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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
Accessory Hepatic Vein Stenting in the Management of Budd-Chiari Syndrome: A Case Report
Correspondence Address :
Dr. Rahul Arkar,
Associate Professor, Department of Interventional Radiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune-411018, Maharashtra, India.
E-mail: rrarkar@gmail.com
The Budd-Chiari Syndrome (BCS) is associated with hepatic venous outflow obstruction. A 22-year-old female patient presented with abdominal pain and backache for 12 days, along with generalised weakness. Physical examination revealed pitting pedal oedema and abdominal distension. An abdominal ultrasound with Doppler Ultrasonography (USG) was performed, revealing liver parenchymal disease with gross ascites and occlusion of all three Hepatic Veins (HV), suggestive of BCS. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) of the liver, as well as a right hepatic venogram using Digital Subtraction Angiography (DSA), showed chronic total occlusion at the ostium. An Accessory Hepatic Vein (AHV) was identified, joining the Right Hepatic Vein (RHV) to the Inferior Vena Cava (IVC). The accessory RHV exhibited high-grade stenosis (approximately 90-95%) at its junction with the IVC. Recanalisation of the AHV (balloon dilatation/stent insertion) was performed. Post-procedure accessory hepatic venogram showed a patent stented segment with a significant reduction in adjacent venous collaterals. No procedure-related complications were observed. The present case highlights the importance of AHV stenting in BCS patients, as it helps maintain normal physiology, in contrast to Direct Intra-hepatic Porto-systemic Shunt (DIPS), which alters normal physiology by allowing portal venous blood to mix directly into the systemic circulation, bypassing the liver parenchyma.
Internal jugular vein, Liver, Transjugular intrahepatic porto-systemic shunt
A 22-year-old female patient presented to the emergency department with complaints of generalised weakness, pedal oedema, and abdominal pain, which had been ongoing for 12 days and was associated with progressive abdominal distension. The abdominal pain was chronic in nature, a dull ache that was aggravated by walking or coughing. The pain was relieved in a supine position. She also experienced back pain for 12 days. All other systems reviewed were non-contributory. The patient’s past medical history, hormonal therapy, abdominal surgeries, smoking, and alcohol drinking were non-contributory.
On examination, the patient appeared pale. Vital signs were as follows: pulse rate of 92/min, blood pressure of 110/70 mmHg, respiratory rate of 20/min, and a normal temperature. Abdominal examination revealed generalised tenderness. Gross ascites and an enlarged tender liver were noted. Basic haematological investigations revealed a haemoglobin level of 9.0 gm/dL, leukocyte count of 3700/mm3, and platelet count of 206,000/mm3. The liver enzymes were as follows: aspartate aminotransferase (AST) 16 U/L, alanine aminotransferase (ALT) 8 U/L, alkaline phosphatase 78 U/L, total bilirubin 0.94 mg/dL, and renal function test (serum creatinine) 0.62 mg/dL.
Abdominal and pelvic USG revealed liver parenchymal disease and gross ascites. Contrast-enhanced CT and MRI scans revealed hepatomegaly with a flip-flop enhancement pattern, occlusion of the HV, and a patent AHV joining the IVC (Table/Fig 1). A right Internal Jugular Vein (IJV) was accessed using a 10F sheath, and the right common femoral vein was accessed using an 8F sheath. A right hepatic venogram showed chronic total occlusion at its ostium. A large AHV was joining the RHV to the IVC. This accessory RHV showed high-grade stenosis (approximately 90-95%) at its junction with the IVC (Table/Fig 2).
The AHV stenosis was crossed using a Terumo 0.035-inch wire and a 4F H1 diagnostic catheter. Balloon angioplasty of the stenosis was performed using an 8×40 mm angioplasty balloon. However, the check venogram showed persistent stenosis. Subsequently, an 8×25 mm express LD stent was deployed across the stenosis (Table/Fig 3). The stent was post-dilated using an 8 mm balloon inflated up to 12 atm. The post-procedure accessory hepatic venogram showed a patent stented segment with a significant reduction in adjacent venous collaterals (Table/Fig 4). The procedure was uneventful.
The patient was kept on anticoagulation with heparin-warfarin overlap for three days and subsequently continued on warfarin alone with a target INR of 2.5. After achieving a therapeutic INR range, the patient was discharged in stable condition after seven days. During the six-month follow-up, the patient was doing well with no evidence of ascites. The follow-up Doppler showed a patent stent with good velocity and in-stent flow (Table/Fig 5). The patient continued anticoagulation therapy with warfarin tablets.
