Archive for May, 2009

Cases Network: The inside story – peer review 2

May 22, 2009

Following our look at the peer-review process for Cases Journal last week, now it’s time to see how it works in the Journal of Medical Case Reports (JMCR). Here you can find out exactly what is happening when a manuscript is under review.

When a manuscript is correctly formatted for JMCR, we will assign a suitable Associate Editor (AE) from our editorial board. Our AEs have a very important role in JMCR. We aim to invite an AE who specialises in the medical field relevant to the manuscript.  For JMCR we require two reviewer reports on a manuscript before a first decision is made. We ask the AE to suggest up to five appropriate peer-reviewers to assess each submission and they sometimes provide one of the two required reports themselves.

Reviewers are invited to complete a short online report. After logging in to our website reviewers confirm their ability to review and can download the manuscript. They are asked first to identify what the ‘type’ of case report is, for example, ‘unexpected or unusual presentations of a disease’ or ‘an unexpected event in the course of observing or treating a patient’. This helps us to check that each manuscript meets the criteria for JMCR.

There are then 10 quick yes/no questions (a few more than in Cases Journal) to answer:

Thinking1. Has the case been reported coherently?

2. Is the case report authentic?

3. Is the case report ethical?

4. Is there any missing information that you think must be added before publication?

5. Is this case worth reporting?

6. Is the case report persuasive?

7. Does the case report have explanatory value?

8. Does the case report have diagnostic value?

9. Will the case report make a difference to clinical practice?

10. Is the anonymity of the patient protected?

Reviewers can then provide additional comments for the authors. The reviewer is also asked to provide a statement declaring whether or not they have any competing interests.

After completing the review form and leaving any useful comments to the authors, the reviewer finally selects a recommendation for the next step:

1. Accept submission

2. Revisions required

3. Resubmit for review

4. Resubmit elsewhere

5. Decline submission

6. See comments

When two review reports have been completed for a manuscript, if any revisions are suggested by the peer-reviewers, their comments are sent to the corresponding author to allow them to submit a revised manuscript. Following this resubmission, the assigned AE is asked to make the first decision:

1. Accept

2. Send back to reviewers’ for re-review

3. Reject

Peer review decisions*Author tip* – Reviewers’ comments are very valuable to us when making editorial decisions. Be sure to address any issues they raise when revising a manuscript and explain any changes that you make, either using notes within your manuscript or in a separate cover letter.

Re-reviews, AE decisions and author revisions continue until the AE is either happy to accept the manuscript or unfortunately has to recommend that the manuscript is unsuitable for JMCR.

When an AE recommends accepting a manuscript, it is then forwarded to one of our five Deputy Editors (DE). We work very closely with the DEs and rely greatly on their contribution to the editorial process. The DE is responsible for providing a final decision: a) Accept and publish; b) Reject; c) Reject and transfer to Cases Journal; d) Major revisions; e) Minor revisions. With option (c), a manuscript can be transferred directly for publication in Cases Journal without the need for any further review.

Peer review decisions

*Author tip* – If your submitted manuscript is declined from JMCR, remember Cases Journal, where your case may be more appropriate for publication.

When this thorough review process is complete, manuscripts are passed on to a member of the editorial team for formatting and every manuscript is professionally copyedited.

Before being passed on to our production team, all manuscripts are viewed by the Editor-in-Chief, Professor Michael Kidd, to ensure that every publication in JMCR is over the best possible quality.

To find out about the final production stages before publication of manuscripts in Cases Journal and JMCR, keep watching our blog for the next in our ‘Inside Story’ series.

Cases network: The inside story

Lindsay Dytham and Richard Sear

Editorial Assistants – Cases Network


Cases Network awards – congratulations to our winners

May 20, 2009

Richard Smith, Editor-in-Chief of Cases Journal, announced the winners of the first Cases Network Awards at our meeting “Celebrating case reports, the stories in health care” on Friday.

Dr Antonio Oliva, from Rome, was at the meeting to personally accept his award for ‘Most important report of an adverse drug reaction’, for his paper ‘Fatal injection of ranitidine: a case report‘.

