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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
A Case Report on Spontaneous Coronary Artery Dissection in a Patient with Churg-Strauss Syndrome
Correspondence Address :
Dr. Neel Kanth Issar,
D-5 Officer’s Mess, Air Force Station, Hindon, Ghaziabad-201004, Uttar Pradesh, India.
E-mail: neelissar7@gmail.com
Spontaneous Coronary Artery Dissection (SCAD) is a rare but of one the important causes of sudden cardiac arrest and Acute Coronary Syndrome (ACS). It is complex and often under diagnosed. It has multifactorial aetiologies. It is predominantly seen in young women presenting with ACS, with no pre-existing history of Coronary Artery Disease (CAD) and is commonly diagnosed via coronary angiography. It may be associated with autoimmune disease, connective tissue disorder, collagen vascular disease, Marfan syndrome, intense physical exercise and during peripartum period. The various treatment modalities for SCAD are conservative medical treatment, Percutaneous Coronary Intervention (PCI), and surgery. Here, authors describe a case of 33-year-old women who presented with ACS, with no pre-existing history of CAD. Patient responded well with medical management. This condition has grave prognosis, if not detected and treated promptly. So it is very important to keep SCAD as differential diagnosis in ACS among young patients.
Acute coronary syndrome, Autoimmune disease, Connective tissue disorder, Sudden cardiac arrest, Young women
A 33-year-old female, known case of bronchial asthma, presented with polyarthralgia (small and large joints), weakness, fatigue and reduced appetite for 15 days. She also complained of retrosternal chest pain radiating to left arm since one day. There was history of abnormal behaviour of one day. Patient was known case of bronchial asthma, well controlled with Metered Dose Inhalers (MDI). She suffered from sinusitis. Her last child birth was two years ago. There was no history of diabetes, hypertension or dyslipidaemia.
On evaluation, following findings were observed, random blood sugar 92 mg/dL, Haemoglobin 12.1 gm%, Total Leukocyte Count (TLC) 7000/cumm, eosinophil 22%, hypereosinophilia Absolute Eosinophil Count (AEC) 1540, platelet count 1,90,000/μL, Vitamin D 13.8 ng/mL, Total bilirubin 0.7 mg/dL, Direct bilirubin 0.2 mg/dL, Serum Glutamic Oxaloacetic Transaminase (SGOT) 60 IU/L, Serum Glutamic Pyruvic Transaminase (SGPT) 62 IU/L, urea 23 mg/dL, creatinine 0.9 mg/dL, thyroid profile Thyroid Stimulating Hormone (TSH) 2.7, Triiodothyronine (T3) 1.38, Tetraiodothyronine (T4) 9.0 and International Normalised Ratio (INR) 1.2. Lipid profile showed total cholesterol 190 mg/dL, triglyceride 150 mg/dL, High Density Lipoprotein (HDL) 58 mg/dL, Low Density Lipoprotein (LDL) 120 mg/dL. Coronavirus Disease 2019 (COVID-19) Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test was negative. Among fever protocol, Peripheral Blood Smear (PBS) for Malarial Parasite (MP) was negative, dengue serology was negative, widal test and typhi dot was negative. Urine examination was normal but chest X-ray showed pulmonary infiltrates (Table/Fig 1).
Electrocardiogram (ECG) (Table/Fig 2) showed Flat T Lead I, II, III, avL, avF and T Inversion V1-V6, Trop T was Positive, Creatine Kinase MB (CKMB) 18 IU/L. Echocardiogram demonstrated Left Ventricular Ejection Fraction (LVEF) 60%, no regional wall motion abnormality and valves were normal. Coronary Angiography (CAG) showed right dominant circulation, normal Left Main Coronary Artery (LMCA), Left Anterior Descending (LAD) Type 1 SCAD on LAD with TIMI (Thrombolysis in Myocardial Infarction) grade III flow at origin of D, with normal Left Circumflex and right Coronary Artery (Table/Fig 3), (Table/Fig 4).
