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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
Primary Aldosteronism: A Series of 11 Cases
Correspondence Address :
Dr. Pranab Kumar Sahana,
171 A, Ramesh Dutta Street, Kolkata-700006, West Bengal, India.
E-mail: pranabsahana@gmail.com
Primary Aldosteronism (PA) should be suspected in patients with resistant hypertension, early-onset hypertension, hypertension with hypokalaemia, and metabolic alkalosis. The diagnosis is often missed due to a lack of awareness and cumbersome investigations. Eleven cases of PA who attended the Endocrinology Outpatient Department (OPD) and were also admitted to the hospital over the last three years (January 2020 to January 2023) were studied, and data were collected and analysed. All 11 patients had hypertension, and five out of 11 had resistant hypertension and 36.36% (four patients) had a family history of hypertension. In this cohort, nine out of 11 patients presented with hypokalaemia (81.81%), and five of them had hypokalaemic paralysis at presentation. In 54.54% of patients, plasma aldosterone was in the range of 20-40 ng/dL, with a mean plasma Aldosterone conc. of 31.7 ng/dL. Plasma Renin Activity (PRA) was suppressed in all eight patients. In nine out of 11 patients, PAC/PRA was >20. A left-sided adrenal adenoma was observed in 54.54% of cases. Six patients (54.54%) received surgical management (laparoscopic adrenalectomy), and the remaining five patients were doing well with medical management (antihypertensives and spironolactone). This case series illustrates the need for screening of PA in patients with resistant hypertension, specifically those with hypokalaemia. Elevated PAC is diagnostic, especially in the context of suppressed PRA. Computed Tomography (CT) is the modality of choice for localising the adenoma in most cases. Clinicians can make decisions regarding the choice of treatment based on these two investigations.
Adrenal, Adenoma, Aldosterone, Hypertension, Hypokalaemia, Renin
PA is a disorder of the adrenal gland, caused by the hypersecretion of aldosterone. PA is the most common cause of secondary hypertension, with a prevalence of over 20% in resistant hypertension [1,2] and 10% in individuals with severe hypertension (Systolic Blood Pressure (SBP) ≥180, Diastolic Blood Pressure (DBP) ≥110 mmHg) (3),(4). PA increases cardiovascular morbidity and mortality even after blood pressure is controlled (5),(6). Therefore, early identification and specific treatment of PA are essential, although only a small fraction of patients with PA are diagnosed and treated (7).
PA should be suspected in patients with resistant hypertension, hypertension with hypokalaemia, or early-onset hypertension with metabolic alkalosis. The presence of hypokalaemia alongside hypertension should immediately raise suspicion of PA, although hypokalaemia may be absent in many PA patients (8),(9). A plasma aldosterone level >20 ng/dL with suppressed PRA strongly suggests PA, and confirmatory tests like saline suppression are unnecessary (9). This case series highlights the recent expansion of knowledge about PA and provides a practical approach to its diagnosis and treatment. To the best of our knowledge, this is the first case series on PA from Eastern India. This case series demonstrates the utility of properly conducted PAC/PRA ratio, along with absolute values of PAC, in the diagnosis of PA. Hypokalaemia, including hypokalaemic paralysis, is a useful but important hint for the diagnosis of PA.
A consecutive series of 11 PA cases, who attended the endocrinology OPD or were admitted to the hospital over the last three years (January 2020 to January 2023) were studied. Data was collected and analysed regarding their demographic profile, clinical and biochemical features, and imaging characteristics.
Patients were managed conservatively or surgically based on treatment guidelines and patient preferences. Prior to surgery, patients provided their consent as per the institutional protocol. The mean age in this population was 46 years (Table/Fig 1), and the majority were female (72.72%). All patients had hypertension, with 45.45% (5 out of 11) had resistant hypertension and 36.66% (four patients) having a family history of hypertension. Nine out of 11 of patients presented with hypokalaemia, and 45.45% (five patients) had hypokalaemic paralysis at presentation. In 54.54% of patients, plasma aldosterone levels ranged from 20-40 ng/dL, with a mean PAC of 31.7 ng/dL. PRA was suppressed in eight patients. Adrenal adenomas were identified in all 11 patients by imaging (Contrast Enhanced Computed Tomography (CECT) abdomen with adrenal protocol), with 54.54% of them being left-sided. The mean maximum dimension of the adrenal adenomas was 1.64 cm. Six patients (54.54%) received surgical management (laparoscopic adrenalectomy), and the remaining five patients were doing well with medical management (antihypertensives and spironolactone). In four out of the six patients who received surgical management, antihypertensive medications were stopped during follow-up visits as blood pressure was well controlled. The summary of all 11 patients is given in (Table/Fig 2). (Table/Fig 3),(Table/Fig 4),(Table/Fig 5),(Table/Fig 6),(Table/Fig 7) shows histological and radiological images of cases.
