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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
Successful Removal of 147 Fibroids from the Uterus via Abdominal Myomectomy: A Case Report
Correspondence Address :
Ritisha Basu,
IP38NW, Ipswich, United Kingdom.
E-mail: basu.ritisha312@gmail.com
Uterine fibroids are a common gynaecological condition that can sometimes be large and multiple, significantly impacting the affected woman's quality of life. Managing multiple fibroids in women who want to preserve their fertility can be complex, as myomectomy is more challenging compared to hysterectomy. A 30-year-old woman was admitted with complaints of heavy menstrual bleeding, severe anaemia, and an abdominal mass equivalent to a 36-week gravid uterus. Ultrasound followed by Magnetic Resonance Imaging (MRI) revealed multiple fibroids. Since she strongly desired to preserve her fertility, an abdominal myomectomy was planned. The present case highlights the removal of 147 fibroids from the patient, along with a discussion on the challenges faced during surgery and the postoperative period. The authors emphasises that such cases require a highly multidisciplinary approach and should be performed in institutions with adequate blood banks and intensive care support.
Fertility, Haemorrhage, Hysterectomy, Intensive care
A 30-year-old female presented at the outpatient department with heavy menstrual bleeding that had been worsening over the past six months. She also complained of extreme fatigue, weakness, palpitations, and had an abdominal mass corresponding to a 36-week gravid uterus. According to her medical history, she was diagnosed with a fibroid uterus during her first pregnancy 10 years ago, after which she underwent a laparoscopic myomectomy in 2016. She had one child who is now 10 years old, and she strongly desired to preserve her fertility. The laparoscopic myomectomy performed six years ago provided relief from her symptoms for a year, but then she started experiencing heavy menstrual bleeding again. The patient tried treatment with Gonadotropin hormone-releasing Hormone (GnRH) analogues and ulipristal acetate, but these methods failed to alleviate her symptoms or reduce the size of her fibroids.
Additionally, during the Coronavirus Disease 2019 (COVID-19) pandemic in 2020-2021, the patient was unable to follow-up on her treatment and instead relied on local herbs to manage her symptoms. The untreated heavy menstrual bleeding for two years resulted in severe anaemia. She received a blood transfusion at a local hospital and was eventually brought to the institution with a Haemoglobin (Hb) level of 2.9 gm/dL, accompanied by extreme fatigue and palpitations. On examination, the patient exhibited severe anaemia, poor nutritional status, and had an abdominopelvic mass that was mobile, firm, non tender, and had irregular contours, almost touching the xiphisternum. Ultrasound revealed multiple uterine fibroids, with the largest one measuring 10×8 cm. Distortion of the endometrial cavity was also observed. MRI of the patient revealed multiple well-defined lesions appearing iso to hypointense on long TR images, originating from the anterior and posterior wall and fundus of the uterus, located intramurally and subserosally, and causing compression of the endometrium (Table/Fig 1).
Due to the presence of multiple fibroids confirmed clinically and via imaging, the patient was advised to undergo a hysterectomy as a safer management option. However, since the patient was keen on preserving her fertility, she opted for a myomectomy after providing informed consent. The informed consent process included discussing the high possibility of requiring multiple blood transfusions, the potential need for an intraoperative hysterectomy, the risk of injury to surrounding organs such as the urinary bladder, ureter, and fallopian tube, as well as the possibility of fibroid recurrence and counselling regarding future reproductive outcomes, such as uterine rupture. Before the surgery, the patient needed a transfusion of eight units of Packed Red Blood Cells (PRBC) to increase her Haemoglobin (Hb) level to 10.5 g/dL. Additionally, 4 units of PRBC, 4 units of Fresh Frozen Plasma (FFP), and 4 units of platelets were reserved in anticipation of significant blood loss during the surgery.
The surgery was performed under general anaesthesia with a midline vertical incision, which had to be extended above the umbilicus for adequate exposure. Upon entering the abdomen, multiple fibroids were observed, distorting the shape of the uterus, with the largest measuring approximately 8×5 cm on the fundus.