Ultrasound abdomen revealed left kidney hydronephrosis with thinning of cortex. Left adnexa shows anechoic cyst of size 45×35 mm with thin septa. Other organs were normal. Magnetic Resonance Imaging (MRI) Brain revealed multifocal altered signal intensity foci in bilateral frontoparieto occipital lobes, bilateral thalamoganglionic region and both cerebellum with many of the lesions showing restricted diffusion. Image findings were non specific, although possibility of encephalitis cannot be ruled out.
Considering polyarthralgia, Connective tissue work up was done and Rheumatoid Factor (RF) negative, C-reactive Protein (CRP) positive, Anti-cyclic Citrullinated Peptide antibodies (CCP) 5.9 U/mL, Antinuclear Antibodies (ANA) 0.42, Antiphospholipid Antibodies (APLA) IgM 4.9 U/mL, IgG 6.2 U/mL, Uric acid 4.1 mg/dL, Antineutrophilic cytoplasmic antibodies (ANCA) cANCA 4.12 U/mL and pANCA 3.2 U/mL. Extractable nuclear antigens (ENA) profile (Qualitative) was Negative. Serum autoimmune encephalitis panel was negative.
To diagnose Churg-Strauss syndrome, the American College of Rheumatology (ACR) proposed six criteria (1): Asthma, peripheral blood with eosinophilis count more than 10% pulmonary infiltrates (transient), paranasal sinusitis, histopathology demonstrating vasculitis with presence of extravascular eosinophils and Mononeuritis multiplex or polyneuropathy. If four or more criteria are present, it yields a sensitivity of 85% and a specificity of 99.7%. In index case, patient met with five of above six criteria for the diagnosis of Churg-Strauss syndrome.
In view of TIMI-III flow, the patient was managed with Tab. Ecosprin 150 mg OD, Tab. Clopid 75 mg OD, Tab. Atorvastatin 40 mg HS, Tab. Metoprolol XL 25 mg and Glucocorticoids. Patient responded well with the treatment and improved. The patient was maintained on conservative medical management with close outpatient follow-up in view of COVID-19 pandemic. Unfortunately, the patient got infected with coronavirus during her monthly follow-up and later succumbed to COVID-19.
The SCAD is defined as an emergency condition that occurs when coronary artery wall is separated by haemorrhage with or without tear. It is a rare, complex and under diagnosed cause of myocardial infarction. It has been seen that in 1.7-4% cases SCAD leads to ACS (2). Index patient developed acute myocardial infarction with no signs of atherosclerosis. SCAD is a rare underlying cause of ACS (3). There are three types of SCAD. Type 1 has a double lumen under contrast staining of the arterial wall. Type 2 reveals diffuse (2-3 cm), smooth narrowing and can vary in severity (depending on intramural haematoma). Type 3 mimics atherosclerosis and appear as focal or tubular stenosis (4).
Motreff et al., described five specific angiographic features of SCAD: (1) no atheroma on other coronary arteries; (2) radiolucent flap(s); (3) arterial wal showing contrast dye staining; (4) starting and/or ending of the angiographic ambiguity on a side branch; and (5) smooth and linear narrowing of the lumen calibre, or stenosis of varying severity which can mimic a “stick insect” or “radish” (5). SCAD is seen most commonly in young women that is, around 70% of the patients (female to male ratio- 2:1) and 30% of them occur in the peripartum period (6). The most frequent site of dissection is LAD which accounts for 60% of coronary dissections. The second most common site is Right Coronary Artery (RCA) which is predominantly seen in males, followed by the left main artery (7).
The aetiology of SCAD is multifactorial and is divided into four groups (8). First group consists of hereditary connective tissue disorders which are associated with a defective arterial wall (e.g. Marfan and Ehlers-Danlos syndromes). Second group includes underlying atherosclerotic changes which is most commonly seen in men at an age of average 55 years. The third group is related to peripartum period in females due to fluctuation in blood levels of oestrogen and relaxin, shear stress and increased blood flow (9). The last group is idiopathic SCAD. Some other important causes of SCAD are chest trauma, severe exercise, consumption of certain medications like cocaine, cyclosporine, 5-fluorouracil, oral contraceptives, and fenfluramine (10).
