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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
Intestinal Parasitic Infections In HIV Seropositive Patients –A Study
Correspondence Address :
Dr. Silpi Basak, M.D,Professor of Microbiology,Jawaharlal Nehru Medical College, Sawangi (M) Wardha (India)Phone: (07152) 287765,Mobile: 09421726385,E-mail: drsilpibasak@gmail.com
Opportunistic infections are the hallmark of the Human Immuno Deficiency Virus (HIV) infection. In recent years, intestinal infections such as Cryptosporidium, Cyclospora and Isospora are becoming more prevalent in Acquired immunodeficiency syndrome (AIDS) patients. Strongyloides stercoralis infections can lead to the hyperinfection syndrome and even to lethal disease in immunosuppressed patients. The present study was undertaken to study the prevalence of parasitic infections in HIV seropositive patients.
Out of 268 stool samples, 148, stool samples were collected from HIV seropositive patients with diarrhoea and 120 stool samples were collected from HIV seronegative patients with diarrhoea. All the 268 stool samples were examined by wet mount preparation (saline, Lugol’s iodine) and staining (modified Ziehl Neelsen staining) for the detection of the parasitic infection.
The total number of intestinal coccidian parasite was 52 (35.1%)(in HIV seropositive patients. No intestinal coccidian parasite was found in HIV seronegative patients. Co-infection with Cryptosporidium, Isospora and Cyclospora was observed in three (2%) of the HIV seropositive cases. However, the larva of Strongyloides stercoralis was found in two (1.4%) of the HIV positive patients and both the patients had chronic diarrhoea.
Intestinal coccidian parasite, HIV infection, Diarrhoea.
Introduction
Acquired Immunodeficiency Syndrome (AIDS) is the major global public health problem of the 21st century. Worldwide, an estimated 33 million people are living with HIV infection (1). This is alarming due to the unique pathogenesis of HIV that mainly affects the CD4+ T helper cells and hence, opportunistic infections are the hallmark of HIV infection. The World Health Organization (WHO) defines diarrhoea wasting syndrome along with HIV seropositivity as AIDS defining illness (2). The opportunistic coccidian parasites like Cryptosporidium, Isospora, Cyclospora, etc. cause diarrhoea in almost 90% of AIDS patients in developing countries (3).
Hence, the present study was undertaken to study the prevalence of intestinal parasitic infections in HIV seropostive patients with diarrhoea.
The study was conducted from January 2008 to December 2008. HIV seropositive patients were defined as those who had been tested positive for HIV antibodies by any of the two tests (i.e. ELISA/Rapid/Simple) as per the recommendations given by WHO (4).
A total of 268 stool samples of 148 HIV serppositive and 120 seronegative patients were included in this study. Diarrhoeal stool samples of HIV seropositive and HIV seronegative patients were examined by wet mount preparation (saline and Lugol’s iodine) and modified acid fast staining (5) to detect parasitic infections. Modified acid fast staining was specifically done to detect intestinal coccidian parasites e.g. Cryptosporidium, Isosopora belli and Cyclospora species. No special staining for Microsporidia was included in the study. Persistence of diarrhoea for more than 4 weeks in a patient was defined as chronic diarrhoea (6).
A total number of 268 diarrhoeal stool samples of 148 HIV seropositive patients and 120 HIV seronegative patients were examined for the detection of intestinal parasitic infections. Amongst 148 HIV seropositive patients, 96 had chronic diarrhoea and 52 patients had diarrhoea of an average of three-seven days duration, whereas HIV seronegative patients had diarrhoea of an average of two-four days duration. Only one stool sample from each patient was collected.
The number of HIV seropositive patients who attended the O.P.D with diarrhoea twice and thrice during the study period with an average interval of one and a half months was five and two, respectively. Out of these five seropositive patients, two had Cryptosporidium infection and one patient had infection with Entamoeba histolytica on both the occasions, whereas two other patients had infection with Entamoeba histolytica on the first visit, but developed Isospora belli infection on the second visit. Two patients who attended the OPD thrice at average intervals of one and a half months had Entamoeba histolytica infection on all the three occasions.
