Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

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)
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.
On April 2011

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
On Jan 2020

Important Notice

Year : 2012 | Month : May | Volume : 6 | Issue : 4 | Page : 745 - 746 Full Version

High Altitude Illness: A Nepal Perspective

Published: May 1, 2012 | DOI:
Vivek Kiyawat, Brijesh Sathian, N. Suresh Baboo, Rachit Chawla, Ashvita Garg

1. Intern, Jai Prakash Hospital, Bhopal, India. 2. Assistant Professor & Managing Editor in Chief NJE , Dept. of Community Medicine, Manipal College of Medical Sciences, Pokhara, Nepal. 3. Professor of Physiology, Manipal College of Medical Sciences, Pokhara (Ex-Professor and Chief of Environmental Physiology Division of the Institute of Aerospace Medicine, Indian Air Force, Bangalore-560017, India and the Ex-Commanding Officer of 701, Medical Staging Section of General Reserve Engineer Force which provided the medical cover to the Indian Border Roads Organisation during the building of the highest road in the world at Khardung La at19000 ft AMSL). 4. Intern, RML Hospital, New Delhi, India. 5. Intern, Ferozpur Civil Hospital, Ferozpur, India.

Correspondence Address :
Dr. Vivek Kiyawat
F – 91/67 Tulsi Nagar Bhopal, Madhya Pradesh, India.
Phone No: +91-7869119178

The basic impetus for carrying out this work was based on the experience of one of the authors, Brijesh Sathian, during his trip to the Dhaulagiri Ice Fall (3950m) from Pokhara (827m), when he experienced nausea, vomiting, dizziness, headache and loss of appetite. His trip involved a rapid ascent of 3123 m for a 24 hour duration (which involved both air transport from Pokhara to Jomsom and trekking from Jomsom to the Ice fall, which involved a 10 hour trek).

High altitude illness collectively describes the syndromes that come into play shortly after the ascent to a high altitude and it mainly affects unacclimatized individuals. It encompasses the syndromes of acute mountain sickness (AMS), high altitude cerebral oedema (HACO) and high altitude pulmonary oedema (HAPO) (1).

Acute Mountain Sickness (AMS)
Acute mountain sickness is a self-limiting condition which is charcterized by mild to moderate headache, loss of appetite, nausea, dizziness and insomnia (2). Acute mountain sickness is usually seen at a moderately high altitude of above 2800 m (3). The occurrence and the severity of AMS depend on the altitude, the rate of ascent and the physical exertion after the entry into the high altitude, besides other variables. Recent studies have indicated AMS as a polygenic condition with a strong environmental component (4). An incidence of 68% has been documented by Basnyat et al in their study among pilgrims, at an altitude of 4300m in Nepal (5). The rate of ascent has also been reported as a risk factor for the development of AMS. However, no difference between the sexes with regards to the susceptibility to AMS has been reported (6).

High altitude pulmonary oedema (HAPO)
HAPO is a life-threatening non-cardiogenic form of pulmonary oedema that afflicts vulnerable individuals, following a rapid ascent to a high altitude of above 2500 m (7). A major determinant for the incidence of HAPO is the vulnerability of an individual (8). The symptoms of HAPO are known to develop within the first four days at a high altitude (9). These include incapacitating fatigue, chest tightness, dyspnoea and a dry non-productive cough which progresses to cough, with a pink frothy sputum due to haemoptysis (2). The hallmark of HAPO is an excessively elevated pulmonary artery pressure in response to hypoxic pulmonary vasoconstriction, which leads to an elevated pulmonary capillary pressure and protein content, as well as an oedema fluid rich in the red blood cells. HAPO is a form of hydrostatic pulmonary oedema with an altered alveolar-capillary permeability (10). A reduced clearance of the fluid from the alveoli may also contribute to this non-cardiogenic pulmonary oedema8. Among the pilgrims, at an altitude of 7300m, Basnyat et al observed the incidence to be 5%. They also observed that women had a higher incidence of HAPO at an altitude of 4300m (5).

