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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
Clinicomycological Spectrum of Fungal Rhino-Sinusitis from University Hospital, North India
Correspondence Address :
Dr.Vikas Kumar
Service Senior Resident
Department of Microbiology, Institute of Medical Sciences,
BHU, Varanasi, India.
E-mail: drg.vikas@gmail.com
Background: Fungal infection of the paranasal sinuses is an increasingely recognized entity, both in normal and immunocompromised individuals. Various agents including bacteria, viruses and fungi have been introduced as aetiological origins of the disease. Fungi have been reported as a common cause of sinusitis and among them Aspergillus species are the usual. The objective of this study was to explore the frequency of different fungi isolated by in vitro culture from biopsy samples obtained from operated rhinosinusitis patients.
Materials and Methods: A total of 47 patients clinically diagnosed with sinusitis and who underwent sinonasal surgery performed between 2008-2011 in the University hospital were included in this study.
Results: Fungal cultures were positive in 10 (21.3%) of 47 patients from surgical specimen. Aspergillus spp , Fusarium, Rhizopus, Candida albicans and Bipolaris species were isolated in these cases.
Conclusion: The overall frequency of fungal sinusitis in studied population was 21.3%. Early diagnosis and combination therapy of surgery and antifungal therapy is needed. Although culture helps in definite diagnosis and identification, direct microscopic detection (10% KOH) of fungal structures in biopsies permits a rapid presumptive diagnosis.
Fungi, Rhinosinusitis, Candida albicans, Aspergillus sp,Fusarium,Rhizopus
Introduction
Sinusitis is the term representing inflammation of the paranasal sinus mucosa. Fungal sinusitis is one of important health care problem and its incidence and prevalence are increasing day- by -day The term rhinosinusitis has become a common replacement for the term sinusitis because sinusitis is often precede by rhinitis and rarely occurs without concurrent nasal airway inflammation due to the contiguous nature of nasal and paranasal sinus mucosa, as well as their interactions and potentially shared involvement in various inflammatory processes. A wide range of fungal species are involved as a common cause of sinusitis but the most common are those belonging to genus Aspergillus. Fungi can cause both acute and chronic rhinosinusitis and can occur as either invasive or non-invasive conditions (Table/Fig 1) (1).
1. Acute Fulminant Invasive Fungal Sinusitis
Of the invasive disorders, the acute fulminate necrotizing form is the classic fungal infection epitomized by ‘mucormycosis’. It usually occurs in immunosuppressed hosts. The risk factors include diabetes mellitus, immunodeficiency, cancer and immunosuppressive drugs.
Wide surgical debridement of infected tissue and concomitant antifungal drug therapy is required urgently. Prognosis is poor without correction of the underlying immunocompromised states.
2. Chronic Invasive Fungal Sinusitis
It usually occurs in patients with diabetes mellitus and commonly leads to periorbital tissue invasion and the ‘orbital apex syndrome’ (2), (3). Surgical resection and systemic antifungal drugs are required, but the infection may recur and is difficult to treat.
3. Granulomatous Invasive Fungal Sinusitis
A more indolent form of invasive disease has been termed granulomatous invasive fungal sinusitis. Sinus mucosal resection may be curative, but systemic anti-fungal drugs are commonly used postoperatively to assure complete resolution of fungal infection.
4. Fungal Ball
In fungal ball, multitudes of fungal hyphae are compressed into a thick exudate within a sinus lumen. This non-invasive fungal sinusitis is resistant to medical management and must be removed surgically. This may occur in patients with previous sinus surgery, oral-sinus fistula, history for cancer chemotherapy or those without any known predisposing factor (1),(4),(5). It is also called as “sinus mycetoma”.
5. Allergic Fungal Sinusitis
AFS is the other form of non-invasive fungal rhinosinusitis. It represents more of a hypersensitivity response to the presence of extra-mucosal sinus fungal hyphae; with a prominent element of fungal-specific type I immediate hypersensitivity although the disease appears complex and likely involves the interplay of various inflammatory modalities (6), (7).
Fungal sinusitis has remained a diagnostic and therapeutic challenge since its prominence about two and a half decades ago, so the current purpose of this study was to explore the frequency of different fungi isolated by in vitro culture from biopsy samples obtained from operated rhinosinusitis patients and to increase awareness among physicians.
