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
Unusual Presentation of Aplastic Anaemia: Evolving into Myelodysplastic Syndrome with Excess Blasts 1 and Type III Paroxysmal Nocturnal Haemoglobinuria Clone
Correspondence Address :
Tathagata Chatterjee,
Professor and Head, Department of Immunohaematology and Blood Transfusion, ESIC Medical College and Hospital, Blood Bank, Faridabad, Haryana, India.
E-mail: ctathagat@hotmail.com
Aplastic Anaemia (AA) is an immune mediated, primary haematopoietic disorder characterised by pancytopenia with significant morbidity and mortality. Allogeneic Haematopoietic Stem Cell Transplant (HSCT) is the treatment of choice in younger patients whenever Human Leucocyte Antigen (HLA) matched donor is available. For older patients and those in whom matched donor is not available, immunosuppressive therapy is the frontline treatment. With the long survivals of AA patients, clonal evolution into Myelodysplastic Syndrome (MDS) and clinically evident Paraoxysmal Nocturnal Haemoglobinuria (PNH) is frequently seen over a period of 5-10 years. The prognosis and overall survival of post AA, MDS is poor and the only treatment of choice is Allogeneic HSCT. The overall survival of post AA, MDS is however comparable to de novo MDS post-transplant. The authors hereby discuss a case of 26-year-old male patient, known case of AA who evolved into MDS with Excess Blasts 1 (MDS-EB-1) and type III PNH clone over a period of six years.
Haematopoietic stem cell transplant, Human leucocyte antigen, Immunosuppressive therapy, Pancytopenia
A 26-year-old male patient, known case of Aplastic Anaemia (AA), diagnosed at All India Institute of Medical Sciences (AIIMS), New Delhi in April 2014, presented with weakness and fatigability in September 2021. In 2014, patient had pancytopenia with haemoglobin of 6.1 g/dL, Total Leucocyte Count (TLC) of 3000/mm3 and platelet count of 70,000/mm3. Bone Marrow Biopsy (BMB) showed a patchy cellularity of 15-20% with increased lymphocytes and plasma cells. Patient received Immunosuppressive Therapy (IST) with cyclosporine and 20-25 units Packed Red Blood Cells (RBCs). He had an uneventful disease progression from year 2016-2019.
In January 2020, patient started having complaints of fatigability and weakness. He underwent Bone Marrow Aspirate (BMA) and biopsy in September 2020 which revealed patchy cellularity of 15-20% with increased lymphocytes and plasma cells. BMA revealed 2% blasts with myeloid to elytroid (M:E) ratio of 1:3 and increased iron deposition (Grade 4).
He eventually came to our hospital for allogeneic HSCT with a clinical diagnosis of AA in September 2021. He had a fully matched donor with 6/6 HLA matching from his sister. The authors advised a fresh BMA and BMB. His haemoglobin at this point was 3.7 g/dL, TLC was 2500/mm3 and platelet count 13,000/mm3. BMA was adequate with 50% cellularity and 7% blasts and M:E ratio of 2:1 (Table/Fig 1). Dysmegakaryopoiesis was noted in the form of micromegakaryocytes and hypolobated megakaryocytes. BMB (Table/Fig 2) demonstrated similar findings with presence of blasts in the paratrabecular spaces, which showed membranous positivity for CD34 and membranous and cytoplasmic positivity for CD117 (Table/Fig 3),(Table/Fig 4). Final impression was AA converted to MDS with excess blasts-1 (MDS-EB-1), World Health Organisation (WHO) 2016 classification (1).
The authors also got Fluorescein-labeled proaerolysin (FLAER) test for detection of Paroxysmal Nocturnal Haemoglobinuria (PNH) clone and immunophenotyping by flow cytometer along with cytogenetics study for MDS. FLAER was positive for type III PNH clone. Flow cytometer revealed the blasts to be positive for Cluster of Differentiation (CD)45, HLADR, CD13, CD33, CD14, CD64, CD11b with aberrant expression of CD7 and cytoplasmic CD3 (cCD3). Cytogenetics by Fluorescence in-situ Hybridisation (FISH) showed positivity for deletion (del) 7q; del 5q, del 20q and trisomy 8 were found to be negative. Overall impression was AA converted into MDS-EB-1 with del 7q and type III PNH clone.
