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Cover page of the Journal of Health Sciences


 
 Table of Contents  
LETTERS TO EDITOR
Year : 2019  |  Volume : 12  |  Issue : 2  |  Page : 181-182

Improvising the audacity of case report: Suggestions for developing guidelines while reporting anatomical variations


1 Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
2 Department of Anatomy, Pondicherry Institute of Medical Sciences, Puducherry, India

Date of Web Publication4-Jun-2019

Correspondence Address:
Dr. V Dinesh Kumar
Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry - 605 006
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_319_18

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How to cite this article:
Kumar V D, Rajprasath R. Improvising the audacity of case report: Suggestions for developing guidelines while reporting anatomical variations. Indian J Health Sci Biomed Res 2019;12:181-2

How to cite this URL:
Kumar V D, Rajprasath R. Improvising the audacity of case report: Suggestions for developing guidelines while reporting anatomical variations. Indian J Health Sci Biomed Res [serial online] 2019 [cited 2019 Aug 24];12:181-2. Available from: http://www.ijournalhs.org/text.asp?2019/12/2/181/259642



Sir,

For many anatomists, writing a case report represents the first effort at getting articles published in medical journals and it is considered a useful exercise in learning how to communicate scientifically.[1] Historically, case reporting was an upgraded form of letters written by an anatomist to declare the oddity of “serendipitous” anatomical variations to peers across the globe. Later, when anatomy was correlated with clinical specialties, documentation of variations in cadaver served as an indicatory database, serving as a knowledge source for operating surgeons.

In the era of evidence-based medicine, case reports occupy the lowest rung of evidence ladder. In addition, case report publication, in its true sense, is not given due weightage both by the journal editors[2] and faculty recruitment/promotion processes. Quoting few real-life examples, some authors try to extrapolate an unusual variation and derive an arbitrary prevalence rate (e.g., 1 out of 30 cadavers showed a variation in that particular structure) for mere publication purpose. Many genuine and rare case reports get published in journals (predatory or authentic) which hibernate in the blind spot of search engines. Yet, another problem with database search is, one variant structure is being given more than one name, by two different authors (e.g., ectopic vessel, abnormal communication, and aberrant artery, all denoting a same structure). Thus, it is a treacherous exercise for an anatomist who wish to conduct a meta-analysis or systematic review on a particular variant.

What constitutes a genuine case report? Applying the recommendations given by Huth[3] to anatomy discipline, we could ascertain that a worthwhile case report should be (a) a unique variation that may represent a previously unknown or unreported structure and (b) an “outlier” with features strikingly outside the realm of what is usually seen with a particular pattern. Regarding the acceptance of an anatomical case report for publication, some loopholes do exist. For example, the depth to which a reviewer/editor screens the existing literature database to ascertain that the presented case report is undoubtedly unusual varies from journal to journal. Furthermore, some reviewers get carried away by the seemingly attractive discussion of the case report. We, as anatomists, should also accept the fact that we do not have standard guidelines to define the rarity of a case report. As of now, the criteria by which a manuscript is being accepted or rejected are largely subjective.

Through this letter, I would like to emphasize the need for developing uniform standardized guidelines and nomenclature for anatomical case reporting, and it should be followed up in a systematic approach so that a series of similar cases could be assessed as a series at a later stage.[4] Case reports should be evaluated based on how well is the variation being documented, uniqueness, objectivity with which it has been described, and lucidity with which the information is being interpreted with respect to existing broader principles.[5] This mandates a cohesive effort from authors, journal editors, and leading anatomists for creating and validating operational guidelines for reporting anatomical variations.

Based on the above-mentioned points, I would like to suggest few recommendations as follows:

  1. Similar to anatomical structures, variations should also be named following uniform nomenclature (avoiding confusion in terminologies such as “ectopic,” “aberrant,” and “abnormal” and validated format for reporting should be implemented)
  2. It would be better if the authors perform pooled analysis of similar variants along with case report which could be advanced further
  3. Objective criteria should be adhered regarding the “rarity” and “clinical relevance” of variations while considering for publication
  4. Meticulous database along with coding for individual regions serving as repository for all documented variations would be a much yielding endeavor.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Peh WC, Ng KH. Writing a case report. Singapore Med J 2010;51:10-3.  Back to cited text no. 1
    
2.
Warner JO. Case reports – What is their value? Pediatr Allergy Immunol 2005;16:93-4.  Back to cited text no. 2
    
3.
Huth EJ. Writing and Publishing in Medicine. Baltimore: Lippincott Williams and Wilkins; 1999. p. 103-10.  Back to cited text no. 3
    
4.
Lennon P, Fenton JE. The case for the case report: Refine to save. Ir J Med Sci 2011;180:529-32.  Back to cited text no. 4
    
5.
Pierson DJ. Case reports in respiratory care. Respir Care 2004;49:1186-94.  Back to cited text no. 5
    




 

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