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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
Research Protocol
Full Version
Assessment of Nailfold Capillaroscopy Findings in Pregnant Women having Preeclampsia: A Research Protocol
Correspondence Address :
Dr. Shreya Gupta,
Resident, Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College (JNMC), Sawangi [M], Wardha-442004, Maharashtra, India.
E-mail: sngsng2096@gmail.com
Introduction: Pregnancy causes significant vascular and cutaneous changes in a woman’s body. Preeclampsia is one of the life-threatening conditions associated with high blood pressure and proteinuria after the 20th week of pregnancy. It can cause placental hypoperfusion and placental insufficiency, leading to foetal defects or, in severe cases, foetal loss, which can be prevented by early diagnosis and treatment. There are many ways to observe and study the microcirculation non invasively the safest and most accessible method is nailfold capillaroscopy. Nail-fold Video Capillaroscopy (NVC) is a hand-held digital microscope used to observe the microcirculation at the nailfold of the hands. Thus, comparing the capillary status with healthy subjects will help establish an early diagnosis and manage cases to prevent further complications in the mother and newborn.
Need of the study: The pathophysiology states that preeclampsia is related to systemic endothelial dysfunction, causing the release of Tumour Necrosis Factor (TNF) alpha, a proinflammatory mediator, leading to hypoxia of the placenta and the loss of endothelial cell-lined capillaries. Thus, there is a need to find if there is an established correlation in association of decreased Capillary Density (CD) in individuals with preeclampsia. Although evidence supporting a link between decreased CD and preeclampsia is limited, timely assessment and prevention are crucial. Nailfold capillaroscopy, an accessible and non invasive imaging method, holds promising calibre for understanding microvascular changes in preeclampsia. This could facilitate post-conception monitoring and early interventions to identify and address circulatory issues in affected women with preeclampsia.
Aim: To study and compare the nailfold capillary changes in women diagnosed with preeclampsia and women having normal and uneventful pregnancies.
Materials and Methods: A comparative cross-sectional study will be done in the Outpatient Department (OPD) and Inpatient Department (IPD) of Obstetrics and Gynaecology and the Outpatient Department of Dermatology at AVBRH, Sawangi (Meghe), Wardha, Maharashtra, India, from March 2023 to March 2025. A total of 150 pregnant women will be considered in the study, with 75 women being normal pregnant women (controls) and 75 pregnant women diagnosed with preeclampsia (cases). In order to confirm the gestational age of the patients, fundal height and abdominal circumference measurements will be taken. Demographic data, Basal Metabolic Index (BMI), weight gain during pregnancy, laboratory reports including Complete Blood Count (CBC), coagulation profile (Prothrombin Time, International Normalised Ratio, Activated Partial Thromboplastin Time), liver function tests, kidney function tests, urine examinations, and serial ultrasonography reports available for the patients will be noted. Pre-examination blood pressure will be recorded and compared with the baseline to confirm the status of preeclampsia after obtaining written consent from the patients. Nailfold capillaroscopy will be performed using a (Dinolite -AF4115ZT) dermoscope equipped with a 200X magnification, high-resolution lens in a non polarised light setting with oil immersion as a fluid coupling. The observations will be used to interpret the results of the study. Results will be calculated for finding differences between the two comparative groups of cases and controls at a p-value of ≤0.05.
Blood pressure, Gestation, Nailfold microcirculation, Non invasive
Pregnancy involves cutaneous and vascular changes in a female’s body. The shift in blood volume and the adaptations required for the growing foetus pose challenges for a mother, as a hypercoagulable state is witnessed from the 8th week of pregnancy itself. Vasoconstriction due to increased sodium concentration, plasma expansion, and retrograde trophoblastic invasion of spiral vessels, especially in the latter half of the first trimester, are the reasons for strong uteroplacental vascular compliance (1). Preeclampsia is a life-threatening condition in pregnant females associated with high blood pressure (≥140/90 mmHg) along with proteinuria (urinary albumin ≥300 mg/24 hours), usually beginning after 20 weeks of pregnancy. It has a prevalence rate of 5-8% of total pregnancies globally, making it the second leading cause of foetal and maternal deaths (2).
