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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
Acute Myeloid Leukaemia Unmasked by Paraplegia: A Case Report
Correspondence Address :
Dr. Krupa Bhanushali,
Junior Resident, Department of Paediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi, Wardha-442107, Maharashtra, India.
E-mail: krupa.bhanushali22@yahoo.com
Acute Myeloid Leukaemia (AML) is a rapidly progressive myeloid neoplasm that is characterised by clonal expansion of immature myeloid lineage cells, known as blasts in the bone marrow and peripheral blood. It is known to present with pallor, bleeding tendencies and infections. However, Extra Medullary (EM) presentations involving the central nervous system are rare and can delay clinical diagnosis. Hereby, the authors report a case of 14-year-old male child who had a unique presentation of acute myeloid leukaemia. His initial symptoms were indicative of a central nervous system disease, and later the child was diagnosed to have acute myeloid leukaemia with spinal metastasis. A case of AML which does not routinely present with lower limb weakness and bowel or bladder dysfunction can be isolated with this case report and a crucial diagnosis can be caught early on. The present case underscores the critical need for maintaining high suspicion for haematological malignancies in children presenting with neurological deficits. It also highlights the different dimensions of the disease pathology and the disease’s rapid progression to metastasis. The key role of diagnostic imaging to isolate metastasis has also been focused on.
Bone marrow, Metastasis, Myeloid neoplasm, Myeloid Sarcomas, Neurological sequelae, Spinal metastases
A 14-year-old male child was admitted to the Department of Paediatrics with complaints of pain and progressive weakness of bilateral lower limbs for one week, with burning micturition and dribbling of urine and occasional bowel and bladder incontinence for four days. There was no history of sensory involvement and no familial history of similar complaints in a developmentally normal child. The child had a history of on-and-off bowel and bladder incontinence in the last 7-8 months, 1-2 episodes every month, lasting for around 3-4 days, for which no medical advice was sought. These complaints worsened in the preceding week, and the child was unable to pass urine or stool for two days, accompanied by dull, central abdominal pain. He also had complaints of bilateral lower limb weakness with difficulty and pain during walking a short distance. The mother also reported visible weight loss, as evidenced by the loosening of clothes over a 6-month period, with a history of night sweats present.
On admission, the child was vitally and haemodynamically stable with a Body Mass Index (BMI) of 12.2 kg/m2, underweight, Glasgow Coma Scale (GCS) score 15/15, with vitals within normal limits. Evidence of pallor was present but there was no enlarged lymph node or mass. On abdominal examination, inspection did not reveal any abnormality however, on palpation, the bladder was palpable well above the pubic symphysis and was tense. There was no splenomegaly or hepatomegaly noted, percussion did not reveal any abnormality. On neurological examination, higher mental functions and cranial nerve examination normal, however motor examination was suggestive of increased tone in all four limbs with reduced power and exaggerated reflexes in lower limbs with plantar extensors, no cerebellar signs or meningeal signs. The child was catheterised with a Foley’s catheter and 400 mL of urine was drained immediately on insertion. Cardiovascular, respiratory and other organ systems were not involved. Considering the neurological findings, child was suspected to have some central nervous system involvement, probably a mass or lesion leading to upper motor neuron lesions. The child was started on antibiotics-ceftriaxone (100 mg/kg/day for seven days) and symptomatic treatment like fever management and pain management was done Routine complete blood count revealed haemoglobin 8.3 g/dL and total leukocyte count 30,000 cells/mm³. Differential leukocyte count showed myeloblasts 35%, promyelocytes 5%, myelocytes 5%, mature polymorphs 25%, lymphocytes 20%, monocytes 7%, eosinophils 2%, and basophils 1%. Platelet count was reduced (66,000/mm³). Premature blast cells were noted on peripheral smear, suggestive of acute leukaemia (Table/Fig 1), and hence the child was taken up for bone marrow biopsy and aspiration, due to a strong suspicion of leukaemia. Bone marrow aspiration and biopsy revealed a hypercellular marrow with marked myeloid predominance. Differential count showed monoblasts 7%, myeloblasts 45%, promyelocytes 5%, myelocytes 15%, metamyelocytes 10%, band forms 5%, lymphocytes 5%, normoblasts 6%, plasma cells 1%, and eosinophils 1%. The blast percentage (52%) with evidence of granulocytic maturation beyond the promyelocyte stage is suggestive of AML with maturation (French-American-British (FAB) classification: AML-M2 subtype) (Table/Fig 2).
Flow cytometry was sent for further specifications, and the results were positive for Cluster of Differentiation (CD)13, CD33, Myeloperoxidase (MPO), CD56, CD38, Human Leukocyte Antigen – DR isotype (HLA-DR), CD34, and CD117. The child had no improvement in neurological symptoms with persistent retention of urine and stools, and paraesthesia in both lower limbs and was hence planned for chemotherapy.
MRI of the spine with contrast was done, which was suggestive of an intradural Extra Medullary (EM) lesion in the spinal canal at the level of L5-S1 of size 1.4×1.8×3 cm {Anteroposterior×Transverse ×Craniocaudal (AP×TV×CC)}, causing mass effect on the thecal sac in the form of displacement of the nerve roots towards the right with obliteration of the anterior and posterior thecal sac. Presacral mass lesion of size of approximately 6.1×2.2×8.2cm (TV×AP×CC) with extension along the sacral foramina and post elements. The features were suggestive of lymphoid infiltrative masses (Table/Fig 3). The child was started on intravenous hydration as per daily requirements, oral allopurinol at 10 mg/kg/day, Sulphamethoxazole and trimethoprim at 160 mg per day and fluconazole at 12 mg/kg/day. Initial suspicion was of a mass compressing the cord as child had complaints of lower limb weakness. Since there was no ascending progression of the weakness and also similar history in the past, Guillain-Barré syndrome was excluded.
