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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
Considerations for Optimal Dental Management in a 10-year-old Child with Congenital Heart Disease and Dextrocardia: A Case Report
Correspondence Address :
Sahili Santosh Mungekar,
Sagar, HIG Building Nos. 6, Room Nos. 161, 6th Floor, Behind Raheja Hospital, Mahim West, Mumbai-400016, Maharashtra, India.
E-mail: sahilimungekar@yahoo.com
Congenital Heart Disease (CHD) is one of the most common developmental anomalies seen in children and there is an increased risk of developing oral disease and its systemic effects in children with CHD. The present case report highlights the dental management of a 10-year-old boy with CHD and dextrocardia. The diagnosis for the patient included dextrocardia (where the position of the heart is developmentally changed from the left to the right-side), complete atrioventricular septal defect and double outlet right ventricle with pulmonary stenosis. After consultation, diagnosis and treatment planning and upon obtaining consent from the parents and modifying the child’s behaviour, the dental needs of the child were addressed on a visit-by-visit basis. A quadrant approach was adopted to complete the extractions of all retained carious primary teeth, followed by restorative treatment. Oral prophylaxis was performed, followed by topical fluoride application and the patient was then referred to the Department of Orthodontics for treatment of malalignment. This case report focuses on the guidelines followed for antibiotic prophylaxis against Infective Endocarditis (IE) and highlights the importance of maintaining good oral health for this group of patients. The dental management of children with CHD can be complex, as oral health is often neglected by both parents and patients. Cardiovascular problems can significantly impact both the child and the parent, affecting management and financial implications. The dental considerations require early diagnosis of dental problems and prompt treatment to prevent complications and difficulties in implementing treatment due to systemic repercussions. The present case report aimed to improve dental care for children with severe systemic alterations, as there is a lack of scientific literature regarding the dental management of paediatric patients with CHD.
Antibiotic prophylaxis, Dental health services, Heart defects, Infective endocarditis
A 10-year-old boy, previously diagnosed by medical professionals with dextrocardia and pulmonary stenosis, came for his first dental visit at the Department of Paediatric and Preventive Dentistry with a chief complaint of misaligned teeth. The medical history was evaluated. The child was delivered at 37 weeks of gestation and there were no unfavourable outcomes related to the pregnancy and delivery. He is the only son of the couple, who have two daughters, in a moderately educated family setting from a non consanguineous marriage. There is no family history of congenital anomalies.
Physical examination revealed that the overall growth and development were delayed, though the child had good intellectual status. He had a mesocephalic head, cyanotic lips and clubbing of the nail beds on his upper and lower limbs, which was confirmed by the Schamroth window test (Table/Fig 1) (1). The facial profile was convex. A chest X-ray revealed hilar/subhilar patchy consolidations with evidence of cardiomegaly/dextrocardia (situs inversus) (Table/Fig 2). The patient was not taking any medications for this condition.
His chest colour Doppler and echocardiogram revealed CHD with dextrocardia, complete atrioventricular septal defect, double outlet right ventricle and pulmonary stenosis, which were diagnosed three months prior to his first dental visit to the Department. There was no evidence of Infective Endocarditis (IE) (Table/Fig 3). The child’s behaviour was rated as positive according to the Frankl behaviour rating scale.
Intraoral soft-tissue examination revealed a red, bumpy tongue with enlarged taste buds, known as “strawberry tongue” (Table/Fig 4). The child was in the mixed dentition stage with completely erupted teeth 16, 26, 36 and 46. Retained deciduous teeth were present: 51, 52, 62, 71, 72 and 82. Angle’s Class I molar relation was present on both sides. A deep bite was noted. Stains (++) and calculus (+) were present (Table/Fig 5). The patient used non fluoridated toothpaste and brushed once a day in the morning.
The orthopantomogram of the patient showed retained deciduous teeth numbered 51, 52, 62, 71, 72 and 82. The gonial angle, condylar heads and skeletal pattern of growth all appeared normal. (Table/Fig 6). After assessing all these findings, the parents were advised to obtain a medical fitness certificate from the physician and to consult regarding the strawberry tongue. The paediatrician prescribed multivitamins for the strawberry tongue. The treatment plan was explained to the parents and after obtaining written consent, treatment was started with antibiotic prophylaxis using three tablets of Amoxicillin 500 mg one hour before the dental appointment, as the patient weighed 30 kg.
A caries risk assessment of the patient was calculated using the Caries Risk Assessment for Treatment (CRAFT) tool, which concluded that the patient had a high caries index (Table/Fig 7) (2).
Two days later, the child’s second visit was scheduled, during which 2 mL of local anaesthesia without adrenaline (Lox 2%, Neon Laboratories Ltd., India) was administered, with 1 ml each delivered using buccal and palatal infiltration techniques. The retained primary teeth numbered 51, 52 and 62 were extracted. The procedure was uneventful and hemostasis was achieved using a gauze piece (pompom) and digital pressure. The patient was advised to continue the previously prescribed antibiotics and a tablet of paracetamol 250 mg was prescribed to be taken only if pain occurred.
