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
Comparison of Laboratory Parameters and Outcomes in Perforation Peritonitis Patients before and after Peritoneal Drain Placement: A Prospective Cohort Study
Correspondence Address :
Anjali Singh,
C-7, Type 4 Block, Kalpana Chawla Government Medical College, Karnal-132001, Haryana, India.
E-mail: anjalisingh010688@gmail.com
Introduction: Patients with perforation peritonitis present in the Emergency Department with various causes, but bowel perforation is the most frequent cause. These patients often arrive late at tertiary centres, resulting in severe peritoneal contamination and septic shock. Therefore, preoperative peritoneal drain placement provides adequate drainage and better outcomes in such cases.
Aim: To compare various clinical and laboratory parameters in patients with perforation peritonitis before and after the placement of a peritoneal drain, prior to any definitive surgical treatment.
Materials and Methods: A prospective cohort study was conducted in the Department of General Surgery at Kalpana Chawla Government Medical College in Karnal, Haryana, India, from October 2022 to June 2023. All cases of perforation peritonitis that were critically-ill or in shock upon presentation in the emergency department were planned for intraperitoneal drain placement before definitive surgery. A total of 140 patients were enrolled in the study, and their clinical parameters (temperature, pulse rate, SpO2, and urine output) and laboratory parameters (such as leucocyte count, electrolytes (Na+, K+, Ca++), pH, base excess, bicarbonate values, lactate, Random Blood Sugar (RBS), and haematocrit) were compared before and 24 hours after drain placement. Statistical analysis was performed using paired t-test.
Results: The mean age of the patients was 46.03±18.06 years, and 116 (82.85%) of the cases were male. The most common co-morbid condition was pulmonary disease {Chronic Obstructive Pulmonary Disese (COPD)/Asthma}, diagnosed in 96 (86.57%) cases. The most common perforation site was duodenal, followed by gastric and ileal, observed in 65 cases (46.42%), 23 (16.34%) cases, and 21 (15%) cases, respectively. There was a significant improvement in clinical parameters such as temperature, pulse rate, Saturation of Peripheral Oxygen (SpO2), and urine output after drain placement (p-value <0.001). There was also an improvement in laboratory parameters including leucocyte count, electrolytes (Na+, K+, Ca++), pH, base excess, and bicarbonate values (p-value <0.001). The mortality rate was 20%, with 28 cases resulting in death.
Conclusion: Although preoperative intraperitoneal drain placement is not a standard surgical procedure for patients with perforation peritonitis, it resuscitates and stabilises the patient, thereby helping in reducing morbidity and mortality postoperatively.
Base excess, Bicarbonate, pH
Perforation peritonitis is the most frequently encountered surgical emergency, with a mortality rate of about 30% (1). The most commonly reported age range is between 45 and 60 years, with a male-to-female ratio of 3:1 (2),(3). Peritonitis and intra-abdominal infection are not synonymous. Peritonitis denotes inflammation of the peritoneal cavity caused by bacteria or irritation from extravasated secreations (4),(5). Proximal gastric perforation is more common compared to distal perforations. Although laparotomy is the gold standard for perforation peritonitis patients, there are various alternative procedures available, such as primary peritoneal drainage, laparoscopic sanitation, Taylor’s conservative method, and laparostomy (6),(7),(8),(9),(10).
Drains provide removal of pus, blood, and fluid, which are sources of bacterial proliferation and infection. Preoperative intra-peritoneal drain placement is practiced by surgeons in emergencies to stabilise and resuscitate critically-ill patients who are not suitable for immediate surgery under general anaesthesia. These patients exhibit symptoms such as feeble pulse, unrecordable blood pressure, rapid respiratory rate, low urinary output, low SpO2, and cold and clammy peripheries. This procedure allows time to stabilise the patient before surgery and can be easily performed at primary health centres under local anaesthesia before transferring them to higher centres for definitive treatment (11),(12),(13).
Therefore, present study aimed to compare various clinical and laboratory parameters in patients with perforation peritonitis before and after the placement of a peritoneal drain, prior to any definitive surgical treatment.
The present prospective cohort study was conducted in the Department of General Surgery at Kalpana Chawla Government Medical College in Karnal, Haryana, India from October 2022 to June 2023. Data collection was done after obtaining approval from the Institute Ethical Committee (IEC no: KCGMC/IEC/
2022/134).
Inclusion criteria:
• Critically-ill or shock patients presenting with perforation peritonitis in the emergency department.
• Patients who were not fit for surgery under general anaesthesia at the time of presentation.
• Patients with renal profile derangement due to dehydration and sepsis.
• Patients with sepsis-induced coagulopathy.
• Patients aged between 25 and 60 years, including both genders.
Exclusion criteria:
• Haemodynamically stable patients.
• Spontaneous bacterial peritonitis.
• Anastomotic leak peritonitis (postoperative).
• Sealed-off perforation managed conservatively.
• Peritonitis due to other causes such as pancreatitis, ruptured liver abscess, ruptured gall bladder, etc.
• Patients with other systemic illnesses or malignancies.
Sample size calculation: Last month, a total of 97 surgeries were performed. Out of these, 15 were exploratory laparotomies. Therefore, the prevalence of perforation peritonitis was 15/97*100=15.5%. The study utilised convenient sampling, and based on this prevalence, a minimum sample size of 140 patients was required.
