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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 Series
Full Version
Rare Neurological Presentations of Paediatrics COVID-19 Cases Reported at a Tertiary Care Hospital in Mizoram, India
Correspondence Address :
Dr. Ganesh Shanmugasundaram Anusuya,
Professor, Department of Community Medicine, Saveetha Medical College and Hospital, Thandalam, Chennai, India.
E-mail: drgany2007@rediffmail.com
Apart from the regular respiratory symptoms, neurological manifestations like headache, encephalopathy, encephalitis, seizure, coma, demyelinating disorders, and aseptic meningitis has been seen in paediatric Coronavirus Disease-2019 (COVID-19) positive cases. The present case series is about three children, of age range 9 to 15 years, who presented with encephalitis between January 2022- February 2022. All the children tested positive for COVID-19, either by Rapid Antigen Test (RAT) or by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). One patient had necrotising encephalitis like changes in the MRI neuroimaging of the brain, but negative Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Ribonucleic Acid (RNA) PCR in Cerebrospinal Fluid (CSF). The second patient’s Magnetic Resonance Imaging (MRI) brain was suggestive of acute encephalopathy, but with normal CSF analysis. The third patient presented with clinical findings suggestive of encephalitis with normal CSF study and normal MRI. The children were managed with antipyretics, antiepileptics, antibiotics, and antiviral, injection mannitol, and steroids. After the completion of the treatment, all the children were alive and were discharged from the hospital.
Altered sensorium, Coronavirus, Encephalitis, Encephalopathy, Outcome
The primary target of SARS-CoV-2 is the respiratory system, but neurological manifestations like encephalopathy, headache, seizure, coma, altered sensorium, encephalitis, and aseptic meningitis have been reported in the COVID-19 positive paediatric patients (1),(2),(3),(4),(5),(6). The first neurological symptoms with SARS-CoV-2 were reported in March 2020 (7) with a positive specific SARS-CoV-2 RNA in CSF followed by multiple reports of SARS-CoV-2 associated encephalitis, with only few showing viral detection in the CSF. The entry of mechanism can be through haematogenous dissemination via endothelial cells or via the cribriform plate and olfactory bulb (8). The present case series is about three cases of CNS involvement of SARS-CoV-2 infection in children, without any respiratory symptoms.
Case 1
A previously healthy 9-year-old girl presented to the local Primary Health Centre with repeated episodes of convulsions (generalised tonic clonic) with neck rigidity, altered sensorium, projectile vomiting (three episodes), and two days history of fever. The child tested positive for SARS-CoV-2 by RAT. She was then, immediately referred to Zoram Medical College (ZMC) after initiating emergency medications (inj. midazolam for convulsion, inj. paracetamol for fever and intravenous (i.v.) fluid dextrose normal saline).
The child presented to the hospital with generalised tonic clonic seizure, Glasgow Coma Scale (GCS) score ranged from 8 to 9, muscle power were: left upper and lower limb 3/5 each, right upper and lower limb 1/5. Muscle tone was decreased in all the four limbs. Deep tendon reflexes were decreased in all the limbs. Plantar reflex was extensor response on right and flexor response on left side. Both pupils were normal in size and reaction. RT-PCR from nasopharyngeal swab was positive for SARS CoV-2. Fundus examination was normal with no signs of papilloedema. The child was given inj. mannitol 20%, inj. leveteracetum, inj. methylprednisolone and inj. cefotaxime. The CSF analysis showed white cell count (WCC) of 2/mm3 (smear was scanty cellular, no atypical cell seen) and CSF protein was 33 mg/dL. CSF RT-PCR for SARS-CoV-2 RNA was negative. The CSF for Acid Fast Bacilli (AFB) and Gram stain were negative. There was no growth after 72 hours of incubation for both aerobic and anaerobic culture. The blood parameters were not suggestive of Multisystem Inflammatory Syndrome in Children (MIS-C).
The MRI brain showed a heterogeneous mass in both thalami on Susceptibility Weighted Imaging (SWI), bilateral symmetrical areas of diffuse restriction in both thalami on Diffusion Weighted Imaging (DWI), the classic acute necrotising appearance of “tricolour/target-like appearance” or “concentric/laminar structure” in both thalami, hyperintense signals in both thalami on T2 weighted image (T2WI), multiple foci of gyral oedema, bilateral cerebellar and dorsum of brainstem involvement on T2WI. The MRI findings were consistent with necrotising encephalitis (Table/Fig 1)a,b,c,d,e,f. (Table/Fig 1)g,h shows bilateral cerebellar and dorsum of brainstem involvement on T2WI respectively. Following therapy, the patient showed clinical and neurological improvement. Her muscular weakness improved and the patient started taking orally. She was discharged on 10th day without any focal neurological deficit. The laboratory findings are shown in (Table/Fig 2).
Case 2
A previously healthy 13-year-old boy presented at a primary health centre with altered sensorium, seizures and two days history of fever. The boy was referred to the Institute (tertiary hospital). He showed positivity for SARS-CoV-2 rapid antigen.
On the way to the hospital, his consciousness deteriorated and became unresponsive. On admission, his vitals were unstable pulse rate 138 per minute, respiratory rate 24/minute, blood pressure 100/80 mmHg, temperature 101° F, room air SpO2 was 85%.
On Central Nervous System (CNS) examination, both pupils were equal in size and reactive to light; no cranial nerve palsy or neck rigidity. All the deep tendon reflexes were normally elicitable. Plantar reflex was flexion response on both side. The fundus examination showed no papilloedema. The boy had GCS of 10 (E4V1M5). He did not require intubation. The patient was started on injection remdesivir, inj. dexamethasone, empirical i.v. antibiotics, and levetiracetam immediately on reaching to our Paediatrics Intensive Care Unit (PICU). Nasopharyngeal RT-PCR was tested positive for SARS-CoV-2 at time of admission. CSF analysis are showed in (Table/Fig 3) and was negative for SARS-CoV-2 RNA. The contrast MRI brain showed cortical enhancement in left frontal lobe on T2 and Fluid Attenuated Inversion Recovery (FLAIR) images suggestive of acute encephalopathy (Table/Fig 4).
