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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
Transient Voice Loss after Spinal Anaesthesia for Lower Limb Surgery: A Case Report
Correspondence Address :
Dr. Navneeta Bisht,
Senior Resident, Department of Anaesthesia, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly-243202, Uttar Pradesh, India.
E-mail: bishtnavneeta@gmail.com
Spinal Anaesthesia (SA) with hyperbaric bupivacaine and opioids is a preferred technique for lower limb surgeries in many centres. Among the various complications of such anaesthesia, postprocedural voice loss is relatively uncommon and has been reported very rarely in cases other than parturient patients. The sudden onset of such symptoms after anaesthesia and various other attributable causes may have implications for the subsequent surgery. The authors reported here a case of postprocedural voice loss in a 24-year old male patient prepared for open reduction and internal fixation surgery for a femur fracture. The patient developed immediate dysphonia along with tingling of the face and itching of the nasal alae after the administration of a subarachnoid block. The patient had a normal heart rate, blood pressure, and respiratory pattern. There was no history of any previous episode or possible attributable psychological condition. The authors carefully monitored the patient, assessed various causes of such a presentation, and noticed it to be transient and without any serious implications. They attributed the cause to the rostral spread of fentanyl, and the surgery was resumed. The authors concluded that immediate and transient voice loss after SA is an unexpected and unavoidable complication for lower limb surgery and may occur in non obstetric cases as well. However, if hypovolemia and respiratory abnormalities had been excluded, reassurance and close observation may be appropriate.
Aphasia, Fentanyl, Non obstetric, Temporary
A 24-year-old, 60 kg male was taken for emergency surgery after sustaining a road traffic accident 12 hours prior. The patient had a mid-shaft femur fracture and was scheduled for an open reduction and internal fixation under SA. There was no history of co-morbidities, addiction, drug allergies, medications, or previous surgeries. The patient was haemodynamically stable, conscious, oriented, and without any other major injuries. Preanaesthetic evaluation for the emergency procedure revealed no abnormality. He had a pulse rate of 84/min, blood pressure of 120/80 mmHg, and respiratory rate of 16/min. After aseptic precautions, a subarachnoid block with 2.5 mL of 0.5% hyperbaric bupivacaine (12.5 mL) and fentanyl 0.5 mL (25 mcg) was administered. The patient experienced throat uneasiness and was unable to swallow with a husky voice approximately 10 minutes after the SA. Subsequently, he lost his voice completely. He also reported tingling on the right side of his face and itching on nasal alae during the painting and draping for the surgery. The patient was promptly evaluated, and a sensory block at the level of T6 without any motor loss in the upper limbs was observed. The lower limbs were completely paralysed. His pulse was 84/min, and BP was 110/84 mmHg. Respiratory rate was 18/min, spontaneous, regular with an End-tidal Carbondioxide (EtCO2) waveform. No changes in vitals or block level were noted after 10 minutes of observation. As the pulse rate, blood pressure, and respiratory pattern were normal, and no contributory or psychological history was identified during preanaesthetic clinical findings, the patient was reassured and not further investigated at that moment, and the surgery resumed.
After 30 minutes, the voice was noted to improve, and by 50 minutes, the voice had returned to normal. The surgery was completed in 120 minutes. The patient was observed for two hours postoperatively and examined after the effects of SA had worn off. The clinical examination did not reveal any neurological abnormalities. The patient was discharged on the 3rd postoperative day without any related symptoms and was followed-up regularly by the Department of Orthopaedics. No related complaints were noted six months later at the patient’s last visit.
The SA with hyperbaric bupivacaine and opioids is a preferred technique for lower limb surgeries in many centres. Complications such as hypotension, failed SA, subdural block, post-dural-puncture headache, etc., commonly occur after such anaesthesia. However, postprocedural voice change or aphasia as a complication of SA is relatively uncommon and is mainly reported in parturient patients (1). The chance of postprocedural voice change in non parturients is rare (2),(3). Moreover, the immediate onset of such symptoms after anaesthesia and various attributable causes may have implications for subsequent surgery. The authors report a case of voice change after a subarachnoid block with hyperbaric bupivacaine and fentanyl for femur fracture surgery. They also reviewed the literature concerning such complications.
