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 Series
Full Version
Ectopic Enigma- A Case Series of Unusual Presentations of Tubal Ectopic Pregnancy
Correspondence Address :
Dr. Sowmya Shree Thimmappa,
Door No. 25, 5th Main, 6th Cross M Block, Kuvempunagara, Mysuru, Karnataka, India.
E-mail: sownshree@gmail.com
A pregnancy that develops outside of the uterus is referred to as an ectopic pregnancy. The fallopian tube is the most typical location for ectopic pregnancy. Two percent of reported pregnancies are ectopic pregnancy. Hereby, authors present a case series of three cases, of unusual presentation of tubal ectopic pregnancy. First case was 22-year-old female, para1 living1, presented with abdominal pain, vomiting and no history of amenorrhoea. Her beta Human Chorionic Gonadotropin (HCG) was 82042 mIU/mL. A live ectopic pregnancy of 11 weeks with intact gestational sac ruptured en caul was noted on laparotomy. She underwent right salpingectomy. Second case was a 36-year-old, Abortion 2 Ectopic1, with one and a half months of amenorrhoea, abdominal pain and spotting per vagina with beta HCG of 27472 mIU/mL. Laparoscopy revealed, left sided unruptured tubal stump ectopic pregnancy and was managed by excision of tubal stump ectopic . Third case was a 26-year-old, para 2 living 2, with history of 2 months of amenorrhoea, abdominal pain and spotting per vagina. Laparotomy revealed right infundibular ectopic pregnancy with incomplete abortion with active bleeding. She underwent right salpingectomy. Cases were managed successfully. This case series emphasises the significance of having a high index of suspicion for ectopic pregnancy in all reproductive-age women regardless of their presentation.
Ectopic pregnancy, Ectopic en caul, Infundibular ectopic, Stump ectopic, Tubal abortion
Ectopic pregnancy is defined as a pregnancy that develops outside the uterine cavity (1). Indian studies have found an incidence of ectopic pregnancy ranging from 1-2% (2). Fallopian tubes, account for 90% of ectopic pregnancies and the remaining 10% is seen in the cervix, ovary, myometrium, and other locations (3). At 6 to 9 weeks of gestation, extrauterine pregnancies are most frequently diagnosed. Most patients present with vague complaints (4).
Case 1
A 22-year-old women, para 1 living 1, presented with complaints of diffuse lower abdominal pain for 6 hours and vomiting for 20 days. There was no history of amenorrhoea, with minimal menstrual flow during her last menstrual cycle, 20 days back. Patient was treated for provisional diagnosis of peritonitis in a local hospital and was started on antiemetic and analgesic medication. On examination severe pallor was present, pulse rate was 120 beats per minutes, blood pressure of 80/60 mmHg. Her abdominal examination revealed, diffuse tenderness associated with guarding and signs of free fluid. On bimanual examination, uterus was normal in size with right forniceal fullness and cervical motion tenderness. On investigation haemoglobin was 6 gm%, beta Human Chorionic Gonadotropin (? HCG) was 82042 mIU/ mL. Ultrasound examination showed, well-defined thick-walled sac like structure in the right adnexa with evidence of live foetus of Crown Rump Length (CRL) 4.43 cm, corresponding to 11 weeks 2 days. Moderate ascites with echogenic fluid was noted in the pouch of douglas (POD) (Table/Fig 1). She was diagnosed with right ampullary tubal ectopic pregnancy of 11 weeks. Patient underwent emergency laparotomy after obtaining informed written consent. An intact gestational sac with live foetus, and surrounding chorionic tissue was noted, adjacent to ruptured right fallopian tube (Table/Fig 2). A diagnosis of right ampullary tubal ectopic pregnancy of 11 weeks, ruptured en caul was made (Table/Fig 3). Right salpingectomy was done. 2 liters of haemoperitoneum was noted, which was suctioned out. Patient received three units of packed Red Blood Cell (RBC) transfusion. Histopathological examination revealed, wide areas of haemorrhage with many chorionic villi in the wall. Postprocedure patient was haemodynamically stable with repeat haemoglobin of 9 gm% and discharged on 5th postoperative day. On follow-up after 4 weeks, her ? HCG was <5 mIU/mL.
