Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Lucknow
On Sep 2018




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On Aug 2018




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MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
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It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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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.
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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.
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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

Important Notice

Case report
Year : 2022 | Month : May | Volume : 16 | Issue : 5 | Page : VD01 - VD02 Full Version

COVID-19 Infection Induced Mania


Published: May 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/54949.16297
Ishani Roy, Debasish Sanyal

1. Postgraduate Trainee, Department of Psychiatry, KPC Medical College and Hospital, Kolkata, West Bengal, India. 2. Professor and Head, Department of Psychiatry, KPC Medical College and Hospital, Kolkata, West Bengal, India.

Correspondence Address :
Dr. Ishani Roy,
Flat 26, 10, Judges Court Road, Alipore, Kolkata, West Bengal, India.
E-mail: ishaniroy10@gmail.com

Abstract

Coronavirus Disease-2019 (COVID-19) infection or Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV 2) infection, is associated with various psychiatric consequences, which are because of various types of stressors, may be due to fear of infection or social isolation, hospitalization, death and so on. In the present case report, a 44-year-old female with a history of pentazocine addiction and no known history of previous psychiatric illness was admitted to the Emergency Department with vacant, withdrawn look, unnatural fixed posture, mutism, refusal to eat. These symptoms developed after discharge from another hospital where she was treated for COVID-19 induced severe pneumonia (resolving). The very next day, the patient demonstrated excessive talkativeness and jovial mood with echolalia. The patient was treated symptomatically and recovered without the use of any antipsychotics. This report highlights the probability of the mania like symptoms being linked to COVID-19 (SARS-CoV-2 infection) highlighting the need for assessment of various psychiatric manifestations during COVID-19 infection.

Keywords

Coronavirus disease-19, Echolalia, Venlafaxine

Case Report

A 44-year-old female divorcee, currently unemployed, residing with her uncle’s family (patient’s parents passed away 5 years ago), and a known case of hypertension, diabetes mellitus, hypothyroidism (under medication-controlled) was admitted to the Emergency Department on account of mutism, withdrawn, with vacant look, reduced movements and unnatural fixed posture and refusal to eat for more than 12 hours on that day. A written informed consent was taken from the patient’s guardian, as the patient was mentally unstable to give her consent.

A discharge summary from previous hospital revealed that the patient was discharged two days prior from the said hospital, where the patient was admitted with severe respiratory distress and fever, later diagnosed with severe COVID-19 induced pneumonia. She was treated with tablet ivermectin, capsule doxycycline (100 mg), tablet paracetamol, oxygen therapy by mask and other supportive care as Oxygen Saturation (SpO2) was gradually decreasing. The patient was started on tablet prednisolone which was to be tapered over three weeks. The patient was discharged after two and a half weeks with a tapering dose of prednisolone when the target SpO2 level was reached.

The family members also revealed that the patient was addicted to pentazocine for past 12 years. The patient’s average intake was approximately 15 ampules/day but she had reduced it to 2-3 ampules/day in the last six months by herself. During the patient’s prolonged hospital stay in the previous hospital, there was abrupt abstinence of pentazocine use which continued till now. According to the family, there was no such similar episodes in the past or presence of any other mood symptoms. None of the family members suffered from similar problems. The patient was admitted from the Emergency Department to the Intensive Care Unit.

On the second day, the general examination and psychiatric evaluation revealed that the patient was oriented to time, place, and person. She was alert and conscious. The patient’s facial expression was vacant, impassive and indifferent. Rapport could be established but with difficulty. The patient was withdrawn but did not have mutism, that was mentioned by the Emergency Department on day 1 of examination. Clinically, she did not fulfill the criteria of catatonia, hence no structured scale to test catatonia was administered. Neurological examination did not reveal any features of facial dystonia or any abnormalities like drooping of eyelids. The patient did not demonstrate any withdrawal symptoms to pentazocine during hospital stay.

Vitals including blood pressure, pulse rate and temperature were normal, though respiratory rate was slightly increased. Occasionally falling SpO2 was maintained with intermittent oxygen therapy by oxygen mask. Hypoxia was avoided and patient was monitored. On physical examination of the respiratory system showed bilateral apical crepitations and diminished air entry in lower lobes of both the lungs. There was no abnormality detected in the central nervous system, cardiovascular and gastrointestinal systems.

