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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
Dengue Fever Presenting as Ischaemic Stroke: A Case Report
Correspondence Address :
Dr. Praneeth Perumalla,
21/225-4, 1st Road Extension, SKD Colony, Adoni-518301, Andhra Pradesh, India.
E-mail: praneethperumalla2@gmail.com
Several neurological manifestations are common in dengue fever. They are encephalitis, encephalopathy, Guillain Barre Syndrome (GBS), Intracranial haemorrhage, but, ischaemic stroke is a rare complication. This is a case report of ischaemic stroke in a patient with dengue fever. A 39-year-old female patient presented to the emergency department with the chief complaints of fever, retro orbital pain since four days, and one episode of seizure on the day of presentation. Examination revealed left homonymous hemianopia. Diagnosis of dengue was made based on Immunoglobulin M (IgM) Enzyme-Linked Immunosorbent Assay (ELISA) positive for dengue. Magnetic Resonance Imaging (MRI) brain showed acute infarcts in right temporal, right occipital and right hippocampal region. Severity of hemianopia decreased as the days progressed and platelet count gradually improved to normal limits within five days. Adequate fluid management was given and the patient was discharged once stable. Anti-platelets were started after two weeks during the follow-up. Examination during follow-up showed decrease in hemianopia to just mild blurring of vision on left gaze. Ischaemic stroke is rarer entity and clinicians should be made aware of this complication.
Coagulopathy, Encephalitis, Thrombocytopaenia, Vasculitis
A 39-year-old female patient presented to the emergency department with the chief complaints of fever, headache since four days and one episode of seizure on the day of presentation to the hospital. History of presenting illness revealed high grade fever of 101 degree Fahrenheit which was intermittent and was not associated with chills and rigours. History of headache and retro-orbital pain was from four days. On the day of presentation to the hospital, there was an episode of generalised tonic clonic seizure and decreased vision on left gaze. There was no significant past history or family history. On examination the general condition of the patient was good and vitals were stable. Neurological examination revealed left sided homonymous hemianopia. Initially there was a complete loss of vision in left sided visual field which gradually improved from day four of admission. Rest of the neurological examination was normal. Other systemic examination was normal. Investigations revealed IgM positive dengue associated with leukopaenia and thrombocytopaenia which showed a decline in count initially followed by gradual rise as shown here (11700-72000-57000-89000-147000/μL). Other investigations have been tabulated below (Table/Fig 1).
MRI brain showed acute infarcts in right temporal, occipital and right hippocampal region with MR angiography showing absent flow in right posterior cerebral artery (Table/Fig 2),(Table/Fig 3). Adequate fluid therapy was given after two weeks during follow-up as the main stay of treatment and the patient was discharged once stable. The platelets improved to the normal limits. During the follow-up visit she showed an improvement in the field of vision from complete loss of vision on left gaze to just blurring of vision. Antiplatelet agents were started during follow-up visit.
The prevalence of neurological manifestations in a dengue fever is rare. In a study, conducted among patients admitted with dengue fever 2.64% patients developed neurological manifestations (1). Headache is very common in dengue which was also one of the complaint of the patient in this study and seen in >97% patients but not included in neurological manifestations (1). The relationship between dengue and neurological manifestations is very difficult to establish and dengue may be a co-incidental or precipitating factor and many investigations need to be done to rule out other causes of these manifestations as done in the present patient before attributing the present neurological manifestations to dengue (2). Encephalopathy is considered to be the most common neurological manifestation of dengue (3). It was reported in many studies to be present in 19.4% of patients with neurological manifestations as stated by Koshy JM et al., study, 22% as stated by Sahu R et al., study (4),(5).
