Article in PDF
How to Cite
Citation Manager
Readers' Comments (0)
Audio Visual Article Statistics
Link
to PUBMED
Print this Article
Send to a Friend
Advertisers
Access Statistics Resources
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
Angiographic Profile of Type 2 Diabetic Patients with ST Elevation Myocardial Infarction: A Cross-sectional Study
Correspondence Address :
Dr. G Krupashree,
Chetana Hostel, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India.
E-mail: onetemmekgopal@gmail.com
Introduction: Coronary atherosclerosis is common in diabetics, and it is diffuse in form, with multivessel involvement. It demonstrates the involvement of multiple vessels rather than a single vessel.
Aim: To evaluate the angiographic profile of diabetic patients with ST Elevation Myocardial Infarction (STEMI).
Materials and Methods: The present study was a cross-sectional study which enrolled 104 diabetic patients presenting with STEMI from December 2019 to March 2020. Seventy percent or more stenosis in any major coronary artery or its major branches (>2.5 mm) was considered as significant.
Results: Mean age of the patients was 55.61±11.32 years, with 75 subjects being males and 29 subjects being females. A total of 28 (26.92%) had Anterolateral Wall Myocardial Infarction (ALWMI), 4 (3.84%) had Anteroseptal Wall Myocardial Infarction (ASWMI) 39 (37.5%) had Anterior Wall Myocardial Infarction (AWMI), 1 (0.96%) had extensive AWMI, 2 (1.9%) had Inferolateral Wall Myocardial Infarction (ILWMI), while 30 (28.84%) patients had Inferior Wall Myocardial Infarction (IWMI). Furthermore, 51 (49.0%) were thrombolysed while 53 (50.96%) patients were non thrombolysed. Thirty eight (36.53%) had single vessel disease, 40 (38.46%) had double vessel disease, while 26 (25%) had triple vessel disease. Among these patients, Left Main Coronary Artery (LMCA) was involved in 3 (2.88%) of patients. Seventy three patients had a Glycated Haemoglobin (HbA1c) of greater than 8.5 and had multivessel involvement, whereas 31 had a HbA1c of less than 8.5. Major Adverse Cardiac Events (MACE) was observed during hospital stay in the form of death, recurrent myocardial infarction and cardiovascular stroke, which occurred in 20 (19.23%) patients of the total 104 diabetic patients.
Conclusion: In the present study, the severity and extent of Coronary Artery Disease (CAD) and incidence of triple/multivessel disease was significantly high in diabetics. Diabetic patients with high HbA1c had more coronary vessel involvement. In this case, Coronary Artery Bypass Graft (CABG) is the mode of treatment.
Coronary artery disease, Left main coronary artery, Major adverse cardiac events
Diabetes mellitus is the second most common disease in the world, after cardiovascular disease. It is estimated that roughly 100 million people globally are affected by diabetes (1). Diabetes is a condition that causes both chronic and acute consequences. Cardiac disease is by far the most common cause of death among diabetics (2). Dyslipidaemia is seen in all patients with type 2 diabetes, and diabetics with high cholesterol have a 2-3 times higher risk of Coronary Artery Disease (CAD) than non diabetics.
Coronary artery disease is the most common symptom of cardiac involvement in diabetics. Diabetic cardiomyopathy and cardiac autonomic neuropathy are less common. In hospital, autopsy, and epidemiological as well as longitudinal studies in many populations, accelerated and increased prevalence of CAD has been well documented. Cardiovascular disorders account for 70-80% of deaths in diabetics. Coronary artery disease is responsible for 40% of diabetic deaths in their fourth decade, and it accounts for 50- 70% of deaths among diabetics over the age of 65 years (2).
The deleterious macrovascular effects of diabetes mellitus are well known, and these are associated with an increased rate of atherosclerosis, which predisposes individuals to occlusive CAD, Myocardial Infarction (MI), and death. Patients with diabetes are more likely to develop a diffuse and fast progressing form of atherosclerosis, which increases the need for revascularisation (3).
Coronary angiography is the “gold-standard” procedure for identifying and evaluating CAD. Coronary artery disease manifests itself in a variety of ways, from stable angina to Acute Coronary Syndrome (ACS) to asymptomatic illness (4),(5). To build an effective therapeutic plan, it is necessary to understand coronary architecture (5). The prognosis of CAD is largely determined by the severity of the illness, the involvement of the left main and left anterior descending arteries, and Left Ventricular (LV) function (6).
