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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
Death due to Dengue Encephalitis: A Rare Case Report
Correspondence Address :
Dr. Aniket Kurhade,
Assistant Professor, Department of Medicine, Dr. Vikhe Patil Memorial Hospital, Ahmednagar, Maharashtra, India.
E-mail: anikurhade@gmail.com
Dengue is a global public health concern, affecting around 50 million individuals and causing mortality in 20,000 patients per year. It is an arboviral disease caused by a single-stranded Ribonucleic Acid (RNA) virus belonging to the Flavivirus group and is transmitted by mosquitoes, specifically Aedes aegypti or albopictus. It comprises four serotypes, DENV1 to DENV4, and infection from one serotype only provides lifelong immunity for that subtype. Due to antibody-dependent enhancement, past infection with one serotype increases the prevalence of dengue haemorrhagic fever. The disease spectrum can range from asymptomatic infection to fever, fatal dengue haemorrhagic fever, or dengue shock syndrome. Due to improved disease knowledge, its involvement in the neurological system has been explored. Neurological abnormalities in dengue infection are rare and can be misdiagnosed due to other causes. Present case is of a young 23-year-old male with a history of fever 3-4 days prior, which later manifested with seizures and drowsiness. Despite emergency treatment, encephalitis and viral myocarditis developed, eventually leading to brain death within 24 hours of admission.
Brain death, Cerebral oedema, Convulsions, Dengue shock syndrome, Drowsiness, Headache, Viral myocarditis
A 23-year-old male with no previous co-morbidities presented at the emergency room in a drowsy and confused state, followed by an episode of generalised tonic-clonic convulsion. The patient had a recent travel history to Assam for 15 days; however, while returning, the patient started experiencing intermittent high-grade fever and associated chills and rigor of three to four days’ duration, along with a diffuse, dull, aching, continuous headache of three days’ duration and three to four episodes of non bilious vomiting prior to the presentation with irritability and body ache. He sought primary treatment from a local practitioner, but his symptoms failed to improve.
On examination, his body temperature was 102.4°F, heart rate 150 bpm, Blood Pressure (BP) 100/70 mmHg, respiratory rate 40/min, and Oxygen Saturation (SpO2) 80% on room air. Cardiovascular System (CVS) examination revealed audible heart sounds S1 and S2 with tachycardia, and Respiratory System (RS) examination revealed tachypnoea with bilateral wheezing. The abdomen was soft and non tender. Central Nervous System (CNS) examination showed the patient to be drowsy, sluggish in responding to verbal commands, and moving all four limbs in response to stimuli. The Electrocardiogram (ECG) showed sinus rhythm with tachycardia-related changes.
Due to rapid deterioration in SpO2 and a Glasgow Coma Scale (GCS) score of 8/15 (eye-opening: 2/4, verbal response: 2/5, motor response: 4/6), and for airway protection, intubation was performed, and the patient was placed on mechanical ventilatory support. Non contrast Computed Tomography (CT) of the brain revealed no significant abnormalities (Table/Fig 1), and High-Resolution Computed Tomography (HRCT) of the chest revealed no significant abnormalities (Table/Fig 2). Magnetic Resonance Imaging (MRI) and Cerebrospinal Fluid (CSF) examination could not be performed due to the patient’s critical condition. The patient was then transferred to the Intensive Care Unit (ICU). The patient’s laboratory parameters showed severe alterations indicating severe infection with multisystem involvement (Table/Fig 3).
Considering the febrile illness with thrombocytopenia and multisystem involvement, the patient was further investigated for malaria, dengue fever, rickettsial fever, enteric fever, and leptospirosis, which all yielded negative results. Dengue NS antigen was reactive, while IgM and IgG were non reactive. The initial diagnosis of dengue fever with thrombocytopenia and multisystem involvement was made, which was confirmed with serological evidence. The patient was started on intravenous ceftriaxone, doxycycline, mannitol, dexamethasone, and potassium correction. After two hours in the ICU, his condition started to deteriorate haemodynamically and neurologically, requiring multiple ionotropic supports (noradrenaline, vasopressin, dobutamine).
The echocardiogram showed sinus tachycardia, global Left Ventricular (LV) hypokinesia, mild mitral regurgitation, Grade-III LV diastolic dysfunction, and severe LV dysfunction with Left Ventricular Ejection Fraction (LVEF) of 15%. Troponin-I level was 2520 pg/mL, and Creatinine Phosphokinase (CPK-MB) level was 137 U/L, suggesting viral myocarditis. Intravenous methylprednisolone (1gm stat) was administered. Later, the patient became deeply comatose; the doll’s eye reflex was absent; pupils were dilated and non reactive to light, and bilateral absent plantar response. Brainstem reflexes were absent. The Electroencephalogram (EEG) showed no discernable background activity.
Despite continuous ionotropic support, his condition deteriorated over the next few hours. The patient went into bradyarrhythmia and experienced a cardiorespiratory arrest. Cardiopulmonary Resuscitation (CPR) was initiated according to Advanced Cardiovascular Life Support (ACLS) protocols, but the patient could not be revived.
