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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 Prevalence Of Intestinal Parasitic Infections In HIV Infected Patients In A Rural Tertiary Care Hospital Of Western Maharashtra (A 5 Year Study)
Correspondence Address :
Dr Ruchi Katiyar, Assistant Professor, Department of Microbiology, Rural Medical College, Pravara Institute of Medical Sciences (Deemed University), Loni, Taluka-Rahata, Ahmednagar, Maharashtra, India-413736. Mobile number-+919890250597,Email:ruchi_katiyar@yahoo.com
Purpose: To determine the prevalence of intestinal parasites in patients with HIV infection.
Methods: Stool samples from 332 HIV infected patients with diarrhoea and 246 patients HIV infected patients without diarrhoea were examined for intestinal parasites by microscopy.
Results: Intestinal parasites were seen in 68.57% HIV patients with diarrhoea as compared to their presence in 30.08% HIV patients without diarrhoea. Giardia intestinalis was the most common parasite which was detected.
Conclusion: There is a high prevalence of intestinal parasitic infection in HIV patients. Giardia intestinalis is a predominant intestinal parasite which causes diarrhoea among HIV patients, followed by Cryptosporidium parvum.
Human immunodeficiency Virus, Diarrhoea, Intestinal parasites, Western Maharashtra.
INTRODUCTION
Infections with the Human Immunodeficiency Virus (HIV) are being increasingly reported from South East Asia (1). Despite the widespread HIV awareness programmes which are going on at present, a large number of patients either go undiagnosed or present late with multiple infections (2). Diarrhoea is a common complication of infection with HIV, leading to weight loss and cachexia. It occurs in almost 90% of the HIV patients (3).
Parasitic infections of the gastrointestinal tract are a major cause of morbidity in developing countries and are increasingly important in certain populations from the developed countries, particularly in patients with Acquired Immuno Deficiency Syndrome (AIDS) (4).
Several species of intestinal parasites have been associated with diarrhoea which occurs with HIV infection. The most commonly reported parasites include Cryptosporidium parvum, Isospora belli, Microsporidium Spp , Giardia intestinalis, Entamoeba histolytica and Cyclospora spp. Besides these, the nematode, Strongyloides stercoralis can cause diarrhoea and an overwhelming infestation in patients with such immunosuppresive disorders (2),(5).
Opportunistic parasitic infections can cause severe morbidity and mortality. Because many of these infections are treatable, an early and accurate diagnosis is important. The detection of these parasites will help in the proper management of these patients, because drugs are available for the treatment of most of these infections (5).
The diarrhoeal diseases due to the parasitic aetiology among HIV patients is on the rise during recent times and only few studies regarding the prevalence of intestinal parasites are available from rural setups . So, we have undertaken this study at a rural tertiary care hospital of Western Maharashtra.
A retrospective study was carried out in the Parasitology section of the Department of Microbiology, Rural Medical College, Loni, for a period of 5 years (August 2004-July 2009). Loni is a small town in the district of Ahmednagar and is located around 180 km from Pune, Maharashtra. A total of 578 HIV seropositive patients were included in the study. The 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 (6).
Stool Examination
A total of 3 freshly voided stool samples were obtained in sterile plastic containers from all the subjects who were enrolled in the study. Diarrhoea is defined as the passage of abnormal liquid or unformed stool at an increased frequency. Diarrhoea may further be defined as ‘acute’ if it is present for < 2 weeks, ‘persistent’ if it is present for 2-4 weeks and ‘chronic’ if it is present for > 4 weeks in duration7. The stool samples were macroscopically examined for consistency, colour, the presence of blood and mucus, adult intestinal helminths and segments of tapeworm. Saline and iodine preparations were examined microscopically for the ova of helminths, as well as for the cysts and the trophozoites of protozoa. Formalin ether concentration was done when the stool did not reveal any parasite by direct microscopy (8). The modified Ziehl Neelsen staining method was used for the detection of the coccidian parasites (8).
Statistical Method
Statistical analysis was done by using the Chi square test and the Z test.
Out of the 578 HIV seropositive patients who were studied, 332(57.44%) presented with diarrhoea, whereas 246(42.56%) did not have diarrhoea. The maximum incidence of diarrhoea which was associated with HIV infection was seen in the age group of 31-40 years, followed by the age group of 21-30 years (Table/Fig 1). The percentage of HIV infected females presenting with diarrhoea (70.3%) was more than that of the males (51.9%) (Table/Fig 2).Out of the 578 stool samples which were screened, 303 samples revealed intestinal parasites, 229 in HIV positive patients with diarrhoea and 74 in HIV positive patients without diarrhoea (Table/Fig 4). Initially, 265 parasites were seen by direct microscopy and an additional 38 parasites were seen after the formalin ether concentration technique (Table/Fig 3).Of the 332 HIV seropositve patients with diarrhoea, 147(44.28%) patients had episodes of acute diarrhoea, while 185(55.72%) had chronic diarrhoea. In 147 patients who presented with acute diarrhoea, 113(76.87%) stool samples revealed intestinal parasites, while in stool samples from 185 patients with chronic diarrhoea, 116(62.7%) showed the presence of intestinal parasites.
