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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
Original article / research
Full Version
Serum Neopterin Estimation as an Indicator for Safe Blood Transfusion
Correspondence Address :
Shameem Banu A.S.
Professor & Head, Department of Microbiology,
Saveetha Medical College & Hospital, Saveetha University,
Thandalam, Kancheepuram District – 602 105
Tamilnadu, India.
E mail: shameembanu10@rediffmail.com
Mobile Number: 9940127670
Background and Objective: Neopterin is regarded as an early biomarker of the cellular immune response. Neopterin concentrations in body fluids are raised with high sensitivity infections. The determination of neopterin is an innovative tool for monitoring diseases which are associated with the activation of cell-mediated immunity. There is not much data of India available on serum neopterin estimation among voluntary blood donors attending the blood bank for assessing various transfusion transmitted diseases which are necessary for this study.
Materials and Methods: Blood samples were collected from Government General Hospital blood bank by venipuncture and serum was obtained by centrifugation. Serum antibodies against Human Immunodeficiency Virus (HIV-1&2), Hepatitis C Virus (HCV), Treponema pallidum, Cytomegalovirus (CMV-IgM) and Hepatitis B Virus surface antigen (HBsAg) were determined in all donor samples by routine ELISA method. Screening was done for malaria and filarial parasite by making smears. Serum neopterin was measured by a commercially neopterin enzyme immunoassay kit.
Results: A total of 304 donors were screened out of which 58 had elevated neopterin levels contributing to 19.07%. A total of 43 samples were positive for any one or more of the screening tests. All the 43 samples well correlated with neopterin elevation.
Conclusion: We conclude that the risk of transmitting new pathogens may be reduced using neopterin assay as a routine in blood banks.
Transfusion Transmitted Infection, Human Immunodeficiency Virus (HIV-1&2) Hepatitis B Virus surface antigen (HBsAg) and Hepatitis C Virus (HCV)
Introduction
The first case of transmission of a viral illness through blood transfusion was reported in 1943. Laboratory testing for viral transfusion-transmitted viruses began in 1969 with testing for hepatitis B surface antigen (HBsAg) (1).From the beginning till today it has been our aim to save life and also to ensure that the individual does not acquire any transfusion transmitted disease by following transfusion.
The diseases transmitted through blood can be classified based on the group of organisms such as bacterial, viral, protozoal and so on. Only in case of known pathogens,there are specific tests available for the detection of these microorganisms. At first to reduce the frequency of transfusion transmitted disease, screening of the blood donors for elevated levels of liver enzymes in the blood for hepatitis, followed by Hepatitis B and then Hepatitis C screening was done (2). Later risk of contracting HIV through blood transfusion was noted and screening for it became mandatory. It seems reasonable for the blood banks to apply a limited primary set of specific tests to exclude the most dangerous infection. But a battery of screening tests is increasing for blood donors in order to ensure safe blood for the recipient. As the number of screening tests increases, one blood bag becomes costly and also difficult to face screening for the presence of too many pathogens.
Specific tests for known pathogens may have miss evolving ones in blood donors. A multi-specific gatekeeper test would reduce the residual risk of unknown pathogens (3). The determination of neopterin levels in human body fluids offers a useful and innovative tool to monitor diseases associated with the activation of cell-mediated immunity. Neopterin is one such marker which is early, sensitive and non-specific marker of cellular immunity. Increasing neopterin levels in various infections precede the clinical manifestation and seroconversion. Normally samples are not tested for all possible infections. Its upper limit of normal in healthy adults is 9-10 nmol/l (4). Serum levels above 10 nmol/l are regarded as elevated. Therefore, the measurement of neopterin in blood donor samples is a useful tool in order to reduce the risk of infections via blood transfusion (5).
Since 1986, neopterin screening of blood donations has been done in the Austrian Tirol to detect potentially hazardous donations (3). It is a bioactive substance released by the activated monocyte/ macrophage, and an early and sensitive marker used for reflection of cellular immune activation status induced by the lymphocyte macrophage system. It has been suggested that it is an excellent marker for the activation of the monocyte/macrophage axis in some clinical situations (6),(7).
