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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
Synchronous Tumours: A Combination of Carcinoid and Adenocarcinoma
Correspondence Address :
Dr. Koushik Lakshmipathy,
No. 32, Karunigar Street, Velliyur Village and Post, Thiruvallur, Chennai-601103, Tamil Nadu, India.
E-mail: kkoushik15@gmail.com
Synchronous tumour refers to cases in which the second primary cancer is diagnosed within six months of primary cancer. Carcinoid tumours are innocuous at time of presentation, emphasising the need for multidisciplinary approach for the diagnosis. A 80-year-old male patient came with complaints of cough with expectoration on and off for three years, with occasional minimal haemoptysis, haematemesis on and off for two months, loss of weight and loss of appetite for the past two months and complaints of increased cough for the past one week. Chest X-ray showed ill-defined opacity in the left lower zone. Contrast enhanced computed tomography showed two well defined heterogenous enhancing lesion in the superior and lateral basal segment of left lower lobe. Bronchoscopy guided biopsy revealed typical carcinoid. In view of recurrent diarrhoea, patient underwent endoscopy which revealed poorly differentiated adenocarcinoma. Gastrointestinal symptoms along with lung symptoms can be attributed to disseminated carcinoid or carcinoid syndrome. Carcinoid syndrome occurs in fewer than 5% of cases. It presents with symptoms like diarrhoea, wheezing, palpitations, hypotension. In the present case authors were attributing the gastric symptoms to carcinoid syndrome. Endoscopy was done in view of diarrhoea which revealed a second malignancy. Multiple tumours diagnosed have to be evaluated and staged separately and the treatment should be decided on staging to attain maximum clinical response. Patient condition worsened and patient expired in two weeks. All symptoms in a tumour patient should not be attributed to paraneoplastic syndromes and metastasis, further workup should be done using a multidisciplinary approach.
Carcinoid syndrome, Endobronchial mass, Gastrointestinal symptoms
A 80-year-old male patient presented complaints of cough with expectoration on and off for three years, with occasional minimal haemoptysis, haematemesis on and off for two months, loss of weight and loss of appetite for the past two months and complaints of increased cough for the past one week. He was a type 2 diabetic on oral hypoglycaemic agents for 30 years and has systemic hypertension diagnosed three years ago and on regular treatment. On examination, patient vitals were stable and systemic examination was normal. Routine blood investigations were within normal limits. Chest radiography showed homogenous opacity in the left lower zone. A differential diagnosis of tuberculosis/malignancy was made. Sputum examination for Acid Fast Bacilli (AFB) staining was negative. Contrast Enhanced Computed Tomography (CECT) chest showed two well defined lobulated heterogenous enhancing lesion in the superior and lateral basal segment of the left lower lobe with bronchial cut-off sign and mediastinal lymphadenopathy (Table/Fig 1)a,b. After the CECT a provisional diagnosis of malignancy was made and planned for bronchoscopy. Bronchoscopy revealed an endobronchial growth in the superior segment of left lower lobe (Table/Fig 2). Endobronchial biopsy taken was sent for Histopathological Examination (HPE) showed wall of bronchus lined by columnar epithelium with a subepithelial neoplasm composed of nests, tubules and trabeculae of polygonal cells separated by thin fibrovascular septae suggestive of a neuroendocrine tumour consistent with typical carcinoid. In view of persistent haematemesis Upper Gastrointestinal Endoscopy (UGE) was done which (Table/Fig 3)a,b showed a globular friable mass in the body of the stomach and biopsy was done and sent for HPE which showed multiple fragments of gastric mucosa with areas of intestinal metaplasia, dense mononuclear infiltrates and infiltrating large nests and islands of malignant cells with vague glandular pattern suggestive of poorly differentiated adenocarcinoma (Table/Fig 4)a,b. Patient was advised for Gallium Ga 68-DOTANOC Positron EmissionTomography (PET) scan for further workup but patient condition worsened and patient expired in two weeks.
Bronchial carcinoid tumours comprise 1-2% of lung tumours with equal distribution between males and females (1). Bronchial carcinoids produce and secrete many hormones like serotonin, Adrenocorticotropic Hormone (ACTH), somatostatin, and bradykinin. Carcinoid tumours are classified as typical and atypical carcinoids based on mitotic index. Carcinoid tumours are mostly solitary, peripheral and well circumscribed and solitary presenting as hilar or perihilar mass and few present as endobronchial lesion with or without lobar or segmental atelectasis. Clinical features of carcinoid are dyspnoea, cough, haemoptysis along with endobronchial obstruction maybe seen in some cases. Fewer than two mitoses per 10 high power fields without necrosis is seen in typical carcinoids and two to ten mitoses per 10 high power fields in atypical carcinoids. Atypical carcinoids tend to be more aggressive and present with regional lymph node invasion (2).
