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
Original article / research
Full Version
Prognostic Value of Long Corrected QT Interval on Electrocardiogram in Acute Organophosphate Poisoning: A Cohort Study
Correspondence Address :
Dr. Archana Gandhi,
A/47, Sankheshwarnagar, Near AIR, Makarpura Road, Vadodara-390009, Gujarat, India.
E-mail: draug20@gmail.com
Introduction: According to data available from National Poison Information Centre India, suicidal poisoning with household agents (organophosphates, carbamates etc.) is the most common modality of poisoning. There are reports suggesting relationship between prolonged corrected QT interval and the severity of Organophosphate (OP) poisoning. Corrected QT (QTc) interval is measured in 12 lead electrocardiograms taken on admission.
Aim: To assess prognosis of acute organophosphate poisoning patients by studying association of corrected QT interval with its complications and mortality.
Materials and Methods: The cohort study was conducted at Medicine Department of Medical College, Baroda and Sir Sayaji General Hospital, Vadodara, Gujarat, India, from December 2017 to November 2018. The study included 60 patients with a history of OP poisoning. The QTc interval in electrocardiogram was determined by using the Bazett formula. Prognostic importance of QTc interval was assessed by correlating it with Paradeniya Organophosphorus Poisoning Scale score, hospital stay, atropine requirement, requirement of ventilatory support and mortality. Data was analysed by using descriptive statistics and Chi-square test.
Results: The organophosphate poisoning was seen more in younger age group, between 18-29 years (68.4%). The QTc prolongation was seen in 12, 80% of patients in moderate grade of Paradeniya Organophosphorus Poisoning Scale and in 9 (20%) patients among mild grade of Paradeniya Organophosphorus Poisoning Scale (p-value=0.0001). Amongst patients who needed hospital stay for more than 7 days, QTc prolongation was seen in 43% of patients, and in patients who needed hospital stay for less than 7 days QTc prolongation was seen in 9% of patients (p-value=0.0223). Statistically significant association was seen between atropine ampule requirement and QTc prolongation. Total 29 (48.3%) patients developed respiratory depression, and amongst them 19 (65.5%) had QTc prongation (p-value <0.0001). Thirteen (22%) patients died and amongst them 12 (92.31%) had QTc prolngation. In those who survived (47,78%) only 9 (19.15%) had QTc prolongation (p-value <0.0001).
Conclusion: Prolonged QTc interval in electrocardiogram is a good prognostic indicator in patients with organophosphorus poisoning. Early identification of prolonged QTc interval and subsequent timely shifting of patients to Intensive Care Unit (ICU) and subsequent intensive management in a patient of OP poisoning would be of profound value at any level of health care setting for favourable outcomes.
Atropine, Hospital stay, Paradeniya organophosphorus poisoning scale, Respiratory depression
Poisoning with organophosphorus compound is a global problem. World Health Organization estimates that one million serious unintentional poisonings occur every year and an additional two million people are hospitalised for suicide attempts with pesticides (1).
India is a predominantly agricultural country where pesticides and insecticides are routinely used for farming and access to these poisonous chemical substances by the population is easy. According to National Poison Information Centre India, suicidal poisoning with household agents is the most common modality of poisoning (2). Official data of National Crime Records Bureau for 2020 suggest that 25% of total officially recored suicides in India’s (1,53,052) were due to ingestion of poison (2).
Presently, organophosphates are one of the most widely used insecticides world over. Acute poisoning with these compounds is much more dangerous and necessitates emergency medical support. Pharmacological effects of organophosphate compounds are primarily due to prevention of hydrolysis of acetylcholine by acetylcholinesterase. Thus acetylcholine acts for an excessively longer time, causing symptoms.
Prognosis of organophosphate poisoning can be determined by various clinical parameters like amount of poison ingested, Glasgow Coma Scale score, respiratory paralysis, duration of coma and biochemical markers like plasma cholinesterase and red cell acetyl cholinesterase activity (3),(4),(5). Peradeniya Organophosphate Poisoning scale (POP scale) is scoring system where 5 clinical manifestations of OP Poisoning are selected as parameters and severity of poisoning assessed on that (5). It becomes very difficult to know and rely on history about the amount of poison ingested. Respiratory paralysis and deterioration in consciousness may not be present in early phase. Categorisation of OP patients by POP score requires medical expert’s eye and observation. Therefore, it is of paramount importance to identify prognostic parameter that is easy and reliable for patients of OP poisoning.
