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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
Anaesthetic Management of Pyelolithotomy Patient with Restricted Mouth Opening due to Previous Mandibular Surgery- A Case Report
Correspondence Address :
Kala Balasubramanian,
Professor, Department of Anaesthesia, Sree Balaji Medical College, Chrompet, Chennai, Tamil Nadu, India.
E-mail: kalamhn@gmail.com
Anaesthetic management of a patient with compromised kidney function, who had restricted mouth opening due to previous surgery for mandibular fracture requiring general anaesthesia, is a challenge for anaesthesiologists. This is a case report of a 45-year-old male patient with renal calculus who underwent left pyelolithotomy surgery under general anaesthesia at our institution. He was admitted with left loin pain of two weeks’ duration. Airway control was difficult due to limited mouth opening resulting from mandibular fracture four months prior, for which he underwent open reduction and internal fixation at a different hospital. We anticipated difficulty in securing the airway due to mandibular plate fixation. The airway was secured with orotracheal intubation using a levitan optical stylet under airway block. This case report highlights the importance of optical stylet in the plan B of managing a difficult airway, when a fiberoptic bronchoscope is not available in a critical situation.
Body mass index, Bronchoscopes, Intratracheal, Intubation, Oxygen saturation
A 45-year-old male patient weighing 65 kg was admitted with a complaint of left loin pain lasting two weeks. Four months prior, the patient sustained a facial/jaw injury in a road accident and underwent open reduction and internal plating for mandibular fracture at a dental college hospital. The patient had restricted mouth opening [see Table/Figures 1 and 2] and no other comorbidities. During this admission, the patient was diagnosed with a left renal calculus, which was confirmed by urologists. The patient was scheduled for left-side pyelolithotomy. His respiratory, cardiac, and renal parameters were normal according to his chest X-ray, electrocardiogram (ECG), echocardiogram (ECHO), and biochemical reports. His blood pressure was 120/80 mmHg, SPO2 was 98%, his height was 160 cm, weight was 65 kg, and his body mass index (BMI) was 25.4. Airway examination showed a Mallampatti class 4, an inter-incisor distance of only 2 cm (restricted mouth opening), but normal neck movements.
Blood investigation: Complete blood count, renal function test, and blood sugar were within normal limits, and a lateral view of the facial bones showed plating for mandibular fracture. The patient was assessed as ASA PS II (tobacco chewer, difficult airway). Due to anticipated difficult intubation, awake intubation under airway block using a levitan optical stylet or fiberoptic bronchoscope was planned. The patient was informed about the procedure, including airway block and intubation, and obtained consent. On the day of surgery, the patient received injection glycopyrrolate 0.2 mg one hour prior to surgery and was then shifted to the operating room. An intravenous (i.v.) line was secured using an 18 gauge cannula, and the oral cavity was anesthetized with a 4% lignocaine gargle. The patient was connected to a multi-parameter monitor for non-invasive blood pressure, electrocardiogram (ECG), and oxygen saturation (SPO2). The patient was premedicated with injection midazolam 1 mg i.v. and injection fentanyl 100 mcg i.v. The anesthesia workstation was checked, and a difficult airway cart was kept ready, which included a laryngoscope with different size blades, McCoy blade, intubation bougies, levitan optical stylet, fiberoptic bronchoscope, and equipment for surgical airway including percutaneous cricothyrotomy kit.
