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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
Ruptured Endometrioma Presenting as Acute Abdomen with Highly Raised Serum CA-125 Levels: A Case Report
Correspondence Address :
Anagha Kamath, Assistant Professor
Department of Obstetrics and Gynaecology,
Kasturba Medical College, Behind Leo Furnitures,
Karangalpady, Mangalore.
A 35 yr old lady, para 2, living 2, with 2 previous caesarean sections, presented with the features of acute abdomen. The clinical and laboratory evaluations revealed a bilateral ovarian mass with solid and cystic components, with raised serum CA-125 levels and raised ESR. The differential diagnosis included abdominal or genital tuberculosis, secondary carcinoma of the ovaries and endometriomas. This case is being reported and discussed in detail, for which an emergency exploratory laporotomy was performed. The intraoperative features suggested the diagnosis of spontaneous peritonitis which was secondary to ruptured b/l ovarian endometriomas.
A 35yr old lady who hailed from Chikmagalur India, a labourer by occupation, para 2, living 2, with 2 previous 2 LSCS, presented on the third day of her menstrual cycle, with complaints of abdominal distension, nausea, vomiting, breathlessness since 2 days; low grade, mild and intermittent fever since 1 month; oligomenorrhoea and lower abdominal pain which was mild and intermittent, since 6 months. On examination, she was found to be afebrile, had tachypnoea and tachycardia, was normotensive; had normal cardiovascular and respiratory systems; her per abdomen had the features of abdominal distension, guarding, rigidity, tenderness in the right iliac fossa, shifting dullness and sluggish bowel sounds. The per speculum examination revealed bleeding through the os with a normal vagina and cervix; her per vaginal examination revealed a normal sized uterus, fullness in the right fornix and presence of the pouch of Douglas. Her per rectal examination confirmed the fullness in the pouch of Douglas.
On further investigation, her blood tests showed leukocytosis of 15,000, neutrophilia, ESR of 37, normal liver and renal function tests and urine pregnancy test was negative. The ultrasound of abdomen and pelvis depicted a bilateral adenexal mass with solid and cystic components, the right ovary measured 7.4*3.4cm, there was fluid in the pouch of Douglas and ascites. The serum CA-125 level was 1625units; her Beta human chorionic gonadotrophin level was 0.9units, and alpha feto protein AFP level was 2.63 units.
The high CA-125 levels raised the suspicion of an ovarian malignancy. After taking clearance from the physician, the surgeon and the anaesthetist, an emergency exploratory laporotomy was performed, wherein the chocolate coloured fluid was drained from the peritoneal cavity and sent for cytology. Her bowel exploration revealed no abnormality and she had a left ovarian mass of 7*6cm and a right ovarian mass of 4*3cm. Adhesions were also present in her uterus, urinary bladder and rectum. The adhesions were released, a total abdominal hysterectomy with bilateral salpingo oophorectomy was done and the tissues were sent for histopathological studies to the Department of Pathology, Kasturba Medical College, Mangalore.
HISTOPATHOLOGY
The histopathological studies reported features which were suggestive of endometriomas. The ascitic fluid was negative for malignant cytology.
Endometriosis is defined as the presence of endometrial glands and stroma outside the normal location, which are most commonly found in the pelvic peritoneum, but may also be found in the ovaries, the rectovaginal septum and the ureters, but rarely in the bladder, the pericardium and the pleura. Endometriomas are the cystic endometrial lesions which are contained within the ovaries. The spontaneous rupture of an endometriotic cyst is very rare. Very few cases have been reported till now and most of them have been associated with pregnancy (1). The rupture of an endometriotic cyst is one of the representative acute gynaecological disorders which are manifested by acute abdominal pain and inflammatory reactions (2). This frequently induces elevations in the body temperature, the WBC count and the serum CRP levels, all of which are acute inflammatory reactions. These inflammatory responses are considered to be induced by the content of an ovarian endometriotic cyst. Since abdominal pain is a major symptom in this case, the differential diagnosis from any underlying intestinal disease is often necessary, and infectious diseases in the adnexa should also be ruled out.