Dr. Litynski reported PA in 1953, which involves the overproduction of the hormone aldosterone that suppresses renin and inhibits the influx of sodium and the efflux of potassium, resulting in hypertension and hypokalaemia (8). PA should be considered in patients with severe hypertension or drug-resistant hypertension when taking three or more antihypertensives, including a diuretic, or in those with a family history of early-onset hypertension before the age of 40 years, and always in patients with an adrenal adenoma and HTN (9).
PA usually manifests between 30-50 years of age. The mean age in this case series was 46 years. Alam S et al., studied 202 patients with young-onset HTN and got 36 cases (17.8%) of PA. The mean age in their study was 43.9±10.9 years (10). Late-onset disease has also been described in the literature (11).
In this case series, 81.81% of patients presented with hypokalaemia, and 45.45% presented with acute onset quadriparesis, signifying the severity of hypokalaemia. The frequency of hypokalaemia in PA varies widely in different studies, ranging from 9-37% (12). Burrello J et al., studied 5100 patients with HTN and 804 patients were identified with hypokalaemia (15.8%). PA was diagnosed in 226 of these 804 patients (28.1%). 8.3% had an adrenal adenoma, and 15.3% were diagnosed with bilateral PA (13).
Bilateral Adrenal Hyperplasia (BAH) and Aldosterone-Producing Adenoma (APA) are the most frequent causes of PA, with a prevalence of 70% and 30% respectively (14). Surprisingly, all patients in the current case series had unilateral involvement, with five of them on the right side and the remaining six on the left side. Sometimes, aldosterone-producing microadenomas and most bilateral lesions are undetectable with computed tomography or magnetic resonance imaging because of poor accuracy (15),(16).
The majority of patients (81.81%) had PAC levels above 20.0 ng/dL, with only two had PAC <20.0 ng/dL. One patient had a PAC of only 10 ng/dL, signifying that a fixed cut-off should always be combined with clinical acumen as well as other investigation modalities.
PRA was suppressed in eight cases. The Endocrine Society guidelines reinforce the specificity of elevated aldosterone levels (>20 ng/dL) in the presence of hypokalaemia and suppressed renin (17). In this case series, nine out of 11 patients had an Aldosterone Renin ratio (ARR) >20. PA cases are screened based on an ARR >20 (using PAC in ng/dL and PRA in ng/mL/hr) (17). ARR can vary widely in different populations, and no single ARR threshold is recommended for clinical decision-making (18). Adrenal Venous Sampling (AVS) was done in two patients with age more than 40 years but the results were inconclusive. AVS was not performed in other eligible patients due to the clear diagnosis and the technical difficulty of the procedure (19). CT scan of the abdomen was used as the imaging procedure. Most adenomas were more than 1 cm and hypodense with a washout of more than 50%, consistent with the literature (20). Six patients (54.54%) underwent unilateral adrenalectomy, resulting in normalisation of potassium levels and a reduction of more than 50% in blood pressure. In a worldwide cohort of 380 patients with PA, complete and partial success rates of 30% and 48%, respectively, were achieved in patients undergoing unilateral adrenalectomy according to the PA surgical outcomes consensus (21).
PA is an important cause of hypertension that often goes undiagnosed. Hypokalaemia is common and is often associated with acute onset paralysis of the limbs. This case series highlights the need to screen for PA in patients with hypertension and hypokalaemia or resistant hypertension. A plasma aldosterone level more than above 20 ng/dL with suppressed plasma renin activity confirms the diagnosis in most cases. Most lesions are small and unilateral. It is important to diagnose PA early, as it is a curable condition. Once PA is diagnosed, an adrenal CT scan with adrenal protocol should be performed, followed by AVS in eligible cases to localise the adenoma and determine whether surgical or pharmacological treatment with mineralocorticoid receptor antagonists is appropriate.
Ethical issues: This case series included patients who were seen in the Endocrinology OPD or admitted to the IPD under the Endocrinology Department over the past three years and were managed as per standard protocols. No active intervention was taken for research purposes during their admission, and patient identities were not disclosed. Patients provided consent in accordance with institutional protocols.
DOI: 10.7860/JCDR/2023/64668.18437
Date of Submission: Apr 12, 2023
Date of Peer Review: May 24, 2023
Date of Acceptance: Aug 14, 2023
Date of Publishing: Sep 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: Apr 13, 2023
• Manual Googling: May 24, 2023
• iThenticate Software: Aug 01, 2023 (10%)
ETYMOLOGY: Author Origin
EMENDATIONS: 8
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