Article in PDF
How to Cite
Citation Manager
Readers' Comments (0)
Audio Visual Article Statistics
Link
to PUBMED
Print this Article
Send to a Friend
Advertisers
Access Statistics Resources
Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Prevalence of Thyroid Dysfunction in Patients with Gallstone Disease: A Cross-sectional Study
Correspondence Address :
Dr. Chinmay Dangi,
217, Subhash Nagar, Near New Passport Office, Udaipur-313004, Rajasthan, India.
E-mail: dangichinmay@gmail.com
Introduction: Patients with gallstone disease have already been investigated for the prevalence of previously undetected thyroid dysfunction, and the findings point to a possible link between hypothyroidism and gallstone disease. This research was carried out to support the need for assessment of the thyroid status in patients presenting with gallstones.
Aim: To determine the prevalence of thyroid disorders and to study the relationship between thyroid dysfunction and sociodemographic variables in patients with gallstone disease.
Materials and Methods: A cross-sectional, observational, hospital-based study was carried out at Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India, in 117 patients with gallstones from January 2021 to June 2022. The sampling method was consecutive sampling. Standard baseline investigations and thyroid profiles were conducted. Operative and perioperative factors such as age (ranging from 18-80 years), sex, co-morbidities, radiological findings (number and size of stones, presence of Common Bile Duct (CBD) stones), thyroid profile, surgeries performed, and significance (p-value) of these factors were assessed based on the Chi-square test.
Results: The mean age of participants was 44 years. There were 37 (68%) males and 80 (32%) females. Of the 117 patients, 49 patients (41.9%) were found to have hypothyroidism, and the remaining 68 patients (58.1%) were euthyroid. Among these 49 patients, only 15 were known to have hypothyroidism, while the remaining 34 patients were newly diagnosed. Of the 49 patients, 30 were females and 19 were males. There was no significant association between hypothyroid state and gallstone formation in either males (p-value: 0.154) or females (p-value: 0.194).
Conclusion: A low prevalence of hypothyroidism was observed in both sexes. Further large population studies are needed to compare these findings.
Choledocholithiasis, Cholelithiasis, Hypothyroidism, Sphincter of oddi dysfunction, Subclinical hypothyroidism
Cholelithiasis is one of the most encountered intra-abdominal pathologies for a general surgeon. The three main categories are cholesterol, pigment (black or brown), and mixed stones. In Western nations, 80% of stones are cholesterol or mixed, but in Asia, 80% of stones are pigment (1). The gallbladder may contain one or multiple stones. They form because of changes in the normal metabolism and transport of cholesterol through the hepatobiliary system (2). The supersaturation of cholesterol in bile during the nucleation process has been emphasised as a key phase in the formation of gallstones in several research studies conducted in the West to discover risk factors for gallstones (3). Among adults, thyroid diseases are a common medical condition. There has been debate over the past 10 years as to whether thyroid conditions can result in the formation of stones in the hepatobiliary system. A study has suggested that dysfunction of the thyroid gland and the pathophysiology of lipids are related, tending to modify the contents of bile (2). Studies by Raghuvanshi BS et al., Laukkarinen J et al., Tombisana S et al., have also shown that hypothyroid patients have decreased biliary flow due to hypomotility (1),(3),(4). Patients with gallstone disease have already been investigated for the prevalence of previously undetected thyroid dysfunction, and the findings point to a possible link between hypothyroidism and gallstone disease. The diagnosis and treatment of people with gallstones may be impacted if there is a higher prevalence of thyroid dysfunction (1),(5),(6),(7),(8). Therefore, this research study was conducted to determine the prevalence of thyroid disorders in patients with gallstone disease.
This cross-sectional, observational study was conducted at Department of General Surgery, Geetanjali Medical College and Hospital, Udaipur, India, on 117 patients from January 2021 to June 2022, after obtaining approval from the Institutional HREC (vide approval no. 2021/1879 dtd. 1/2/2021). Written informed consent was taken from patients or their guardians before proceeding with the study.
Inclusion criteria: Patients in the age group of 18-80 years, patients with the radiological finding of gallstone disease,patients with controlled co-morbid conditions (diabetes mellitus, hypertension) were included in the study.
Exclusion criteria: Patients with previous history of thyroid surgery and taking thyroid replacement for treatment, stones in the pancreatic duct, patients with cholangitis, pregnant females, patients on drugs causing hypothyroidism: Amiodarone, Lithium, antidepressants, Phenytoin, Interferon, Imatinib, patients on drugs causing gallstones: Estrogen/OCPs, Fenofibrate, Gemfibrozil were excluded from the study.
