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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
Original article / research
Full Version
Assessing the Role of MAPH Score in Predicting Acute Coronary Syndrome: A Cross-sectional Study
Correspondence Address :
Dr. KP Athira,
Abish Residence, Surathkal, Mangalore-575014, Karnataka, India.
E-mail: athirachithra@gmail.com
Introduction: Incorporating the concepts of hyperviscosity, platelet hyperactivity, and age-related risk of Acute Coronary Syndrome (ACS), a new score has been put forward-the Mean platelet volume-Age-total Protein-Haematocrit (MAPH) score, which can determine the increased thrombotic tendency associated with ST-Segment Elevation Myocardial Infarction (STEMI). The MAPH score includes parameters such as Mean Platelet Volume (MPV), age, total protein, and haematocrit. Researchers have found that a high MAPH score is associated with a high thrombus burden in cases with STEMI and Non ST-Elevation Myocardial Infarction (NSTEMI). However, the association between MAPH score and ACS is undefined.
Aim: To assess the role of MAPH score in predicting ACS.
Materials and Methods: This cross-sectional study was conducted in the Department of Pathology, Srinivas Institute of Medical Sciences and Research Centre Mangalore, Karnataka, India for six months. The study included 100 clinically diagnosed cases of ACS and 100 healthy controls. The demographic data, MPV, total protein, and haematocrit values of all cases and controls were collected and tabulated, and statistical analysis was performed. Receiver Operating Characteristic (ROC) curve analysis was performed on each MAPH score parameter, and cut-off values for each parameter were obtained based on the Youden index. After calculating the MAPH score of cases and controls, multivariate logistic regression analysis was performed to evaluate the role of the MAPH score as an independent predictor of ACS.
Results: A statistically significant increase in MPV (p-value=0.017) and total protein (p-value <0.001) was noted among the cases. The calculated cut-off values for MPV, age, total protein, and haematocrit were 8.4 fL, 54 years, 6.8 g/dL, and 49.1%, respectively. A statistically significant increase in the MAPH score was noted among the cases compared to the controls. Finally, multivariate logistic regression analysis identified the MAPH score as an independent predictor of ACS.
Conclusion: This was the first study investigating the association between MAPH scores in patients with ACS. The MAPH score was identified as an independent predictor of ACS and can be used as a screening tool to predict and diagnose the condition in primary healthcare settings. This helps to ensure early coronary revascularisation and reduce Coronary Artery Disease (CAD)-related mortality and morbidity to a greater extent.
Coronary artery disease, Haematocrit, Myocardial infarction, Primary healthcare, Thrombosis
Cardiovascular Diseases (CVD) are the leading cause of mortality and morbidity worldwide, accounting for 31% of all deaths globally. CAD, secondary to atherosclerosis and its complications, contributes to most of these deaths. Atherosclerotic plaques undergo erosion or rupture with added thrombus formation, leading to a complete or partial blockage of coronary arteries. The resulting cardiac ischaemia often leads to alarming clinical manifestations. The most baleful clinical presentation of CAD is ACS (1),(2). ACS covers the spectrum comprising STEMI and NSTEMI, and Unstable Angina (UA) (3). ACS requires immediate medical intervention to relieve the occlusion in coronary arteries. Partial occlusion leads to NSTEMI and UA, but complete occlusion leads to STEMI. The aetiopathogenesis of thrombosis, leading to arterial occlusion, is discussed in depth in the current era (4). Many studies are evaluating the role of hyperviscosity in thrombus formation (5). Studies conducted by Çinar T et al., and Caimi G et al., describe an association between acute myocardial infarction and hyperviscosity (6),(7). Cellular components, erythrocyte deformability, and plasma viscosity are the factors that determine blood viscosity. It is found that high molecular weight proteins in the plasma and haematocrit play a major role in contributing to hyperviscosity (8),(9).
Platelets play a significant role in the induction of atherosclerotic lesions and thrombus formation. The metabolically and enzymatically active larger platelets have a higher potential to create thrombosis, and the extent of platelet activation can be evaluated by assessing the Mean Platelet Volume (MPV). Researchers have found that MPV is higher in cases with ACS. Hence, they consider that MPV can be a biomarker in differentiating chest pains of cardiac origin from others (10),(11). Incorporating the concepts of hyperviscosity, platelet hyperactivity, and age-related risk of ACS, a recent study by Abacioglu OO et al., has put forward a new score-“The MAPH score”-that can determine the increased thrombotic tendency associated with STEMI. The parameters included in the MAPH score are MPV, age, total protein, and haematocrit (4). Researchers have found that a high MAPH score is associated with a high thrombus burden in cases with STEMI and NSTEMI (4),(12). However, the association between the MAPH score and ACS is yet to be defined. Hence, the present study aims to assess the role of the MAPH score in predicting ACS.
