Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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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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Muzaffarnagar Medical College,
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,
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
(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)
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.
On April 2011

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
On Jan 2020

Important Notice

Original article / research
Year : 2011 | Month : August | Volume : 5 | Issue : 4 | Page : 700 - 702

A Study on Genital Fixed Drug Eruption in a Tertiary Care Hospital

Sanjay Kumar Kanodia, Amoolya K. Seth, Shailja Ratan Shukla

Asst.Professor, Department of Dermatology, Venereology and Leprosy, National Institute of Medical Science & Research, Nims University, Jaipur-303121. Associate Professor, Department of Psychiatry, National Institute of Medical Science & Research, Nims University, Jaipur-303121. Professor & Head, Department of Dermatology, Venereology and Leprosy, National Institute of Medical Science & Research, Nims University, Jaipur-303121.

Correspondence Address :
Dr. Sanjay Kumar Kanodia
C-90, Sethi Colony, Jaipur-302004
Phone numbers-09928977411
Facsimile numbers 01412607053


Background: Genital fixed drug eruption (FDE) present as single oval lesion, most commonly over glans penis and are many times wrongly diagnosed and treated as sexually transmitted diseases.

Objectives: The aim of this study was to present a series of cases of genital lesions with fixed drug eruptions, diagnose the suspected drug and identify the change in pattern of drugs causing them.

Methods and Material: Patients with the genital FDE were interviewed for onset and duration the disease with history of all drugs taken and a list of suspected drugs was made for each patient. Rechallenge test (oral provocation test) was done for the suspected drug with a quarter of a single therapeutic dose, followed if necessary, by a step-wise increase to one half, one full and double of a dose for subsequent days. A definiteerythema at or around the existing lesion was considered as positive provocation test.

Results: Thirty eight cases (35 males and 3 females) were enrolled in the study with clinical diagnosis of FDE. The lesions were most commonly present on the glans penis (68.42%) as hyperpigmented macule (47.36%) accompanied with pruritus (71.05%), burning (55.26%) and pain sensation (28.94%). Oral rechallenge test showed positive result in 29 cases with nimesulide (35.29%) as the most common offending drug followed by fluconazole (25.52%) and tetracycline (14.70%).

Conclusion: The study emphasizes the changing trend of genital FDE and the importance of oral provocation test for diagnosing genital fixed drug eruptions. The findings in this study is in contrast to the previous studies which showed antimicrobials (tetracyclines) as the commonest cause of genital FDE’s.


Fixed drug eruptions(FDE), Genital lesions, Oral rechallenge test (oral provocation test), Nimesulide

Genital lesions of any kind are a cause of confusion to the dermatologists, because of their varying possible causes. Genital fixed drug eruption (FDE) in particular, is the cause for apprehension in the sufferer. These appear as oval, erythematous macules and recur at the same areas, following every administration of the responsible drug (1).The patients are often unaware of the nature of the drugs which are consumed by them and do not relate their complaints to the use of the drugs.

The incidence of FDE induced by a specific drug depends on the frequency of the agent which is used in a given part of the world (2). Although a large number of drugs have been incriminated to cause FDE, certain drugs have been found to be responsible more often. The aim of this study was to identify the agents which commonly caused genital FDE in the patients of a tertiary care hospital in the post millennium era.

Material and Methods

This study was done from February 2009 to March 2011 after obtaining ethical approval from the institution where it was done. Patients with the clinical diagnosis of genital FDE were enrolledand interrogated regarding the onset and the duration of the disease. They were also asked about the history of all the drugs which they had taken. A list of suspected drugs was made for each patient on the basis of their detailed history. Systemic examination and routine blood examination along with liver and renal function tests were done for each patient. Sexually transmitted diseases were ruled out by the clinical examination and the relevant laboratory tests.

The rechallenge test (oral provocation test) was done for the suspected drug after taking a written consent from the patients. It was started with a quarter of a single therapeutic dose, followed if necessary, by a step-wise increase to one half, one full and double of a dose for subsequent days. A definite erythema at or around the existing lesion indicated a positive provocation test. The drugs which were used for the provocation test included nimesulide, ampicillin, teracycline, fluconazole, cotrimoxazole and aspirin as per the history of the suspected drugs for FDE. The rechallenge was considered to be negative if exacerbation of the lesion was not seen within 24 hours, even after the administration of the double dose. Biopsies were not done at the genital site in any of the cases because of ethical and medical reasons.


A total of thirty eight patients (35 males and 3females) with genital FDE, in the age group of 13 to 56 years (mean age = 27.5 years), visited the dermatology outpatients department. The duration of the lesions varied from 2 days to 3 years. A maximum number of patients had lesions on the glans penis (68.42%). Hyperpigmented macular lesions were present in 18 patients (60.52%). The most common symptoms which were presented by most of the patients were pruritus (71.05%), followed by a burning sensation (55.26%).

