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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
Efficacy of Pulmonary Rehabilitation in Pulmonary Tuberculosis Sequelae with Cystic Bronchiectasis and Pulmonary Hypertension
Correspondence Address :
Pooja Ramesh Tiwari,
Plot No. 10, Sad Guru Nagar, Paloti Street, Wardha, Maharashtra, India.
E-mail: poojartiwari06@gmail.com; vishnudiwakarpt@gmail.com
Cystic bronchiectasis, also known as saccular bronchiectasis (a severe type of bronchiectasis), is a condition that occurs as a complication and sequelae after pulmonary Tuberculosis (TB). There is chronic permanent dilation of bronchi that occurs after destructive changes in elastic and muscular layers of bronchial walls which further leads to the ballooning of bronchi and difficulty in clearing secretions with recurrent infection of the respiratory tract. Pulmonary hypertension is another major complication after bronchiectasis which affects pulmonary circulation. A 44-year-old female reported to the physiotherapy department with cystic bronchiectasis and pulmonary hypertension. The positive symptoms were chronic cough with mucoid sputum, low-grade fever, chest pain, breathlessness (modified Medical Research Council (mMRC) grade III), and easy fatiguability. The goals were set and inpatient Pulmonary Rehabilitation (PR) started with the aim of reducing burdening of symptoms and promoting the Quality of Life (QoL). The therapeutic interventions were splinted coughing techniques, deep breathing exercises, thoracic expansions, postural correction exercises, dyspnoea relieving positions, strength training, and pacing techniques. After rehabilitation the ventilation along with strength improved, dyspnoea was reduced, and exercise tolerance was increased.
Dyspnoea, Physiotherapy, Quality of life, Therapeutic interventions, Ventilation
A 44-year-old female patient, a farmer by occupation, visited the medicine department with chief complaints of breathlessness (mMRC grade III), dry cough, and early fatigue for 1 year. The current symptoms are described in (Table/Fig 1). She was diagnosed with pulmonary TB, nine years back and took medications for eight months. For three years she had a similar episode of chest pain, cough, fever, and breathlessness and was diagnosed with post-TB sequelae, for which she again took medication for six months. After all suggested investigations were done shown in [Table/Fig-2,3], the patient was diagnosed with post-TB with cystic bronchiectasis and pulmonary hypertension. After the diagnosis patient was referred to the Department of Physiotherapy for further management.
The patient was conscious, well-oriented, cooperative, afebrile, haemodynamically stable, and relates most of her medical history. She was ectomorphic, with a Body Mass Index (BMI) of 17 kg/m2. She was on three liters of oxygen via nasal prongs, and the use of accessory muscles while breathing was observed. Respiratory examination revealed supraclavicular hollowness, barrel chest shape, and positive trail’s sign as the trachea deviates to the left-side. Chest expansion was reduced at the nipple and xiphisternum levels, respectively. On percussion, a dull note was present over the left lung in the supramammary, mammary and inframammary regions. On auscultation, the air entry was reduced in the left upper, middle, and lower zones and right lower zones.
Physiotherapy management: The physiotherapy prescription started with the education of the patient and family about the present condition. Explaining to them the problems regarding their condition, goals to overcome it, and the importance of exercise therapy. The two weeks of inpatient rehabilitation are detailed in (Table/Fig 4).
The outcome measures were taken on the first day of referral, then after two weeks of physiotherapy rehabilitation, and after one week while follow-up. So, the pre, post, and follow-up are given in (Table/Fig 6). On the follow-up the dyspnoea was relieved from mMRC grade III to mMRC grade I, and the patient was able to cover more distance without getting fatigued in test-retest on a Six-Minute Walk Test (6MWT) further improvement was measured in the modified Borg scale (1) followed by chest pain reduction while activity and on rest for that was used Numeric Pain Rating Scale (NPRS) (2) along with the improvement in quality of life was assessed using World Health Organisation Quality of Life (WHOQoL) (3).
Pulmonary TB is a major global health challenge and the second leading cause of infectious disease-related deaths, affecting individuals of all ages. Even after recovery, patients may still experience sequelae, with 295.9 cases per 100,000 people experiencing structural lung damage leading to physiological impairments and disability (4). Cystic bronchiectasis is a persistently progressive condition characterised by the destruction of the muscular and elastic components of the lungs, resulting in wider and damaged large airways. This condition can occur after an infection or fibrotic changes in lung tissues and is more prevalent in females, with significant morbidity (5). Pulmonary hypertension is a rare but critical condition that affects pulmonary circulation, with a prevalence of 10-52 cases per million. Individuals with pulmonary hypertension typically experience primary symptoms of breathlessness, decreased functional abilities, and reduced QoL (6).