There are publications that found a relationship between prolonged corrected QT (QTc) interval and the severity of poisoning (6),(7),(8),(9). Corrected QT interval is measured in 12 lead electrocardiograms taken bedside. This study aimed to assess prognosis of acute organophosphorus poisoning by corrected QT interval and its association with complications and mortality of organophosphate poisoning patients.
The cohort study was conducted at Medicine Department of Medical College, Baroda and Sir Sayaji General Hospital, Vadodara, Gujarat, India, from December 2017 to November 2018. Permission of institutional ethics committee was taken before starting the study (EC Reg No: ECR/85/Inst/GJ/2013/RR-16). Total 60 patients were included in the study.
Inclusion criteria: Patients with organophosphorus compound intoxication were included in the study.
Exclusion criteria: Patients with diabetes mellitus, documented heart disease, renal failure, respiratory disease, hepatic failure and electrolyte imbalance, ingestion with other agents and treatment taken from other medical centre before admission in SSG Hospital were excluded from the study.
Data collection: Age, gender, occupation, routes of exposure, intention of ingestion, compounds involved and presenting complaints like giddiness, vomiting, excessive salivation, lacrimation, altered sensorium, convulsion were noted at the time of admission. Thorough examination was done with special emphasis on cholinergic features like pinpoint pupils, excessive salivation, lacrimation and fasciculation. Routine blood investigations and serum cholinesterase levels were checked in all patients.
Bazett formula: Bedside 12 leads Electrocardiogram was done on admission and corrected QT interval was counted by Bazett formula as below (10).
(QTc= Corrected QT interval, QTc prolongation considered in Male >0.44 sec and in Female is >0.46 sec.)
Peradeniya organophosphorus poisoning scale: Severity of Organophosphorus poisoning was graded as mild, moderate and severe as per Peradeniya Organophosphorus Poisoning scale (POP scale) which includes size of pupil, presence of fasciculation, respiratory rate, and pulse rate, level of sensorium and presence or absence of seizures (11).
Patients were followed-up daily during indoor admission up to discharge or expiry. Complications like respiratory depression, convulsion, altered sensorium, hypotension, sudden cardiac arrest, arrhythmias and need for ventilator support were noted. Outcome was assessed based on days of hospital stay, total atropine dose requirement, ventilator support and mortality.
Statistical Analysis
All data was analysed in 60 patients by using descriptive statistics frequency, percentage, Chi-square test. A p-value <0.05 was considered significant. Data was entered in Microsoft Excel sheet and analysed by using Epi Info™ software.
In the present study, the maximum prevalence of OP compound ingestion was in age group between 18-29 years (68.4%). Male and female patient ratio was 1.1:1 (Table/Fig 1). Amongst 60 patients recruited in the study, 21 (35%) had prolonged QTc interval on electrocardiogram. There was no statistically significant association between age and QTc interval prolongation, as well as gender and QTc interval prolongation. Fifteen (25%) patients presented 6 hours after exposure to OP compound and amongst them QTc prolongation was seen in 14 (93.33%) patients, only 15.56% patients had QTc prolongation amongst 45 patients who presented within 6 hours of exposure (p-value <0.0001).
As per the POP scale, 45 (75%) patients were in mild category, 15 (25%) in moderate category and no patient in severe category. QTc prolongation was seen in 80% of patients of moderate category, whereas only in 20% of patients of mild category (p-value=0.0001) (Table/Fig 2).
The total number of atropine required during treatment was between 11-100 ampules in 46 (77%) patients, followed by 101-200 ampules in 8 (13%) patients. Only 2 (3%) patients required >200 ampules of atropine. Amongst 8 patients who required 101-200 atropine ampules (60-120 mg atropine) QTc prolongation was seen in 7 (87.5%) patients and both two patients who required more than 200 atropine (120 mg) ampules had QTc prolongation (p-value=0.0011, Chi-square test). This suggests that patient with QTc prolongation required high atropine dose during treatment than the patient who had normal QTc in patients of OP poisoning (Table/Fig 3).
Amongst 33 patients who were discharged within 7 days, only 9% had QTc prolongation. Amongst 14 patients who required hospital stay of more than 7 days, QTc prolongation was seen among significantly higher number of patients (43%) (Table/Fig 4).
