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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
SARS-CoV-2 Vaccination Associated Transverse Myelitis: A Case Report
Correspondence Address :
Bhargavi Kumar,
G 802,Purva Amaiti, Trichy Road, Singanallur, Cimbatore-641005, Tamil Nadu, India.
E-mail: kmcbhargavi@gmail.com
While policy makers around the globe have meticulously organised mass immunisation against Coronavirus Disease 2019 (COVID-19), its safety concerns and adverse events that need prompt evaluation are also emerging. Acute Transverse Myelitis (TM) is a rare neurological phenomenon where motor, sensory or autonomic disturbance occurs as a result of spinal cord injury. The aetiology of transverse myelitis is thought to be immune-mediated as a result of infection, parainfectious disorder, autoimmune disease or malignancy. Though a rare disease, acute TM warrants prompt recognition and aggressive therapy for favourable neurological patient outcomes. Hereby, authors presented this case of a 61-year-old male patient who developed symptoms of acute TM, 20 days after receiving an adenovirus vectored ChAdOx1 nCoV-19 vaccine against SARS-CoV-2. The patient was treated with intravenous steroids, supportive care with Foley’s catheterisation and his weakness and bladder control improved over 1 week.
Adverse reactions, Coronavirus, Immunisation, Severe acute respiratory syndrome coronavirus 2
A 61-year-old male presented to the Medicine Department with complaints of constipation and urinary retention for three to four days accompanied by bilateral lower limb weakness. He had a past medical history of seizures 20 years ago and haemorrhagic cerebrovascular accident but was not on any regular medications. The patient had received the first dose of Coronavirus Disease 2019 (COVID-19) vaccine (ChAdOx1 nCoV-19) 20 days prior. His family history was unremarkable for muscular disorders, multiple sclerosis, stroke or any rheumatological disorders.
On physical examination, his heart rate was 72 beats per minute, respiratory rate of 15 breaths per minute, blood pressure was 130/80 mmHg, temperature of 98.4o Fahrenheit, and oxygen saturation of 99% on room air. He was conscious, oriented to time, place, person and did not have neck stiffness or signs of meningeal irritation.
On neurological examination, higher mental functions and cranial nerve examination was normal. He had asymmetrical paresis in lower limbs- power of 0 in the toes, 2 across the ankle joint, power 4 in the left knee, 3 in the right knee and power 3 in the hip joint. Deep tendon reflexes were absent in both the lower limbs and bilateral plantar response was mute. Sensory examination (fine touch, temperature, position sense, joint sense and vibration) was normal. Neurological examination of the upper limbs was within normal limits. Other systemic examination was unremarkable.
Initial laboratory analysis showed a normal complete metabolic profile, complete blood count, and a negative Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) nucleic acid amplification test. Echocardiography, ultrasonography abdomen was normal and Electroencephalography (EEG) showed no epileptiform discharges. Visual Evoked Potentials (VEP) for both eyes revealed bilateral optic neuritis. Antinuclear Antibody (ANA) profile was negative. The patient underwent Magnetic Resonance Imaging (MRI) of brain and spinal cord which was suggestive of acute demyelination (Table/Fig 1), (Table/Fig 2). Lumbar puncture was performed and Cerebrospinal Fluid (CSF) analysis was done (Table/Fig 3).
Based on the investigations and clinical findings, a diagnosis of postvaccination- longitudinally extensive transverse myelitis was made. The patient was started on injection methylprednisolone at a dose of 1 g/day for 5 days. He was catheterised and given antiepileptics, laxatives, antipyretics and supportive care along with regular physiotherapy. The patient’s symptoms of constipation, urinary retention, and weakness resolved over the next 1 week. The urinary catheter was removed and he was discharged home after 12 days of admission. Two weeks later, patient was followed-up in the Outpatient Department (OPD) and he was able to walk without support.
The world is still combatting SARS-CoV-2. Many vaccines were given emergency approval after phase 3 trials. Intensive and mass Immunisation programs are being organised for vaccination and notable reduction in disease severity is noted. Nevertheless, adverse reactions post vaccinations were reported raising safety concerns adding to the vaccine hesitancy. According to the vaccine adverse event reporting system (VAERS), 51,755,447 doses of various COVID-19 vaccines have been administered in the United States until March 2, 2021 of which 9,442 adverse reactions were reported (1). According to the Ministry of Health and Family Welfare, India has reported at least 70,102 cases of Adverse Events Following Immunisation (AEFI), and 1,013 deaths following the COVID-19 vaccines. Of this, Covishield contributed to 90.3% of the total adverse events and to 91% of the vaccine related mortality as of 30th January 2022 (2).
Neurological complications are already recognised rare adverse effects seen in certain vaccines namely diphtheria pertussis tetanus, measles mumps rubella, influenza and hepatitis B vaccines (3). The vaccines against SARS-CoV-2 are either adenovirus vector based (ChAdOx1nCoV-19),m-RNA based (BNT162b2), protein based or inactivated virus based vaccines. All of these act by inciting an immune reaction against COVID-19 and include an antigen, a delivery system and an adjuvant. Vaccine associated adverse events may be attributable to any of these components. COVID-19 vaccine associated neurological complications that were reported worldwide include demyelinating disorders, cortical venous thrombosis, encephalopathy, stroke, seizures, myasthenic syndromes, Guillain-Barré syndrome and Bell’s palsy (4).
