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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
Clinico-epidemiological Profile of HIV Patients with Respiratory infections and Tubeculosis in Western India
Correspondence Address :
Dr. Asmita A. Mehta, MD, Assistant Professor, Dept of Pulmonary
Medicine, Amrita Institute Of Medical Sciences. Kochi-682041,
Kerala, India.
E mail: asmitamehta@aims.amrita.edu
Phone: 91- 9037450374, Fax: 0484-280 2177
In this study, 50 HIV seropositive patients who attended the Pulmonary Medicine Clinic of a tertiary care teaching institute in western India were enrolled. Of these, 39 were men and 13 were women. The mean age of the study subjects at the time of diagnosis was 34.96 years. Heterosexual contact was the commonest mode of transmission in 34 (68%) patients, followed by blood transfusion in 9(18%). A history which was suggestive of a risk factor for HIV transmission could not be elicited in 7
(14%) patients. Cough (96%), weight loss (96%), fever (88%), chronic diarrhoea (70%) and dyspnoea (52%) were the common presenting symptoms. Tuberculosis was the commonest respiratory infection (72%), followed by bacterial pneumonia (22%), pneumocystic jiroveci infection (6%) and fungal infection (4%). Among the 32 patients who had a diagnosis of active pulmonary TB infection, the tuberculin test was positive in 20 patients and it was negative in 16 patients.
HIV, TB, Lung infection
The HIV infection is a global pandemic. With the availability of highly active anti retro viral therapy and the use of prophylactic antibiotics, the occurrence of opportunistic infections has decreased. Despite the use of prophylactic antibiotics over the years, AIDS most frequently affects the lungs, and hence, the failure of the respiratory system is one of the leading causes of death in HIV/AIDS patients. It has been estimated that 90% of the HIV infected persons live in the developing countries (1), (2). Overall, the average prevalence rate of HIV among adults in India is about 0.9% and it accounts for 10% of the global HIV burden and 65% of that in south and southeast Asia.(3),(4) In India, there were 2.5 million people living with HIV and AIDS at the end of 2007, while the incidence of TB was approximately 1.8 million cases per year (3).
The primary objective of this study was to assess the relative prevalence of pulmonary infections and TB among HIV seropositive patients. It was also aimed to study the occurrence, the clinical and the radiological profile and the pattern of the pulmonary infections in the HIV disease.
The present study was conducted at a tertiary care teaching institute in Gujarat, western India. Those patients who visited the Department of Pulmonary Medicine between November 2004 to July 2005 were included in the study. The Ethics Committee of the Institute approved the protocol. A written informed consent was taken from all the patients. Their history was recorded on a pre-designed schedule, which included the socio-demographic profile of the patients, the mode of transmission, the presenting symptoms, opportunistic infections, etc. A detailed physical examination was done for all included patients.
The diagnosis of HIV was confirmed by ELISA and a rapid test, as recommended by the National AIDS Control Organization (NACO).
Each patient was also subjected to routine hematological, biochemical, and bacteriological investigations (sputum acid fast bacilli smears, sputum gram staining and cultures). X-ray of the chestwas taken in all the patients. The Hepatitis B surface antigen and VDRL tests were also done in all the patients.
Special investigations like Giemsa staining and Indian ink preparation staining of the sputum, the computed tomography chest, ultrasound of the chest/ abdomen and body fluid examination were also performed in the patients when indicated. A Trimethoprim-Sulphamethoxazole (TMP/SMX) prophylaxis was given when indicated.
CD4 counts were not done due to financial constraints
During the period of the study, 50 patients were included in the study. Their socio-demographic characteristics are given in (Table/Fig 1).
The commonest mode of acquiring the infection was through heterosexual contact (68%), followed by a blood transfusion history in 18% of the patients, while 14% of the patients did not give any specific history. None of the patients gave a history of drug abuse or homosexual behaviour in our study. The patients were from the lower socio-economic class and were working as labourers (36%), drivers (24%) and diamond cutters (14%), while 26% were unemployed at the time of the hospital visit. The most common presenting complaints were cough, weight loss, fever and chronic diarrhoea. The presenting complaints of the patients are shown in (Table/Fig 2). The radiological findings of all the patients are shown in (Table/Fig 3). (Table/Fig 2), (Table/Fig 3)(Table/Fig 4)
The tuberculin test was done in all the 50 patients. The results are shown in (Table/Fig 5).
All the patients with TB were started on the anti TB treatment under the revised national TB control programme.
Bacterial pneumonia was the second most common infection (22%). Among the 11 patients, 7 had streptococcal pneumonia, 3 had staphylococcal pneumonia and 1 had klebsiella infection. The clinical presentation and the outcome of the pneumonia were found to be same, as was seen in the non-HIV patients. They were treated with antibiotics according to their sensitivity profile and their response to treatment was similar to that which was seen in the HIV seronegative patients.
Pneumocystic jiroveci pneumonia was found in 3 (6%) cases. The diagnosis was based on the typical symptoms of malaise and dyspnoea, serum LDH elevation and the X-ray findings of ground glass opacities and low peripheral O2 saturation. An induced sputum/ bronchoalveolar lavage for pneumocysits was done for all the patients; however, it turned out to be negative. TMP/SMX along with steroids was given to all the patients. Adverse reactions to the therapy were mild and tolerable. One patient died of respiratory failure during the treatment.