One of the mechanisms that also contributes to preeclampsia is the Capillary Bed (CB), a composite of CDe and Capillary Diameters (CDi), which is lower in the third trimester than in the first trimester, leading to cardiovascular risk (3). Women who are pregnant and have preeclampsia are twice as likely to be at risk of experiencing cardiovascular problems and three times more likely to experience hypertension in the future (1). Patients with extreme grades of preeclampsia may present with typical symptoms such as headache, epigastric pain, or visual disturbances, along with signs of uncontrollable high blood pressure, ankle oedema and proteinuria (4). Preeclampsia is a recurrent pregnancy complication that disrupts placental perfusion and releases soluble factors such as Tumour Necrosis Factor (TNF) α into the bloodstream. As a result, the placenta experiences hypoxia and hypoperfusion. Endothelial dysfunction may also cause symptoms of preeclampsia such as raised blood pressure and maternal and child distress, thus additionally damaging the maternal vascular endothelium, leading to heat stress and multiple organ damage. The risk of Small Gestational Age (SGA) is prevalent in such pregnancies, and the Haemolysis, Elevated Liver Enzymes, Low Platelet Count (HELLP) syndrome is an additional complication in mothers aged 35 years or more (4). Nailfold capillaroscopy is a Universal Serial Bus (USB) enabled hand-held device designed to visualise the microvasculature (5) and can be used to observe the changes seen in pregnant women with preeclampsia. It can be done on the patient’s bedside with the USB-enabled NVC device; in this case, the Dinolite AF4115ZT is used. Presently, the aim to carry out this research is to study and compare the nailfold capillary changes in women diagnosed with preeclampsia and women having normal and uneventful pregnancies.
Primary objectives: To study the nail vasculature findings in pregnant women with a normal uneventful hypothesis pregnancy and in women with preeclampsia.
Secondary objectives: To compare the nail vasculature findings obtained in women diagnosed with preeclampsia and women with a normal uneventful pregnancy.
REVIEW OF LITERATURE
According to a study by Antonios TFT et al., quantifying the structural rarefaction of skin capillaries in pregnancy is a potentially useful clinical marker for predicting preeclampsia (6). In May 2022, Armstrong JL from Ontario, Canada hypothesised that preeclampsia is associated with a decline in the number of nailfold capillaries per 1 mm2 that persists postpartum. These microvascular changes may help identify women at the highest risk for future cardiovascular disease and who may benefit from cardiovascular disease screening, lifestyle modification, and pharmaceutical intervention. There is evidence of functional, but not structural, differences in CD found between women with preeclampsia and pregnant women aged 18 to 40 years with intact capillary concentrators (7). Thevissen K and Gyselaers W studied NVC in pregnant women with and without cardiovascular risks and concluded that capillary rarefaction precedes the onset of hypertension, becoming the primary phenomenon and can be a positive predictor in the early diagnosis of preeclampsia (8).
The present study represents an early exploration of answering the question of whether capillary changes can be significant in predicting circulatory defects in preeclamptic women and preventing complications. The results derived from previous studies are not clear, possibly due to the preliminary nature of the research and the limited sample size, which further constrains the main findings. Here, we aim to establish a relationship between changes in macro and microcirculations. Preeclampsia is known to increase blood pressure, but its effect on microcirculatory CD remains unclear.
A comparative, cross-sectional study will be done in the outpatient and inpatient Departments of Obstetrics and Gynaecology and the Outpatient Department of Dermatology at AVBRH Sawangi Meghe, Wardha, Maharashtra, India from March 2023 to March 2025. Written informed consent will be taken from all study participants. Institutional Ethics Committee consent has been obtained (IEC Number: Ref. No. DMIMS (DU)/IEC/2023/742). The Clinical Trials Registry-India (CTRI) trial registration has been done (Trial Registration: Reg No: CTRI/2023/09/057807).
• Inclusion criteria: Pregnant patients recruited for the study will be between the ages of 18 and 40 with a singleton pregnancy diagnosed with preeclampsia, a gestational age of 20 weeks or more, and willing to deliver at Acharya Vinoba Bhave Rural Hospital.
• Exclusion criteria: Pregnant patients diagnosed with any pre-existing systemic illness such as high blood pressure, diabetes, lupus, kidney disease, gestational diabetes, coronary heart disease, Raynaud’s syndrome, scleroderma, arthritis, or collagen-vascular diseases will be excluded from the study. Pregnant patients who are consuming drugs or have a drug history that may interact with or disrupt the study protocol will also be excluded. Additionally, patients with onychophagia, onychotillomania, or any other nail disease will be excluded from the study.
