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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
Malignant Hypertension Leading to Non Arteritis Anterior Ischaemic Optic Neuropathy-Unilateral Involvement an Exigency
Correspondence Address :
Dr. Ruchita Kabra,
Junior Resident, Department of Medicine, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
E-mail: ruchitapkabra@gmail.com
Non arteritis Anterior Ischaemic Optic Neuropathy (NAION) is mentioned as loss of blood supply to the optic nerve further causing sudden onset and painless vision loss in eye. Exact mechanism, leading to reduced or loss of flow of blood to an optic nerve in NAION, is unknown but there are certain risk factors responsible for NAION like diabetes, malignant hypertension, Hypercholesterolaemia, platelet polymorphism, phosphodiesterase inhibitors, hyperhomocysteinemia, nocturnal hypotension, sleep apnea, contribute to it. This case report is about a 40-year-old patient who presented with a complaint of sudden onset vision loss in one eye which was further diagnosed as NAION on fundus examination. This shows association of malignant hypertension and NAION. Early diagnosis of the condition led to complete recovery of vision loss. Early management of blood pressure and timely management of NAION using antihypertensives and steroids in this patient found to be fruitful and patient regained his vision back.
Antihypertensive, Blood pressure, Vision
A 40-year-old male patient visited the Outpatient Department with complaint of sudden loss of vision in his left eye, noticed since morning. Vision loss was painless in nature. Patient specifically complained of loss of vision particularly in inferior half portion of left eye. On inquiring, he had no complains of floaters, sudden flashes of light, headache, giddiness, light or noise intolerance, pain on eye movements. He was not known to have co-morbidities like hypertension, diabetes mellitus, bronchial asthma, tuberculosis or any chronic systemic disorder or any medications.
On examination, the patient was conscious and oriented. His were recorded, pulse was 90 beats/min (regular, high volume), blood pressure was 240/146 mmHg, respiratory rate was 18/min. Cardiovascular system examination revealed normal S1, S2 heart sounds, no S3 or any murmur, respiratory and abdominal system revealed no abnormality, Neurological examination was done and was normal. In view of hypertensive emergency, the patient was given injectable labetalol 20 mg intravenous followed by 40 mg, he was monitored for his vitals and Blood Pressure (BP) was monitored at regular interval. Once the BP was normal, he was started on oral antihypertensives like tab. amlodepine 5 mg twice a day, tab. telmisartan 40 mg twice a day, tab. prazosin 5 mg twice a day, tab. metoprolol 50 mg twice a day.
To rule out further complications of malignant hypertension, the patient was evaluated for ophthalmic examination, Electrocardiogram (ECG), 2D Echocardiogram, Magnetic Resonance Imaging (MRI) of brain, chest radiograph.
On ophthalmic examination, his best corrected visual acuity was 6/9 in two eyes, colour vision was normal in both eyes with inferior vision loss in left eye with no rapid afferent pupillary defect. Fundus examination with indirect ophthalmoscope showed disc pallor, arteriolar attenuation at posterior pole and retinal pigment epithelium alteration at macula in right eye (Table/Fig 1). Optic disc oedema with pallor, more superiorly than inferiorly with arteriolar attenuation was seen in the left eye (Table/Fig 2). Visual field testing showed inferior altitudinal field defect in left eye (Table/Fig 3).
The ECG was suggestive of left ventricular hypertension (Sokolow-Lyon criteria) (1). The 2D Echocardiogram was suggestive of left ventricular hypertrophy with increased thickness of the posterior wall and septum. Chest radiograph showed displacement of cardiac apex to lateral and downward and rounded appearance of cardiac apex also called as “Shmoo sign” (Table/Fig 4). The Brain showed chronic lacunar infarct in right side of pons. Laboratory investigations are presented in (Table/Fig 5).
The patient was diagnosed to have malignant hypertension causing unilateral non arteritic ischaemic optic neuropathy on the second day of admission. The patient was continued with oral medications to control his blood pressure and regular monitoring of blood pressure was done.
On day 5 of admission, BP was controlled, patient was given injectable methylprednisolone 1 gm in 100 mL normal saline once a day for 3 days for the treatment of NAION. Ophthalmic examination was done daily to look for further progression of the disease and it showed no progression. After 6 days of hospital stay, patient was discharged. Blood pressure on discharge was 130/80 mm Hg. Patient was on four antihypertensive drugs on discharge (tab. amlodipine 5 mg twice a day, tab. telmisartan 40 mg twice a day, tab. prasosin 5 mg twice a day, tab. metoprolol 50 mg twice a day).
