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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
Lateral Medullary Syndrome Presenting as Persistent Singultus and Upper Motor Neuron Facial Palsy in a Young Adult: A Rare Case
Correspondence Address :
Dr. Suprit Malali,
Postgraduate Resident, Department of General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi, Meghe, Wardha-442005, Maharastra, India.
E-mail: supritbm@gmail.com
Lateral Medullary Syndrome (LMS) is a collection of different neurologic symptoms after cerebral haemorrhage/infarction. The areas most frequently afflicted are the cerebellum and the posterolateral portion of the brain stem’s medulla oblongata; the Posterior Inferior Cerebellar Artery (PICA) supplies blood. Dizziness, vertigo, nystagmus, nausea, ataxia, dysphagia, vomiting, hiccups, hoarseness, sensation impaired on half of the face, impaired thermal sensation and pain on the contralateral side of the limbs, trunk, ipsilateral face, along with Horner’s syndrome are amongst the typical symptoms of lateral medullary infarction. Hiccups are among the signs that are simple to ignore, although they can also result in oesophagitis, and respiratory depression, as Wallenberg’s syndrome is the most frequently reported. The authors discuss the case of a 30-year-old male who complained of recurrent, uncontrollable hiccups as an LMS-presenting symptom and was brought to our hospital. He arrived at our emergency room complaining of persistent, intractable hiccups and cerebellar symptoms on the left-side. In addition to being hypertensive, he had a long history of tobacco (chewing) and alcohol addictions dating back six years. He had 7, 9 and 10th cranial nerve involvement. The authors are reporting this case because the patient had Upper Motor Neuron (UMN)-type facial palsy, a rare presentation in LMS.
Hiccups, Posterior inferior cerebellar artery, Stroke
A 30-year-old male patient came in complaining of vomiting 5-6 times, uncontrollable hiccups for 10 days slurring of speech, and left-sided facial weakness for one day. The patient has just received antacids (inj. Pantoprazole 40 mg), but there was no significant improvement in the symptoms. The patient has had a history of hypertension for the last 10 years for which he was taking regular medication (Tab Telmisartan 40 mg once a day). The patient has been an alcoholic for six years and used to consume around 40-60 mL twice a week and tobacco chewer for eight years. On general examination, his pulse was 80 per minute and his blood pressure was 170/100 mmHg in his right arm, supine position. His respiratory, abdominal and cardiovascular system examination was within normal limits.
On Central Nervous System (CNS) examination his higher mental function was unimpaired. He had a deviation of the angle of mouth to the right, suggestive of Upper Motor Neuron (UMN) 7th cranial nerve palsy (Table/Fig 1). He was also having voice hoarseness as well as nasal regurgitation due to a lack of gag reflex, suggestive of 9th and 10th cranial nerve involvement. On motor system examination his tone was normal with 5/5 power and all deep tendon reflexes were intact. The left finger-nose test, left heel-to-knee test, and left dysdiadochokinesia test were impaired and torsional nystagmus was present, suggestive of the involvement of the cerebellum. Complete Blood Count (CBC), Liver Function Test (LFT), Kidney Function Test (KFT), serum electrolytes, and sugars were all within normal limits (Table/Fig 2).
Computed Tomography (CT) of brain showed an acute infarct in the medulla on the left-side (Table/Fig 3) (Yellow arrow). Magnetic Resonance Imaging (MRI) of brain showed (Table/Fig 4) (Red arrow) a Diffusion-weighted image showing a high signal in the lateral part of the left medulla oblongata. The patient was started on dual antiplatelet (Tab Ecosprin 75 mg od, Tab Clopidogrel 75 mg od), statins, Tab Baclofen 10 mg once a day and increased to 20 mg three times a day and Injectable prokinetic agents (Metoclopramide 10 mg three times a day), and later was given four times a day; there was no improvement in the frequency and intensity of hiccups. Suctioning was done frequently. Due to an absent Gag reflex, he was intubated to protect his airway from the pent-up secretions. As we could not wean off the mechanical ventilation, a tracheostomy was done. He was discharged after one month and followed-up every month. The patient improved significantly, and the hiccups settled after 2.5 months. The tracheostomy tube was decannulated after three months. On regular follow-up, the patient is doing well.
Repeated involuntary, spasmodic, and momentary contractions of the diaphragm cause hiccups characterised by rapid closure of the glottis and a distinctive “hic” sound (1). Most people will sometimes suffer hiccups, also known as singultus, which are often short-lived and self-limiting (1),(2). Rarely do hiccups persist for more than 48 hours, necessitating immediate medical attention and thorough medical examinations to identify any underlying pathology (3).
Although the precise location of the hiccups’ neuroanatomical center is unknown, it is thought to be a region of the brain stem that interacts with the brain stem’s respiratory centers, hypothalamus, medullary reticular formation, and phrenic nerve nuclei. The dorsal sympathetic fibres and sensory branches of the vagus and phrenic nerves make up the afferent pathway. In contrast, the motor fibres of the phrenic nerve make up the efferent pathway. Both internal and external factors can produce hiccups (3). Lesions in the pathway between the CNS and the phrenic nerve, most commonly in the brain stem, illnesses such as a dolichoectatic basilar artery, ischaemic stroke, encephalitis, tumours and multiple sclerosis, cause major hiccups. Phrenic nerve disorders can result in peripheral hiccups like gastric distension (4).
