Article in PDF
How to Cite
Citation Manager
Readers' Comments (0)
Audio Visual Article Statistics
Link
to PUBMED
Print this Article
Send to a Friend
Advertisers
Access Statistics Resources
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
Clinical Characteristics and Outcomes of Coronary Artery Disease among South Indian Women- A Retrospective Study
Correspondence Address :
Ramesh Sankaran,
No. 1, Ramachandra Nagar, Chennai, Tamil Nadu, India.
E-mail: sankaranramesh39@gmail.com
Introduction: The prevalence of Coronary Artery Disease (CAD) is increasing among Indian women and is the leading cause of death. Clinical presentation of CAD in women can widely vary from atypical chest pain, silent ischemia to massive myocardial infarction and death. Women have poor prognosis than men after myocardial infarction and are less likely to undergo revascularisation compared to men.
Aim: To study the risk factors, clinical characteristics, severity of CAD and to evaluate the outcomes in women undergoing coronary angiogram.
Materials and Methods: This retrospective study included 912 women who had undergone coronary angiogram in our hospital from January 2018 to December 2018. The patients were divided into three groups- Group A consisted of 230 (25%) women with age <50 years. Group B consisted of 591 (65%) women with age between 50 to 69 years. Group C consisted of 91 (10%) women with age >70 years. Continuous variables were analysed by paired t-test and categorical variables were analysed by chi-square test.
Results: Most women were post menopausal (73.6%). Common risk factors were diabetes mellitus (63%) hypertension (56%), and hypothyroidism (16.8%). Out of the total study population, 51% (n=466) presented with a diagnosis of chronic stable angina, 34.7% (n=317) presented with acute coronary syndrome, and 7% (n=66) had atypical chest pain. Out of 500 patients with significant CAD, requiring revascularisation only 316 (63.2%) had undergone interventions out of which 193 (61%) had undergone percutaneous coronary intervention and 123 (39%) had undergone Coronary Artery Bypass Grafting (CABG) as the modality of revascularisation.
Conclusion: Clinical presentation of CAD in women varies widely from atypical chest pain to acute infarction. Diabetes and hypertension are the most common risk factors for CAD in our study. Chronic stable angina was the most common spectrum of presentation. Single vessel disease is the most common finding on coronary angiogram.
Chest pain, Diabetes, Hypertension, Post menopausal
Cardiovascular Disease (CVD) incidence in women increases after menopause and equals men by the sixth decade (1),(2),(3). In India, 16.9% of mortality in women is attributed to CVD (4). CAD has resulted in more number of deaths than the combined number of deaths due to infections, malignancy and accidents (5),(6). Change in hormones after menopause alone cannot explain the increased risk of CVD. Traditional risk factors like age, hypertension, diabetes mellitus, dyslipidemia, tobacco use, family history along with emerging risk factors, metabolic syndrome, polycystic ovarian disease and hysterectomy contributes to CAD (7). Two out of three women with CVD have risk factors (8). Diabetes mellitus and metabolic syndrome increase the risk of CAD more in women compared to men (9),(10),(11),(12). According to Global Longitudinal Study of Osteoporosis in Women (GLOW) metanalysis, women with ST-Segment Elevation Myocardial Infarction (STEMI) had more risk factors, had a more extended door to balloon time and two-fold higher in-hospital mortality (13). Among the women undergoing Coronary artery bypass graft (CABG) for CAD, there were higher mortality and morbidity and less relief of angina (14).
Although being a predominant cause for mortality in women, CAD risk factor profile and angiographic patterns in Indian women is not studied well (15),(16). CAD is also underdiagnosed and undertreated in women (17), hence, this present study was conducted to study the risk factors, the severity of CAD and the management of the same.
This study was a single center, retrospective observational study conducted at Sri Ramachandra Medical Center in Chennai, Tamil Nadu, India from January 2018 to December 2018. Data was analysed during December 2019 to February 2020.
Inclusion criteria: All women aged 18 years and above, who had undergone coronary angiogram in the study centre during the study period were included in this study.
Exclusion criteria: Women aged less than 18 years, women who had undergone coronary angiogram previously and diagnosed to have CAD, women who had undergone prior percutaneous coronary intervention or CABG were excluded from the study.
