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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
The Bacterial Profile Of Neonatal Septicaemia In A Rural Hospital In South India
Correspondence Address :
Dr. Edwin Dias
Professor and HOD
Department of Paediatrics
K.V.G Medical College
Kurunji Baug. Sullia
Email:dredwindias@gmail.com
Introduction: Neonatal sepsis is the most common cause for neonatal deaths in the NICU. Newborn blood culture and sensitivity testing are important tools in the diagnosis of neonatal sepsis and in the institution of early antibiotic treatment. Material and Methods: This study was conducted by analyzing the blood cultures and the sensitivity reports of 100 newborns who were admitted to the NICU over a period preceding one year. Results: Of the 100 newborns, 32 (32%) showed positive blood culture reports. Out of the 32 positive blood cultures, 19 (59.4%) showed positivity for Coagulase negative Staphylococcus, 7 (21.9%) showed positivity for Staphylococcus aureus, 3 (9.4%) showed positivity for Pseudomonas aeruginosa, 1 (3.1%) showed positivity for Enterococci, 1 (3.1%) showed positivity for Micrococci and 1 (3.1%) showed positivity for Flavobacteria. Overall, most of the neonatal sepsis was caused by Coagulase negative staphylococcus. The sensitivity pattern of the first line of antibiotics was as follows; out of the 19 Coagulase negative staphylococcus strains, 13 (68.42%) showed sensitivity to amikacin and ciprofloxacin, 15 (78.95%) to sparfloxacin, 9 (47.37%) to erythromycin, 10 (52.63%) to azithromycin, 12 (63.16%) to gentamicin and cephalexin and 5 (26.32%) to penicillin. Out of the 7 Staphylococcus aureus strains, 6 (85.71%) showed sensitivity to amikacin, 5 (71.43%) to erythromycin, 4 (57.14%) to sparfloxacin and ciprofloxacin, 3 (42.86%) to azithromycin and cephalexin and 1(14.29%) to penicillin and gentamicin. Out of the 3 Pseudomonas aeruginosa strains, 2 (66.7%) were sensitive to ciprofloxacin and amikacin and 1 (33.3%) was sensitive to to sparfloxacin, azithromycin and gentamicin. Enterococci showed sensitivity to sparfloxacin, cephalexin, and ciprofloxacin. Flavobacteria showed sensitivity to gentamicin, erythromycin, ciprofloxacin, sparfloxacin and amikacin. Their resistance patterns were also studied. Conclusion: Coagulase negative staphylococcus is the most common cause for neonatal sepsis in the NICU. Most of the organisms were sensitive to Amikacin.
Neonatal septicaemia, Blood culture, Antibiotic sensitivity.
INTRODUCTION
Neonatal sepsis is the most common cause for neonatal deaths in the NICU (1). Neonatal septicaemia is an important cause of morbidity and mortality among neonates in India, with an estimated incidence of approximately 4% in intramural live births (2).
Neonatal septicaemia is defined as a disease of infants who are younger than 1 month of age, who are clinically ill, and who have positive blood cultures (3). Identification of aetiology is important, since it can induce a change in the management policy (4) For the effective management of neonatal septicaemia with appropriate antibiotics that would minimise the risk of severe morbidity and mortality, besides reducing the emergence of multidrug resistant organisms by rational antibiotic use, the study of the bacteriological profile and the antibiotic sensitivity pattern play a significant role (5),(6). Thus, newborn blood cultures and sensitivity testing are important tools in the diagnosis of neonatal sepsis and in the institution of early antibiotic treatment. The institution of prompt treatment is essential for ensuring optimum outcome in neonates with sepsis, who often reach the health care facilities late and in a critical condition, in order to prevent mortality and morbidity.
This study was carried out to determine the bacteriological profile and antibiotic sensitivity pattern of neonatal sepsis in our NICU, so that the antibiotics which were used in empirical treatment could be tailored to tackle the organisms in our NICU.
This study was conducted by analysing the blood cultures and the sensitivity reports which were obtained during January 2008 to January 2009 from 100 newborns who were admitted to the NICU, Medical College and Hospital, Sullia, a rural teaching hospital in South Karnataka.
