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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
Old Wine in a New Bottle: Acromegaly Presenting as Diabetic Ketoacidosis
Correspondence Address :
Dr. Subhodip Pramanik,
Flat No. 601, Tower 1, HIG Apartment, Siliguri, West Bengal, India.
E-mail: subhodip.mck@gmail.com
Acromegaly is a rare disease characterised by chronic excess of Growth Hormone (GH) levels. Insulin signalling is impaired, gluconeogenesis is excess and peripheral insulin resistance is increased in acromegaly causing hyperglycaemia and diabetes. Diabetic Ketoacidosis (DKA) is a rare but known complication of diabetes in acromegaly. Most cases of acromegaly come into light due to the classical soft tissue changes in the face and extremities. A high index of suspicion is required to diagnose this condition in early stage. Here, a case of 22-years-old male presented with DKA and on investigation was found to have acromegaly due to a GH secreting pituitary macroadenoma. This management and subsequent follow-up of the case along with review of literature is also done. Such a presentation of acromegaly was rare but rewarding.
Growth hormone excess, Ketosis, Pituitary macroadenoma
A 22-years-old male patient presented to the Emergency Department with generalised weakness, increased thirst, frequent urination, and weight loss since one month. On inquiry, he gave a history of an increase in the size of his hands and feet and changes in his facial appearance from past last three years. He also complained of headache, vomiting, and decreased vision since three months. He was not a known diabetic or was not on any antidiabetic medication. There was no family history of diabetes. On examination, he was conscious and oriented. His blood pressure was 130/80 mmHg, pulse rate was 110/min, weight was 78 kg and Body Mass Index (BMI) was 30.1 kg/m2. He looked dehydrated. Features of acromegaly such as coarse facial appearance, thick lips, macroglossia, large hands, and feet were obvious (Table/Fig 1), (Table/Fig 2). Immediate investigations revealed blood glucose of 430 mg/dL, serum sodium (Na) 132 meq/l, serum potassium (k) 3.9 meq/l. Arterial blood gas analysis showed high anion gap metabolic acidosis and blood ketones were positive suggestive of DKA.
Patient was treated with intravenous fluids and intravenous regular insulin as per the DKA protocol. Once the patient recovered from DKA, acromegaly was confirmed by a serum Insulin-like growth factor level of 746 ng/mL and a serum GH level of 50 ng/mL two hours post 75 g oral glucose load. Morning serum cortisol was 2.46 mcg/dL, prolactin 22 ng/mL, free T4 was 0.679 ng/dL, Thyroid Stimulating Hormone (TSH) 1.15 mIU/mL, Follicle-Stimulating Hormone (FSH) was 0.498 mIU/mL, Luteinizing hormone (LH) 0.159 mIU/mL and testosterone was <20 ng/dL. Magnetic Resonance Imaging (MRI) revealed a mass measuring 29×28×34 mm in the sellar-suprasellar region, completely encasing the right cavernous sinus and extending to the left cavernous sinus and also compressing the optic chiasma (Table/Fig 3), (Table/Fig 4). Visual field testing showed bitemporal hemianopia.
The patient underwent transnasal transsphenoidal, decompression of the tumour. He was started on hydrocortisone, thyroxine, and testosterone supplementation. Multiple daily subcutaneous insulins (40 units per day) were administered to maintain adequate glycaemic control. The patient followed-up after six months. The postoperative MRI of the sella revealed a residual component of the tumour on the right cavernous sinus although the optic chiasma was free of tumour. In view of clinical and biochemical active acromegaly, the patient was started on long-acting octreotide injections. Currently, the patient is on metformin 1000 mg per day with reasonable glycaemic control.
Glucose intolerance and diabetes are known complications of acromegaly (1). GH hypersecretion may lead to insulin resistance causing impaired glucose tolerance or diabetes in 15% to 38% of cases of acromegaly (2). Clinically, acromegaly presents with coarse facial features, acral enlargement and features of metabolic and multisystem involvement. Screening test for for diagnosis is Insulin-like Growth Factor-1 (IGF-1), followed by confirmatory testing with glucose suppressed GH and MRI hypothalamopituitary region with dyanamic contrast. Usual aetiology is GH secreting adenoma (macroadenoma more common than microademona), however ectopic GH secreting tumours have also been reported. Treatment is usually done with transsphenoidal surgery followed by radiotherapy or medical therapy (somatostatin analogue or pegvisomant) (1). GH and IGF-1 modulate insulin action by altering the number of insulin receptors and post-receptor mechanisms. It initially manifests as increased fasting insulin levels and exaggerated insulin response to a glucose load. Later there is fasting hyperglycaemia and a loss of insulin response to glucose (3).
In a large study, on 522 patients of acromegaly presence of diabetes correlated with active disease and serum IGF-1 levels and diabetes was less prevalent in those patients who achieved biochemical control of acromegaly through surgery or pharmacological treatment (4). Although diabetes significantly improves after control of GH hypersecretion, the prevalence of diabetes in acromegaly patients who are in remission is higher than in the general population (5),(6). In some treated acromegaly patients co-existent hypogonadism, hypothyroidism and the treatment of adrenal insufficiency may contribute to insulin resistance and persistent diabetes (7). Our patient continued to have a need for oral hypoglycaemic drugs despite biochemical control of acromegaly, which matched with the other cases reported in literature (8),(9).
DKA as a presenting feature of Cushings syndrome has been reported previously in the literature (8). Kabadi UM, reported two cases of acromegaly presenting as moderate to severe DKA and they underwent complete remission of diabetes after surgery in one and surgery followed by somatostatin analog injection in the other patient (9). Similarly, Simmons LR et al., reported a young patient of acromegaly who presented with DKA which resolved completely with transsphenoidal adenohypophysectomy (10). Recently, Quarella M et al., reported a case of unrecognised acromegaly presenting with DKA precipitated by an Sodium Glucose Co-transporter-2 (SGLT-2) inhibitor (11).
In the present case patient was not a known case of diabetes or did not have any family history of diabetes. He presented with the acute complication of DKA. Typical features of acromegaly on examination lead to confirmation of the diagnosis. This emphasises the importance of considering the diagnosis of acromegaly in a young patient presenting with diabetic complications.
Secondary causes of diabetes is common and should always be suspected in young age or if presentation is with atypical features. A high index of suspicion is essential, especially when the clinical findings are subtle. The insidious nature of soft tissue changes in acromegaly may cause them to go unnoticed by the patient leading to a delayed diagnosis, but may present with metabolic decompensated state like diabetes ketoacidosis. Proper workup and management of acromegaly is rewarding to prevent further complications.
10.7860/JCDR/2021/48795.15099
Date of Submission: Jan 31, 2021
Date of Peer Review: Apr 24, 2021
Date of Acceptance: May 26, 2021
Date of Publishing: Jul 01, 2021
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 12, 2021
• Manual Googling: May 22, 2021
• iThenticate Software: Jun 14, 2021 (8%)
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