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

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Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
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Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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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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On Sep 2018




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Calcutta National Medical College & Hospital , Kolkata




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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,
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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.
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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 : October | Volume : 5 | Issue : 5 | Page : 974 - 977

Morphometric Study of Spleen in North Indian Adult Population: CT Scan Image Based Study

Adil Asghar, Shagufta Naaz, Dushyant Agrawa l, P.K. Sharma

Assistant professor, Dept. Of Anatomy, RMCH, Bareilly, India. Assistant professor, Dept. Of Anaesthsiology, RMCH, Bareilly, India. Assistant professor, Dept of Anatomy, LLRMC, Meerut, India. Professor, Dept. Of Anatomy, KGMU, Lucknow, India.

Correspondence Address :
Adil Asghar, Flat No-31 Faculty residence,
RohilKhand Medical College Bareilly Campus, Bareilly,
Uttar Pradesh-243006 (India)
Phone: 09760108646, 09319772935,09258167641
E-mail: dr_adilasghar2003@yahoo.co.in

Abstract

Introduction : A prospective study was done on 126 patients (72 male and 54 female) whose abdominal CT scan was found normal and no disorder was diagnosed which alters the size of spleen to estimate normal linear dimensions of spleen in North Indian adult population.

Material & Methods : Collected CT scan were evaluated with the help of Able 3-D doctor software. Body habitus of patients were determined. All linear dimension of spleen – length, width and thickness were calculated and they were analysed with body habitus – Age, height, weight,BSA (body surface area) and BMI (body mass index) was calculated by linear and non-linear regression model to know exact pattern of correlation.

Result : The mean length, width and thickness of spleen were 10.67±1.62 cm, 6.26±1.66 cm and 4.86±1.22 cm respectively.

Conclusion : All linear splenic dimensions have significant positive correlation with height of patients and normative data can be produced with the help of regression formula developed with the help of statistics which can be used as research tool where objective determination of splenomegaly is required.

Keywords

Spleen, Height, CT-scan

Introduction
Spleen is a reticulo-endothelial and lymphoid organ and sometimes works as hemopoietic organ. Otherwise this organ is graveyard of RBCs. Spleen is enlarged in various clinical disorders e.g. infection, metabolism or storage disorder and haematological abnormalities (1),(2). Spleen is never palpable till it is enlarged two-three times of its own size (3). There are many modes of investigation to identify the enlarged spleen e.g. – plane radiograph, sonography, computed tomography, MRI and radionuclide scan. Out of these modalities sonography and computed tomography are most reliable for intraabdominal organs (4). Various studies were done by sonography to study the linear dimension of spleen – length, width, and thickness. But CT-based linear dimension are still unavailable. Unfortunately, dimensions determined by 2-D USG are limited predominantly by the variable, irregular contour of spleen but also by the difficulty in completely scanning the entire organ or visualizing complete contours as because of the presence of overlying structures such as bone, bowel gas or kidney (5). CT imaging is more accurate than ultrasonography because this drawback is not seen with computed tomography (6), (7), (8).

Our study was aimed to give CT-based linear dimension of spleen in North Indian adult population which was missing till date and to generate the normative data. India is a malarial endemic zone and its presence in this large geographical area, makes it difficult to get normal data due to splenomegaly. We tried here to observe the correlation of linear dimension of spleen with body habitus.

Material and Methods

CT scans of 126 patients (72 male and 54 female) were used to measure the volume of spleen. The age of patients ranged from 20 to 70 yrs (55.33 ± 17.2yrs) (Table/Fig 1). The data was collected from December 2006 to April 2009 with permission of Department of Radio-diagnosis, KGMU Lucknow and informed consent taken from each patient. CT scans were obtained for various clinical indications like follow-up of abdominal trauma, abdominal pain and in a case to exclude an abdominal mass or adenopathy. The patient’s body weight and height at or near the time of the CT examination were recorded. Spleen axial and cross sectional image were obtained by CT Helical instrument. The technical parameters were 120 kV potential, 120 mA current, 10mm slice width with identical reconstruction index and a rotation time of 1.5 secs. The medical records of all patients were reviewed. Patients whose spleens appeared abnormal on CT scans were excluded. Additionally, any patients who had clinical, biochemical or imaging evidence of conditions that could affect the size of the spleen, haematological disorders, abdominal malignancies, infection and portal hypertension, splenic trauma, cyst, and autoimmune diseases were excluded from the study.

CT-scan dicom images of each patient were observed in Able- 3D-doctor software. Spleen was identified in each cross section and longitudinal section of CT-scan images. The length of spleen was recorded in longitudinal section along 10th rib in cephalocaudal direction (Table/Fig 2). Width of spleen was also recordedin longitudinal direction (Table/Fig 3) and thickness measured in cross-section image (Table/Fig 4). All dimensions were recorded maximum appreciated in sections for better accuracy.

Statistical analysis
All statistics were generated by SPSS version 10.The student t-test was used for comparison of means. p<0.05 was considered significant for comparison of means and for regression analysis. Association between splenic dimensions and physical standards of patients was assessed with the Pearson correlation coefficient; to identify the exact pattern of relationship, non-linear regression as well as linear regression was applied. Multiple regression analysis was applied in backward stepwise fashion to test the independent effect of all physical standards on splenic parameters.

Results

The average ages of male and female patients were 57.33 ± 12.94 years and 54 ± 13.32 years respectively. Mean weight and height in male and female were 65.8 ± 7.2 kg, 165.34 ± 7.4 cm and 59.22 ± 8.31 kg and157.2 ± 8.3 cm respectively. No significant difference of physical standards was found in both sexes (Table/Fig 1). The mean splenic dimensions were 10.67 ± 1.62 cm in length, 6.26 ± 1.66 cm in width, 4.86 ± 1.22 cm in thickness (Table/Fig 5).