Airway block: A superior laryngeal nerve block was given just inferior to the greater cornua of the hyoid bone and superior to the thyroid cartilage by injecting 2 mL of 2% lignocaine on both sides. A trans-tracheal block was given through the cricothyroid membrane with 3 mL of 2% lignocaine after getting a give-way and confirming the position by aspirating air from the trachea. The patient had a cough while receiving the injection, which helped to spread the local anesthetic drug in the larynx and trachea. A levitan optical stylet was kept ready with an 8 mm ID PVC cuffed endotracheal tube, which was railroaded onto it. Injection midazolam 1 mg and injection fentanyl 50 mcg were given. The patient was preoxygenated with 100% O2 for five minutes. Then, with the help of a conventional laryngoscope, tongue lateralisation was performed. The levitan optical stylet was introduced, and the tip was placed behind the epiglottis. Viewing through the eyepiece, the glottic inlet was seen, and the optical stylet with the endotracheal tube was introduced into the trachea under visual guidance. The tracheal rings were seen, and the carina was identified. Continuous insufflations of oxygen at 5 l/min were given through the oxygen port. Under vision, the endotracheal tube was pushed downwards into the trachea, and then the optical stylet was removed. The endotracheal tube was fixed at 21 cm at the right-side angle of the mouth. An ETCO2 monitor was connected, and an oro-pharyngeal temperature probe was also inserted. Induction was performed with injection propofol 100 mg, followed by injection vecuronium 6 mg i.v. General anesthesia was maintained with N2O and O2 at a 2:1 ratio with desflurane 3-5%. The patient was positioned for the surgical procedure (pyelolithotomy), and the placement of the endotracheal tube was again confirmed. The duration of the procedure was three and a half hours. Intraoperatively, injection fentanyl 20 mcg and injection vecuronium 1 mg were repeated twice. The patient received injection ondansetron 4 mg and injection dexamethasone 8 mg i.v. At the end of surgery, the patient was reversed with injection neostigmine 2.5 mg and injection glycopyrrolate 0.4 mg. Extubation was performed after adequate oropharyngeal suctioning and after adequate recovery of reflexes and muscle power. Post-extubation oxygenation with 100% O2 for five minutes was performed. The patient was observed on room air for about 10 minutes and was then shifted to the recovery room. After half an hour, the patient was shifted to the postoperative ward.
Numerous case reports and experiences of airway management in patients with limited mouth opening have been published in various journals. However, most of these cases are managed with fiberoptic-guided (FOB) orotracheal or nasotracheal intubation, retrograde guidewire-assisted fiberoptic nasal intubation, and blind nasal intubation (1),(2). Tracheostomy is also reported as a life-saving measure in patients with associated neurological or neuromuscular diseases. Nowadays, blind nasal intubation is not commonly practiced due to the availability of various sophisticated airway gadgets. If mouth opening is adequate, supraglottic intubating airway devices can be used, and FOB is reserved for patients with limited mouth opening and a deviated trachea due to various pathologies or trauma. However, FOB usage requires skill and training to handle it effectively. Tracheostomy is an invasive technique that can be performed either as a planned procedure if all other non-invasive options are not feasible or as a life-saving emergency. We kept all necessary equipment, including FOB and tracheotomy sets, in the difficult airway cart. For this patient, the levitan optical stylet was chosen as a device to aid intubation to combat the difficult airway due to limited mouth opening. The levitan FPS is a rigid optical device and a wonderful alternative option in a patient with restricted mouth opening. The length of this optical stylet is 30cm, 5mm in diameter, and the distal shaft of the stylet is malleable. It has a port for oxygen resource and a portable light source (3),(4),(5). It can be used as an independent device or along with a direct laryngoscope to aid orotracheal intubation. Its main advantage is a very high first-pass success rate, and its distal end being malleable can be manipulated according to the airway curvature (Table/Fig 3), (Table/Fig 4). Sahu S et al., (6) used a light wand for emergency intubation to secure the airway in patients with facial trauma (6). Rhee KY et al. recommended the use of a lighted stylet for both oral and nasal intubation in difficult airway situations (7). Gaszynski compared the levitan FPS with the Lary-Flex video laryngoscope for ease of intubation in morbidly obese patients and found that both devices improved laryngeal visualisation (8). However, the levitan FPS optical stylet had a better laryngeal view compared to the eary-Flex video laryngoscope, and the latter produced less cardiovascular response to intubation (8),(9). light wandintubation was found to be cost-effective, easy to use, and easy to maintain compared to other devices for difficult intubation (10). Additionally, compared to the routine Macintosh laryngoscope, the optical stylet was clinically beneficial in improving the intubating conditions in patients with cervical spondylosis (11).
While the fiber optic bronchoscope is considered the gold standard for difficult airway management, the malleable optical stylet is a cost-effective and useful alternative for securing the airway in conditions such as restricted mouth opening and emergency intubation situations. This simple and user-friendly device also has the provision to oxygenate the patient during the intubation procedure and minimise aerosol exposure if suitably protected (when done under a camera-assisted technique) in patients with restricted mouth opening.
DOI: 10.7860/JCDR/2023/60004.18068
Date of Submission: Sep 03, 2022
Date of Peer Review: Feb 27, 2023
Date of Acceptance: Apr 17, 2023
Date of Publishing: Jun 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Sep 05, 2022
• Manual Googling: Apr 08, 2023
• iThenticate Software: Apr 15, 2023 (6%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
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