Patient was taken up for allogeneic HSCT with reduced-toxicity conditioning regimen with treosulfan, fludarabine and grafalon (ATG). He was transfused with stem cell harvest on day six with the CD34 dose being 6 million/Kg body weight. Daily hologram and biochemical parameters were done. Patient received cyclosporine 150 mg twice a day and is under constant supervision and regular cyclosporine levels were monitored. He was engrafted on day 10 and it has been more than 100 days now post-transplant.
The patient in the present case report, was diagnosed with AA in 2014 at a young age of 19 years with a fully matched donor. After an uneventful duration of three years, there was clonal evolution into MDS. The case highlights the importance of early HSCT which has a five years overall survival approaching 82% in patients <20 years of age. This case also highlights the importance of identifying patients of AA, not responding to IST for early intervention and allogeneic HSCT even if a fully matched donor is not available. AA is an immune mediated, primary haematopoietic disorder characterised by pancytopenia with significant morbidity and mortality (2). The incidence of AA is much more in South Asian countries compared to the West (3). The main modalities of treatment for AA include optimised supportive treatment, Haematopoietic Stem Cell Transplant (HSCT) and IST. HSCT is the treatment of choice for paediatric and young patients whenever HLA matched donor is available. For older patients and patients in whom matched donor is not available, IST with cyclosporine or Anti-thymocyte Globulin (ATG), is the frontline treatment (4). AA patients, especially the ones on IST are likely to show clonal evolution into MDS in 5-20% cases over a period of 5-11 years (5),(6),(7). Association of AA with PNH clones is well established and clinically evident PNH is seen in 15-25% cases of AA (5),(6). With the long survival, the progression of AA to MDS has been reported to be 10-15% in some studies and 7% to Acute Myeloid Leukaemia (AML) within 10 years, especially those on IST. More than 50% cases of AA acquire PNH clones lacking surface Glycosylphosphatidylinositol (GPI)-linked proteins (5),(6),(7),(8). Recent data has shown genetic abnormalities in upto 50% patients with acquired AA, involving genes commonly mutated in myeloid malignancies (5).
The development of MDS/AML in AA is associated with a dismal prognosis and allogeneic HSCT is the only mode of treatment for such patients. Post AA, MDS patients behave similarly as de-novo MDS patients post-transplant with respect to overall survival, relapse rate and relapse free survival (9). Cytogenetic is the only independent prognostic factor in both the group (9).
Approximately 3-26% AA patients show cytogenetic changes, of which numerical or structural abnormality of chromosome 7 is the most common, accounting for almost 40% (10). In the setting of AA, monopsony 7 is associated with worse prognosis and poor response to IST and increased progression to MDS, while del (13q) and trisomy 8 are associated with an improved response to IST and a better prognosis (5),(8). In the presently discussed case, deletion 7q was detected which is associated with poor response to IST and increased rate of progression to MDS. However cytogenetic studies were done after evolution into MDS and not when primary diagnosis of AA was made. The pathophysiology of MDS as clonal evolution in AA patients may be secondary to immune regulation, possibly heightened by IST and immunomodulators used during the disease course (6).
Allogeneic HSCT is the only mode of increasing the patient survival for cases that have developed MDS/AML. Cytogenetic evaluation should be done in AA patients at the time of diagnosis itself as abnormalities in chromosome 7 are associated with poor prognosis.
DOI: 10.7860/JCDR/2022/56765.16749
Date of Submission: Mar 30, 2022
Date of Peer Review: Apr 18, 2022
Date of Acceptance: May 19, 2022
Date of Publishing: Aug 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: Apr 06, 2022
• Manual Googling: May 17, 2022
• iThenticate Software: Jul 11, 2022 (6%)
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