Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
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Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



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Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

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I wish JCDR a great success and I hope that journal will soar higher with the passing time."



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Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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

Important Notice

Original article / research
Year : 2008 | Month : June | Volume : 2 | Issue : 3 | Page : 843 - 846

Spectrum of Ocular Diseases at a Military Hospital in Ladakh, North India

JHA K N

Department of Ophthalmology Manipal Teaching Hospital/ Manipal College of Medical Sciences Pokhara, Nepal.

Correspondence Address :
Kirti Nath Jha Professor, Department of Ophthalmology Manipal Teaching Hospital/ Manipal College of Medical Sciences Pokhara, Nepal

Abstract

The objective of this study was to study the spectrum of patients with ocular diseases, attending a referral military hospital in a remote hilly region of north India. 793 consecutive patients were treated in the Ophthalmology Department over a four year period (Jan 2001 to Dec 2003) at a referral military hospital in Laddakh, Jammu and Kashmir. Males outnumbered females (M: F ratio 3:1), with 56.7 % patients being below 40 years age The spectrum of diseases in the descending order was: refractive errors 33.8%, cataract 21.4%, inflammatory conjunctival diseases 16.8%, pterygium 8.4 %, corneal diseases 5.5%, injuries 3.9 %, diseases of ocular adnexa 3.4%, glaucoma 2.4%, uveitis 2.1%, and miscellaneous 2.3%. Among the cases of blindness, cataract accounted for 85% of cases, refractive errors for 5.5 %, injuries for 5.5 %, corneal opacity for 1.9% , glaucoma for 0.5%, and others for 1.6 %.

Keywords

conjunctival diseases, Ladakh, cataract, refractory errors

Introduction
Due to its extreme cold climate and its remoteness, Laddakh remains one of the east known parts of the country. Therefore, this geographically large region with a small population (1, 63,000; Census 1991) has remained outside the realm of epidemiological research and statistics, because of which health problems of this region are practically non-existent in literature. This hospital-based study of ocular morbidity was carried out at a referral military hospital that delivers medicare to the locals under the army’s goodwill programme, ‘Operation Sadbhavana’. This hospital attracts patients from all the regions-central Laddakh, Nubra valley, Suru valley, Zanskar and Changthang of Laddakh, where the whole of the population is permanently located at high altitudes (i.e. above 9000 feet above mean sea level). In Laddakh, human habitations exist at altitudes of up to 14,500 feet under temperature conditions that dip down in some areas to as low as - 60º C in winters. The relative humidity in this region varies between a low of 31-64 %.

Material and Methods

To assess the prevalence of eye diseases in the Laddakhi population, a descriptive study was carried out on the patients attending the Eye Department of our hospital for OPD / indoor treatment over a three year period (January 2001 to Jan 2004). The patients included soldiers of Laddakhi origin, their dependents, and the civilians of Laddakhi origin only.

A total of 793 patients were treated during this period. Any individual who reported for the second time for the same illness was eliminated for the purpose of assessing the disease prevalence.

Results

Amongst 793 patients, 595 were males and 198 were females. The M: F ratio was 3: 1. The age distribution of the patients is given in (Table/Fig 1)450 (56.7 %) individuals were below 40 years of age, and 343 (43.3%) were aged 40 years and above. As regards ethnicity, 94.7 % were Laddakhi natives, and 5.3 % were Tibetan refugees settled in Laddakh . The prevalence of eye diseases is given in (Table/Fig 2). Among the cases of blindness, cataract accounted for 85%, refractive errors for 5.5 %, corneal opacity for 1.9%, glaucoma for 0.5%, injuries for 5.5 %, and others for 1.6 %.

Discussion

High altitude areas are natural stress areas due to low barometric pressure, and consequently, low oxygen concentration (1). In addition, lowered temperature and low humidity causing dryness of skin, nose and mouth, increased intensity of sunshine causing injury to eyes and skin, and cosmic electric conditions, pose additional problems to health. Although ground reflection of UVB from grass is negligible, it is markedly increased from snow, sand, and concrete (2). Therefore, UV light exposure in high altitude areas like Laddakh, where vegetations are scarce, terrain is rocky, and large areas remain snow bound for large parts of the year, increases markedly. Since surface reflectivity is an important factor in determining UVB ocular dose (3), exposure to deleterious UVB in Laddakh is high. This increases the risk of cataract formation due to chronic exposure of eyes to UVB that damages the lens protein and DNA (2), and snow blindness in unprotected eyes.