Sample size calculation:
n=(Zα/2)2×P(1-P)/d2
Where, Z α/2 is the level of significance at 5%, i.e., 95%
Confidence Interval (CI)=1.96
p=Prevalence of preeclampsia=5%=5.0=0.05 (2) (prevalence rate of preeclampsia ranging between 5-8% of total pregnancies globally)
d=Desired error of man=0.05
n=(1.96)2×0.005×(1-0.05)/(0.05)2
n=73
n=75
Hence, two groups will be formed:
Group-A (cases): Patients diagnosed with preeclampsia in pregnancy with a gestational age of 20 weeks or more.
Group-B (controls): Patients with normal, uneventful pregnancies with a gestational age of 20 weeks or more.
A sample size (n) of 75 in each group will be considered, making a total sample size (n) of 150.
Study Procedure
Demographic descriptions such as age, marital status, hypertensive status, Gravida, Preterm, Living child, Abortion (GPLA) score, BMI, and total weight gain during pregnancy will be noted. A detailed blood workup will include laboratory values such as coagulation profile {including Prothrombin Time (PT), International Normalised Ratio (INR), Activated Partial Thromboplastin Time (APTT)}, CBC, liver function test (including Serum Glutamic Pyruvic Transaminase (SGPT), Serum Glutamic Oxaloacetic Transaminase (SGOT), Alkaline Phosphatase (ALP), total bilirubin values), kidney function test values (including urea, creatinine, serum sodium, serum potassium), and urine examination showing microscopy and albumin. Serial ultrasound results available with the patient will also be noted.
The patient will be counselled and explained about the procedure. Written informed consent will be obtained, and the patient will be settled in a sitting/lying position for the examination process. Fundal height, abdominal girth, and blood pressure will be measured. The examination will be conducted at room temperature to exclude additional vasoconstriction. The patient may use acetone to remove the varnish. The appropriate cap on the nail body will be selected, attached to the device, and a small amount of infused oil will be applied to the nailfold of each finger (except the thumb) to improve vision and visibility of capillaries. Nailfold capillaroscopy will be performed using (Dinolite- AF4115ZT) in a non polarised mode with oil immersion as a fluid coupling. The contact angle and direction of the capillary microscope will be manually adjusted to reduce the light according to the observer’s perception (9).
Nailfold findings will be evaluated as quantitative findings such as CD (width), mean CD, and qualitative findings such as cross-linked capillaries (sinus or twisted) and capillary morphology, which will combine to form the overall pattern evaluated while examining the capillaroscopic pattern (10),(11). Comparison and assessment of probabilities for the occurrence of circulatory defects will be conducted through statistical analysis.
Outcomes: To evaluate and compare the capillaroscopy results by measuring CD, mean CD, the number of cross-linked capillaries (sinus or twisted), and capillary morphology in both the case and control groups.
Statistical Analysis
All results will be calculated using R Studio software version 3.2. Demographic descriptions such as age, marital status, hypertensive status, GPLA score, and BMI, over the baseline characteristics, will be tabulated and described by frequency and percentage for categorical data and mean standard deviation for quantitative data such as total weight gain during pregnancy and laboratory values including coagulation profile (PT, INR, APTT), CBC, liver function tests including SGPT, SGOT, ALP, total bilirubin, kidney function test values including urea, creatinine, serum sodium, serum potassium, urine examination showing microscopy, and urine albumin.
Inferential statistics will be tested using an independent t-test analysis for nailfold findings as quantitative/numerical measurements, such as CD (width) and mean CD. The Chi-square/Fisher’s-exact test will be used for qualitative/morphological findings, such as capillary morphology and cross-linked capillaries (sinus or twisted), to find the significant difference between the two comparative groups: preeclampsia (cases) and normal pregnant women (controls). Results will be calculated for a significant difference at a p-value of <=0.05 with a 95% CI.
Authors’ contribution: Conceptualisation: All authors, Data Collection: Dr. Shreya Gupta, Revising the manuscript for intellect content: All authors, All the authors have read and agreed to the final manuscript.
Proforma
DOI: 10.7860/JCDR/2024/69038.19430
Date of Submission: Dec 11, 2023
Date of Peer Review: Jan 13, 2024
Date of Acceptance: Apr 01, 2024
Date of Publishing: May 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• 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: Dec 12, 2023
• Manual Googling: Mar 26, 2024
• iThenticate Software: Mar 29, 2024 (6%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
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- Indian Science Abstracts (ISA)
- Journal seek Database
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- www.omnimedicalsearch.com