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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
Anaesthetic Management of a Patient with Dilated Cardiomyopathy and Acute Decompensated Heart Failure
Correspondence Address :
Dr. Nitu Yadav,
Number 412, First Floor, Sector-14, Rohtak, Haryana, India.
E-mail: ynitu29@gmail.com
Dilated Cardiomyopathy (DCM) is a non ischaemic heart muscle disease with left or biventricular dilatation and systolic dysfunction in the absence of other heart disease. DCM can lead to substantial morbidity and mortality due to complications like heart failure and arrhythmias. Intraoperative management of a patient with acute decompensated heart failure due to DCM is a challenge for anaesthesiologist. This case report is about a 58-year-old male patient, who was a known case of DCM with low left ventricular ejection fraction (10-15%), chronic kidney disease, chronic pancreatitis and hypertension. He came to the emergency department with acute decompensated heart failure and subacute intestinal obstruction. After initial stabilisation, he was scheduled to undergo emergency exploratory laparotomy for obstruction. Intraoperative management of the patient was done successfully by ensuring normovolemia, avoiding ventricular afterload, avoiding myocardial depression and providing adequate pain relief through multimodal analgesia. The article mentions various anaesthetic concerns, risks involved and preparations required in such a case.
Anaesthetic concerns, Intestinal obstruction, Systolic dysfunction
A 58-year-old male patient, who was a known to have idiopathic DCM, visited the Emergency with complaints of difficulty in breathing since morning and pain abdomen, non passage of stools since five days. He also had a history of admissions for acute heart failure in the past. He was hypertensive, and had chronic pancreatitis and chronic kidney disease since four years. He was a chronic smoker and chronic alcoholic. He was operated for intestinal obstruction in 2015 under general anaesthesia. He was not taking any medications currently.
On examination, the patient was tachypneic with respiratory rate of 30/min, he had dilated neck veins, bilateral pedal oedema, distended abdomen, and bilateral crackles heard on auscultation. Diagnosis of acute decompensated heart failure was made. Patient was put on oxygen therapy and physician started tab. ecosprin plus atorvastatin, tab. torasemide plus spironolactone, tab. ivabradine, tab. ramipril and tab. glyceryl trinitrate. After initial stabilisation, ultrasound abdomen and Contrast Enhanced Computed Tomography (CECT) abdomen was done, which was suggestive of subacute intestinal obstruction. So, the patient was scheduled for emergency exploratory laparotomy.
On preanaesthetic examination, the patient was conscious and oriented. He had pallor and pedal oedema. He had heart rate of 97/min, blood pressure 90/60 mmhg, respiratory rate 18/min, bilateral crackles on auscultation, and he maintained 95% saturation on simple face mask at 5L/min of oxygen flow. On per abdomen examination, distension and guarding was present. Investigations showed haemoglobin 8 g/dL, Total Leucocyte Count (TLC)- 3000 cmm, blood urea 118 mg/dL, S. creatinine 2.4 mg/dL and International Normalized Ratio (INR) 0.8. His chest radiograph showed cardiomegaly (Table/Fig 1). Electrocardiogram (ECG) showed sinus tachycardia, left axis deviation, QS wave in V2-V3, ST elevation in V2-V4 (Table/Fig 2). Ultrasound abdomen revealed dilated gut loops, cholelithiasis, chronic pancreatitis, hepatosplenomegaly and increased echogenicity of kidneys. 2D Echocardiography showed left ventricular ejection fraction of 10-15%.
The patient was shifted in operation theatre after explaining all risks and consent was taken. All routine monitors were attached. Prior to induction, under all aseptic precautions two wide bore i.v. cannula secured, cannulation of left radial artery done and epidural catheter at T9-T10 was inserted. Induction was done using injection fentanyl 100 mcg, inj. etomidate 14 mg and inj. succinylcholine 100 mg. Injection lignocaine 2%, 60 mg was given i.v. to blunt intubation response. Rapid sequence intubation under direct layrngoscopy with endotracheal tube of 7.5 mm was done. Maintenance of anaesthesia was done using isoflorane + nitrous oxide + injection atracurium, FiO2 was kept 0.35, under all aseptic precautions right internal jugular vein cannulated. Arterial blood pressure monitoring was done. Central venous pressure-guided fluid therapy was given intraoperatively using balanced salt solution. Multimodal analgesia was given using inj. ketorlac i.v., inj. paracetamol i.v. and with epidural top ups using inj. bupivacaine 0.125%. Inj lasix 20mg i.v. was given in graded manner for low urine output. Total blood loss was 400 mL during surgery. So, one-unit packed cell volume was transfused. The patient had non sustained ventricular tachycardia intraoperatively which was managed using inj. amiodarone. Multimodal mode of analgesia was used including paracetamol, opioids and thoracic epidural.
