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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
Haemolytic Disease of Newborn in a baby Delivered by Mother with Complete Anti-D Prophylaxis: An Unusual Case Report
Correspondence Address :
Dr. Prashant Madhav Sakhavalkar,
Associate Professor, Department of Critical Care Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune-411018, Maharashtra, India.
E-mail: prashant.sakhavalkar@dpu.edu.in
Haemolytic Disease of the Newborn (HDN), also known as erythroblastosis foetalis, is an immune-mediated disorder among neonates with a wide range of clinical presentations. The occurrence of HDN due to ABO-Rh incompatibility between the mother and baby is becoming rare due to increased knowledge of the disease and adherence to Good Clinical Practices (GCP) during pregnancy. This case report highlights a rare case of HDN in which, despite following GCP, standard care, an uneventful antenatal period, and timely administration of Anti-D immunoprophylaxis, the mother delivered a baby with HDN. The baby was successfully managed by a group of skilled and caring clinicians. Therefore, it is crucial to screen all at-risk mothers for HDN to identify it earlier and treat it successfully. This case report is rare in terms of the baby’s survival with HDN born to a mother who had already received timely Anti-D immunoprophylaxis. Additionally, there is a need to emphasise on recent advances in diagnosis, such as foetal Doppler studies, and treatment options.
Erythroblastosis foetalis, Haemolytic anaemia, Immunoprophylaxis, Rh incompatibility
A 34-year-old female, G2P2L1A0 with a blood group of A Rh negative, tested positive for the Indirect Coombs Test (ICT) during her second pregnancy at the 28th week of gestation. In her first pregnancy, she received 300 μg of Anti-D immunoprophylaxis at 28 weeks and immediately after a cesarean section via the intramuscular route. During her first pregnancy, the baby was born at 38 weeks of gestational age. The mother experienced mild pregnancy-induced hypertension, but the baby did not have any antenatal or postnatal complications.
During her second pregnancy with an uneventful antenatal period, she tested ICT positive with a titre of 1:64. Hence, the test was repeated immediately at another laboratory, which also confirmed the positive titre of 1:32, leading to the diagnosis of alloimmunisation.
Further evaluation was conducted under the guidance of a foetal medicine specialist who recommended regular foetal colour Doppler ultrasound focusing on Middle Cerebral Artery (MCA) Peak Systolic Velocity (PSV). Serial antenatal measurements of MCA-PSV were performed at 28, 33, and 35 weeks, respectively, and were within normal limits for gestational age (Table/Fig 1). The eleven-cell panel tests for Anti-D Antibody showed positivity in five cell panels.
The pregnancy was safely continued until 38 weeks of gestation under expert guidance. Delivery was carried out via LSCS to prevent uncontrolled Foeto-Maternal Haemorrhage (FMH) and hence placental transfer of alloantibodies. A baby boy weighing 3.2 kg with an APGAR score of 9 was born.
The neonatologist diagnosed mild HDN based on maternal history and haematological parameters (Table/Fig 2). Thalassaemia was ruled out based on peripheral smear and Glucose-6-phosphate Dehydrogenase (G6PD) enzyme assay ruled out the deficiency of G6PD. Cord blood analysis excluded ABO incompatibility. On the second day, the baby was transferred to the Neonatal Intensive Care Unit (NICU) for 14 days due to a high total bilirubin level of approximately 13.6 mg/dL and a low haemoglobin level of 11.9 g/dL.
Postnatal serial monitoring of haematological parameters and Liver Function Tests (LFT) was conducted for 14 days (Table/Fig 3). Daily bilirubin levels were monitored, showing persistently high levels until the 9th day, followed by a decrease. Haemoglobin levels fluctuated from 11.9 g/dL on admission to as low as 8.6 g/dL at the time of discharge. A brain Ultrasonography (USG) was performed to rule out kernicterus.
The treatment given to the newborn included intensive phototherapy for a total of 12 days, two days of Intravenous Immunoglobulin (IVIG), two Packed Cell Volume (PCV) transfusions, IV fluids, expressed maternal breast milk, and enteral folvite. Exchange transfusion was not considered as the baby responded well to the treatment provided. The baby was discharged successfully on day 15, being clinically stable, free from jaundice, although with low haemoglobin due to maternal antibodies circulation in the newborn’s system for around three months, leading to haemolysis and anaemia.
The baby was followed-up until three months of age by a haematologist and neonatologist, treated with one PCV transfusion and a 5 mg dose of enteral folvite during this period, while maintaining normal LFT levels. Consent has been obtained from the parents to publish this case.