In the studied population, 56.7% patients were below 40 years of age, and 43.3 % were above 40 years of age. The M: F ratio was 3:1, because a majority of our patients constituted serving and ex- soldiers.

Refractive errors accounted for a majority of OPD attendance (33.8 %). Amongst the cases of refractive errors, 64.5 % were myopic with or without astigmatism, if aphakia was excluded.

Cataract constituted for 21.4 %. This is in spite of the fact that 56.7 % of the patients were below 40 years of age. This high prevalence of cataract is supported by another study involving a Tibetan population that reported an overall 60% higher incidence of cataract in Tibet (altitude 4000m) than in Beijing (altitude 50 m) (4). Amongst the cases of cataract, about 60 % were mature and hyper mature types. Such high cumulative levels of UVB exposure, significantly increases the risk of cortical cataract (5). Age-wise, 75% of the cases of cataract were above 40 years of age.

Traumatic cataract accounted for 14.4% of total cataracts. This high prevalence of traumatic cataract is an interesting fact in Laddakh. Among the cases of traumatic cataracts, a majority of patients were below 20 years of age, and belonged to the regions where a thorny shrub seabuckthorn (Leh-berry), grows in abundance in the wild. In the below 20 years age group, 10(71.42 %) out 14 cataracts were traumatic in nature.

Inflammatory conjunctival diseases accounted for 16.8 % of cases, of which about half (8.2 %) were the cases of allergic conjunctivitis only. This problem is seen more commonly and in florid forms in higher altitudes like Changthang (northern plains) region and in Zanskar regions. Pterygium accounted for 8.4% of cases. This figure is lower than the prevalence rate in some of the south Asian countries like Indonesia, where age adjusted prevalence rate of any pterygium was 10.0% (6). Among the cases of pterygium, 63% cases were bilateral, which is much higher than the 4.1 % rate reported in the above quoted study (6).

About 5% of total cases reported with non-specific complaints like irritation, redness and sensation of a foreign body in their eyes in the absence of any other identifiable eye disease. These cases could be due to high UV exposure and aridity of the region, and therefore needs to be studied separately for correlation with relative humidity; altitude and possible tear film abnormalities.

The prevalence of glaucoma was seen in 2.4 % of cases. A majority of the cases of glaucoma reported in the advanced / absolute stage because of lack of awareness and access to eye care facilities in far-flung areas. Therefore, there is a need for screening of the susceptible population for early detection of glaucoma. However, none of the cases of glaucoma from our study population had

Conclusion

In conclusion, refractive errors (33.8%) and cataract (21.4%) account for more than half of the OPD attendance. Among the various forms of cataract, prevalence of traumatic cataract is high (14.4%), with a majority (71.4 %) of them belonging to the below 20 years age-group. In addition, a good proportion, about 16.8% of cases suffer from conjunctival inflammatory diseases. About half of them (8.2 %) suffer due to various forms of allergic conjunctivitis. Allergic conjunctivitis is particularly common in the higher altitude regions of Changthang and Zanskar. Prevalence of pterygium is high (8.4 %) in Laddakh where almost two third of cases (63%) suffer from bilateral affliction.

References

1.
Shoene R B, Hackett PH, Thomas H F. High altitude. In: Murray JF, Nadel JA, editors. Textbook of Respiratory Medicine, 3rd ed. Philadelphia: W B Saunders Company, 2000.1915-50.
2.
Andley U. Photooxidative Stress. In: Albert D M, Jacobiec F A, editors. Principles and Practice of Ophthalmology. Philadelphia: W B Saunders Company, 1994; 575-90.
3.
Slinley DH. Physical factors in cataractogenesis: Ambient ultravoilet radiation and temperature. Invest Ophthalmol Vis Sci 1986,27:781.
4.
Hu TS, Zhenm Q, Sperduto RD, et al. Age–related cataract in Tibet eye study. Arch Ophthalmol 1989; 107:666.
5.
Taylor HR. The biological effects of UVB on the eye. Photochem Photobiol 1989; 50:489.
6.
Gazzard G, Saw SM, Farook M, et al. Pterygium in Indonesia: prevalence, severity and risk factors. Br. J Ophthalmol. 2002; 86(12): 1341-6.

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