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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
Role of Madhutailik basti and Shaman chikitsa in the Management of Acute on Chronic Pancreatitis: A Case Report
Correspondence Address :
Reeya Gamne,
Postgraduate Scholar, Department of Kayachikitsa, Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod, Wardha-442001, Maharashtra, India.
E-mail: reeya.gamne@gmail.com
Chronic pancreatitis is a condition characterised by persistent inflammation of the pancreas, leading to permanent damage and loss of its exocrine and endocrine functions. Clinical symptoms of the disease include abdominal pain, nausea, vomiting, steatorrhoea, indigestion, and weight loss. In Ayurveda, it can be correlated with Grahani dosha, a disorder of the duodenum and gut. Mandagni, which is the hypo-functioning of Agni, is considered the root cause of Grahani dosha and is addressed through various treatment modalities in Ayurveda. Hereby, the authors present a case report of 40-year-old male diagnosed with chronic pancreatitis presented with severe pain in the epigastric and left hypochondriac region of the abdomen, decreased appetite, nausea, and constipation for five years. After three years of conservative treatment and unsuccessful advice to undergo Endoscopic Retrograde Cholangiopancreatography (ERCP), the patient sought Ayurvedic treatment. The treatment involved Shodhan (purificatory) and Shamana (palliative) approaches, including Vata pitta shamaka kriya, Mridu virechana (mild purgation), and the use of Yakrutottejaka (hepato stimulant), Pramehaghna (pancreas protecting), and Rasayana (rejuvenating) formulations. Within four months, the patient experienced a significant improvement, with total remission of symptoms and a notable reduction in objective criteria such as serum lipase and serum amylase levels. The present case report suggests that Ayurvedic modalities can be effective in treating chronic pancreatitis. However, to draw definitive conclusions, further research with extensive follow-up and a larger sample size is necessary.
Endoscopic retrograde cholangiopancreatography, Grahani, Purification therapies
A 40-year-old male patient visited the Kayachikitsa Outpatient Department (OPD) with chief complaints of severe and continuous pain in the epigastric and left hypochondriac region of the abdomen, indigestion, decreased appetite, nausea, and constipation for the last five years. He had already been diagnosed with chronic pancreatitis by an allopathic physician. He underwent conservative treatment for three years {Tab. Omeprazole 20 mg, Cap. Pancreatin (25000 IU), and Tab. Dulcoflex} and was advised to undergo Endoscopic Retrograde Cholangiopancreatography (ERCP) for the same but did not get satisfactory relief. He had been a chronic alcoholic for eight years and had been mildly hypertensive (130/90 mmHg) for the last six months, for which he was on regular medication (Amlodipine 2.5 mg). There was no significant family history of pancreatitis or hypertension. All the vital parameters and systemic examinations were normal.
On abdominal examination: The shape and contour of the abdomen were normal with no dilated veins, visible peristalsis, striae, or surgical scars. The umbilicus was centrally placed and inverted. Cullen’s sign was positive (Table/Fig 1) (1). Upon palpation, the abdomen was slightly hard, with no organomegaly, and no free fluid was present. Tenderness (Grade 4) was present in the epigastric region in the left upper quadrant (2). Muscle guarding and rigidity were present. There was no rebound tenderness, and the fluid thrill test was absent.
This condition can be differentially diagnosed with peptic ulcer disease and chronic cholecystitis. Hence, the final diagnosis of acute on chronic pancreatitis is confirmed by clinical symptoms like severe abdominal pain in the epigastric region, anorexia, nausea, physical examination findings such as tenderness, and laboratory parameters like elevated serum amylase (100 U/L) and serum lipase (381 U/L), as well as Ultrasonography (USG) and Magnetic Resonance Imaging (MRI) showing borderline dilated common bile duct, atrophic pancreas, and dilated and tortuous main bile duct.
Treatment protocol: When the patient came to the OPD with severe abdominal pain, local snehan and swedan (oleation and sudation) were administered, followed by Shodhan basti (purificatory enema) (Table/Fig 2) stat. This was followed by Yashtimadhu taila matra basti (medicated oil enema) in the evening. Subsequent Shodhana and Shamana treatments were planned (Table/Fig 3),(Table/Fig 4).
The patient was advised a liquid diet such as coconut water, takra, fruit juices, etc., for the first two days. Gradually, they were shifted to a semi-solid diet and then solid foods such as daliya, khichdi, fruits, etc. On the 8th day, discharge treatment was given to the patient (Table/Fig 5).
On Discharge
At the first follow-up, Arogyavardhini vati and Gandharva haritaki powder were stopped, and all other medications were continued for the next three months.
The therapeutic outcome, improvement in the patient’s symptoms, and quality of life are mentioned in (Table/Fig 6).
Chronic pancreatitis is an inflammatory condition of the pancreas that causes atrophy or fibrosis, leading to a progressive loss of exocrine and endocrine functioning (4). This illness is clinically characterised by indigestion, decreased appetite, abdominal pain, and nausea caused by Agnisada (diminished digestive power), associated with Grahani in Ayurveda (derangement of Agni placed in Grahani). Pathologically, the disease initiates due to improper food digestion, further vitating Agni and Doshas, leading to the formation of ama, resulting in symptoms such as abdominal pain, nausea, dyspepsia, constipation, and diarrhoea (5).
