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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
Clinical, Angiographic Profile and Short-term Prognosis in Patients with ST Elevation Myocardial Infarction- A Cross-sectional Study
Correspondence Address :
Dr. Shantanu,
Room No. 88, SR Hostel, SCB Medical College and Hospital,
Cuttack-753007, Odisha, India.
E-mail: shantanu.manipal@gmail.com
Introduction: Acute Myocardial Infarction (MI) is one of the most common causes of death and disability throughout the world. The most common of all Acute Coronary Syndrome (ACS) in Indian patients is acute ST Elevation Myocardial Infarction (STEMI). Although acute MI more commonly occurs in patients older than 45 years of age, young men and women can also have MI.
Aim: To study the risk factors, clinical presentation, angiographic profile and short-term prognosis in patients with STEMI with age ≤45 years.
Materials and Methods: A cross-sectional study was carried out in the Department of Cardiology, SCB Medical College and Hospital, Cuttack, Odisha, India. A total of 198 patients of age ≤45 years with acute STEMI, of both genders diagnosed based on symptoms, Electrocardiogram (ECG), Echocardiogram (Echo) and biomarkers were enrolled from June 2019 to November 2020. Categorical variables were tabulated in frequency with percentage distribution and continuous variables were summarised in mean±SD (Standard Deviation).
Results: This study included 198 patients, aged ≤45 years, with STEMI. STEMI was more common in males. The mean age was 38.28 and 42.15 years for males and females, respectively. Smoking (63.5%) was the most common risk factor, followed by dyslipidemia (28.5%). Most of the patients (86.5%) presented with typical chest pain. Killip’s Class I was most common (92.5%) at the time of admission. Anterior Wall Myocardial Infarction (AWMI) was the presentation in the majority (61%). Most patients (47%) had Single Vessel Disease (SVD). One third of the patients had re-canalysed vessels. Type A lesion was commonly seen (61%) and 60% patients underwent coronary angioplasty.
Conclusion: In young STEMI patients males were commoner and smoking and dyslipidemia were found to be the common risk factors, smoking being twice more common than dyslipidemia. Typical chest pain of Killip Class I and AWMI were seen in majority. Half of the patients had SVD and one third was found to be re-canalysed. Type A was the commonest lesion and two thirds of the study population could undergo coronary angioplasty.
Acute coronary syndrome, Coronary artery disease, Young myocardial infarction
Acute MI is one of the most common causes of morbidity and mortality in the whole world as well as developed nations. Despite respectable advancements within the management of infarction, there is a substantial scope for the betterment of end result of the patients. India has a huge burden of ACS (1). A lot of the knowledge about patients with ACS is from registries which provide data on the demography, treatments and outcomes. In India, the most frequent among all ACS is acute STEMI (2). More often than not, younger patients are more likely to be male, have a history of smoking and hyperlipidemia but less likely to have other co-morbidities and demonstrate less extensive Coronary Artery Disease (CAD) or normal on coronary angiography. A study showed that smoking played a predominant role in 82% patients whereas cocaine in 4% patient with STEMI (3). Traditionally, CAD is disease of elderly. However, younger people less than 45 years of age also bear the brunt of CAD. An age threshold of 45 years has been used in different studies to define “young” patients with CAD or MI (4),(5). CAD in younger people of age less than 40 years was found to represent solely 3% of all patients with CAD. CAD in the young is being recognised with increasing frequency and is as high as 12% in India. The reason for this early presentation of CAD is not very clear. There is an upward tendency of acute MI in the younger population (2).
In India, the incidence of STEMI is 12-16% (6). One centre has reported a 47 times increase in the incidence of first MI below the age of 40 years in the last 20 years. This population is noteworthy because of greater expected longevity. Long-term management of young patients who have survived a MI is particularly challenging because there are few data regarding prognosis in these patients (5). Moreover, it is yet to be determined whether young patients with normal coronaries and MI have a different prognosis from those with obstructive coronary disease. Angiographic knowledge concerning the extent and severity of CAD in the young patients with manifest CAD is incredibly scarce (7). The available data is suggestive of a higher burden of single vessel CAD and less of triple vessel disease in the younger population (8). The disease causes significant morbidity, psychological trauma and financial burden for the whole family when it occurs at a younger age (3). But unfortunately, the data regarding demographic, clinical and angiographic profile of this population is lacking in India (9),(10).