Non arteritic Anterior Ischaemic Optic Neuropathy (NAION) is referred as loss of blood flow to the optic nerve which can lead to sudden painless loss of vision in one eye. It is called “non-arteritic” because there is decreased blood flow and without any true inflammation of vessel. It is called “anterior” as reduced blood flow to optic nerve occurs in most front part of the nerve. It is called “ischaemic” because injury is because of reduced blood supply. It is called “optic neuropathy” because it is an injury to the optic nerve. Optic nerve ischemia may occur at different locations along the course and it is related to various causes which differentiates these syndromes by their causes and different locations and their signs and symptoms along with treatment and outcome also varies (2).
By definition, Anterior Ischemic Optic Neuropathy (AION) shows involvement of first 1 mm part of the head of optic nerve which is also called as optic disc, and which can be seen as visible disc swelling. The AION is of two types i.e., arteritis and non arteritis (3). Arteritis type of AION always occurs in association with giant cell arteritis. Non arteritis type of AION are mostly idiopathic but some of them showed specific causes such as malignant hypertension.
The majority of cases of AION are non arteritis type (4). Non arteritis AION is the commonest cause of acute onset neuropathy of optic nerve in patients of age more than 45. Men and women are nearly equally affected (5),(6).
The pathogenesis of non arteritis AION is controversy as not a single mechanism is perfectly illustrated. It is assumed that it results from ischemia or infarct, within the retrolaminar portion of the proximal part of optic nerve head which is supplied by the short branch of posterior ciliary arteries (7),(8),(9). Majority of patients suffering from NAION has small optic discs which measures less than 0.3 mm, which is referred to as crowded disc and prone for ganglion cell death (10),(11),(12),(13),(14). The optic nerve head can autoregulate the blood flow (15). Risk factors like vasospasm or medications or hypertension or arteriosclerosis may decrease the optic disk capacity to autoregulate the blood flow (16),(17).
By definition, malignant hypertension is an acute onset rise of blood pressure that is systolic BP more than/ equals to 180 mmHg and/or diastolic BP more than/ equals to 120 mmHg with diffuse necrotising vasculitis, arterial thrombi and fibrin deposition in arterial wall, which clinically can be recognised with papilledema (18). Malignant hypertension may result because of kidney dysfunction, autonomic dysfunction or non compliance to medications. Ocular involvement of malignant hypertension may include retinopathy, with constriction of arteriole, retinal haemorrhages, cotton wool spots, or disc oedema in severe involvement.
Hypertensive optic neuropathy is a late manifestation of malignant hypertension. Main difference between accelerated hypertension and malignant hypertension is papilledema-papilledema is present in malignant hypertension and absent in accelerated one. Optic disc edema is a commonly detected in patients of malignant hypertension. The cause behind optic disc edema is variable. It may be due to raised intracranial tension or ischemia at the optic nerve head (19),(20).
Malignant hypertension is associated with acute onset involvement of end-organs which leads to end-organ damage. This includes eye involvement leading to retinopathy, brain involvement leading to encephalopathy, intracranial haemorrhage, renal involvement leading to renal failure, large vessel involvement leading to aortic dissection (21), rupture of an abdominal aneurysm (22), cardiac and respiratory involvement leading to increased pressure in pulmonary veins ultimately leading to pulmonary oedema, and acute myocardial infarction (23). These patients require urgent hospitalisation, early diagnosis and early management. Within few months, changes in fundus due to raised blood pressure revert back, but there may be some irreversible loss of vision occurring due to irreversible injury to vascular supply leading to vascular shutdown (19).
Simultaneous involvement of bilateral NAION is rare. Simultaneous involvement of eyes due to NAION leads to vision loss in both eyes. Simultaneous involvement occurs because first eye involvement remains unnoticed unless and until second eye is involved. This case report shows unilateral involvement of eye due to NAION secondary to malignant hypertension. Early diagnosis of the condition lead to early treatment and halt the progression of the disease.
DOI: 10.7860/JCDR/2022/55673.16716
Date of Submission: Feb 13, 2022
Date of Peer Review: Mar 21, 2022
Date of Acceptance: May 18, 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: Feb 19, 2022
• Manual Googling: Apr 27, 2022
• iThenticate Software: Jul 12, 2022 (5%)
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