Study Procedure
The sampling process was consecutive. After admitting patients with a radiological finding of gallstones, a thorough history was obtained, and a clinical examination was conducted. Standard baseline blood investigations, including lipid profiles and liver function tests (S. bilirubin total, direct, indirect), were performed. The disease process and potential management options were explained to patients/guardians. For analysis of the patient’s thyroid profile, a morning fasting blood sample was sent to the Biochemistry Laboratory in Geetanjali Hospital, Udaipur, and analysed using the Chemiluminescence method on the Vitros ECIQ instrument. The patients’ thyroid status, whether euthyroid, hypothyroid, or hyperthyroid, was noted. Patients with serum Thyroid Stimulating Hormone (TSH) levels between 0.5 and 4.9 mIU/L were considered normal. Subclinical hypothyroidism was defined as serum TSH levels between 5 and 10 mIU/L with normal T3 and T4 levels. TSH concentrations greater than 10 mIU/L were considered clinical hypothyroidism (9). The patient’s treatment plan, whether conservative or surgical, was chosen after a thorough review. The investigator immediately recorded all the information on the data collection sheets. Hypothyroidism was considered as the dependent variable. Independent variables that were considered included:
- Age (ranging from 18 years to 80 years),
- Sex (male or female),
- Co-morbidities (hypertension, diabetes),
- Ultrasound findings (number and size of stones, presence of CBD stones),
- Thyroid profile (T3, T4, TSH),
- Surgeries performed (laparoscopic/open cholecystectomy, CBD exploration).
Statistical Analysis
The Statistical Package for the Social Sciences (SPSS version 25.0) software was used for statistical analysis. The Chi-square test was applied for non parametric values, and a p-value of <0.05 was considered significant.
The selected patients’ ages ranged from 18 to 80 years. The mean age of the study population was 44±11.16 years, which was statistically not significant. There were 32% males and 68% female patients in this study (Table/Fig 1). The most common co-morbidity present was hypertension, seen in 15 (12.8%) patients (Table/Fig 2). Forty-nine patients (41.9%) were found to have hypothyroidism, and the remaining 68 patients (58.1%) were found to be euthyroid (Table/Fig 3). Only 15 of these individuals had known hypothyroidism, while the remaining 34 were newly diagnosed. Out of the 49 hypothyroid patients, 30 were female and 19 were male. The predominant age group was 40-49 years, with a mean age of 45 (±8.9) years (Table/Fig 4).
It was observed that 82 patients (70.1%) had multiple stones in their gallbladder 35 patients (29.9%) had a single stone in their gallbladder and eight patients had CBD stones. There was no significant association between hypothyroid state and gallstone formation in either males (p-value: 0.154) or females (p-value: 0.194).
In the assessment of thyroid profiles, the mean and standard deviation were found to be as follows for hypothyroid patients: T3 (2.544±1.051), T4 (6.323±2.33), and TSH (5.728±4.235) (Table/Fig 5).
Both laparoscopic and open treatments were used to handle the patients. Out of the 115 patients who underwent laparoscopic cholecystectomy, two patients had to be converted to an open operation due to bleeding, adhesions, and other intraoperative difficulties. Additionally, eight patients (6.8%) underwent CBD exploration along with cholecystectomy. Among all hypothyroid patients, one patient underwent open cholecystectomy, and 48 underwent laparoscopic cholecystectomy. Out of these 48 patients, five also underwent CBD exploration for managing CBD stones. The postoperative conditions were stable.
To assess the importance of thyroid dysfunction as a contributing factor and determine whether thyroid profile should be included in routine investigations for patients with gallstone disease, this study aimed to determine the prevalence of thyroid dysfunction in such patients. All 117 patients underwent a thyroid profile assessment, and it was found that 49 patients (41.9%) had hypothyroidism, which was statistically insignificant with a p-value of 0.194. The remaining 68 patients were found to be euthyroid.
Among these individuals, only 15 had a known diagnosis of hypothyroidism, while the remaining 34 were newly diagnosed. Out of the 49 patients with hypothyroidism, 30 were females and 19 were males, but the difference between the sexes was not statistically significant. This finding was consistent with studies conducted by Raghuvanshi BS et al., (24% prevalence) and Watali YZ et al., (14% prevalence) (1),(7).
