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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
Cardiovascular Risk among Healthcare Workers in DCH and DCHC Hospitals during COVID-19 Duty: Correlation of Stress Score with Blood Pressure and Lipid Profile
Correspondence Address :
Dr. Sanjay Wasnik,
Flat No, 201, FBlock GMC Campus, Banjali, Ratlam, Madhya Pradesh, India.
E-mail: jchpune@gmail.com
Introduction: Healthcare workers (HCW’s) are at the frontline of the Coronavirus Disease-2019 (COVID-19) pandemic, participating directly in the diagnosis and treatment of Coronavirus patients for the past two years. This puts them at a larger risk of causing long-term stress, mental anguish, and other negative psychological impacts.
Aim: To evaluate stress score, serum lipid profile and blood pressure in a Dedicated COVID Hospital (DCH) and Dedicated COVID Health centre (DCHC) among HCWs, and to correlate the perception of psychological stress with serum lipid profile.
Materials and Methods: This was a hospital-based cross-sectional study conducted from the month of March 2021 to August 2021. Seventy-five HCWs (35 men and 40 women) from DCH and DCHC were included in this study. In these participants, socio-demographic and perceived stress, serum lipid profile was measured. The studied population was divided into two groups: Group A (HCWs in direct contact with COVID-19 patients) and Group B (HCWs not in direct contacts with patients). Stress scores, serum lipid levels, systolic and diastolic Blood Pressure (SBP and DBP) of all the participants were measured and compared with that of controls, using Student’s t-test. Stress scores of HCWs in direct contact with patients were correlated with SBP and DBP and serum lipid profile by using Pearson correlation coefficient (r).
Results: Stress levels were significantly higher in Group A (p>0.05), but serum lipid levels were not significant. Stress levels of Group A were found to correlate strongly with blood Total Cholesterol (TC), (p<0.001) serum Triglyceride (TG), (p<0.01) High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), Very Low Density Lipoprotein (VLDL), LDL/HDL, and SBP and DBP (p<0.001).
Conclusion: Stress scores were elevated in HCWs in direct contact with patients (Group A) and these strongly correlate with serum lipid levels and BP. The health authorities are responsible for implementation of strategies to manage this psychological stress.
Coronavirus disease-2019 pandemic, Dyslipidaemia, Psychological stress
On 13th March 2020, World Health Organisation (WHO) declared COVID-19 a pandemic disease (1). In this pandemic, from the last two years, HCWs are on the frontline directly dealing with COVID-19 patients in the context of care, diagnosis and treatment. This puts them at a larger risk of causing long-term stress, mental anguish, and other negative psychological impacts. Scarcity of specific treatment and inadequate medical facilities along with increasing number of COVID-19 cases overwhelming workload and lack of personal protection equipment increases the mental burden of HCWs (2),(3). Previous research conducted during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak revealed that healthcare personnel experienced negative psychological effects. High levels of stress, as well as anxiety and depression symptoms were found among the HCWs associated with uncertainty, stigmatisation, reluctance to work and resignation (4),(5),(6). The emergency nursery department was found to be more likely to develop distress and behavioural detachment in several studies (7),(8),(9). Currently, HCWs who care for these patients are experiencing comparable affects on their mental health as a result of the COVID-19 pandemic. The public health crisis produces an environment of uncertainty and tension, necessitating health personnel's assessment and containment. COVID-19 research has thus far primarily focused on epidemiological studies, prevention, diagnosis, and treatment. Few studies have examined the mental health difficulties that HCWs experience during a pandemic (10),(11). Dyslipidaemia is prevalent in all over the world (12). Researchers had found the relationship between the occupational psychological stress and lipid disorders (13),(14),(15),(16). Prevalence of cardiovascular risk is more in workers doing night shift due to stress induced dyslipidaemia (17),(18). Most of the studies in frontline workers during COVID-19 pandemic was done on perception of anxiety, psychological stress and depression after exposure to physical and mental burden during pandemic but only few literature is available on association between perception of stress and biochemical stress markers during COIVD-19 pandemic.
In the second wave of COIVD-19, patient load as well as mortality was high in comparison to first wave. So, it is important to study the effect of stress on health in DCH. So, this study was conducted to evaluate stress score, serum lipid profile and blood pressure in a DCH and DCHC among HCWs and to correlate the perception of psychological stress with serum lipid profile.
The present hospital-based cross-sectional study was conducted (from March 2021 to August 2021), after Institutional Ethical Committee (IEC) approval was obtained (GMC Ratlam/2020/IEC/approval/2019 dated 14/12/2020).
Inclusion criteria: HCWs (n=75) between age group 25-40 years and doing morning shift duties in DCH and DCHC since at least one year were included in the study.
Exclusion criteria: Known case of diabetes, hypertension, individuals under treatment with glucocorticoids, psychotropic drugs, with Hypothalamic Pituitary Adrenal (HPA) axis alterations or a previous diagnosis of mental health disorders, dyslipidaemia, central obesity, cardiovascular diseases were excluded from the present study.
After obtaining written informed consent from all participants, they were divided into two groups. Group A (n=40) HCWs in direct contact with COVID-19 patients and Group B (n=35) HCWs not in direct contact with patients.