The pathophysiology of pancreatitis can be associated with Vataja Grahani dosha, as Vata dosha is prevalent and in the Amaavastha (proinflammatory stage), due to the chronicity and recurrence of pancreatitis (6). Based-on the predominance of Dosha and Dhatu (body tissue), the primary objectives of the treatment were to manage the symptoms, protect the pancreas structure and function against further disruptions, and restore the elevated biochemical values (7).
In the present case, authors observed how a patient with chronic pancreatitis received treatment according to Ayurvedic protocol, including Langhana, Deepana, Pachana, Vatanulomana, Yakrita sanrakshatmaka, and Rasayana medications. There were significant changes in subjective and objective parameters, such as a reduction in pain and tenderness, improvement in symptoms of constipation, anorexia, and nausea. Serum lipase levels (381 U/L to 34.01 U/L) and amylase levels (100 U/L to 38.83 U/L) restored to their normal levels within four months of treatment, suggesting that the treatments being taken are effective. In this instance, no side effects from the prescribed medication were noted.
Similar cases have been reported in the past. One case conducted by Singh A et al., involved a 30-year-old female, a known case of chronic pancreatitis for the last 2.5 years, who complained of continuous dull pain in the abdomen, indigestion, decreased appetite, and nausea. Serum lipase was raised. Ayurvedic management given for six weeks showed the restoration of serum lipase levels (109 to 52 U/L) and other symptoms (8). Another similar case study conducted by Sawarkar G and Sawarkar P, involved a 12-year-old teenage girl who presented with pain and tenderness in the epigastric region, loss of appetite, fever on and off, general malaise, loss of weight, intermittent constipation, anxiety, and mental irritation for one and a half months. After 16 months of regular treatment, the patient experienced relief in all subjective parameters (9). In both studies, the management involved the use of Vata-pitta shamaka kriya (pacification of vitiated Pitta and Vata), Mriduvirechana (mild purgation), Yakrutottejaka (hepatostimulant), Pramehaghna (pancreas protective), and Rasayana (rejuvenating) formulations, which showed promising results.
The probable mode of action of Shodhan chikitsa (Purificatory treatment): Snehan-Swedana (oleation and sudation) helps in relieving pain and bringing vitiated doshas into the Koshtha (abdomen) (10). Shodhana basti (purificatory enema) helps in Vatanulomana (carminative) and detoxification, thus relieving pain and constipation by pacifying Vata dosha. Madhutailik basti has Deepana (appetiser), Pachana (digestive), Rasayana (rejuvenating), Balya, and Anulomaka (carminative) properties, helping in breaking the pathogenesis of the disease. Guduchi (Tinospora cordifolia) used as kalka (paste) acts as an antioxidant and immunomodulatory agent (11). Matra basti (medicated oil enema) given by Yashtimadhu taila has Madhura rasa (sweet taste), Sheeta virya (cold potency), Madhura vipaka (final taste of a drug-sweet). It is Vata-pitta shamaka. Its healing, anti-ulcer, anti-inflammatory, and skin regeneration activity helps in reducing symptoms (12).
Mode of action of Shaman chikitsa (Palliative treatment): Shivakshar Pachan Churna has Deepana, Pachana, and Tridosha shamaka properties, enhancing digestive fire and relieving symptoms like anorexia (5). Gandharva haritaki helps with mala shodhana (bowel evacuation) as well as vatanumolana (carminative), causing detoxification of the body by removing the vitiated doshas and aiding in breaking the pathogenesis (13). Kamdudha rasa possesses Madhura and Sheeta virya (sweet and cold potency) drugs that pacify Pitta dosha, thereby helping in relieving symptoms like nausea (14).
Shankha vati improves digestive fire, thus aiding in increasing appetite and relieving nausea and pain (15). Phaltrikadi kwath is Kledahara (removes impurities), having Deepana, Pachana, Yakruttotejaka, Anulomaka, and Tridoshahar properties that relieve symptoms like anorexia, constipation, and nausea (16). Arogyavardhini vati, having hepatoprotective and antioxidant properties, improves the digestive system, opens up the body’s channels so that nutrients can reach the tissues, balances body fats, and eliminates toxins (17).
The present case report demonstrates the significant role of Ayurveda in successfully managing acute on chronic pancreatitis. There were significant changes in subjective and objective parameters, and improvement in the patient’s symptoms within four months of treatment suggests that the treatments being taken are effective. In this instance, no side effects from the prescribed medication were noted. Hence, it can be concluded that chronic pancreatitis can be effectively managed with Shodhan and Shaman chikitsa as described in Ayurveda. However, since present case is a single case, a study on a greater number of patients is needed to prove the efficacy of these drugs.
DOI: 10.7860/JCDR/2024/68122.19360
Date of Submission: Oct 17, 2023
Date of Peer Review: Jan 03, 2024
Date of Acceptance: Mar 06, 2024
Date of Publishing: May 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 18, 2023
• Manual Googling: Jan 18, 2024
• iThenticate Software: Mar 04, 2024 (8%)
ETYMOLOGY: Author Origin
EMENDATIONS: 8
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