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

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On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
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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.
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Aug 2018

Dr. Rajendra Kumar Ghritlaharey

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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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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)
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.
On April 2011

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
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : September | Volume : 16 | Issue : 9 | Page : KD01 - KD03 Full Version

Advancing Pulmonary Rehabilitation Approach in Improving Well-being in a Long COVID-19 Syndrome Case

Published: September 1, 2022 | DOI:
Pallavi Rajeshwar Bhakaney, Vishnu Vardhan

1. Resident, Department of Cardiorespiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India. 2. Professor and Head, Department of Cardiorespiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India.

Correspondence Address :
Dr. Vishnu Vardhan,
Meghdoot Apartments, Sawangi (M), Wardha, Maharashtra, India.


Being a highly contagious disease, Coronavirus Disease-2019 (COVID-19) has shown its impact throughout the world. Clinical manifestations are seen primarily involving the respiratory system. Fever, cough, fatigue, and breathlessness are the commonly seen symptoms. Several cases of COVID-19 manifest as viral pneumonia-induced Acute Respiratory Distress Syndrome (ARDS). COVID-19 symptoms appear not only during the course of the illness but also as its after effects. Long COVID-19 is said to be multisystem syndrome, categorised as postacute or chronic depending upon the time frame. It is characterized by the presence of symptoms beyond four weeks of the actual disease. Change in structural components in the lung leads to having a functional consequence on the body, affecting the cognitive, psychosocial, mental and physical well-being of the patients. Studies have shown alveolar damage same as ARDS. The most common pulmonary sequences seen are dyspnoea, cough (dry/with expectoration) and decreased diffusion capacity leading to reduced endurance. The present case report was of a 45-year-old nurse, who presented with the symptoms of postacute long COVID-19. Her previous scan of thorax showed a severity score of 11/25 after being tested COVID-19 positive. In view of the presenting complaints, a tailor-made pulmonary rehabilitation program was administered which showed great improvement in overall health condition. This case had been reported to document the effects of post COVID rehabilitation program on aspects such as functional capacity, quality of life, anxiety and depression using novel measures such as Incremental Shuttle Walk Test (ISWT), World Health Organisation Quality of Life-Brief Version (WHOQOL-BREF), and Depression, Anxiety and Stress Scale - 21 Items (DASS-21). Rehabilitation has been proven to be effective and safe in improving the exercise performance, quality of life affected due to COVID-19 and psychological function of the patients.


Aerobic training, Exercise, Functional independence, Respiratory function

Case Report

A 45-year-old female patient, a nurse by occupation came to the COVID rehabilitation centre with complaints of intermittent joint pain, fatigue, tiredness in doing activities of daily living and trouble sleeping for seven days. She was a known case of hypertension for five years and used to take tablet Amlodipine Additionally, reported a history of being COVID-19 positive one month ago with symptoms like breathlessness, sudden morning chest pain with palpitations and low saturation level and hypoxia on room air. Previous laboratory data available with the patient from the time of hospitalisation is shown in (Table/Fig 1) (1),(2). After the discharge of the patient from the hospital the above mentioned values came to a normal range and the patient got stable haemodynamically. High Resolution Computed Tomography (HRCT) thorax was done at first when the patient arrived to the hospital. Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test was done and it came out to be positive and was suggestive of multiple ill-defined patchy ground-glass opacities with septal thickening and consolidation in bilateral lung fields imaging grading is COVID-19 Reporting and Data System (CORAD-6) (3) with a severity score of 11/25 as shown in (Table/Fig 2).

The patient was hospitalised immediately and started on antibiotics, prednisolone, antiplatelet, nebulisation and other multivitamin supplements. The patient was put on a face mask with 10 litres of O2 as she was inefficient in maintaining oxygen saturation at room air. After a stay of 20 days in the hospital, the patient was discharged as she got symptomatically better. A home exercise regime was given at the time of discharge to be done for six weeks. The home exercise regime consisted of patient education, where the patient was educated about lifestyle, to be active, to take a nutritional diet and to be involved in social activities. Exercises like huffing and coughing techniques, breathing exercises, and thoracic expansion exercises were also included.

The patient came for physiotherapy rehabilitation with complaints of dyspnoea, early fatigue, joint pain and decreased lung capacity. The patient was educated about her present condition, the effects of long COVID-19 and its impact on functional capacity and quality of life. On examination, the patient was haemodynamically stable. Observation showed that the patient was minimally restless and using accessory muscles while breathing. The detailed evaluation included basic vital signs- Heart rate (HR) - 88 bpm (beats per minute), Blood pressure (BP) - 120/90 mmHg, Oxygen saturation (SpO2) - 97% on room air, and the temperature was febrile with 39.5°C. The degree of dyspnoea was 2 on the Modified Medical Research Council (MMRC) dyspnoea scale (4). Auscultatory findings revealed reduced air entry at bilateral lower zones. The systemic evaluation was followed by a functional assessment. DASS-21 (5) and WHOQOL-BREF (6) scales were filled by the patient, in order to assess the level of anxiety and depression and affected quality of life post-COVID. An ISWT was performed by the patient under supervision to assess the exercise capacity on a 9-meter track (7).

After thorough assessment, a tailor-made exercise protocol was prescribed. The exercise regime focused on relieving dyspnoea, inducing relaxation and improving the functional capacity of the patient so as to reduce fatigue. The intervention program consisted of 12 treatment sessions which were supervised. The exercises were planned according to the Frequency, Intensity, Time, Type (FIIT) principle (8). Wherein the frequency was three times a week, with 30-60 minutes of exercises including warm-up, aerobic exercise, and cool-down (as tolerated by the patient).