Neopterin (6-D-erythro-trihydroxypropylpterin) is a low molecularweight compound derived from guanosine triphosphate GTP (8), a pteridine derivative released into circulation from activated macrophages. The activated monocyte-macrophage is an important source of neopterin. Serum neopterin (s-neo) level is an indicator of both macrophage activation and interferon gamma (IFN-γ) activity, a major macrophage activating factor. Neopterin can be measured more easily and accurately than IFN-γ levels in serum (9).
Increased amounts of neopterin in body fluids are associated with a variety of diseases in which activation of the cellular immune mechanism is involved, such as certain malignancies, infections, allograft rejection, autoimmune disease of cardiac and renal failure, coronary artery disease and myocardial infarctions (10). Elevated neopterin levels were observed in silicotic individuals, rheumatoid arthritis, neuropsychiatric abnormalities, Kaposi.s sarcoma, intrahepatic cholestasis of pregnancy, pulmonary tuberculosis and follow-up of antituberculosis treatment, activation of cell-mediated immunity (CMI) during pregnancy and severe burn sepsis (11). In addition, immunological processes can be initiated by endotoxins produced by gram-negative bacteria which leads to an activation of T-lymphocytes and formation of interferon-γ and thus may lead to an increase of neopterin concentrations in body fluids.
Determination of neopterin levels reflects the stage of activation of the cellular immune system which is Important in the pathogenesis and progression of various diseases. Therefore, so-called “nonspecific test” like measurements of neopterin concentrations would be useful to detect various disorders which represent a certain risk for blood transfusion recipients.
Blood samples were collected after obtaining consent from voluntary donors who are attending Government General Hospital blood bank by venipuncture and serum was obtained by centrifugation. All analyses were performed within 1 day after blood collection. To exclude infections hazardous to blood recipients, serum antibodies against HIV-1&2, HCV, T. pallidum, and HBV surface antigen were determined in all donor samples. HBsAg – Micro screen ELISA test, HIV-Lab systems, Rapid Plasma Regain test –Span diagnostics, HCV antibody detection (ELISA) –LG HCD3.0, CMV IgM ELISA Novum Diagnostica were performed. Screening was done for malaria and filarial parasite by making smears. In addition p24 antigen assay-Innotest HIV antigen mAb was done. Neopterin ELISA-IBL neopterin enzyme immunoassay kit was used. Serum neopterin was measured by a commercially available ELISA method (Neopterin GenWay Biotech Inc) with a detection limit of 0.7 nmol/l and the specificity is about 99.95%.
Out of 304 voluntary blood donors screened 253 (83.22%) were males and 51 (16.77%) were females. Age wise distribution of male and female donors and number of donors with elevated neopterin level is shown in (Table/Fig 1). A total of 304 donors were screened,Out of 304 voluntary blood donors screened 253 (83.22%) were males and 51 (16.77%) were females. Age wise distribution of male and female donors and number of donors with elevated neopterin level is shown in (Table/Fig 1). A total of 304 donors were screened,with neopterin is shown in (Table/Fig 3). Distribution of elevated neopterin levels in various transfusion transmitted diseases is shown in (Table/Fig 4).
Study was conducted on voluntary blood donors attending the blood bank for a period of 3 months at Government General Hospital. Three hundred and four voluntary blood donors were selected and the age group in our study was in the distribution of 18-46 years, whereas study on the voluntary donors in Tirol region in Austria the age distribution was 17-64 years (3). Among 304 donors, 253 were males and 51 were females. Majority of male donors (110) were in the 21 to 25 age distribution while in the females majority (22) was in the 15 to 20 age group.
In our study out of 304 donors, 58(19.07%) of them showed elevated neopterin levels whereas study by Honlinger et al showed only 1.6% (12). Out of 58 neopterin elevated donors 67.74% were having values in the range of 10-15nmol/l. The Tirol study showed 0.09% donors with values above 25 nmol/l (12) whereas in our study we observed this value in 5.17% donors.
