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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
Tailor-made Pulmonary Rehabilitation Program Aiding Return to Preinfection Fitness in Massive Cavitatory Lung Abscess: A Case Report
Correspondence Address :
Dr. Gayatri Surendra Kaple,
Ingale Nagari, Tadas Layout, Pepri, Meghe, Wardha, Maharashtra, India.
E-mail: gkaple9@gmail.com
Lung abscess is a form of liquefactive necrosis of the lung tissue that causes the formation of cavities (greater than 2 cm) which are filled with necrotic debris and fluid because of microbial infection. Aspiration, which may happen while the patient is not conscious and end in a pus-filled cavity. It is very rare to find out lung abscess with a complicated infection of Streptococcus pneumoniae stereotype 6B. A 42-year-old male patient was referred to a tertiary care hospital with chief complaints of breathlessness of grade II on the Modified Borg Scale, cough with expectoration, and right-sided chest pain. Chest X-ray and High Resolution Computed Tomography (HRCT) High Resolution Computed Tomography (HRCT) scan of the thorax were done and the patient was diagnosed with right lower lobe lung abscess caused by Streptococcus pneumoniae. The patient was managed by bronchoscopy and bronchoalveolar lavage (washing). A complete plan of rehabilitation was designed to meet the patient's objectives, and it was executed and followed for 1 month. The patient showed considerable functional improvement in terms of aerobic capacity, endurance, and exercise tolerance ability. It was concluded that medical care combined with pulmonary rehabilitation, together as a multidisciplinary approach result in improved outcomes related to the quality of life of the patients.
Bronchoscopy, Bronchoalveolar lavage , Liquefactive necrosis, Pus-filled cavity
A 42-year-male farmer reported to the medicine Outpatient Department of a tertiary care hospital with the chief complaint of breathlessness, cough with expectoration and right-sided chest pain since 1 month. The patient was apparently well 1 month ago when he gradually started experiencing breathlessness accompanied by chest pain while walking for a mile and had to sit down and rest for a few seconds. After some weeks passed the patient started coughing with expectoration and there was brown colour phlegm. He was a chronic alcoholic for 10 years and had stopped consuming alcohol for 1 month. The patient’s wife also noticed a drastic change in the patient’s weight. The patient reported a loss of appetite resulting approximately 7 kgs weight loss in 1 month. Thereafter, the patient had visited a nearby local hospital and underwent radiological investigations and was found to have consolidation in the right mid-zone along the costal margin. Following which the patient was referred to the tertiary care hospital where the patient gave a history of fever (on and off), cough with mucoid brownish coloured expectoration, breathlessness (Modified Borg grade: II that is walks slower than same age people because of breathlessness) (1), and was admitted to the Respiratory Medicine Ward.
On general examination, the respiratory rate was 24 breaths/min with the abdominothoracic type of breathing, heart rate was 89 beats/minute, and oxygen saturation was 97% on 6 litres of oxygen support via nasal cannula. Pallor was present while inspecting for the positive findings. Chest expansion revealed a difference of 2 cm, 2 cm, and 1 cm at axillary, nipple, and xiphisternum levels, respectively. On percussion, the dull note was present at the right lower zone and coarse inspiratory crackles, along with liver and cardiac dullness. Additionally, the dull note was present in the traubes space. Auscultation also revealed decreased air entry on the right side at inframammary and infrascapular levels.
Blood haemoglobin levels were constantly lower than normal ranging between 8.5-9.3 gm/dL. Total red blood cells count was constantly low (i.e. below 3.07 cells/μL) whereas, the white blood cells count and platelet counts were 18,200/cumm and 1,36,000/ cumm respectively.
Several investigations such as blood tests including, Complete Blood Count (CBC), Kidney Function Test (KFT), Liver Function Test (LFT), and Optochin tests were carried out. Other diagnostic assessments such as sputum culture, and chest X-ray were also conducted. Sputum assessment revealed foul-smelling purulent brown coloured thick phlegm. The Optochin test was performed revealed that the strains were sensitive. The patient was diagnosed with cavitatory lung abscess.
Bronchoscopy reports suggested mucopurulent secretions present in the right lower lobe. After the diagnosis confirmed the pharmaceutical medications was also started. Pharmacological management was done with Inj. pipracillin, tazobactam 4.5 gm i.v. (TDS), Inj. metronidazole 100 mL i.v. (TDS), tablet paracetamol 650 mg (OD), tablet levocetirizine and montelukast (HS), tablet pantoprazole 40 mg (OD), tablet acetylcysteine 600 mg (TDS), syrup ambroxol, guaifenesin, and terbutaline 10 mL (BD), nebulizer-salbutamol sulphate and ipratropium bromide (TDS) and budesonide (micronized) (BD), intravenous fluids-77 mEq/L sodium and 77 mEq/L chloride with multivitamin injection. Physiotherapeutic interventions were also started.
But when the patient’s chest condition was deteriorating then once again sputum culture was taken and an optochin test was after 10 days. The optochin test was sensitive and thereafter he was diagnosed with an infection of streptococcus pneumoniae which resulted in a complication of lung abscess on 12th day.
The bronchoalveolar lavage i.e. washing was done on 16th day. The bronchoalveolar lavage was done thrice in a span of 24 hours, the report suggested that the fluid collected was 43 mL of brownish, turbid material. The smear shows scattered acute inflammatory cells, few lymphocytes, and macrophages. This was performed in respiratory medicine examination room.