Study Procedure
Vital signs of all the patients were recorded, and laboratory investigations were performed, including Complete Blood Count (CBC), Liver Function Test (LFT), Kidney Function Test (KFT), Serum electrolytes, coagulation profile (PT-INR), Arterial Blood Gas (ABG), and viral markers. ECG, RBS, and Chest X-ray (PA view) were also done at the time of admission. Subsequently, an intraperitoneal drain was placed, and the patients were optimised with fluids, blood, blood products, and broad-spectrum antibiotics. Nasogastric decompression and a urinary catheterisation were performed. Clinical parameters such as temperature, pulse rate, SpO2, and urine output, as well as laboratory parameters including leucocyte count, electrolytes (Na+, K+, Ca++), pH, base excess, bicarbonate values, lactate, RBS, and haematocrit, were re-evaluated 24 hours after drain placement. After obtaining informed consent, the patients were shifted to the operation theatre for a definitive surgical procedure.
Operative technique: Percutaneous peritoneal drain placement was performed under local anaesthesia through a 2 cm incision in the left iliac fossa (on the lateral 1/3 and medial 2/3 of a line joining the anterior superior iliac supine and pubic tubercle). The external oblique aponeurosis, internal oblique, and transverse abdominis muscles were split under vision with the help of artery forceps. The index finger was swiped in all directions to protect the bowel and ensure adequate drainage. A wide-bored interabdominal Abdominal Drainage Kit (ADK) drain (size 32 FG) was placed through an incision into the pelvic cavity by the principal investigator. Once the patient was optimised, they underwent a standard laparotomy for a definitive surgical procedure.
Statistical Analysis
The statistical analysis was conducted using IBM Statistical Package for Social Science (SPSS) version 20.0. The analysis utilised paired t-test. Measures of central location (mean and median) and measures of dispersion (Standard Deviation {SD}) were used to estimate all quantitative variables. All statistical tests were considered significant at a two-tailed level of significance (p<0.01 and p<0.05).
A total of 140 patients were included in present study. The mean age of the patients was 46.03±18.06 years, with 83% of them being males. The most common co-morbid condition was pulmonary disease (COPD/asthma), diagnosed in 68.57% of patients (Table/Fig 1). The most common site of perforation was the duodenum (46.42%), followed by the stomach (16.34%), and then the ileum (15%). Only a single case of sigmoid perforation was encountered (Table/Fig 2).
There was a significant improvement in the clinical parameters of the patients, including temperature, pulse rate, respiratory rate, SpO2, and urine output, after drain placement (p-value <0.001) (Table/Fig 3). There was also improvement in White Blood Cell (WBC) counts, electrolytes (Na+, K+, Ca++), blood urea, serum creatinine, pH, base excess, and bicarbonate levels after drain placement (p-value <0.001). The values of lactate, RBS, and haematocrit were not statistically significant after intraperitoneal drain placement (Table/Fig 4),(Table/Fig 5). The mean duration of operative time was 70±3.26 minutes, and the mean duration of Intensive Care Unit (ICU) stay was six days. A total of 36 patients (25.71%) had postoperative fever, 31 patients (22.14%) had wound infection in the postoperative period, and 28 patients expired, resulting in a mortality rate of 20%.
In present study, the mean age of the patients was 46.03±18.06 years, with 82.85% (116/140) being male. This is consistent with the findings of Baloch I et al., and Afridi SP et al., who also reported a male preponderance [14,15]. A total of 43.57% (61 patients) presented in the emergency department with a duration of symptoms exceeding 72 hours, indicating delayed presentation. This could be attributed to seeking treatment from nearby centres or local practitioners before reaching a tertiary center. Kocer B et al., reported that delayed presentation after 24 hours is associated with increased morbidity (16).
The most common site of perforation in in present study was the duodenum (46.42%), followed by the stomach (16.34%), and then the ileum (15%). Appendicular perforation was found in 8.57% of cases. This is consistent with the findings of Chakma SM et al., who reported similar rates of duodenal and appendicular perforation (17). Smith I et al., considered base deficit and bicarbonate levels as prognostic markers in ICU patients, with lower base deficit and higher bicarbonate levels associated with increased mortality (18). In present study, pH, base excess, and bicarbonate values significantly improved after intraperitoneal drain placement (p-value <0.001), indicating reduced morbidity and mortality in these patients. The mortality rate in present study was 20% (28 out of 140 patients), which is comparable to the study conducted by Baloch I et al., (16% mortality) (14). Among these 28 patients, 23 had associated asthma/COPD.
A study by Kareem T et al., in 2021 during the Coronavirus Disease-2019 (COVID-19) pandemic reported that intraperitoneal drainage 7early in the management of perforation peritonitis decreased morbidity and mortality in COVID-19 infected patients (19). Intraperitoneal drainage significantly improved the physiological status of the patients and aided in their resuscitation (20). Stable patients with bowel perforation without signs of peritonitis and radiological evidence of sealed perforation can be managed conservatively (21). Delayed presentation, old age, and co-morbidities such as pulmonary disease, coronary arterial disease, and diabetes mellitus are poor prognostic factors associated with higher mortality rates. Early diagnosis and control of septicaemia may lead to more favourable outcomes (19).
Limitation(s)
The present study had certain potential limitations. It was a unicentric, prospective observational study with a limited sample size. Additionally, authors did not compare the outcomes between the drain and no-drain groups.
Preoperative drain placement resulted in significant improvement in vitals and biochemical parameters, leading to reduced mortality and morbidity in patients with perforation peritonitis. This procedure can be performed even at primary health centres under local anaesthesia using the described technique. After drain placement, patients can be safely transferred to a higher centres for further management, such as definitive surgery.
DOI: 10.7860/JCDR/2023/66811.18805
Date of Submission: Jul 31, 2023
Date of Peer Review: Oct 04, 2023
Date of Acceptance: Nov 06, 2023
Date of Publishing: Dec 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: Aug 01, 2023
• Manual Googling: Oct 24, 2023
• iThenticate Software: Nov 04, 2023 (4%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
- 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