Coronary atherosclerosis is common in diabetics, as revealed by angiography, and it is diffuse in form, with multivessel involvement. It demonstrates the involvement of multiple vessels rather than a single vessel. Diabetic patients had a much higher rate of left main coronary artery involvement than non diabetic patients (7).
Coronary artery narrowing of more than or equal to 70% was considered as significant stenosis (8). When compared to non diabetic individuals, diabetic patients exhibit a worse angiographic picture of ischaemic heart disease, with a higher prevalence of multivessel disease, narrow arteries, calcification, intracoronary thrombus, and less developed collaterals. Insulin-dependent diabetics have a higher prevalence of diffuse CAD with narrow arteries, presumably due to the metabolic illness’s longer progression and severity (9).
Diabetic patients with ACS are at a higher risk for recurrent heart attacks and strokes, but they also benefit more from vigorous treatment than their non diabetic counterparts. Potent antiplatelet therapy, such as aspirin, clopidogrel, and Glycoprotein (GP) IIb/IIIa receptor antagonists, heparin or Low Molecular Weight Heparin (LMWH) early invasive evaluation, and, if suitable, stent-based Percutaneous Coronary Intervention (PCI) are the mainstays of treatment (10). In patients with complicated coronary architecture, Coronary Artery Bypass Graft (CABG) may be a viable option. Surgeons, on the other hand, are typically hesitant to operate in the presence of ongoing ischaemia. The use of drug-eluting stents has been linked to a significant reduction in restenosis in both non diabetic and diabetic patients. This results in further improvement in the outcomes of diabetic patients with ACS (11).
The present study aimed to assess diabetic patients’ risk factors and angiographic profile, as well as the impact of diabetes mellitus on the clinical course of patients with ST Elevation Myocardial Infarction (STEMI).
The present study was a single-centre cross-sectional study carried out in the Intensive Coronary Care Unit (ICCU), Department of General Medicine, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India, from December 2019 and March 2020. The Institutional Ethics Committee (IEC) approved the study vide letter number KIMS: ETHICS COMM: 107/2: 2018-19. The patients were enrolled into the study after obtaining written consents from them or their attendants.
Sample size estimation:
n=(z)2pq/d2 n=sample size, CI=95%, d=0.2, z=1.96, p=0.125,
q(100-p)=0.875
n=(1.96)2 x0.125x0.875/(0.2)2x10
n=104
Inclusion criteria: Diabetic patients with acute MI who had ST segment elevation and T wave changes with reciprocal changes, as well as new pathological Q waves on their Electrocardiogram (ECG).
Exclusion criteria: Patients with acute STEMI who were non-diabetic. Detailed history, clinical examination and the following investigations with coronary angiography were carried out: Complete Blood Count (CBC), blood urea, serum creatinine, serum electrolytes, Liver Function Test (LFT), ECG, 2D ECHO, Glycated Haemoglobin (HbA1c), and coronary angiography.
Statistical Analysis
The data was entered into Microsoft Excel datasheet and was analysed using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) statistics software version 23.0. Data collected was represented as number and percentages in tabular form. p<0.05 was considered for statistical significance after assuming all the rules of statistical tests. Chi-square test was used as test of significance for qualitative data.
The study included a total of 104 diabetic patients with acute STEMI admitted in ICCU. Mean age of subjects was 55.61±11.32 years; 75 subjects were males and 29 subjects were females. Majority of subjects were in the age group of 51 to 70 years (28.9%).
(Table/Fig 1) shows duration of diabetes, other co-morbidities and risk factors among patients. Majority of patients were diabetic for more than 5 years, associated with other co-morbidities like hypertension and risk factors like alcoholism, smoking, and tobacco chewing.
There were 55 (52.88%) patients who had atypical chest pain and 49 (47.12%) people who had typical chest pain. Along with chest pain they also presented with other symptoms like dyspnoea, sweating, vomiting, and abdominal pain (Table/Fig 2).
Among 104 patients, 39 patients had AWMI, 28 patients had ALWMI, 30 patients had IWMI. Most of the patients were in the age group of 51-70 years. (Table/Fig 3),(Table/Fig 4) shows that there was no association between HbA1c values, diabetes duration, and type of STEMI.
