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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
Progressive Paraparesis due to Extramedullary Haematopoiesis in Thalassaemia Intermedia Treated Successfully with Radiotherapy: A Case Report
Correspondence Address :
Bithi Pal,
88, College Street, Kolkata-700073, West Bengal, India.
E-mail: bithipal29@gmail.com
Extramedullary Haematopoiesis (EMH), a rare complication of Thalassaemia Intermedia (TI), can present with pressure symptoms including Spinal Cord Compression (SCC) and can be treated using surgery, radiotherapy, hypertransfusion, or hydroxyurea. Hereby, the authors present a case report of a 20-year-old male young thalassaemic patient presented with progressive paraparesis. Neurological examination suggested SCC, and Magnetic Resonance Imaging (MRI) of the spine revealed paravertebral masses due to EMH. The patient was treated with radiotherapy to a dose of 30 Gy over three weeks. There was immediate, near-complete resolution of symptoms, and the patient could walk without assistance. He has been doing well since 1.5 years of treatment. So, in cases of TI, one should think of EMH as a differential diagnosis for paraparesis. Early clinicoradiological diagnosis of EMH-induced SCC is necessary and possible, as there is a high chance of complete remission of symptoms with radiotherapy, which is a non invasive and effective treatment option.
External beam radiotherapy, Magnetic resonance imaging, Spinal cord compression
A 20-year-old male patient presented with complaints of tingling and numbness in both feet, along with progressive difficulty in standing, walking, slippage of footwear without awareness for the last seven months. There was no history of loss of bladder or bowel control, back pain, or weakness in the upper limbs. He was diagnosed with Haemoglobin E-b (HbE-b) thalassaemia at the age of five years. As the patient did not depend on frequent blood transfusions, the diagnosis was classified as Thalassaemia Intermedia (TI). The Haemoglobin (Hb) level was maintained at 6-8 g/dL after the diagnosis. There was no history of spontaneous or trauma-induced bone fractures.
On clinical examination, the patient was conscious, alert, and cooperative. The height and weight of the patient were 161 cm and 53 kg with a normal build. He had characteristic facies with frontal bossing and malar prominence. He was pale and mildly icteric. The cranial nerves examination revealed no abnormality. The motor examination of both lower limbs revealed normal tone with mild loss of power (Medical Research Council scale (1) for muscle strength: Grade 4/5) in the flexor group of muscles of both hip and knee joints. The power of other groups of muscles (extensors of hip and knee joints, dorsiflexors and planterflexor of both ankle joints) was within normal limits. The deep tendon reflexes were exaggerated in both lower knee joints and normal in both ankle joints. Bilateral plantar reflexes were extensor. The motor and sensory neurological findings of both upper limbs were within normal limits. There was no bony tenderness over the vertebrae.
The laboratory investigations were as follows: Hb-7.90 g/dL (13-17 g/dL in males, 12-15 g/dL in females), Total Leukocyte Count (TLC)- 18,800/cumm (4,000-11,000/cumm), platelet count-185×103/cumm (150-400×103/cumm), Mean Corpuscular Volume (MCV)- 74.4 fL (80-100 fL), Mean Corpuscular Haemoglobin (MCH)-21.1 pg (27-31 pg), Red Cell Distribution Width (RDW)-30.4 (12-15). Hb electrophoresis showed Adult Haemoglobin (HbA) 8.5% (95-98%), Foetal Haemoglobin (HbF) 40.4% (<0.6%), and HbA2 53.3% (2-3%). Biochemical investigations showed serum bilirubin- 3.4 mg/dL (0.1-1.2 mg/dL), unconjugated bilirubin- 2.3 mg/dL (0.2-0.8 mg/dL), serum urea- 37 mg/dL (5-20 mg/dL), serum creatinine- 1.1 mg/dL (0.7-1.3 mg/dL). The peripheral blood smear showed marked anisopoikilocytosis, microcytic severely hypochromic Red Blood Cells (RBCs), teardrop cells, target cells, elliptocytes, schistocytes, basophilic stippling, and polychromatophils, with an overall impression of microcytic hypochromic anaemia with haemolysis (Table/Fig 1)a-c.