Dengue infections pose a significant healthcare concern, with approximately 390 million reported cases, both symptomatic and asymptomatic, particularly in Southeast Asian regions (1). The high prevalence of dengue can be attributed to poor environmental sanitation and increased mosquito infestation (2). The Dengue virus is an arbovirus with a single-stranded RNA, and it presents four serological variants. The clinical presentation of dengue can range from mild symptoms such as headache, myalgia, fever, rash, and abdominal pain to more severe conditions like dengue haemorrhagic fever, dengue shock syndrome, gastrointestinal bleeding, ascites, pleural effusion, fulminant hepatitis, and cardiomyopathy. About 10% of dengue cases exhibit neurological disorders such as encephalitis, encephalopathy, myelitis, Guillain-Barre Syndrome, and meningitis. Neurological manifestations are primarily observed in cases with severe dengue infections (3). These neurological complications can resemble encephalitis and may delay treatment, leading to cerebral oedema or brain death (4). Therefore, it is crucial to consider dengue-associated encephalitis in patients presenting with neurological symptoms in endemic areas. Early diagnosis is essential, and confirming the infection through testing for NS1 antigen in CSF is recommended (5). In 2009, the World Health Organisation (WHO) included neurological manifestations as a criterion for assessing the severity of dengue infection (3). Although dengue encephalitis is a rare presentation with limited literature available (6),(7), in the case presented above, the infection progressed rapidly, and the patient’s condition deteriorated despite receiving optimal rescue treatment. Initially, CNS involvement was believed to be secondary to dengue haemorrhagic fever, causing cerebral oedema, sodium imbalance, and hepatic and renal failure. Hepatic encephalopathy, cerebral hypoperfusion, cerebral oedema resulting from vascular leakage, and coagulopathy leading to intracranial bleeding can all contribute to dengue encephalopathy and encephalitis (8). The exact pathophysiology of CNS involvement in dengue is not clear; however, it is believed that the impairment of the Blood-Brain Barrier (BBB) due to hyperactivity of TNF-α and IL-6 allows the entry of the virus (9). Brain autopsies have revealed dengue-specific IgM antibodies and positive Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) results in the CSF, indicating CNS invasion of the dengue virus during acute infection (10).
Autopsy findings in dengue patients with CNS involvement have revealed significant cerebral oedema, which obliterates the sulci and causes flattening of the gyrus. Haemorrhagic spots throughout the brain have also been observed, and there is one reported case of brain herniation in the literature (11). Certain laboratory parameters, such as increased mean haematocrit or elevated serum transaminase levels, show an association with severe dengue infection and high body temperature, independently predicting the occurrence of encephalitis (12). Two studies have indicated higher mortality rates in cases of dengue encephalitis, with rates of 32% and 33.33% [13,14]. The cases of encephalitis caused by dengue are more commonly reported in young adult males, as seen in the case presented above (14). Cases with dengue-positive CSF are associated with an increased mortality rate, suggesting severe infection (14).
Encephalitis is the most common CNS manifestation of dengue, characterised by symptoms such as headaches, seizures, and altered consciousness, which can also be present in other cerebral diseases. Many patients with encephalitis also exhibit typical dengue symptoms such as fever, myalgia, rash, or bleeding (15). Confirming the diagnosis of neurological dengue infection can be done by detecting the presence of dengue IgM, virus RNA, or antigens, along with CSF analysis, CT, or MRI of the brain (16). In the present case, MRI of the brain and CSF analysis could not be performed due to the patient’s haemodynamic instability. In a study by Solomon T et al., out of nine patients with confirmed dengue infection and encephalitis, the virus or antibody could only be isolated in two patients (15). The pathogenesis of a severe dengue infection depends on secondary infections, the virulence of the virus, and the susceptibility of the host (17). Secondary dengue infection enhances the virulence through antibody-dependent enhancement, leading to increased severity of the disease (13).
The patient presented in this case had a travel history from Assam, an endemic region for dengue infection (18). In addition to fever, vomiting, and headache, the patient developed drowsiness and experienced one episode of tonic-clonic convulsion. Upon admission, systemic examinations and vital parameter assessments revealed encephalitis with a deteriorating condition, ultimately resulting in brain death. Laboratory findings confirmed dengue infection and indicated a poor prognosis. Despite treatment with ionotropic medications and supportive care, the patient could not be saved. The role of antiviral drugs and treatment strategies in critical cases like these needs to be defined to reduce mortality. Currently, there is no FDA-approved antiviral drug for dengue fever. Therefore, dengue-associated neurological manifestations, such as encephalitis and encephalopathy, although rare, must be considered in cases of fever, especially during a dengue epidemic, as they can be life-threatening and require immediate intervention.
Acute dengue infection was previously considered non encephalitic. However, due to increasing viral neurotropism, neurological manifestations in dengue infection are on the rise. Although encephalitis in dengue patients is generally thought to be benign, it can be fatal in some cases. In the present case, despite receiving emergency treatment, the patient developed encephalitis and viral myocarditis, ultimately leading to brain death within 24 hours of admission. Therefore, physicians should be aware and vigilant in the early diagnosis of neurological manifestations, altered sensorium, and severely abnormal laboratory and imaging findings, as they could potentially indicate dengue encephalitis and allow for earlier intervention, thus reducing mortality and morbidity. In suspected cases, early neuroimaging, preferably MRI, is recommended.
DOI: 10.7860/JCDR/2023/63767.18563
Date of Submission: Feb 26, 2023
Date of Peer Review: Jun 13, 2023
Date of Acceptance: Sep 11, 2023
Date of Publishing: Oct 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 28, 2023
• Manual Googling: Jun 20, 2023
• iThenticate Software: Sep 09, 2023 (8%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
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