Even in western countries data regarding STEMI in young patients is limited and MI in patients ≤45 years has been poorly described. This, prompting the present authors to undertake the study to provide insight about the population aged ≤45 years about the risk factors, clinical presentation, angiographic profile and short-term prognosis.
A cross-sectional study was carried out in the Department of Cardiology, SCB Medical College and Hospital, Cuttack, Odisha, India, from June 2019 to November 2020. The study protocol was approved by Institutional Ethics Committee, SCB Medical College and Hospital, Cuttack, Odisha, India (IEC No.:443).
A total of 198 patients of age ≤45 years with acute STEMI admitted in the institution who gave consent and satisfied the inclusion criteria during the study period were enrolled.
Inclusion criteria:
• Patients with acute STEMI age ≤45 years, both male and female.
• Patients with history of MI and presenting with recurrent infarction.
• MI diagnosed by:
Detection of a rise and/or fall in cardiac biomarkers values preferably cardiac troponin (cTn), with at least one value above the 99th percentile of the Upper Reference Limit (URL) and with at least one of the following: symptoms of ischaemia, new or presumed new significant ST-T wave changes or new left bundle branch block, development of the pathologic Q wave in the electrocardiogram, evidence of new loss of viable myocardium on imaging or new regional wall motion abnormality or identification of an intracoronary thrombus by angiography or autopsy.
• Symptoms of ischaemia
• New or presumed new significant ST-T wave changes or new left bundle branch block.
• Development of the pathologic Q wave in the electrocardiogram.
• Evidence of new loss of viable myocardium on imaging or new regional wall motion abnormality.
• Identification of an intracoronary thrombus by angiography or autopsy.
Exclusion criteria:
• Patients with MI age >45 years and <18 years.
• Patients with Non STEMI (NSTEMI) or unstable angina.
Statistical Analysis
Data was entered in a Microsoft Excel worksheet and all the categorical (qualitative) variables were coded numerically. Further data was transported in Statistical Package for the Social Sciences (SPSS) version 20.0 for windows for descriptive statistical analysis. Categorical variables were tabulated in frequency with percentage distribution and continuous variables were summarised in mean±SD.
Males were the dominant population in the current study. Females were older (42.15±2.28; range 37-45 years) than males (38.28±4.96; range 24-45 years). Smoking was the most common risk factor, followed by dyslipidemia. Traditional risk factors like diabetes mellitus, hypertension was less common. Majority of the patients presented with chest pain and were in Killip Class I (11) at presentation (Table/Fig 1).
The AWMI was the most common presenting diagnosis and majority of the patients presented with a window period of 6-12 hours (Table/Fig 2). Majority of the patients did not had any complications and had mild LV systolic dysfunction (EF 40-50%) (Table/Fig 3). Obstructive CAD was most commonly seen with SVD being most common one third had re-canalysed vessels. LAD was the most common artery involved (Table/Fig 4).
Type A lesion was most common and 60% patients underwent coronary angioplasty (Table/Fig 5).
With rising prevalence of CAD in India, WHO estimates that India will soon be the cardio-diabetic capital of the world (12). CVD tends to be more aggressive and starts manifesting at a younger age, which was also noted in present study. The mean age of presentation in male was 38.28±4.96 years and female 42.15±2.28 years. The maximum number of patients falling within 36-40 years age group (39.4%) which was comparable to Sricharan KN et al., Sharma R et al., Sinha SK and INTERHEART Study south Asian registry (13),(14),(15),(16).
One of the most commonly reported risk factor for CAD is male gender. Present study consisted of 93.5% males and 6.5% of females. It may be attributed to the protective effects of oestrogens in preventing atherosclerosis and widespread presence of smoking in males that has been shown in various previous studies. The present study showed comparable results to studies done by Gallet B, (92.5% males and 7.5% females), Glover MU (92% males and 8% females) and Weinberger I et al., (86.6% males and 3.4% females) (17),(18),(19).