Most common complication was respiratory depression (48.3%) which led to need for ventilatory support (48.3%), followed by altered sensorium (38.3%), and hypotension (21.7%). There was statistically significant association of complications of respiratory depression, ventilator requirement, altered sensorium and hypotension with QTc prolongation on ECG (p-value <0.0001) (Table/Fig 5). Complications like convulsion, sudden cardiac arrest and acute kidney injury were recorded in 1 (1.7%), 1 (1.7%) and 3 (5%) patients only and so association with QTc prolongation could not be established for these complications. Arrhythmias were not documented in any patients so association of QTc with arrhythmia also could not be established.
In the present study, out of 60 patients, 47 (78%) patients survived and 13 (22%) patients died. Amongst 13 patients who died, 12 (92.31%) had prolonged QTc in ECG on admission (p-value <0.0001) (Table/Fig 5).
Organophosphates are frequently used pesticides which can lead to life threatening intoxication. All these compounds act by irreversible inhibition of Acetylcholinesterase (Ach). The clinical symptoms range from classical cholinergic syndrome to flaccid paralysis and seisures. Patients with history of OP ingestion can present at any level of health care setting like primary health centre, community health centre or tertiary care centre. There is an urgent need to identify patients who need urgent referral to tertiary care centre and prompt admission and intensive management in critical care unit. In the present study, authors aimed to assess association of prolonged QTc interval in bedside ECG taken on admission with various prognostic parameters.
To conclude present study, no association of QTc prolongation in OP poisoning patients with age and gender of patients was found. Shadnia S et al., also observed the similar results (8). Patients who presented after 6 hours of exposure of OP compound, QTc interval prolongation was seen in majority of patients in the present study.
For OP compound poisoning Senanayake N et al., proposed POP scale for grading the severity of poisoning based on five cardinal manifestations which includes pupil size, respiratory rate, fasciculation, pulse rate, level of consciousness (11). They found correlation between POP scores obtained on admission and three outcome variables, namely, death, the need for ventilatory support and the dose of atropine required were significant and so proposed that this score can be used for grading severity on first contact and predict possible outcomes in patients with OP intoxication. In the present study, patients with OP intoxication were graded as mild, moderate and severe as per POP scale on admission. It was found that QTc prolongation in ECG taken on admission had significant association with severity of OP poisoning graded as per POP scale (p-value=0.0001). Similar findings were reported by Tripathy SK et al., (12).
Total number of atropine required ranged from less than 10 ampule (6 mg) to more than 200 ampule (120 mg) during hospitalisation. Patients who required more than 100 ampule i.e. 60 mg of atropine, 90% had QTc prolongation in ECG taken on admission. So correlation between QTc prolongation in ECG and atropine requirement was significant in this study. Shadnia S et al., also found that higher atropine dose is required in patients with QTc prolongation (8).
In the present study, it was observed that majority of the patients who needed hospital stay for more than 7 days had QTc prolongation against those who needed hospital stay for less than 7 days. A similar observation was also seen in study done by Shadnia S et al., (8).
Most common complication found was respiratory depression (48.3%), chest excursion and single breath count, which led to need for ventilatory support (48.3%). Other complications found were altered sensorium (38.3%) and hypotension (21.7%). Association between QTc prolongation and respiratory depression, need for ventilatory support, hypotension and altered sensorium were statistically significant (p-value <0.0001). Tripathy SK et al., also observed significant association of QTc prolongation with respiratory failure (p-value <0.0001) (12).
In the present study, 22% mortality was observed, whereas, Shadnia A et al., observed 35.7% mortality and Tripathy SK et al., observed 10% mortality in their patients (8),(12). QTc prolongation had significant association with mortality of patients in the present study, and in study by Shadnia A et al., and Tripathy SK et al., (8),(12).
Limitation(s)
Sample size was small. QTc interval was counted in Electrocardiogram, done on admission. Changes in QTc interval in subsequent days was not studied.
Identification of QTc interval prolongation in bedside ECG taken on admission of patients with OP compound intoxication has prognostic implication. Therefore, timely shifting of patients with QTc interval prolongation in bedside ECG to a tertiary care centre with critical care facility is of utmost importance. Continuous monitoring, intensive treatment and administration of atropine in adequate dosage in very early course of treatment is also of vital importance in patients of organophosphates intoxication with QTc prolongation in ECG.
DOI: 10.7860/JCDR/2022/53737.16697
Date of Submission: Jan 30, 2022
Date of Peer Review: Mar 03, 2022
Date of Acceptance: May 23, 2022
Date of Publishing: Aug 01, 2022
Author declaration:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• 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: Feb 02, 2022
• Manual Googling: May 21, 2022
• iThenticate Software: Jul 09, 2022 (12%)
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