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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
Acute Confusional State in a Neuropsychiatric Systemic Lupus Erythematosus Patient: A Case Report
Correspondence Address :
Sambhu Prasad,
Assistant Professor, Department of Psychiatry, All India Institute of Medical Sciences, Patna, Bihar, India.
E-mail: sambhu3011@gmail.com
Systemic Lupus Erythematosus (SLE) affects various systems in human including central and peripheral nervous systems. The Neuropsychiatric Systemic Lupus Erythematosus (NPSLE) is a severe complication of SLE which causes a formidable challenge in term of diagnosis and its management. Acute confusional state (delirium) is a rare entity of numerous symptoms of NPSLE which is being overlooked even though it is associated with increased mortality. The present case report describe about the presentation of SLE consisting of hyperpigmentation maculopapular rashes over face, neck regions, lower back and extremities in a 36-year-old female with abrupt onset and fluctuating course of psychotic symptoms, acute confusional state and oddities in behaviours. Treatment with low dose of antipsychotic (aripiprazole) resolve the symptom with due consideration taken to rule out steroid induced manifestation of above symptoms.
Antipsychotic treatment, Diagnostic challenge, Fluctuating thinking and behaviour oddities, Hyperpigmented maculopapular rashes
A 36-year-old female presented in the Dermatology Department with 8 months history of pain in multiple joints and intermittent low-grade fever. The pain was localised to joints, non radiating, mild to moderate grade in intensity, without any aggravating or relieving factors. Around 4 months back, she developed lesions over the exposed areas of the face, neck, lower back, and extremities. Lesions were hyperpigmented, involved the nose, and extended to bilateral malar areas, both the eyebrows, forehead, and chin sparing the nasolabial folds. She also developed thinning of frontal hair margin, hyperpigmented macule, and patches over the bilateral palm, hyperkeratotic plaques over the bilateral sole, erythema over nail folds in hand and feet (Table/Fig 1). Patient did not report of any similar illness in past or in family members.
On examination, she had a temperature of 99°F, pulse rate of 86/min, no pallor, icterus, cyanosis, clubbing, lymphadenopathy, blood pressure was 136/90 mmHg, respiratory rate was 24 cycles/min, clear heart sounds per abdominal examinations reveal no abnormality and no focal neurological deficits. The laboratory investigations showed mild anaemia (Haemoglobin was 7.6 gm/dL), Antinuclear Antibody (ANA) was positive (grade++++), urine analysis showed the presence of albumin 100 mg/dL (3+), 24 hour urinary protein showed 501.2 mg/day, Thyroid Stimulating Hormone (TSH) was 16.06 IU/mL, serum electrolytes were within the normal range (Table/Fig 2).
She was diagnosed with Systemic Lupus Erythematosus (SLE) with lupus nephritis and admitted to the Dermatology Ward for initiating immunosuppressive therapy including three consecutive days of intravenous methylprednisolone pulses (1,000 mg/day for three days). Followed by oral prednisone 0.5 mg/kg/day for 4 weeks and the dose was further tapered by 5 mg every other day each week to a dose of 0.25 mg/kg every other day or the minimal dose required to control extrarenal disease (1). On the second day of admission, she developed a low-grade fever, pain during swallowing food with a sudden change in behaviour (shouting, running, restlessness, making odd hand and facial gestures) for which psychiatric consultation was done. Pulse therapy was stopped due to the suspicion of steroid-induced psychosis and she was started on hydroxychloroquine 200 mg BD, azathioprine 50 mg BD, thyroxin 50 microgram/day, paracetamol 650 mg for control of pain.
