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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
Case report
Full Version
Anaesthetic Considerations in the Video-assisted Thoracoscopic Excision of Pulmonary Aspergilloma: A Case Report
Correspondence Address :
Dr. Chandi Priya Singh,
Resident, Department of Anaesthesia, Dr. D.Y. Patil Medical College Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune-410018, Maharashtra, India.
E-mail: cpriya2612@gmail.com
Video-assisted Thoracoscopy (VATS) is often used for diverse chest and lung ailments, which requires one-lung ventilation utilising a double-lumen tube. It involves small incisions and real-time imaging, resulting in enhanced postoperative recovery. A dry field allows the surgeon better visualisation of the thoracic cavity. To ensure that the patient is fit for prolonged single-lung ventilation, preoperative assessment is vital. While there are advantages and disadvantages to minimally invasive procedures, anaesthesia management and single-lung ventilation are key steps in a successful VATS procedure. Care must be taken to avoid elevated peak pressures intraoperatively. Hereby, the authors present a case report of a 49-year-old smoker with cough, fever, a known treated case of pulmonary Koch’s, and chronic lung disease. After a thorough clinical examination and imaging, he was diagnosed to have a cavitary lesion in the lung, suggestive of Aspergilloma. Authors performed thorough preoperative evaluation prior to surgery, which included pulmonary function tests to help identify the performance of the residual lung. For this patient, VATS was employed to resect the cavitary lesion along with the fungal ball. Single-lung ventilation with a double-lumen endotracheal tube was utilised to collapse the right lung and provide a better operative field. The surgery was uneventful with minimal blood loss, and histopathology confirmed the diagnosis. Due to the minimal access route, the duration of ventilation and recovery is hastened. Appropriate antibiotic/antifungal support, along with aggressive chest physiotherapy and incentive spirometry, is initiated early in such patients, as the pain following VATS is bearable.Video-assisted Thoracoscopy (VATS) is often used for diverse chest and lung ailments, which requires one-lung ventilation utilising a double-lumen tube. It involves small incisions and real-time imaging, resulting in enhanced postoperative recovery. A dry field allows the surgeon better visualisation of the thoracic cavity. To ensure that the patient is fit for prolonged single-lung ventilation, preoperative assessment is vital. While there are advantages and disadvantages to minimally invasive procedures, anaesthesia management and single-lung ventilation are key steps in a successful VATS procedure. Care must be taken to avoid elevated peak pressures intraoperatively. Hereby, the authors present a case report of a 49-year-old smoker with cough, fever, a known treated case of pulmonary Koch’s, and chronic lung disease. After a thorough clinical examination and imaging, he was diagnosed to have a cavitary lesion in the lung, suggestive of Aspergilloma. Authors performed thorough preoperative evaluation prior to surgery, which included pulmonary function tests to help identify the performance of the residual lung. For this patient, VATS was employed to resect the cavitary lesion along with the fungal ball. Single-lung ventilation with a double-lumen endotracheal tube was utilised to collapse the right lung and provide a better operative field. The surgery was uneventful with minimal blood loss, and histopathology confirmed the diagnosis. Due to the minimal access route, the duration of ventilation and recovery is hastened. Appropriate antibiotic/antifungal support, along with aggressive chest physiotherapy and incentive spirometry, is initiated early in such patients, as the pain following VATS is bearable.
Cavity, Single-lung ventilation, Thoracic, Tuberculosis
A 49-year-old male patient with a history of respiratory issues sought care at the Cardiology Outpatient Department. His primary complaint was a persistent cough for three months with breathlessness, modified Medical Research Council (mMRC) scale grade 1, and a history of Aspergillosis and drug-resistant tuberculosis, for which he was previously treated with antitubercular medicines two years ago.
Preoperative pulmonary function tests were normal, and then the patient was considered for video-assisted thoracoscopic surgery. Left pulmonary artery embolisation was performed to reduce bleeding during surgery. He was a known case of chronic liver disease with jaundice and hepatic encephalopathy for two years; he had been on diuretic therapy for the same duration. He had been taking anti-diabetic medications for two decades, such as dapagliflozin (10 mg once a day), sitagliptin (50 mg twice a day), and voglibose (0.2 mg twice a day). Two years prior to this presentation, he had a history of resistant pulmonary tuberculosis (300/600 mg). Additionally, he had a long-standing history of alcohol consumption for over seven years. On examination, his heart rate was 72 beats per minute, blood pressure was 110/70 mmHg, and oxygen saturation was 98% in room air. The Electrocardiogram (ECG) revealed normal sinus rhythm, while 2-dimensional (2D) echocardiography showed an ejection fraction of 60%, Pulmonary Artery Hypertension (PAH), moderate mitral regurgitation, and moderate tricuspid regurgitation. A chest X-ray indicated a cavitary lesion in the left lobe with calcified margins and patchy ground-glass opacities (Table/Fig 1). High-resolution Computed Tomography (HRCT) revealed a lesion measuring 4.6×3.7 cm in the superior segment of the left lower lobe, with a solid component within the cavity measuring 2×2.7 cm, suggestive of aspergilloma. Atherosclerotic calcifications were observed in the aortic arch and its branches. Lymph nodes, several centimeters and sub-centimeters in size, were noted in various regions.
