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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
Antiphospholipid Syndrome Complicated by Unilateral Pleural Effusion and Deep Vein Thrombosis: A Case Report
Correspondence Address :
Shricha Bhutda,
MBBS Intern, Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra -442004, India.
E-mail: shribhutda1999@gmail.com
Antiphospholipid Antibodies (APLA) are autoantibodies directed against phospholipid-binding proteins. The development of thromboses in veins/arteries or the incidence of maternal morbidity, particularly miscarriages, in the presence of APLA constitutes Antiphospholipid Syndrome (APS). These Antiphospholipids (APLs) include antibodies against two glycoproteins, anticardiolipin antibodies, and Lupus Anticoagulant (LA). APLs are a diverse group of autoantibodies that have been linked to thrombus development, elevated maternal morbidity and mortality, and other symptoms that collectively constitute APS. Approximately half of APS cases are secondary disorders, while the remaining cases are autoimmune co-morbidities such as Systemic Lupus Erythematosus (SLE). This multisystem disorder mainly causes venous and arterial thrombosis and can also manifest as cutaneous, pulmonary, renal, and haematological involvement. APLA syndrome with pleural effusion is a rare complication. Patients with antiphospholipid syndrome can develop various types of pulmonary disease. The authors present the case of a 38-year-old male patient with a history of Deep Vein Thrombosis (DVT) and psoriasis, a known case of APLA syndrome, who presented with neck pain and breathlessness. Pulmonary embolism was ruled out, and the patient was discharged on oral anticoagulants. The present case highlights APLA as the culprit for the myriad presentations in the present case.
Corticosteroid, Cardiovascular problem, Immune system, Lungs, Psoriasis
A 38-year-old male, a truck driver by occupation, presented to the Emergency Department with complaints of neck pain radiating to the back, breathlessness for two days, and throbbing pain in the right calf region. The pain in the calf was acute in onset, progressive, and accompanied by swelling in the right leg for six days. The patient had no history of hypertension, diabetes, bronchial asthma, or tuberculosis.
The patient had a known case of Antiphospholipid Syndrome (APLA) for the past eight years and psoriasis for the past five years. He also had a history of Deep Vein Thrombosis (DVT) for the past one year and was taking a daily dose of 5 mg of warfarin for nine months. On examination, the patient appeared anxious, with a pulse rate of 110/min and blood pressure of 110/70 mmHg. There were no signs of pallor or icterus, and the Jugular Venous Pressure (JVP) was normal. However, there was unilateral oedema in the right leg, (Table/Fig 1),(Table/Fig 2). and cardiovascular examination revealed normal heart sounds without murmurs. Respiratory examination revealed dull percussion note on the left side of the chest and absent air entry on the left side of the lung. The patient also complained of chest pain, leading to an Electrocardiogram (ECG) (Table/Fig 3) that showed ST segment depression (1 mm in V1-V3) and ST segment depression of 1 mm in V1 to V6. D-dimer test was negative, but Creatine Phosphokinase-Myocardial Band (CPK-MB) and Troponin Y were positive, suggesting a probable diagnosis of unstable angina. The patient was given a loading dose of aspirin, clopidogrel, and atorvastatin and was then shifted to the cardiac Intensive Care Unit (ICU). A 2D-echo was performed, revealing a Left Ventricular Ejection Fraction (LVEF) of 60% and Grade 1 Diastolic Dysfunction(1). Coronary angiography was advised, but the patient declined.
A chest X-ray showed pleural effusion on the left side of the lung.(Table/Fig 4). Other potential causes, such as cardiac or pulmonary thrombosis, malignancy, and collagen vascular disease, were ruled out. A right lower limb doppler revealed a long segment complete lumen occluding echogenic thrombus extending from the mid- femoral vein into the saphenofemoral junction, popliteal vein, tibia-peroneal trunk, peroneal vein, and short saphenous vein up to 10 cm distal to the knee joint.
As a result, aspirin, clopidogrel, and low molecular weight heparin were discontinued, and warfarin was initiated to maintain an International Normalised Ratio (INR) of 2.5. The patient was discharged without any follow-up.
It is extremely rare to observe antiphospholipid syndrome with unilateral pleural effusion. In this case, the patient was discharged on oral anticoagulant warfarin with a daily dose of 10 mg.