Sample size calculation: The data of total of 912 women who had undergone treatment in the study medical centre during the study time period and fulfilling the inclusion criteria formed the sample of the present study and was categorised into three groups based on age to <50 years [Group A, n=230 (25%)], 50 to 69 years [Group B, n=591 (65%)] and >70 years [Group C, n=91 (10%)].
Study Procedure
Data were collected from Medical Records Department electronic data base of the study institute. Information pertaining to risk factors, electrocardiogram (ECG), echocardiogram (echo), Treadmill Test (TMT) findings, details of coronary angiogram and revascularisation were collected from the case sheets stored in the electronic data base.
Demography, risk factor profiling, treadmill test positivity and its association with angiographic CAD severity was analysed. Data regarding the women who had undergone revascularisation after being diagnosed to have significant obstructive CAD post-coronary angiogram was also collected.
Statistical Analysis
International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) version 20.0 was used for statistical analysis. Descriptive statistics were expressed in terms of ratio, proportion or percentage for categorical data, mean, median, and range for discrete quantitative data. Continuous variables were analysed by paired t-test when appropriate. Categorical variables were analysed by Chi-square test.
The patients were divided into three groups. The mean age group of study population was 56.8±9.7 years. The baseline characteristics and risk profiles are listed in (Table/Fig 1). Diabetes was the most common risk factor constituting 63% (n=576) of the present study population. Hypertension was the next most common risk factor constituting 56% (n=508) of the present study population.
Out of the total study population, lipid profile was done in 583 (63.9%) patients. In the patients with lipid profile, Low Density Lipoprotein-Cholesterol (LDL-C) >130 mg/dL was seen in 214 (36.7%), High Density Lipoprotein-Cholesterol (HDL-C) <40 mg/dL was seen in 102 (17.4%) patients. Hypothyroidism was seen in 16.8% (n=154) of the study population. Tobacco abuse was seen in 5.2% (n=48) of the study population. Positive family history for CAD was noticed in 7.2% (n=66) of the study population.
Spectrum of clinical presentation: Out of the total study population, 51% (n=466) presented with a diagnosis of Chronic Stable Angina (CSA) and 7.2% (n=66) had atypical chest pain. A total of 34.7% (n=317) presented with acute coronary syndrome (MI+NSTEMI+STEMI). CSA was the most common presentation among all the age groups. Another 6.2% (n=63) had presented with various conditions like rheumatic heart disease, supra ventricular tachycardia and dilated cardiomyopathy, who had undergone coronary angiogram as a preoperative routine.
Assessment of CAD: Abnormal ECG was noticed in 57.8% (N=528) of the study population. Prevalence of abnormal ECG increased with increasing age. Abnormal echocardiogram with Ejection Fraction (EF) <50% was seen in 353 (38.7%) patients. With increasing age, there was an increasing prevalence of abnormal echocardiogram. TMT was not performed in large group of study population constituting 64.6% (N=590). Out of 532 patients presenting with CSA and atypical chest, pain only 228 (42.8%) had undergone TMT. Among 322 people who had undergone TMT, it was positive in 279 (86.6%), inconclusive in 21 (6.6%) and negative in 22 (6.8%).
Coronary angiogram: Data regarding CAD severity pattern on angiogram is mentioned in (Table/Fig 2). Out of 912 patients, 277 (30.3%) had normal epicardial coronaries. This was more commonly seen in Group A patients (46.3%) than in Group B (26%) and Group C (18.6%) patients (p<0.0001). Non-obstructive CAD was seen in 135 (14.8%) patients with 35 (15.2%) in Group A and 90 (15.2%) in Group B followed by 10 (10.9%) of Group C population.
Obstructive CAD was seen in 54.8% (n=500) of the study population. The frequency of obstructive CAD increases with increasing age as evidenced by 38.6% in Group A, 58.7% in Group B and 70.3% in Group C having significant CAD. Among the obstructive CAD, SVD was seen in 190 (38%) patients, DVD in 131 (26.2%), TVD in 170 (34%) and left main disease in 9 (1.8%) patients (Table/Fig 2).