Various databases such as PubMed, Medline, Embase, and Google Scholar were searched with keywords ‘spinal anaesthesia’, ‘aphasia’, ‘voice change’, and ‘voice loss’. Contemporary literature was reviewed in the background of the present case scenario. Informed written consent was obtained from the patient for the utilisation of unanonymised data, and the manuscript was prepared following standard ethical practices.
Various causes involving the afferent, central, or efferent neural pathway may be attributed to a voice change. While anatomical abnormalities involving this pathway, such as Cerebrovascular Accidents (CVA), tumours, and cranial nerve injuries, may cause permanent voice change, temporary voice changes may be implicated in various complications of SA such as cerebral hypotension, hypoxia, Transient Ischaemic Attack (TIA), and anaesthetic agents. High SA, subdural anaesthesia, intrathecal opioids, conversion reaction, reduced Intracranial Pressure (ICP), Transient Ischaemic Attack (TIA), etc., have been implicated in such complications (4),(5). Various causes and associated leading clinical features have been compiled in (Table/Fig 1) (1),(4),(5),(6),(7),(8),(9). Fentanyl, due to its lipophilic property, has a faster rate of rostral spread through Cerebrospinal Fluid (CSF) and affects speech areas and cranial nerves of the brain. As there is rapid clearance from CSF, the effects are temporary and short-lasting (9). However, immediate postprocedural voice change is relatively uncommon after SA. Transient or long-duration voice changes after SA may have a delayed onset and have been mainly reported in parturient patients earlier (7).
Earlier studies have described such complications and their management. The majority of the symptoms were transient and short-lasting. Reassurance to the patient and close monitoring of vitals thus remain the mainstay for the management of such complications. Identification of the causes and directed management is essential subsequently. The key observations of the literature review have been enlisted and compared with the present study in (Table/Fig 2) (2),(5),(9),(10),(11).
The present case highlights the development of sudden-onset dysphonia after SA due to the opioid component of such anaesthesia. The rostral spread of fentanyl and subsequent effect of opioid receptor blockade of the Central Nervous System (CNS) may explain the very transient symptoms in the present case. However, these complications may be observed in obstetric patients due to physiological alterations related to pregnancy. The occurrence of voice change in the present case was immediate and unexpected.
The authors approached in the present case to establish the diagnosis by exclusion of possible causes. They checked the blood pressure, respiratory rate, pattern, and level of sensory-motor block immediately. Ensuring these parameters were normal, a high spinal or subdural block was excluded. Conversion reaction was excluded by confirming the lack of suggestive history from the awake patient on the table. The possibility of TIA could not be excluded with certainty at that moment but was ruled out based on low suspicion as per the patient’s preoperative anaesthetic check-up. TIA was excluded in the postoperative and follow-up period with subsequent clinical examinations and investigations. The authors ruled out cranial nerve palsy as a result of brainstem stretching from reduced ICP and subarachnoid anaesthesia, as the onset was too early and spontaneous recovery occurred in a very short duration. Therefore, they concluded that the possible cause would be the blockade of opioid receptors of the CNS due to the rostral spread of fentanyl.
The authors carried on with the surgery with periodic assessment. The surgery was completed without any compromise, and symptoms were completely reversed without any further added intervention. No residual symptoms were noted after reversal and follow-up. The present case also highlighted the transient nature of such complications and the conservative approach for management.
Postprocedural voice change after SA may occur mainly as a result of cranial nerve involvement or the effect of anaesthetic drugs on speech areas of the brain. When this complication is attributed to fentanyl, the voice changes are immediate. Immediate and temporary voice changes as a complication after SA for limb surgery may be unavoidable and encountered unexpectedly. However, in the absence of respiratory abnormalities and haemodynamic changes, the immediate concerns of high SA, TIA, etc., are excluded. In these cases, reassurance, a return to surgery, and close observation may be appropriate. Although these complications are mainly reported in parturient patients earlier, they may occur in other cases, and the present case report may be used as a reference in such scenarios.
DOI: 10.7860/JCDR/2024/69933.19414
Date of Submission: Feb 04, 2024
Date of Peer Review: Mar 05, 2024
Date of Acceptance: Mar 18, 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. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 05, 2024
• Manual Googling: Mar 11, 2024
• iThenticate Software: Mar 14, 2024 (1%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
- 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