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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
Cross-sectional Study on the Pattern of Skull Fractures in Fatal Two-wheeler Road Traffic Accidents at a Tertiary Care Hospital in Northeastern India
Correspondence Address :
Swagata Dowerah,
Rupnagar, Dibrugarh-786003, Assam, India.
E-mail: swagatadowerah@gmail.com
Introduction: Death due to Road Traffic Accidents (RTA) is one of the leading causes of mortality and morbidity in a developing country like India. As there is a paucity of literature on the nature and type of injuries in RTAs in the locality of Upper Assam, a retrospective study on postmortem cases of fatal two-wheeler accidents was conducted to address the magnitude of the problem.
Aim: To analyse different types of skull fractures and causes of death among two-wheeler RTAs at tertiary care Hospital in Northeast India.
Materials and Methods: The present cross-sectional study was conducted in the mortuary of Assam Medical College, Dibrugarh, Assam, India, for a period of one year from August 2020 to July 2021. The records of all RTA cases involving two-wheeler motorcycles brought for postmortem examination during this period were studied for parameters including age, gender distribution, cause of death, type of skull fracture, intracranial haemorrhage, and time of occurrence, and analysed using descriptive statistics.
Results: There were 532 fatal RTA cases recorded, out of which 292 involved two-wheelers (54.89%). Males (87.67%) outnumbered females (12.33%). The most affected age group was between 21-30 years with a total of 98 cases (33.56%), followed by 31-40 years with 68 cases (23.29%). Skull fracture was present in 103 cases (35.27%). Fissured fracture was the most common type seen in 64 cases (62.14%) followed by depressed fracture in 19 (18.45%). The most common single bone fracture was of the Temporal bone in 44 cases (42.72%), followed by frontal bone in 18 (17.48%). Coma was the most common cause of death, seen in 214 cases (73.29%), followed by haemorrhagic shock in 42 (14.38%). Subdural Haemorrhage (SDH) alone was the most common intracranial haemorrhage found in 159 cases (74.30%), followed by Extradural Haemorrhage (EDH) alone in 7 cases (3.27%).
Conclusion: Injuries to the skull and brain are the leading cause of death in RTAs. Adequate measures should be taken to prevent mortality and morbidity, achievable through strict enforcement of road safety measures, awareness among the people, and improving road infrastructure along with emergency medical services.
Autopsy, Cause of death, Subdural haemorrhage, Time of death
Road Traffic Accidents (RTA) are increasing at an alarming rate in developing countries like India, constituting one of the leading causes of mortality and morbidity due to trauma. Globally, approximately 1.3 million people die each year as a result of RTAs, costing most countries 3% of their gross domestic product (1). More than half of all road traffic deaths occur among vulnerable road users such as pedestrians, cyclists, and motorcyclists. Shockingly, 93% of the world’s road fatalities occur in low and middle-income countries, despite these countries having only around 60% of the world’s vehicles (1). Notably, road traffic injuries are the leading cause of death for children and young adults aged 5-29 years (1).
In India, the impact of RTAs is significant, with 1.20 lakh cases of “deaths due to negligence relating to road accidents” recorded in 2020, resulting in an average of 328 deaths per day, even during COVID-19 lockdowns. The comparative analysis of National Crime Records Bureau (NCRB) data from 2017 to 2020 shows a concerning trend, with a high number of lives lost per 100 road crashes (2). Despite a reduction in overall road fatalities by nearly 14% from about 1.5 lakh in 2019 to 1.3 lakh in 2020 due to Coronovirus Disease-2019 (COVID-19) restrictions, indicators such as the severity of crashes and the increased share of two-wheeler occupants’ deaths in total fatalities are alarming (2).
Two-wheeler deaths accounted for 38% of all road deaths in 2019, up from 35% in 2018, with a total of 58,747 deaths reported from two-wheeler crashes (3). India, with only 1% of the world’s vehicles, unfortunately, accounts for 11% of global RTA deaths, with approximately 450,000 accidents and 150,000 deaths occurring annually. This translates to 53 road accidents every hour and one death every four minutes in the country (4).
