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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
A Case of Tuberculous Myocarditis Presenting as Monomorphic Ventricular Tachycardia: Multimodality Imaging-guided Diagnosis and Management
Correspondence Address :
Dr. TR Muralidharan,
Professor and Head, Department of Cardiology, SRM Medical College Hospital and Research Centre, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology, Nagar, Kattankalathur, Chengalpattu-603203, Tamil Nadu, India.
E-mail: muralidt@srmist.edu.in
Myocardial involvement in tuberculosis is extremely uncommon and is often diagnosed only at autopsy. Ventricular arrhythmias as the presenting manifestation of tuberculous myocarditis are rare and pose important diagnostic and therapeutic challenges. A 36-year-old female presented with palpitations and sustained monomorphic ventricular tachycardia requiring electrical cardioversion. Baseline electrocardiography showed sinus rhythm with right bundle branch block, and transthoracic echocardiography demonstrated a structurally normal heart. Electrophysiological study revealed three distinct ventricular tachycardia morphologies, suggesting a diffuse arrhythmogenic substrate. Cardiac magnetic resonance imaging demonstrated myocardial oedema and late gadolinium enhancement involving the interventricular septum and lateral wall. Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography (FDG PET-CT) showed patchy myocardial uptake and multiple hypermetabolic cervical and mediastinal lymph nodes. Computed Tomography (CT)-guided lymph node biopsy revealed necrotising granulomatous lymphadenitis consistent with tuberculosis, and the tuberculin skin test was strongly positive. Given the high risk of recurrent malignant arrhythmias during the inflammatory phase, an implantable cardioverter-defibrillator was implanted prior to initiation of antitubercular therapy. The patient received antitubercular therapy with adjunctive corticosteroids and completed nine months of treatment. She remains asymptomatic on follow-up with no recurrence of ventricular tachycardia. The present case highlights the importance of considering tuberculosis in patients presenting with inflammatory ventricular arrhythmias in endemic regions and demonstrates the complementary role of cardiac magnetic resonance imaging and fluorine-18 FDG PET-CT in establishing the diagnosis and guiding management.
Arrhythmias, Cardioversion, Diagnostic imaging, Electrocardiogram, Granuloma, Lymphadenitis
A 36-year-old woman with no prior history of cardiovascular disease, diabetes mellitus, hypertension, autoimmune disease, or known tuberculosis presented to an outside hospital with a one-day history of acute-onset palpitations associated with presyncope. She denied fever, cough, weight loss, night sweats, recent travel, or known close contact with individuals diagnosed with tuberculosis. There was no family history of sudden cardiac death or inherited cardiomyopathy. The presenting electrocardiogram demonstrated sustained monomorphic ventricular tachycardia, and she underwent successful direct-current cardioversion.
The patient was subsequently referred to the study centre for further evaluation. On admission, she was haemodynamically stable. Physical examination was unremarkable, with no clinical features suggestive of heart failure, systemic infection, or extracardiac tuberculosis.
Baseline electrocardiography demonstrated sinus rhythm with right bundle branch block (Table/Fig 1)a. The presence of right bundle branch block raised the possibility of conduction system involvement and suggested an underlying myocardial disease process rather than idiopathic ventricular tachycardia. Transthoracic echocardiography revealed normal left and right ventricular size and systolic function, with no regional wall motion abnormalities or significant valvular pathology.
Given the occurrence of sustained ventricular tachycardia in an apparently structurally normal heart, an electrophysiological study was performed. Programmed ventricular stimulation induced three distinct ventricular tachycardia morphologies. The presence of multiple inducible ventricular tachycardia morphologies suggested a diffuse and heterogeneous arrhythmogenic substrate involving different myocardial regions, favouring an inflammatory or infiltrative myocardial process rather than a focal idiopathic ventricular tachycardia. These findings prompted further evaluation for occult inflammatory cardiomyopathy (Table/Fig 1)b.
Cardiac magnetic resonance imaging demonstrated increased myocardial T2 values consistent with myocardial oedema, and patchy mid-myocardial and subepicardial late gadolinium enhancement involving the interventricular septum and lateral wall, in keeping with active myocardial inflammation (Table/Fig 1)c.
To further evaluate for an underlying inflammatory or infiltrative process, 18F-FDG PET-CT was performed. The study showed heterogeneous patchy myocardial FDG uptake and multiple FDG-avid supraclavicular, cervical, and paratracheal lymph nodes (Table/Fig 2).
The CT-guided biopsy of a supraclavicular lymph node demonstrated necrotising granulomatous lymphadenitis. No alternative infectious or malignant aetiology was identified, and the findings were consistent with tuberculosis (Table/Fig 3). The tuberculin skin test was strongly positive.
Based on the presence of active myocardial inflammation, sustained ventricular tachycardia and histological confirmation of tuberculosis from extracardiac tissue, a diagnosis of tuberculous myocarditis presenting with malignant ventricular arrhythmias was established.
Given the recognised risk of recurrent ventricular arrhythmias during the inflammatory phase and early initiation of antitubercular therapy, a transvenous implantable cardioverter-defibrillator was implanted prior to commencing treatment (Table/Fig 4).
Standard antitubercular therapy consisting of isoniazid, rifampicin, pyrazinamide, and ethambutol was initiated. Adjunctive prednisolone (1 mg/kg/day) was administered during the initial inflammatory phase and gradually tapered over 6-8 weeks. The patient completed nine months of antitubercular therapy without complications. At 12-month follow-up, she remained asymptomatic, and device interrogation revealed no ventricular arrhythmia episodes or implantable cardioverter-defibrillator therapies.
