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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
Emergency Bilateral Internal Iliac Artery Ligation – A Hospital Based, Cross Sectional Study
Correspondence Address :
Dr. Veeresh Nagathan,
Professor, Department of OBG,
S. Nijalingappa Medical College,
Bagalkot 587102, Karnataka India.
Phone: 09448237313
E-mail: dr.nagathan@yahoo.com
Background: A pelvic haemorrhage is a life threatening complication in both gynaecology and obstetrics cases and it has to be controlled immediately. Bilateral Internal Iliac Artery Ligation (BIIAL) is a time tested and an easy method and it achieves this goal without compromising the rest of the pelvic blood supply.
Objective: This study was done to describe the indications, the surgical techniques and the effectiveness in controlling the pelvic haemorrhages in the obstetrics and the gynaecology cases.
Material and Method: A total of 18 emergency BIIALs were performed between 2001-2010 in the obstetrics and gynaecology cases by the general surgeons and the gynaecologists.
Results: 16 patients could be successfully treated and two patients died due to delays in performing the surgery (an increased interval between the primary surgery and the BIIAL).
Conclusion: An emergency BIIAL is a safe , effective and a simple technique to adopt. A delay in performing the procedure increases the mortality and the morbidity. This technique should be performed more often when it is indicated by obstetricians and gynaecologists.
Postpartum haemorrhage, Hysterectomy, Internal iliac artery ligation
Introduction
An emergency BIIAL is a highly effective, simple and a safe surgical procedure for controlling the pelvic haemorrhages in gynaecology and obstetrics patients. It is a life saving procedure which preserves the reproduction capacity by avoiding hysterectomies in such situations. An emergency bilateral IIAL is indicated mainly in the post partum haemorrhages which are due to the atony of uterus rather than due to an obstetric trauma. However, some have reported the useful use of bilateral IIAL in patients with ruptured uteri and placenta accreta (1). For a supra-levator haematoma which does not respond to a conservative management, the recommended treatment is BIIAL and not hysterectomy (2). The surgical techniques and their effectiveness have been extensively described in the literature (3),(4).
A total number of 18 emergency BIIALs were performed between 2001-2010 in the obstetrics and gynaecology cases by the general surgeons and the gynaecologists. Among the 18 patients in whom we did BIIAL, in 8 patients, the surgery was performed at a referral centre (a teaching hospital) and in the other 10, it was done in a private hospital.
Inclusion criteria: The patients with uncontrolled bleeding, who had been undergoing LSCS and hysterectomy,. 8 such cases were included in our study.
Exclusion criteria: The patients with normal intra operative blood losses were excluded from the study.
8 patients with atonic Post Partum Haemorrhages (PPHs) following vaginal deliveries were referred to the surgeon by obstetricians within 5 to 8 hours of the child birth, after there was a failure toSectioncontrol the PPH by conservative methods. All the 8 patients were successively managed by doing BIIALs (Table/Fig 1).
5 women who developed post LSCS bleeding required emergency BIIALs. The indication for LSCS in three cases was foetal distress and in two cases, it was a Cephalo-Pelvic Disproportion (CPD). One patient died after 8hrs of doing the BIIAL due to a delay in performing the surgery.
Among 3 of 5 women who required BIIALs for pelvic haemorrhages following abdominal hysterectomies, one woman died due to a delay in performing the surgery (an increased time in between the primary surgery and the BIIAL). There was a huge pelvic haematoma and an irreversible shock.
THE SURGICAL TECHNIQUE
All the patients in this study underwent BIIAL by a transperitoneal approach under spinal anaesthesia through an existing incision for the primary surgery. The pelvic haematoma was evacuated and the puerperal uterus was moved anteriorly, away from the line of the incision in the retroperitoneum and it was incised in line with the ureter, after identifying both the ureters and after the bifurcation of the aorta into the right and left common iliac arteries on either side. The division of the common iliac artery into the internal and the external iliac arteries were dissected. Sutures were placed around the internal iliac artery, by working within the adventitia of the artery, to avoid damage to the veins which were in the vicinity of the artery. Before the ligation of the artery, it was confirmed again by palpating the pulsations at the level of the femoral artery, by the surgeon and the assistant. We used Vicryl no 1 for the ligature. The artery was tied without cutting the vessel. There were no pre-operative and post-operative complications. The time which was taken to perform the surgery was 30 minutes.
In the obstetric cases, the age group ranged from 18-30yrs and in the gynaecology cases, the age group ranged from 45-52yrs. Among the total 18 cases which underwent BIIAL, 13 underwent it for obstetric causes and 5 underwent it for gynaecological causes. Among the 13 obstetric cases, 9 were primis and only 4 were multis. For 10 women, the BIIAL was performed in a private hospital and for 8 women, it was performed in a medical college hospital (a tertiary care centre). One woman with post abdominal hysterectomy with a pelvic haematoma and another woman with post LSCS with PPH died due to a delay in performing the BIIAL (the time interval between the primary surgery and the BIIAL was 8 hours.
In the other 16 women, we were able to control the haemorrhage effectively. 2 patients who underwent BIIALs following LSCS and another 2 patients who underwent BIIAL following abdominal hysterectomies, who were on table i.e immediately following the primary surgery, did not require blood transfusions. Whereas, the rest of the 14 patients who underwent BIIALs with a significant time interval following the primary surgery, required blood transfusion.
India is among those countries which have a very high maternal mortality and the major cause according to the 2001-2003 SRS1224Survey, is haemorrhage (38%). The single most common cause which accounts for a quarter of all the maternal deaths is an obstetric haemorrhage. Reich and Nechtow (5) have emphasized that the bigger pitfall with BIIAL was waiting too long to perform it. Some surgeons combine BIIAL with bilateral ovarian artery ligation to improve the haemostatic effect (6),(7). In the present study there were no complications noted as compared to the previous studies (Table/Fig 2). The facilities in the private hospitals will be inadequate in terms of the availability of blood, the manpower and the equipments, which need to be corrected. Though BIIAL is life saving, it also has some complications which one has to be aware of, while this procedure is performed. The reported complications with BIIAL are:
1. An inadvertent ligation of the external iliac artery. This can be avoided by the assistant by appreciating the femoral pulsations, when the artery is compressed manually by the surgeon before the ligation. 2. An injury to the internal iliac vein. 3. An injury to the ureter.
Inspite of the availability of simpler and effective methods to control post-partum haemorrhages, the mortality and the morbidity are still higher. In certain situations, the surgical intervention and BIIAL saves lives. An early BIIAL has been emphasized, as a delay leads to an irreversible haemorrhagic shock and multiorgan failure, as it was observed in one of our cases. Bilateral ligation of the main trunk of the internal iliac artery is essential for an effective control of the haemorrhage. IIAL is technically simple and safe and it has minimum operative complications and a short learning curve. Obstetricians and gynaecologists can adopt this operative technique to save lives in emergency situations in private hospitals. The post-graduates need to be trained in performing this life saving surgical procedure in medical college hospitals. Inspite of the bulky uterus and the big haematoma in the pelvis, the exploration of the retroperitoneum in the pelvis and the identification of both the internal iliac arteries and the in situ ligation were not difficult.
ID: JCDR/2012/4643:2472
Date of Submission: Jun 05, 2012
Date of Peer Review: Jul 12, 2012
Date of Acceptance: Sep 19, 2012
Date of Publishing: Sep 30, 2012
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