BCS is a rare disease characterised by hepatic venous outflow obstruction at the level of the HV or IVC, resulting in portal hypertension [1,2]. The obstruction can be thrombotic or non-thrombotic and can occur anywhere along the venous course, from the hepatic venules to the junction of the IVC and the right atrium. BCS occurs in approximately one in 100,000 of the general population worldwide (3). Patients may present with acute signs and symptoms such as abdominal pain, ascites, and hepatomegaly, or with more chronic symptoms related to long-standing portal hypertension. A proper clinical history and imaging are essential for a definitive diagnosis (3). Diagnostic tools commonly used to diagnose BCS include Doppler USG of the liver, MRI, hepatic venography, and liver biopsy (3). Various treatment options, including Transjugular Intrahepatic Portosystemic Shunt (TIPS), surgical shunts, and liver transplantation, have been described as potential treatment options for BCS (4),(5),(6),(7). Early diagnosis of the disease is crucial 8for appropriate treatment. More than half of the cases of classic BCS occur between the ages of 20 and 39 years (8). The proposed etiologies of BCS, as described by Valla DC (3), include multifactorial disease in which several pro-thrombotic conditions, observed in atleast 35% of patients, contribute to the development of thrombosis in an uncommon location such as the HV. Myeloproliferative diseases are observed in approximately 50% of patients with BCS and a mutation in the JAK2 gene. Among other acquired conditions, Behcet’s disease, paroxysmal nocturnal haemoglobinuria, antiphospholipid syndrome, oral contraceptive use, and pregnancy have been documented as aetiologies for BCS. In BCS due to Behcet’s disease, IVC involvement is more common than HV involvement. Oral contraceptive use is associated with HV involvement rather than IVC involvement. Inherited conditions such as Factor 5 Leiden, protein C deficiency, and protein S deficiency also contribute to the development of BCS in a subset of the population (3). Various treatment options for BCS include treating the underlying disease, anticoagulation therapy, percutaneous angioplasty, TIPS, and liver transplantation (3). Anticoagulation therapy is recommended for all patients with BCS, even in the absence of a prothrombotic disorder. Percutaneous angioplasty is recommended for patients with short-segment stenosis of either the HV or IVC. When HV involvement is predominant, anticoagulation along with angioplasty provides symptomatic relief in 20-30% of patients with BCS. TIPS using a covered stent graft is used for suitable patients who have failed anticoagulation/ angioplasty. Liver transplantation is an option for patients in whom previous options have failed or are not possible (6),(7).
Recanalisation of the HV has been increasingly used in the treatment of BCS in recent years with the aim of relieving hepatic congestion and resolving BCS symptoms (1),(2),(9),(10). Nowadays, TIPS is commonly used as the first-choice treatment for BCS. However, shunt dysfunction is a common problem, occurring in up to 13%-50% of patients when metal stents are used for TIPS (11). In contrast, recanalisation of the HV is a physiological procedure, unlike TIPS, as it does not directly mix portal venous blood with systemic blood.
A recent study by Lv LL et al., in 2021 reported that recanalisation of the AHV can safely and effectively treat HV-type BCS, and may result in longer patency compared to recanalisation of the main HV (MHV) (12). Similar findings were reported by Li DM et al., and Xia F-F, with a sample sizes of 46 and 27 respectively (13),(14). The present case also showed similar results, with AHV recanalisation being performed without any complications and with good patency.
Patients with BCS may experience progressive liver dysfunction even if they are treated with a patent surgical shunt or TIPS shunt. Therefore, lifelong follow-up and monitoring with liver function tests are necessary for these patients. Some of them may eventually require liver transplantation (15).
AHV stenting is a safe, physiological, and effective treatment option for patients with BCS. It provides an effective and satisfactory means of treating patients and is associated with good long-term outcomes.
DOI: 10.7860/JCDR/2023/67455.18693
Date of Submission: Sep 09, 2023
Date of Peer Review: Sep 26, 2023
Date of Acceptance: Oct 05, 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: Sep 12, 2023
• Manual Googling: Aug 10, 2023
• iThenticate Software: Oct 03, 2023 (9%)
ETYMOLOGY: Author Origin
EMENDATIONS: 5
- 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