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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
Trends In Prescribing Gastroprotective Agents With Non Steroidal Anti-Inflammatory Drugs In An Orthopaedic Outpatient Unit Of A Tertiary Care Hospital
Correspondence Address :
Dr. Ullal Sheetal D.,Deptt. of Pharmacology, Kasturba Medical College,
Light House Hill Road, Mangalore, India. mail:sheetal.ullal@manipal.edu
Ph: 9448306242
Background: Non steroidal anti-inflammatory drugs (NSAIDs) are the most common drugs prescribed the world over. However, they have many adverse effects, especially gastrointestinal toxicity, which is the reason for their frequent co-prescription with gastroprotective agents. Misoprostol, has been specifically approved for prevention of NSAID-induced ulcers in high-risk patients. Proton pump inhibitors too have been used with outstanding efficacy for this indication.
Aim: This drug utilization study was conducted to study the co-administration of NSAIDs with gastroprotective drugs in an Orthopaedic Outpatient Unit of an urban, tertiary care, teaching hospital.
Settings and Design: A prospective drug utilization study
Patients and Methods: This was a prospective study conducted in the Orthopaedic Outpatient Unit of an urban, tertiary care, teaching hospital, for six months. Prescriptions were collected from patients attending the Orthopaedic Outpatients Department. The co-prescription of NSAIDs with gastroprotective agents was analyzed.
Results: A total of 1008 prescriptions were studied; 884 prescriptions contained NSAIDs, out of which 288 (32.58%) were co-prescribed with gastroprotective agents. The most common gastroprotective agents combined with NSAIDs were Proton pump inhibitors (81.19%). H2 receptor blockers were a distant second (17.81%), while Misoprostol was not used at all.
Conclusion: NSAIDs are commonly co-prescribed with gastroprotectives. Diclofenac is the most commonly co-prescribed NSAID, while Naproxen was least commonly co-prescribed with gastroprotectives. Proton pump inhibitors were most frequently used, while Misoprostol was not used at all, probably because of its higher costs, frequent side effects and the need for multiple daily dosing.
NSAIDs, gastoprotectives, drug utilization study
Introduction
Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used medicines in the world. They have a wide variety of indications for use, ranging from treatment of acute pain to more chronic conditions such as rheumatoid arthritis. These agents exert their effect by inhibiting the activity of the enzyme cyclooxygenase, with a resultant reduction in prostaglandin synthesis and an alleviation of the inflammatory response(1). Their association with gastrointestinal toxicity – dyspepsia, peptic ulcers and gastrointestinal bleeds is well known(2).
The demonstration of two unique isoforms of cyclooxygenase (designated COX-1 and COX-2) has led to a greater understanding of the mechanism of action of NSAIDs and has also provided an explanation for their toxicity(1). Selective COX-2 inhibitors were developed with the aim of minimizing gastrointestinal toxicity, while maintaining anti-inflammatory activity(3). However, clinical and experimental data, as well as reviews suggest that the long term use of selective COX-2 inhibitors is associated with an increase in systolic blood pressure and cardiovascular morbidity and mortality due to myocardial infarction(4),(5).
The use of NSAIDs is an important predisposing factor for peptic ulcer disease in the community. Approximately 10-20% of patients who receive long-term NSAID therapy develop asymptomatic peptic ulceration and ulcer-related complications (bleeding and perforation) develop in 1-2% of persons per year(6). This warrants a cautious use of NSAIDs in high risk individuals who include the elderly, those already receiving gastro-toxic agents and those with a history of gastro-intestinal diseases(7). So, the best alternative in such individuals would be the co-administration of NSAIDs with gastroprotective drugs. Misoprostol, an analog of prostaglandin E1, has been specifically approved for the prevention of NSAID-induced ulcers in high-risk patients. Proton pump inhibitors too, have been used with outstanding efficacy for this indication.
Drug utilization studies are continuing programmes that review, analyze and interpret the pattern of drug use against pre-determined standards. This drug utilization study was conducted to study the co-administration of non-steroidal anti-inflammatory drugs (NSAIDs) with gastroprotective drugs in an Orthopaedic Outpatient Unit of an urban, tertiary care, teaching hospital.
Patients and Methods
A prospective study was conducted in the Orthopaedic Outpatient Unit of an urban, tertiary care, teaching hospital, during July and August 2006. Prescriptions were collected from patients attending the Orthopaedic Outpatients Department. The co-prescription of NSAIDs with gastroprotective agents was analyzed. The Institutional Ethics Committee’s approval was obtained before starting the study.
The use of gastroprotective agents with the 12 most commonly prescribed NSAID preparations, either as monotherapy or Fixed Dose Combinations (FDC), was analyzed in detail.
Total number of prescriptions : 1008
Number of prescriptions with oral NSAIDs: 884
Number of prescriptions with gastroprotective agents: 303
Number of prescriptions with oral NSAIDs and gastroprotective agents: 288 (32.58%)
The gastroprotective agents prescribed were proton pump inhibitors (PPIs) (81.19%), H2 antagonists (17.82%) and antacids (0.99%). None of the other gastroprotective agents were used. The different drugs used in these groups are shown in (Table/Fig 1).
The use of gastroprotective agents along with the 12 commonly used NSAIDs, either as monotherapy or FDCs, is shown in (Table/Fig 2). The NSAID which was most commonly used with gastroprotectives was Diclofenac. Naproxen was the least used NSAID with a gastroprotective agent.
When gastric side effects are a cause of concern, non selective COX inhibitors are co-prescribed with an anti-ulcer agent. The use of selective COX-2 inhibitors seems to have decreased after the cardiac adverse effects which were observed with these drugs(4),(5).
Diclofenac was the most commonly co-prescribed NSAID with a gastroprotective agent - 69.60%. Naproxen was least commonly co-prescribed with a gastroprotective agent - 1.96%.
Proton pump inhibitors were the most commonly used gastroprotective agents, followed by H2 antagonists. Literature too suggests that Proton pump inhibitors produce more sustained acid suppression as compared to H2 blockers (8) and promote ulcer healing despite continued NSAID therapy (6). Antacids were rarely used, and rightly so, since they are indicated only for symptomatic relief of pain and are associated with a number of drug interactions, thereby restricting their rational indication (9). Misoprostol, the drug indicated for the prophylaxis of high risk individuals, was not used at all (7). This may be because of various reasons including the higher cost, frequent side effects and the need for multiple daily dosing of Misoprostol. In any case, similar or even better efficacy is obtained by Proton pump inhibitors in preventing and/or treating NSAID-induced peptic ulcers.
• NSAIDs are commonly co-prescribed with gastroprotectives.
• Diclofenac is the NSAID which is most commonly co-prescribed with gastroprotectives.
• Proton pump inhibitors are the gastroprotectives which are most frequently co-prescribed with NSAIDs.
• Misoprostol was not used at all, probably because of its higher costs, frequent side effects and the need for multiple daily dosing.
The work should be attributed to The Departments of Pharmacology and Orthopaedics, Kasturba Medical College, Mangalore, Karnataka.
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