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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
The Gamut of Renal Lesions on Autopsy: A Two-year Cross-sectional Study from North Eastern Odisha, India
Correspondence Address :
Dr. Pragyan Lisha Panda,
Plot 251, Sector 5, Niladrivihar Chandrasekharpur, Bhubaneswar-751021, Odisha, India.
E-mail: plpanda.panda@gmail.com
Introduction: Kidney diseases have shown a rising upward trend in the last few decades due to the increase in incidence of associated chronic diseases like diabetes, hypertension. However the frequency and spectrum of renal pathology in autopsy specimens is not well documented or overlooked by physicians as well as pathologists.
Aim: To analyse the spectrum of various types of renal pathologies, based on the histopathological analysis of renal tissue where autopsies were performed routinely with no history of renal diseases.
Materials and Methods: This cross-sectional study was carried out over a period of two years from June 2021 to June 2023 in the Department of Pathology of SCB Medical College and Hospital, Cuttack, Odisha, India, and consisted of 84 cases of well-preserved renal autopsies. The autopsy samples were routinely processed and stained by Haematoxylin and Eosin (H&E) and then reported. Special stain of Periodic Acid Schiff (PAS) was done. Gross and microscopic findings were studied. The study was compared with other relevant studies. The data was analysed using Microsoft Excel 2019.
Results: A total of 84 cases were included in the study. The male:female ratio was 1.27:1. The age group with the highest number of cases (35 cases) was 21-40 years. Among the 84 cases the commonest pathology was seen in tubules (40 cases, 47.62%) and glomeruli (7 cases, 8.33%), followed by vascular pathologies (5 cases, 5.95%) and interstitial lesions (4 cases, 4.76%). Renal cell carcinoma was incidentally detected in two cases and Wilms tumour in one case. Five cases had normal histology.
Conclusion: The study illuminates the various renal lesions on autopsy and showed tubular lesions were more common than glomerular lesions in renal autopsy. Renal lesions are more common in males. The focus should be to develop more effective diagnostic methods for renal lesions so that intervention can be fast and sharp resulting in less mortality.
Glomeruli, Renal cell carcinoma, Tubules, Wilms tumour
Autopsy is the most coveted legal procedure in all medicolegal deaths and is the gold standard for determining the cause of death. It is derived from the Greek word autopsia, means “to see for oneself”. It serves as an important tool for retrospective quality assessment of the clinical diagnosis and aids as an educational tool to the clinician (1). Sometimes the lesions are diagnosed at autopsy only as they do not cause any symptoms or functional changes in the patient.
Chronic Kidney Disease (CKD) is a major global public health problem with an estimated prevalence of 8-16% worldwide (2). Kidney disease is consistently reported as the 9th leading cause of death in the United States (3). Histopathologic evaluation of autopsy of kidneys may be the only opportunity to identify kidney diseases as usually kidney biopsy is avoided in critically ill patients. This is important as these findings may have implications for the surviving family members, particularly for kidney diseases with a gene involvement. The prevalence of kidney diseases is increasing as a consequence of the accumulation of multifactorial risk factors such as hypertension, diabetes, dyslipidaemia and obesity (4). Incidence of biopsy/autopsy proven cases of renal pathology in population varies in different parts of the world (5).
Autopsies in hospital deaths help to know about the complications occurring in intensive care unit and add to information about existing co-morbidities of the patient that could have resulted in death or affected the response to treatment. The spectrum of renal pathology in adult autopsies is very wide and it includes glomerulonephritis, acute tubular necrosis, chronic pyelonephritis, vasculitis, amyloidosis, diabetic nephropathy, thrombotic microangiopathy, light chain cast nephropathy, membranous nephropathy, focal segmental glomerulosclerosis, atheroembolic disease, infections like polyomavirus nephropathy, bile cast nephropathy, oxalosis, nephrocalcinosis, and urate nephropathy (6). This study was done to find out the spectrum of kidney diseases in autopsy specimens in the State and compare their distribution according to age, sex and histopathological findings. This study covers the North Eastern Odisha population which has not been done before.
This was a cross-sectional study carried out over a period of two years from June 2021 to June 2023 in the Department of Pathology of SCB Medical College and Hospital, Cuttack, Odisha, India. The kidneys of medicolegal autopsies performed during these years were included in the study after taking due approval from Institutional Ethics Committee (Ref. No.53/7th IEC Meeting).