Baseline investigations were done and there was no abnormality detected in the patient’s electrolyte levels, Liver Function Tests (LFT), Kidney Function Tests (KFT), thyroid function tests (T3, T4, TSH), Fasting Blood Sugar (FBS) and postprandial blood sugar levels. Complete Blood Count (CBC) was normal. Chest X-ray showed resolving pneumonia. Cerebrospinal Fluid (CSF) study showed no abnormality. Magnetic Resonance Imaging (MRI) of brain was non contributory. Administering Electroconvulsive Therapy (ECT) as a treatment was considered but, the idea was abandoned in view of the resolving respiratory symptoms after COVID-19 induced severe pneumonia.

In view of the patient’s respiratory condition and other co-morbidities there were limited treatment options available. The patient had initially presented with refusal to eat, withdrawn and apathetic demeanor. Hence, venlafaxine (75 mg) was started thinking that it is a case of severe depression (1).

On the next day, the patient started demonstrating excessive talkativeness, showed overfamiliarity. The patient was extremely jovial and seemed to be in high spirits. The individual under consideration was alert, conscious and oriented to time but not co-operative. Rapport was established with difficulty. Eye contact was initiated but not maintained. Psychomotor activity was increased. The mood and affect were elated and there was emotional lability, pressure of speech, echolalia, perseverance, clang associations. There was also presence of flight of ideas and loosening of associations. The case under review had mood congruent manic delusions concerning her God gifted powers of saving the world. Higher mental functions could not be assessed. There were no signs of meningeal irritation- no neck rigidity, no photophobia, Kernig’s sign was negative, and Brudzinski’s sign was negative (2). The neurological findings were corroborated by the Neurology team of the hospital where treatment was going on. Patient’s changed mental status gave rise to confusion as of whether it was venlafaxine induced or it was because of post COVID-19 infection complication. The Naranjo Adverse Drug Reaction Probability Scale was administered (3). The total score of the scale was computed to be 1. Thus, assigning it to a probability category of doubtful (<1). This determined that, the drug venlafaxine was not the cause of the signs, the patient had shown. However, as a precaution, venlafaxine was withdrawn even though there was no conclusive evidence suggestive of it being the offending agent. Drug interactions were also reviewed and none were found to be the strong contenders for the patient’s present condition.

The patient was treated and managed by the medical COVID-19 expert team units for the resolving COVID-19 infection as a continuation of what was being given in the previous hospital and was discharged without any psychiatric treatment since the psychiatric symptoms resolved by themselves. The patient was advised to attend Psychiatry Outpatient Department after discharge. However, the patient has not come for follow-up.

Discussion

With the advent and spread of COVID-19 infection, correlation between COVID-19 infection and psychiatric morbidity is getting highlighted gradually day-by-day. In the present case report, patient’s age of onset being mid-life, a correlation with viral infection, a very limited short course of illness, history of pentazocine addiction but no other substance abuse, no family history of psychiatric disorder, it was suspected that this episode of the patient demonstrating manic symptoms could probably be a neuropsychiatric sequalae of COVID-19 infection.

The case illustrates an association of neuropsychiatric symptoms with COVID-19 infection with a significant pulmonary involvement. While vasculitis and encephalitis can be possible mechanism, neuro examination and investigation ruled out those diagnoses. COVID-19 infection can have neuropsychiatric sequalae and there are pathological mechanisms which can explain them. There are reports which corroborate direct viral infiltration into central nervous system as neurotropism and neuro-invasive potential has been demonstrated by many strains of coronavirus (4),(5).

The route is believed to be the migration of coronavirus from the respiratory tract via retrograde axonal transport from the olfactory bulb to brain (5),(6). Haematogenous dissemination into the central nervous system via infected leucocyte can be another possible route (5),(7). Another interpretation of link between COVID-19 infection and manic like symptoms can be the effect of inflammation. Previous findings have demonstrated that infection associated immune activation and subsequent release of inflammatory factors was one of the potential pathogenesis of bipolar disorder (8),(9). It was found that patients infected with COVID-19 produced high amounts of pro-inflammatory factors and chemokines probably leading to activated T-helper-1 (10).