All the X-ray findings are shown in (Table/Fig 1) showing the consolidation with the arrows. The High Resolution Computed Tomography (HRCT) scan impression is presented (Table/Fig 2).
Physiotherapy management: The physiotherapy rehabilitation was initiated after the diagnosis of right-side lower lung abscess was confirmed. The goal of the physiotherapy regimen was to improve ventilation and oxygenation, bronchial hygiene, and exercise tolerance. It comprised of myriad of separate interventions, like mobilization of secretions, breathing exercises, thoracic expansion exercises, and manual pressure at the left lower zones to maintain the expansion, physical mobility exercises, and posture retraining. All the brief introduction to goals, intervention, rationale, and dosage are given in (Table/Fig 3).
Outcome measures: Sputum production quantity after airway clearance technique was 20 mL preintervention and 32 mL Postintervention.
Progression of the overall physical condition of the patient was done by Six Minute Walk Test (3) and Modified Borg Scale (1).
Modified Borg Scale:
• On 1st day of referral was II
On the time of discharge it was I
On follow-up (1 week after discharge) was I
• Six-minute walk test:
On 1st day of referral was 220 m;
On the time of discharge it was 260 m
On follow-up it was 320 m.
Bar graph showing the progression of the overall physical condition of the patient by Six-Minute Walk Test (3) and Modified Borg Scale (1) (Table/Fig 4).
Lung abscesses account for around 0.2% of all pneumonia cases requiring hospitalization, according to Beth Israel Deaconess Medical Center's experience, however, physiotherapy care is necessary to return the patient to their usual activities of daily living. Pulmonary rehabilitation aims to improve disease-related deficits by increasing exercise tolerance capacity, ventilation, and lowering labor of breathing (4),(5),(6).
The present case was diagnosed to have a right lower lobe lung abscess based on clinical results and investigations. Pulmonary rehabilitation was delivered focusing primarily on enhancing exercise tolerance capacity, ventilation, and reducing the work of breathing, thereby improving the disease-induced impairments.
Lung abscess genesis, diagnosis, and treatment protocol have been described earlier. Antibiotics with a specific target and adequate drainage are essential for recovery. The mortality of lung abscesses has fallen to roughly 2-38.2% due to the widespread use of antibiotics (7). The patient’s age, malnutrition, comorbidities, immunity, suitable and timely antibiotics, and supportive care all play essential roles. In up to 68% of cases, postbronchoscopy fever occurs, with greater rates following bronchoalveolar lavage. Infectious problems after bronchoscopy are quite rare (8).
However, in this case, there was no postbronchoscopy fever, and the patient was identified with a causative factor for cavitatory lung abscess Streptococcus pneumoniae, which was treated by bronchoscopic drainage (9).
Long-term health effects of chronic respiratory disorders can be effectively combated with a thorough pulmonary rehabilitation program. The key interventions for rehabilitating patients with deteriorating health status due to respiratory problems include patient education, breathing methods, and graded exercise training programs. Disability results from pulmonary impairment caused by lung damage (10).
In this case, a specialized rehabilitation program was developed and implemented. A regular exercise program reduced the number of exacerbations and hospital readmissions, resulting in improved functional capacity, and dyspnoea level.
Diaphragmatic breathing and pursed-lip breathing are two controlled breathing techniques that increase psychological well-being by lowering anxiety and depression (10). Six weeks of pulmonary rehabilitation on lung abscess has shown improvements in functional capacity, quality of life, and respiratory dysfunction-related outcomes, according to the study. Walking is utilized in an aerobic training program to focus on lower limb endurance (11).
On examination during follow up the patient showed improvement in Modified Borg scale from II-I and six-minute walk test was improved from 260 m at the time of discharge to 320 m.
According to popular belief, pulmonary rehabilitation should last at least 8 weeks to have a significant impact on exercise efficiency and quality of life (11),(12). In the present case, posture training and walking were offered as part of a supervised program, and after 2 weeks of unsupervised at-home instruction, telephonic follow-up was maintained.
The X-ray indicated a cavitatory lung abscess, It can be challenging to diagnose the infectious pathogens at the time of confirmation of diagnosis. It is uncommon for Streptococcus pneumoniae to be the infectious cause of lung abscesses because Staphylococcus aureus typically causes them (13).
The present case report described an integrated plan for the rehabilitation of lung abscess. The patient's recovery occurred during the rehabilitation program, the majority of the therapeutic objectives were met, including airway clearance to improve ventilation and saturation, improving the patient’s exercise tolerance capacity, reducing work of breathing, and increasing functional capacity through energy conservation techniques. The patient received physiotherapy, which helped him to heal faster, lower his discomfort significantly, and enhance his day-to-day tasks, something he could not do before starting physiotherapy.
Authors would like to thank the study participant for their participation and for giving their valuable time to the study. The authors are grateful to the RNPC College of Physiotherapy for their support and assistance.
DOI: 10.7860/JCDR/2022/57717.16817
Date of Submission: May 13, 2022
Date of Peer Review: Jun 21, 2022
Date of Acceptance: Jul 04, 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 14, 2022
• Manual Googling: Jun 29, 2022
• iThenticate Software: Jun 30, 2022 (11%)
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