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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
Original article / research
Full Version
Comparison of Blood Pressure Variation among Patients Undergoing CECT Thorax and NCCT Thorax: A Cross-sectional Study
Correspondence Address :
Ms. Amita Digambar Dabholkar,
Assistant Professor, Department of Medical Imaging Technology, Yenepoya School of Allied Health Sciences, Yenepoya (Deemed to be University), Mangaluru-575018, Karnataka, India.
E-mail: dabholkaramita99@gmail.com
Introduction: Advancements in Computed Tomography (CT) have been continuously updated with the intravenous administration of contrast media, which enhances the visibility of internal organs and structures in CT scans. Contrast media administration often alters blood pressure.
Aim: To observe the blood pressure variations among patients undergoing Contrast-enhanced Computed Tomography (CECT) thorax and Non Contrast Computed Tomography (NCCT) thorax.
Materials and Methods: A cross-sectional study was conducted at the Department of Radiodiagnosis and Medical Imaging at Yenepoya Medical Hospital, Deralakatte, Mangaluru, Karnataka, India from February 2022 to August 2022. Patients who underwent examinations of NCCT thorax and CECT thorax within the age group of 20-80 years, involving 62 participants (31- CECT, 31- NCCT) were included. Intravascular contrast material was administered to the patient during a CECT thorax scan. One reader independently recorded the Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) five minutes before and five minutes after the venous phase in the CECT thorax and five minutes prior to and five minutes after in the NCCT thorax group. A paired t-test was used for the comparison of SBP and DBP within the group.
Results: The mean SBP before the scan was 120.7 mmHg {Standard Deviation (SD)=13.6} and after the scan was 130.7±12.1 mmHg. The mean DBP before the scan was 78.9±8.9 mmHg, and after the scan was 84.2±12.0 mmHg, respectively, before and after the injection of contrast. Therefore, a significant difference was found in the mean SBP and DBP before and after the injection of contrast within the CECT thorax group.
Conclusion: There was an increase in blood pressure in patients who had undergone CECT thorax in both males and females. Hence, evaluating BP will provide awareness of different risk factors that can be caused due to the administration of contrast media.
Contrast-enhanced computed tomography, Diastolic blood pressure, Non contrast computed tomography, Systolic blood pressure
Computerised axial tomography is another name for CT. The CT scanner was developed by a partnership between an inventive engineer, Godfrey Hounsfield, who designed the machine, and a great neuroradiologist, James Ambrose, who established its clinical utility. It is invaluable in establishing the diagnosis and is highly acceptable to patients. The growth of CT is a fascinating story of scientific achievement (1).
Advancements in CT have been continuously updated with the intravenous administration of contrast media (2). Radiographic contrast media are a group of medical drugs used to improve the visibility of internal organs and structures in CT (3). The intravenous administration of contrast media often alters blood pressure (4). Measurements of blood flow, blood pressure, and heart rate made it possible to analyse the time relationship between the haemodynamic changes after the injection of contrast medium (5).
The force applied by the circulating blood on the walls of the blood vessels is defined as blood pressure. The maximum pressure in the main circulation during systole as the heart contracts is known as SBP. The SBP should be 120 mmHg and lies in the 110-140 mmHg range. The minimum pressure reached during diastole, just before the next systole, is known as DBP. The DBP should be 80 mmHg and lies in the 60-80 mmHg range (6).
A mercury sphygmomanometer is considered the gold standard for measuring blood pressure, but the general prohibition on mercury devices has reduced its use in hospitals. Alternative methods, such as automated electronic devices, are now used. The brachial artery is the best place for measurement (7). Blood pressure can vary according to age and can be affected by factors such as diet, excessive alcohol consumption, and environmental factors (8). Age-related variation in blood pressure is based on pathophysiology and includes affecting blood vessel wall thickening and stiffening, as well as decreasing the speed and strength of cardiovascular muscular contraction (9). It can be observed that the mean SBP and DBP can be higher in males compared to females (10).
The administration of contrast media may lead to kidney dysfunction, especially in patients with pre-existing renal impairment and those with diabetes. It can also cause cardiac-related problems like vasodilation and an increase in coronary blood flow. Understanding various risk factors and checking for them before using contrast agents enables early detection and immediate treatment of adverse reactions (3),(11). With these considerations, the current study aimed at observing the blood pressure variations among patients undergoing CECT thorax and NCCT thorax.