Case 2
A 36-year-old female, abortion 2 ectopic1, presented with history of one and a half months of amenorrhoea, mild abdominal pain and spotting per vagina for 4 days. Patient had consulted a private practitioner 2 days prior. She was advised oral progesterone supplements and early obstetric scan. Past obstetric history revealed, two spontaneous incomplete abortions followed by instrumental evacuation 2 years back. She had undergone emergency laparotomy with left sided salpingectomy, 4 months back for left sided ampullary tubal ectopic pregnancy. On examination her pulse rate was 86 per minute, blood pressure was 120/80 mmHg, per abdominal examination revealed, no evidence of free fluid and no guarding or rigidity. Haemoglobin was 12 gm%, beta HCG was 27472 mIU/mL. Ultrasound pelvis showed unruptured left sided tubal ectopic pregnancy with CRL of 9.8 mm corresponding to 7 weeks 3 days of gestation with no cardiac activity. She underwent diagnostic laparoscopy which showed left sided tubal stump ectopic pregnancy of 5x4 cms with dense adhesion of the omentum to the ectopic sac and posterior surface of the uterus (Table/Fig 4). Laparotomy followed by adhesiolysis and tubal stump excision was done. Vasopressin was injected into the tubal stump to minimise bleeding. Postoperative period was uneventful and ? HCG was <5 mIU/mL at one month follow-up.
Case 3
A 26-year-old, Para 2 Living 2, presented with history of 2 months of amenorrhoea, complaints of abdominal pain for 4 days with spotting per vagina for 1 day. Patient was not on any medication and presented to the emergency department with the above complaints. On examination pulse rate was 135/min, blood pressure was 80/50 mmHg, diffuse abdominal tenderness with signs of free fluid in the abdomen was noted. Ultrasound showed, ruptured right tubal ectopic pregnancy with haemoperitoneum. On laparotomy, right infundibular tubal ectopic pregnancy with active bleeding through the fimbrial end with gestational sac in the peritoneal cavity and haemoperitoneum of 1 litre was noted. Diagnosis of infundibular tubal ectopic pregnancy with incomplete tubal abortion was made (Table/Fig 5). Right salpingectomy was done. Patient received two units of packed RBC transfusion and was discharged on 5th postoperative day. Histopathology showed, chorionic tissue in the right fallopian tube confirming incomplete tubal abortion. Patient was lost to follow-up.
Ectopic pregnancies account for 75% of maternal deaths in the first trimester and 9-13% of all pregnancy-related deaths. They are estimated to occur in 1-2% of pregnancies (5). A risk factor is unknown in 50% of women, who are diagnosed with an ectopic pregnancy (6). A transvaginal ultrasound assessment and pregnancy confirmation, serve as the minimal diagnostic examination for a suspected ectopic pregnancy (1). Over 90% of ectopic implantation cases take place in the fallopian tube, making it the most frequent location (4). The majority of ectopic pregnancies develop in the fallopian tube at various sites, with the ampulla (70%) being the most frequent, followed by the isthmus (12%), fimbria (11.1%), and interstitium (2.4%) (7). Unruptured tubal pregnancy is often detected between 6.9±1.9 weeks (8).