In the study by Tombisana S et al., the highest number of patients with hypothyroidism belonged to the age group of 46-55 years, comprising 17 individuals (39.5%). The youngest patient was 21 years old. Among the 126 female patients in the same study, 29 (23.1%) had hypothyroidism, and 6 (4.7%) had hyperthyroidism. For male patients, 14 (18.9%) had hypothyroidism, and 3 (3.9%) had hyperthyroidism (4).
Another study by Laukkarinen J et al., reviewed multiple articles on the association (5). They found that in seven patients with diagnosed untreated hypothyroidism, the patients had low FT4 levels (4.5 pmol/L [3.8-6.4] vs 18.2 pmol/L [14.5-26.9]; p<0.001) and high TSH levels (75.6 pmol/L [41-180] vs 0.6 pmol/L [0.1-2.4]; p=0.002) compared to the euthyroid stage in gallstone patients. Their previous study also suggested a 7% prevalence in 2002 (10).
This suggests that thyroid dysfunction is associated with changes in bile composition and excretion rate, as well as changes in biliary emptying. These changes may be the probable causes for the increased prevalence of gallstones in hypothyroidism. This inference raises the possibility that changes in the Sphincter of Oddi’s function, rather than changes in cholesterol metabolism or bile excretion rate, may be the driving force behind the link between CBD stones and hypothyroidism (5).
A study conducted by Singh AK et al., showed hypothyroid disorders in 20% of male cholelithiasis patients, while euthyroid status was observed in 72.5%. Among female cholelithiasis patients, hypothyroid disorder was found in 14% and hyperthyroid disease in 7% (11).
In the thyroid profile assessment in present study, the mean and standard deviation were found to be as follows: T3 (2.544±1.051), T4 (6.323±2.33), and TSH (5.728±4.235), respectively. The mean TSH value for the predominant age group (40-49) was 6.81, and for the predominant gender (female) was 5.65.
In the study by Raghuvanshi BS et al., 12 out of 50 patients showed hypothyroidism characterised by increased TSH levels in their thyroid profile, with a prevalence rate of 24%. Another study conducted by Völzke H et al., showed that out of 385 people, 10.3% had low serum TSH levels, 88.6% had normal levels, and 1.1% had high levels. The analysis showed a higher percentage of cholelithiasis in males with low serum TSH levels. However, their investigation did not find direct evidence of a link between high blood TSH levels and gallstone disease in females (6).
A similar cross-sectional study conducted by Ghadhban BR and Abid FN found that out of the total number of patients, 8 (7.8%) had subclinical hypothyroidism, and 95 (92.2%) were euthyroid. The subclinical hypothyroid group showed a female gender predominance with 81.6%, while the prevalence among males was 18.4%. This study showed a gender-specific relationship to gallstone disease (12).
In patients with high TSH values, multiple stones were seen in 67.3% and 32.7% had a single stone in their gallbladder. Additionally, five patients had stones in the common bile duct. These findings are similar to the conclusions of the study by Laukkarinen J et al., which showed a high prevalence of subclinical hypothyroidism in CBD stone patients. Specifically, five out of eight patients with CBD stones had subclinical hypothyroidism (10).
Limitation(s)
The study duration was short, and the sample size was small. Previous studies by Raghuvanshi BS et al., Singh J, Laukkarinen J et al., and Vanderpump MP et al., have shown an increased prevalence of subclinical thyroid dysfunction in patients with choledocholithiasis and its potential correlation. However, due to small sample size in present study, the results were insufficient to make definitive conclusions. Further evaluation is needed to explore the association between choledocholithiasis and thyroid dysfunction, particularly in larger population studies (1),(8),(10),(13). Present study data was insufficient to comment on any association between changes in thyroid function and the postcholecystectomy patient status.
There was no significant association between hypothyroidism and gallstone formation in present study. The prevalence of hypothyroidism was low, suggesting no effect of thyroid dysfunction on the formation of gallstones. Further large population studies are needed to compare these findings and provide recommendations for screening and early diagnosis of subclinical hypothyroidism through regular TSH monitoring. Early treatment of subclinical hypothyroidism may help prevent the burden of cholelithiasis in this subgroup of patients.
DOI: 10.7860/JCDR/2023/63835.18510
Date of Submission: Mar 01, 2023
Date of Peer Review: May 18, 2023
Date of Acceptance: Jul 20, 2023
Date of Publishing: Oct 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 22, 2023
• Manual Googling: May 31, 2023
• iThenticate Software: Jul 18, 2023 (10%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com