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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
Original article / research
Full Version
A Clinical Study of Ectopic Pregnancy
Correspondence Address :
Dr. Rashmi A Gaddagi,
Assistant Professor in Department of OBG,
PUSHPAGIRI ; 1675/92,93; Ranganath badavane main road
Near Hadadi Road; Davangere 577005, Karnataka, India.
Phone: 09886130299
E-mail: obgrashmi@gmail.com, orthoraju@rediffmail.com
Background- Motherhood- An eternal, universal and inherent dream which every woman has. This dream may not always be pleasant and it can involve nightmares. One of this is ectopic pregnancy – a pregnancy which can be life threatening . The present study involves a study on all the cases of ectopic pregnancy who were admitted to the Cheluvamba hospital during November 2004 to May 2006.
OBJECTIVES
1. To know the age group, parity and the risk factors with re¬spect to the ectopic pregnancy. 2. To know the clinical presentation of the ectopic pregnancy. 3. To know the outcome of the ectopic pregnancy.
Materials And Methods- A total of 37 patients who were di¬agnosed as ectopic pregnancy cases were analyzed between the period from November 2004 to May 2006. All these cases were analyzed after applying the inclusion and exclusion criteria with respect to the 1. History 2. Clinical presentation 3. Investigations 4. Treatment
Results- The incidence of the ectopic pregnancy in the pres¬ent study was 1:399 pregnancies . A majority of the cases were multigravidas. In most of the cases, there were no identiable risk factors. However, they did present with pain in the abdomen, amenorrhoea and bleeding per vagina in at least 50% of the cases. Almost half (40%) were in a state of shock at admission. Ultrasound , a urine pregnancy test and culdocentesis were the investigative modalities which were used. All the cases were managed by surgical management. On laparotomy, a majority of the cases were found to be ampullary pregnancies, followed by interstitial pregnancies. The tube was ruptured in almost 80% of the cases and there was a haemoperitoneum. Almost all the patients had intraoperative and/ or postoperative blood transfusions. There was no significant post operative morbidity in these cases.
Interpretation And Conclusion- The early diagnosis of an ectopic pregnancy is one of the greatest challenges for a physician. It requires a high index of suspicion i.e to diagnose an ectopic pregnancy, one must be ectopic minded .The im-portance of an early diagnosis lies in the fact that the lady can be offered a conservative line of management which can definitely have a beneficial effect on her reproductive career.
Ectopic pregnancy, Ampulla, Culdocentesis, Salpingectomy
Introduction
Ectopic pregnancy is defined as any intra or extrauterine pregnancy in which the fertilized ovum implants at an aberrant site which is inconducive to its growth and development (1). Ectopic pregnancy is assuming greater importance because of its increasing incidence and its impact on womens fertility [2,3]. Ectopic pregnancy remains the leading cause of maternal deaths in early pregnancy (4). With respect to the management of ectopic pregnancy, there has been tremendous technical advances. The early diagnosis and treatment of this condition over the past two decades has allowed a definitive medical management of unruptured ectopic pregnancies even before there were clinical symptoms in these high risk women [5,6]. The current trend is a conservative way of management of these pregnancies be it chemotherapeutic agents or conservative surgical approaches, the ultimate goal is TUBAL CONSERVATIVE PROCEDURES rather than radical surgeries [7,8]. METHODOLOGY OBG& GYN SOURCE OF THE DATA This study was undertaken at the Cheluvamba Hospital, Mysore, between November 2004 to May 2006 after obtaining ethical committee clearance from the hospital authorities. The source of the data included all the woman in the reproductive age group (15-44 years) who were admitted to the Cheluvamba Hospital with an ectopic pregnancy. METHODS OF COLLECTION OF THE DATA All the women with ectopic pregnancies (who were diagnosed after a clinical examination and investigations) were included in the study. INCLUSION CRITERIA The women who were diagnosed as ectopic pregnancy cases, who were in the reproductive age group of 15-44 years. EXCLUSION CRITERIA No exclusion criteria
• This study was undertaken at the Cheluvamba Hospital from November 2004 to April 2006.
• A total of 37 cases of ectopic pregnancy were diagnosed.
• The incidence of ectopic pregnancy in the present study was 1:399 pregnancies or 1:285 deliveries.
• A majority of the patients (70.2%) belonged to the 21-30 years age group.
• 27% were nulliparas, 10.8% were primiparas and the rest (62.2%) were multiparas.
• The aetiological /risk factors: 37.83% had no risk factors; 16.21% had a prior history of tubectomy; 16.21% had a history of infertility (primary or secondary); 18.91% had a history of D and C; Cu-T each; 1 case conceived while she was on OCP, but she gives a history of missed pills; and a history of previous ectopic preg-nancy and appendicectomy were seen in 2.7% each. A history of PID and previous LSCS were found in 8.1% of the cases each.
• A majority of the cases presented with pain in the abdomen (89.2% of cases); amenorrhoea (75.7%) and spotting (43.2%).
• Around 40.5% of the cases were brought in a state of shock.
• Tenderness on cervical movement was present in 75.7% of the cases and masses in the fornices were present in 70.3% of the cases.
• The urinary pregnancy test was positive in 97.3% of the cases and culdocentesis was positive only in 37.8% of the cases.