On detailed evaluation by the Psychiatry team, she expressed suspicion of being mocked by villagers due to her skin lesions 10 days before getting admitted. For the last 2 days, she expressed her suspicion and fear of being killed by the people in the ward which was contrary to any evidence, had a fluctuating orientation to time, place, and person, showed hypervigilant behaviour, with worsening of symptoms in the evening. She had perplexed affect, incoherent speech and her thought content revealed persecutory delusion, fleeting in nature, and had a perceptual abnormality in the form of auditory hallucination commenting type with impaired recent and immediate memory. She was pre morbidly well-adjusted and had no significant past or contributory family history. She denied being treated for her psychiatric or medical conditions elsewhere. Diagnosis of delirium was made on basis of the above findings as per 10th revision of the International Classification of Mental and Behaviour Disorders (ICD-10) (2). Magnetic Resonance Imaging (MRI) of the brain was advised for identification of lesions associated with Neuropsychiatric Systemic Lupus Erythematosus (NPSLE) (like infarcts or myelopathy) and other differential disorders (like tumours or infections) which showed tiny diffusion bright foci in bilateral centrum semi ovale and parietal lobe gyri suggestive of vasculitis, reversible vasoconstrictive changes (Table/Fig 3).
Treatment was started with haloperidol 5 mg in divided doses which was gradually increased to 10 mg. There was an improvement in orientation and behavioural changes. After 1 week, her psychotic symptoms subsided. During treatment she developed tremors in tongue and hand, had decreased eye blinking, masked facies, rigidity and decreased arm swing during walking. On suspicion of Extra Pyramidal Symptoms (EPS) due to haloperidol, the dose was reduced to 5 mg/day and she was switched to aripiprazole 7.5 mg/day. After control of psychotic symptoms, she was given pulse therapy with dexamethasone 80 mg, and cyclophosphamide 500 mg for 3 consecutive days. When she did not have any active psychiatric symptoms, she was discharged on hydroxychloroquine 200 mg BD, azathioprine 50 mg OD, thyroxin 50 mcg/day and aripiprazole 7.5 mg/day which was tapered and stopped within 1 week. She was maintaining well during subsequent follow-up which was done initially weekly for a month then fortnightly and increased to monthly intervals.
The acute confusional state is one of the rare manifestations of NPSLE and it is associated with increased morbidity and mortality (3). The prevalence of acute confusional state in SLE reported to be round 4-7% (4),(5). It is a diffuse neurological dysfunction that is equivalent to delirium in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) and varies widely from mild confusion and disturbed attention to profound disorganisation with agitation and hallucinations (6). It occurs due to Central Nervous System (CNS) infection, metabolic changes, alteration of drug treatment etc., especially corticosteroids (7). Here, authors reported a case of delirium with SLE and discuss the challenges in its diagnosis and management.
There are many similar studies which found that identification of acute confusional state and differentiating it from psychosis in SLE remains a challenge and it also affects its management. Similarly, they also highlighted that the role of low doses of antipsychotic (risperidone, haloperidol, quetiapine) with steroids to tackle such entity as with our case (8),(9),(10),(11). If psychosis is identified, it is important to differentiate primary NPSLE from corticosteroid-induced psychosis. Corticosteroid-Induced Psychotic Disorder (CIDP) typically starts 5~14 days after initiation or after an increase in the dose of corticosteroid therapy, is dose-dependent, and regresses with steroid discontinuation (12). In the present case, as corticosteroid was given only for 1 day, it was likely that acute confusional state was not corticosteroid-induced. A strict differential diagnosis and individualisation of treatment depending on the neuropsychiatric presentation and severity of symptoms is crucial in the management of NPSLE. If NPSLE is severe (acute confusional state, seizures, encephalitis), it should be treated with immunosuppressive drugs. However, the challenge of using corticosteroid or pulse therapy is Corticosteroid-Induced Psychiatric Disorder (CIPD) (13).
A great degree of expertise and clinical skill is needed for identification of acute confusional state as an initial manifestation of NLSLE or its treatment so that it is not falsely attributed to a psychiatric symptoms and medical treatment will be foregone. Various symptoms of delirium as disorganised thinking may overlap the core symptoms of psychosis leading to bias in diagnosis and its management as in our case. Thus, early recognition and timely treatment of such entities is important for reducing mortality and morbidity.
DOI: 10.7860/JCDR/2022/52527.16334
Date of Submission: Sep 22, 2021
Date of Peer Review: Dec 16, 2021
Date of Acceptance: Jan 12, 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: Sep 23, 2021
• Manual Googling: Dec 15, 2021
• iThenticate Software: Mar 31, 2022 (11%)
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