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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
Clinician's corner
Pendular Knee Jerk in a Spastic Limb- Seeking Poetic Justice for Conventional Neuroscience!
OH01-OH02
Correspondence
Dr. Sourya Acharya,
Professor and Head, Department of Internal Medicine, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India.
E-mail: souryaacharya74@gmail.com
In a conventional clinical round, my resident presented a case of a Cerebrovascular Event (CVE) with right-sided hemiparesis and requested me to demonstrate ankle clonus. I demonstrated it for him and the other junior residents attending the rounds [Video-1]. I then asked the senior resident to demonstrate all the deep tendon reflexes, which he did correctly, and we all observed the exaggerated deep tendon reflexes in the right-sided upper and lower limbs. A conventional clinical neurologic question-and-answer session regarding tone and reflexes continued for some time, starting with the definition and classification of tone, causes of hypertonia, and the differences between spasticity, rigidity and paratonia. We also discussed the grades of reflexes, clonus and hyperreflexia.
Then, I purposefully stumbled upon the “pendular knee jerk.” I was pleased to hear the response. The senior resident answered, “The pendular knee jerk is seen in cerebellar disease. When we strike the patellar tendon, the leg swings to and fro like a pendulum for more than four times,” and he explained that it is due to hypotonia in cerebellar disease. A “hung-up” knee reflex, which is seen in chorea, also exhibits a pendular quality, again due to hypotonia. In a way, the pendular knee jerk hints at decreased tone (hypotonia).
By that time, the 75-year-old patient had gotten up and was sitting at the edge of the bed with his legs dangling down. I struck the patellar tendon on the right-side, and what I observed sparked my neurologic insight. I recorded it [Video-2]. Was this unconventional neurology? A pendular knee reflex with an added rotatory movement that continued for more than six times.
There was a silent awe and pause of several seconds; all eyes were on me, and my eyes were on the patient’s knee. I repeated the experiment another three or four times to confirm what I had seen, and it was... pendular... for five to six movements, then it became rotatory/circumducting for another four to five oscillations. Now I pondered upon the explanation.
The knee-jerk reflex, or patellar reflex, is a monosynaptic stretch reflex that assesses the integrity of the L2, L3, and L4 segments of the spinal cord. When the patellar tendon is struck with a reflex hammer, it stretches the muscle spindle in the quadriceps muscle. This action generates a signal that travels to the spinal cord and synapses directly (bypassing interneurons) at the L3 or L4 level. Subsequently, an alpha motor neuron transmits an efferent impulse back to the quadriceps femoris muscle, inducing its contraction. This contraction, coupled with the relaxation of the antagonistic hamstring muscles, results in the extension of the leg (1).
In neurologic conditions, an exaggerated knee reflex denotes a lesion in the pyramidal tract (upper motor neuron), while a decreased or absent reflex denotes a lesion in the lower motor neuron. A pendular knee reflex, defined as the swinging of the leg more than four times after striking the patellar tendon, is observed in cerebellar disease (2).
In patients with cerebellar impairment, hypotonia- characterised by reduced resistance to passive movements—leads to an abnormal dampening of the elicited movement. As a result, following percussion of the patellar tendon, these patients exhibit a pendular knee jerk, where the leg continues to swing more than four times. Thus, a pendular knee jerk is indicative of hypotonia (3).
In this case, when we apply the conventional definition of a pendular knee jerk, which is based on the number of oscillations, the criteria for the clinical diagnosis of pendular knee jerk is established. According to the literature, a pendular reflex is associated with hypotonia. However, in this case, it was observed in a hypertonic limb. Clonus is a grade 4 reflex, demonstrated at the knee and ankle as sustained rhythmic contractions upon sudden, sustained dorsiflexion of the ankle or when a sudden downward stretch is applied to the patella. In rare clinical situations, clonus, the hallmark of hyperreflexia, can transform into a pendular quality when the patellar tendon is tapped. Clonus should not be replaced or mistaken for a pendular jerk; rather, when a pendular jerk is seen in a hypertonic, hyperreflexic limb, clonus explains the neurologic basis of the observation.
Clonus is a rhythmic, oscillating stretch reflex that is usually elicited at the ankle and patella. The cause of the oscillations is related to lesions in upper motor neurons and is generally accompanied by other signs of upper motor neuron lesions, like hyperreflexia, spasticity, loss of superficial reflexes, and a positive Babinski sign (4),(5).
In this case, when the patellar tendon was tapped, the clonus manifested as repeated oscillations that mimicked a pendular knee reflex, and the rotatory oscillations were due to adductor spasticity. To conclude, if we traditionally adhere to the definition of a pendular knee jerk, then it follows that “not all pendular reflexes may signify hypotonia. In a spastic limb with grade 4 hyperreflexia, clonus may manifest itself with multiple oscillations.”