Magnetic Resonance Imaging (MRI) of the spine showed a lobulated hyperintense lesion involving the paravertebral portion with involvement of the spinal canal has been depicted in (Table/Fig 2). The lesion extended from the D3-D4 level downward to the D12 level. The radiological appearance strongly suggested Extramedullary Haematopoiesis (EMH) in the context of an underlying haematological condition. Contrast-enhanced Computed Tomography (CECT) of the brain and chest showed evidence of EMH. CECT of the abdomen showed hepatosplenomegaly (Table/Fig 2). So, the case was diagnosed as EMH in the background of Thalassaemia Intermedia, presented with clinical features of Spinal Cord Compression (SCC).
The present patient was deemed a poor candidate for surgical decompression due to the large extent of the lesion, the risk of haemorrhage, and haemodynamically instability due to anaemia. Consequently, radiotherapy was planned for the patient. Initially, the patient received 20 Gy in 10 fractions (2 Gy per fraction) over two weeks delivered by a 6 MV photon beam in a linear accelerator. The radiation dose was escalated to 30 Gy in view of good clinical response and tolerable haematological toxicities. Corticosteroids was given during radiation at a dose of 8 mg twice daily, which was then gradually tapered within two weeks after completing radiation. The power of both lower limbs improved during radiation treatment. The patient was able to stand and walk unaided after completion radiation therapy. A follow-up MRI scan done, six weeks after completing radiotherapy showed residual disease, but the clinical response was excellent. The patient has been followed up for the last 1.5 years and is still doing well.
The clinical phenotype of β-thalassaemia who does not require frequent blood transfusion is termed as TI (2). EMH is the production of blood cell precursors outside the bone marrow, which occurs in TI as a compensatory mechanism to overcome a chronic hypoxic state (3). Case reports of present condition have shown that the mid and lower thoracic region of the spine has a predilection for SCC due to EMH in thalassaemia patients, which can be related to the smaller diameter of the spinal canal and limited mobility (4),(5). The clinical features can be described under the following headings: a) generalised feature is fatigue; b) thoracic manifestations include bilateral paravertebral masses, rib expansion; c) abdominal manifestations include hepatosplenomegaly, perirenal involvement; d) neurological manifestations include seizure, hydrocephalus, cord compression (6). Some of the important differential diagnosis are lymphoma, sarcoma, metastatic disease, Castleman’s disease (6). Though biopsy is the gold standard for tissue diagnosis, it carries a risk of catastrophic haemorrhage. Thus, MRI became the imaging modality of choice for the diagnosis and follow-up for SCC due to EMH (5). The radiological appearance of EMH is isointense on T1-weighted MRI and hyperintense on T2W-weighted MRI (7).
There is no standard treatment guideline available for this condition as most of the cases were reported sporadically (8). Different treatment modalities were used like hypertransfusion, surgical decompression, radiotherapy, and hydroxyurea (9). Surgical excision with or without radiotherapy is an effective treatment option (4),(10). But radical excision of the EMH mass was not always possible due to the difficult site, risk of bleeding, and nerve injury (11). On the other hand, haematopoietic tissue is very radiosensitive, thus rapid shrinkage of the EMH mass is possible with radiation. There are case reports available in the literature where an excellent response was achieved after treating with radiotherapy alone (12),(13). Saha A et al., described a case of thalassaemia with SCC due to EMH in a 21-year-old female whose neurological symptoms recovered nearly completely with External Beam Radiation Therapy (EBRT) (14). Munn RK et al., in 1988 showed that radiotherapy with corticosteroid is an effective treatment option, and the response is usually long-lasting (15). The overall prognosis of present condition is said to be good, if earlier detection and prompt treatment can be administered.
The Spinal Cord Compression (SCC) due to Extramedullary Haematopoiesis (EMH) in the background of thalassaemia or any other haematological disorders is a rare phenomenon. Prompt diagnosis through thorough clinical examination, MRI of the spine, followed by radiotherapy alone or in combination with other treatment options, results in a good and long-lasting response. The case reported by authors showed a very good clinical response, when treated with radiotherapy in a 20-year-old male thalassaemia patient, who presented with progressive spastic paraparesis due to EMH.
DOI: 10.7860/JCDR/2024/70761.19695
Date of Submission: Mar 22, 2024
Date of Peer Review: May 17, 2024
Date of Acceptance: Jun 11, 2024
Date of Publishing: Aug 01, 2024
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: Mar 23, 2024
• Manual Googling: May 18, 2024
• iThenticate Software: Jun 10, 2024 (6%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
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