In our present case report, a 35yr old lady presented with chronic symptoms of 6 months duration, which was superimposed by an acute abdomen of 2 days duration. Acute abdominal pain, with a history of fever, with a guarding rigidity with leucocytosis, suggested peritonitis. Clinically, the differential diagnosis included abdominal or genital tuberculosis, carcinomas in the gastro- intestinal system or in the ovaries and endometriomas.
The investigations revealed leukocytosis, raised ESR, very high serum CA-125(1625IU/ml) levels, bilateral ovarian masses with ascites which pointed out more towards the secondaries in the ovaries or ruptured chocolate cysts with peritonitis which was secondary to bowel perforation. Intraoperatively, the features of a chocolate to brownish coloured fluid in the peritoneum andthe bilateral ovarian cysts clearly suggested the diagnosis of spontaneous peritonitis which was secondary to ruptured, bilateral ovarian endometriomas with raised serum CA-125 levels.
Serum CA-125 is the gold standard tumour marker for the evaluation of pelvic masses. Distinguishing the benign conditions from the malignant standard cut off of 35 IU /ml (the normal range being 0 -35 IU/ml) can be misleading, especially in menstruating women and hence, a cut off from 65 to 200 IU /ml is necessary. The levels of CA-125 which are > 65 U/mL, correlate highly with ovarian malignancies and distinguish the malignant diseases from the benign diseases, with a specificity of 88 to 92% and a sensitivity of 75% to 83% (1). Plasma CA-125 levels which are > 194 U/mL are considered as a positive criterion for differentiating the malignant pelvic masses from the benign pelvic masses (2).
Serum CA-125 measurement is now a consolidated method for diagnosing endometriosis, but its interpretation has posed a number of problems, particularly its utility in diagnosing minimalmild endometriosis, whereas its value as a diagnostic aid in the moderate-severe stages is well recognized. The serological testing for CA-125 has been widely used not only to detect endometriosis, but also to monitor its progression (3) (4). The patients with endometriosis rarely have CA-125 levels which are >100 IU/ ml. However, endometriosis constitutes a major non-malignant gynaecological disease wherein the serum CA-125 levels are in the malignancy range (>1,000 IU/ml) (5). The severity of endometriosis has been shown to be positively correlated with elevated CA-125 levels. Serum CA-125 is significantly elevated with respect to the ovarian and mixed endometriosis lesions in comparison with the exclusive extraovarian foci (6).
The CA-125 levels are reported to rise immediately after the rupture of an endometriotic cyst and also following malignant transformation (7). An acute rise of the serum CA-125 levels to up to 9300 IU/ ml following the rupture of ovarian endometrioma has been reported (8). The sudden release of endometriotic cyst fluids containing very high concentrations of CA-125, combined with pelvic peritoneal irritation, may contribute to the unusual rise of the serum CA-125 levels. This is the highest value which has been reported so far with histologically confirmed endometriosis. However, Kahraman A et al reported a 25-year-old woman with unruptured unilateral endometrioma and stage IV endometriosis, with extremely elevated serum CA-125 levels of 7,900 U/mL (9). This case demonstrated that abnormally high levels of plasma CA- 125 may be encountered in large ovarian endometriomas without rupture and without the overflow of the thick, “chocolate” cyst fluid throughout the abdominal cavity. Chii-Shinn Shiau et al reported CA-125 levels of 6310 IU/ ml with an unruptured endometrioma (10).
The consensus conference recommendations from an expert panel of gynaecologists in the US stated that hysterectomy withbilateral salphingo oophorectomy (BSO), which was reserved for females with symptomatic endometriosis and thsose who have completed child bearing and recognized the risk of premature hypooestrogenism, including the females with possible osteoporosis and decreased libido (11), which justifies our management in this case.
Ovarian endometrioma and endometriosis may be present acutely and they may be associated with extremely elevated serum CA-125 levels. For this reason, ovarian endometrioma should be considered with respect to the differential diagnosis of reproductive-age women who is present with an acute abdomen and an ovarian mass, even if it resembles an ovarian malignancy. Moreover, very high CA-125 levels do not necessarily forebode an ovarian malignancy.
I acknowledge the surgical and nursing staff of Wenlock and Lady Goshen Government Hospitals, Mangalore; and the Department of Pathology, Kasturba Medical College, Mangalore, without whose help this work would not have been possible. The unyielding support of the patient and her family has always been with me.
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