After assessing the feasibility of a myomectomy and inspecting and palpating the fibroids, the procedure commenced. It was decided not to administer diluted vasopressin (20 Units in 200 mL normal saline) all at once, but rather to inject it in succession around the fibroids just before enucleation. Special care was taken to avoid injury to the fallopian tube. As the enucleation of the fibroids proceeded, the endometrial cavity was opened, as several fibroids had submucosal components. The surgical challenges included complete identification of the fibroids, obliteration of the uterine dead space, achieving haemostasis, and reconstructing the uterus after the removal of 147 fibroids (Table/Fig 2). The surgery lasted for three hours, with an average blood loss of approximately 2.5 litres. During the procedure, the patient required five units of packed red Blood Cells (PRBC), five units of Fresh Frozen Plasma (FFP), and five units of platelets. Due to the substantial blood loss, the patient was transferred to the Intensive Care Unit (ICU) and received vasopressor support while being intubated. Extubation took place the following day, and vasopressor support was gradually discontinued 12 hours after the surgery. The patient was initiated on high-dose antibiotics (Piperacillin-tazobactam) and closely monitored for urine output. Deep Venous Thrombosis (DVT) prophylaxis was administered to the patient through anti-DVT stockings immediately after the surgery and via injection of low molecular weight heparin 24 hours later. The patient recovered well from the surgical stress and was transferred from the ICU to the ward on day 3 post-surgery. Histopathological examination revealed multiple leiomyomas. A follow-up appointment after one month demonstrated significant improvement in the patient's symptoms and quality of life.
Uterine fibroids, or leiomyomas, are benign smooth muscle tumours that arise from cells of the uterine myometrium. They are a common gynaecological condition, affecting up to 80% of premenopausal women (1). While many women with fibroids are asymptomatic, those with symptoms often experience heavy menstrual bleeding, abdominal pain, increased abdominal girth, urinary frequency, constipation, recurrent miscarriages, dyspareunia, and sometimes subfertility (2).
Fibroids are a significant health problem among women aged 15-54 years, accounting for 29% of gynaecologic hospitalisations (3). Additionally, fibroids account for 40%-60% of all hysterectomies and 30% of hysterectomies among young women aged 18-44 years (4). Several factors have been associated with an increased risk of developing uterine fibroids. Ethnicity appears to be a significant risk factor, with individuals of black race having a higher incidence of fibroids (1). Other risk factors, such as nulliparity, obesity, polycystic ovary syndrome, diabetes, and hypertension, also contribute to fibroid prevalence (5). Notably, multiple cutaneous and uterine leiomyomatoses have been linked to the fumarate hydratase gene, which codes for a mitochondrial enzyme. Furthermore, cytogenetic abnormalities, particularly deletions of chromosome 7, have been observed in a substantial proportion of fibroid specimens (5).
Uterine-sparing surgery is generally recommended as a treatment for multiple fibroids in women of reproductive age to preserve fertility. In those desiring fertility, myomectomy is typically recommended over Uterine Artery Embolisation (UAE). This is because UAE is associated with a higher rate of re-intervention, a higher likelihood of intrauterine adhesions, and a general lack of evidence regarding fertility and pregnancy outcomes [6,7]. UAE may also sometimes lead to inadvertent embolisation of ovarian vessels, causing a decrease in ovarian reserve and compromising reproductive function (8). However, in women of childbearing age who wish to preserve their fertility, management can be difficult in patients presenting with multiple large fibroids, particularly if a hysterectomy would be the safer and more cautious approach.
The present case report highlights the challenging case of the removal of 147 fibroids from a woman who wanted to preserve her fertility, emphasising the intraoperative and postoperative difficulties faced. Similarly, case reports in the literature discussing the removal of multiple fibroids have focused on the importance of meticulous surgical steps and the significance of decreasing blood flow to the uterus using a tourniquet and vasopressin (9),(10). Additionally, having an accurate understanding of the location of fibroids is necessary for meticulous preoperative planning. Research has shown that MRI has superior sensitivity and minimal measurement discrepancies (11).
The present case highlights that myomectomy in such high-risk cases can be complex and requires multidisciplinary support, including a significant need for blood products and intensive care. Such cases should only be attempted in institutions where such support is available, as timely intervention can save the patient's life. In the postoperative period, with the background of haemorrhage, higher antibiotics should be administered to prevent sepsis, DVT prophylaxis must be ensured, and urine output should be closely monitored. It is also important to counsel the patient about the risks involved in such cases, especially when a safer alternative surgery, such as hysterectomy, is available. Additionally, one cannot ignore the effect that the COVID-19 pandemic had on this patient, as she went untreated for two years, leading to severe anaemia and the need for such a complex surgery due to the rapid growth of the fibroids.
DOI: 10.7860/JCDR/2023/64584.18685
Date of Submission: Apr 08, 2023
Date of Peer Review: Jul 14, 2023
Date of Acceptance: Aug 23, 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: Apr 12, 2023
• Manual Googling: Jul 29, 2023
• iThenticate Software: Aug 21, 2023 (7%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
- 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