Post-Tuberculosis Lung Damage (PTLD) presents with both obstructive and resistive airway abnormalities, resulting in increased respiratory symptoms and decreased QoL. The presence of chest pain and breathlessness has been closely associated with low QoL, influencing physical, psychological, and social areas of health in patients with pulmonary TB sequelae. This condition has been linked to depression, severe hypoxaemia, age, socio-economic class, and physiological well-being (7). Although the specific condition is not curable, medication and physiotherapy can reduce the burden of the condition and promote life expectancy (8).
PR (Pulmonary Rehabilitation) is a multidisciplinary program for patients with respiratory impairment that compromises their clinical and functional status, affecting their QoL. In a study conducted on eight patients with TB sequelae, PR was found to have a positive impact on health-related QoL and aerobic capacity, assessing disability, exercise capacity, and participation. The study confirms that PR improves health status associated with unexpected haematosis or chest pain and other patient-related outcomes (9).
A study was conducted in 2019 to see the efficacy of PR on TB sequelae, an old disease with a new approach. This rehabilitation focused on aerobic exercises for eight weeks held three times a week, with training intensity ranging from 60-90% of maximum oxygen intake. The results were encouraging, with a 1.7 mL/kg/min increase in peak oxygen consumption (VO2) and a 63.6 m increase in the 6MWT distance. Hence, positive feedback was achieved by improving the physical and functional status of patients with TB, as well as providing psychological support, shortening the convalescent period, and allowing patients to return to work sooner (10). A study was conducted in 2022 to assess the efficacy of exercise therapies in patients with bronchiectasis regarding pulmonary functions, exercise capacity, and QoL. During eight weeks of rehabilitation, the key outcomes were Incremental Shuttle Walk Distance (ISWD) and 6-MWD. The secondary outcomes were Forced Expiratory Volume in one second (FEV1), St. George’s Respiratory Questionnaire (SGRQ), and Leicester Cough Questionnaire (LCQ). The results concluded that PR increases exercise capacity and lung function (particularly FEV1) in individuals with bronchiectasis when compared to normal treatments (11). Patients suffering from respiratory symptoms typically have respiratory muscle weakness. Inspiratory Muscle Training (IMT) has been found to improve inspiratory muscle strength, endurance, functional exercise capacity, dyspnoea, and QoL when used alone. At equivalent work rates, IMT paired with exercise training may result in higher decreases in dyspnoea intensity than exercise training alone (12).
In cases of pulmonary hypertension, breathlessness can be a problem in rehabilitation. Patients with major risk should be monitored properly, and this could be achieved in supervised PR programs. PR provides patients with both physiotherapy and nursing support. The personalised, individualised approach allows the optimum rehabilitation solution to be delivered to patients based on their needs (13). There are two ways to measure outcomes: subjectively and objectively. In this case, both outcomes were taken into consideration. The main focus was on the 6MWT and retest, which shows reliability and significance in patients with respiratory problems (14). Almost every respiratory condition affects QoL. Therefore, present study followed the World Health Organisation (WHO) definition of QOL and used the WHOQoL scale. This was because they are universally accepted and accepted and hence reliable to use as a multidimensional questionnaire (3).
The PR in post-TB sequelae with cystic bronchiectasis and pulmonary hypertension was effective and clinically significant in improving oxygenation and ventilation by removing oxygen support, increasing strength, relieving dyspnoea, improving exercise capacity, and ultimately improving patients’ QoL. This case report provides an integrated management plan for Cystic Bronchiectasis as a post-TB sequela. The patient achieved full recovery while rehabilitation and symptoms were managed, reducing the burden of the disease and promoting QoL. The intervention and its outcomes heavily rely on physiotherapy skills and knowledge, and more research is needed to determine the effectiveness of physiotherapy interventions in pulmonary hypertension.
DOI: 10.7860/JCDR/2023/60872.18323
Date of Submission: Oct 17, 2022
Date of Peer Review: Dec 08, 2022
Date of Acceptance: Feb 01, 2023
Date of Publishing: Sep 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• 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: Oct 21, 2022
• Manual Googling: Dec 15, 2022
• iThenticate Software: Jan 31, 2023 (5%)
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