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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
Case report
Full Version
Allergic Contact dermatitis with exfoliation secondary to calamine/diphenhydramine lotion in a 9 year old girl
Correspondence Address :
Dr. Gupta S, Department of Dermatology and Venereal Disease, Manipal Teaching Hospital/Manipal College of Medical Sciences, Pokhara, Nepal.
Phone:+977 61 526416 Extn: 131.
E-mail: babitasanjeev@yahoo.com
Calamine/diphenhydramine lotion is a bland, smoothening, antipruritic lotion commonly used in several dermatological conditions. Skin reactions due to this preparation are very rare. We report a case of contact dermatitis following the application of Calamine/diphenhydramine in a 9 year old child. The drug was stopped and the patient was managed symptomatically. The causality, severity and preventability assessments were carried out as per the standard criteria. We could not confirm the exact cause behind the adverse drug reaction (ADR) as the child’s parents was not willing for rechallenge. Since calamine is made up of zincoxide and ferric chloride, the exact compound that might have caused the ADR is not confirmed. Since Calamine/diphenhydramine is a commonly used preparation, one should be aware of this reaction.
Calamine is basic zinc carbonate coloured with ferric oxide. Calamine had mild astringent and antipruritic actions and is used as a dusting powder, cream, lotion, or ointment in a variety of skin conditions(1). Diphenhydramine is a H1-antihistaminic used in allergic conditions, which is known to cause skin hypersensitivity. Contact dermatitis is an acute or chronic skin inflammation, occurring due to contact with irritant or allergic substances(2). Topical antibiotics and topical anesthetics are usually implicated in contact dermatitis(3). Contact dermatitis due to calamine lotion per se is not reported in the literature. There are rare reports of contact dermatitis due to diphenhydramine(4). We hereby report a case of contact dermatitits due to calamine/diphenhydramine lotion in a nine year old female child. We also established the causality, severity and preventability assessments of the reaction as per the Naranjo scale(5), Hartwig scale(6) and the Modified Schummock and Thornton scales (7) respectively.
A nine year old girl presented to Dermatology OPD, Manipal Teaching Hospital, Pokhara, Nepal, with complaints of itching and wheals of two days duration. There was neither any history of fever, throat ache, dyspnoea, dysuria, pain abdomen, nor any new food or drug intake. On examination, patient was conscious and cooperative, with stable vitals and no abnormality was detected on systemic examination. On local examination, evanescent, erythematous, oedematous well defined plaques were seen over neck, chest and right forearm. There was no maculopapular rash, target lesions or angioedema. She was diagnosed as Acute Urticaria. A complete blood count and urine routine examination revealed no abnormalities. She was advised Tab. Cetirizine 10mg 1 tab. HS, Tab. Ranitidine 150mg 1 tab. Twice daily (a.c.) for 1week, Tab. Albendazole 400mg 1 tab. h.s. stat, along with calamine/diphenhydramine lotion for local application twice daily. Five days later she presented to the Dermatology OPD, with burning sensation and pruritus over the sites of application of calamine/diphenhydramine lotion. On examination, dry, rough skin with pin head sized papules were evident over both forearms, and there was xerosis and exfoliation of the skin over the neck.
Considering the history and clinical findings, a provisional diagnosis of allergic contact dermatitis with exfoliation due to calamine/diphenhydramine lotion was made. Calamine was stopped and the patient was put on emollient along with fluticasone cream, to be applied twice daily for 2 weeks. She was advised to continue Tab. Cetrizine 10mg 1tab. once daily for 10 days and Tab. Ranitidine 150 mg 1 tab twice daily for 1week. Patient was followed up after 10 days. The lesions had subsided. The patient did not consent for a patch test, and so was advised to avoid calamine lotion in future.