This cross-sectional study was conducted in the Department of Pathology, Srinivas Institute of Medical Sciences, Mangaluru, Karnataka, India, from January 2023 to June 2023. Data collection and analysis were completed in July 2023. Ethical clearance was obtained (SIEC/SIMS&RC/05(39)/2023).
Inclusion criteria: All clinically diagnosed cases of ACS were included in the study as cases. Subjects who came for routine health check-ups without any clinical complaints and having complete blood count and biochemical parameters such as liver function tests and total cholesterol values within normal limits were included as controls.
Exclusion criteria: Cases with severe hepatic disease, end-stage renal disease, febrile illness, thrombocytopenia, severe anaemia, those who received chemotherapy, and those with missing clinical data were excluded from the study. Controls who were on cholesterol-lowering drugs were also excluded from the study.
Sample size calculation: The estimated minimum sample size was 85, with a confidence interval of 95%, prevalence of 8% (13),(14), and an attributable error of 6%. The current study included 100 cases of ACS and 100 controls. Patient files of all cases and controls were reviewed. Complete blood counts and liver function were analysed using automated haematology and biochemistry analysers. The demographic data, MPV, total protein, and haematocrit values of all cases and controls were collected and tabulated.
Calculation of MAPH score: ROC curve analysis was performed on each MAPH score parameter, and each parameter’s cut-off values were obtained based on the Youden index. Values equal to or more than the cut-off were given a score of one, and values less than the cut-off were given a score of zero. The total score was obtained by adding the score of each parameter (4).
Statistical Analysis
Statistical analysis was performed using Microsoft Excel 2021 and and stats.pvalue.io. A comparison between the cases and controls was conducted with the Welch t-test. The significance of individual parameters in the MAPH score was analysed. A p-value <0.05 was considered statistically significant. After calculating the MAPH score in cases and controls, p-values, cut-off values, and ROC analysis were performed. Finally, multivariate logistic regression analysis was conducted to evaluate the role of the MAPH score as an independent predictor of ACS.
The current study included 100 cases of ACS and 100 controls. A male predominance was noted among the cases (n=62, 62%) and controls (n=68, 68%). Most cases were aged 71 to 80 years (n=33, 33%), followed by 61 to 70 years (n=27, 27%). The mean age of the cases with ACS (65.19±13.63 years) was higher than the control (51.22±20.27 years) group. Laboratory parameters such as MPV, total protein, and haematocrit were higher among the cases. This difference in MPV, age, and total protein was statistically significant (p-value=0.017, p-value <0.001, p-value <0.001, respectively). The statistical significance of higher haematocrit in cases was not established (p-value=0.61). The mean values and statistical significance of individual MAPH score parameters (MPV, age, total protein, and haematocrit) in cases and controls are summarised in (Table/Fig 1).
ROC analysis was performed on each parameter in the MAPH score (Table/Fig 2), and cut-off values to predict ACS were calculated based on the Youden index. The cut-off and Area Under the Curve (AUC) values for MPV, age, total protein, and haematocrit were (8.4 fL; 0.603), (54 years; 0.702), (6.8 g/dL; 0.720), and (49.1%; 0.511), respectively. Based on the cut-off values, the MAPH score was calculated, and ROC analysis of the MAPH score (Table/Fig 3) was performed. The mean MAPH score was higher in cases (2.39±0.79) than in the controls (1.17±0.77). This difference was found to be statistically significant (p-value <0.001). The cut-off value to predict ACS, calculated based on the Youden index, was two, and AUC was 0.848. MAPH score sensitivity was 89%, and specificity was 60% when the cut-off value was 2. The ROC curve analysis and cut-off values of the MAPH score and individual parameters, with sensitivity and specificity, are summarised in (Table/Fig 4).
Finally, multivariate logistic regression analysis identified the MAPH score as an independent predictor of ACS (Odds ratio 0.260 and p-value <0.001) (Table/Fig 5).