A total of 47 patients with clear symptoms of chronic rhinosinusitis that their diagnosis had been confirmed by CT scan and who underwent sinonasal surgery performed between 2008-2011 in the University hospital were included in the study. Information regarding age, sex, clinical presentation, radiological appearance, and type of treatment were recorded whenever available. Biopsy samples from their polyps and sinusoidal mucosa dissected under surgery operations and aseptically transferred to sterile phosphate buffered saline to make invitro cultures. A small amount processed sample was mixed with 10% KOH and was examined using light microscopy for presence of fungal elements. The size and morphology was noted. Gram stain was performed to observe the yeasts. Specimen was inoculated on to Sabouraud’s dextrose agar (SDA); SDA with chloramphenicol for fungal culture. All cultures done in parallels, one in 250C and another incubated in 350 C. All cultures were kept in proper condition upto 3 weeks and observed for fungal growth daily for one week and then weekely. Growth if any was identified on the basis of rate of growth, colour, texture, pigmentation of fungal colony and morphological features in microscopy (lacto phenol cotton blue stain /LPCB mount). Yeast cells were further confirmed by germ tube test, chlamydospores production on cornmeal agar and growth at 420C. Slide cultures were also done to explore microscopic features of the isolates.
Clinical data of ten patients with allergic fungal sinusitis are summarized in [Table/Fig-2]. The mean age of the patients was 40 years (range 11-80 years). There was female predominance (6/10 cases).The clinical presentation of most of the patients was nasal obstruction of the corresponding side, with or without headache and nasal discharge. The duration of symptoms before diagnosis ranged from one months to 60 months, with a mean duration of 14.5 months. Most of the patients had a history of chronic rhinosinusitis or bronchial asthma. Radiographically, most of the patients showed opacification and soft tissue mass involving multiple paranasal sinuses either in one or both sides. Out of the 47 cases of sinusitis investigated; fungal infection was observed in 10 patients. On microscopic examination out of these 10 cases, direct KOH mount was positive in seven cases. In vitro cultures on fungal culture medium of the patients sample, showed pure growth of the fungus. On Lacto phenol cotton blue staining examination, the isolated fungi were Aspergillus flavus (3), Aspergillus fumigatus (2), Fusarium (1), Rhizopus (1), Bipolaris (1) and Candida albicans (2) (Table/Fig 3), (Table/Fig 4), (Table/Fig 5), (Table/Fig 6), (Table/Fig 7), (Table/Fig 8) and (Table/Fig 9).
The overall incidence and prevalence of fungal sinusitis is increasing, particularly during the last three decades. A major contributor to this emergence is growing number of immunocompromised and susceptible individuals. Fungal agents are part and parcel of soil and the environment, atmospheric air, acts as the most common source of infections. Fungal spores find easily their ways to sinusoidal cavities through respiration. The colonization and invasion of paranasal sinuses by various species of Aspergillus has been substantially observed as clinically significant. The aetiology has been found to be different in different types and subtypes of fungal sinusitis. The Norther part of India, Sudan and South Western states of the USA are endemic areas for fungal sinusitis. Aspergillus flavus is the predominant agent in the Indian subcontinent, whereas in other parts it is A.fumigatus (8), (9). Among the studied population, 10 out of 47 patients (21.3%) had fungi in in-vitro cultures and the most commonly isolated fungus belonged to Aspergillus (5 cases) and Candida albicans (2 cases) and there was a Fusarium,Rhizopus, Bipolaris case too. In a study conducted by Rupa et al., from India, Aspergillus species were the most common fungi isolated (95.8%) in a series of 24 patients with AFS (10). Study from abroad, Matsuwaki et al., reported a case of AFS caused by Penicillium spp. and Cladosporium spp (11), Fadl et al., reported 4 cases of AFS, and all were Aspergillus spp (12) and Sabokbar et al., showed Candida spp. as the predomninant agent in fungal rhinosinusitis (13).
Here in the present study sample size was small so further study should be recommended involving a larger number of samples.
In conclusion, this study highlights the importance of paranasal sinus mycosis in North India. As fungal diseases are not notifiable infections like viral, bacterial or parasitic disease hence these are not given much attention and usually diagnosis is established very late. Therefore early diagnosis and recognition of fungal sinusitis is very important, not only because it is curable in the early stages, but also to prevent progression of the disease in to the more serious and destructive invasive forms. Therefore our suggestion to clinicians is that all the chronic rhinosinusitis patients should be screened for fungal aetiology. Treatment requires surgical debridement to remove the hypertrophic tissue and mucinous secretions, nasal and oral corticosteroids are often used to modulate the immune response. In refractory cases, systemic antifungal therapy may be warranted.
Special thanks to Mycology section of Department of Microbiology and Department of Otorhinolaryngology, IMS, BHU, Varanasi who helped us in this research.
ID: JCDR/2012/4285:0027
Date of Submission: Mar 16, 2012
Date of Peer Review: Apr 17, 2012
Date of Acceptance: Apr 20, 2012
Date of Publishing: May 31, 2012
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