Among 201 patients presenting with Unstable angina (92)/Non- STEMI (109), 9 (4.4%) had normal coronaries and 22 (10.9%) had non-obstructive CAD. SVD was seen in 60 (29.8%) patients, DVD in 38 (18.9%), TVD in 66 (32.8%) and left main disease in 6 (3%). Out of 116 patients with STEMI, normal coronaries were seen in 5 (4.3%), SVD in 30 (25.8%), DVD in 40 (34.4%), TVD in 38 (32.7%) and left main disease in 1 patient. Among 279 patients with TMT positivity, 136 (48.7%) had normal coronaries, 42 (15%) had non-obstructive CAD. SVD was seen in 47 (16.8%), DVD in 35 (12.5%), TVD in 19 (6.8%). Among 22 patients with negative TMT, 17 (77.2%) had normal/insignificant CAD.
Revascularisation: Out of 500 patients with significant CAD requiring revascularisation only 316 (63.2%) had undergone intervention out of which 193 (61%) had undergone percutaneous coronary intervention and 123 (39%) had undergone CABG as the modality of revascularisation (Table/Fig 3).
In the present study, apart from age more than 50 years, diabetic status, hypertension, dyslipidemia contributed significantly for CAD in women. This was similar to study done by Mohammad AM et al., (18). Chronic stable angina (51%) was the most common presentation for which angiogram was done. Angiogram was done for acute coronary syndrome in 317 patients (34.7%). Diabetes mellitus (63%), hypertension (56%), post menopausal status (73.6%) were three factors that correlated with significant CAD. Among 204 (22%) patients who had all the three risk factors, 176 (64%) had significant coronary disease. In pre-menopausal women who had undergone coronary angiogram, 48% had significant CAD. Diabetes (65%) and hypertension (45%) were the significant risk factors among pre-menopausal age group. Ankit S et al have showed diabetes and hypertension are predominant risk factors in pre-menopausal women (19). In INTERHEART study, nine risk factors (current or former smoker, age, sex, obesity, diabetes mellitus, hypertension, no alcohol intake, less intake for fruits and vegetables, psychosocial factors, dyslipidemia) contributed to acute myocardial infarction (7). Women with multiple risk factors had higher odds ratio of myocardial infarction. Hypertension was more prevalent among women than men due to late presentation (7),(20).
In the present study, Positive TMT was the reason for coronary angiogram in 279 women. TMT was done mostly among women with atypical chest pain and chronic stable angina. Only 36% of women with positive stress test had significant CAD. Another 34% of positive patients with diabetes had either normal or non-obstructive CAD, indicating that positive TMT may be secondary to microvascular dysfunction. Mark DB et al., have shown higher false positive TMT in low-risk women (21).
In the present study, 500 out of 912 (54.8%) women who underwent CAG had significant CAD. It’s similar to another Indian study done by Ezhumalai B and Jayaraman B al in which incidence of significant CAD was 45% (15). In women less than 50 years 60% had normal or non-obstructive CAD. In women more than 50 years and less than 69 years, 60% of them had significant CAD. In women aged above 70 years, 70% had significant CAD. A 60% of women aged above 50 years had multivessel disease but nearly 45% of women with age less than 50 years had single vessel disease. Only 1.8% of women in our study had Left Main Coronary Artery (LMCA) stenosis. This is in contrary to various other studies where LMCA stenosis was seen in range of 4-7% (15),(22),(23),(24).
Revascularisation was done only in two third of the women with significant CAD. Nearly 36.8% did not undergo revascularisation in index admission. Various studies have also shown that women are more likely to have late presentation, mortality and are undertreated when compared with men (24),(25),(26),(27),(28),(29).
Limitation(s)
This is a single centre study. Since it’s a retrospective study, there were limitations in data collection.
The present study is retrospective observational study on risk factor profile and CAD among south Indian women in a tertiary care university hospital. Women in younger age group had more false positive TMT. In premenopausal women diabetes was the predominant risk factor for CAD. Younger age group women have lesser chance of CAD when compared with higher age group. Non-obstructive CAD is also more common in younger age group, women presenting with chronic stable angina and atypical chest pain. Women aged above 50 years and who attained menopause had higher percentage of significant CAD. One third of women with significant CAD do not undergo revascularisation either by PCI or CABG. Larger multi-centre, prospective study will throw more light on risk factors for CAD in women.
10.7860/JCDR/2021/47495.15156
Date of Submission: Nov 19, 2020
Date of Peer Review: Feb 16, 2021
Date of Acceptance: May 21, 2021
Date of Publishing: Jul 01, 2021
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? NA
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Nov 20, 2020
• Manual Googling: Feb 18, 2021
• iThenticate Software: Jun 10, 2021 (9%)
ETYMOLOGY: Author Origin
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com