Article in PDF
How to Cite
Citation Manager
Readers' Comments (0)
Audio Visual Article Statistics
Link
to PUBMED
Print this Article
Send to a Friend
Advertisers
Access Statistics Resources
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
The Cutaneous Adverse Effects of Lithium
Correspondence Address :
Amandeep Singh
Assistant Professor
Department of Pharmacology
Gian Sagar Medical College and Hospital
Ramnagar, Patiala, India
Phone: + 91-9876102154
Fax: +91-1762-520024
Email: angad.aman@gmail.com
Lithium is the one of the most commonly prescribed psychotropic medications for bipolar disorder and it is associated with a wide range of cutaneous side effects. Psychiatrists should closely monitor the side effects in patients who are on lithium treatment. Early recognition and propermanagement will help in avoiding the issues of noncompliance and the further deterioration of the mood symptoms in these patients. The liaison of psychiatry, dermatology, and primary care services could prove to be very helpful in the management of these patients.
Lithium, Ipolar disorder, Acne, Acneiform eruption, Psoriasis
Bipolar disorder or manic-depressive illness is a disabling psychiatric illness that is characterized by episodes of both elevated or irritable mood and depression (1). The manic phase of this life-long, chronic mood disorder is characterized by an elevated, expansive or irritable mood which lasts for at least 1 week (or for any duration if hospitalization is necessary) and is accompanied by at least 3 or more of the following: inflated self esteem/ grandiosity, a decreased need for sleep, pressured speech or over-talkativeness, flight of ideas/ racing thoughts, distractibility and an increase in goal-directed activity/ psychomotor agitation, and high-risk behavior; further, the symptoms should not be the direct physiological effect of a substance (e.g. a medication) or a general medical condition (e.g. hyperthyroidism) (2).
Lithium (Gr. lithos, stone) was discovered as an element by Johan August Arfwedson in 1817. About a year later, a Swedish chemist, William Thomas Brande (1788-1866) and an English chemist, Sir Humphry Davy (1778-1829) extracted its pure metallic form (3). Since Cade’s report of lithium use from Australia in 1949, lithium has been the main therapeutic advancement for bipolar disorder (4). It was approved by the U.S. Food and Drug Administration (FDA) in 1970 for the treatment of acute mania and in 1974 for the maintenance therapy and the prophylaxis of patients with bipolar affective disorder (5). Lithium, being a monovalent cation (symbol Li+), its half-life (t1/2) is about 24 hours and it is excreted unchanged by the kidneys. Lithium has a narrow therapeutic index— a sustained blood lithium level of at least 0.8 mEq/L, with a range of 0.6-1.0 mEq/L should be maintained; (2) the therapy needs to be carefully titrated and monitored. Unlike other psychotropic agents, lithium typically produces no obvious effects (such as euphoria) in normal individuals at therapeutic concentrations, but it acts as a mood stabilizing agent and prevents episodes of mania/ hypomania as well as depression in patients of bipolar disorder. Lithium has also been shown to reduce the risk of suicide (6).
Lithium has a wide range of systemic adverse effects which affect several body systems including the skin (7). The reported prevalenceof the cutaneous side effects varies from 3% to 45% in different studies (8). (9). (10) (11). (12). (13). Acne/ acneiform and psoriasiform rashes are among the major cutaneous adverse effects of lithium and these may result in noncompliance. However, not all the patients with pre-existing dermatological disease show flares while they are on lithium treatment. Male patients who take lithium are more susceptible for the development of cutaneous reactions than their female counterparts (8).
Mechanism of induction/ exacerbation of the skin lesions
The mechanism by which lithium induces or exacerbates skin diseases is not exactly known, but its role in modulating second messenger systems such as adenylyl cyclase and inositol monophosphatase– mediated pathways, resulting in alteration in calcium homeostasis (14). The decrease in cyclic adenosine monophosphate (cAMP) and inositol that results from lithium treatment causes low intracellular levels of calcium, thus leading to a lack of differentiation and an increased proliferation of keratinocytes and to enhanced chemotaxis and the phagocytic activity of the polymorphonuclear leukocytes (15). Its effect on the serotonergic function (16). has also been implicated. The pustular propensity of lithium is attributed to lysosomal enzyme release and an increased neutrophil chemotaxis (17). (18). Lithium has been reported to alter the T cell function in vitro (19). The cutaneous effects of lithium are not related to excessive serum levels of lithium or other evidences of toxicity and may occur at normal therapeutic serum lithium levels (7).