This cross-sectional study was conducted in the Department of Radiodiagnosis and Medical Imaging at Yenepoya Medical Hospital, Deralakatte, Mangaluru, Karnataka, India from February 2022 to August 2022. Approval from the Institutional Ethics Committee was obtained (YEC2/947). Written informed consent was obtained from all participants. Based on indications, they were allocated to 31 NCCT thorax and 31 CECT thorax patients (a total of 62 patients) and were imaged with 128-slice CT scanners (Revolution EVO).
Sample size: Sample size estimation was performed using G*power software.
Inclusion and Exclusion criteria: Samples based on the age group between 20-80 years were included, and patients with a history of hypertension, contrast allergy, age below 20 years and above 80 years, and patients who were not willing to give consent were excluded from the present study.
Study Procedure
Data were collected by instructing the patients to lie down on the CT examination table for five minutes before taking BP measurements. A sphygmomanometer was used to measure BP, and measurements were taken by experienced staff. Intravascular contrast material was administered to the patient during a CECT thorax scan. The contrast media used was non ionic low-osmolar water-soluble contrast media (Iohexol injection USP 350 mg and Contrapaque 350 mg) injected at a rate of 2-3 mL/sec for about 60-65 mL. One reader independently recorded the SBP and DBP five minutes prior to and five minutes after the venous phase in the CECT Thorax, and five minutes prior to and five minutes after the NCCT thorax group. To determine the impact of intravenous administration of contrast media on blood pressure variation, mean SBP and DBP from both groups were compared.
Statistical Analysis
Data analysis was conducted using International Business Machine (IBM) Statistical Package for the Social Sciences (SPSS) version 23.0. A paired t-test was used for the comparison of SBP and DBP within the group.
The present study consisted of 62 patients who were further divided into two groups, NCCT and CECT thorax, with 31 patients in each group. There were 15 female and 16 male patients in each group. The mean age of the NCCT thorax group was 51.6 years (SD=16.6) and the mean age of the CECT thorax group was 51.9 years (SD=16.2). The mean weight of the NCCT thorax group was 55.7 kg (SD=13.8) and the mean weight of the CECT thorax group was 55.9 kg (SD=13.8). The mean BMI of the NCCT thorax group was 22.3 kg/m2 (SD=4.3) and the mean BMI of the CECT thorax group was 22.8 kg/m2 (SD=4.9).
Among the NCCT thorax group, the mean SBP before the scan was 124.0 mmHg (SD=10.5), and the mean SBP after was 121.3 mmHg (SD=14.1). The mean DBP before and after the scan was 78.7 mmHg (SD=8.5) and 76.3 mmHg (SD=11.3), respectively. Among the CECT Thorax group, the mean SBP before and after the scan was 120.7 mmHg (SD=13.6) and 130.7 mmHg (SD=12.1), respectively. The mean DBP before the scan was 78.9 mmHg (SD=8.9), and the mean DBP after the scan was 84.2 mmHg (SD=12.0). Hence, the authors found a significant difference in mean SBP and DBP before and after the injection of contrast within the CECT thorax group. There was no significant difference in mean SBP and DBP before and after the study among the NCCT thorax group (Table/Fig 1),(Table/Fig 2).
Using the paired t-test, a significant difference in mean SBP and DBP in males and mean SBP in females was observed in patients who underwent a CECT thorax scan. No significant difference in mean SBP and DBP in the NCCT thorax group in females and males (Table/Fig 3).
High blood pressure is a significant risk factor for various fatal and non fatal cardiovascular and renal events, including myocardial infarction, stroke, atherosclerosis, aortic aneurysm, hypertensive heart disease, heart failure, peripheral artery disease, and end-stage renal disease (12).
BP is altered in physiological and pathological variations. Physiological factors like sex, body build, diurnal variation, sleep, after exercise, and emotional conditions. Pathological variations include hypertension and hypotension (13).
The present study showed an increase in SBP from 120.7±10.5 to 130.7±12.1 mmHg and DBP from 78.9±8.9 to 84.2±12.0 mmHg, which was associated with intravenous administration of non ionic low-osmolar contrast media in CECT thorax. A study similar to the present was conducted by John AM and Yadav S, showing a similar finding: an increase in both SBP from 116.64±6.349 to 128.08±6.489 mmHg and DBP from 77.33±6.351 to 87.19±5.95 mmHg was observed in CECT abdomen (14).
