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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 Series
Full Version
Symptomatic COVID-19 Positive Parturients Posted for Lower Segment Caesarean Section
Correspondence Address :
Dr. M Jisha,
Nihir Near Yakkara Bridge, Yakkara PO., Palakkad-678701, Kerala, India.
E-mail: drjisham80@gmail.com
Since the outbreak of the Coronavirus Disease-2019 (COVID-19) pandemic many elective cases were postponed worldwide. But emergency Lower Segment Caesarean Sections (LSCS) is one surgery which can’t be postponed at any cause, since two lives are at risk. The present case series reports 16 symptomatic COVID-19 patients in whom emergency LSCS was performed. The aim of presenting the series was to analyse how far the clinical and laboratory findings were deranged in such patients and to find out whether the current anaesthetic techniques were safe in these patients. Out of a total of 157 COVID-19 positive patients who had undergone LSCS in the study, 16 presented with symptoms such as fever, cough, dyspnoea, rhinitis, headache and palpitation. Six (37.5%) were preterm. Seven patients had elevated C-Reactive Protein (CRP) (>5 mg/L). Liver function tests abnormalities were seen in 5 (31.25%). Most of the patients had elevated D-dimer of which (>1500 ng/mL) were seen in seven. The most common indication was foetal distress. COVID pneumonia was an indication for LSCS in 3 (18.75%). All the surgeries were performed under subarachnoid block. Of the four patients who had fall in oxygen saturation two were admitted in Intensive Care Unit (ICU) and one required Non Invasive Ventilation (NIV). There were no mortalities. Thus, LSCS can be done safely under subarachnoid block even in symptomatic COVID-19 parturients. Elevation of D-dimer is common in pregnancy and it does not always indicate severe COVID-19 disease.
Anaesthesiology, Coronavirus disease-2019, Pregnancy, Spinal anaesthesia
The COVID-19 infection presents with a wide array of severity ranging from asymptomatic to severe pneumonia requiring ventilatory support. Pregnant women may be especially susceptible to respiratory pathogens because of the physiological changes in both their immune and cardiorespiratory systems making them intolerant to hypoxia. Symptoms of COVID-19 in pregnant patients are similar to non pregnant individuals (1). Neutrophilia, lymphopenia, elevated levels of D-dimer, CRP, serum transaminases, and other inflammatory markers like ferritin, procalcitonin are found in COVID parturients (1),(2). Spinal anaesthesia is safe in COVID-19 positive patients undergoing elective LSCS (3). Neuroaxial anaesthesia may be associated with exaggerated hypotension in COVID-19 parturients (4). General anaesthesia is less preferred in LSCS to avoid the aerosolisation of viral particles during endotracheal intubation and extubation (5). There is limited data on emergency LSCS in symptomatic COVID-19 patients.
The series presents the symptomatic COVID-19 positive parturients admitted for emergency caesarean section, between March 2020 and February 2022. Of the total 157 COVID-19 positive LSCS, 16 patients presented with symptoms of coronavirus infection. The presenting symptoms like fever, headache, rhinitis, cough, breathlessness, and palpitation along with indication for surgery and any co-morbidities were noted. To avoid unnecessary exposure of radiation to mother and foetus, and due to patient overload Computed Tomography (CT) chest was done only in one patient.
Age of the 16 patients ranged from 19-38 years. The common presenting symptoms in these cases were cough, fever and dyspnoea. Six patients had preterm deliveries (37.5%), of which the shortest gestational age was 33 weeks and five days for case number seven. The indications for caesarean section in these patients were foetal distress (six patients), previous LSCS in labour (five patients), COVID-19 pneumonia (three patients), and one each for failed induction and meconium-stained amniotic fluid (Table/Fig 1).
Laboratory tests showed leukocytosis in five patients of which four had neutrophilia. Platelet count, random blood sugar, blood urea and creatinine were not deranged in these patients (Table/Fig 2). Liver function tests were deranged in five patients. D-dimer values were elevated between 500 ng/mL to a maximum value of 4690 ng/mL in eleven patients (Table/Fig 3) and CRP above 5 mg/L in seven patients. All surgeries were done under Lumbar Subarachnoid Block (LSAB) with 1.7 mL to 1.8 mL of 0.5% bupivacaine heavy with or without buprenorphine 30 μg. Intraoperative tachycardia was seen in case numbers 1, 12, 13 and 15. Blood pressure did not show fluctuations and mean blood pressure was maintained above 65 mmHg throughout. Oxygen saturation was maintained above 95% in case numbers 4,5,8,12 and 16 with the help of oxygen supplementation through face mask. Postoperative Intensive Care Unit (ICU) admission was needed in case numbers 12 and 16 of which case number 12 required NIV (Table/Fig 4). The duration of hospital stay ranged from a minimum of four days to a maximum of 15 days. No mortality occurred among these cases.
Healthcare workers faced a new challenge with the onset of the novel Coronavirus infection. In spite of these challenges, emergency LSCS is one surgery which cannot be postponed at any cost. In the series, 16 symptomatic COVID-19 patients underwent LSCS successfully, without any perioperative mortality. Cough, fever, and dyspnoea were the common symptoms of these patients. Few studies have reported similar observations (6),(7). Foetal distress and previous LSCS patients in labour were the two common indications for emergency LSCS in the study. Aydin Güzey N and Uyar Türkyilmaz E, evaluated 254 caesarean sections in COVID-19 and the two common indications for surgery were foetal distress and previous LSCS patients in labour (8), this correlates with findings in the present study. In three patients the indication for LSCS was COVID-19 pneumonia to reduce further stress on already compromised lung. Preterm delivery and foetal distress were found to be more in third trimester in COVID-19, according to the analysis of Kapote D and Nayak AH (9). In the present series, there were six preterm deliveries.