All the donors screened for routine basic screening test (HIV 1 &2 Ab, HBsAg, HCV and RPR). After screening, out of 58, only 15 donors were positive for infections screened, which includes HBsAg(8), HIV(5), HCV (2) respectively. All these 15 donors who were positive for infection, correlated with elevated level neopterin. The remaining 43 donors with elevated neopterin level was screened for CMV IgM, MP/MF and p24 Ag. Out of 43 donors, CMV IgM was positive in 22 and p24 Ag was positive in 3.
Among blood donors CMV IgM were positive in 22 donors (7.24%) when compared to study done by Honlinger et al it was almost double which showed 3.7% positivity (12). It was demonstrated that in an asymptomatic course of CMV infection the increase of neopterin even starts before CMV-IgM seroconversion, and CMVIgM seropositivity correlated with the highest neopterin values. Similarly donors with increased neopterin levels the occurrence of an acute Epstein-Barr-virus infection or parvovirus infection was 4 to 6 times more likely than in the donors with neopterin levels within the normal range (13).
In our study out of 304 screened, 8 (2.6%) were positive for HbsAg. The neopterin content in the sera of viral B hepatitis was 19.9%+ –5.7nmol/l. Among the eight HbsAg positive donors, 5 of them showed neopterin levels in the range of 15-20nmol/l. The data was obtained for an evident increase in neopterin levels associated with virus B hepatitis this was well supported by another study done by Somsonov et al (14).
Five HIV positive donors correlated with neopterin assay whereas three (0.986%.) donors with elevated neopterin level had p24 Ag which the routine test missed. A study by Fuchs et al showed increased neopterin levels in all 100% HIV positive donors. Three quarters of asymptomatic persons with HIV infection have increased neopterin levels (3), and these levels are even higher during acute HIV infection (15). In addition, in human immunodeficiency virus (HIV) infection, neopterin levels increase in parallel with progressive disease, are inversely correlated with CD4+/CD8+ T-cell subset ratios and are of predictive significance (16).
Hepatitis C virus infection also correlated with elevated neopterin levels. The two(0.6%) HCV positive samples had neopterin values in the range of 10.1–15nmol/l. Similar result was obained by Harald Schennach et al (17).
In almost all the patients with acute viral infections neopterin levels were increased, irrespective of the specific nature of the virus, this was demonstrated in patients with acute hepatitis A or B (18), patients with Epstein-Barr-virus infection (infectious mononucleosis) and cytomegalovirus (CMV) infection but also in patients with measles (19). Usually neopterin concentrations closely reflect the extent and the activity of the disease. Neopterin determinations may also be used as an additional parameter for differential diagnosis, e.g. patients with chronic non A/non B-hepatitis show significantly higher neopterin levels than patients with non-infectious fatty liver (20).
Eighteen samples which had elevated neopterin values but were not positive for any one of the screening tests. Follow up of these donors and repeat neopterin after 4 weeks would throw more light on it. In our opinion keeping the safety of the patients in mind, these eighteen samples should not be used for transfusion. To improve the safety of blood donations, additional neopterin testing of blood donations became mandatory for all Austrian blood-transfusion services in addition to testing for HIV-1 and -2 antibodies, hepatitis C virus (HCV) antibodies, hepatitis B virus (HBV) surface antigen, alanine aminotransferase (ALT), and Treponema pallidum antibodies (21). The neopterin assay thus detects a variety of potentially harmful diseases or conditions which would not be revealed by the usually employed battery of routine tests. Hence we conclude that the risk of transmitting new pathogens may be reduced using neopterin assay as a routine in blood banks.
1. Neopterin concentrations in body fluids are raised with high ensitivity infections.
2. Neopterin measurements provide an insight into the present state of cell-mediated immune response.
3. Risk of transmitting new pathogens to recipient is reduced using neopterin assay as a routine in blood banks.
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