Pulmonary carcinoids are associated with paraneoplastic syndromes such as carcinoid syndrome and cushing’s syndrome (2%). Gastrointestinal symptoms along with lung symptoms can be attributed to disseminated carcinoid or carcinoid syndrome. Carcinoid syndrome occurs in fewer than 5% of cases (3). It presents with symptoms like flushing (80%) diarrhoea (80%), wheezing (10-20%), palpitations and hypotension (60-70%) (4). In this case authors were attributing the gastric symptoms to carcinoid syndrome. Endoscopy was done in view of haematemesis which revealed a second malignancy. The patient was lost in view of dual primary within a month.
Multiple primary malignancies are classified into two categories synchronous tumour in which cancers occur at the same time and metachronous tumour in which the cancers are diagnosed 6 months apart. The diagnosis of synchronous tumours should be done based on the Warren and Gates criteria of i) each tumour should be histologically distinct; ii) each tumour should have a definite picture of malignancy; iii) possibility of one tumour being metastasis should be ruled out (5). The frequency of second tumour was reported to be around 3-5 % in a meta-analysis (6). The pathophysiology of multiple primary malignancies still remains unknown. Few factors that can cause multiple malignancies are ionising radiation, increased number of organ transplants and increased newer treatment modalities like hormonal manipulation, targeted therapies, genetic manipulation and advent of immunomodulators. Multiple tumours diagnosed have to be evaluated and staged separately and the treatment should be decided on staging to attain maximum clinical response. Operable synchronous malignancies can be operated in a single setting with minimal morbidity and mortality which is less taxing on the patients psychologically and financially. Data regarding multiple primary malignancies in developing countries is very sparse hence, studies are required for incidence and other characters (7).
The treatment of choice in carcinoid tumours is surgical resection in view of localised tumour. The most common approach is segmentectomy followed by ablation pneumonectomy or bronchoplasty. Video-Assisted Thoracoscopic Surgery (VATS) guided sleeve resection is done in some cases.The European Society of Thoracic Surgeons of Neuroendocrine Tumours showed that patients who underwent resection of typical carcinoids had a five year survival rate of 94% (8). In recent trials RADIANT- 2 and RADIANT -4 everolimus mTOR inhibitor drug has been given to patients with progressive, well-differentiated, non functional neuroendocrine tumours of gastrointestinal or lung origin that are unresectable or metastatic used as targeted therapy. It is tolerated in patients who take it along with octreotide long-acting release (9).
Hajjaj N et al., reported a case of adenocarcinoma and endobronchial carcinoid of lung in 57-year-old female who was an ex-smoker. She presented with a chief complaint of fatigue and weight loss. No respiratory symptoms like cough, haemoptysis and shortness of breath were present. Her computed tomography showed right hilar mass and the second minimally invasive adenocarcinoma was diagnosed postoperatively lobectomy of right middle lobe (10). The present case had predominant respiratory symptoms and second tumour in stomach which was diagnosed by an endoscopic biopsy.
Alghanmi HA, reported a case of double primary lung cancers, and synchronous colon cancer patient presented with complaints of severe abdominal pain, vomiting and constipation. Computed tomography chest showed a well-defined soft tissue nodule at the lower base of the left lower lobe measuring 2.5 cm. Dual lung cancers were diagnosed postlobectomy. Postoperatively, lung showed both adenocarcinoma and carcinoid, colon had adenocarcinoma. Patient underwent surgery followed by chemotherapy and is on regular follow-up. The patient was diagnosed in an early stage of disease (11). The present case was diagnosed in a late stage of disease and the patient expired within two weeks of discharge from hospital.
A high level of suspicion is required to diagnose synchronous tumours and a multidisciplinary approach is of merit due to rare nature of this entity so that they are not overlooked and excluded from differential diagnosis in favour of more common aetiologies.
DOI: 10.7860/JCDR/2022/59202.17130
Date of Submission: Jul 20, 2022
Date of Peer Review: Aug 28, 2022
Date of Acceptance: Sep 30, 2022
Date of Publishing: Nov 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: Jul 30, 2022
• Manual Googling: Sep 16, 2022
• iThenticate Software: Sep 20, 2022 (11%)
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