There were 51 thrombolysed patients and 53 patients who were non thrombolysed. Thrombolysis was performed on 44 patients with typical chest pain, while thrombolysis was not done on five patients with typical chest pain. Seven individuals with atypical chest pain received thrombolysis, but the remaining 48 patients did not. Sixty three (60.58%) patients had LV dysfunction, while 41 (39.42%) had a normal 2D ECHO. Twenty three of the 51 patients who underwent thrombolysis showed LV dysfunction. Left ventricular dysfunction was found in 40 of the 53 individuals who did not receive thrombolysis (Table/Fig 5). Seventy three patients had a HbA1c of greater than 8.5, whereas 31 had a HbA1c of less than 8.5.
Coronary angiography was used in the study. Double Vessel Disease (DVD) was found in 40 (38.46%) patients, Single Vessel Disease (SVD) in 38 (36.54%), and Triple Vessel Disease (TVD) in 26 (25%). The observation that DVD/TVD was more than SVD, suggests that in diabetes there was multivessel involvement (Table/Fig 6).
The Left Anterior Descending (LAD) vessels were involved in 79 individuals in the study, 60 of whom were males and 19 of whom were females. It also demonstrates that diabetic individuals are more likely to have LAD involvement. Left Circumflex (LCX) vascular involvement was found in 62 patients, 45 of whom were males and 17 of whom were females. There were 50 patients with Right Coronary Artery (RCA) vascular involvement, 33 of whom were men and 17 of whom were women. Three patients, one male and two females, had Left Main Coronary Artery (LMCA) vascular involvement (Table/Fig 7). Patients had Percutaneous Transluminal Coronary Angioplasty (PTCA) with stenting in 58 cases, CABG in 28 cases, and medical treatment in 18 cases.
According to the findings, 15 diabetic individuals within a period of less than 5 years had DVD, 18 had SVD, and 10 had TVD. There were 25 DVD patients, 20 SVD patients, and 16 TVD patients with a duration of more than 5 years. It shows that diabetic patients who have had the disease for more than 5 years have multivessel involvement (Table/Fig 8).
Outcome
The MACE was observed during the hospital stay in the form of death, recurrent MI, and cardiovascular stroke occurred in 20 (19.23%) of patients of total 104 diabetic patients.
A total of 104 diabetic patients with acute STEMI were included in the study. The study looked at risk factors, diabetes duration, HbA1c levels, and angiographic profile. Among the predominant male sample, multivessel/triple vessel involvement was more common. Diabetic patients with poor glycaemic control (HbA1c>8.5%) made up 70.2% of the participants in this study. This shows that inadequate glucose management causes greater coronary artery involvement and stenosis severity to increase. This observation was consistent with Malthesh MK et al., (1). In the index study, the peak incidence of MI in diabetics was observed in the fifth and sixth decades. This result resembled the findings of Chowdhary I and Sambyal V (2).
With a diabetic duration of more than 10 years, triple/multivessel disease was significantly greater (58.7%). These findings are consistent with another study by Lüscher TF et al., which found that the risk of coronary heart disease increased 1.38 times for every 10 years of diabetes duration (3).
The LAD was the most commonly affected vessel in the index study, and coronary angiography revealed that diabetics had a considerably greater prevalence of multivessel illness. This finding is consistent with other studies that also found that diabetics have a greater incidence of multivessel disease (4),(5). Few other authors reported an increased incidence of TVD, and more diffuse lesions were noted. As a result, the extent and severity of CAD in diabetic patients with ACS were much higher (6),(7). Further, there is literature that showed the angiographic extent and severity of CAD to be high among diabetic patients with ACS (8),(9),(10),(11),(12),(13).
Limitation(s)
It was a single-centred study. There was no follow-up data, that could have provided more information regarding MACE.
The severity and extent of CAD and triple/multivessel disease was significantly high among diabetics. With a diabetic duration of more than 10 years, the risk of triple vessel or multivessel illness was found to be significantly higher. Diabetics with poor control, high HbA1c levels, and a greater number of coronary vascular involvement required CABG as a therapy option. Involvement of LMCA was significantly high and severity of stenosis and total occlusion of vessels were more commonly seen in diabetic patients. The LAD artery was the most commonly involved vessel.
DOI: 10.7860/JCDR/2022/53314.16873
Date of Submission: Nov 17, 2021
Date of Peer Review: Feb 09, 2022
Date of Acceptance: May 23, 2022
Date of Publishing: Oct 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: Nov 18, 2021
• Manual Googling: May 23, 2022
• iThenticate Software: Sep 15, 2022 (19%)
ETYMOLOGY: Author Origin
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com