Live ectopic gestation ruptured en caul: In this patient tubal rupture occurred at 11 weeks of gestation with foetus being extruded en caul along with the chorionic tissue. There are only few tubal ectopic pregnancies reported beyond 11 weeks. Ectopic pregnancy ruptured en caul has not been reported to the best of our knowledge. Gari R et al., reported a case of live 13 weeks ruptured ectopic pregnancy. This patient had presented with history of three months of amenorrhoea and generalised abdominal pain and was managed successfully with emergency laparotomy and salphingectomy (9). Largest tubal ectopic pregnancy, reported ever is of 14 weeks of gestation by Elmoheen A et al., (10). This patient was a 40 year old who presented with abdominal pain, mild dysuria and loose motion. She was managed by laparotomy and salphingectomy. The fallopian tube wall lacks a submucosal layer, which allows ovum implantation within the muscular wall. Additionally, the quickly expanding trophoblasts destroy the muscularis layer, preventing pregnancy from continuing, as a result at 7.2±2.2 weeks fallopian tube ruptures (8). In the present case report, ectopic pregnancy rupture occurred at 11 weeks of gestation. Treating clinician should have high suspicion of ectopic pregnancy, even beyond early first trimester.
Stump ectopic pregnancy: Ectopic pregnancy occurring in tubal stump is rare. According to Ko PC et al., the prevalence of tubal stump pregnancy following tubectomy is remarkably low, at only 0.4% (11). Melcer Y et al., reported nine women who underwent laparoscopic salpingectomy for tubal stump pregnancy. According to the findings of this study, the study group experienced a shorter time gap than the control group between the initial salpingectomy and the following stump pregnancy (12). In the present case report, patient had undergone salpingectomy 4 months prior, to recurrence of ipsilateral tubal stump ectopic pregnancy. Shorter period to conception from previous surgery, may be one of the predisposing factor. Tubal surgeries that leave a tubal residue, may be considered similar to salpingostomy for risk of recurrence (13). The management options for tubal stump ectopic pregnancy includes laparoscopy or laparotomy followed by resection of tubal stump ectopic pregnancy or conservative medical management with methotrexate. In one of the case series by Feng Sun et al., 42 cases of tubal ectopic pregnancies were managed laparoscopically with favourable pregnancy outcome (14). A case of left tubal stump pregnancy was effectively treated, according to a report by Ozceltik G et al., employing a two-step approach by transvaginal natural orifice transluminal endoscopic surgery (15). Selection of route of operation depends on surgeons preference. In the present case report, patient underwent laparotomy followed by tubal stump excision.
Infundibular ectopic pregnancy with incomplete tubal abortion: The term “tubal abortion” refers to the extrusion of the foetus via the fallopian tube’s abdominal ostium into the peritoneal cavity. It may cause considerable bleeding and be either total or incomplete (16). Actual statistics on the prevalence of tubal abortions are unavailable. According to reports, the incidence rate is 2.5% of all tubal pregnancies, with frequency varying between 6% to 73% (16). Aryal S et al., reported a case of ‘tubal abortion masquerading as acute appendicitis with a negative urine pregnancy test’ (17). Chirculescuel B et al., reported a case of 30 year old women with complete tubal abortion, diagnosed on laparoscopy and managed conservatively (16). The patient’s haemodynamic stability, Beta HCG level, gestational sac size, and desire for future fertility are the factors that must be taken into consideration while choosing the appropriate treatment approach. Through accurate diagnosis of tubal abortion, these patients can be managed conservatively. In the present case report, patient was haemodynamically unstable with continuing active bleeding from the fimbrial end hence, underwent salpingectomy.
Ectopic pregnancies are one of the major cause of maternal mortality in the first trimester and are on the rise throughout the world. High index of suspicion, early ultrasonography, serum beta HCG helps to diagnose ectopic pregnancies at an early stage. Unusual modes of presentation of ectopic pregnancy other than tubal rupture, presentation beyond early first trimester should be kept in mind when managing patients in the reproductive age group.
DOI: 10.7860/JCDR/2022/57674.16936
Date of Submission: May 17, 2022
Date of Peer Review: Jun 21, 2022
Date of Acceptance: Jul 29, 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: May 24, 2022
• Manual Googling: Jul 26, 2022
• iThenticate Software: Aug 29, 2022 (19%)
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