Upon reporting the ADR to the Pharmacovigilance cell, the Pharmacists carried out the Causality assessment, severity assessment and preventability assessment of the ADR as per the Naranjo scale, Hartwig scale and the Modified Schummock and Thornton scales respectively. The causality assessment revealed the ADR to be ‘Probably’ associated with the drug. Similarly the severity assessment revealed the ADR to be ‘Moderate Level 3’ suggesting that The ADR requires that the suspected drug be withheld, discontinued or otherwise changed. It was found that the ADR was ‘not preventable’.
Allergic contact dermatitis is an exogenous eczema which is a delayed type hypersensitivity response, mediated when the allergen is engulfed and processed and presented to the dermal T cells by the
Langerhans cell, the antigen presenting cell in the epidermis(2). Clinically, it may present in varying
forms ranging from erythema, vesiculation, erosion, crusting, scaling and exfoliation (peeling) and is usually associated with variable itching. Though, in most cases, a clinical suspicion is sufficient for diagnosis, a definite diagnosis is made only by a patch test (8).
Calamine is widely used in the field of dermatology as a smoothening, antipruritic agent in manifest conditions like urticaria, insect bite reaction, varicella, herpes zoster and pruritus. During our literature review we could not locate any reports of contact dermatitis due to calamine lotion per se. We suspect that the allergic contact dermatitis in this case could have been caused by diphenhydramine, which was also a component of this particular formulation of calamine lotion.
In one case report, a 59-year-old woman experienced vesicular dermatitis after applying Pellisal-Gel(R), a diphenhydramine-containing cream, for an insect bite. Skin patch testing revealed the patient was positive for diphenhydramine(9). A 53-year old male who was treated with diphenhydramine for 5 years by varying routes including oral, topical, and injection in the treatment of a pruritic eruption as the result of hair dye dermatitis, was noted to have a contact allergic dermatitis for the same, (with no dermatitis on the scalp) which coexisted with a photoallergic dermatitis that worsened in summer and improved in winter(10).
Upon occurrence of contact dermatitis, the causative agent should be identified and removed(2). In our case, the treatment with calamine/diphenhydramine lotion was stopped immediately following which the patient improved. The management of contact dermatitis include oral, topical steroids and smoothening agents(8). Our patient was managed with topical steroids and Vitamin E cream as the lesions were only moderately severe. We could establish a probable causal relation ship (Naranjo score 6) (5) between calamine/diphenhydramine and the reaction.
The severity assessment revealed the ADR to be Moderate (Level 3) (6) suggesting that the suspected drug be withheld, discontinued, otherwise changed, and/or on antidote or other treatment is required. There was no increase in length of stay. Since this patient did not have a history of skin reaction due to calamine/diphenhydramine, this reaction was unpreventable. Our observation is supported by the Modified Schumock and Thornton scale(7).
(Table/Fig 1):Dry rough skin with exfoliation over neck and upper back.
Though we could establish a ‘probable’ causal relation ship between the drug and the ADR, we failed to confirm as the child’s parents was not willing for rechallenge. We also could not carryout the patch test. Since calamine is made up of zincoxide and ferric chloride, the exact compound behind the cause of the ADR is not confirmed. Moreover, the possibility of excipients causing such an ADR also cannot be ignored.
(Table/Fig 2):Dry rough skin with exfoliation over neck with erythema extending to the chest
Calamine/diphenhydramine is a commonly used combination for smoothening irritated or itchy skin as diphenhydramine, having antipruritic as well as mild local anaesthetic activity, compounds the smoothening effect of calamine. Diphenhydramine is a commonly prescribed systemic antihistaminic, which is available as an over the counter medication in many countries for a myriad of conditions including nasal allergy and common cold. Since calamine is a commonly used drug, one should be aware of this particular reaction, and as far as possible combination of calamine and diphenhydramine is to be avoided. Upon occurrence of this reaction, the drug should be stopped and the patient should be managed accordingly. We would have liked to patch test the patient with calamine as well as calamine/diphenhydramine to definitely establish the causality of the reaction. This couldnot be done as the child’s parents did not consent for the same.
Conflict of Interest: None declared
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