Discussion

Frank et al used conventional sonography to evaluate 793 healthy patients (17-82yrs.) and found out that 95% of patients had splenic length <11cm, width<7cm and thickness <5cm (9). Niederau et al studied 915 healthy subjects using sonography and found that mean longitudinal and transverse diameter of spleen to be 5.8 ± 1.8 cm and 5.5 ± 1.4 cm respectively. These dimensions were muchsmaller than other studies because author did not measure the maximum dimension (10). Picardi et al. found mean longitudinal dimension of spleen ranged from 8 to 11 cm (median: 9.5 cm)(11). Mittal et al. performed pilot study of normal measurement of spleen by ultrasonography on Rajasthani population and found average length of spleen 9.40 ± 0.91 cm in males and 9.34 ± 0.95 cm in females(12). In older subjects they found mean length of spleen 9.64 ± 0.64 cm. Spielmann et al, average length of spleen was found to be 11.4 ± 1.7 cm in males and 10.3 ± 1.3 cm in females (13). Konus et al. found mean longitudinal dimension: 10.1 ± 1.03 cm(14). In our study mean splenic length in North Indian population was 10.67 ± 1.62 cm (female: 10.34 ± 1.58 and male 10.91 ± 1.67 cm, p>0.05). Mittal et al. measured average width of spleen in male as well as female 3.45 ± 0.59 cm and 3.59 ± 0.55 cm respectively. Average width of spleen measured by Spielmann was 5.0 ± 0.8 in males and 4.2 ± 0.7 cm in females. In our study mean width of spleen 6.26 ± 1.66 cm (male: 9.74 ± 1.62 cm and female 5.61 ± 1.58 cm, p>0.05) and mean thickness of spleen 4.86 ± 1.22cm (female: 4.70 ± 1.19 cm and male: 4.97 ± 1.29 cm, p>0.05). All these dimension of spleen are best correlated with height of the patients [Scatter Plot-1, 2, 3]. Age of person had significant negative correlation with cephalo-caudal length of spleen but rest of splenic dimension did not have significant correlation with age (Table/Fig 6).

Conclusion

Finally we conclude that the length, width and thickness of spleen are correlated with height and age (20-70 yrs). Dimensions of spleen measured by ultrasonography were slightly less than the CT-measurements most probably because of overlapping of ribs or bowel gas. Difference may arise due to maximum dimension taken into consideration.

All dimensions of spleen have significant positive correlation with height but length of spleen (cephalo-caudal) has significant negative correlation with age. Other splenic dimensions – width and thickness does not have significant correlation with age.

References

1.
Kardel T, Holm HH, Rasmussen SN: Ultrasonic determination of liver and spleen volumes. Scand J clin lab Invest (1971); 27:123.
2.
Rosenberg HK, Morkowitz RI, Kolberg H, Park C, Hubbard A, Bellah RD: Normal splenic size in infants and children: sonographic measurements. AJR (1991); 157:119-121.
3.
De Odorico I, Spaulding KA, Pretorius DH, Lev-Toaff AS, Baily TB and Nelson TR et al.: Normal splenic volumes estimated using three dimensional ultrasonography. J ultrasound Med (1999); 18:231-236.
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Prassopoulos P, Daskalogiannaki M, Raissaki M, Hatjidakis N, Gourtsoyiannis N: Determination of normal splenic volume on computed tomography in relation to age, gender and body habitus. Eur. Radiol. (1997); 7:246-48.
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Ishibashi H, Higuchi N, Shimamura R, et al: Sonographic assessment and grading of spleen size. J clin ultrasound (1991); 19:21.
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Brieman RS, Beck JW, Korobin M: Volume determinations using computed tomography. AJR (1982); 138:329.
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Lamb PM, Lund A., Kanagasabay RR, Martin A, webb JA and Reznek RH et al.: Spleen size: How well do linear ultrasound measurements correlate with three dimension CT volume assessments? Br J Radiol. (2002); 75:573-77.
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Yetter EM, Acosta KB, Olson MC and Blundell K: Estimating splenic volume: sonographic measurements correlated with helical CT determination. (2003); 181:1615-20.
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Frank K, Linhart P, Kortsik C: Sonography milzgroben bestimmung: Normal mabe beim milzgesunden Erwachsenen (English abstract). Ultraschall Med (1986); 7:134.
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Niederau C, Sonnenberg A, Jurgen E, Muller TS, Wolf P: Sonographic measurement of normal liver, spleen, pancreas and portal vein. Radiology (1983); 149:537-40.
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Picardi M, Martinelli V, Ciancia R, Morante R, Sodano A, Fortunato G, Rotoli B: Measurement of spleen volume by ultrasound scanning in patients with thrombocytosis: a prospective study. (2002); 99(11):4228-30.
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Mittal R, Chowdhary DS: A Pilot study of the normal measurements of the liver and spleen by ultrasonography in Rajasthani population. Journal of clinical and diagnostic research. (2010); 4: 2733-36.
13.
Spielmann AL, Delong DM and Kliewer MA: Sonographic evaluation of spleen size in all tall healthy atheletes. AJR (2005); 184:45-49.
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Konus OL, Ozdemir A, Akkaya A, Erbas G, Celik H, Isik S.: Normal liver, spleen and kidney dimensions in neonates, infants and children: evaluation with sonography. Am J Roentgenol. (1998); 171: 1693-98.

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