The management of SCAD comprises of medical treatment, PCI, and surgery. Conservative medical management is done usually for patients with mild involvement. Surgery or PCI is indicated in patients with extensive dissections leading to persistent ischaemia. Conservative medical management of SCAD is similar to the ACS, and includes use of anticoagulants, aspirin, clopidogrel, beta blockers, nitrates, and sometimes calcium channel blockers (11).
The most important feature seen on histological examination is predominant eosinophilic infiltrate which is seen in almost 50% of dissections. The presence of eosinophil granule components in the vessel wall and their tissue damaging effects helps in explaining role of eosinophils in the dissection process. Eosinophilic granule comprise of enzymes like acid phosphatase, collagenase, major basic protein, arylsulfatase, and beta-glucoronidase. These enzymes damage the collagen fibers of the arterial wall leading to initiation of dissection process. In fact, SCAD has also been reported in cases of Churg-Strauss syndrome, and drug-induced eosinophilia (12),(13).
Left main coronary artery or multivessel dissection is associated with bad outcome (14). The main modality for diagnosing SCAD is coronary angiography. Common coronary angiographic findings detected are intimal flap, two separate communicating lumens, multiple dissecting lines, and coronary aneurysm communicating with the lumen. Association of LAD is more commonly seen in females, whereas right coronary artery (RCA) inclusion is prevalent in males. Dissection of left main artery is rare (15).
The PCI requiring cases present a unique challenge due to difficulty in identifying the true arterial lumen and placement of a secure guidewire. Intravascular imaging modalities such as intravascular ultrasound (IVUS) or Optical Coherence Tomography (OCT) may be required for precise localisation of the site and extent of dissection and identify the true lumen. ChromaFlo, has been used for optimal therapeutic strategies during PCI. It shows blood flow by comparing sequential axial IVUS images and as blood flows, it interprets any differences in the position of echogenic blood particles (16).
A new promising technology OCT is emerging. OCT has high-resolution (10-20 μm) intraluminal images with ultra-structural details. Lim C et al., has mentioned OCT as a useful adjunct because of its small diameter as compared to IVUS probe (17). In the present study, these modalities were not used as it could cause wire induced propagation of dissection and also because the patient was stable.
The 1994, Chapel Hill consensus conference on the classification of vasculitis did not modify the ACR criteria (1),(18). Renal involvement (35% vs 4%) and peripheral neuropathy (84% vs 65%) is more commonly seen in ANCA positive patients than those without ANCA. Furthermore, in the biopsy sample of ANCA patients vasculitis was more often observed than ANCA negative patients (79% vs 39%). Interestingly, it has been observed that patients without ANCA are more likely to develop fever (55% vs 30%) and cardiac disease (49% vs 12%) (18),(19).
Management of SCAD is guided by the clinical symptoms, haemodynamic status of the patient, the extent and location of the dissection. In cases of distal dissection with preserved coronary flow conservative medical therapy is reasonable. Hence, through the present case authors would like to signify the importance of a neglected cause of acute myocardial ischaemia and sudden death i.e SCAD.
The SCAD is a rare cause of coronary artery syndrome seen most commonly in young women with no previous history of cardiac disease. Clinical symptoms, electrocardiographic findings and laboratory investigations are often similar to AMI. Early diagnosis is important for the treatment. The most preferable modality of treatment of SCAD is conservative management.
DOI: 10.7860/JCDR/2022/50801.16171
Date of Submission: Jun 11, 2021
Date of Peer Review: Aug 01, 2021
Date of Acceptance: Mar 03, 2022
Date of Publishing: Apr 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: Jun 16, 2021
• Manual Googling: Feb 21, 2022
• iThenticate Software: Mar 22, 2022 (17%)
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