Ischaemic Heart Disease (IHD) records a significant mortality rate, morbidity rate, and socio-economic burden in the present era. IHD has caused more than two million deaths globally in the past two decades. According to recent World Health Organisation (WHO) statistics (2019), the leading cause of death in India is IHD, accounting for 90 deaths per 100,000 female population and 130 deaths per 100,000 male population (15). Hence, reducing the mortality and morbidity associated with IHD has to be prioritised in the current era. Researchers have identified various non modifiable risk factors for IHD and thus for ACS, which include male gender, age, genetics, and family history. A sedentary lifestyle with an unhealthy diet, smoking, obesity, diabetes mellitus, hypertension, and dyslipidaemia are the modifiable risk factors associated (16),(17). Among these risk factors, age strongly predicts mortality associated with ACS (18). Tal S et al., and Maden O et al., observed that individuals over 65 years are at an increased risk of developing thromboembolic events (19),(20). Similarly, in the current study, 60% of the cases were aged above 60 years. Enzymatically active large platelets with an increased MPV play a crucial role in the development of atherosclerosis and ACS. Therefore, MPV is an excellent indicator for identifying patients at risk of developing ACS (21),(22). Similarly, the current study also identified a statistically significant increase in MPV in patients with ACS. Studies have reported the association between blood hyperviscosity and ACS. Higher haematocrit and high molecular weight proteins in the plasma are significant factors leading to hyperviscosity (5),(7),(8),(23). The current study observed a statistically significant increase in total protein in ACS, but the statistical significance of the rise in haematocrit in ACS was not established.
Incorporating the concepts of advancing age, hyperviscosity, and platelet activation, Abacioglu OO et al., put forward the new MAPH score in 2021, which helps to determine the higher thrombus burden in cases with STEMI. Their study compared various parameters between the high thrombus grade group and low thrombus grade group and found that a MAPH score of more than two predicts a high thrombus load. Similarly, the current study predicts a high-risk of ACS, which can be secondary to a high thrombus load, when the MAPH score is more than two. According to Abacioglu OO et al., the sensitivity and specificity at a MAPH score >2 were 56.3% and 92.2%, respectively. The authors also identified that the MAPH score performs better than known biomarkers, such as High Shear Rate (HSR) and Low Shear Rate (LSR) (4). HSR and LSR are markers derived from haematocrit and total protein values, indicating serum viscosity and thrombotic tendencies (6),(24).
Çakmak Karaaslan Ö et al., suggest that the MAPH score is an independent predictor of high thrombus burden in cases of NSTEMI. Their study compares various parameters between the low thrombus burden group and the high thrombus burden group. The authors identified the best cut-off value of the MAPH score as two, which yields a sensitivity and specificity of 67.9% and 69.3%, respectively. The authors also suggest that this simple scoring tool helps in choosing appropriate clinical management and decreasing adverse consequences (12). Similarly, the current study identifies the MAPH score as an independent predictor of ACS, which can manifest as a result of a high thrombus load.
Akhan O and Kis¸ M, consider the MAPH score an indicator of blood viscosity. Therefore, they suggest that the score can predict the Coronary Slow Flow phenomenon. Similarly, findings from the current study also imply that the MAPH score can be considered as an indicator of blood viscosity. Akhan O and Kis¸ M, compared parameters between the coronary slow flow group and the normal flow group. According to the authors, at an MAPH score cut-off of 2.5, the sensitivity and specificity are 43% and 86%, respectively (25). The coronary slow flow phenomenon is a unique clinical situation with specific angiographic diagnostic criteria, where there is a delay in the distal opacification of the coronaries during angiography. Several studies have identified a relationship between hyperviscosity and CSF (26),(27),(28),(29). The MAPH score cut-offs with sensitivity and specificity given by various studies are summarised in (Table/Fig 6) (4),(12),(25).
Limitation(s)
The present study had limitations as it was conducted at a single institute. Therefore, multicentre prospective studies, including a more extensive study population, are needed to overcome these limitations.
The MAPH score has been identified as an independent predictor of ACS. Therefore, the MAPH score can be used as a screening tool to predict and diagnose ACS in primary healthcare settings. This helps ensure early coronary revascularisation and reduces CAD-related mortality and morbidity to a greater extent.
DOI: 10.7860/JCDR/2024/69056.19174
Date of Submission: Dec 13, 2023
Date of Peer Review: Jan 05, 2024
Date of Acceptance: Jan 30, 2024
Date of Publishing: Mar 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
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ETYMOLOGY: Author Origin
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