The third visit was scheduled five days later. During this visit, the extraction of the lower retained primary teeth numbered 71, 72 and 82 was performed using the same technique (Table/Fig 8). The fourth visit was scheduled 10 days later, during which oral prophylaxis was conducted, followed by the application of topical fluoride using acidulated phosphate fluoride (Pascal APF Fluoride gel, Pascal International Inc.) (Table/Fig 9).
The child was advised to have a follow-up every three months until the complete eruption of the permanent teeth. Diet counselling for both the parent and child was provided, with instructions to reduce the consumption of sugar-containing foods and to increase the intake of fruits and vegetables. Furthermore, the child was advised to brush twice a day with fluoridated toothpaste and to rinse daily with a fluoridated mouthwash. The patient was also referred to the Department of Orthodontics for correction of the deep bite and convex profile.
The CHD is defined by Mitchell SC et al., (1971) as a gross structural abnormality of the heart or intrathoracic great vessels that is actually or potentially of functional significance (3). CHD and morphological changes of the heart are considered to be among the most common anomalies in newborn infants, with an incidence of eight out of 1,000 live births worldwide (4). Dextrocardia refers to the positioning of the heart on the right-side of the thoracic cavity. It is a congenital anomaly that occurs during embryogenesis and results in anatomical left-right asymmetry (5).
Children with CHD have been found to have similar or poorer oral health compared to children without cardiac defects [6-9]. With the increased survival of patients with CHD, there comes an increased burden of complexity in managing these children’s oral health and disease. However, IE remains a major and serious complication in the dental management of patients with CHD. The presence of transient bacteraemia is considered one of the major risk factors in the pathogenesis of IE (10),(11),(12),(13),(14),(15). CHD itself seems to impact dentition, as enamel-forming cells are very sensitive to changes in metabolic conditions. Clinically, this is presented as thinner or softer teeth, making them more susceptible to dental caries (16). One of the major reasons for the neglect of oral health appears to be the focus on the child’s heart disease, which remains central to the parents’ and child’s daily lives (17),(18). The management of such patients requires a balance between medical and dental faculties, based on the guidelines of the American Heart Association (AHA) (19).
Additionally, positional anomalies and crowding in the permanent dentition have been shown to be more prevalent in children with CHD (9). It is essential that prior to prescribing drugs for dental purposes, appropriate consultation is made with the child’s physician (20). Therefore, before proceeding with dental management, a medical fitness certificate should be obtained from the child’s cardiologist.
The child’s caries risk assessment was calculated using the mobile-based app CRAFT (Caries Risk Assessment For Treatment) and categorised the patient as high-risk (2). According to the American Academy of Paediatric Dentistry (AAPD) revised guidelines for 2020-21, patients with CHD must be prescribed antibiotic prophylaxis to prevent the increased risk of developing IE (21). Three tablets of Amoxicillin (500 mg) were prescribed to be taken one hour before the dental appointment as antibiotic prophylaxis.
Children with CHD experience difficulties in managing the usual stress associated with dental therapy. Reducing stress and anxiety is the primary goal in the successful dental management of these patients. Local anaesthetics play a major role in controlling pain in patients with CHD. The literature indicates that there is no absolute contraindication to the use of local anaesthetics containing vasoconstrictors (22). However, adrenaline-containing local anaesthetics can affect the cardiovascular system (23). An increase in cardiac output and stroke volume may occur if the concentration of adrenaline in the blood rises (24). Therefore, to prevent this, the extractions of retained deciduous teeth were performed using local anaesthesia without vasoconstrictors.
Children with CHD are at an increased risk of oral diseases, which may further jeopardise their overall general health. As a preventive measure, oral prophylaxis followed by topical fluoride application was performed for the child.
Children with CHD should have good access to dental care, as it is vital for their overall health. This access allows them to attain and maintain good oral health throughout their lives, limiting the need for complicated dental treatments and reducing their risk of IE. However, dental professionals encounter certain challenges when treating patients with CHD, such as high dental needs, complex medical histories, dental-related anxiety and a low level of awareness regarding the importance of oral health. Consequently, the priority given to oral care may be insufficient. The dental team plays a crucial role in regularly following up with patients who have CHD, providing enhanced prevention, proper diagnosis and effective management of their oral health.
DOI: 10.7860/JCDR/2024/73802.20246
Date of Submission: Jun 24, 2024
Date of Peer Review: Jul 23, 2024
Date of Acceptance: Oct 01, 2024
Date of Publishing: Nov 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: Jul 03, 2024
• Manual Googling: Jul 25, 2024
• iThenticate Software: Sep 28, 2024 (9%)
ETYMOLOGY: Author Origin
EMENDATIONS: 8
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