Two patients (4%) were diagnosed to have pulmonary fungal infections. One patient had cryptococcal meningitis which was secondary to a lung infection. He was treated with intravenous Amphotericin B, but he succumbed to his illness after 3 days of treatment.
The respiratory system is very commonly involved in HIV infected patients. The spectra of respiratory infections include mild community acquired pneumonia to severe life threatening infections and diseases like malignancy. However, we did not find severe and rare cases in the present study. The male to female ratio was 3.55:1. Blood transfusion and heterosexual exposure were the commonest risk factors. Most of the women acquired the infection through their husbands, who in turn got it from commercial sex workers, which was similar to that which was reported by other studies in India (5)(6)(7)(8) None of the patients gave a history of intravenous drug abuse or homosexuality. In a study which was conducted by S.Bhagyavatidevi et al in Manipur, intra venous drug abuse was main risk factor (87%), followed by heterosexual exposure and promiscuity( 13%) (9). This may be due to an increased rate of intravenous drug abuse in the north eastern part of India as compared to the western part of India (10)(11)(12)(13).
The spectra of the opportunistic infections which were observed in this study were similar to those which were reported from the southern and the northern parts of the country (8), (14). The prevalence of tuberculosis (38.8%) was highest among the opportunistic infections in HIV seropositive patients. This finding was consistent with those of the studies which were conducted by Neeraj et al and Shrama et al (8), (11) Extra-pulmonary tuberculosis was morecommon than pulmonary tuberculosis (47% vs 53%) in the present study, which was in contrast to the studies which were conducted by Zuber Ahemed et al (38% vs 80%), S. Bhagyabati et al (22% vs77%) (9), (12). The diagnostic reliability of the skin test was reduced due to the anergy which was caused by HIV. A recent analysis by Saumya Swaminathan et al also confirmed that the tuberculin skin test has a low positive predictive value (18.8- 48.8%) in patients with HIV and tuberculosis(13). Diffuse pulmonary infiltrates/opacities, mediastinal adenopathy and pleural effusions were the dominant radiological presentations and cavitation was uncommon (Table/Fig 3) in the present study. This was consistent with the findings of the studies which was conducted by Swaminathan et al and Zubeer Ahmed et al (12), (14).
The second common pulmonary infection was bacterial pneumonia (22%). In all published series, typical pyogenic bacteria and more particularly, S. pneumonia, Staph aureus and Klebsiella were the major responsible bacteria. The kinds of pathogens and their relative frequencies in the present study were consistent with those in most of the published reports (15)(16)(17). In a vast majority of cases, the clinical presentation of HIV-infected subjects with bacterial pneumonia, was similar to that of HIV sero-negative patients with community-acquired pneumonia (18). The onset was acute or subacute with fever, cough, purulent sputum, dyspnoea and chest pain (19)(20)(21)(22)(23)(24). The physical examination revealed abnormalities, mainly crackles, which was comparable with those reported by previously published series of studies (16). The radiological findings were also similar to that of the previously reported series of studies and they consisted of multilobar consolidation, bilateral involvement with either patchy bronchopneumonia or alveolointerstitial infiltrates (16), (21)
Though, Pneumocystis jiroveci pneumonia remains the commonest AIDS defining illness in the western population, (15) its incidence was much lower in our study (6%). This correlated with other previously and recently published data from India (14), (25)(26)(27). The clinical presentation and the radiological features in our patients were similar to that which were reported by a study which was conducted by Udwadia et al (28).
Similarly Kaposi’s sarcoma, atypical mycobacterial infections and disseminated cytomegalovirus disease, which are common in western literature, were not seen in this study. Similar trends were observed in other studies from other parts of India (9), (10), (13). The incidence of pulmonary fungal infections was low, with a poor outcome.
The strength of our study was that our data came from a tertiary care referral center that caters to general patients and treats HIV/ AIDS patients on a day to day basis and so, our results reflect the real situation in a general population of Gujarat, though we had only a small sample size. A limitation of our study was that CD4 counts were not done due to the nonavailability of the lab tests for it inside the hospital and due to financial constraints on the part of the patients due to which they could not get it done from outside laboratories. This was a hospital-based study and the patients who were included were those who reported with respiratory symptoms to the Pulmonary Medicine Clinic. Thus, we may have missed the group of not seriously ill/asymptomatic patients who may have opted to not attend the hospital for care.
HIV infection is one of the major infectious diseases in developing countries like India and due to the chronicity of the illness, it has a huge impact as compared to other infectious diseases. People with high-risk behaviour and the spouses of the affected people need to be educated for the primary and the secondary prevention of the disease. Ultimately, we conclude that while managing HIV infected patients, a high degree of suspicion, a detailed clinical history and clinical examination along with the intelligent use of investigations, would help in an early diagnosis of the pulmonarymanifestations and this in turn, would help in the better control and prevention of the complications, morbidity and the spread of drug resistant infections to other populations.
There are not many studies published from western part of India on similar issues, and this data may be helpful for future larger population based survey.
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