Out of total 96 cases, 12 cases of autolysed tissues were excluded from the study and 84 cases of well-preserved renal medicolegal autopsies were included in the study to reduce false positive cases. Data pertaining to age, gender, Medicolegal case number, clinical and postmortem findings were recorded from deceased postmortem papers. Thorough gross examination including weight dimensions, colour was recorded and then tissue was fixed in 10% neutral buffered formalin. After processing in autoprocessor, H&E stain was done in autostainer and then mounted carefully. A minimum of two sections per kidney specimen were studied. One section to cover all the minute details in four compartments based on anatomical site namely, glomerular, tubular, interstitial, vascular and special stain like PAS was done on the other section. All the histological sections were examined microscopically by two experienced pathologists who were blinded and their findings were recorded. No interobserver variability was seen and the kappa value was 1.
Statistical Analysis
The data was collected and entered in a Microsoft Excel spreadsheet in tabulated form. Statistical parameters like the relative frequency of various renal lesions, the site of distribution and demographic data like the distribution of diseases with respect to age and sex were evaluated using Microsoft Excel 2019.
In the present study, males constituted 47 (55.95%) and females accounted for 37 (44.05%) cases. The male: female ratio was 1.27:1 (Table/Fig 1). Highest percentage of females (19 cases, 22.61%) was found in the 21-40 years age group and highest percentage of males (22 cases, 26.2%) in 41-60 years age group. Overall, the age group with the highest number of cases was 21- 40 years (35 cases, 41.67%) (Table/Fig 2). The youngest patient was eight-year-old and the oldest was 80-year-old. The most common cause of death in the study population was due to acute renal failure (21 cases, 25%) followed by acute myocardial infarction (15 cases,17.85%), congestive cardiac failure (14 cases,16.66%) and chronic renal failure (4 cases, 4.76%) (Table/Fig 3). The other causes of death were chronic pyelonephritis, lobar pneumonia, acute respiratory distress syndrome, adenocarcinoma lung, acute lung injury, malignant hypertension, aortic stenosis, haemolytic crisis, cirrhosis, rheumatic heart disease. The least common causes of death were acute pyelonephritis, dilated cardiomyopathy, hypertrophic obstructive cardiomyopathy, emphysema, bronchopneumonia, interstitial pneumonia, polycystic kidney disease, tuberculosis lung, septic abortion, hepatitis.
There were five cases without any remarkable pathology in kidney tissue. Congestion in renal tissue was seen in 20.23% of cases. But this is a very non specific finding found in autopsies of various organs. Among the four renal compartments, the commonest pathology was that of the tubular compartment (45.23%). A total of 36 cases had acute tubular necrosis (Table/Fig 4). There were five cases only with hyaline arteriosclerosis (Table/Fig 5). One case showed hydropic change. In glomerular lesions, one case of crescentic glomerulonephritis, five cases of focal glomerulosclerosis (Table/Fig 6), one case of global glomerulosclerosis (Table/Fig 7), one case of chronic glomerulonephritis (Table/Fig 8) was detected. One case of simple renal cyst and one case of polycystic kidney disease (Table/Fig 9) contributed to cystic lesions of kidney. There was one case of acute pyelonephritis and three cases of chronic pyelonephritis (Table/Fig 10)a-c. A total of 4.76% cases of interstitial nephritis were diagnosed. Renal cell carcinoma was incidentally detected in two cases (2.38%) (Table/Fig 11) and Wilms tumour (Table/Fig 12)a,b in one case (1.19%). Acute tubular necrosis was most common in 21-40 years age group (15 cases) while glomerular lesions was equally distributed in 21-40 and 41-60 years age group (3 cases each) (Table/Fig 2).
Autopsies throw light on the cause of death which otherwise would have remained unexplored. It specially helps in those cases where there is sudden death or where the cause remains questionable (6). This study had 55.95% males and 44.05% females. Larsen ST and Lynnerup N also reported male preponderance with 68.39% males and 31.61% females (7). Several authors have similar male dominance in their studies (8),(9),(10). Pelemo OE et al., and Kakadiya J et al., reported 67% males, while Mulay PS reported 68% males.
However, Perrone ME et al., differed and reported 46% males and 54% females (11) as their study was a specially designed clinical autopsy series to explore renal diseases that remain unrecognised.
The maximum number of cases (41.67%) belonged to the age group 21-40 years followed by 41-60 years (34.52%) in the present study. This was in concordance with the study of Patel S et al., and Kaur A et al., in which maximum number of deaths with renal lesions occurred in 21-40 years of age (Table/Fig 13) (12),(13). Pelemo OE et al., also had similar age distribution with maximum number of cases of medicolegal autopsies (68.4%) in the age group of 20-49 years (8), But Larsen ST and Lynnerup N differed with the highest number of cases in the age group of 40-59 years (45%) followed by 20-39 years (23%) (7) due to higher elderly population in their demographic pattern.
