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
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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."



Prof. Somashekhar Nimbalkar
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
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




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"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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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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




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Best regards,
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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.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
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 : 2010 | Month : August | Volume : 4 | Issue : 4 | Page : 2697 - 2701

Incidence of Japanese Encephalitis in a Tertiary care Centre

Shriyan A *

M.B.B.S , M.D ,D.P.B A.J.Institute of Medical Sciences,Dept. of Microbiology, Kuntikan , NH-17Mangalore 575004Karnataka,(INDIA) Department of Microbiology , K.M.C. Manipal

Correspondence Address :
Amrita Shriyan ,Assistant Professor A.J.Institute of Medical Sciences,Dept. of Microbiology,
Kuntikan , NH-17Mangalore
Phone.No9986252598
E.mail:dramrita@ymail.com

Abstract

Background: Arbovirus are responsible for a significant number of viral encephalitis cases worldwide. Japanese Encephalitis virus is a mosquito-borne flavivirus that causes a major epidemic of acute encephalitis in humans throughout Asia (5). Scientific literature unequivocally shows the prevalence of Japanese encephalitis in various parts of India (4). In India, cases have been reported from Tamil nadu , Andra Pradesh , Uttar Pradesh , Bihar , Assam , West Bengal , Karnataka , Goa and Maharashtra (6). In recent years, South India has become endemic for the Japanese Encephalitis Virus. While there are reports from other parts of Karnataka which are on the border of Tamil Nadu and Andhra Pradesh, till date, no data is available from South Karnataka.
Aim : The present study was conceived to estimate the incidence and clinical profile of Japanese Encephalitis among the patients which were clinically diagnosed with Viral Encephalitis at a tertiary care centre in South India.
Material and Methods: One hundred randomly selected cases of clinically diagnosed Encephalitis who were admitted in K.M.C. , Manipal, were included in the study . In - house MAC ELISA was used to detect specific IgM antibodies in the Cerebrospinal fluid (25,26).
Results : Anti- JEVirus IgM antibodies were detected in 8 % cases of clinicallydiagnosed encephalitis who were admitted to the K.M.C. Hospital. The mortality rate of the Japanese Encephalitis cases was 12.5 % . No sequalae was recorded in the Japanese Encephalitis cases who survived in our study.

Keywords

Japanese encephalitis virus , Viral encephalitis , IgM antibody capture ELISA

Introduction
A number of neurotropic viruses like Herpes Simplex Virus , St. Louis Encephalitis Virus , Japanese Encephalitis Virus , West Nile Virus and Arbovirus are attributed to be the causative agents of Viral encephalitis worldwide (3). Japanese Encephalitis which is caused by a mosquito borne neurotropic RNA virus, has emerged as a disease with major epidemics, with a very high mortality and morbidity (7),(8).

All flaviviruses are antigenically related , cross reactions being most evident and hence, the need for tests showing the greatest specificity (9). Culex tritaeniorhychus and Culex vishnuii species are the main vectors which transmit the disease from the reservoir hosts to man . They generally breed in paddy fields and are invariably found outdoors (10). The virus is transmitted in the zoonotic cycle among mosquitoes and vertebrate amplifying hosts , chiefly pigs and wading birds (30).
Viral encephalitis is an acute inflammation of brain parenchyma which is characterized by fever , headache , confusion , seizures , altered levels of consciousness and focal neurological disturbances in various combinations. Patients who seek medical attention may have aseptic meningitis or encephalitis, of whom 5 % to 25 % die (14),(20).

The rate of asymptomatic and symptomatic infection varies between 25 : 1 to 1000: 1 . The incubation period varies from 1 – 6 days, or as long as 14 days . The onset of illness can be abrupt, acute ( < 1 day ), subacute ( 1-3 days ) or gradual ( > 3 days ). Children under 15 years of age were principally affected in endemic areas (19). Waning immunity or other biological factors associated with aging, have been speculated to be risk factors (12),(13) . This is followed by the encephalitis stage which manifests with altered sensorium, convulsions, neck stiffness , muscular rigidity , mask like facies and abnormal movements (17,18,19) . The principal complications are secondary bacterial infectionsand gastro-intestinal haemorrhage in the acute and subacute phase of the illness (20),(21). Japanese encephalitis which is acquired during the first two trimesters of pregnancy may lead to foetal infection and miscarriage (15),(22). The causes of relapse, seizures and sequale were convulsions , frank mental retardation , frank motor defecits, scholastic backwardness , behavioural problems and subtle neurological signs (20),(21),(27).

Material and Methods

Method
One hundred clinically diagnosed cases of Encephalitis who were admitted in the K.M.C. Hospital, Manipal, were included in the retrospective study . The cerebrospinal fluids were randomly selected after excluding bacterial and other viral etiology for meningitis and encephalitis The diagnostic criteria for Japanese encephalitis which was adopted in this study was the demonstration of IgM antibodies in cerebrospinal fluid samples . The Avidin – Biotin system which was used in this test was used to increase the sensitivity and specificity to 100 % . CSF for serology which was received from all cases were collected and stored at – 70 degrees centigrade until they were tested by MAC ELISA (28),(29).
Control group : To check the specificity of the ELISA technique which was employed for the detection of the Japanese Encephalitis Virus infection , Fifteen Cerebrospinal fluid samples which were diagnosed as caused by the Herpes Simplex Virus (5 cases) , Subacute Sclerosing Panencephalitis (5 cases) and Mumps (5 cases) were included in the study . A detailed history and clinical examination was carried out in all cases . Other investigations like Blood count and Haematological and Biochemical Analysis were also compared.