Giardia intestinalis (27.41%) was the most common parasite in patients with diarrhoea, followed by Cryptosporidium parvum (9.64%). The prevalence of Entamoeba histolytica (12.6%) was more in patients without diarrhoea as compared to the prevalence of Giardia intestinalis. Among the intestinal helminths, Ancylostoma duodenale (8.73%) was the commonest helminth which was detected, followed by Hymenolepsis nana (2.85%), Ascaris lumbricoides (3.61%), Taenia spp (1.51%) and Strongyloides stercoralis (0.60%) (Table/Fig 4).
In case of Taenia spp , Hymenolepsis nana, Ancylostoma duodenale and Ascaris lumbricoides, there was no significant difference in the diarrhoea and the non diarrhoea groups. It indicates that in these parasitic infections, diarrhoea was not a common presenting symptom (Table/Fig 4).
Intestinal parasitic infections are the commonest and the major causes of morbidity and mortality in HIV positive patients, worldwide (2). These organisms usually cause a self limiting illness in immunocompetent individuals, but in the case of immune compromised patients, they can cause life threatening, profuse, watery diarrhea (9). The present study documents that infections with intestinal parasites are common in HIV seropositive patients of this rural area of Western Maharashtra.
Figures from various studies demonstrate the striking geographical variations with respect to the prevalence of intestinal parasites in HIV infected patients, (9),(10),(11). Ayyagari et al (12) has reported a high prevalence of Isospora belli from the northern parts of India, whereas Kumar et al (3) has reported Cryptosporidium parvum as the commonest parasite which was associated with HIV infections in southern India.
Giardia intestinalis was the most common parasite which was detected in patients with diarrhoea (27.41%), which is comparable to the study of Sethi et al (13), whereas Mukhopadhya et al (14) reported Giardia intestinalis predominately in non diarrhoeal patients. Basak et al15 from Wardha reported a low incidence of Giardia intestinalis in their study.
Our study projects Cryptosporidium parvum as the most common coccidian parasite which was associated with HIV positive patients, both with diarrhoea and without diarrhoea. Studies by Basak et al (15), Tuli et al (16), Mohandas et al (17) and Sadraei et al (18) have also shown the same results, while Gupta et al (2) and Mukhopadhya et al (14) have reported a low prevalence of Cryptosporidium parvum as compared to Isospora belli. Among the intestinal helminths, Ancylostoma duodenale was reported to be the commonest parasite, which was comparable to that which was reported by Sethi et al (13).The major parasite which was detected in HIV positive patients without diarrhoea was Entamoeba histolytica, which was in contrast to that which was reported by Sethi et al (13).The trophozoites containing ingested RBCs were identified as E.histolytica, but the cysts of E. histolytica and E. dispar are morphologically identical and therefore, they cannot be differentiated microscopically. The cysts were presumed to be that of E.histolytica, as E.dispar is a non invasive and non pathogenic species (5). The cysts of E.histolytica were considered in asymptomatic patients, because asymptomatic, non invasive, intestinal infections by E.histolytica are the most common events and the excretion of E.histolytica cysts characterized them. The facility for the isoenzyme electophoresis technique was not available in our setup.
A high prevalence of intestinal parasitic infections in HIV positive individuals may be due to poor water supply and lack of personal hygiene, which is common in a rural scenario. A significant number of intestinal parasites were also seen in HIV positive patients without diarrhoea (30.08%), thus indicating that there may be asymptomatic infections which may be going undiagnosed, thereby increasing the morbidity and mortality which are associated with them.
However, the techniques which were employed for diagnosing the common parasitic infections are simple and rapid as compared to those which are used for bacterial, fungal and viral infections. But, timely diagnosis is hampered by the delay in the diagnosis of HIV and the lack of resources for its investigation in rural parts of the developing countries. Patients from the rural areas belong to a poor socio economic background, and cannot afford diagnosis and treatment. The authors suggest that along with early diagnosis and treatment, steps should be taken to improve the water supplyand sanitation and to provide health education to prevent the morbidity and mortality which are associated with HIV infected individuals in rural areas.
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