The pathophysiology of dengue encephalopathy is multifactorial and is due to cerebral oedema, hypoxia, haemorrhage and associated systemic dysfunction like shock, hyponatraemia, liver and kidney failure (2),(3). Encephalitis is also seen in dengue. It is an illness with altered sensorium, fever, seizures and focal deficits usually occurring with viral illness. Dengue is an uncommon cause of encephalitis (6). The term encephalitis has been used in different contexts in various studies, hence the prevalence of it changes. In the latest study by Kulkarni R et al., its incidence was 15.6% (1). It is diagnosed by CSF pleocytosis, radiological and serological features. The radiological pattern of dengue encephalitis is also very variable (7). Seizures can also occur in dengue patients, as seen in the present case and seizures can also occur without any radiological abnormality but the patient had radiological abnormality in the form of infarct which was the cause for seizures. Its incidence varies from 43-70% (8),(9). Opsoclonus myoclonus syndrome can also occur in dengue but has a rare incidence (1). It occurs as a postinfectious complication of dengue. Posterior Reversible Encephalopathy Syndrome (PRES) usually seen with elevated blood pressure and having a characteristic MRI findings of bilateral white matter hyperintensities more commonly seen posteriorly. It has also been described in infections like dengue (10). Capillary endothelial dysfunction seen in dengue leads to loss of cerebral autoregulation and vasogenic oedema leading to PRES. For attributing PRES to dengue there should be absence of accelerated hypertension or drugs precipitating PRES. Syncope can occur in dengue due to hypotension, high grade fever or myocarditis. It is a common finding seen in 27.3% patients (1). Intracranial haemorrhage occurs in dengue secondary to thrombocytopenia and vasculitis. Haemorrhage can be subdural, subarachnoid and intra parenchymal (11). Surgical intervention can be challenging as there is associated thrombocytopenia. GBS is an acute neuropathy due to antecedent infection. GBS has been reported in few cases following dengue infection [12-14]. Dengue antigens may mimic antigens in peripheral nerves and cell mediated immunological response to viral antigens may target peripheral nerves in dengue associated GBS (1). Brachial plexopathy has also been reported in dengue (15),(16). Hypokalemic paralysis has been described with dengue in various case series (4),(5),(17). The mechanism postulated is transient renal tubular acidosis with increased urinary potassium wasting secondary to stress related increase in catecholamines in dengue (1). Dengue usually causes intense myalgias but myositis and rhabdomyolysis have been rarely reported (18),(19). Dengue can also cause a large number of ophthalmological manifestations in the convalescent phase suggesting an immunological basis. Optic neuropathy is the most common among the ophthalmological manifestations (12),(13).
Ischaemic stroke is a very rare entity in dengue and only a few cases have been reported across the globe (20). One among those rare cases seen with dengue causing ischaemic stroke is this case. The pathogenic mechanism for the occurrence of dengue is thought to be due to meningo-vasculitis. Other mechanisms postulated were deranged haemostasis, hypotension, severe volume depletion leading to transient hypercoagulable state during dengue (1). The most probable cause among these in present case might be the meningo-vasculitis and transient hyper coagulable state as this ischaemic stroke occurred during the peak of thrombocytopaenia. Both arterial and venous thrombosis can occur in dengue but they are very rare. Only few cases have been recorded of dengue causing ischaemic stroke. The cause for this low incidence of dengue causing ischaemic stroke can be due to the decreased awareness of dengue presenting as ischaemic stroke and the difficulty in establishing the causative relation between dengue and ischaemic stroke.
Neurological manifestations of dengue are a serious entity and utmost importance has to be given for it. Ischaemic stroke which is not very common in dengue, must be looked for in suspected cases, as early recognition and management can reduce both mortality and morbidity. Delayed recognition of ischaemic stroke can lead to increased risk of death. Thus, it is a priority to identify ischaemic stroke and other neurological manifestations in dengue as early as possible to enhance neurological recovery. Physicians should be made aware of these rare complications of dengue fever so as their early recognition is possible and strict intensive care management can be provided to such cases.
DOI: 10.7860/JCDR/2023/62146.17750
Date of Submission: Dec 10, 2022
Date of Peer Review: Jan 20, 2023
Date of Acceptance: Mar 24, 2023
Date of Publishing: Apr 01, 2023
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, 2022
• Manual Googling: Feb 11, 2023
• iThenticate Software: Mar 16, 2023 (8%)
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