A total of 100 blood samples were collected from the clinically suspected cases of neonatal septicaemia, on the basis of antenatal risk factors, signs and symptoms of sepsis and elevated C- reactive protein levels from a peripheral vein, with proper antiseptic precautions before starting any antibiotic therapy. A second sample was collected on the same day to rule out contamination with the skin flora. Approximately 2cc of blood was drawn and inoculated into Brain Heart Infusion broth and it was incubated at 370C for 24 hrs. Subcultures were made on both blood agar and MacConkey’s agar after 24 hrs and 48 hrs. Negative cultures were followed up by examining the broth daily for 10 days. Growth, if any, was identified by standard bacteriological techniques (7) including gram staining, colony characteristics and biochemical reactions. Antibiotic sensitivity was performed by the Kirby Bauer’s disc diffusion method. Antibiotic sensitivity was tested for the following antibiotics: Gentamicin, Amikacin, Ciprofloxacin, Penicillin, Sparfloxacin, Erythromycin and Cephalexin.
Of the 100 newborns, 32 (32%) showed positive blood culture reports. Out of the 32 positive blood cultures, 28(87.5%) were gram positive bacterial isolates and only 4(12.5%) were gram negative bacteria. The commonest isolate was Coagulase negative Staphylococcus, followed by Staphylococcus aureus (Table/Fig 1).
(Table/Fig 1): Organisms found in our NICU
The results of the antibiotic sensitivity testing (Table/Fig 2) revealed that most of the isolates were sensitive to Amikacin.
(Table/Fig 2): Antibiotic sensitivity and resistance pattern of organisms found in our NICU
This study was conducted to determine the most predominant bacteria which caused neonatal septicaemia and their antibiotic susceptibility pattern in our NICU. A majority of our study population was poor and did not have proper antenatal checkups.
In most of the studies, gram negative bacteria were the principle pathogens which caused septicaemia (8),(9). In the present study, gram positive bacteria were the predominant isolates, among which Coagulase negative Staphylococcus (CONS) [19 (59.4%)] was the commonest cause of neonatal sepsis. Similar findings were noticed by others (10), (11), (12), (13), and (14). CONS septicaemia was noticed in babies who are hospitalised for 10 days or more. Our findings correlated with the study conducted by Anand et al (15). Previous studies have shown that the colonisation of babies by CONS occurs by the 3rd day of life (16). CONS is usually isolated from intravascular catheters, cerebrospinal fluid shunts and prosthetic valves, and is normally dismissed as a contaminant when isolated from blood. Though CONS is usually considered as a skin contaminant, the presence of this bacterium in blood in critically ill babies, especially in the 2nd week of life, should be considered as significant and should be treated, especially when it is isolated repeatedly. In our study, we noticed that early onset septicaemias were predominantly caused by gram negative bacteria and Staphylococcus aureus.
5(5%) of the neonates died due to sepsis. The neonates with CONS recovered after intensive treatment. The antibiotics which were used were based on the standard protocol of the hospital and the department policies, which are changed regularly pending the blood culture reports and infectious committee recommendations. The other causative organisms were Staphylococcus aureus- 7 (21.9%), Pseudomonas aeruginosa -3 (9.4%), Enterococci -1 (3.1%), Micrococci- 1 (3.1%) and Flavobacteria - 1 (3.1%). The antibiotic sensitivity pattern differs in different studies as well, at different times in the same hospital (8). This is because of the emergence of resistant strains as a result of the indiscriminate use of antibiotics. This can be avoided by using drugs to which most organisms are susceptible. From this study, it was suggested that the appropriate empirical regimen should consist of Amikacin until the culture results arrived, as most of the organisms found in our NICU were highly sensitive to Amikacin.
Coagulase negative staphylococcus was the most common cause for late onset neonatal sepsis in our NICU. Most of the organisms in our NICU have shown sensitivity to Amikacin, as found in other studies (17).
The microbial aetiology of neonatal septicaemia is diverse. Thus, every NICU should emphasize the importance of a periodic study of the microbial bacterial spectrum and the resistance pattern of the microorganisms which are responsible for neonatal infections, in order to design a specific empirical antibiotic regimen for the NICU.
THE FUTURE PROSPECTS OF THIS STUDY
• To distinguish between the hospital and community acquired infections of newborns
• The correlation of neonatal morbidity and mortality with simultaneous blood cultures and sensitivity profiles
• The correlation of gestation age and birth weight with blood cultures and sensitivity results
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