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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
Serositis as a Presenting Feature of Dengue Fever in a Young Female: Forecast of Upcoming Dengue Shock Syndrome
Correspondence Address :
Dr. Dhruv Talwar,
Junior Resident, Department of Medicine, JNMC, Sawangi, Meghe, Wardha, Maharashtra, India.
E-mail: dhruv.talwar2395@gmail.com
Dengue fever is a prominent challenge in the developing countries throughout the world, with dengue shock syndrome as a leading cause of morbidity and mortality during the seasonal dengue epidemics. Most common presenting features of dengue fever are high grade fever with chills, headache, rash, nausea and vomiting. With the increasing challenges of treating dengue shock syndrome to prevent mortality in the young, it is important to determine factors which can be used to predict dengue shock syndrome. This report showcases a case of 20-year-old young female who presented with the chief complaint of pedal oedema, pain in abdomen along with breathlessness. Upon investigations it was found to be dengue fever with pleural effusion and ascites. The patient later developed dengue shock syndrome, which was managed successfully with the help of intravenous fluids, inotropic support and platelet transfusion. Hence, this case report highlights the importance of detection of serositis in the form of ascites, pleural effusion and pedal oedema in dengue fever as a tell-tale sign of upcoming dengue shock syndrome and the pathophysiology behind it.
Ascites, Pedal oedema, Pleural effusion
A 20-year-old female presented to the Outpatient Department (OPD) with the chief complaint of swelling of both lower limbs, pain in abdomen along with breathlessness for two days. There was history of fever for one day (high grade along with chills). There was no history of nausea, vomiting, retro-orbital pain, headache or rash. Patient had no prior co-morbidities like hypertension, diabetes mellitus, tuberculosis or bronchial asthma.
On examination, pulse was 78 beats per minute, regular in rhythm with normal volume and no special character, blood pressure was 120/70 mmHg in right arm supine position, bilateral pedal oedema was present (Table/Fig 1), there was no pallor, icterus, cyanosis or lymphadenopathy. On systemic examination, there was dull note present on percussion in bilateral infrascapular region with diminished air entry in bilateral infrascapular region. Abdomen was soft and tenderness was present in epigastrium, fluid thrill and shifting dullness was present. Heart sounds were normal and patient was conscious and oriented. Patient was admitted in intensive care unit and investigations were carried out.
As patient gave history of fever associated with chills, differential diagnosis of malaria, dengue, scrub typhus, urinary tract infection and acute appendicitis was made and tested accordingly.
On investigating, patient was found to be dengue non structural protein one positive, IgM positive status and other laboratory investigations are mentioned in (Table/Fig 2). Chest radiograph showed bilateral pleural effusion (Table/Fig 3). Ultrasonography of abdomen showed ascites (Table/Fig 4). Diagnostic pleural tapping was done and fluid was sent for investigations which revealed exudative aetiology. The provisional diagnosis of dengue with serositis was made.
As patient was diagnosed with dengue fever, she was managed with platelet transfusion, intravenous fluids and antibiotics. On day two of admission, her blood pressure was 70/50 mmHg, and she was given intravenous fluids followed by inotropic support and started with injection noradrenaline infusion as per requirement and Blood Pressure (BP) was monitored. The final diagnosis was dengue shock syndrome with serositis. She improved clinically during the course of hospital stay and her inotropic support was tapered accordingly, and stopped on day four of admission.
Her platelet count was monitored regularly and started increasing (39,000/dL on admission to 1,23,000/dL on day six). Her pleural effusion, pedal oedema and ascites resolved completely by day 14 of admission and she was discharged in stable condition.
Dengue fever is one of the most common arthropod borne illness of viral origin in developing countries like India. It is transmitted by mosquito vector of the genus Aedes. Dengue has emerged as a leading problem for healthcare facilities in the recent years with periodic epidemics in the tropical, subtropical and temperate areas. Spectrum of dengue fever can range from benign looking innocent fever to life threatening dengue shock syndrome (1). A small number of patients who have history of being infected with dengue fever earlier in life with one of the four serotypes of dengue virus (DENV 1,2,3 or 4) have risk of developing endothelial leak on being infected with another serotype (2). This condition is known as severe dengue or dengue shock syndrome or dengue haemorrhagic fever.
