They
 say you never forget your firsts— first love, first job, or like in my 
case, my first paper that was accepted for publication in an 
international, peer-reviewed journal. That first experience taught me a 
lot about the publication process of journal submissions. 
My
 story began with my father gifting me a cell phone. At that time, I was
 working as a trainee for my MD course and started using the phone to 
take photos when patients would be presenting with unique symptoms.
 One day, a few of us trainees were discussing a case where the patient 
had skin blisters and hypertrichosis (excessive body hair). We had no 
conclusion about the diagnosis of the case, though we had some ideas of 
what it could be. We decided to present the case in the grand round. In 
grand rounds, rare cases and cases that are difficult to diagnose are 
discussed by the trainees in presence of all faculty members. After 
hours of discussion and cross-examining, a conclusion is reached for 
those cases. After the presentation and discussion, our professor asked 
us to check the patient’s urine under the Wood’s lamp. We were surprised to find the urine was coral red in color. But it helped us finalize our diagnosis— porphyria cutanea tarda!
During
 this time, alongside recording the patient’s medical history and 
examination findings, I had continued to take photograph of him. Since 
it was a rare case, I thought I would write about it and send the paper 
out for publication. 
When
 I began searching for similar cases, I was surprised to find that no 
similar cases had been recorded in my country, Bangladesh. But outside 
Bangladesh, quite a lot of work had been done in this field. So, I 
proceeded to write a case report and send it to my professor for 
feedback. I also attached some of the photos I have taken with my cell 
phone to those in the case report.
Then
 it was time to choose a journal. I was a novice to the process of 
online submission but you live and you learn! After facing lots of 
difficulties initially, I successfully submitted the case report to the 
New England Journal of Medicine. Within two days, I received my first 
rejection. When I informed my professor of the outcome, he asked me to 
submit it again but to an Asian journal. So, I submitted it to a journal
 published by Wolters Kluwer Medknow. The paper was rejected again but 
this time I got some feedback— I was asked to use more recent references
 and ‘plagiarism’ was also mentioned. They also recommended that I try 
to submit the article to a journal that only publishes case reports. 
I
 revised the article to avoid plagiarism, used more recent references 
and then searched the internet for a journal that specializes in 
publishing case reports. I found one in India! After carefully reading 
the journal’s instructions for authors, I formatted the manuscript as 
per their guidelines and uploaded the manuscript to their website.
Finally,
 good news! The article was provisionally accepted but needed some 
revision of the content and photographs. I was asked to edit the 
photograph to conceal the identity of the patient and also asked to keep
 the patient consent form duly signed. I revised the paper as per their 
comments and uploaded it again. After a few days they finally accepted 
the paper and it was published on their website later.
What
 I learnt from this first dip in the process of journal submissions was 
that we need to meticulously check the patient and their history, 
document all the information related to the case, and photographs of the
 symptoms (while protecting the identity of the patients.) I also learnt
 that written consent must be taken from the patient before sending the 
paper out to journals. I also had takeaways about formatting, references
 and how to document data in a way that would make writing a paper 
easier for me. But my biggest takeaway was this— we should not be 
disheartened when we face rejection, but keep on our path with 
determination until we are successful.

 
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