IgM Antibody Capture ELISA ( MAC ELISA ) is the method of choice to demonstrate virus specific antibodies in both in Blood and Cerebrospinal fluid samples (23),(25).

Principle : Solid phase support ( microtitre plate wells ) were coated with Anti – Human IgM antibodies which were capable of binding all IgM isotype antibodies which were present in the specimen. Specific Antigen was then added , followed by enzyme labeled antigen – specific antibodies. If IgM antibodies which were specific for the antigen in question were present , the sandwich complex would result in an enzymatic colour change which was proportional to the concentration of the IgM specific antibody which was present. This method is highly specific and more sensitive.(29)(30)

In the present assay, known positive and negative controls were provided by the Department of Neurovirology, NIMHANS, Bangalore. The assay was considered to be valid only when the controls gave expected results (Quality control) by in house MAC ELISA for the detection of IgM antibodies to the Japanese Encephalitis Virus by an IgM antibody capture ELISA. (22),(23),(24),(25),(29)

Results

The study was performed over a period of two years among patients with clinically diagnosed Viral Encephalitis at a tertiary care centre in South India. IgM Antibody Capture ELISA (MAC ELISA) is the gold standard to demonstrate the presence of virus specific antibodies in cerebrospinal fluid (23),(25),(29).

The number of CSF samples tested = 100
Japanese Encephalitis Positive by MAC ELISA = 8 cases (8 %).
Any test sample with more than 100 units is considered to be Positive for IgM antibodies to the Japanese
Encephalitis Virus
Samples with ELISA units between 30 –99 were considered to be probably positive for the IgM antibodies to the Japanese Encephalitis Virus, but they required further testing with the DengueWest Nile Virus Antigen, as well as with the Normal mouse brain Antigen in order to exclude false positive reactions.

A sample with ELISA units less than 30 units was considered to be Negative for the IgM antibodies to the Japanese Encephalitis Virus

In our study, it was noticed that children younger than 15 years of age were affected with the Japanese encephalitis virus infection, which was also well documented by several earlier reports (11),(28). The age distribution of the Japanese Encephalitis cases is as mentioned in (Table/Fig 1). Various clinical features which were reported in these cases have been compiled in (Table/Fig 2). The mortality rate of the Japanese Encephalitis was 12.5 %. No sequalae were recorded in the Japanese Encephalitis cases who survived in our study.

Discussion

Japanese Encephalitis is one of the leading causes of Acute Encephalopathy, affecting children and adolescents in Tropical and Sub – tropical Asia. Epidemic outbreaks of Japanese Encephalitis continue to pose a significant public health problem in most parts of India, especially in the Southern states.(16). Manipal being only 70 kilometres away from the Kerala border, which is endemic for Japanese Encephalitis along the west coast did not have any recorded outbreaks of Japanese Encephalitis till date. The present study was carried out to diagnose Japanese Encephalitis cases among patients who were clinically diagnosed as Encephalitis in the K.M.C Hospital , Manipal .


The diagnostic criteria for Japanese Encephalitis which was adopted in this study was the demonstration of the IgM antibodies by MAC ELISA in CSF samples, as reported by others, which is the Gold standard for the diagnosis of Japanese Encephalitis .94,95. Among the clinical manifestations, reported fever was present in 100 % of the cases and altered sensorium and headache accounted for 85 % - 100 % and 50 % of the cases respectively , Male preponderance , Pleocytosis and incidence in children younger than 15 years of age which were noticed in our study is also well documented by several earlier reports (11),(19),(28).

The diagnostic criteria for Japanese Encephalitis which were adopted in this study was the demonstration of the IgM antibodies by MAC ELISA in CSF samples, as reported by others, which is the Gold standard for the diagnosis of Japanese Encephalitis (28),(29).

To ensure the specificity of the assay, known positive and negative controls were included . There was no geographical or temporal clustering of cases.Predominance of infection was observed in males .Male to female ratio was 3 : 1
Out of 8 positive cases , 75 % were males and 25 % were females.


Conclusion

The disease was of a sporadic nature affecting all age groups , but predominantly, children formed 8 % of the cases which were admitted to the K.M.C .Hospital during ourstudy. The mortality rate of Japanese Encephalitis was 12.5 %. No sequalae was recorded in the Japanese Encephalitis cases who survived.

No specific antiviral therapy is available for Japanese encephalitis . The specific aetiological diagnosis of Japanese Encephalitis cases helps the patient management protocols and avoids unnecessary use of antiviral therapy . Acyclovir therapy which is of no proven advantage in the cases of Encephalitis which were caused due to the Japanese Encephalitis Virus needs supportive and symptomatic treatment Thus, the management protocol was restricted to temperature control, seizure control, sedation and the control of aggravating intracranial pressure and fluid and electrolyte management (.26,27).

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Rashmi K ,Asha Mathur ,A.Kumar , S.Sharma ,S.Chakraborthy and U.C. Chaturvedi In Clinical features and Prognostic indicators of Japanese encephalitis in children in Luknow .Indian J.Med Res (A) 91 ,Sept 1990;321 – 327
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