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
Case report
Full Version
A Rare Case Report of a 8-weeks-old Infant with Hypercalcaemia and Subcutaneous Fat Necrosis
Correspondence Address :
Dr. AN Shruthi,
Assistant Professor, Department of Biochemistry, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India.
E-mail: shruthisomrao@gmail.com
Subcutaneous Fat Necrosis (SCFN) is an uncommon transient panniculitis more commonly seen in first week of newborn life. Hypercalcaemia is tell-tale of this disorder, resulting in consequences like metabolic derangements, polyuria, seizures, vomiting, nephrocalcinosis and cardiovascular disturbances contributing to morbidity and mortality of SCFN. This is a case report of an eight-week-old male infant who presented with hypercalcaemia and multiple nodules all over the body. Histopathology is the gold standard method which helps in diagnosis and evaluation of a patient with SCFN. In this case, histopathological report revealed focal areas of fat necrosis in the fat lobules along with lobular panniculitis with infiltration of lymphocytes, histocytes, fibroblasts and multinucleated giant cells. Its granules were suggestive of SCFN. The diagnosis of SCFN was confirmed by skin biopsy and additionally supported by hypercalcaemia. This study highlights the importance of performing detailed skin examination for the evaluation of patients until the resolution of hypercalcaemia and skin lesions. In this case, hypercalcaemia resolved by the end of 12th week of life. Though, it is a benign and self-limiting condition, educating and creating awareness among the parents is of utmost importance and to prevent renal and cardiac complications associated with hypercalcaemia. Rehydration therapy, calcium and Vitamin D restricted diet are the modes of treatment for treating this condition.
Hypertriglyceridemia, Lobular panniculitis, Neonatal sepsis, Rehydration, Thrombocytopenia
An eight-week-old male infant referred from outside clinic (suspecting neonatal sepsis for further management) was admitted to the paediatric unit. The infant presented with multiple nodules since 2nd week of life on the nape of the neck which increased all over the body in size and number. The infant had history of fever, failure to thrive and refusal of feeds since 7th week of life. Birth history revealed that he was delivered by emergency caesarean section due to foetal distress and low birth weight (1520 grams) at 37th week of gestation. Soon after birth, the baby experienced severe peripheral asphyxia secondary to meconium aspiration which required intubation and suction. Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) Score (1) was 2 and 8 at 1 and 5 minute, respectively. Positive pressure ventilation and positive end expiratory pressure were administered under intensive care for a week. The newborn did not receive body cooling therapeutic hypothermia. Mother noticed nodules over the nape of the neck during second week of life, which gradually increased in size and number, spreading all over the body in a span of four weeks, which gradually decreased over the next two weeks. There was no family history of hypertriglyceridemia.
On the day of admission the infant was febrile: temperature- 99.5°F (Fahrenheit), pulse-130/minute, respiratory rate-46/minute, cardiovascular, respiratory and central nervous system examination normal, per abdomen-soft, liver palpable. Multiple well defined palpable nodules measuring about 1×1 cm to 3×3 cm were present predominantly over the upper back, cheeks, upper limbs (Table/Fig 1) and lower limbs. Lesions were non tender and not attached to the deeper structures. There was no local rise of temperature. Differential diagnoses were sepsis, SCFN or sclerema neonatorum. The clinical evaluation and skin biopsy confirmed the diagnosis of SCFN and was additionally supported by hypercalcaemia (Table/Fig 2).
Reference ranges of above parameters were extracted from Beckman Coulter kit insert (information sheet) (2),(3).
The baby was admitted for 12 days. During the stay in the hospital all biochemical and haematological investigations were repeated to monitor the progress of the baby. All parameters remained normal except for few parameters which are mentioned in the (Table/Fig 3).
Histopathology report: In the upper right arm, the dermis showed normal adnexal structures. Subcutaneous fat showed focal areas of fat necrosis in the fat lobules. Lobular panniculitis with infiltration of lymphocytes, histocytes, fibroblasts and multinucleated giant cells (Table/Fig 4). Its granules suggestive of SCFN. The diagnosis 2was SCFN confirmed by skin biopsy of nodule and hypercalcaemia (20 mg/dL). Blood culture and clinical stability of the infant ruled out the sepsis.
Ultrasound of abdomen and radiograph of chest reports were normal. On hospitalisation, the infant (weight-3.28 kg) was treated for urinary tract infection with appropriate antibiotics injections intravenously every 12th hourly (ceftriaxone 160 mg for seven days from day one and amikacin 25 mg for three days from day third (Escherichia coli susceptible to amikacin). Dehydration was corrected with intravenous fluids {DNS (Dextrose and Sodium Chloride) 6 mL per hour}. The infant was treated for fever by anamol 80 mg suppository 3/4th per rectal and dolo drops 0.4 mL (100 mg/mL) as and when required. The infant was initially started with paladai feeds and mother was encouraged to breast feed her baby. Cutaneous nodular lesions continued to regress and the infant was physically stable at the time of discharge. The mother was advised to exclusively breast feed her baby till six months and not to start complimentary feeds like ragi porridge and soup of green leafy vegetables. The serum calcium level was 20 mg/dL on the day of discharge. The baby was followed-up to six weeks periodically from day of discharge. Serum calcium level reduced to normal (10.5 mg/dL) by the end of 12th week of life without any complications.