Stress scores of all subjects were evaluated using Depression, Anxiety and Stress Scale-21 (DASS-21 scale) (19). It comprises of seven questions and subitems which are rated as normal, mild, moderate, severe and extremely severe. Each parameter was scored in a self-rated Likart scale for 0 (Did not apply to me) to 3 (Applied to me to some degree, considerable degree and very much) for the past one week.
All participants were called in the next morning at 8:00 a.m. Subjects were allowed to take relax for 10 min before recording blood pressure and heart rate. Blood pressure was tested in supine with digital sphygmomanometer. The next day morning venous blood was drawn from these individuals after 12 hours of fasting to measure serum TG, TC, LDL-C and HDL-C. TC and HDL-C by using Dimension RxLMax (Siemens). Using Friedwelds formula (20), LDL-C was calculated. HDL-C was measured using the calorimetric enzymatic method.
Statistical Analysis
Using student’s t-test, Statistical analysis was performed in 2 parts-In first part, stress scores, cardiovascular risk factors and morning serum lipid level of Group A and Group B were compared. In second part, stress scores of HCWs in direct contact with patients were correlated with SBP, DBP and serum lipid profile by using Pearson correlation coefficient (r).The value of the Pearson correlation coefficient (r) ranges from +1 to -1. Where 1 is the positive correlation, 0 is no correlation, and -1 is the negative correlation. Statistical software used for statistical analysis was Epi Info.
A total of 75 HCWs were recruited for this study. Group A included 40 healthcare workers in direct contact with COVID-19 patients and Group B included 35 HCWs not in direct contact with patients working in the same DCH and DCHC hospital. Both groups together consist of 35 men and 40 women. (Table/Fig 1) shows demographic profile of HCWs. (Table/Fig 2) shows significant elevation of stress levels in Group A as compared to Group B (p=0.003). Lipid profile was found to be increased non significantly in Group A workers. Both systolic BP and diastolic BP were increased non significantly in Group A.
(Table/Fig 3) shows correlation between stress scores of HCWs in direct contact with COVID-19 patients admitted in DCH and DCHC hospitals with cardiovascular risk factors such as serum lipid profile, systolic and diastolic BP and Pearson correlation coefficient (r) was calculated. Stress scores were found to be strongly correlate with serum TC (p<0.001), serum TG (p<0.01), HDL (p<0.001), LDL (p<0.0001), VLDL (p<0.0001), LDL/HDL (p<0.0001) and systolic (p<0.001), and diastolic BP (p<0.001), with r values 0.713, 0.274, -0.411, 0.644, 0.808, 0.672, 717 and 0.810 respectively.
This study aimed to determine whether HCWs working in DCH and DCHC (group A) can experience increased stress and can demonstrate increased levels of serum lipid levels than their colleagues who worked in same hospital set-up but not in direct contact with COVID-19 patients (Group B). In the present study, stress score and serum lipid level were evaluated in HCWs at DCH and DCHC hospital in the context of COVID-19 pandemic. The results revealed elevated level of stress scores in Group A as compared to Group B HCWs. Recent studies also found that COVID-19 duties affect mental health-anxiety, depression, and post-traumatic stress symptoms (21),(22). In addition, HCWs represent the population that are particularly vulnerable to mental illness due to long working hours, risk of infection, lack of personal protective equipment, physical fatigue, and separation from family members (23). To our knowledge, in India few studies has been done to evaluate stress biomarkers such as serum lipid profiles in this population.
It can be rightly said that physical and psychological stress are indeed a risk factor for increasing TG, and LDL and decreasing HDL. Various studies have reported that chronic stress alters HPA axis activity, which contributes to the development of mental disorders such as depression, anxiety, and burnout (24),(25),(26). According to the results of previous studies, the cardiovascular risk factors will be affected more by physical and mental stress in some of the working environmental conditions such as shift duties exposure to heat (27),(28),(29).
Muldoon MF et al., (30) proposed that psychological stress increases serum lipid levels by increasing hepatic lipoprotein lipase activity due to increase sympathetic response. In addition, the present study showed strong association between perceived stress and serum lipid levels in HCWs doing COVID-19 duties, which was similar to the study done in workers engaged in different types of working environmental condition (31),(32). Sawai A et al., observed that mental stress elevates BP in young men (34). In summary, this study demonstrates the importance of assessing the psychological and physical stress of HCWs, which is a vulnerable population statistic in the context of the COVID-19 pandemic. Additionally, serum lipid level has been a valuable screening instrument for stress.
Limitation(s)
A possible limitation of this study was related to the small number of HCWs evaluated as only HCWs working in the morning shift i.e. from 8:00am to 2:00 pm were selected for the study. However, depression values are clinically confirmed by inventory. In addition, stress levels and lipid profiles are indicators that support the results of this study.
Stress scores were elevated in HCWs in direct contact with patients and were strongly correlated with serum lipid levels and BP which affects physical and mental health as well as put them on high cardiovascular risk on long-term basis. The implementation of strategies to manage this psychological stress is the responsibility of the health authorities.
DOI: 10.7860/JCDR/2022/56112.16652
Date of Submission: Mar 05, 2022
Date of Peer Review: Apr 14, 2022
Date of Acceptance: May 02, 2022
Date of Publishing: Jul 01, 2022
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
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 14, 2022
• Manual Googling: Apr 29, 2022
• iThenticate Software: Jun 28, 2022 (24%)
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