The HDN is a haemolytic condition that affects rhesus-positive infants born to rhesus-negative mothers. The incidence of HDN is estimated to affect around 3 to 8 out of every 100,000 patients per year (1). The most common causes of HDN are ABO blood group incompatibility and FMH. The spectrum of HDN ranges from mild anaemia and insignificant hyperbilirubinemia to severe hydrops foetalis in newborns (2). Although HDN impacts infants globally with a wide range of clinical symptoms, its prevalence in Asians is less than 1%, yet it remains concerning due to perinatal mortality and morbidity (1),(3). HDN was previously responsible for foetal loss in 1% of all pregnancies before the development of the Anti-D vaccine. Approximately 1 to 3 per thousand Rh-negative women develop alloimmunisation, even with proper RhD immunoprophylaxis. ABO mismatch affects 15 to 25% of pregnancies (1). The spectrum of HDN varies from being asymptomatic to fatal and is classified as mild, moderate, or severe based on the levels of indirect bilirubin and haemoglobin. Treatment options vary accordingly and depend on the gestational age of the baby, medical history, and the extent of the disease (2).
Recent advances in radiological diagnostic tools, such as measuring the MCA-PSV in the foetus, provide an effective, reliable, and non invasive method for monitoring alloimmunised pregnancies at risk of foetal anaemia (2),(4).
Treatment options during pregnancy include intrauterine blood transfusion based on serial USG Doppler examinations, the severity of anaemia, and the quantitative measurement of maternal anti-Rh D antibodies. Postnatal treatment options include IV fluids, intense phototherapy, IVIG, and exchange transfusion for severe anaemia.
Asymptomatic and undetectable FMH during pregnancy can expose Rh-negative mothers to Rh-positive red cells (2).
It is recommended that non sensitised Rh-negative women delivering Rh-positive infants should receive Anti-D Ig (300 micrograms) IM or IV within 72 hours of delivery. Additional Anti-D can be administered if FMH exceeds 15 mL of foetal red blood cells (5). Rhesus antibodies typically appear after the 28th week of pregnancy, significant transplacental haemorrhage may occur during pregnancy, and the half-life of Anti-D antibodies is approximately 17-22 days. Therefore, Anti-D should not be given before 28 weeks of pregnancy (6).
A similar case was described by Yousuf R et al., where a multiparous 30-year-old woman at 38 weeks of gestation, despite receiving anti-D prophylaxis at 28 weeks of gestation, delivered a full-term baby boy with HDN (7). A systematic literature review of 60 articles on the antenatal landscape by de Winter DP et al., revealed a prevalence of 0.047% and 0.006% for Rh(D)- and K-mediated HDFN, respectively. The most frequently mentioned prenatal procedure was Intrauterine Transfusion (IUT). The range of the average gestational age at the first IUT was 25-27 weeks. There are dangers involved with this early time, which have been seen in IUT-related results. For pregnancies with Rh(D)-mediated HDFN treated with IUT, the rate of hydrops foetalis was 14.8% (range, 0-50%), but for K-mediated HDFN, it was 39.2%. The overall foetal death rate across 19 investigations was 19.8%±29.4%, with a mean±SD. The range of the mean gestational age at birth was 34 to 36 weeks (8).
Of the 29,663 pregnant women tested at the Department of Transfusion Medicine by Raguz MJ et al., 545 (1.8%) had antibodies against antigens detected by the Indirect Antiglobulin Test (IAT). Over the course of a 20-year trial in West Herzegovina, 310 (1.0%) newborns with HDN received treatment. According to the study findings, 230 out of 545 pregnant women, or 42%, had received the AB0 vaccination. 64% (199/310) of newborn infants with HDN had AB0 HDN, which is the most frequent type. Only 19% (59/310) of newborns with RhD HDN received treatment. The lack of non-RhD immunisation preventative programs and the inconsistent immunological screening of RhD-positive pregnant women in the area were the causes (9).
Despite timely maternal Anti-D prophylaxis, the probability of HDN development in offspring in this case may be due to an inadequate dose of Anti-D that was disproportionate to FMH or the potency of the Anti-D injection.
The case under discussion involved mild HDN, which was promptly diagnosed and carefully monitored by a team of dedicated medical professionals. Consequently, the pregnancy continued for 38 weeks without any apparent advancement of HDN, and additional complications associated with preterm birth were averted.
This case report is unusual in terms of the survival of a baby with HDN born to a mother who had already received timely Anti-D immunoprophylaxis. Additionally, ICT must be performed during pregnancy regardless of Anti-D prophylaxis. Despite timely Anti-D prophylaxis, alloimmunisation and HDN can occur, as in this case. Recent advancements in radiological diagnostic tools, such as measuring the MCA-PSV in the foetus, provide an effective, reliable, and non invasive approach to monitoring alloimmunised pregnancies at risk of foetal anaemia. HDN is preventable and not always fatal.
DOI: 10.7860/JCDR/2024/69375.19428
Date of Submission: Jan 01, 2024
Date of Peer Review: Feb 06, 2024
Date of Acceptance: Mar 22, 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. No
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jan 01, 2024
• Manual Googling: Feb 29, 2024
• iThenticate Software: Mar 19, 2024 (9%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
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