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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
Doctor I Am Swaying -An Interesting Case of Ataxia
Correspondence Address :
Deepak Madi
Assistant Professor,
Department of General Medicine,
Kasturba Medical College,
Attavar,Mangalore,575001, India.
Phone: 9845609148
E-mail: Deepakmadi1234@gmail.com
Auto-immune Hypothyroidism is one of the common causes of hypothyroidism. The usual clinical features of auto-immune hypothyroidism are constipation, fatigue, cold intolerance and weight gain. Rarely it can present with neurologic problems like reversible cerebellar ataxia, dementia, peripheral neuropathy,psychosis andcoma. A 45-year-old male presented with the history of gait-ataxia.Investigations revealed the hypothyroidism. Anti-TPO antibody was positive. Thyroid replacement therapy was started and our patient improved completely within 3 weeks. The main aim of this case report is to highlight the fact that hypothyroidism has to be considered in all patients who present with acute onset of cerebellar ataxia.
Hypothyroidism, Cerebellar ataxia, Auto-immune thyroiditis
Introduction
Hypothyroidism is a common problem in clinical practice. In almost all the cases, the neurologic manifestations occur along with the systemic features of the disease. However, symptoms of neurologic dysfunction may be the presenting feature in some patients. Most of these neurological complications improve completely after thyroid hormone replacement. In 1960 Jellinekand Kelly published their paper on an ataxic syndrome affecting six patients who were also found to have hypothyroidism (1). In five of them cerebellar signs improved after hormone replacement. Jellinek and Kelly also mentioned the fact that the classical signs and symptoms of hypothyroidism may not be clinically obvious in patients with ataxia. Our patient did not have other classical signs and symptoms of hypothyroidism. Hypothyroidism should be considered in all cases of cerebellar ataxia as it is a reversible cause of ataxia. There is hardly any recent published data on hypothyroidism causing ataxia. We present this case to highlight the fact that hypothyroidism can present as acute cerebellar ataxia.
A 45-year-old male presented to our hospital with history of unsteadiness of gait since 2 weeks. It was acute in onset and progressive in nature. There was no history of weakness of limbs, headache, vomiting, convulsions or loss of consciousness. There was no history of trauma to the head, fever or drug intake. History of occasional consumption of alcohol was present. On examination his vitals were normal. Cognitive functions were normal. Neurological examination showed gait ataxia, dysarthria and dysmetria on finger-nose and heel-to-knee tests. There was clumsiness of rapidly alternating pronation and supination in the upper limbs mainly on the left side. There was horizontal nystagmus. The gait was wide-based and there was a tendency to fall to left side. Tandem walking was impaired.
His fundus was normal. His power and reflexes were normal. Sensory system was normal. There was no evidence of autonomic dysfunction. His investigations revealed:Hb: 13.3g% ,TLC:6,000 /mm3, DLC: N54, L36,E6,M4, ESR: 13mm Platelet count: 2, 28, 000/ mm. Serum electrolytes,blood sugar, renal and liver function tests were normal. HIV spot: negative. Serum CPK: 1315U/L. Total cholesterol: 280mg/dl, Triglycerides: 204mg/dl, HDL cholesterol: 24 mg/dl, LDL cholesterol: 206.20mg/dl, VLDL cholesterol: 40.8mg/dl.
T3:0.410ng/ml (0.6-2.02), Free T4: 0.137ng/ml(0.93-1.71), TSH: 198.7uIU/ml(0.27-5.5). The Serum anti-TPO antibody was elevated(143 IU/l; reference: <34). His chest X-ray was normal. Ultrasonography of thyroid showed: hypoplastic thyroid with reduced echo texture. Patient refused FNAC of thyroid. MRI brain (Table/Fig 1) was normal. His lab investigations suggested hypothyroidism (auto-immune).Hewas started on 100μg of thyroxine. He improved completely within 3 weeks. TSH after 3 months of therapy was 3.49 uIU/ml.
Hypothyroidism is one of the causes of acute onset (usually reversible) ataxia (2).Stroke,viral encephalitis and drugs can also cause acute cerebellar ataxia.Mass lesions in the posterior fossa, infections such as HIV, deficiency syndromes such B1 and B12, alcohol and para-neoplastic syndromes are causes of subacute onset cerebellar ataxia in an adult. Hypothyroidism has been recognized as a cause of gait ataxia (3). Restoring a euthyroid state after hormone supplementation has reversed the cerebellar symptoms in most patients (4), suggesting that symptoms were due to endocrine mediated dysfunction of the cerebellum. In some patients with hypothyroidism, the cerebellar deficits have persisted despite adequate treatment (5). Our patient was started on 100μg of thyroxine and he improved completely within 3 weeks.
Selim and Drachman have reported six cases of cerebellar ataxia associated with auto-immune thyroiditis in whom the cerebellar symptoms progressed despite remaining euthyroid (6).They postulated that there were two separate mechanisms resulting in cerebellar nysfunction in patients with thyroid disorders. In hypothyroidism is not associated with auto-immunity, the endocrine disorder produces cerebellar dysfunction that could be reversed by thyroid replacement.In patients with autoimmune thyroiditis not reversed by thyroid replacement therapy, auto-immune mediated cerebellar degeneration was a likely mechanism. Our patient showed an excellent response to treatment. Dinkar et al have reported a case of Hashimoto’s encephalopathy presenting purely with subacute cerebellar syndrome (7). A similar case has been reported by Nakagawa et al (8). Necropsies of patients with hypothyroidism and cerebellar ataxia have been reported.Barnard et al described degenerative changes in the cerebellum, particularly in the anterosuperior portion of the vermis, together with atrophy of ventral portion of the pons, transverse pontine fibres, and middle and superior peduncles in a patient with hypothyroidism and cerebellar ataxia. When I was a postgraduate student my neurology professor would always mention that hyponatremia and hypothyroidism should be considered in patients presenting with ataxia as they were reversible causes of ataxia. As a student I had read in Harrison(text book of medicine) that hypothyroidism can present with ataxia but I had never imagined that I would encounter a patient with ataxia as the predominant manifestation of hypothyroidism in my clinical practice.
Uncommon presentations of common conditions is sometimes seen in medicine.We recommend testing for thyroid hormones and Antithyroid antibodies(anti-TPO) in patients who present with ataxia. Classical signs of hypothyroidism may not be clinically obvious in patients presenting with ataxia. Such a case report will sensitize the clinicians about the fact that hypothyroidism can present as acute cerebellar ataxia so that they can start appropriate treatment without wasting time.
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