A study conducted by John AM and Yadav S found that the increased blood pressure in the contrast-enhanced study was induced directly by the contrast media and not solely by the bolus effect (15). These observations support the findings in the present study that blood pressure in the CECT Thorax study was induced directly by contrast media administration.
Nakano S et al., found hypertensive crises with the injection of non ionic low-osmolar contrast media during CT examination, which supports the findings in the present study of an increase in blood pressure after contrast injection (16).
In a study by Kwon HM et al., in patients undergoing contrast CT scans, they discovered a sudden decrease in blood pressure following the injection of contrast material, determined by measuring the QRS R amplitude from the Electrocardiogram (ECG) data (17). In the present study, blood pressure was measured using a sphygmomanometer before and after contrast injection in CECT Thorax, and the authors found an increase in blood pressure after contrast injection.
Widmann G et al., conducted a study in which blood pressure and heart rate were measured from 1-3 minutes after the administration of contrast media and normal saline solution. They found that the administration of Iopromide resulted in systemic hypotension (18). In the present study, the authors used Iohexol contrast media, which showed increased blood pressure after contrast injection, and in the case of NCCT thorax, there was a slight decrease in blood pressure.
Some animal studies reported the effect of non ionic intravenous contrast media administration on blood pressure during CT scans. Harnish PH et al., conducted a study on rabbits in which a variation in blood pressure was observed with contrast media injection and no changes in blood pressure with saline injection (4). The present study, performed on humans, observed blood pressure variation with contrast media injection and slight variation in NCCT thorax scan.
A study conducted by Morris TW et al., in which contrast media was administered by the hand push method in rabbits, observed a decrease in SBP (19). This finding does not agree with the present study, in which a pressure injector administered the contrast media. The present study showed an increase in SBP after the injection of contrast media.
A study conducted by Harnish PP et al., on male Wister rats used two types of contrast media, Iohexol, and diatrizoate. They found that blood pressure increased by 23.2±2.9 mmHg in the diatrizoate group and only 1.8±3.1 mmHg in the Iohexol group (20). In the present study, the authors used only one type of contrast media (non ionic contrast media), Iohexol, which showed a difference in blood pressure (SBP and DBP) before and after the injection of contrast within the CECT thorax.
Kent ST et al., conducted a study using an ambulatory blood pressure monitoring device, which can identify compositions that cannot be measured in the clinic. They found that SBP was 124±9 mmHg in men and 118±9 in females, and DBP was 75±9 mmHg in men and 73±9 mmHg in females (21). In the present study, the authors used a manual BP apparatus to measure blood pressure. They found changes in SBP were 127.2±10.8 mmHg in men and 124.7±16.6 mmHg in females. DBP was 80.6±10.1 mmHg in males and 79.8±14.4 mmHg in females. Both studies show that blood pressure is higher in males compared to females.
The strength of the present study was that the authors used a manual BP apparatus to check SBP and DBP, as it provides accurate readings compared to the digital BP apparatus, and BP measurement was conducted by one experienced staff nurse. Future studies can be performed to check variations in serum creatinine levels after CECT scans and in angiography cases. Clinically, before using contrast agents, taking a blood pressure reading allows for the early identification and prompt treatment of any adverse reactions that can be caused by contrast agents.
Limitation(s)
The blood pressure measurement was biased because the interobserver was not present, there were a limited number of samples, and the cause of decreased blood pressure in the NCCT thorax was unknown.
Comparing BP variations before and after the scan in both groups, the authors found an increase in blood pressure in the patients who had undergone CECT Thorax. Understanding various risk factors and checking for them before using contrast agents enables early detection and immediate treatment of adverse reactions. Hence, evaluating BP will provide awareness of the different risk factors that the administration of contrast media can cause.
DOI: 10.7860/JCDR/2024/69645.19472
Date of Submission: Jan 19, 2024
Date of Peer Review: Mar 04, 2024
Date of Acceptance: Mar 25, 2024
Date of Publishing: Jun 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• 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
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ETYMOLOGY: Author Origin
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