With various clinical manifestations of Cerebrovascular Event (CVE), Lateral Medullary Syndrome (LMS) remains an intriguing clinical entity (5). The posterolateral section of the medulla oblongata, which is the component getting arterial blood flow from the Posterior Inferior Cerebellar Artery (PICA) is the region of the brain stem involved in LMS (6). Dizziness, vertigo, nystagmus, nausea, ataxia, dysphagia, vomiting, hiccups, hoarseness, sensation impaired on half of the face, impaired thermal sensation and pain on the contralateral side of the limbs, trunk, ipsilateral face, along with Horner’s syndrome are amongst the typical symptoms of lateral medullary infarction. Hiccups are among the signs that are simple to ignore, although they can also result in oesophagitis, and respiratory depression, as Wallenberg’s syndrome is the most frequently reported (7).
Though a few theories have been put up, how hiccups in people with LMS occur is still being determined. It involves the dorsolateral medulla region, which contains the nucleus ambiguous and the motor neurons of the vagus that project to the premotor neurons and larynx that govern the diaphragm. The motor neurons of the larynx, which control the glottis, and the premotor neurons, which control the inspiratory muscles, are affected, causing hiccups. Constant hiccups frequently point to a severe underlying illness requiring thorough examination. Most of the more than 100 causes of hiccups are found in the digestive system. Recently, there has been a notable focus on brain stem lesions, with particular emphasis on identifying significant contributing factors. Numerous different diseases of the medullary area can bring on hiccups. Clinical studies (3),(6),(8),(9) have shown a correlation between the 9th and 10th cranial nerve symptoms and hiccups, which appeared to be associated with a complete lesion in the middle of the lateral medullary area (9). A small region of the medullary reticular formation, the Hiccup-evoking Site (HES), can be electrically stimulated to cause a response resembling a hiccup, and hiccups are quickly stopped by microinjecting the Gamma Aminobutyric Acid (GABA) analogue baclofen into the HES (8).
Patients with LMS frequently had hiccups when the lesions were in the central medulla’s dorsolateral region. Hiccups and signs of cerebellar, vestibular, and 5th, 9th, and 10th cranial nerve involvement were closely correlated (9). It has been documented that gabapentin treats chronic hiccups in LMS patients. The effects of gabapentin may include enhancing GABA-mediated inhibition or specifically reducing calcium influx by inhibiting voltage-operated calcium channels (10). This may stop the diaphragm’s intermittent myoclonus, which results from the isolated nucleus’s recurrent activity.
One case report revealed facial palsy in LMS with the possible hypothesis that there is abnormality in the Dejerine’s pyramidal tract. The hypothetical supranuclear corticobulbar fibre loop in the medulla descends ventromedially, decussates at the superior medulla, and then ascends dorsolaterally to the facial nerve nucleus. Chakraborty U et al., opines that LMS exhibited unusual features such as hemiparesis, UMN facial palsy, and the absence of typical bulbar symptoms and classical Horner’s syndrome, which is similar to the present study. These variations stem from differences in the affected neuroanatomical structures (11). When considering the neurological correlation, these manifestations align with a potential diagnosis resembling Babinski-Nageotte syndrome, specifically characterised by UMN-type facial palsy. Ibrahim M et al., (12) wrote in their case report that a patient presented with horizontal nystagmus, indicative of true bulbar palsy affecting the cranial nerves responsible for the bulbar function, which was not observed in the present case. The patient exhibited dysphagia, primarily for fluids, along with nasal phonation of the voice. An MRI of the brain was requested and revealed acute lacunar infarctions in the lateral and posterior aspects of the right side of the medulla, as well as the posterior inferior aspect of the right cerebellar hemisphere within the PICA territory. To manage the dysphagia, a nasogastric tube was inserted. The patient’s treatment plan included lioresal 25 mg three times a day and phenergan (an antihistaminic) twice a day to control hiccups. Additionally, the patient was prescribed clopidogrel 75 mg/day and Angiotensin-converting Enzyme Inhibitors (ACEI) to regulate blood pressure. Upon discharge, the patient retained the nasogastric tube and was scheduled for follow-up at the neurology clinic (12).
The LMS presenting with involvement of the facial nerve is very rare. Hence, the authors are presenting this case suggesting not overlooking the LMS in the presence of these rare involvements, instead recognising the unusual presentation at the earliest and managing appropriately for a better prognosis. Early recognition and diagnosis are imperative in optimising patient outcomes. Prompt intervention, which may include targeted therapies, rehabilitation, and supportive care, can contribute to better recovery and mitigate potential complications associated with LMS. The present case report emphasises the value of taking a cautious approach to seemingly unimportant hiccups, especially when they are present and exhibit symptoms resistant to initial treatments.
DOI: 10.7860/JCDR/2024/67831.19147
Date of Submission: Oct 03, 2023
Date of Peer Review: Dec 04, 2023
Date of Acceptance: Jan 15, 2024
Date of Publishing: Mar 01, 2024
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: Oct 03, 2023
• Manual Googling: Dec 21, 2023
• iThenticate Software: Jan 13, 2024 (10%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
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