Out of the 38 cases, the rechallenge test was positive in 34 patients with various doses of drugs, as shown in Table 2. The onset of the lesion was noticed as early as 3 hours to a maximum of 23 hours (mean=8.5hours) after the administration of the drug. Nimesulide was the most common offending agent, affecting 12 patients (35.29%), followed by fluconazole in 8(25.52%) and tetracycline in 5 patients (14.70%). The test was positive for half the drug dose in 18 cases, followed by positivity for a full dose in 9 and positivity for a 1/4th dose of the drug in 6 cases. We considered the drug to be responsible for FDE only, in cases where the rechallenge test was positive. The blood and systemic examination showed no abnormality in all the patients, except for one case where the liver function test results were marginally high (Table/Fig 1) (Table/Fig 2).


The observations of the present study implicated nimesulide as the most common agent which caused genital FDE, which differed from the findings of other studies. In earlier studies, antimicrobials were the most commonly implicated drugs for FDE, with tetracycline on the top of the list in the three series (2)(3)(4)(5). In studies on genital FDE in the premillenium era, tetracycline was the widely used drug. In the context of NSAIDs also, acetyl salicylic acid and phenylbutazone were found to be the most common offending agents in these studies.

Nimesulide is a nonsteroidal, anti-inflammatory agent with antipyretic and analgesic properties, which is commonly prescribed in India (6).The dermatological side effects which were previously reported with respect to its use were pruritus, urticaria, purpura, maculopapular rash and localized toxic pustuloderma (7),(8).There are only a limited number of studies on FDE which are the secondary effects of nimesulide (9),(10). To the best of our knowledge, there is no previously reported study which has expressed nimesulide as the common cause of genital FDE.

With the changing times, the trend of drug use also changes. The increasing use of nimesulide and fluconazole, with the over- thecounter availability of these drugs in the Indian market, could be one of the reasons for the increased reporting of their adverse effects. The under reporting of the side effects of nimesulide in the western literature may be possibly due to its non-availability in these countries.

This study also emphasizes the importance of the rechallenge test (oral provocation test) for pin pointing the diagnosis of fixed drug eruptions, specifically so in genital cases where a biopsy is not possible due to the chances of scarring and for ethical reasons. The provocation testing is both safe and reliable and it must be done to confirm the cause of the fixed drug eruptions (11). The administration of graded doses is a rational approach so as to elicit the signs of reactivation at the minimum dose (12).

It is interesting to note that in our study, only three females reported with genital FDE, who were referred by gynaecologists for ruling out venereal diseases. This can be explained on the basis of the stigma and embarrassment due to genital problems in females, because of which they probably do not report to dermatology outdoors.

As FDE are sometimes confused with multiple venereal diseases, it is of utmost importance for all the medical specialists to study the entity of and to identify genital FDE clinically and by doing the provocation test so that these cases are not missed.

Key Message

With the changing trend, time and availability, nimesulide is emerging as common cause of genital FDEs.


Baker H. Fixed eruptions. Text Book of Dermatology, Third ed, Editors, Blackwell Scientific Publications, Oxford. 1979; p 1121-22.
Pasricha JS. Drugs causing fixed eruptions. Br J Dermatol. 1979;100:183-85.
Sehgal VH, Gangwani OP. Genital fixed drug eruptions. Genitourin Med. 1986;62:56-58.
Pandhi RK, Kumar AS, Satish DA, Bhutani LK. Fixed drug eruptions on male genitalia: a clinical and etiological study. Sexually transmitted diseases J. 1984;11:164-66
Csonka GW, Rosedale N, Walkden L. Balanitis due to fixed drug eruptions which are associated with tetracycline therapy. Brit J Vener Dis. 1971;47:42-44.
Malhotra S, Pandhi P. Analgesics for pediatric use. Indian J Pediatics. 2000;67:589-90.
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Corderio MR, Gonacalo M, Fernandes B, Oliveira H, Figuedo A. Positive lesional patch tests in fixed drug eruptions from nimesulide. Contact Dermatitis. 2000;43:307.
Valsecchi R , Reseghetti A, Cainelli T. Bullous and erosive stomatitis which is induced by nimesulide. Dermatology. 1992;185:74-5.
Baer RL, Witten VN. Drug eruptions. A review on the selected aspects of an age-old but always timely and fascinating subject. In: Yearbook of dermatology series 1960-61. Chicago: Yearbook Medical Publishers, 1961:9-37.
Kauppinen K. Cutaneous reactions to drugs, with special reference to severe bullous muco-cutaneous eruptions and sulphonamides. Acta Derm Venereol [Suppl] (Stockh) 1972;52:68.

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