Dr Oliva’s case describes a patient’s anaphylactic reaction to treatment with this common drug.

The other winners announced were:

Best contribution from a patient


Cases Network: Best contribution from a patient award

A woman living with osteoarthritis: a case report by Jane Richardson, Christian Mallen and Helen Burrell.

As well as being listed as an author of the case, Helen Burrell is the patient the case focuses on, and she contributed some of her poems about living with osteoarthritis as the ‘Patient’s perspective’ section of the case.

Greatest potential impact on clinical practice

The first report of human illness associated with the Panola Mountain  Ehrlichia species: a case report by Will Reeves, Amanda Loftis, William Nicholson and Alan Czarkowski from the United States Department of Agriculture.

Best case from general practice

Preventing long term relapsing tinea unguium with topical anti-fungal cream: a case report by Bruce Arroll and Amanda Oakley

Our congratulations to all the winners for their excellent contributions to our journals!

Congratulations also to the runners-up:

Greatest impact on clinical practice

First isolation of two colistin-resistant emerging pathogens, Brevundimonas diminuta and Ochrobactrum anthropi, in a woman with cystic fibrosis: a case report by Magalie Menuet, Fadi Bittar, Nathalie  Stremler, Jean-Christophe Dubus, Jacques Sarles, Didier Raoult,  Jean-Marc Rolain

Acute syphilitic chorioretinitis after a missed primary diagnosis: a case report
by Claudia Handtrack, Harald Knorr, Kerstin U Amann, Christoph Schoerner,  Karl F Hilgers, Walter Geißdörfer

Fatal fulminant herpes simplex hepatitis secondary to tongue piercing  in an immunocompetent adult: a case report by Shaheen E Lakhan and Lindsey Harle

Most important report of an adverse drug reaction

Cholestatic hepatitis as a possible new side-effect of oxycodone: a case report by Vincent Ho et al

Best case from general practice

Diagnosing a popliteal venous aneurysm in a primary care setting: a case report by Emmanouil K Symvoulakis et al

Cases Network: The inside story – peer review

May 14, 2009

Last time in our ‘Inside story’ blog series, we described what happens when you first submit your case report to our journals and the importance of formatting your manuscript correctly.

So what happens to your manuscript once the formatting is acceptable? This is the time when the peer-review process can begin. This process differs slightly for Cases Journal and Journal of Medical Case Reports, and this week we will concentrate on Cases Journal.

Each correctly formatted manuscript is sent to a member of our editorial board. We pair up the subject of the manuscript to the speciality of the ed board member and invite them to fill out a short online report. After logging into the website the reviewer will be asked to answer 6 simple questions about the manuscript:

1. Is the manuscript understandable?

2. Is it ethical?

3. Is there any information missing?

4. Could this be this first report of its kind?

5. Is it authentic?

6. Comments to authors:

green tick 2*Author Tip* – It is important to note that a manuscript doesn’t have to be the first of its kind in order to be published. Cases Journal will publish any report that is understandable, ethical, authentic, and includes all information essential to its interpretation.

After completing the review form and leaving any useful comments to the author and/or editor, we ask the reviewer to make a suggestion on the next step:

1. Accept submission

2. Revisions required

3. Resubmit for review

4. Decline submission

Once a manuscript is accepted it is passed on to a member of the editorial team for formatting, before being passed onto the production team…. but more about the world of production at a later date.

We’ll be posting again next week to give you the inside story on peer review for Journal of Medical Case Reports.

Risk of pituitary-related depression following head injury

May 12, 2009

Head injuries can often cause damage to the pituitary gland leading to hormonal problems. Here, Caroline Churchill gives her account of her son’s head injury as a child, and the problems he suffered as an adult including sexual dysfunction and depression, leading eventually to suicide. Brain injury is already recognized as quadrupling suicide risk, and Caroline believes that her son’s childhood accident could have been the cause of his problems.