In the present study five cases (5.95%) had no remarkable pathology in renal tissue. This was in concordance with study done by Kaur A et al., (25%) cases and Sandu VK et al., (22.5% cases) showing normal histology (13),(14).
In this study, glomerular lesions comprising sclerosis and glomerulonephritis were identified in 9.52% of cases, aligning with findings from Hailemariam S et al., autopsy study on 237 cases, which reported glomerular or vascular pathology in 28% (15). Notably, 33% of cases exhibited non glomerular lesions, while 29% demonstrated combined lesions. Mulay PS study showed glomerular lesions, specifically glomerular sclerosis and glomerulonephritis, in 14.17% of cases (9). The commonest lesion was chronic pyelonephritis, followed by glomerulosclerosis and glomerulonephritis in a study by Kakadiya J et al., examining the tubular compartment, involvement was observed in 45.25% of cases, potentially attributed to factors such as snake bites, drug overdoses, and poisoning (10). This finding was consistent with Sandu VK et al., study (14). Acute tubular necrosis was identified in 36 cases in the present study, while Mulay PS reported tubular and interstitial lesions in 30.90% of cases, encompassing acute tubular necrosis, chronic pyelonephritis, tubular haemorrhages, and interstitial nephritis (9). Neha S et al., study had 7.6% cases of pyelonephritis (16). Present study found only 1.19% cases of acute and 3.57% cases of chronic pyelonephritis. Lower incidence of pyelonephritis may be explained by as the included autopsy cases were not suffering from obvious renal diseases. These were only incidental findings or unnoticed medical condition. Interstitial nephritis was observed in 4.76% cases consistent with cases of Mulay PS and Verma AA and Murmu R in 6.4% and 5.7% respectively (9),(17).
Various forms of changes in renal vessels like thickening of tunica media and intima and hyalinisation of wall with luminal narrowing were observed in (5.95%) cases in the present study. Other studies had shown the prevalence of hyaline arteriosclerosis in elderly age group due to age related changes in the vessel wall (5),(18). But present study observed hyalinisation of renal vessels in 21-60 years most as compared to more than 60 years. This variation in observation may be due to shorter life span in this population of Northern-East region, but yet to be established. Mulay PS study had renal arteriosclerosis in 125 (22.7%) cases. This difference can be possibly attributed to a higher prevalence of hypertension in their patient population. Renal cell carcinoma was detected in 2.38% of cases, closely aligning with the observations made by Kozlowska J and Okon K who reported a 2.76% incidence in their work (19). These findings underscore the importance of comprehensive renal assessments, considering both glomerular and tubular involvement, as well as vascular and neoplastic conditions, in understanding renal pathology.
The commonest cause of death in present study was due to acute renal failure (Table/Fig 3) followed by acute myocardial infarction and congestive cardiac failure. In non renal causes of death like lobar pneumonia, aortic stenosis, congestive cardiac failure the spectrum of renal lesions was diverse. The cause of death varied among different authors. Patel S et al., found the commonest cause of death was pulmonary oedema in their study (12). Hypertensive heart disease (64.4% cases) was the commonest cause of death according to Pelemo OE et al., (8). This could be due to the higher prevalence of cardiovascular diseases in their population.
Limitation(s)
Immunofluorescence could not be done due to lack of resources, which could have added to the diagnosis in a good number of cases.
The study revealed a nuanced understanding of renal conditions, with tubular lesions emerging as more prevalent than glomerular lesions in renal autopsy cases. Acute renal failure emerged as the most common cause of death, followed by acute myocardial infarction and congestive cardiac failure. These findings underscore the need for a vigilant approach in case analysis. Autopsy materials emerged as invaluable in refining our understanding of disease progression and aetiology. Recognising autopsy as an irreplaceable treasure in pathology, authors emphasise the urgency of promptly transferring specimens to prevent autolysis. In conclusion, the present study enhances diagnostic capabilities and lays the foundation for nuanced interventions in patient care, aligning with the overarching goal of advancing healthcare outcomes through meticulous research.
DOI: 10.7860/JCDR/2024/67095.19161
Date of Submission: Aug 19, 2023
Date of Peer Review: Oct 24, 2023
Date of Acceptance: Jan 07, 2024
Date of Publishing: Mar 01, 2024
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. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 23, 2023
• Manual Googling: Nov 16, 2023
• iThenticate Software: Jan 05, 2024 (17%)
ETYMOLOGY: Author Origin
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