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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
Images in Medicine
Full Version
The Trident in the Brain- A Case of Osmotic Demyelination Syndrome Secondary to Alcohol Withdrawal
Correspondence Address :
Dr. Nipun Bawiskar,
Resident, Department of Medicine, Datta Meghe Institute of Medical Sciences
(Deemed To Be University), Wardha, Maharashtra, India.
E-mail: nipun.bawiskar@gmail.com
Osmotic Demyelination Syndrome (ODS) is characterised by demyelination of pons and is also called as central pontine myelinolysis. It has been observed in patients with alcohol dependence, although hyponatraemia remains the most common cause. It should be suspected in chronic alcoholics and especially in those with protracted delirium tremens. Magnetic Resonance Imaging (MRI) is the modality of choice to diagnose this condition with a trident or pig snout appearance of pons being the characteristic finding. This publication discusses the case of a 27-year-old male who reported to the casualty ward in a delirious state following an episode of tonic clonic seizures and was diagnosed with alcohol withdrawal with pontine myelinolysis.
Hyponatraemia, Pig’s snout appearance, Pons, Tonic clonic seizures
A 27-year-old male was brought to the casualty in a delirious state following an episode of generalised tonic clonic seizure. He had no previous history of fever, trauma, headache, vomiting, loss of consciousness or seizures. On inquiring about his drinking pattern, it was established that he was an addict with the minimum consumption of at least 250 mL of country liquor a day since eight years. Following an attempted to cease consumption of liquor for three days, he developed a tonic clonic seizure and was brought to the emergency department of our hospital. There were no co-morbidities like diabetes, hypertension, bronchial asthma or tuberculosis.
On examination he was conscious but disoriented with a Glasgow Coma Scale (GCS) score of E4V4M5. His pulse was 88/min, Blood Pressure (BP) was 100/70 mmHg and respiratory rate was 33 breath/min. The Central Nervous System (CNS) examination revealed gaze evoked horizontal nystagmus, hypertonia in all four limbs, power of 5/5 with exaggeration of reflexes and an extensor planter response. On auscultation of the chest, breath sounds were equal on both sides with no adventitious sounds, normal heart sounds and no murmur. The abdomen was soft and non tender with no evidence of free fluid or organomegaly.
Laboratory investigations revealed a haemoglobin of 10 mg/dL, mean corpuscular volume of 100 fL, White Blood Cell (WBC) count of 13800/mm3 a platelet count of 2,58,000/mm3, Glutamic Oxalacetic Transaminase (SGOT) of 67 IU/L, Glutamic-pyruvic Transaminase (SGPT) of 49 IU/L, serum bilirubin of 1.4 mg/dL, serum protein of 4 mg/dL, serum ammonia of 12 micromol/L, serum lipase of 24 U/L, serum amylase of 35 U/L with the urea as 24 mg/dL, creatinine as 1.4 mg/dL, sodium as 137 mmol/L and potassium as 3.8 mmol/L. He was managed as a case of alcohol withdrawal with cefotaxim, thiamine, antacids, antiemetics, lorazepam and i.v. fluids. Following the above treatment, patient improved; he was conscious, oriented, showed spasticity in all four limbs, catatonia, hyperreflexia, an extensor planter response, nystagmus and dysarthria.
An MRI brain was done on the 2nd day which was suggestive of altered signal intensities in the mid brain and pons on T2WI/Fluid Attenuated Inversion Recovery (FLAIR) (Table/Fig 1) with corresponding hypo intensity in T1WI with restriction on Diffusion Weighted Imaging (DWI) (Table/Fig 2) and a corresponding dark signal on Apparent Diffusion Coefficient (ADC). The signals were bilaterally symmetrical in the upper pons sparing the peripheral pons and corticospinal tract that gave it the classical pig snout appearance a.k.a “trident sign” seen in ODS. A neurologist was consulted who advised continuation of thiamine, antacids, antiemetics and lorazepam. Following this the patient was discharged on request. He was treated in the hospital for a total duration of 10 days during which there was only a slight improvement in spasticity and dysarthria.
The ODS is characterised by demyelination of pons most commonly due to hyponatraemia. A few case reports published have shown this to be an occurrence though rare among hypernatraemic individuals postpartum or those on haemodialysis for chronic renal failure. It has also been observed in those with alcohol withdrawal, burns, anorexia and severe liver disease (1). Chronic alcoholics with severe liver disease and Wernicke’s encephalopathy are more likely to develop this condition (2). The proposed hypothesis to explain this syndrome is osmotic injury to the endothelium which may cause release of myelinotoxic substances that damage the grey matter. We report a case of Central Pontine Myelinolysis (CPM) in a young male with alcohol withdrawal and no electrolyte abnormalities.
Hyponatraemia with rapid correction of sodium levels is the bestknown cause of ODS. With hyponatraemia of longer duration, the brain can remain isotonic by reducing the intracellular levels of osmolytes. With correction there is an increase in the extracellular tonicity which ultimately increases the intercellular tonicity. In rapid correction there isn’t sufficient time for the brain to adjust causing osmolytes to continue moving out into the extra cellular space which causes demyelination (3). In alcohol withdrawal, ODS is unrelated to the sodium levels. Commonly these patients present with tremors, anxiety, tonic-clonic seizures, psychomotor agitation and gait disturbances (4). Withdrawal is distinguished from CPM by intact orientation and absence of visual hallucinations. Development of spastic quadriparesis and pseudo bulbar palsy indicates the involvement of pons and midbrain as evidenced in our case. Inability to maintain cerebral protective mechanisms against osmotic stress has been postulated as one of the reasons for CPM due to alcohol withdrawal (4),(5). Refeeding syndrome is a metabolic condition that occurs in patient who is starved or malnourished following reinstitution of nutrients. During prolonged periods of starvation most intracellular minerals are depleted. Consumption of food following this period of starvation leads to an osmotic stress which may cause shrinkage of cells with shearing of oligodendrocytes provoking demyelination especially in the region of pons (6). A case of refeeding syndrome has been reported in an alcoholic with one week of fasting prior to presentation (6). This theory can be ruled out in the index patient as the history obtained suggests no nutritional deficit or fasting. The MRI brain is used most commonly as a diagnostic modality in CPM with the classical trident sign or pig snout appearance of the pons confirming the diagnosis. Intensive rehabilitation and conservative management remains a key in managing a case of osmotic demyelination with the prognosis being slightly better when it is caused due to alcohol withdrawal than due to rapid correction of sodium.
The ODS or central pontine myelinolysis is a condition seen in patient with alcohol withdrawal with the characteristic trident sign or pig snout appearance of the pons which is a characteristic finding on MRI brain. Thus, MRI brain helps in confirming the diagnosis and further proceeding with the management.
DOI: 10.7860/JCDR/2022/51657.16151
Date of Submission: Jul 30, 2021
Date of Peer Review: Sep 13, 2021
Date of Acceptance: Dec 15, 2021
Date of Publishing: Apr 01, 2022
AUTHOR DECLARATATION:
• 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 31, 2021
• Manual Googling: Dec 14, 2021
• iThenticate Software: Dec 18, 2021 (20%)
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