Have you seen a similar case? There are particularly few cases in the literature  of hormonal problems after head trauma in childhood, and we welcome submission of any case reports of this type. As pituitary damage can happen in 1 in 4 head injuries, there must be a lot of cases out there that others can learn from.

Caroline writes:

“Our 31-year-old son committed suicide last August. At first we were baffled because he excelled at his job and had many friends. But we discovered letters between him and his ex-girlfriend showing he was impotent, which she later confirmed applied to all their four years together. We wondered if this could stem from a terrible head injury (right temporal fracture) he’d had aged seven, when he’d fallen from a tree, been in a coma for five days and hospitalised for a month. We then found abundant research from 1998 on, showing that 25% of moderate/severe head injuries cause pituitary damage. The effects include growth hormone deficiency, loss of libido, amenorrhoea in women, ED in men, infertility and depression. Particularly revealing was Acerini’s Childhood Hypopituitarism after Traumatic Brain Injury that showed childhood injuries too can cause hypopituitarism, the onset sometimes coming many years after injury. This explained how our son could have grown tall, had a normal adolescence, and yet been affected.

We were surprised that something so well documented hadn’t filtered through to medical practice. In 1984 when his accident happened, the research did not exist so obviously we weren’t warned, but later the signs were there, if someone could have read them. The following time-line comes partly from our knowledge, partly from his medical notes:

  • Disappeared before A-levels
  • Depressed in final year at university (failed to take degree)
  • Depressed in November 1999
  • Disappeared for 2 weeks in 2003, year after girlfriend left. Returned saying had attempted suicide. Tried cross-dressing before disappearance, visited transvestite chat-room.
  • September 2003, saw a GP, psychiatrist and counsellor, nobody picked up on past head injury or suggested pituitary screening. Apparent recovery.
  • February 2007 saw GP re headaches, mum fearing tumour from brain injury. Tests negative, but again no pituitary screening. GP observed proptosis in right eye but thyroid tests normal.
  • (Also early 2007 ex-girlfriend asked him to test for chlamydia, perhaps worried re heavy petting, but test negative. GP notes say genitalia normal, our son ‘not currently sexually active.’)
  • Five weeks before suicide, told manager he was depressed, she fixed counselling. Had five sessions before gassing himself with helium. Bank statements show he’d planned this for seven weeks.

We’re amazed that the 2007 NICE guideline on head injury does not advise pituitary screening, and their sample discharge letter does not mention the risk. If hypopituitarism can occur years later, warning people is vital.”

Christian Koch on publishing case reports and TV’s Dr House

May 1, 2009

We caught up with Professor Christian Koch, one of our Deputy Editors for Journal of Medical Case Reports, for a few insights on his work with the journal.

What would you say is the ‘best’ paper you have reviewed and why?

CK: I have handled many “good” papers, each unique in its own way. However, one of the very best ones I can remember was one that dealt with the question whether several tumors in an individual could represent a syndrome, although only a subset of “potential” candidate genes had been tested and was negative (J Med Case Reports. 2007 Mar 28;1:9).

This should remind us of the initial observations and publications of the combination of medullary thyroid cancer and pheochromocytoma in some patients (for instance, Sipple syndrome or Multiple endocrine neoplasia type 2) many decades ago and the discovery of the RET proto-oncogene in 1985 and finally the implication of its role in MEN2 in 1993.

All this underscores that careful observation, a sharp mind, and sometimes an approach similar to the one of “Dr. House” (on TV) will not only help our individual patients but many others in the future.

Why do you feel it is important to publish case reports?

CK: We are in an era of “evidence-based medicine”. However, we finally begin to realize that much of the so-called evidence is derived from heterogeneous patient populations and not necessarily applicable to our individual patients we see on a daily basis. Numerous recent studies including ENHANCE, ACCORD, ADVANCE, and the VA Diabetes Outcome Trial, have shown us that heterogeneity of patients, equipment, investigators, etc. can limit our thrive for evidence on a large scale and make us think about personalized, individualized medicine…. that is, why publishing case reports is important in my mind.