The SCFN is an uncommon, self-resolving panniculitis commonly seen in full term or post term newborns in the first few weeks of life (4). The aetiology of the disease is unclear. It usually presents with nodules or plaques on skin of arms, cheeks, upper back, and thighs. In spite of a favourable prognosis, it may also be complicated with metabolic and haematological alterations like hypercalcaemia, hypertriglyceridemia, hypoglycaemia or thrombocytopenia (4),(5),(6) which should be managed by timely intervention (6),(7),(8).
The SCFN is typically seen in maternal or neonatal stress, including maternal diabetes, cord prolapse, meconium aspiration, perinatal asphyxia, neonatal sepsis or therapeutic hypothermia (9),(10),(11). The subcutaneous lesions are firm, erythematous or purplish nodules present on back, shoulders and upper limbs and thighs (4),(7). The pathogenesis of SCFN remains unclear. It has been postulated that the normal blood supply to the neonatal fat tissue is affected during neonatal distress, which results in hypoxia and hypothermia leading to inflammation and necrosis in fat tissue (9),(12),(13). The newborn fat consists of more amount of saturated fatty acids compared to adult fat, because of its higher melting point associated with the tendency for solidification and crystallisation (5),(9). The histopathology contributes to diagnosis with characteristic lobular panniculitis, mixed inflammatory cell infiltrate and radially arranged crystals (4),(6),(12). The skin lesion does not require any treatment as the disease is self-resolving (7),(14),(15).
Hypercalcaemia (Serum Ca >10.5 mg/dL) (16) was diagnosed in the present case (Serum Ca-20 mg/dL). The pathogenesis for hypercalcaemia is not clear (17) and research has shown
many mechanisms which include: a) increased prostaglandin activity leading to osteoclast activation; b) calcium released from necrotic fat cells; c) increased production of activated vitamin D by macrophages which causes release of calcium from bone and
increased absorption of calcium from the gut (18),(19),(20). Farooque A et al., demonstrated the presence of extrarenal 1α-hydroxylase in immune cells associated with SCFN (21). Hypercalcaemia can lead to gastrointestinal, neurological and cardiac life-threatening complications. Hypercalcaemia may reduce renal concentrating capacity presenting with polyuria and dehydration leading to kidney failure and metastatic calcifications (4),(7),(12),(15). It is vital to monitor the patient’s serum calcium levels for at least six months after the diagnosis (7),(12). For this case, infant was followed-up for a period of three months until serum calcium returned to normal (10.5 mg/dL). Hypercalcaemia treatment includes aggressive hydration, drugs like furosemide and prednisolone to decrease serum calcium and low vitamin D and calcium diet (14),(22). In 76% of cases resolution of hypercalcaemia seen within 4 weeks of detection (23).
In this case, the infant’s serum was turbid at eighth week. The observed hypertriglyceridemia may be due to the resolution of nodules and mobilisation of lipid from necrotic adipose tissue (4),(12),(24). Thrombocytopenia is known to be associated with SCFN due to sequestration of platelets in subcutaneous tissue (12),(18). In this case, thrombocytosis was present which was similar to cases observed by Lorenzo C et al., and Sahni M et al., (10),(11). It may be attributed to the reactive inflammatory response of SCFN (10),(11). The present case showed multiple features of SCFN which is supported by a skin biopsy in the clinical diagnosis. Serum parathyroid hormone and vitamin D levels was not measured as the patient attenders could not afford the costs which would have further strengthened our laboratory diagnosis.
The SCFN is a rare self-limiting condition. Early diagnosis and appropriate intervention are required to prevent the complication that arises from SCFN. Hypercalcaemia is a potentially lifethreatening complication that occurs in this subset of patients. Periodic monitoring until the resolution of lesions and hypercalcaemia is required. This helps in reducing morbidity and mortality for SCFN in the newborn. Educating and reassuring the parents regarding its self-limiting nature is also an important part of the treatment protocol. This case highlights the importance of early recognition, initial management. This case presentation can be used as reference for SCFN cases at tertiary care hospital.
Authors would like to acknowledge the child’s parents for providing detailed information and co-operating by giving all the relevant information. Authors would like to extend their heartiest thanks with deep sense of gratitude and respect to Dr. Akshay (Dermatology, RRMCH) and all those who provided us immense help and guidance.
DOI: 10.7860/JCDR/2022/54891.16405
Date of Submission: Jan 11, 2022
Date of Peer Review: Feb 10, 2022
Date of Acceptance: Mar 23, 2022
Date of Publishing: May 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: Jan 17, 2022
• Manual Googling: Mar 22, 2022
• iThenticate Software: Apr 19, 2022 (17%)
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