Following age, cigarette smoking is the most important and consistent risk factor for CAD with contribution ranging from 62-90% in various studies (19),(20). Like previous studies, smokers comprised 63.5% of the population. It negatively affects all phases of atherosclerosis by speeding up the thrombotic process, endothelial dysfunction, and coronary vasoconstriction, induces proinflammatory effects and ultimately creates a thrombotic setting (20). Smoking termination programs should be started as primordial prevention (21). Studies done by Kaul U et al., Glover MU, Zimmerman F, Colkesen AY and Siddique M et al., have also highlighted the increased risk associated with smoking and reduced prevalence of conventional risk factors as found in present study (18),(22),(23),(24),(25).
The prevalence of patients with BMI >25 kg/m2 was 18.5% in present study which was similar to South Asian cohort of INTERHEART (12) study (20%). Lakka HM et al., have outlined that abdominal obesity increases the predicament for ACS in middle-aged men and in association with smoking, the prospect of coronary events escalates by 5.5 times (26). Central obesity which is a significant part of metabolic syndrome is more commonly seen in patients of Indian origin. Dyslipidemia was second most common risk factor present in 28.5% patients at the time of admission which was comparable to 36% in Sricharan KN et al., and Sinha SK study (21%) study (13),(15). Traditional risk factors like diabetes mellitus, hypertension were less common among patients ≤45 years of age.
Chest pain was the commonest presenting symptom followed by sweating. Present study was comparable to Sinha SK study in North India which showed chest pain and sweating were the presenting symptoms in 94% and 60% of the patients respectively (15) and Sricharan KN et al., study in which 90% of the patients presented with chest pain while 50% presented with sweating (13). Most of the patients (92.5%) were in class I at the time of admission. Whereas 7.5% were in ≥II KILLIP class just like observed in Zimmerman F, (7%) (23). AWMI was most common presentation in 61% patients, which was comparable to, Sinha SK (65%), Weinberger I et al., (57%) and Colkesen AY (60%) study (15),(19),(24). IWMI was present in 33.5% patients in the current study which was similar to Sinha SK (35%), Weinberger I et al., (37%) and Colkesen AY (40%) study (15),(19),(24).
All patients underwent coronary angiogram and out of them 34% had normal or re-canalysed vessels, among the patients having obstructive CAD, 47% had SVD and 15% had Double Vessel Disease (DVD). LAD was the most common artery involved (45.5%) which was similar to the earlier studies by Zimmerman F, ColkesenAY and Badui E et al., (23),(24),(27). Also, the present study showed comparable results to the study done by Sricharan KN et al., and the Sinha SK in the percentage involvement of vessels: normal/re-canalysed (34%), SVD (47%) and DVD (15%) (13),(15). Type A lesion was most common 61%, followed by Type C (20%) which were comparable to the findings reported by Sinha SK study (15). So, the present study was comparable to other national and international studies in angiographic profile.
Limitation(s)
The study took place at a single centre. Only regular risk factors like hypertension, diabetes mellitus, smoking, dyslipidemia were studied. Other risk factors like homocysteinemia, hereditary thrombophilia, anti-phospholipid antibody syndrome and genetic factors were not studied. Study of new risk factors and their relation to ACS in younger population needs to be addressed in larger randomised controlled trials.
Among young STEMI patients, males were more common, and smoking and dyslipidemia were found to be common risk factors, smoking being twice more common than dyslipidemia. Typical chest pain with Killip Class I and AWMI were seen in majority. Half of the patients had SVD and one third was found to be re-canalysed. Type A was the most common lesion and two thirds of the study population could undergo PTCA.
10.7860/JCDR/2021/50021.15236
Date of Submission: Apr 23, 2021
Date of Peer Review: Jun 17, 2021
Date of Acceptance: Jul 15, 2021
Date of Publishing: Aug 01, 2021
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• 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
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