Based on the bone marrow biopsy and aspiration with flow cytometry reports along with the neuroimaging, child was diagnosed with AML, M2 type with spinal metastasis. Child was planned for the azacitidine and Venetoclax protocol or for the 7+3 protocol-Cytarabine and anthracycline. Parents were advised for karyotyping and molecular marker testing of peripheral blood and then further conduction of chemotherapy; however, parents declined any further treatments and were then lost to follow-up.
Haematological malignancies can infiltrate EM soft tissue masses that occur at sites other than the bone marrow and present 2with varying symptoms. Extra Medullary Leukaemia (EM AML), also known as Myeloid Sarcoma (MS), is an uncommon as a presenting features and occur in 2-9% of newly diagnosed cases (1). As seen in the case, the child was approached with a Central Nervous System (CNS) differential in mind, which later unearthed the diagnosis of AML. A similar case was noted in a 15-year-old male child who had difficulty in walking and was later diagnosed with AML with space-occupying lesions causing severe cord compression in thoracic spinal canal (2). EM tumour masses consisted of malignant primitive myeloid cells that infiltrate and efface the underlying tissue structures, most commonly the lymph nodes, skin, soft tissues, bone, and peritoneum. Because of its rarity, a misdiagnosis rate of 25-47% has been reported (3). EM AML is most commonly labelled as malignant lymphoproliferative disorder or large-cell lymphoma. The clinical presentation is often dictated by the mass effect and location of the tumour (3). As seen in the presenting case, the features that the child presented with, like lower limb paresis, dictated a workup for neurological pathology, which eventually led to the diagnosis of AML.
Considering the wide variety of sites that EM AML can occur, proper imaging is crucial for diagnosis (4). As MS presents as a soft tissue mass, CT imaging is the most suitable diagnostic modality (5). For more effective screening in patients with bone-marrow AML, 18F-Fluorodeoxyglucose-Positron Emission Tomography (18FDG-PET) imaging is highly recommended (4). For cases with suspicion of brain, spine or orbit involvement, MRI with or without gadolinium contrast is considered (6).
Despite a CNS-focused presentation, confirmation of the diagnosis of MS is done by tissue sampling, typically by fine-needle aspiration. MS typically consists of a diffuse and infiltrative population of myeloblasts and granulocytic cell components, with the malignant cells appearing large with abundant cytoplasm and large nuclei. Samples are then further analysed by flow cytometry, fluorescence in situ hybridisation and molecular analysis. Immunohistochemistry (IHC) markers contribute to lineage classification, of which CD68-KP1 is the most commonly expressed marker, followed by MPO (6).
It is important to rule out Non Hodgkin’s lymphoma, lymphoblastic leukaemia, melanoma, plasmacytoid dendritic cell neoplasm, and Ewing’s sarcoma while considering the diagnosis of extra medullary metastasis of AML in atypical presenting features (6),(7).
EM AML with concurrent medullary involvement has an overall poor prognosis, with a 5-year survival rate between 20-30% (3). The presence of cytogenetic alterations has a conflicting role in the prognosis of the disease, with t(8;21) having a relatively better prognosis (8) whereas those involving chromosome 8 had a worse outcome (7).
Treatment modalities of AML with EM disease are governed by the extent of involvement; isolated involvement calls for intensive AML chemotherapy with radiotherapy as consolidation, and when marrow and EM involvement is seen, intensive chemotherapy with Haematopoietic Cell Transplantation (HCT) and radiotherapy, if EM is persistent after induction chemotherapy [9,10]. Chemotherapy in younger individuals includes a two-drug combination-cytarabine plus an anthracycline (daunorubicin or idarubicin), the 7+3 regimen, which was planned for the child (11). The consolidation phase usually involves long-term administration of a single drug-cytarabine. Another option for individuals in whom intensive therapy is unsuitable or not tolerated is azacitidine and venetoclax (10).
Newer modalities in management of AML with metastasis introduced by the US Food and Drug Administration (FDA) include targeted therapies including midostaurin (FLT3 inhibitor), gemtuzumab ozogamicin (CD33-directed antibody-drug conjugate), and enasidenib (IDH2 inhibitor). (11). These biologics have demonstrated an improved response in target sub populations; however, further studies are still required to determine their efficacy.
The present case underlines the importance of maintaining a high index of suspicion for haematological malignancies in children presenting with predominant neurological symptoms. It contributes to improving the overall survival outcome of such atypical cases.
Nervous system symptoms like lower limb weakness and bladder dysfunction can rarely be the initial presentation of AML. Moreover, diagnosis of the same requires a high degree of suspicion due to varied unusual modes of presentation as seen in the above case. Early catch facilitates prompt intervention that improves the prognosis of the disease.
DOI: 10.7860/JCDR/2026/85581.24422
Date of Submission: Dec 01, 2025
Date of Peer Review: Feb 16, 2026
Date of Acceptance: Jun 17, 2026
Date of Publishing: Oct 01, 2026
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 31, 2025
• Manual Googling: Jun 13, 2026
• iThenticate Software: Jun 15, 2026 (3%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com