During the preanaesthetic checkup, the patient was alert and oriented, with good oral health and a Mallampati grade of 1. Intraoperatively, routine American Soceity of Anaesthesiologists (ASA) monitors were attached, and intravenous (i.v) fluids were started after establishing secure peripheral intravenous access. An 18-gauge epidural needle was inserted at the T5-T6 intervertebral space using the Loss of Resistance (LOR) method, and an epidural catheter was placed and secured. A bolus dose of 0.25% Bupivacaine with 3 milligrams of Morphine was administered. A 7 Fr triple-lumen central venous catheter was placed via the right internal jugular vein using the landmark technique and properly secured.
The patient was pre-oxygenated for three minutes with 100% oxygen. Premedication was initiated with Midazolam at a dose of 0.02 mg per kilogram of body weight and Fentanyl at a dose of 2 micrograms per kilogram of body weight. The patient was induced with Propofol at a dose of 2 milligrams per kilogram of body weight, and muscle relaxation was achieved by injecting Vecuronium at a dose of 0.1 milligrams per kilogram. A left double-lumen tube with a size of 37 French was placed and secured at a depth of 26 centimeters, confirmed by auscultation and flexible bronchoscopy.
Throughout the surgery, any drop in blood pressure was managed using 50 to 100 micrograms of injection Phenylephrine. Invasive pressure monitoring was established by cannulating the right radial artery. The peak and plateau airway pressures remained at 30 and 30 cm H2O, respectively. The patient was positioned in a right lateral decubitus position, and a camera port was inserted to remove the pathological mass (Table/Fig 2),(Table/Fig 3),(Table/Fig 4),(Table/Fig 5), achieving haemostasis. An infusion of injection Bupivacaine at a concentration of 0.25% was ongoing at a rate of 0.1 mL/kg per hour. Vasopressors were not required once the cavity was sealed.
Postoperative care: Upon completion of the surgery, intratubal suctioning was performed, and the patient was carefully repositioned after adequate weaning. Respiratory muscle relaxation was reversed using intravenous Neostigmine and Glycopyrrolate (2.5 mg+0.4 mg), and the patient was extubated in the operating room. Arterial blood gas analysis was performed and found to be normal. To aid the patient’s postoperative pain management and facilitate breathing, continuous epidural 0.25% Bupivacaine infusion was maintained at 0.05-0.1 mL/kg per hour. The patient was subsequently transferred to the Intensive Care Unit (ICU) for close postoperative monitoring and care (Table/Fig 6).
Managing patients with aspergilloma in drug-resistant tuberculosis who require surgical intervention can be complex due to the presence of pulmonary adhesions and altered lung anatomy. This is associated with high morbidity and mortality rates that might reach 43%. Moreover, surgery carries a significant risk of complications, such as massive blood loss, bronchopleural fistula, post-resection pleural cavity problems, empyema, and death from respiratory failure (1),(2),(3),(4),(5),(6). There are also several reports of long-term better outcomes and survival after surgery to a greater extent than with medical therapy alone in patients who are experiencing symptoms. According to the most recent reports, the fatality rates are less than 6%, whereas the morbidity rates range from 20% to 40% (4),(5),(6),(7). Although surgery for aspergilloma is considered risky, a recent study conducted in our country by Mohapatra B et al., concluded that surgical excision can be performed with acceptable morbidity and mortality rates to provide the patient with a complete cure and symptom-free survival. This finding is similar to the conclusion reached by Pratap H et al., who also conducted their research in India (8),(9).
Therefore, it is necessary to carefully consider the total risk-benefit ratio and select cases in accordance with this ratio to achieve consistently improved outcomes. Babatasi G et al., concluded that pulmonary resection was the best alternative whenever the diagnosis of aspergilloma has been confirmed and the patient is a suitable candidate for the operation (10). This conclusion was based-on a 39-year series of 80 cases. In patients experiencing symptoms, the question of whether surgical treatment is appropriate is less contentious. However, in present case, surgery via VATS was deemed the operating modality of choice.
However, this is not the case for patients who are asymptomatic, and a significant percentage of treating physicians will choose to manage asymptomatic SA using conservative methods. On the other hand, it is important to keep in mind that approximately 20% of patients diagnosed with aspergilloma develop invasive aspergillosis, which makes surgical procedures more challenging (10). In present case, VATS with one-lung ventilation using a double-lumen tube proved to be an effective approach for aspergilloma excision.
The VATS with one-lung ventilation using a double-lumen tube is a valuable technique for patients with pulmonary tubercular lesions. A multi-modal anaesthetic approach, careful intraoperative management, and postoperative pain control are crucial elements for a successful surgical outcome in these cases. The present case report highlights the importance of a multidisciplinary approach in managing such complex patients. From present case report and the experience with the management, as well as a brief review of the literature, authors understood the advantages of performing VATS in such situations, the improved postoperative outcomes, and the reduced pain. Even for the Anaesthetist, it is essential to ensure adequate ventilation while maintaining optimal pressures.
DOI: 10.7860/JCDR/2024/69061.19328
Date of Submission: Dec 12, 2023
Date of Peer Review: Jan 27, 2024
Date of Acceptance: Feb 28, 2024
Date of Publishing: Apr 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. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Dec 13, 2023
• Manual Googling: Jan 23, 2024
• iThenticate Software: Feb 26, 2024 (9%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
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