Myocardial tuberculosis is an exceptionally rare manifestation of extrapulmonary tuberculosis. Historical autopsy studies have reported myocardial involvement in a very small proportion of patients with tuberculosis, and the condition is often diagnosed only post-mortem (1),(2). The myocardium may be involved through haematogenous dissemination, lymphatic spread from infected lymph nodes, or direct extension from adjacent mediastinal structures (3),(4).
The pathological patterns of myocardial tuberculosis include diffuse infiltrative disease, nodular tuberculoma, and miliary involvement (2),(4). The diffuse infiltrative form is most often associated with conduction abnormalities and ventricular arrhythmias. Granulomatous inflammation, myocardial oedema, myocyte injury, and subsequent fibrosis may create areas of slow conduction and electrical heterogeneity, thereby promoting re-entry and ventricular tachycardia (5),(6). If unrecognised, tuberculous myocarditis may progress to ventricular dysfunction, refractory ventricular arrhythmias, complete heart block, cardiogenic shock, or sudden cardiac death (7),(8).
The diagnosis is challenging because clinical manifestations are non-specific and may mimic cardiac sarcoidosis, viral myocarditis, or other inflammatory cardiomyopathies. In the present case, cardiac Magnetic Resonance Imaging (MRI) demonstrated myocardial oedema and non ischaemic late gadolinium enhancement, fulfilling imaging criteria for active myocarditis (9). The septal involvement also provided a possible explanation for the baseline right bundle branch block, suggesting inflammatory involvement of the conduction system.
Fluorine-18 FDG PET-CT provided complementary information by demonstrating active myocardial inflammation and identifying metabolically active cervical and mediastinal lymph nodes. This was clinically important because it enabled tissue diagnosis from an accessible extracardiac site, avoiding the limited diagnostic yield and procedural risks associated with endomyocardial biopsy (3),(10).
Several similar cases have been reported in the literature. Khurana R et al., reported tubercular myocarditis presenting with ventricular tachycardia and highlighted the role of cardiac magnetic resonance imaging, lymph node biopsy, antitubercular therapy, corticosteroids, and cardioverter-defibrillator implantation (11). Gautam MP et al., described tuberculous myocarditis presenting as refractory ventricular tachycardia of biventricular origin, supporting the concept of a diffuse arrhythmogenic substrate (12). Clivillé DB et al., recently reported myocarditis with concomitant tuberculosis infection presenting with ventricular tachycardia, in which cardiac magnetic resonance imaging and fluorine-18 FDG PET-CT were central to diagnosis (13). Vennamaneni V et al., also emphasised the diagnostic difficulty and variable presentation of tuberculous myocarditis in a recent case report and review (14). Zhang L et al., reported sudden unexpected death due to tuberculous myocarditis involving the sinus node at autopsy, demonstrating the potentially fatal nature of unrecognised myocardial involvement (8).
The electrophysiological finding of three inducible ventricular tachycardia morphologies in the present patient strongly suggested a diffuse arrhythmogenic substrate rather than a focal idiopathic ventricular tachycardia. This finding was concordant with the imaging evidence of multifocal myocardial inflammation and supported the diagnosis of inflammatory cardiomyopathy.
There are no randomised data guiding management of ventricular arrhythmias in tuberculous myocarditis. Antiarrhythmic drugs may provide temporary suppression of arrhythmias, but they do not treat the underlying inflammatory and infective substrate. Catheter ablation is generally less attractive during active inflammation because the arrhythmogenic substrate may be evolving and recurrence risk may be high; it is usually reserved for recurrent drug-refractory ventricular tachycardia after disease stabilisation (6),(15).
In the present patient, implantable cardioverter-defibrillator implantation was undertaken before initiation of antitubercular therapy because of sustained monomorphic ventricular tachycardia, multiple inducible ventricular tachycardia morphologies, and imaging evidence of active myocardial inflammation. In addition, paradoxical clinical worsening after antitubercular therapy has been described in tuberculous myocarditis, supporting close monitoring and arrhythmic protection during the early treatment phase (16).
Adjunctive corticosteroids were administered along with standard antitubercular therapy to suppress myocardial inflammation. Although robust evidence for corticosteroid therapy in myocardial tuberculosis is limited, recent case-series data and extrapolation from tuberculous pericardial disease support its use in selected patients with severe inflammatory cardiac involvement (3),(17).
The patient remained asymptomatic during follow-up, and serial implantable cardioverter-defibrillator interrogation revealed no recurrent ventricular arrhythmias or device therapies. Long-term management should include clinical assessment, device interrogation, monitoring for drug-related adverse effects, and repeat imaging when clinically indicated to assess resolution of inflammation and detect residual scar. The absence of ventricular tachycardia recurrence after completion of therapy supports the concept that active myocardial inflammation played a central role in arrhythmogenesis.
Tuberculous myocarditis is a rare but potentially life-threatening cause of ventricular tachycardia and should be considered in patients presenting with inflammatory ventricular arrhythmias, particularly in tuberculosis-endemic regions. Multimodality imaging with cardiac magnetic resonance imaging and FDG PET-CT can facilitate diagnosis by identifying myocardial inflammation and guiding tissue biopsy from extracardiac sites. Early initiation of antitubercular therapy together with appropriate arrhythmic protection, including implantable cardioverter-defibrillator implantation in selected high risk patients, may result in favourable clinical outcomes.
We thank Dr. Kavitha Babu., Ph.D for her support during the preparation and submission of this manuscript.
DOI: 10.7860/JCDR/2026/89670.24292
Date of Submission: Apr 09, 2026
Date of Peer Review: Jun 04, 2026
Date of Acceptance: Jul 05, 2026
Date of Publishing: Sep 01, 2026
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: Apr 26, 2026
• Manual Googling: Jul 01, 2026
• iThenticate Software: Jul 03, 2026 (6%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
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