The total number of intestinal parasites observed in the stool samples of HIV seropositive patients was 87(58.8%) (Table/Fig 1) ascompared to 36 (30 %) in the stool samples of HIV seronegative patients (Table/Fig 2). The number of opportunistic infections with the intestinal coccidian parasite was 52 (35.1 %) in HIV seropositive patients, out of which co-infection with Cryptosporidium, Isospora and Cyclospora was observed in three (2 %) cases. Cryptosporidium sp. was found in 42 cases (28.4 %), followed by Isospora belli seven in cases (4.7%), Cyclospora sp in three cases (2%) (Table/Fig 3), (Table/Fig 4), (Table/Fig 5) and other protozoal pathogens e.g. Entamoeba histolytica was present in 21 cases (14.1 %) and Giardia lamblia in 12 (8.1 %) of HIV seropositive cases. Mixed infections with Entamoeba histolytica and Giardia lamblia was found in four (2.7%) HIVseropositive cases. The larva of Strongyloides stercoralis was found in two (1.4 %) of the HIV positive patients and both the patients had chronic diarrhoea (Table/Fig 6). Out of 52 intestinal coccidian parasitic infections, 29 (55.8%) were present in HIV positive patients with chronic diarrhoea.
No coccidian parasite was found in the stool samples of HIV seronegative patients (Table/Figure: 2). Entamoeba histolytica was found in 26 cases (21.7 %), followed by Giardia lamblia in seven cases (5.8 %). The ova of Ascaris lumbricoides was found in one case (0.8%) and the ova of Hymenolepis nana was found in one case (0.8%) in the HIV negative patients. Two HIV seronegative patients had mixed infection with Entamoeba histolytica and Giardia lamblia. The larva of Strongyloides stercoralis was found in one (0.8 %) of the HIV negative patients who was 80 yrs old and was having diarrhoea for more than eight days (Table/Fig 7).
The CD4+ T cell count was done in only 33 HIV seropositive patients due to financial constraints and due to lack of the patients’ compliance. Out of these 33 patients, 29 patients had intestinal coccidian parasitic infection. The CD4+ T cell count was 500 to 200 cells/mm3 in five patients (17.2%), 200 to 100 cells/mm3 in twelve (41.3%) patients, 100 to 50 cells/mm3 in seven (24.1%) patients and <50 cells/mm3 in three (10.3%) patients with intestinal coccidian parasitic infection respectively.. Two patients having cryptosporidium infection had a normal CD4+ T cell count (616 and 589 cells/mm3) respectively.
Among the opportunistic infections, intestinal parasitic disease is the commonest and is a major cause of morbidity and mortality in HIV positive individuals worldwide (7). The coccidian parasites i.e. Cryptosporidium sp, Isospora belli, Cyclospora sp. and Microsporidium sp. are known to cause life-threatening profuse watery diarrhoea in HIV positive individuals because of their low immune status (8).
In our study, the coccidian parasites were found in HIV seropositive patients only and Cryptosporidium sp. (28.4%) was the most common, followed by Isospora belli (4.7%). In 2002 and 2005, two reports from North India (9),(10) had also reported Cryptosporidium sp. to be the most common coccidian parasite in HIV positive patients. Similarly, in another study conducted in the Centre for AIDS and related diseases, National Institute of Communicable Diseases, Delhi, Dwivedi et al had reported that Cryptosporidium sp was predominant (63.9%) and Isospora belli was present in only 4% of the HIVseropositive patients with diarrhoea (11). Cryptosporidium sp. was the most common parasite (25%), followed by Isospora belli in 20% of the patients who have been reported from CMC, Vellore (12). But Gupta et al in 2008, had reported from North India about the preponderance of Isospora belli (50%), followed by Cryptosporidium sp. (23.6%) in HIV positive patients (13). Similarly, the higher prevalence of Isospora belli as compared to Cryptosporidium sp. have been reported from South India (3),(14).
The five HIV seropositive patients who showed the same parasite infection when they attended the OPD twice or thrice at one and a half month intervals, may have been infected because of their unhygienic living conditions. One HIV positive female patient aged 28 years had infection with Cryptosporidium sp. and was treated for that, but continued to have watery diarrhoea and was found to have lactose intolerance also.
In a country of 2.5 million HIV positive adults, India is now facing the HIVepidemic (15). Screening of the coccidian parasite is still not done as a routine test in HIV positive patients in most of the Microbiology Laboratories, but a good number of HIV seropositive patients suffer from diarrhoea due to coccidian intestinal parasites.
Hence, to conclude, routine screening of the stool samples of HIV seropositive patients with diarrhoea should be done for prompt patient care, to prevent the fulminant form of the disease. As most of the opportunistic parasitic infections occur through the faecal oral route, they can be prevented by using safe drinking water and food, by maintaining personal hygiene and by avoiding walking bare foot.
The authors highly acknowledge Datta Meghe Instituteof Medical Sciences University (M.S) for funding the project.
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