A nation-wide surveillance study from UK using online case report portal yielded 18% of new onset neuropsychiatric syndromes which included 10 cases with psychosis, six cases with dementia like symptoms and four cases with affective disorders post COVID-19 infection (11).

In the last couple of years, COVID-19 infection and post COVID-19 psychiatric sequalae resulted in substantial number of morbidity amongst individuals along with stretching of healthcare system structure. Many aspects of this disease are still unknown. Urgent study and clinical research are needed to correlate the disease mechanism with existing therapeutics and maybe finding out newer solutions in a more meaningful manner to improve long-term management of both medical and psychiatric complications of COVID-19 infection. From another point of view, one may consider this like a ‘mania like symptom’ rather than a ‘maniac switch’. However, the authors feel that the latter description fits less well into the case.

Conclusion

Antidepressant induced manic episode is a known entity, however, it’s occurrence in the treatment of depression in a COVID-19 infected patient is rarely reported in literature. As the fight with COVID-19 infection continues the realization that, apart from physical illness, long-term psychiatric morbidities are also a cause of concern, and the management should be tailor made in the light of concurrent COVID-19 infection. This case documents a severe depressive episode in a COVID-19 infected patient who rapidly changed over to manic episode probably due to venlafaxine. Clinicians need to be cautious about such phenomenon when treating a COVID-19 infected patient with depression and addictive illnesses.

Acknowledgement

Authors sincerely thank Head of the Department and mentor Dr. D Sanyal and my parents for their encouragement and support.

References

1.
Gutierrez MA, Stimmel GL, Aiso JY. Venlafaxine: A 2003 update. Clinical therapeutics. 2003;25(8):2138-54. [crossref]
2.
Saberi A, Syed SA. Meningeal signs: Kernig’s sign and Brudzinski’s sign. Hospital Physician. 1999;35:23-26.
3.
Naranjo C, Busto U, Sellers E, Sandor P, Ruiz I, Roberts EA. Naranjo ADR probability scale. Clin Pharmacol Ther. 1981;30:239-45. [crossref] [PubMed]
4.
Troyer EA, Kohn JN, Hong S. Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. Brain, behavior, and immunity. 2020;87:34-39. [crossref] [PubMed]
5.
Chacko M, Job A, Caston F, George P, Yacoub A, Cáceda R. COVID-19-induced psychosis and suicidal behavior: Case report. SN Comprehensive Clinical Medicine. 2020;2(11):2391-95. [crossref] [PubMed]
6.
Desforges M, Le Coupanec A, Dubeau P, Bourgouin A, Lajoie L, Dubé M, Talbot PJ. Human coronaviruses and other respiratory viruses: underestimated opportunistic pathogens of the central nervous system. viruses. 2019;12(1):14. [crossref] [PubMed]
7.
Jacomy H, Fragoso G, Almazan G, Mushynski WE, Talbot PJ. Human coronavirus OC43 infection induces chronic encephalitis leading to disabilities in BALB/C mice. Virology. 2006;349(2):335-46. [crossref] [PubMed]
8.
Benros ME, Waltoft BL, Nordentoft M, Ostergaard SD, Eaton WW, Krogh J, et al. Autoimmune diseases and severe infections as risk factors for mood disorders a nationwide study. JAMA psychiatry. 2013;70(8):812-20. Available from: https//doi.org/10.1001/jamapsychiatry.2013.1111PubMed. [crossref] [PubMed]
9.
Lu S, Wei N, Jiang J, Wu L, Sheng J, Zhou J, et al. First report of manic-like symptoms in a COVID-19 patient with no previous history of a psychiatric disorder. J Affect Disord. 2020;277:337-40. [crossref] [PubMed]
10.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. [crossref]
11.
Varatharaj A, Thomas N, Ellul MA, Davies NW, Pollak TA, Tenorio EL, et al. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: A UK-wide surveillance study. Lancet Psychiatry. 2020;7(10):875-82. [crossref]

DOI and Others

DOI: 10.7860/JCDR/2022/54949.16297

Date of Submission: Jan 13, 2022
Date of Peer Review: Feb 07, 2022
Date of Acceptance: Apr 25, 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. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jan 15, 2022
• Manual Googling: Feb 07, 2022
• iThenticate Software: Mar 16, 2022 (7%)

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