Clinical manifestations
The association of psoriasis with lithium was first described by Carter in 1972 (20). Acneiform eruption due to lithium carbonate was described by Yoder in 1975 (21). it still remains a prominent cause of drug-induced acne (22). Other types of skin reactions include acne conglobata, hidradenitis suppurativa, folliculitis, alopecia, thinning of hair, macular/maculopapular rashes, and diffuse, erythematous, pruritic, maculopapular eruption (23). Other rare cutaneous reactions/ single case reports include lichenoid stomatitis (24). ulcerated lesions of the vaginal mucosa with acneiform eruption on the thighs (25).follicular hyperkeratosis (26). Darier’s disease (27). (28). keratodermia (29). oedema, pruritus, urticaria, purpura, allergic vasculitis, pretibial ulceration (30). keratosis pilaris like folliculitis, exfoliative dermatitis, dermatitis herpetiformis like eruption (31). erythema multiforme and linear IgA bullous dermatosis (7).
Acne and acneiform eruptions
Acneiform eruptions mainly consist of monomorphic pustules on an erythematous base and tend to affect the extremeties mainly. These lesions are usually not associated with comedones. Severe conglobata forms and hidradenitis suppurativa might be induced (32). In a case report, the histological examination of severe acneiform eruption due to lithium on the face, chest and back revealed it to be folliculitis rather than true acne (33). This type of an eruption may be very resistant to the standard topical dermatological treatment (32). Psoriasis and psoriasiform lesions.
Lithium has been implicated in a variety of clinico-morphological presentations of psoriasis. The period for the development of psoriasis lesions after the initiation of the lithium treatment is variable and it ranges from a few weeks to several months. Generally, this period is longer for the induction and shorter for the exacerbation of the psoriasis lesions (34). The common presentation of psoriasis which is secondary to lithium treatment is the typical plaque-type lesions, but other manifestations may also occur and these may include pustular psoriasis (35) (36). scalp psoriasis, fingernail abnormalities (37). erythroderma (38). and psoriatic arthropathy (39) (40). The histopathological picture of lithium-induced psoriasis is compatible with that of ordinary psoriasis and there are no specific histopathological differences (41).
Management
In evaluating the lithium-treated patients with cutaneous adverse effects, the role of stress and psychological factors, as well as other concomitant medications should be thoroughly evaluated. Acne and acneiform eruptions usually respond to topical antibiotics and retinoids. Psoriasis which is induced or exacerbated by lithium could be managed with conventional treatment methods such as topical steroids, keratolytics, vitamin D analogues, oral retinoids, PUVA (psoralen and ultraviolet A) therapy, and methotrexate. However, many of these side effects may respond less readily to the conventional therapy while the patient is receiving lithium. (32) Reduction in the dose is a reasonable option and it is worth trying. However, in resistant cases, lithium discontinuation may be considered and the patient may be switched on to another mood stabilizer like divalproex. The psoriatic lesions generally disappear within a few months’ time after the discontinuation of the lithium treatment. Some newer therapeutic agents which are being used specifically in the treatment of lithium-induced psoriasis include inositol, (42) and omega-3 fatty acids. (43)
Bipolar disorder is a serious mental illness, with most of the patients having a recurrent or chronic illness, thus making it one of the most important causes of disability at the ages from 15–44 years. (44) Lithium is the mainstay of treatment in bipolar disorder, though a number of alternatives are now available like divalproex, other anticonvulsants, atypical antipsychotics like olanzapine, etc. Besides the systemic side effects, lithium is associated with a variety of cutaneous side effects and these may result in suboptimal adherence by the patients. The prescribers should closely monitorthe cutaneous lesions in the patients who are on lithium treatment. Though all the patients with pre-existing skin diseases show flares, skin diseases which are induced and/or exacerbated by lithium treatment may sometimes become difficult to treat with the conventional methods and may manifest as a source of frustration on the part of both the patients and the providers. Therefore, a proper and early recognition and treatment will help in avoiding the issues of noncompliance in therapy and the further deterioration of the mood symptoms in these patients.
- 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