• Ultrasound revealed a ruptured ectopic pregnancy in 43.2% of the cases; an unruptured pregnancy in 8.1% of the cases and a heterogenous mass in 40.5% of the cases. In 83.8% of the cases, a fluid was noted in the Pouch of Douglas.
• A majority of the cases were ampullary pregnancies (69.7%). nterstitial/cornual pregnancy was seen in 15.2% of the cases and 3% of the cases were isthmal pregnancies, while 9.1% of the cas¬es showed pregnancy in a rudimentary horn.
• 78.3% showed a ruptured ectopic pregnancy on laparotomy. Tubal abortion was seen in 4 cases and an unruptured ectopic pregnancy in 3 cases.
• 86.4% of the cases showed a haemoperitoneum on lapa¬rotomy.
• The most common procedure which was done was salp¬ingectomy in 51.4% of the cases, followed by salpingo-oophorec¬tomy in another 13.5% of the cases. In 5.4% of the cases (i.e. 2 cases) total abdominal hysterectomy was done. Both these cases were cornual pregnancies. • Most of these cases (36) had blood transfusions intraoperatively and post-operatively.
•The postoperative period was uneventful, except 1 case which developed pulmonary oedema which was secondary to the fluid overload.(Table/Fig 2),(Table/Fig 3),(Table/Fig 4).
INCIDENCE
The incidence of ectopic pregnancy has increased since the last 20 years. The incidence in this present study was 1:399 pregnancies or 1:285 deliveries (Table/Fig 1).
RISK FACTORS AND ECTOPIC PREGNANCY
Previous Abortions and D and C
In the current study -18.91 % In Rose Jophy et al., study - 25 .8 %
PID and Ectopic Pregnancy
In the current study - 8.1 %
In March Banks’ study (1998) - 4%
In Savitha Devi’s study (2000) - 25%
In Rose et al., study (2002) - 34.4%
HISTORY OF INFERTILITY
In the current study - 16.21 %
In March Banks’ study (1998) - 2.9%
In Savitha Devi’s study (2000) - 48.07%
In Rose et al., study (2002) - 15.1%
In Arora et al., study (1998) - 11.2%
In Mitra et al., study (1980) - 55.2%
PREVIOUS ECTOPIC PREGNANCY
In the present study- 2.7% In Rose et al., study (2002) - 3.2 % This is because tubal disease is nearly always bilateral and because there is a strong tendency for ectopic pregnancy to occur first on one side and then later on the other side (9).
HOWEVER, THE MOST IMPORTANT FACT WHICH NEEDS ATTENTION IS THAT IN A MAJORITY OF THE CASES (37.83%), THERE WAS NO RECOGNIZABLE RISK FACTOR. THIS STRESSES THE FACT, THAT TO DIAGNOSE ECTOPIC PREGNANCY, WE MUST BE ECTOPIC MINDED.
CLINICAL SYMPTOMS
The classical findings of pain in the abdomen, amenorrhoea and vaginal bleeding is not seen in all the cases . This is because the clinical picture is dependent on several fac¬tors, the most important factor being the time which is taken for a disturbance to occur in the ectopic pregnancy. The more extensive and rapid the disturbance is, the more clear is the clinical picture. On the other hand, an undisturbed unruptured ectopic pregnancy is more likely to be missed unless it is recognized by ultrasonog¬raphy (10).
GENERAL PHYSICAL EXAMINATION
In the present study, most of the cases (40.5%) presented with shock as compared to those in other studies. This was because a majority of the cases (78.37%) presented with a ruptured ecto¬pic pregnancy. Pallor was a significant finding which was seen in almost 70-80% of the cases of ectopic pregnancies. Thus, GPE gives an important clue to the diagnosis and also an idea regarding the condition of the tube (11).
CLINICAL SIGNS
Result
In the present study, as most of the cases were suggestive of a ruptured ectopic pregnancy, they were taken up for laparotomy and salpingo-oophorectomy / salpingectomy (67.6%). The other procedures which were done were:
1. Milking for tubal abortion - 5.4%
2. Rudimentary horn excision - 8.1%
3. Cornual excision and repair - 2.7%
4. Broad ligament sac excision and salpingectomy.
5. Two cases underwent total abdominal hysterectomy with salpingo-
oophorectomy. These were cases of cornual pregnancies,
both of which were ruptured.
OPERATIVE FINDINGS
CONCLUSIONS
The incidence of ectopic pregnancies is on the rise, as was evident by the findings of this study. All the cases were diagnosed with a high index of clinical suspicion and the USG findings added to the diagnosis. Though the recent trend in the management of ectopic pregnancy is the use of a conservative surgical or medical line of management, radical surgery or salpingectomy was the treatment modality which was used in the present study. This was mainly because a majority (80%) of the cases were referred or they came late to the hospital after the ectopic pregnancy had ruptured. But fortunately, there has not been even a single mortality. The maternal morbidity was also significantly less .
DOI: JCDR/2012/4015:0000
Date of Submission: Jan 18, 2012
Date of Peer Review: Mar 01, 2012
Date of Acceptance: Mar 17, 2012
Date of Publishing: Jun 22, 2012
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