Males and females are almost equally affected in terms of thrombosis developed in arteries/veins in the clinical presentation of APS, an autoimmune illness that affects more women than men on average. APS can be diagnosed based on clinical and test results. Symptoms of the illness include recurrent venous and arterial thrombosis, as well as females experiencing pregnancy loss. The patient tested positive for LA, anti-beta2 glycoprotein IgG, and borderline antiphospholipid antibodies (IgG). It is well recognised that LA increases the risk of thrombotic events, and several publications have shown the relation of antiphospholipid syndrome with thrombosis at various sites (2),(3),(4).
The clinical symptoms of APS can affect numerous organs and systems, leading to a wide range of manifestations. In the current case, the emergence of arterial/venous thrombosis was observed in a patient who had a history of the same problem and presented with DVT in the left leg. Additional thromboembolic events at various sites have been documented, such as pulmonary embolism and cerebral venous thrombosis. While hypercoagulability may be the first symptom in many cases, joint pain and swelling have also been described. APS can affect various systems, including cardiovascular, genitourinary, endocrinological, and central neurological systems (5),(6),(7),(8).
In a 75-year-old patient with erythema, purpura, and dyspnoea who had a history of APS and was taking aspirin and warfarin for the same, a similar case of unilateral pleural effusion was observed. The 2patient also had dermal and subcutaneous small vessel thrombosis. A patient’s Computed Tomography (CT) and chest X-ray revealed a left pleural effusion, which was repeatedly drained but recurred. To treat this, oral prednisolone was given, which helped the patient with both a skin lesion and a pleural effusion. Pleural effusion associated with APS is relatively uncommon (9).
Pulmonary thromboembolic illness, which is a condition in a patient who tests negative for PL and is clinically identical to typical emboli, was the first serious pulmonary consequence to be noted. Pulmonary hypertension may develop as a result of recurrent pulmonary emboli. There are numerous potential reasons for pulmonary hypertension in the APLA syndrome, and between 10% and 20% of individuals with chronic thromboembolic pulmonary hypertension also have APL. A statistically significant link between pulmonary hypertension and the presence of IgA anticardiolipin above 2SD has been found in a prospective examination of 500 SLE patients. Chronic anticoagulation is required in every case to treat pulmonary hypertension and avoid the development of fresh thrombotic events. Along with these symptoms, patients with pulmonary capillaritis, alveolar haemorrhage, and microvascular pulmonary thrombosis have also been documented (10).
In addition to thrombosis, APS can cause serious cardiovascular problems. A collection of symptoms known as Acute Coronary Syndrome (ACS) is brought on by the rupture of coronary atherosclerotic plaques with thrombi. ST-segment elevation, non ST elevation, and unstable angina are all components of ACS. Recent research has shown a connection between APS and ACS. For instance, Djokovic A et al., observed that out of 374 patients with APS, including 36 patients with unstable angina, 101 had cardiovascular problems. Acute myocardial infarction and APS are frequently treated with Percutaneous Coronary Intervention (PCI), as documented in several examples (11),(12),(13),(14),(15),(16).
Warfarin and heparin are two of the most common treatments for acute thrombotic events. Given the significant risk of recurrence in the first six months after therapy withdrawal, it is imperative that patients who experience a thrombotic episode take steps to prevent recurrent thrombosis (17).
It is still unknown what caused the pleural effusion in the present case. Malignancies, viral illnesses, pulmonary emboli, collagen vascular disease, and heart failure are among the common causes of pleural effusion. Few cases of APS-related pleural effusion have been documented, and those that have appeared to be side-effects of concomitant SLE, pulmonary embolism, or catastrophic APS. The most typical pleuropulmonary sign of SLE is pleuritis, which can lead to pleural effusion (18),(19),(20),(21).
Antiphospholipid syndrome (APS) with DVT, pleural effusion, psoriasis, and unstable angina is a rare presentation. DVT is common in patients with a history of APS, and the mainstay of treatment is long-term anticoagulation. Since pleural effusion can be a life-threatening condition, timely diagnosis and treatment are essential, along with proper follow-up. Corticosteroids and immunosuppressants continue to be the preferred choices for patients with APS and pleural effusion.
DOI: 10.7860/JCDR/2023/65303.18624
Date of Submission: May 08, 2023
Date of Peer Review: Jun 08, 2023
Date of Acceptance: Jul 24, 2023
Date of Publishing: Nov 01, 2023
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 09, 2023
• Manual Googling: Jun 15, 2023
• iThenticate Software: Jul 20, 2023 (10%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
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