After completion of surgery patient was shifted to intensive care unit for elective ventilation. He was successfully extubated after 12 hours and shifted to ward in stable condition after two days. The patient was discharged after five days with advice for follow-up in cardiac and surgery outpatient department.
The DCM is a myocardial disease with structural and functional abnormalities of heart which reduces global myocardial contractility and left ventricular or biventricular dysfunction (1). Aetiologies of DCM include genetic mutations, exposure to toxins, autoimmune diseases, endocrine and neuromuscular causes, inflammation and infections (2). DCM may clinically presents with dyspnoea, weakness, swollen legs, swollen ankles, fatigue and chest pain, arrhythmias, acute or chronic decompensation of heart and cardiogenic shock (3). Pharmacological modalities of treatment include Angiotensin-Converting Enzyme (ACE) inhibitors, angiotensin receptor antagonist, mineralocorticoid antagonist and funny current channel (If) inhibitors (4). Cardiac pacing is considered in moderate to severe symptomatic heart failure (New York Heart Association (NYHA) grade 3 and 4) patients (5). Prognosis of DCM patients depend upon the degree of systolic dysfunction of left ventricle, with threshold limit of 35% for high risk of sudden cardiac death on basis of clinical trials done previously (6).
If a patient is in acute heart failure and requires any surgery, usually one week wait is preferred before posting for surgery. But this can not be applied for patients requiring emergency surgery. Anaesthetic concerns in the index patient were acute decompensation of heart, low ejection fraction (10-15%), emergency nature of the surgery and other multiple co-morbidities – hypertension and chronic kidney disease. Induction agents with minimal or no myocardial depression effect are preferred like ketamine and etomidate (7). Inhalational agents in low Minimum Alveolar Concentration (MAC) (≤1) and opioids like fentanyl and remifentanyl does not cause myocardial depression in low doses (8). Multimodal analgesia is preferred. Epidural reduces afterload thus increasing left ventricular forward flow and cardiac output (9).
There are few cases reported regarding management of the patients having DCM. Singh T et al., reported a case of anaesthetic management of a 23-year-old parturient with DCM undergoing elective caesarean section. The patient was a known to have DCMP since six years and her symptoms were well controlled on drugs. She had ejection fraction of 36%, mitral regurgitation, aortic regurgitation, global hypokinesia and poor systolic function of left heart. In operation theatre routine monitors (ECG, SpO2 and non-invasive blood pressure) were attached. I.V. line secured using18 G cannula. Under all aseptic precautions, spinal anaesthesia was given using 1.2 mL of 0.5% bupivacaine plus 25 μg fentanyl at L3-L4 space. Postoperative analgesia was provided with diclofenac transdermal patch (10). This case differs from the index case as it was elective surgery and she was not in acute decompensation of heart. Also, they did not use invasive monitoring and multimodal analgesia for intraoperative and postoperative pain relief. Good intra and postoperative analgesia is necessary to reduce pain and stabilisation of haemodynamics and reducing mortality and morbidity.
Raj R et al., reported a similar case of anaesthetic management of a 43-year-old female undergoing emergency appendectomy. She had DCMP since one and half years. She had no other co-morbidities and had no feature of congestive heart failure. Her echocardiography showed left ventricular ejection fraction of 20%. Inside operation theatre all routine monitors were attached. After securing i.v. line, left radial artery and right internal jugular vein cannulation was done under local anaesthesia. Combined spinal epidural block was given under all aseptic precautions. Intraoperative hypotension was managed using boluses of ephedrine (11). This case differs from the index case as this patient had no other co-morbidities and she was not in congestive heart failure. Appendicectomy is lower abdominal surgery so done under regional anaesthesia, while exploratory laparotomy required general anaesthesia.
Intraoperative management of DCMP is an anaesthetic challenge especially if the patient has low cardiac output and severe left ventricular dysfunction. Acute decompensation of heart is another concern. Management of such patients coming for emergency surgery requires good preoperative assessment of the patient, meticulous planning and managing intraoperative complications. This case report mentions the significance of suitable invasive and non invasive intraoperative monitoring, maintenance of preload, reduction of afterload, good analgesia and avoidance of myocardial depression drugs for successful intraoperative management of DCM patients.
DOI: 10.7860/JCDR/2022/55565.16490
Date of Submission: Feb 09, 2022
Date of Peer Review: Mar 16, 2022
Date of Acceptance: Mar 31, 2022
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: Feb 12, 2022
• Manual Googling: Mar 31, 2022
• iThenticate Software: Jun 13, 2022 (11%)
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