Despite these alarming statistics, there is a notable paucity of literature on the nature and type of injuries in RTAs in the locality of upper Assam. In light of the magnitude of the problem, a retrospective study on postmortem cases of fatal two-wheeler accidents was conducted with the aim to analyse various types of skull fractures and causes of death among two-wheeler RTAs in a tertiary care hospital in Northeastern India.
The present cross-sectional study was conducted in the mortuary of Assam Medical College and Hospital, Dibrugarh, Assam, India from August 2020 to July 2021, using archival data of postmortem cases of RTAs. All cases that occurred during this period were included in the study, following the acquisition of permission from the Institutional Ethics Committee (No. 2023/AMC/EC/1384).
Inclusion and Exclusion criteria: All RTA cases involving two-wheelers brought to the mortuary for postmortem examination during the study period were included, while deaths due to RTAs involving vehicles other than two-wheeler motorcycles and bicycles were excluded from the study.
Study Procedure
The study comprised 292 cases of fatal RTAs involving two-wheelers. Data from all cases were collected from police inquests, dead body challans, postmortem reports, and pretested proforma used for interviewing accompanying police personnel and relatives of RTA victims. The age and sex distribution of cases, the cause of death, type of skull fracture, intracranial haemorrhage (as a percentage of cases), and time of occurrence of RTA cases were studied.
Statistical Analysis
All data were deidentified, and the study parameters were entered into an excel sheet and analysed using descriptive statistics.
During the study period, a total of 1,636 autopsies were conducted, with 532 cases involving RTAs, out of which 292 cases specifically involved two-wheelers.
• The highest incidence of two-wheeler RTAs was found in the age group of 21-30 years, with a total of 98 cases (33.56%), followed by 68 cases in the age group of 31-40 years (23.29%). The lowest incidence was found in the age group of 0-10 years, with 3 cases (1.03%) (Table/Fig 1).
• Males outnumbered females, with a total of 256 cases (87.67%) compared to 36 cases (12.33%). The male-to-female ratio was 7.11:1 (Table/Fig 2).
• Death was most commonly due to coma as a result of intracranial haemorrhages in 214 cases (73.29%), followed by 42 cases of haemorrhagic shock (14.38%). Other causes of death included a combined effect of coma and haemorrhagic shock in 23 cases (7.88%), septicaemia in 5 cases (1.71%), spinal shock in 4 cases (1.37%), and crushed head in 4 cases (1.37%) (Table/Fig 3).
• Subdural haemorrhage (SDH) alone was the most common type of intracranial haemorrhage, found in 159 cases (74.30%), followed by epidural haemorrhage (EDH) in 7 cases (3.27%), and intracerebral haemorrhage (ICH) alone in 2 cases (0.93%) (Table/Fig 4).
• The temporal bone was the most commonly involved site of skull fracture, found alone in 44 cases (42.72%), followed by the frontal bone in 18 cases (17.48%), and the parietal bone in 7 cases (6.80%) (Table/Fig 5).
• Linear fracture was the most common type of skull fracture, found in 64 out of 103 cases (62.14%), followed by depressed fracture in 19 cases (18.45%), comminuted fracture in 12 cases (11.65%), and suture fracture in 8 cases (7.77%) (Table/Fig 6).
• The most common time of occurrence of two-wheeler RTAs was between 12 pm and 6 pm, with a total of 134 cases (45.89%), followed by 82 cases (28.08%) between 6 pm and 12 am. A total of 64 cases (21.92%) were found between 6 am and 12 pm, and the least occurred between 12 am and 6 am, with 12 cases (4.11%) (Table/Fig 7).
The study revealed that fractures of the temporal bone were the most common, with linear fractures being the predominant type. SDH was the most frequently encountered type of haemorrhage, and the majority of fatalities resulted from coma.