High altitude cerebral oedema (HACO)
HACO is one of the most severe forms of high altitude illness. The common symptoms and signs of HACO in the order of frequency are disturbed consciousness, ataxia, headache, anorexia, nausea and papilloedema (11). HACO represents the end stage of AMS (12). High altitude cerebral oedema seems to result from an increase in the intracranial pressure which is directly dependent on an increase in the cerebral volume (13). Basnyat et al observed the incidence to be 31% among the pilgrims at an altitude of 4300m in Nepal (5).

A better knowledge of the high altitude sickness among the members of the trekking groups will be essential for the prevention and preparedness towards this health problem. Indoctrination sessions about the dos and don’ts at a high altitude for trekkers, pilgrims and other associated high risk groups prior to starting the ascent must be done. A slow ascent to the high altitudes must be encouraged. The consumption of depressants like tobacco, alcohol, barbiturates and tranquilizers should be avoided, as these further reduce the respiratory drive. A sufficient amount of fluids should be consumed in order to maintain the hydration levels. Drugs like acetazolamide can be used for the treatment as well as for the prevention of high altitude sickness. They act by increasing the respiratory rate and by thus minimizing the symptoms which are caused by poor oxygenation. Dexamethasone has also been found to be effective in reducing the symptoms of AMS and also in adults with a history of HAPO, by decreasing the systolic pulmonary artery pressure. Nifedipine, a calcium-channel antagonist, plays an important role in the prevention and the treatment of HAPO by inhibiting the hypoxic pulmonary vasoconstriction. The adverse effects of high altitude illness, especially HACO and HAPO must be tackled as medical emergencies. The provision of air evacuation and hyperbaric chamber facilities will be highly useful for decreasing the morbidity and the mortality burden which are caused by high altitude illness. Health professionals at all levels should be trained in the management of high altitude sickness.


Basnyat B, Murdoch DR. High altitude illness. Lancet 2003; 361: 1967-74.
Maggiorini M. Mountaineering and altitude sickness. Ther Umsch. 2001; 58(6):387-93.
Maggiorini M, Buhler B, Walter M, Olez O. Prevalence of acute mountain sickness in the Swiss Alps. Br Med J 1990; 301: 853-55.
MacInnis MJ, Koehle MS, Rupert JL. Evidence for a genetic basis for altitude illness: a 2010 update. High Alt Med Biol. 2010 Winter; 11(4):349-68.
Basnyat B, Subedi D, Stafggs J et al. Disoriented and ataxic pilgrims: an epidemiological study of acute mountain sickness and high altitude cerebral oedema at a sacred lake at a height of 4300m in the Nepal Himalayas. Wilderness Environ Med 2000; 11: 89-73.
Hackett PH, Rennie D, Levine HD. The incidence, importance and the prophylaxis of acute mountain sickness. Lancet 1976; 2: 1149-54.
Stream JO, Grissom CK. Update on high-altitude pulmonary edema: pathogenesis, prevention, and treatment. Wilderness Environ Med 2008; 19(4):293-303.
Maggiorini M. Prevention and treatment of high-altitude pulmonary edema. Prog Cardiovasc Dis. 2010; 52(6): 500-06.
Chawla A. Incidence of Acute Mountain Sickness in patients of high altitude pulmonary edema: Is the Lake Louise scoring accurate? Ind J Aerospace Med 2009; 53(1): 1-5.
Swenson ER, Maggiorini M, Mongovin S, et al. The pathogenesis of high-altitude pulmonary edema: Inflammation is not an etiologic factor. JAMA 2002; 287(17): 2228-35.
Wu T, Ding S, Liu J et al. Ataxia: An early indicator in high altitude cerebral edema. High Altitude Medicine and Biology. 2006; 7(4): 275- 80.
Luks AM, McIntosh SE, Grissom CK et al. Wilderness Medical Society Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness. Wilderness and environmental medicine, 2010; 21: 146-55.
Dumont L, Lysakowski C, Kayser B. High altitude cerebral oedema. Ann Fr Anesth Reanim 2003; 22(4):320-24.

DOI and Others

ID: JCDR/2012/3674:0056

Date of Submission: Nov 21, 2011
Date of peer review: Jan 07, 2012
Date of acceptance: May 15, 2012
Date of Publishing: May 31, 2012

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