The interventions were started with breathing exercises along with a range of motion exercises. Pursed lip breathing, diaphragmatic breathing and segmental breathing along with relaxation techniques like Jacobson’s relaxation were taught to the patient and instructed to be done every four hours. The patient was educated about the effects of bad posture and explained why it has to be avoided. The patient was encouraged to incorporate postural correction techniques along with energy conservation to improve the efficiency of patient care at the workplace. However the patient had complete control over the frequency of exercises in order to prevent a decrement in the training effect. The patient required oxygen support during the first three exercise sessions which were recorded as three litres in the first two sessions and two litres in the 3rd session, followed by no oxygen support in the later weeks as pacing techniques were indulged in the exercise program. An incentive spirometer device was given so as to indulge sustained maximal inspiration with a set of 4 of 10 repetitions. Aerobic exercise was aimed at walking as tolerated by the patient, followed by a phase of cool-down, including stretching exercises for major muscle groups of the upper and lower limbs. The rehabilitative intervention also included psychological support. Motivation when required and promoting self-care were addressed during the intervention. The effectiveness of the program was recorded on the basis of outcome measures.

Outcome measures used included Numerical Pain Rating Scale (NPRS), DASS-21, WHOQOL-BREF and ISWT scale (5),(6),(7). WHOQOL-BREF scale interpretation involved transforming the raw score of the scale into a transformed score, converting it to a range of 0-100 (6). The normal value for the ISWT for the age of 42 years is 624 meters approximately (7). Improvement was seen in patient’s health in the course of rehabilitation as shown in (Table/Fig 3). The course of hospitalisation was briefly recorded as shown in (Table/Fig 4).


The novel coronavirus has threatened the human population (9). Not only are those with co-morbidities more prone to getting the infection but even those with no co-morbidities can also suffer from COVID-19 (10).

George PM et al., has documented the algorithm addressing the need of follow-up of COVID-19 patients. Those suffered from COVID-19 must go through a holistic assessment within four weeks of discharge (11). Vanhorebeek I et al., have shown that a long Intensive Care Unit (ICU) stay causes acquired weakness and has a psychological impact on patients (12). This case showed the prolonged stay of the patient at the hospital first due to COVID-19 and then due to its complications. Yang LL and Yang T, stated in a study about the consequences of COVID-19 that it has acute effects such as muscle dysfunction and weakness, long bed rest and reduced pulmonary function. The study was in favour with the present case study showing positive effects of pulmonary rehabilitation program where the session lasted for about 1-1.5 hours, 4-5 times per week. Aerobic training was given for 30-40 minutes along with resistance training (13). In this case, the effectiveness of inpatient pulmonary rehabilitation along with medical care was seen which resulted in rapid recovery of post-COVID patients. Weeharandi H et al., stated that a rehabilitation program does not reverse the structural changes that are occurred due to COVID-19 but improves the efficiency of the body to cope-up with complications that have occurred (14). An integrated pathway in COVID-19 rehabilitation has been established for the survivors according to their symptoms and needs (15). In the present case report, the patient was admitted to ICU with COVID-19 positive and came to the rehabilitation centre with symptoms of long-COVID. In the initial days, the intervention was focused on education, psychological support and breathing exercises. These exercises collectively showed improvement in the maintenance of oxygen saturation followed by aiming at improving the functional capacity. Improvements were seen in all the components with which the patient came for rehabilitation.

Pulmonary rehabilitation program is proven to be an effective option for patients who suffered with COVID-19, where the outcomes were measured on 6 minute walk distance, pulmonary function and quality of life before and after the intervention given (16). Also, with the rise of this pandemic and the physical mode of transmission of the disease, fear has been significantly increased among people to go for institution-based pulmonary rehabilitation program. Patients are advised to be at home and avoid contact with others. Some typical hospital or clinic centred pulmonary rehabilitation programmes have converted some or all of their learning materials to home-based telerehabilitation during the pandemic to meet this significant care gap. However, some barriers are also there in implementing this approach (17).


The outcome of the present study showed that a holistic, individually tailored pulmonary rehabilitation program is safe and has demonstrable health advantages and well-being in post-COVID-19 patients with symptomatic long COVID-19. A properly planned rehabilitation program containing education of the patient, goal oriented breathing exercises and aerobic training is necessary in patients with long COVID-19 to reach realistic functional goals. Relaxation techniques, breathing exercises, postural correction techniques to reduce the load of breathing and aerobic exercise in the form of walking showed significant improvement in the functional capacity and overall quality of life of post-COVID-19 patients.

Author’s contribution: PRB-made substantial contributions to the conception and design of the manuscript, been involved in drafting the manuscript and VV has revised it critically. PRB and VV have given final approval to the manuscript.


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DOI and Others

DOI: 10.7860/JCDR/2022/57518.16839

Date of Submission: May 03 2022
Date of Peer Review: Jun 02, 2022
Date of Acceptance: Jul 21, 2022
Date of Publishing: Sep 01, 2022

• 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 X-checker: May 06 2022
• Manual Googling: Jun 14, 2022
• iThenticate Software: Aug 15, 2022 (5%)

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  • Journal seek Database
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  • Popline (reproductive health literature)