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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
Thoracoabdominal ectopia cordis: A report of two cases
Correspondence Address :
Rajendra K Ghritlaharey, Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College &
Associated, Kamla Nehru & Hamidia Hospitals Bhopal, Madhya
Pradesh 462 001 (India), Phone No: + 91-755 - 4050571(R),
4050261(O), E-mail: drrajendrak1@rediffmail.com
Ectopia cordis (EC) is defined as the complete or partial displacement of the heart outside the thoracic cavity. It is a rare congenital defect in the fusion of the anterior chest wall, resulting in the extra thoracic location of the heart. We are describing here, two cases of thoracoabdominal EC. One died after emergency surgery and another is awaiting definitive procedures.
Ectopia Cordis, Ectocardia, Thoracoabdominal Ectopia Cordis, Cantrell’s Pentalogy
EC, ectocardia or exocardia is a rare congenital defect in the fusion of the anterior chest wall, resulting in the extra thoracic location of the heart (1). The estimated prevalence of EC is 5.5-7.9 per million live births (2), (3). Depending upon the location of the heart, it could be classified into five types: cervical, cervicothoracic, thoracic, thoracoabdominal and abdominal (2), (3). Thoracic and thoracoabdominal EC account for about 85% of the cases (2), (3). Cantrell, et al, in 1958, first described this syndrome in which anterior diaphragmatic hernia occurred in association with an omphalocele. Thoracoabdominal ectopia cordis is also referred to as: Cantrell-Heller-Ravitch syndrome, pentalogy syndrome; and peritoneo-pericardial diaphragmatic hernia (4).
Case 1
A full term, 2-day-old boy, weighing 3 kg, was admitted with an ectopic heart. Clinical examination revealed the thoracoabdominal location of the heart, with associated exomphalos major (Table/Fig 1). He had cyanosis and his general condition was poor. Under anaesthesia, a skin cover was given to the heart and the exomphalos was repaired. He succumbed few hours after the surgery. No other investigations were possible and the intracardiac lesions could not be known, but we presume that he had severe intra cardiac lesions.
Case 2
A boy was born at 37 weeks of gestation to a G I, P 0, 23 yearsold mother. The antenatal period and the hospital delivery were uneventful. The clinical examination revealed that he weighed 1.7 kg and that he did not have cyanosis or respiratory distress. He had thoracoabdominal EC with exomphalos major (Table/Fig 2) and video of case 2]. The X-ray of his chest / abdomen revealed a sternal defect and a soft tissue shadow in the thoracoabdominal region. Ultrasonography (USG) of the abdomen was suggestive of the thoracoabdominal location of the heart, the exomphalos contained intestines and a part of the heart and the liver. Similar findings were confirmed by computed tomography (CT) scans of the abdomen and chest (Table/Fig 3) (Table/Fig 4). Echocardiography reported ventricular septal defect (VSD) and patent ductus arteriosus (PDA) (Table/Fig 5). As he had intra-cardiac lesions, the exomphalos was treated conservatively and other definitive procedures were deferred. He was discharged on request on the13th post admission day in a good condition with an advice about the need of multiple surgeries and he was gaining weight as well.
EC is defined as the complete or partial displacement of the heart outside the thoracic cavity. It is a rare congenital defect in the fusion of the anterior chest wall, resulting in the extra thoracic location of the heart. Depending upon the location of the heart, it can be classified into five types: cervical, cervicothoracic, thoracic, thoracoabdominal and abdominal. Thoracic and thoracoabdominal EC account for about 85% of the cases (2), (3). The exact aetiology is unknown and it occurs due to the developmental failure of a segment of the mesoderm, between 14 to 18 days after conception (4). Thoracoabdominal ectopia cordis is also referred to as: Cantrell-Heller-Ravitch syndrome, pentalogy syndrome; and peritoneopericardial diaphragmatic hernia (4). The complete syndrome is characterized by two major defects: ectopia cordis and an abdominal wall defect [most commonly an omphalocele, but gastroschisis can also be present). The other three defects of the pentalogy are the disruptions of all the interposing structures: the distal sternum, the anterior diaphragm and the diaphragmatic pericardium. Incomplete expressions of pentalogy have also been reported (4), (5).
Thoracoabdominal EC may be associated with other intracardiac anomalies, cranial and facial anomalies, chromosomal abnormalities, clubfeet, malrotation of the colon, hydrocephalus,and anencephaly (2), (4). Intracardiac anomalies are described in the pentalogy of Cantrell, including VSD (100%), ASD (53%) and tetralogy of the Fallot (20%), and the ventricular diverticulum (20%). Most of the cases are sporadic and no familial tendencyor recurrence has been demonstrated, but thoracoabdominal EC has also been reported in twins (4).
The prenatal diagnosis of thoracoabdominal EC is possible in the first trimester of pregnancy by USG and this depends on the size and extent of the defects. The diagnosis of the complete syndrome requires the five criteria which are described by Cantrell, but incomplete variant forms exhibiting three or four of the features may also present. Ultrasound, echocardiography, CT scan / multi detector computed tomography (MDCT) scan and magnetic resonance imaging, when necessary, should be applied to search for this combination of malformations (4), (6), (7), (8). The surgical correction of these defects is complex and it generally requires a staged closure, but a single stage repair has also been reported, with success (2), (9), (10). The staged repair includes: (1) covering the heart, (2) correction of the intrinsic cardiac defects prior to the orthotopic location of the heart and (3) placement of the heart into the thoracic cavity and sternal / thoracic reconstruction. The potential advantages of the staged repair are; minimization of the compression of the heart and the great vessels, and allowing the thoracic cavity to expand gradually.
Our case one had thoracoabdominal EC, exomphalos and sternal defect, but no diaphragmatic hernia and intracardiac lesions could not be detected. A skin cover for the heart was provided and the exomphalos was repaired. Case 2 also had incomplete pentalogy of Cantrell, ie, thoracoabdominal EC, exomphalos major, sternal defect, VSD and PDA, but no diaphragmatic hernia. In view of the intracardiac lesions and the presence of the skin cover over the heart, the repair of the exomphalos and the definitive procedures were deferred.
The successful repair of such anomalies is dictated by the presence and the severity of the intrinsic cardiac defects and the other associated congenital anomalies, rather than the type of surgical approach itself. Advances in the foetal ultrasound techniques have aided in the early recognition of such anomalies and the termination of the pregnancy prior to viability should be considered and discussed with the parents.
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