Out of the 1,636 autopsies conducted during the study period, 532 cases involved RTAs, accounting for 32.52% of the total, which aligns with previous findings by Patel AP et al., (5). Two-wheeler accidents dominated among the RTAs, with 292 cases (54.89%), consistent with the study by Kumar A et al., where 43.35% of RTA cases involved two-wheeler accidents (6).
The peak incidence of two-wheeler accidents was observed in the age group of 21-30 years, accounting for 98 cases (33.56%). This was followed by 68 cases (23.29%) in the 31-40 years age group and 55 cases (18.84%) in the 41-50 years age group, indicating that 75.68% of the total victims died during the most productive period of their lives. These findings are consistent with previous studies by Sharma RK et al., Kumar R et al., Chaturvedi Y et al., and Hasini BRC et al., (7),(8),(9),(10).
Males comprised 256 cases (87.67%) compared to 36 cases (12.33%) in females, resulting in a male-to-female ratio of 7.11:1. These findings are similar to those of Sharma RK et al., Kumar R and Punia RK, Chaturvedi Y et al., Hasini BRC and Singh OG (7),(8),(9),(10),(11).
The leading cause of death in the study was coma resulting from head injury, with 214 cases (73.29%), followed by haemorrhagic shock with 42 cases (14.38%), consistent with the findings of Sharma RK et al., (7).
The most common intracranial haemorrhage observed was SDH alone (74.30%), followed by EDH alone (3.27%), in line with the findings of Hasini BRC Malik Y and Chaliha RR, Soni S et al., and Guntheti BK and Singh UP (10),(12),(13),(14).
The study showed that the maximum number of road traffic incidents occurred between 12 pm and 6 pm (45.89%), contrasting with the findings of Malik Y and Chaliha RR, who reported a peak occurrence from 6 am to 9 am (25.45%) and Chary RS et al., who noted the highest number of cases (45.20%) between 6 am and 12 pm, coinciding with rush hour for students and working people (12),(15). The increased incidence of RTA cases between 12 pm and 6 pm in the present study may be attributed to the physical and mental fatigue towards the end of the workday, leading to decreased reflexes. Additionally, the earlier onset of evening in the Northeastern part of the country and fading light may contribute to increased RTAs, especially during twilight hours.
Fissured fracture was the most common type of skull fracture in the study, consistent with the findings of Malik Y and Chaliha RR, Guntheti BK and Singh UP Singha YN et al., and Hashmi ZA et al., (12),(14),(16),(17).
The most common bone fracture was observed in the temporal bone (42.72%) in the present study, similar to the findings of Hashmi ZA et al., and Arora S and Khajuria B, but contrasting with those of Singha YN et al., and Ramteke BW et al., (16),(17),(18),(19).
Limitation(s)
While the present study shed some light on the patterns of fracture and injury in two-wheeler accidents, it had some limitations, including the short duration of the study and the fact that it was a single-centre hospital-based study. A multicentre study might have provided more comprehensive information on the parameters studied. However, certain findings, such as the most common time of these accidents, the type of fractures, and the cause of death in the cases, may reflect the on-road behaviour of the population studied, as well as geographical factors. A more detailed study would be required to corroborate the findings of the present study.
Injuries to the skull and brain are the leading causes of death in RTAs. Fissured fracture was the most common type of fracture, with the temporal bone being the most common bone involved in this study. Coma followed by haemorrhage and shock were the leading causes of death. Adequate measures should be taken to prevent mortality and morbidity, which can be achieved by strict enforcement of road safety measures, raising awareness among the people, and improving the road infrastructure along with emergency medical services.
DOI: 10.7860/JCDR/2024/66886.19217
Date of Submission: Aug 06, 2023
Date of Peer Review: Nov 22, 2023
Date of Acceptance: Jan 20, 2024
Date of Publishing: Apr 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? No
• For any images presented appropriate consent has been obtained from the subjects. No
PLAGIARISM CHECKING METHODS:
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ETYMOLOGY: Author Origin
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