The patient responded to the treatment. On the third day, the child became conscious, there was no episode of convulsion, he could sit without support, walk with support and he could take semi-solid diet. The boy was discharged on the 7th day after completion of the dose of remdesivir. At the time of discharge, he was active, stable, no focal neurological defecit and was accepting food orally.
Case 3
A previously healthy 15-year-old male presented at a district hospital with fever associated with headache for four days, mulitple episodes of seizures for three days and altered sensorium for one day. The patient was found positive for RAT for SARS-CoV-2 and then referred to the tertiary centre Zoram Medical College (ZMC). The patient reached the Institute after three hours of journey, during which his consciousness deteriorated.
On admission, the patient had altered sensorium vitals Heart Rate (HR) 140/minute, Temperature 102°F, Blood Pressure (BP) 100/ 80 mmHg, Room Air SPO2 85%. He was drowsy with GCS -- E1V2M5, with GCS scores 8/10, neck rigidity was present. There were no signs of dehydration, his pupils were equal in size and bilaterally reactive to light; he had no cranial nerve palsies, plantar bilateral were extensors response and the deep tendon reflex on knee bilateral were 3+, ankles bilateral were 3+, The fundus examination showed no papilloedema. He was managed with intravenous antibiotic (ceftriaxone), inj. paracetamol, inj. dexamethasone, inj. 20% mannitol and inj. phenytoin, immediately on reaching to the (PICU). Nasopharyngeal RT-PCR was positive for SARS-CoV-2 at time of admission. Lumbar puncture was done on the next day of admission and CSF analysis showed in (Table/Fig 5) and was negative for SARS-CoV-2 RNA. The MRI brain showed normal findings. The child responded to the medical treatment. The child regained consciousness next day and there was no episode of convulsion, he could sit without support. He could walk with support on the 3rd day. Rest of the hospital stay was uneventful. The boy was discharged on the 10th day. Patient was well and had no neurological deficit at the time of discharge.
The virus enters the lungs via Angiotensin-Converting Enzyme 2 (ACE-2) receptor for SARS-CoV-2 and the virus uses the Transmembrane protease, serine 2 (TMPRSS2) for S protein priming (8). Recent studies have demonstrated that SARS-CoV-2 exhibits neurotropic properties (9),(10). A direct neuroinvasive effect of the virus could be explained by its retrograde movement along the olfactory or the peripheral lung nerves to the CNS or via haematogenic migration through the CNS endothelia that express ACE-2 receptors. An indirect effect can result from the leakage of inflammatory mediators through a permeable blood-brain barrier (11).
Neither of three patients had respiratory symptoms or signs of MISC/PIMS-TS (Multisystem Inflammatory, Syndrome, in Children/Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2) or history suggestive of SARS-CoV-2 infection prior to the present infection. The symptoms of encephalopathy, muscle weakness, and reduced reflexes of the 1st case was in consistent with the findings of Tandon M et al., (12). However, the latter study was a systematic review and the age of the study population was greater than 18 years.
The temporal sequence of signs of encephalopathy and neurological symptoms, in a known COVID-19 infection, along with the later MRI brain changes as seen in the first two cases are suggestive of neuroinflammatory process triggered by SARS-CoV-2. The laboratory parameters and the MRI brain findings of the 1st case was similar to the case presented by Lazarte-Rantes C et al., (13) and Tandon M et al., (12). The study by Tandon M et al., in a systematic review of CSF findings of 113 patients from 67 studies (12). The CSF protein levels were elevated in 74.5% (38/51) patients with non-severe COVID-19 and 68.6% (24/35) in those with a severe COVID-19 infection.
All the three cases showed reduced pleocytosis in the CSF, and it was common to see MRI changes during the acute phase of the encephalopathic illness rather than during the recovery phase which was similar with the findings by Ellul MA et al., (6) and Tandon M et al., (12). The normal MRI findings in patients having CNS manifestation with COVID-19 infection had been reported (13).
None of the patients had any other positive viral markers except for SARS-CoV-2. In all the index patients, other infectious causes with CNS manifestations were excluded. As all the three patients had no laboratory findings suggestive of MISC, it was concluded that, these patients had COVID-19 infections with rare neurological manifestations.
Although, SARS-CoV-2 can trigger an inflammatory process which can present as encephalitis features clinically, it is important to exhaust all means of investigations before labelling an encephalopathy as acute COVID-19 encephalitis. Paediatricians need to be aware of this association in paediatrics patients with COVID-19 presenting to the emergency room with neurologic symptoms and clinical worsening. Though acute necrotising encephalitis associated with SARS-CoV-2 due to autoimmune-mediated mechanisms has been described in the adult population, children could also be at risk of developing this disease, following COVID-19 infection.
The SARS-CoV-2 CSF RNA test was negative in all the three cases. The detection of anti-SARS-CoV-2 antibodies in CSF could have supported the diagnosis of patients with COVID-19 encephalitis, but this facility was unavailable in the study centre.
DOI: 10.7860/JCDR/2022/58481.17013
Date of Submission: Jul 18, 2022
Date of Peer Review: Aug 24, 2022
Date of Acceptance: Sep 23, 2022
Date of Publishing: Nov 01, 2022
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: Jul 19, 2022
• Manual Googling: Sep 18, 2022
• iThenticate Software: Sep 21, 2022 (20%)
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