Dengue fever is usually a disease which is self-limiting with a mortality rate of less than one percent when it is diagnosed early and the patient has proper access to healthcare facilities (1). Severe dengue on the other hand has a mortality rate of two to five percent but when it is left untreated the mortality may rise to an alarming 20%. Classically, dengue presents with symptoms such as fever, headache, pain in the retro-orbital area, severe myalgia, arthralgia especially of the knee and the shoulder joint, nausea, vomiting, maculopapular or macular rash predominantly over the face, thorax and flexor surfaces with islands present of skin sparing. In severe dengue, however, signs of endothelial leakage can be seen such as bleeding from sites of minor trauma, signs of gastrointestinal bleed as well as haematuria (3).
Patients may also present with severe pain in abdomen, persistent vomiting which may be accompanied with haematemesis, bleeding from sites of trauma, gastrointestinal bleeding and haematuria (4),(5),(6),(7). Presenting symptoms of severe dengue may also include severe pain in abdomen, persistent vomiting and haematemesis (8). The next 24 hours after these signs of development of endothelial leakage are seen are crucial and if left untreated the patient may develop shock and present with tachypnoea, tachycardia, pallor, dizziness and decreased level of consciousness (9). It is therefore important to predict the development of dengue shock syndrome to prevent mortality and morbidity associated with dengue fever.
Dengue shock syndrome is usually indicated by persistent pain abdomen, vomiting and restlessness (10). Patient presents usually with features suggestive of circulatory collapse such as pallor, tachypnea and tachycardia. Most critical feature of dengue fever remains leakage of plasma. This leakage of plasma is caused by increased endothelial permeability of capillary. This may present as ascites, pleural effusion, pedal oedema and haemoconcentration (11).
In this patient, breathlessness in dengue fever can be due to pleural effusion, acute respiratory distress syndrome, pneumonia and also shock. This differential diagnosis was ruled out by the means of physical examination showing dull node on percussion with diminished air entry which was confirmed by presence of pleural effusion on chest X-ray. Arterial blood gas was also normal with no evidence of acidosis or acute respiratory distress. In a study, conducted in Pakistan, it was established that pleural effusion in cases of dengue fever is usually exudative and is self-resolving (12). A similar approach was followed in this case and the pleural fluid study was suggestive of exudative aetiology which resolved without the need of therapeutic thoracentesis. As this patient had pain in abdomen, ultrasonography of the abdomen was done which revealed ascites. A differential diagnosis for this patient was pancreatic ascites, dengue ascites, renal ascites and cardiac ascites. Pancreatic ascites was ruled out by normal serum amylase and serum lipase levels whereas renal ascites was ruled out by normal serum creatinine and urea levels with a normal renal echotexture on ultrasonography. Cardiac causes of ascites were ruled out through a normal electrocardiography with a normal echocardiography. This leads to the diagnosis of dengue leading to ascites with a positive nonstructural antigen test. Development of this acute ascites in a case of dengue fever is usually considered as an ominous sign and more commonly seems to be associated with severe dengue fever. It also denoted more chances of mortality in dengue fever. Pedal oedema in this case was another sign indicative of plasma leakage.
In a study conducted by Jisamerin J et al., it was found that patients with severe dengue developed serositis and a total of 15.3% patients with dengue had polyserositis, while a total of 31% of patients with severe dengue had serositis with a significant difference observed between severe dengue and dengue with or without warning signs (13). This was also seen in the present case where serosisits was linked with dengue shock syndrome.
Atypical presentations of dengue fever have been reported before however, we report a case of serositis as a sign of impending dengue shock syndrome which shall be essential for the clinicians to detect dengue shock syndrome at the earliest (14),(15),(16).
In the above scenario, it can be postulated that serositis in the patient was due to dengue fever leading to increase in endothelial permeability and plasma leakage. Serositis is a predictor of impending dengue shock syndrome and was treated successfully with fluid replacement therapy judiciously. As the dengue shock syndrome was treated, serositis resolved itself and disappeared on its own. This emphasises that serositis in dengue fever does not need any specific treatment, however, a patient presenting with serositis needs special attention as serositis might be a warning of upcoming deterioration in the form of dengue shock syndrome. It can be concluded that serositis may be an atypical presentation of dengue fever which should not be ignored. Detection of serositis in the form of pleural effusion, ascites or pedal oedema can be a tell-tale sign used to predict dengue shock syndrome in an otherwise benign looking dengue fever.
DOI: 10.7860/JCDR/2022/51965.16421
Date of Submission: Aug 17, 2021
Date of Peer Review: Nov 24, 2021
Date of Acceptance: Dec 23, 2021
Date of Publishing: Jun 01, 2022
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: Aug 19, 2021
• Manual Googling: Dec 22, 2021
• iThenticate Software: Jan 03, 2022 (3%)
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