The coronavirus infection can cause leukocytosis, neutrophilia, lymphopenia and thrombocytopenia (10). Four of the patients had leukocytosis with neutrophilia. The liver plays an essential role in host defense against microorganisms and is frequently involved in most systemic infections, as it receives a dual blood supply from the systemic and portal circulation (11). COVID-19 causes change in several liver biomarkers, which may be closely related to the severity of the disease (12). Elevated liver enzymes are associated with higher rates of preterm deliveries (13). Of the cases in the present case series, deranged liver function tests were found in 5 (31.25%). These include isolated elevation of bilirubin and elevation of both SGOT and SGPT. Also, in one patient only SGOT was elevated, while another patient had both abnormal bilirubin and transaminases level. One of the main mechanisms of liver damage in COVID-19 is the abundance of angiotensin converting enzyme-2 receptor in cholangiocytes and bile duct cells (14). Other causes are hepatic ischaemia, hypoxic reperfusion injury and drug induced hepatic injury. Further research is required to assess any correlation between elevated serum transaminases and perioperative morbidity in pregnant patients.
Pereira A et al., suggested that pregnant patients with severe COVID pneumonia had elevated levels of D-dimer and CRP. D-dimer is elevated in uncomplicated pregnancy as well (15). In the current study, seven patients had maximum D-dimer values above 1500 ng/mL of which two had values above 2500 ng/mL (Table/Fig 4). None of them had thrombotic complications even after LSCS. Of the two patients admitted in ICU postoperatively case number 12 had the highest D-dimer value of 4690 ng/mL and case number 16 had a D-dimer value of 1649.1 ng/mL. These findings show that D-dimer as such cannot be used to predict the severity of pneumonia in pregnancy. A CRP of ≥40 mg/L on admission to hospital should be seen as a reliable indicator of disease severity and increased risk of death (16). In this series, CRP levels of more than 5 mg/L was seen in seven (43.7%) patients-ranging from 6.4 to 33.06 mg/L. An interesting finding in case number seven was that the patient, a known case of bronchial asthma, presented with cough and rhinitis and had a peak D-dimer value of 2568 ng/L and CRP value of 33.06 mg/L, developed no desaturation and had only mild disease. Koumoutsea EV et al., (17) reported two cases of coagulopathy due to COVID-19 with elevated D-dimer without any features of pneumonia. Lack of standardisation of D-dimer values in pregnancy makes it interpretation difficult. But the potential prognostic values of D-dimer in pregnancy cannot be dismissed as such, but requires further investigation. Thromboelastography is an additional tool to assess the thrombotic complications (18).
All 16 patients underwent LSCS under spinal anaesthesia. General anaesthesia was not required in any. Four patients who presented with fever had tachycardia in the perioperative period, which later on subsided with antipyretics. None of them developed significant hypotension that couldn’t be managed with vasopressor bolus. Thus, it shows that even in patients with symptoms and deranged laboratory parameters LSAB can be safely performed in COVID-19.
Four patients who required oxygen therapy in the preoperative period to maintain a saturation above 95%, also tolerated the spinal anaesthesia very well. A few authors have demonstrated the safety of LSAB in COVID caesarean section (3),(19). The benefits of regional anaesthesia are reducing the worsening of respiratory function by intubation and mechanical ventilation and reducing the risk of exposure of health care professionals to coronavirus due to aerosol generation (20). Gahlot D et al., reported a case of LSCS in morbidly obese female successfully managed with LSAB and Total Intravenous Anaesthesia (TIVA) due to the undue prolongation of operative time (21).
Out of the four patients who required perioperative oxygen supplementation, 2 patients-case number 12 and 16 required ICU admission which constitutes 12.5% and 1 patient, case number 12 (6.25%) required NIV. Karasu D et al., (19) found 15% of symptomatic parturients required ICU follow-up which was similar to the present series. Studies showed 5-10% of pregnant patients require intubation and mechanical ventilation (22). No mortality was reported. In a cross-sectional study of COVID positive pregnant patients, by Asalkar M et al., (23) there were nine maternal deaths among 871 cases. All these patients presented with breathlessness and had elevated D-dimer along with leukocytosis. Mean duration of hospital stay in the present series was nine days.
It is difficult to generalise the conclusions due to limited number of patients. Comparison with asymptomatic cases and non COVID parturients are not done in the present study. Neonatal outcomes and vertical transmission of COVID-19 was not evaluated. Extensive laboratory investigations couldn’t be done due to the exhaustion of resources.
The LSCS can be done safely under subarachnoid block even in symptomatic COVID-19 parturients. Preterm deliveries are more common in these patients. Elevation of D-dimer is common in pregnancy and it does not always indicate severe COVID-19 disease. The interpretation of D-dimer values is difficult due to lack of standardisation in pregnancy and further research is required to predict the severity of the disease. Foetal distress and previous caesarean section are the most common indications of surgery. Postoperative ICU requirement and ventilatory support is less even though the patients have symptoms.
DOI: 10.7860/JCDR/2022/60591.17219
Date of Submission: Oct 05, 2022
Date of Peer Review: Oct 28, 2022
Date of Acceptance: Nov 12, 2022
Date of Publishing: Dec 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 10, 2022
• Manual Googling: Nov 02, 2022
• iThenticate Software: Nov 07, 2022 (4%)
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