the disease.

References

1.
Kapoor R, Bansal M, Sastri GJ, Sandhu MS, Garg M et al. Clinical spectrum and prognosis of multiple myeloma in patients younger than 30 years: Is it different from elderly? JK Science 2006; 8(4): 225-28.
2.
Geetha N, Jayaprakash M, Rekhanair A, Ramachandran K, Rajan B. Plasma cell neoplasms in the young. Br J Radiol 1999; 72(862): 1012-15.
3.
Blade J, Kyle RA, Greipp PR. Multiple myeloma in patients younger than 30 years: Report of 10 cases and review of literature. Arch Intern Med 1996; 156: 1463-68.
4.
Durie BGM, Salmon SE. Multiple myeloma, macroglobulinemia and monoclonal gammopathies. In : Hofbrand AV, Brain MC, Hirsh J. (eds). Recent Advances in Haematology. Churchill-Livingstone, Edinbrugh. 1977, 243.
5.
Ishida T, Dorfman HD. Plasma cell myeloma in unusually young patients: a report of two cases and review of literature. Skeletal Radiol 1995; 24: 47-51.
6.
Blade J, Kyle RA, Greipp PR. Presenting features and prognosis in 72 patients with multiple myeloma who were younger than 40 years. Br J Hematol 1996; 93: 345-51.
7.
Hewell GM, Alexanian R. Multiple myeloma in young persons. Ann Intern Med 1976; 84: 441-43.
8.
Ludwig H, Durie BG, Bolejack V, Turesson I, Kyle RA, Blade J et al. Myeloma in patients younger than age 50 years presents with more favorable features and shows better survival: an analysis of 10 549 patients from the International Myeloma Working Group. Blood 2008; 111: 4039-47.

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