Transverse Myelitis (TM) is a rare, acquired focal inflammatory disorder of one or more spinal cord sections (5). The common etiologies are demyelinating illness such as multiple sclerosis, neuromyelitis optica, infections, autoimmune diseases ,malignancies, paraneoplastic and rarely vaccines. The commonly associated infections are cytomegalovirus, varicella-zoster virus, Epstein barr virus, and coxsackieviruses (6). The incidence of COVID-19-related transverse myelitis has been reported as 0.5 case/per million people, roughly 1.2% of all COVID-19 related neurological complications (7). The incidence of acute TM is estimated to be up to 3-5 cases per million people a year and vaccine-associated events are rarer (8). Transverse myelitis could result due to acute or subacute dysfunction of the spinal cord and could be complete or partial as well. In the index patient, MRI showed long segment T2 hyperintense signal changes in the spinal cord from D9-L1 level. The incidence of acute TM varies between 1-8 million per year and peaks between 2nd-4th decades (9). The index patient on the contrary is in the 7th decade of his life.
In a literature review of 39 articles discussing Central Nervous System (CNS) adverse effects of COVID-19 vaccines, five patients had developed transverse myelitis post vaccination (4). However, all occurred within 4 days after vaccination contrary to the present case where the day of onset of symptoms was 20 days postvaccination.
According to the Vaccine Adverse Event Reporting System (VAERS), nine cases of acute transverse myelitis (incidence is approximately 1.739/per million people) were reported among the total 9442 adverse events following COVID-19 vaccines in the United States as of March 2021 (10). Indeed a total of 119 postvaccination Acute Transverse Myelitis (ATM) cases were reported during the period from 1985 to 2017 (1). Other than nine cases, neurological complications contributed to 2.69% of the total Adverse Events Following Immunization (AEFI) following Pfizer-BioNTech, Moderna, and Johnson & Johnson’s (10). So also, two serious events of transverse myelitis were noted following recombinant ChAdOx1 nCoV-19 vaccine (11),(12).
Initially acute transverse myelitis was reported following viral vector vaccines and it was assumed that the viruses used for vaccination can induce autoimmunity, exhibit molecular mimicry, or have epitopes similar to the virus itself (1). Nevertheless, in the mRNA vaccines, autoimmune interactions are probably though to occur between the Angiotensin Converting Enzyme-2 (ACE-2) receptors in the body and the virus spike protein antibody per se. Also, it was proposed that thrombogenic state induced by vaccination can cause spinal cord infarction leading to transverse myelitis (13). Agmon-Levin N et al., proposed that post vaccination transverse myelitis may be the resultant of autoimmune reaction attributed to molecular similarity, accentuation of pre-existing autoimmune process or B lymphocytes’ poly clonal activation leading to a cytokine storm (5).
A large population-based study of more than 32 million people done in the United Kingdom investigated the neurological adverse events associated with the ChAdOx1 nCoV-19 and BNT162b2 vaccines as well as SARS-CoV-2 infection (14). It was found that increased risk of hospital admission was present for Guillain-Barré syndrome, Bell’s palsy and myasthenic disorders in those who received the ChAdOx1 nCoV-19 vaccine. Increased risk of hospital admission for hemorrhagic stroke was observed in those who received the BNT162b2 vaccine. More importantly the risk of neurological outcomes following a positive SARS-CoV-2 test, such as acute CNS demyelinating events, encephalitis meningitis and myelitis, Guillain-Barré syndrome, Bell’s palsy, myasthenic disorders, haemorrhagic stroke and subarachnoid haemorrhagic was documented. A crucial finding in this study was that the risk of neurological infections was far higher by the infection itself in comparison with the few events associated with the vaccine. This strongly advocates the need for vaccination rather than a vaccine reluctance.
Currently, there are no standard guidelines to treat post vaccination transverse myelitis. Conventionally transverse myelitis is managed with intravenous steroids as the first line therapy. Plasma exchange is done in steroid refractory cases (15). Other immunomodulatory therapies include cyclophosphamide and rituximab. The index patient was treated with intravenous steroids for 5 days and showed significant improvement in his neurological symptoms.
Any new disease comes with lot of challenges and new vaccines are to be closely monitored. Adverse events reporting system is not to sideline the vaccine importance or size down mass vaccination campaigns, rather only to add new data and share knowledge to raise global awareness. A causal link has not been conclusively established with the vaccine and side-effects except for the temporal association. The shared pathophysiological mechanism between the virus and vaccines may be central to the development of the adverse events. First contact physicians should be aware of acute TM after COVID-19 vaccination and maintain a high index of suspicion in patients presenting with neurological deficits after receiving the vaccine.
DOI: 10.7860/JCDR/2022/58310.16916
Date of Submission: Jun 07, 2022
Date of Peer Review: Jul 07, 2022
Date of Acceptance: Jul 23, 2022
Date of Publishing: Sep 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: Jun 16, 2022
• Manual Googling: Jul 16, 2022
• iThenticate Software: Aug 23, 2022 (13%)
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
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- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com